TRANSFORMING VIRGINIA

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TRANSFORMING VIRGINIAS SYSTEM OF LONG TERM
SUPPORTS FOR INDIVIDUALSTHREE KEY INITIATIVES

• Systems Transformation Grant
• Money Follows the Person Demonstration
• State Profile Tool Grant

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BACKGROUND

• The 1999 U.S. Supreme Court Olmstead case
  (decided under the Americans with Disabilities
  Act) requires that individuals with disabilities
  of all ages be able live in the most integrated
  setting possible
• The Olmstead decision led to federal initiatives
  such as the President's New Freedom Initiative
  and to Congress appropriating funding for CMS
  Real Choice Systems Change grants, and state
  initiatives such as the Olmstead Task Force and
  its 2003 Report and the Governors Community
  Integration Initiative

CMS Centers for Medicare and Medicaid Services
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BEGINNING VIRGINIAS TRANSFORMATION

• To meet the challenges, work across all systems
  and across all populations is essential
• In 2006, several key state agencies partnered to
  begin systems transformation for long term care
• All three initiatives represent the combined
  efforts of these agencies working with
  stakeholders, particularly individuals who use
  long term support services, as equal partners

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BEGINNING VIRGINIAS TRANSFORMATION

• In early 2006, the Department of Medical
  Assistance Services took the lead as Virginias
  Medicaid agency and worked with the Department of
  Mental Health, Mental Retardation, and Substance
  Abuse Services, the Office of Community
  Integration, the Virginia Department of Social
  Services, the Department for the Aging, the
  Department of Rehabilitative Services, the
  Virginia Board for People with Disabilities, and
  other stakeholders to apply for a CMS funded
  Systems Transformation Grant

CMS Centers for Medicare and Medicaid Services
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TRANSFORMATION CHALLENGES

• The fragmentation of the human services system is
  the greatest barrier to transformation in
  Virginia
• Virginia experiences structural and policy gaps
  between housing and service delivery agencies
• The standardized, automated methods for gathering
  data are limited
• System oversight has been difficult due to silo
  management structures that historically have not
  coordinated the planning, management and
  administration of related activities
• Shortages in the workforce have had a serious
  affect on the availability and quality of care

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SYSTEMS TRANSFORMATION GRANT
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SYSTEMS TRANSFORMATION GRANT

• Virginia was awarded a five-year Systems
  Transformation Grant in September 2006
• First phase of grant involved a nine month
  strategic planning period that required CMS
  approval for advancement to phase two

CMS Centers for Medicare and Medicaid Services
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WHAT IS THE SYSTEMS TRANSFORMATION GRANT?

• The Systems Transformation Grant launches
  activities and initiatives that are a catalyst
  for permanent change. It is not intended to
  bring about total systems change, but it begins
  the process.
• Grant is divided into three major initiatives or
  goals
• Develop a No Wrong Door System
• Increase Person Centered Practices
• Modernize Information Technology

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NO WRONG DOOR (NWD)

• Lead Agency Department for the Aging in
  Partnership with SeniorNavigator and 211 Virginia
• Will expand the No Wrong Door focus to include
  those individuals with all types of disabilities
  who are at risk for institutionalization,
  including individuals with mental illness
• Will develop mechanisms to ensure that
  individuals and families are made aware of the
  availability of a coordinated system for access
  to long term supports and the role of this system
  in helping them understand their choice
• Will streamline the eligibility processing system
  by building on the assessment tools in the No
  Wrong Door system to develop a screening and
  preliminary determination tool for state services

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PERSON CENTERED PRACTICES

• Lead Agency Department of Mental Health, Mental
  Retardation, and Substance Abuse Services
  (DMHMRSAS), in collaboration with the Partnership
  for People with Disabilities and the Department
  of Medical Assistance Services (DMAS)
• Building on the existing foundation, assist
  individuals, family members, professionals, and
  staff in all service systems in understanding the
  principles of person centered thinking and in
  plan development for individuals
• In conjunction with person-centered practices
  activities, study, develop, and implement
  individual budgets that have a consistent,
  user-friendly methodology for all involved
  individuals
• Using as a foundation person centered practices,
  develop and expand self-directed supports,
  including using individual budgets

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MODERNIZEINFORMATION TECHNOLOGY

• Lead Agencies DMHMRSAS and DMAS
• Will design information technology applications
  to support program processes that are person
  centered and enable individuals to direct their
  own services
• Will transform the information technology of the
  Office of Mental Retardation by designing and
  developing a web-based application to improve and
  streamline access to Mental Retardation (MR)
  Waiver services for individuals and their
  families
• Will design a Critical Incident Management
  Reporting System (CIMRS) that tracks critical
  incidents for individuals receiving Medicaid
  Waiver services

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MILESTONES
June 2007
September 2006

• Convened Transformation Leadership Team which
  included diverse stakeholder representation
• Convened state agency and partners workgroup
• Developed and successfully defended strategic
  plan
• Strategic plan approved by CMS
• Began implementation phase

CMS Centers for Medicare and Medicaid Services
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NO WRONG DOORSTATUS HIGHLIGHTS

• Developed draft call protocol to aid the 2-1-1
  operators in assisting callers by referring the
  caller to the right point of entry in the No
  Wrong Door system
• Recommended amendments to the existing Uniform
  Authorization for the Exchange of Information
  form
• Identified the initial content areas for the No
  Wrong Door website

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PERSON CENTERED PRACTICES STATUS HIGHLIGHTS

• Building on Person Centered Practices work
  already going on in Virginia, drafted materials
  that includes seniors and individuals with
  disabilities
• Defined individual budgeting and contacted other
  states to understand their approaches to
  individual budgeting

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MODERNIZE INFORMATION TECHNOLOGY STATUS HIGHLIGHTS

• Identified the inefficiencies in the current
  preauthorization, enrollment, and waitlist
  systems for the Mental Retardation Waiver
• Verified legislative mandates for sharing
  critical incident information and examined what
  is currently being shared

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MONEY FOLLOWS THE PERSON DEMONSTRATION
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MONEY FOLLOWS THE PERSON (MFP) DEMONSTRATION

• In Fall 2006, DMAS and the Office of Community
  Integration took the lead and worked with the
  Department of Mental Health, Mental Retardation,
  and Substance Abuse Services, the Virginia
  Department of Social Services, the Department for
  the Aging, the Department of Rehabilitative
  Services, the Virginia Board for People with
  Disabilities, and other stakeholders to apply for
  Money Follows the Person Rebalancing
  Demonstration
• Virginia was selected by CMS in May 2007 to
  participate
• Virginia will receive significant federal funds
  over a four-year period to support individuals
  who wish to transition from institutions to the
  community

CMS Centers for Medicare and Medicaid Services
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WHAT IS MONEY FOLLOWS THE PERSON?

• A program that supports individuals in
  institutions who wish to move to the community
  and assists them with the transition process
• Nationally, Money Follows the Person is the
  largest investment in Medicaid Long Term Care and
  over 37,000 individuals are projected to be
  transitioned
• It is an opportunity to further develop community
  integration strategies, individual supports, and
  infrastructure for seniors and people with
  disabilities who have long term support needs and
  therefore, will assist Virginia in continuing
  implementation of the Olmstead decision
• Emphasizes community living vs. institutional
  placement to help balance the system

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WHO WILL MFP BENEFIT IN VIRGINIA?

• It is anticipated that 1,041 individuals in
  Virginia will transition out of institutions
  during the four-year demonstration period
• Individuals who have resided in a Nursing
  Facility, Intermediate Care Facility for
  Individuals with Mental Retardation, or Long-Stay
  Hospitals for six months successively and
  continue to require long term support from
  Medicaid
• Individuals living in the community and currently
  using waiver services

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HOW WILL THEY BENEFIT?

• New services being added to certain Medicaid
  Waivers
• All new services are permanent additions
  available to all individuals receiving services
  with these waivers, not just for the
  demonstration period

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STEPS TO LAUNCHING MFP

• Virginia must develop an Operational Protocol
  which serves as the contract between DMAS and CMS
  and which must address the following four key
  objectives
• Increase the use of home and community-based
  services (HCBS) rather than institutional
  services
• Eliminate barriers that prevent choice
• Increase the ability of the Medicaid program to
  assure continued provision of HCBS to individuals
  who choose to transition from institutions
• Ensure strategies and procedures are in place for
  quality assurance
• February 2008 is the target date for submission
  of Virginias Operational Protocol

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STEPS TO LAUNCHING MFP

• Home and Community Based Waiver applications
  amended to add new services and supports
• Service and provider manuals updated to reflect
  new services and supports
• Regulations drafted
• Technology systems for Medicaid claims,
  pre-authorization, and consumer-directed services
  must be modified
• Education and training of individuals and
  providers

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MFP LAUNCH

• May 1, 2008

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STATE PROFILE TOOL GRANT
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STATE PROFILE TOOL GRANT

• Virginia was awarded this grant from CMS in
  September 2007 to participate in the State
  Profile Tool Grant
• A three year initiative
• 1st Eighteen Months Develop a state tool
• 2nd Eighteen Months Participate with other
  grantee states in developing the national
  benchmarks

CMS Centers for Medicare and Medicaid Services
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WHAT IS A STATE PROFILE TOOL?

• A measurement of a states long term support
  system
• A standardized format for gathering information
  and data
• A State Report Card

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WHAT IS THE PURPOSE OF A STATE PROFILE TOOL?

• Provides policymakers and stakeholders with a
  high-level view of the long term support system,
  to ensure that all are working from the same
  knowledge base
• Identifies opportunities for improved
  coordination among long term support programs and
  with other health and social services
• Acknowledges the successes that have occurred
• Identifies service gaps
• Provides a framework for comparing rebalancing
  efforts across States

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STEPS TO DEVELOP VIRGINIAS PROFILE TOOL

• Contract with Thomson Healthcare to develop
  Virginias tool in the first eighteen months
• Thomson recognized as a national leader in this
  area
• Thomson developed the pilot tool for Pennsylvania
• Thomson developed the Technical Assistance Guide
  To Assessing a State Long-Term Care System which
  will be used as the Commonwealths blueprint

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STEPS TO DEVELOP VIRGINIAS PROFILE TOOL

• Identify a Leadership Team to guide the State
  Profile Tool development and national benchmarks
• Conduct regional listening posts to obtain
  stakeholder input to State Profile Tool
  development
• Collect and provide data to Thomson Healthcare
  for formulation of the State Profile Tool
• Submit State Profile Tool to CMS and participate
  in national benchmark project

CMS Centers for Medicare and Medicaid Services
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VIRGINIAS SYSTEMS TRANSFORMATION
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VIRGINIAS SYSTEMS TRANSFORMATION

• Systems Transformation Grant, Money Follows the
  Person Project, and State Profile Tool Grant are
  all initiatives intended to create systemic
  transformation in Virginias long term supports
• To foster a strategic direction and ensure
  optimal outcomes for STG, MFP, and SPT, the
  Transformation Leadership Team formed under STG
  will act as the overarching leadership committee
  for all three initiatives

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VIRGINIAS SYSTEMS TRANSFORMATION

• A Communications Team, started under the Systems
  Transformation Grant, will be combined to develop
  and implement communications and marketing
  strategies for all three initiatives
• Regional listening posts will be held throughout
  summer 2008 to inform stakeholders about the
  three initiatives and gain input about
  opportunities and challenges at the local level

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FOR MORE INFORMATIONVirginia Department of
Medical Assistance Services600 East Broad
Street, Richmond VA 23219

• SYSTEMS TRANSFORMATION GRANT (STG)
• Kristin Burhop, STG Project Director
• [phone]
• Kristin.burhop_at_governor.virginia.gov
• MONEY FOLLOWS THE PERSON (MFP) PROJECT
• Jason Rachel, MFP Project Director
• [phone]
• jason.rachel_at_dmas.virginia.gov
• STATE PROFILE TOOL (SPT) GRANT

Karen Lawson, Policy Research Manager (804)
225-2364 karen.lawson_at_dmas.virginia.gov
Teja Stokes, Senior Policy Analyst (804)
786-0527 teja.stokes_at_dmas.virginia.gov