Embed Size (px)
Citation preview
The Illinois Governor’s Conference on Aging and DisabilityAn Overview of The No Wrong Door Vision, The Home and Community Based Services Final
Rule and Person Centered Counseling
Leigh Ann Kingsbury, MPA, Gerontologist The Lewin Group
December 2014
lewin.com | 2
The No Wrong Door System
• The No Wrong Door vision is a joint vision and effort between the Administration for Community Living (ACL), the Centers for Medicare and Medicaid Services (CMS) and Veterans Health Administration (VHA)
• NWD is a single statewide system of access to long term services and supports (LTSS) for all “populations” and all payers. The system functions include:– Public Outreach and Coordination with Key Referral Sources– Person Centered Counseling– Streamlined Access to Public LTSS Programs– State Governance and Administration
Synthesis of Findings from System Change Grant Programs
• Eight attributes of a high-performing long-term care system 1. Accessible HCBS 2. Systems that support transitions among settings and service systems 3. Comprehensive single-entry point/no wrong door systems for
accessing community-based LTSS 4. Person-centered planning and service delivery 5. Employment supports for people with disabilities 6. Adequate supply of direct service workforce and adequate support for
caregivers 7. Adequate supply of housing to support community-based living
options 8. Quality assurance and quality improvement systems
October 18, 2012, Carol V. Irvin, Rebecca Sweetland Lester3
VHA Partnership:VD-HCBS
2005
2007
2009
2010
10 CMS Hospital Discharge Planning grants to ADRC states
Affordable Care Act: *$50 Million ADRCs*MDS Section Q
Affordable Care Act: *CCTP *Balance Incentive Program
When - Milestones of ADRC Development
2003 12 states, 8 sites
24 states, 42 sites
43 states, 147 sites
47 states, 300 sites
53 states, 525 sites
ACL/CMS/VHA FoA NWD System
Money Follows the Person
2012
ACL 2014
NWD System to Long Term Services
and Supports
“Defining Elements”
ACL 2014
Examples of Potential Staff States Might Want to Have Trained & Certified to Provide Person-Centered Counseling in
Their NWD System
School Districts
Area Agencies on Aging Centers for Independent Living
Local Medicaid AgenciesBehavioral Health Management
Organizations
Alzheimer’s Chapters
Examples of Organizations That Could Be Designated by the State to Perform NWD System Functions
Developmental Disability Management Organizations
Vocational Rehabilitation Agencies
Faith Based OrganizationsOrganizations serving
Ethnic & Minority Populations
Organizations with Peer-to-Peer, including Family
to Family models Other Organizations
ACL 2014
Person-Centered CounselingFunctions
ACL 20147
lewin.com | 8
Purpose of the Final Rule
• Historically, HCBS was designed to increase opportunities for people who use services and supports to stay in their homes
• The definition of “home” and “community” was not always clear, however; and
• HCBS was often defined by the stream of funds and not outcomes for people
• The purpose of the new HCBS Final Rule:– To further promote meaningful community integration for individuals
receiving LTSS in home and community-based (HCBS) services. – To enhance the quality of HCBS and provide protections to participants– Applies to individuals receiving services through 1915(c), 1915(i), and
1915(k) Medicaid authorities
lewin.com | 9
HCBS and Settings Requirements
The HCBS requirements establish an outcome oriented definition that focuses on the nature and quality of individuals’
experiences.
Meaningful quality of life outcomes as defined by the person
lewin.com | 10
Final Rule Requirements and Expectations
• The final rule: – Moves away from defining HCBS based on location or
physical characteristics of a setting– Establishes mandatory requirements for the qualities of
HCBS settings– Defines settings that are not home and community-
based – Establishes expectations for settings presumed not to
be home and community-based • And establishes a process for heightened scrutiny
– Identifies state compliance and transition requirements
lewin.com | 11
Key Characteristics and Qualifications
• Integrated in and supports access to the greater community; ensures the individual receives services in the community to the same degree of access as individuals not receiving Medicaid home and community-based services **– Modifications to any requirement must be supported by assessed need
and justified and documented in the person-centered plan
• Provides opportunities to seek employment and work in competitive integrated settings, engage in community life, and control personal resources.
• Is selected by the individual from among HCBS setting options, including non-disability specific settings and an option for a private unit in a residential setting
lewin.com | 12
Key Characteristics of HCBS Settings, cont’d
• Use person-centered service plans to document options based on the individual’s needs and preferences.
• Ensures an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint
• Optimizes individual initiative, autonomy, and independence in making life choices
• Facilitates individual choice regarding services and supports, and who provides them
lewin.com | 13
Defines Settings that are NOT Home and Community Based and/or Presumed to Not be
• NOT a Home and Community Based Services Setting– Nursing facilities– Institutions for mental diseases (IMDs)– Intermediate care facility for individuals with intellectual disabilities
(ICF/IID)– Hospitals
• Presumed to Not be Home and Community Based– Settings in a publicly or privately-owned facility providing inpatient
treatment– Settings on grounds of, or adjacent to, a public institution– Settings with the effect of isolating individuals from the broader
community of individuals not receiving Medicaid HCBS
lewin.com | 14
Person Centered Planning and the Final Rule
• “…the person centered service plan must be developed through a person centered planning process”
• The person-centered planning process is driven by the individual, – includes people chosen by the individual – and provides necessary information and support to the individual
to ensure that the person directs the process to the maximum extent possible.
lewin.com | 15
Person Centered Planning as Compared to …….?
• How is person centered planning different from other approaches or what we have been doing?
– Likely, many similarities
– Historically, planning has started with and been focused on
“problems, needs (as identified by others) and deficits”
– Person centered planning starts with the person’s interests and
gifts, AND also considers needs, challenges, limitations
– Presumes the person we’re planning with is the expert on his/her
life, even if they need significant support to inform us
– “Nothing about me without me!”
lewin.com | 16
Characteristics of Person Centered Service Planning as Defined in the HCBS Final Rule
• Is timely and occurs at times/locations of convenience to the individual
• Reflects cultural considerations/uses plain language
• Includes strategies for solving disagreement
• Offers choices to the individual regarding services and supports the individual receives and from whom
• Provides method to request updates
• Reflects what is Important To and Important For the person
• Identifies the strengths, preferences, needs (clinical and support), and desired outcomes of the individual
• May include if and what services are self-directed
• Must include individually identified goals and preferences related to relationships, community participation, employment, income and savings, healthcare and wellness, education and others
lewin.com | 17
Person Centered Service Plan Documentation
The following must be included in Person Centered Service Plan Documentation:
• Risk factors and measures in place to minimize risk (e.g., if having access to food at all times creates a significant life risk)
• Individualized backup plans and strategies when needed• Individuals important in supporting the person (paid and non-paid)• Individuals responsible for monitoring plan• Distributed to the individual and others involved in plan• Includes purchase/control of self-directed services• Exclude unnecessary or inappropriate services and supports
lewin.com | 18
Person Centered Counseling Updates
lewin.com | 19
Person Centered Counseling Core Values
• Choice– Decisions are made by the person with support as
needed
• Direction– The person (and/or family/loved ones if involved),
determine what services, where, how much/often
• Control– The person (and/or family/loved ones) decides how
engaged to be and how the process works
lewin.com | 20
ACL is Supporting the Development of 6 Courses for Person Centered Counselors
• An Introduction to the NWD System• Person-Centered Thinking• Person Centered Planning, Practice and Implementation
• (on-line and in person)
• An Introduction to the LTSS and the Role of the Person Centered Counselor
• Who We Serve in the LTSS System• An Introduction to Protection and Advocacy Systems
States may use the ACL-supported courses, may develop their own or may use a combination of both
lewin.com | 21
Person Centered Counseling Courses, cont’d
• On-line format; one course is in-person• Due to be piloted starting in summer 2015• Scheduled to be released on publicly available
platform in early 2016
lewin.com | 22
Contact Information
• For more information on person-centered practices, skills and tools– Leigh Ann Kingsbury
• The Lewin Group Illinois Nursing Home Deflection Project Team– Lisa Alecxih
– Carrie Blakeway-Amero• [email protected]
– Kimberly Smathers• [email protected]
– Anita Tonakarn-Nguyen• [email protected]
