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Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Page 1: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

Federal/State Partnerships for Long Term Care: Next Steps

Mary Jean DuckettCenters for Medicare and Medicaid Services

May 8, 2002

Page 2: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Federal/State Partnership - Key Ingredients

Shared goals

Mutual collaboration

Page 3: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Constituencies:

Medicaid clients/potential Medicaid clients

FamiliesAdvocatesProvidersFederal contractorsCongress

Page 4: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Shared Goals

Varied

Dictated by: Law Regulations Political climate Economic climate Personal needs

Page 5: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Shared Goal - Challenge

Partners may share a goal for different reasons

Partners each have constraints on ability to act

Page 6: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Shared Goal

Meeting the requirements of the Americans with Disabilities Act (ADA) that persons with disabilities be served in the most integrated setting appropriate

Page 7: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Federal Response: New Freedom Initiative

The Policy Increasing access to assistive and

universally designed technologies Expanding educational opportunities for

Americans with disabilities Integrating individuals with disabilities

into the workforce Promoting full access to community life

Page 8: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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New Freedom Initiative

Specific Objectives Include: Full enforcement of the ADA Promotion of home ownership for

people with disabilities Swift implementation of the Olmstead

decision Expanding transportation options

Page 9: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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New Freedom

Emerging Partnership Role for CMS

Page 10: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Emerging Role of CMS

Traditional Roles Regulation Permission giving Shared funding within a regulatory

context

Page 11: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Emerging Partnership Role of CMS

“Culture of responsiveness”Solution finding/administrative

simplificationFlexible waiver approvalsContinuous improvement

Page 12: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Emerging Partnership Role Evidenced by:

Grant availability - Systems Change for Community Living

Information and assistance

Executive Order # 13217

Page 13: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Systems Change for Community Living

February 25, 2001 HHS Secretary Thompson announced the availability of $50,000 “Starter Grants” to help States design innovations, support consumer taskforces, and foster public-private partnerships

“One Page” application54 of 56 States and Territories requested

and received

Page 14: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Systems Change for Community Living

May 22, 2001 Invitation to Apply for “Coordinated Application” Real Choice Systems Change Community-integrated Personal Assistance

Services and Supports Nursing Facility Transitions (State and ILP) National Technical Assistance Exchange for

Community Living161 applications from 51 States and

Territories, requesting $240 million

Page 15: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Systems Change for Community Living

So many applications received that the maximum amount of each award category was reduced so that an additional 19 grant awards could be made

$64 million was awarded to 37 States and one Territory

Page 16: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Systems Change for Community Living

A Technical Assistance Exchange was also funded to assure learning would be gathered and shared as was a Formative Research Component

Unsuccessful States were contacted and the proposals discussed to assist in continued local efforts and possible future submissions

Page 17: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Information and AssistanceThe Resource Network (www.hcbs.org)Technical Assistance Exchange for Community

Living Grantees March Conference

National Contractor for HCBS Quality (MR/DD)Promising Practices NCSL Contract – Olmstead/TWWIIABIA ContractVariety of research and evaluation projects

Page 18: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Community-Based Alternatives - EO #13217Directed DOJ, HHS, Education, Labor,

Housing and Urban Development and SSA to “evaluate the policies and programs, statutes and regulations of their respective agencies to determine whether any should be revised or modified to improve the availability of community-based services for qualified individuals with disabilities”

DOT, VA, SBA and OPM joined voluntarily

Page 19: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Community-Based Alternatives (EO)

Obligated the agencies to involve consumers, advocacy organizations, providers, and relevant agency representatives in the self-evaluation process Written comments (8/27/01) Studies and policy research National listening session (9/5/01) National teleconference (8/15/01)

Page 20: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Community-Based Alternatives (EO)

More than 800 individuals and organizations provided comments through various mechanisms

With respect to the written comments individuals with a disability or family members accounted for about one-third of all comments

Page 21: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Community-Based Alternatives (EO)

Public comments reviewed, organized and distilled

Agencies identified specific actions to address the barriers identified

Status Report to the President on December 21, 2001

HHS Report to White House on March 25, 2002

Page 22: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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State Partnership Responsibilities

Improving existing servicesAccessing potential fundingHave a dialog with constituents with

disabilitiesFacilitate partnerships, including CMS

Page 23: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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State: Improving Existing Services

Evaluation of state law, regulations, and policies to identify barriers

Explore opportunities to provide services through a new, more effective service delivery model(s)

Partner with CMS

Page 24: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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State: Access to Potential Funding

Apply for grant opportunities

Consider waiver flexibility and efficiency

Page 25: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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State/Constituent Dialog

Recognizes strengths, preferences and desired outcomes of families and persons with disabilities

Ensures that constituents receive services they want rather than what is available

Contributes to satisfaction with servicesLeads to problem resolution

Page 26: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Cash and Counseling

Arkansas, Florida and New Jersey under authority of Section 1115 of the Social Security Act

An experimental approach by randomizing enrollees into a treatment or control group. Treatment group participants are elderly and younger Medicaid beneficiaries with significant long-term functional disabilities and their family caregivers

Page 27: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Cash and Counseling

They “self-direct” their own home and community-based personal assistance services utilizing a cash allowance to purchase services or items needed to meet his/her personal care needs

In Arkansas, all of participants were satisfied with the relationship with their workers; 99% were satisfied with how their workers performed personal care tasks

Page 28: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Cash and Counseling

In New Jersey, 90 percent of the early participants said they were “very satisfied” with the relationship they had with those they hired and how tasks were performed

82% of the participants in Arkansas said their lives had improved as a result of receiving and directing their monthly allowance

Page 29: Federal/State Partnerships for Long Term Care: Next Steps Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

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Federal/State Partnership: Next Steps

Continue development of emerging Federal/State roles

Award $55 million in Systems Change Grants for FFY 2002

Implementation of “Delivering the Promise”

Continue to seek legislation and revise regulations and policies to address barriers


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