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DDES INFO MEMO 2004-07

August 17, 2004

STATE OF WISCONSIN
Department of Health and Family Services
Division of Disability and Elder Services

To:
Area Administration Teams
Area Agencies on Aging
Bureau Directors
County Departments of Community Programs Directors
County Aging Units/Tribal Aging Units
County Departments of Human Services
County Departments of Social Services
County Developmental Disabilities Program Coordinators
County Mental Health and Substance Abuse Program Coordinators
County Economic Support Supervisors
County Long Term Support Coordinators
County Public Health Departments
Family Care Aging and Disability Resource Centers Directors
Family Care CMO Directors
Interested Parties
Members of State Council on Long-Term Care Reform
Members of Sub-Committee on Aging and Disability Resource Centers
Tribal Chairpersons/Human Services Facilitators

From: 
Sinikka Santala
Administrator

Re: 
Advanced Information Regarding Opportunity for Development of Aging & Disability Resource Centers

The purpose of this memo is to alert you that DHFS will select and fund new Aging and Disability Resource Centers (ADRCs) in 2005. The selection of the new ADRCs will be determined through a Request for Proposals (RFP) that will be issued in October 2004. DHFS will seek a variety of proposals from large and small counties, tribes, multi-county/tribe consortiums, and collaborations of agencies within service areas. The proposals will be due in early January. The award notices will be announced by the end of January.

The purpose of this information memo is to provide interested agencies with basic information about the expectations for new ADRCs and the anticipated resources to be provided by the Department. For additional information on standards and requirements for the current ADRCs please refer to the Department’s Internet site at: http://dhfs.wisconsin.gov/LTCare/StateFedReqs/CY04RCContract.pdf

Since Wisconsin launched the Community Options Program in 1982 to offer an alternative to nursing homes, long-term care reform has been a primary goal of the Department of Health and Family Services (DHFS). More recent models for reform are Partnership, PACE, and the landmark Family Care Program. DHFS has also launched the Mental Health/Alcohol and Other Drug Abuse (AODA) Redesign Initiative. Fundamental goals remain the same in each new approach:

ACCESS – People know about services and supports and can get what they need when they need it.

CHOICE – People choose where and how to use long-term care and recovery-oriented mental health/AODA supports.

QUALITY – People can achieve the best possible health and social roles with competent, caring service providers.

COST-EFFECTIVENESS – Individuals and government are prudent purchasers of the most appropriate service and support.

A significant element of long-term care reform nationally and in Wisconsin has been the development of the Aging and Disability Resource Center as a "one-stop" customer service center for information, advice and seamless access to opportunities, resources and public programs for people who are elderly or living with disabilities. Starting as an innovation within the Wisconsin ADRCs were redefined and expanded under the Family Care demonstrations in nine counties. As the next phase of long-term care reform, we will be announcing the expansion of ADRCs in an additional five locations via the RFP in October.

The proposal to develop additional ADRCs reflects a convergence of three different initiatives related to one-stop access to information and services.

Aging and Disability Resource Centers are a critical component of Family Care. Family Care is a new way of delivering long-term care services aimed at addressing concerns about the cost and complexity of the current long-term care system, unequal access to care, evidence of rising demand for disability services, and projections of an aging population’s growing need for long-term care. The Family Care Benefit provides cost-effective, comprehensive and flexible long-term care to a Medicaid nursing home eligible population. The ADRC plays a broader role in communities, providing information and seamless access to long-term care benefits, as well as assistance to use a range of other programs and benefits.

County aging units began developing Aging Resource Centers in the early nineties as a better way to organize information and assistance, benefits counseling and other access services for the large numbers of older people and their families who did not qualify for Medicaid or COP waivers. Elders urgently needed help to develop individualized strategies to stay in their own homes, or to find appropriate high quality services to purchase. However, their limited experience with public programs made them cautious about using county services, calling for a new emphasis on outreach and non-stigmatizing locations for service. These concepts were incorporated into the ADRCs.

The Mental Health/AODA redesign reflected a key goal for that initiative to improve access to services and minimize the differences in access and availability of services across the state. A key component of the redesigned system was the development of a recovery-oriented system to support consumer’s active and informed involvement in his or her treatment and recovery. Such involvement must support a consumer’s right to information, choice and dispute resolution. Initially called "Single Entry Points," in the MH/AODA Redesign process, the strategy has evolved to include the development of the resource center model as the ideal vision for a single entry point for mental health/AODA systems.

4. Information about Forthcoming Request for Proposals (RFP)

In order for counties and their partner agencies to start planning their response to the RFP in October, we are providing the following information:

An applicant agency may be any of the following:

• A Wisconsin county agency (or not-for-profit agency established by the county)
• A Wisconsin tribe is eligible within the same frame work as Wisconsin counties throughout this memo
• A consortium formed by two or more counties/ tribes
• Another entity in partnership with a county, tribe or consortium of counties/ tribes

Applicants should include partnerships or collaborations with local agencies in at least the following program areas:

• County/Tribal Aging Programs
• Community Integration Programs for people with developmental disabilities
• Community Options Programs for elders and people with physical disabilities
• County Programs for people with mental illness and substance abuse needs
• County Social Services programs for adults
• County Economic Support agencies

Only those counties currently served by a Family Care ADRC are excluded from applying. ADRCs currently serve Fond du Lac, Jackson, Kenosha, La Crosse, Marathon, Milwaukee (elderly only), Portage, Richland, and Trempealeau Counties. A service area may include one or more counties provided the service area is comprised of counties with contiguous borders, and each county is a full partner in the application process.

To receive funding, the applicant must have a plan to serve at least elderly people and people with physical or developmental disabilities in the first year. At the completion of a three-year implementation, the ADRC will serve all of the following groups of individuals (listed here alphabetically) regardless of their financial means.

• Adults with developmental disabilities
• Adults with physical disabilities
• Adults with mental illness and substance abuse needs
• Elders with disabilities or chronic health problems
• Healthy elders
• Children age 16 and older with disabilities who are transitioning into the adult service network
• Family Caregivers

Applicants may choose initially to implement the ADRC serving elders and one other target group, but DHFS expects that ADRCs will serve all target groups by the end of the implementation phase. In order to assure that the interests of all future "customers" of the ADRC are considered during planning, applications for funding should reflect that relevant partners are engaged and committed to the project early in the planning process.

Aging and Disability Resource Centers (ADRCs) offer the general public a single entry point for information and assistance on issues affecting older people, people with disabilities, people with mental health/AODA needs or their families. As a clearinghouse of information about long-term care and mental health and substance abuse services, they will also be available to physicians, hospital discharge planners, or other professionals who work with older people or other adults with these needs.

ADRCs provide services by telephone or visits to an individual’s home, as well as in accessible community centers. ADRC’s are also a catalyst for community prevention strategies to prevent or delay the use of publicly funded long-term care, mental health and/or substance abuse services. The key objectives of an ADRC include the following:

• Present a welcoming face to the entire community that is attractive, accessible, non-bureaucratic, non-threatening and confidential.
• Reach and serve a broad base of elderly people and people with disabilities, including people with mental health and substance abuse needs, regardless of income or condition.
• Provide reliable and objective information about a broad range of community resources of interest to elderly people, people with disabilities and adults with mental health of substance abuse needs, and help people get access to them when needed and wanted.
• Delay or prevent the need for long-term care or institutional services and/or public funding for them.
• Enable people to make informed, cost-effective decisions about their long-term care and mental health or substance abuse services.
• Identify people at risk and with needs and connect them to services or benefits, including elder abuse services, adult protective services, and crisis intervention services.
• Provide benefits counseling to elders, adults with disabilities, and adults with mental health or substance abuse needs.
• Coordinate the single entry point for publicly funded long-term care or mental health services.
• Coordinate access to eligibility determination for Medicaid, Food Stamps and other public benefits.

New ADRCs will develop the capacity to provide the same core services demonstrated by the original Family Care ADRCs. The State Council Long Term Care Reform advised DHFS to continue this model.

• Public education and outreach to all target populations and their families, including underserved and hard-to-reach populations, and people able to pay for their services. This includes education about the full range of long-term care and mental health or substance abuse services options available and the feasibility of providing care outside of institutions.

• Information and assistance on a wide range of topics related to elders, people with disabilities, people with mental health or substance abuse needs, family caregivers, and links to resources for people to remain in their preferred living situation, often their own homes. This includes information about Medicaid and other public benefits; private insurance including long-term care insurance; housing; nutrition; transportation; chore services; hospice; legal assistance; exercise and health programs; mental health and substance abuse services, etc., both publicly and privately funded.

• Long-term care options counseling to help people plan for their current and future long-term support needs. Providing planning services and timely advice about options helps people to remain as independent as possible, and conserve their private resources while preventing or delaying the need to rely on government funds. This includes pre-admission screening for people entering substitute care.

• Short-term assistance or case management to stabilize an immediate need, or to develop a care plan that the individual or their families can carry out, and facilitate linkages to needed services. Includes providing immediate access to elder abuse, adult protective or mental health crisis intervention services.

• Prevention programs to help people maintain health and functioning and thus delay or prevent the need for long-term care or institutional services. These evidence-based programs may range from falls prevention programs, to chronic disease self-management, depression screening or geriatric assessments.

• Elderly and Disability Benefits Specialist as part of the ADRC staff to help "cut the red tape" in securing and maintaining public and private benefits and services, including SSI, SSDI, Veterans benefits, disability insurance, pensions, Medicaid, Medicare, and Food Stamps. Elderly Benefit Specialists serve individuals who are age 60 and above. Disability Benefit Specialists serve adults under age 60 who have disabilities or mental health or substance abuse needs.

• Administration of the Long-Term Care Functional Screen to provide information for effective options counseling and to determine functional eligibility for publicly funded long-term care. The screen may be performed by qualified ADRC staff, waiver staff, or a combination of both as long as there is close collaboration and no duplication of effort, and access to this service is seamless for the customers of the ADRC.

• Administration of the Mental Health/AODA Functional Screen: The ADRC will be expected to provide options counseling and to determine functional eligibility for mental health or substance abuse services or have working agreements with the county agency with clinical capability for conducting the functional screen when it has been adopted for use in that county.

• Linkages to Medicaid and Medicaid waiver financial eligibility. Every ADRC is responsible to assure that people, who are potentially eligible for Medicaid and for MA Waivers as well as Food Stamps and other means-tested benefits, receive prompt, seamless access to financial eligibility determination through effective protocols developed with Economic Support units. In Family Care benefit counties, ADRC’s are responsible for enrollment in that program.

Counties already serve as the single-entry point to publicly funded long-term care and county-funded mental health and substance abuse services. Counties already perform many of the other functions of an ADRC. However, counties rarely serve this broad a population of private pay customers and the general public, or they are not organized to focus access and information on long-term care and mental health or substance abuse issues.

To receive funds, counties will have to commit to deploying or reorganizing existing staff and other resources – including financial – to achieve a customer-focused service center. Agencies selected to operate ADRCs will plan for implementation, including how to reorganize and deploy current resources, including:

• Organize a governing board or commission that includes a majority of representatives of the populations served and includes a minority of elected officials.

• Plan and coordinate with local agencies including county or tribal aging agency/OAA services, economic support, long-term support, programs for developmental disabilities and mental health and substance abuse, adult protective services, elder abuse and neglect, and public health.

• Design quality assurance and quality improvement mechanisms that address issues of visibility, trust, ease of access, quality of functional screen data, responsiveness, efficiency and effectiveness.

• Develop collaborations with local resources such as Independent Living Centers, homeless outreach and shelter care services, educational and vocational rehabilitation systems, housing resources, health care providers, transportation, employment, Alzheimer’s organizations and diagnostic centers, consumer-operated support programs and volunteer programs.

• Assess needs for telecommunications, information technology (hardware and software) and Internet access.

Successful applicants will have access to the following Department resources:

• Start-up money totaling $55,000 per agency to be used for any identified need related to readiness for implementation. The preferred use is for a full-time project leader, but may also be used for analysis current processes and infrastructure changes needed to facilitate start-up, computer or telecommunication upgrades.

• Funding to start a Disability Benefit Specialist program.

• Ongoing funding will be provided based on the size of the adult population of the service area covered by the ADRC. The minimum provided by the Department will be $100,000 annually. ADRC service areas with populations greater than 1% of the state population will receive higher awards based on demonstrated need and county resource commitment.

• DHFS will, provide additional funding based on a workplan and budget and the level of county support.

• DHFS will develop a toolkit of professional-quality public information materials.

• DHFS will provide a web-based training curriculum on long-term care options counseling.
  
• DHFS will coordinate technical assistance in serving target populations.

• DHFS will facilitate identification of information management solutions for ADRC Information and Assistance client tracking system.

• DHFS will facilitate developing solutions for local resource databases.

• DHFS will provide technical assistance to perform an analysis of current funding resources available to sustain the ADRC and help reconfigure and maximize the funding that could be available through a variety of state, federal and local sources, and through private funding.

CENTRAL OFFICE CONTACT: 
Susan Abbey
Independent Living Programs Supervisor
Bureau of Aging and Long Term Care Resources
PO Box 7851
Madison WI 53707-7851
(608) 266-1794
abbeysu@dhfs.state.wi.us

MEMO WEB SITE: 
http://dhfs.wisconsin.gov/partners/local.htm

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