West Virginia CPASS Summary

<HR ALIGN=\"left\" ALT=\"Horizontal rule dividing sections\"> <A NAME=\"WVCPASS\"></A> <P ALIGN=\"RIGHT\"><EM>Community-Integrated Personal Assistance Services and Supports</EM></P> <H2 ALIGN=\"CENTER\">WEST VIRGINIA</H2> <H3>Identified Problems with the State's Long-Term Care System</H3> <P> <UL> <LI>The Medicaid state plan and waiver program reimburse for personal assistance (homemaker, personal care) services only if provided in the place of residence, with exceptions only for essential errands.</LI> <LI>Eligibility requirements for personal care under the state plan and for homemaker services under the waiver are stringent.</LI> <LI>The state does not offer a consumer-directed personal assistance option under the state plan or the waiver.</LI> <LI>Consumers lack the technical assistance and support to employ and manage their own personal assistants.</LI> <LI>Service providers have little experience with consumer direction and do not utilize opportunities to implement consumer direction within their current systems.</LI> <LI>The state's Certificate of Need process limits consumer provider choice by restricting the entry of new personal care providers into the system. Most consumers depend on local, approved provider agencies to find their personal assistant and can sometimes wait weeks to obtain new or replacement personal assistants.</LI> <LI>Nurse Practice Act regulations prohibit the performance of most medically oriented tasks by unlicensed personnel.</LI> <LI>The state requires that personal care be authorized by a physician annually and supervised by a nurse through a plan of care completed at least every six months. There is no recommendation or requirement for consumer involvement in developing this plan of care.</LI> <LI>Case managers, service coordinators, and other admitting staff are not trained in the value of consumer direction and how to implement it within current policy.</LI> <LI>Lack of comparative data regarding service utilization, cost effectiveness and consumer satisfaction to assist consumers, providers, or policymakers to make informed choices regarding services and policy.</LI> <LI>Lack of a coordinated effort to strengthen the personal assistance profession through improved wages, better benefits, expanded training, technical assistance and attitudinal change.</LI> <LI>Limited funds to support infrastructural changes associated with maximum consumer control of personal assistance services.</LI> </UL> </P> <H3>Perceived Strengths</H3> <P> <UL> <LI>Committed leadership, as evidenced by the disability agenda of the state's new Governor, and many key groups evaluating, analyzing, and recognizing needed policy changes.</LI> <LI>The Olmstead State Plan Task Force issued a report recommending that personal care, home health, and A/D waiver services be made more portable and that West Virginia's Certificate of Need process be liberalized.</LI> <LI>The state has increased the emphasis on community services in recent years as evidenced by large budget increases for waiver services, and has demonstrated an ability to quickly distribute these resources through a strong network of community agencies.</LI> <LI>The state's uniform consumer assessment process (Preadmission Screen [PAS-2000]) allows consumers and their families to enter the system for either nursing home or community care through virtually any provider they choose.</LI> <LI>A new Benefits Planning, Assistance and Outreach Program for SSI and SSDI recipients is increasing consumer awareness of the full range of their options.</LI> <LI>West Virginia has some experience with consumer direction through its two state-funded personal assistance services programs. One of the programs also pays the Centers for Independent Living to train consumers to function as an employer.</LI> <LI>Key changes to personal care implementation in the community can be accomplished through a few wording changes in the Medicaid state plan without requiring legislative authorization.</LI> </UL> </P> <H3>Primary Focus of Grant Activities</H3> <P> <UL> <LI>Promote the consumer-directed option through media campaigns, training, and modification of Medicaid policy and programs.</LI> <LI>Improve availability of services by developing a long-term strategy to improve the recruitment and retention of personal assistants.</LI> <LI>Support a consumer-directed service delivery system by developing data collection and fiscal management systems.</LI> <LI>Demonstrate how maximum consumer control increases both consumer satisfaction and cost effectiveness.</LI> </UL> </P> <H3>Goals, Objectives, and Activities</H3> <P><STRONG>Overall Goal.</STRONG> To enable Medicaid eligible individuals of any age who meet the disability requirements for personal assistance services to choose and direct these services to whatever level they or their designee are willing and able.</P> <P><EM>Some of the following objectives and activities are relevant to more than one goal.</EM></P> <P><STRONG>Goal.</STRONG> Increase opportunities and enhance skills for consumers to control the recruitment, training, supervision, and termination of their personal attendants; to direct their plan of care; and assure that services are fully portable.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Organize consumers to work with advocacy groups, agency personnel, and service providers on an Advisory Board to plan, direct, and evaluate systems change efforts to increase consumer control of personal assistance services (PAS).</LI> <LI>Initiate consumer-directed services within existing waivers that will allow consumers the option of receiving a cash amount for their personal assistance services.</LI> <LI>Develop and implement a demonstration project within the current Medicaid framework to show how maximum consumer control increases both consumer satisfaction and cost effectiveness.</LI> <LI>Provide a training program on management of PAS to consumer groups and agency providers statewide, after initial testing by consumers in the demonstration project.</LI> <LI>Design data collection and fiscal management systems to enable service providers to operate as intermediary financial agents; to assist the state Medicaid agency in implementing future cash payouts; and to monitor consumer compliance with employer responsibilities.</LI> <LI>Modify and/or expand components of the Medicaid state plan and waivers to make personal assistance services fully consumer-directed and portable.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Assure consumer access to comparative information on providers, services, and costs to help them make more empowered decisions on personal assistance services.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Develop a system to compare Medicaid and non-Medicaid personal assistance service providers with respect to consumer involvement, consumer satisfaction, service provision, attendant recruitment, back-up response, and other features important to consumers.</LI> <LI>Empower consumers to utilize comparative information on service providers in making choices through a statewide multimedia campaign and a Website.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Medicaid and non-Medicaid service providers will increase opportunities for consumer input and choice within the current practices of the services offered.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Organize consumers to work with advocacy groups, agency personnel, and service providers on a Advisory Board to plan, direct, and evaluate systems change efforts to increase consumer control of personal assistance services.</LI> <LI>Research, develop, and implement training curriculum statewide which will prepare agency and provider personnel to fully integrate the consumer-directed service model.</LI> </UL> </P> <P><STRONG>Goal.</STRONG> Develop strategies for recruitment and retention of personal assistants.</P> <P><STRONG><EM>Objectives/Activities</EM></STRONG> <UL> <LI>Create consumer-directed program within the current waivers allowing consumers the option of receiving a cash amount for their personal assistance services.</LI> <LI>Develop and implement a demonstration project within the current Medicaid framework that shows how maximum consumer control techniques increase both consumer satisfaction and cost effectiveness</LI> <LI>Modify and/or expand components of the Medicaid state plan and waivers to make personal assistance services fully consumer-directed and portable.</LI> <LI>Collect information to assist statewide agencies in developing and implementing a long-term strategy for improving recruitment and retention of personal assistants.</LI> </UL> </P> <H3>Key Activities and Products</H3> <P> <UL> <LI>Implement consumer awareness and information system and provide support through a CPASS or REAL CHOICE 800 number and a user-directed Website.</LI> <LI>Coordinate with the Bureau for Medical Services to develop a system of comparative data collection on service providers.</LI> <LI>Design agency training curriculum to increase consumer control.</LI> <LI>Design training curriculum to prepare consumers with varying capabilities to direct their own plans of care, exercise risk management procedures, and interview, train, and manage personal attendants.</LI> <LI>Construct a sustainable model for maximum consumer control within a demonstration project.</LI> <LI>Design and disseminate a system for service providers to act as intermediary financial agents.</LI> <LI>Design a system for monitoring cash payments to cover personal assistance services for consumers who elect this option.</LI> <LI>Develop a tool to assist consumers or fiscal intermediaries in complying with all necessary employer-related requirements.</LI> <LI>Develop strategies for recruitment and retention of personal assistants.</LI> </UL> </P> <H3>Consumer Partners</H3> <P> <UL> <LI>The Olmstead State Plan Task Force, originally identified by Executive Order from the Governor in January 2001, comprises consumers and advocates (60 percent), public and private service providers, and state agencies.</LI> <LI>The Olmstead Task Force will create a consumer/agency/service provider (CAS) Advisory Board to continue involvement with and maintain maximum control over the grant project. The CPASS Advisory Board will comprise at least 60 percent consumers or their designated family members.</LI> <LI>A Participatory Action Research (PAR) Board will be established for the demonstration project comprising at least four consumers in the demonstration group, three representatives from the fiscal agent including one nurse supervisor, a Bureau for Medical Services representative, and the program staff.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Planning Activities</H3> <P> <UL> <LI>A consumer and advocate subcommittee of the Olmstead Task Force directed the development of this grant application.</LI> <LI>Persons with disabilities and those with needs for long-term care were active participants in all elements of the grant application development. Input was solicited through a survey, public meetings, and opportunities via a list serve to make changes to application drafts.</LI> </UL> </P> <H3>Consumer Partners and Consumer Involvement in Implementation Activities</H3> <P> <UL> <LI>Persons with disabilities will assist in the design of the consumer direction training curriculum and will participate in its presentation to consumer groups and agency providers statewide.</LI> <LI>A fiscal intermediary, consumers and service providers will participate in the demonstration project.</LI> <LI>The CPASS Advisory Board, comprising 60 percent consumers, will provide advice in programmatic decisions including modifying process objectives, reviewing demonstration project elements and implementing activities.</LI> <LI>Some members of the CPASS Advisory Board will participate in training sessions, legislative presentations, and development of materials to be disseminated.</LI> <LI>The PAR Board will meet monthly to provide input, modification, and evaluation for the demonstration model, and will report to the CPASS Advisory Board.</LI> </UL> </P> <H3>Public Partners</H3> <P> <UL> <LI>Bureau for Medical Services.</LI> <LI>WV Bureau of Senior Services.</LI> <LI>Bureau of Health and Health Facilities (Mental Health).</LI> <LI>LTC Ombudsman.</LI> <LI>Area Agencies on Aging.</LI> <LI>Roane County Senior Services.</LI> <LI>Lewis County Senior Services.</LI> <LI>WV's ADA Coordinator-a consumer with an interest in PAS.</LI> <LI>WV Division of Rehabilitation Services.</LI> <LI>WV Developmental Disabilities Council.</LI> </UL> </P> <H3>Private Partners and Subcontractors</H3> <P> <UL> <LI>AARP.</LI> <LI>WV Council of Home Care Agencies.</LI> <LI>West Virginia Advocates.</LI> <LI>Loved Ones in Home Care.</LI> <LI>Braley and Thompson.</LI> <LI>Cabell County Community Services Organization.</LI> <LI>WV Behavioral Health Providers Association.</LI> <LI>WV Mental Health Consumers Association.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in the Planning Phase</H3> <P> <UL> <LI>State agencies, along with public and private healthcare and service providers, have been meeting with consumers and advocates on the state's Olmstead Task Force and many of the recommendations being offered by that group were subsequently included in the grant application.</LI> <LI>State agencies and public and private partners attended the eight statewide public meetings and teleconferences where objectives of the Real Choice application were reviewed.</LI> <LI>Drafts of the application were shared with state agencies and public and private partners through an interactive listserv. Phone conversations and informal meetings also occurred during the application development.</LI> <LI>A consumer, advocate, and agency subcommittee of the Olmstead Task Force directed the development of this grant application.</LI> </UL> </P> <H3>Public and Private Partnership Development/Involvement in Implementation</H3> <P> <UL> <LI>Public and private partners will be members of the CPASS Advisory Board and the Participatory Action Research (PAR) Board, described above under Consumer Partners and Implementation.</LI> <LI>The Bureau for Medical Services and the Bureau of Senior Services will coordinate with project staff to develop a system of comparative data collection on service providers.</LI> <LI>The Bureau for Medical Services will modify personal care requirements for the purposes of the demonstration project so long as they are cost neutral and do not require legislative authorization.</LI> <LI>The Medicaid service provider agency subcontracted for the demonstration project will conduct background checks on personal care attendants, provide required training, arrange for nurse supervision of services, and accept fiscal agent responsibilities.</LI> <LI>The project will have an ongoing evaluation and dissemination process that includes the participants, boards, and stakeholder involvement.</LI> </UL> </P> <P><STRONG>Existing Partnerships That Will Be Utilized to Leverage or Support Project Activities</STRONG> <UL> <LI>The Medicaid Work Incentive Network (M-WIN), a Medicaid Infrastructure Grant, is already working on making personal assistance services fully portable and on removing health coverage barriers for those in the workplace. The M-WIN Project has also compiled a list of service providers, which is ready for dissemination, and is working with the Bureau for Medical Services on implementing changes to the Certificate of Need Process and the Nurse Practice Act.</LI> <LI>The Developmental Disabilities Council will contribute their specialized knowledge and resources in developing consumer direction training programs.</LI> <LI>The West Virginia Mental Health Consumers Association is offering its expertise in establishing peer supports.</LI> <LI>The CPASS Grant will collaborate and coordinate with the REAL CHOICE and Transitioning to Inclusive Communities (TIC) projects in the development of a user-directed resource directory Website and 1&#150;800 number; the sharing of data; the coordination of curriculum and statewide trainings; and support for policy change.</LI> </UL> </P> <H3>Oversight/Advisory Committee</H3> <P> <UL> <LI>The CPASS Advisory Board will comprise representatives from the partner agencies, community organizations, health care provider groups, and individual consumers as selected by the Olmstead Task Force. The CPASS Advisory Board will be both an active and a responsive entity, providing guidance and direction to the overall project and the demonstration model.</LI> <LI>The board will meet bimonthly and may also be convened more frequently to address critical junctures in the project's operations. Because of their roles within agencies and community groups, board members will provide reality checks and needed resources and assist with the implementation of needed actions.</LI> </UL> </P> <H3>Formative Learning and Evaluation Activities</H3> <P> <UL> <LI>The CPASS Advisory Board will have the power to alter process objectives if feedback identifies a better approach. State agencies such as the Bureau for Medical Services and the Bureau of Senior Service will also share the responsibility for project evaluation and improvement.</LI> <LI>The Participatory Action Research Board for the demonstration project was specifically designed to allow this demonstration to benefit from ongoing learning.</LI> <LI>Based on the evaluation and recommendations of consumers from the demonstration project, an amended training curriculum will be offered to consumer groups throughout the state.</LI> <LI>Program staff will develop a trial system for monitoring consumer compliance with the rules and regulations for employers, and modify the system based on the demonstration project experience.</LI> </UL> </P> <H3>Evidence of Enduring Change/Sustainability</H3> <P> <UL> <LI>The ongoing and active involvement of the CPASS Advisory Board will build commitment and facilitate the sustainability of the systems change elements of the project.</LI> <LI>Training will become a component of ongoing staff development for agency and provider staff. A recommendation will made by the Bureau for Medical Services and the Bureau of Senior Services to make it mandatory.</LI> <LI>Staff will assist in the initial publication of comparative information on a Website and design the system so that ongoing publication can be absorbed by the Bureau for Medical Services at minimal cost.</LI> <LI>Constructing this project to operate within the current Medicaid framework will enhance sustainability by demonstrating possibilities for consumer direction within what already exists. For example, nurse supervisors involved with consumers in the demonstration project will integrate a new method of person-centered planning into the plan of care and will be able to bill for this time within the current Nurse Assessment and Care Planning code.</LI> <LI>The commitment of the Bureau for Medical Services in initiating Systems Change Grants assures sufficient backing to sustain PAS changes. The Bureau has already established committees within its agency to focus on new eligibility options and its support for this project is evidenced by willingness to modify certain personal care requirements within the demonstration project.</LI> <LI>Evaluation data from project activities will be compiled into publications that will be used to promote public and consumer awareness and legislative initiatives for systems change.</LI> <LI>Once consumers develop new skills in choosing and managing their personal assistance services, the process will be further sustained as consumers share information with each other.</LI> </UL> </P> <H3>Geographic Focus</H3> <P>Statewide.</P>