Pennsylvania RCSC Summary | advancingstates.org

<A NAME=\"PERC\"></A> <P ALIGN=\"RIGHT\"><EM>Real Choice Systems Change</EM></P> <H2 ALIGN=\"CENTER\">PENNSYLVANIA</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>Fragmented service system with multiple waivers and state programs.</LI> <LI>Lack of available information on home and community services as a result of piecemeal development over time.</LI> <LI>Complex eligibility determination process because of fragmented eligibility structure.</LI> <LI>Ineffective service provision for persons with complex physical, behavioral and social needs due to lack of provider capacity and expertise.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Strong participation of persons with disabilities, family members and advocacy groups via existing policy and planning initiatives utilized by the Department of Public Welfare and the administration such as the Mental Health and Mental Retardation Committee, the Planning and Advisory Committee for the Office of Mental Retardation, the PA Interagency Coordinating Council for Early Intervention, the Intro-governmental Council on Long Term Care, the PA Council on Aging, the Medical Assistance Advisory Council, the PA Mental Health Planning Council, the Community Living Advisory Committee and the Developmental Disabilities Council.</LI> <LI>Established structure for management of home and community services systems. Key policy and program people from the Office of Social Programs (serving individuals with physical disabilities, traumatic brain injury and adults with autism), the Office of Mental Health and Substance Abuse Services, the Office of Medical Assistance Programs (which is the primary funding agency for the other programs), the Department of Aging, the Office of Mental Retardation (serving individuals with mental retardation and developmental disabilities), and the Office of Children, Youth and Families have formed a core team who meet monthly to coordinate policy, budget requests and programmatic goals and objectives. Smaller teams are empowered to solve problems and issues across program areas and are tracked by the Core Team in terms of outcomes and appropriate deliverables. Executive staff meet quarterly to provide support and consensus regarding outstanding and negotiable issues.</LI> <LI>Strong policy commitment and available financial resources from the administration.</LI> <LI>Growing expertise and capacity in home and community services implementation in terms of both the number of new waivers and number of people served in the community during the past 8 years. During the same time period, our community program designed to move individuals out of state mental hospitals and into the community increased in size and effectiveness.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Develop better methods to manage the overall system in support of community living.</LI> <LI>Develop a cross-disability system of access to home and community services and supports for people of all ages.</LI> <LI>Develop provider expertise and capacity to effectively serve individuals across the broad spectrum of disabilities and long-term illnesses.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> Identify weaknesses or barriers in the current long-term home and community services system and develop and implement strategies designed to provide the foundation for enduring and effective systems change.</P> <P><STRONG>Goal.</STRONG> Develop a cross-disability, comprehensive, understandable, and responsive system of access for home and community services and supports for consumers of all ages.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Identify strategies to adapt the current home and community services system to the needs of consumers.</LI> <LI>Identify best practices of outreach and education efforts related to long-term care.</LI> <LI>Train and provide technical assistance to local providers and service systems using the curriculum and materials developed by the Real Choice Systems Change Grant.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Examine barriers to the provision of needed services for individuals with severe multiple disabilities who currently lack services.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop protocols for full consumer evaluations.</LI> <LI>Make recommendations to change the process for determining financial eligibility for initial applicants and waiver changes.</LI> <LI>Develop provider systems that can serve multiple populations, including cross-system licensure and training.</LI> <LI>Determine the financial structures necessary to provide effective, quality services.</LI> <LI>Examine existing studies and conduct research on how existing waivers can be modified or new waivers developed to serve unserved and underserved populations.</LI> <LI>Evaluate the feasibility of an Independence+ §1115 demonstration project.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop a multi-track provider training curriculum and seminars to develop knowledge of and expertise in best practices in services and supports to individuals with multiple disabilities.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Review available training programs with input from professionals, family members and individuals with disabilities.</LI> <LI>Provide training in complex cross disability issues to individuals with disabilities and professionals. Attempt to bring providers from the various service systems together both in terms of content and to develop networks and cross-system efficiencies during the training itself.</LI> <LI>Expand knowledge and skill base of family members and other stakeholders through the training seminar described above. Family members and stakeholders will be invited to the seminar to participate in a panel and describe gaps and barriers encountered by individuals who need services from multiple systems.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Evaluate the feasibility of an Independence+ §1115 demonstration project and submit application upon approval of the state administration.</LI> <LI>Evaluate existing outreach and education efforts.</LI> <LI>Develop comprehensive materials describing available services and supports.</LI> <LI>Develop training curriculum for local agency staff, community members, and state/local government personnel in approaches to provide effective, comprehensive information, referral and access to services.</LI> <LI>Fund demonstration projects that support better access to services and streamlined eligibility processes.</LI> <LI>Make recommendations to the HCBS Stakeholder Planning Team and the Home and Community-Based Governance Structure, including executive level staff, regarding barriers to the provision of home and community services and supports.</LI> </UL> </P> <H3>Consumer Partners</H3> <P> <UL> <LI>The HCBS Stakeholder Planning Team comprises 25 stakeholders, 17 of whom are consumers/advocates, five are provider organizations and three are county organizations representing individuals with mental illness, mental retardation and the frail elderly. The individuals selected were nominated by their peers.</LI> <LI>The Team was established by the Secretary of Public Welfare in February 2002 to provide planning regarding home and community-based services. The group assisted in writing and reprioritizing the Real Choice Systems Change Grant and will act as advisors to that grant. They meet every 6 weeks. The Department of Public Welfare (DPW) has supported their meetings by utilizing funds from first the Starter Grant and now through the Real Choice Systems Change Grant.</LI> <LI>All grant planning activities were conducted via open meetings and forums. Numerous individuals who are not members of the Stakeholder Planning Team participated and continue to attend the Team's meetings. Individuals involved with the Infrastructure Grant and Nursing Facility Transition Grant attend the meetings regularly.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P> <UL> <LI>Consumers and family members from the HCBS Stakeholder Planning Team essentially developed and wrote the grant application with assistance from DPW staff members. Specifically, consumers with head injuries, physical disabilities, deafness, and mental illness and mental retardation all participated in the planning and development meetings. The parent of a child with physical disabilities also participated.</LI> <LI>Drafts were sent to all Team members and there were numerous opportunities to participate, edit and refine the product. This was true regarding the original application submitted in July 2001 and the revised and reprioritized proposal that was submitted in July 2002.</LI> <LI>The Team and other interested parties developed the goals for the project and the concept. The Secretary of Public Welfare signed and submitted the grant request as prepared by the Team without edits or revisions.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>The Planning Team will act as a conduit for information. All of the Team members are listed on the DPW Website and can be contacted by their own constituents or other individuals for updates and information.</LI> <LI>The Planning Team will advise various agencies responsible for implementing home and community services and support programs and will play a critical role in the development of specific work plans related to the implementation of the grant project by consulting with the Home and Community-Based Governance Structure and specifically the Core Team that meets monthly to refine and coordinate.</LI> <LI>They will be involved in the Request for Proposal process. They will write the goals and objectives of the proposals and participate as members of the proposal evaluation committees.</LI> <LI>They will be participating in the cross-disability planning process that will result in a 5year cross-disability plan for the department in terms of community based alternatives and supports.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>MH/MR Program Administration Association of PA.</LI> <LI>PA Council on Aging.</LI> <LI>PA Developmental Disabilities Council.</LI> <LI>PA Intra-Governmental Council on Long-Term Care.</LI> <LI>Office of Senior Services/Area Agency On Aging.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>Alzheimer's Association.</LI> <LI>Greater PA Chapter.</LI> <LI>Autism Living and Working.</LI> <LI>Brain Injury Association of PA.</LI> <LI>Center for Advocacy for the Rights and Interests of the Elderly.</LI> <LI>Community Living Independently for Elders (LIFE).</LI> <LI>Mental Health Association in PA.</LI> <LI>Parents Involved Network of PA.</LI> <LI>PA Association of Rehabilitation Facilities.</LI> <LI>PA Council on Independent Living.</LI> <LI>PA Health Law Project.</LI> <LI>PA Mental Health Consumers Association.</LI> <LI>PA Protection and Advocacy.</LI> <LI>PA Society for the Advancement of the Deaf.</LI> <LI>Self Determination Housing Project.</LI> <LI>Speaking for Ourselves.</LI> <LI>VIA of the Lehigh Valley.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P> <UL> <LI>The HCBS Stakeholder Planning Team comprises 25 stakeholders, 17 of whom are consumers/advocates, five are provider organizations and three are county organizations representing individuals with mental illness, mental retardation and the frail elderly.</LI> <LI>Consumers and family members from the HCBS Stakeholder Planning Team essentially developed and wrote the grant application with assistance from DPW staff members.</LI> <LI>The public partners provided input and ideas for implementation. DPW assisted with the writing and editing of the application, but it was submitted in the words of the team members.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P><STRONG>Public</STRONG></P> <P>Public partners will assist in developing the request for proposals, they will evaluate the proposals, they will work side-by-side with DPW internal staff to manage and monitor the grant objectives and other important outcomes and deliverables as assigned and tracked by the HCBS Core Team (see Perceived Strengths section for a description of the Core Team).</P> <P><STRONG>Private</STRONG></P> <P>Subcontractors will be selected by the Stakeholder Planning Team members and staff via the RFP evaluation process. They will report to the grant director and the Stakeholder Planning Team.</P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG> <UL> <LI>The Area Agencies on Aging, the Community Resource Centers and the County Mental Health and Mental Retardation Centers will all be encouraged to apply for mini-grants and will selected based on their perceived abilities to break down barriers to receiving services and obtaining information regarding services and eligibility.</LI> <LI>The Home and Community-Based Governance Structure will play a vital role in the overall management of the grant program, while the existing expertise of agency staff and community providers will be tapped to capitalize on available knowledge of promising practices in the implementation of home and community-based services and supports.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P> <UL> <LI>The grant's project director will be responsible for providing ongoing oversight of programs and for tracking the grant activities against the stated objectives in the grant.</LI> <LI>The HCBS Stakeholder Planning Team will act as advisors to the Real Choice Grant and will meet every 6 weeks. They will also assist in tracking and monitoring outcomes and deliverables and participate on internal work teams.</LI> </UL> </P> <H3>Formative Learning and Evaluation Activities</H3> <P>Work plans will include objective review points throughout the implementation process to ensure that any necessary course changes can be affected to ensure that the project is moving toward positive outcomes.</P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>The grant will assist DPW in better understanding the usefulness of an Independence Plus demonstration. This understanding may lead to a cross disability, cross office initiative based on the Independence Plus concept. If so, it may change the way in which DPW provides for citizens who have disabilities and permit service provision to those who are needy but not assessed at a nursing facility level of care.</LI> <LI>The grant will provide better ways to address the barriers that individuals face in terms of entering the system and also to obtain services in the community that are comparable to those available in a nursing facility in terms of access, reliability and funding.</LI> <LI>The grant will provide cross disability training materials and an opportunity for networking and training for providers from all of the appropriate services systems.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide.</P>