Rationale for choosing this goal and California’s readiness for reform through more effectively managing the funding for long-term supports.
As discussed in the Readiness Assessment, recent analysis of California’s long-term care program caseloads and costs conducted by the highly respected, non-partisan Legislative Analyst’s Office as part of a wider analysis of various health and social services programs, found that while spending in general on long-term care services has grown significantly over the last five years ($10.3+ billion in 2001-02 vs. $14 billion in 2005-06) an increasing portion of California’s long-term care spending is for home and community-based services over institutional care (LAO, 2006-07: C-25). Through its prior work to obtain waivers and create programs that successfully help individuals remain at home and avoid institutionalization, California now ranks11th among the 50 states in percentage of Medicaid long-term care funding directed towards HCBS. In 1996, 67% of California’s long-term care payments went to nursing homes (USC/UCLA 2003). By 2004, institutional long-term care service expenditures decreased to 55.4% of the total Medicaid long-term care expenditures, whereas the state’s expenditures for Medicaid HCBS accounted for 44.6% of its total Medicaid long-term care expenditures (Burwell, B., et. al. 2005). According to the Legislative Analyst’s 2005-06 report, spending for community-based services has increased by 6% (from 55% to 61%) over institutional care since it last examined and reported on the data in the 2000-01 Analysis (LAO, 2005-06: C26). California’s estimated expenditures for home and community-based services in 2005-06 are $8.4 billion compared to little more than $5.3 billion for institutional care (LAO, 2005-06: C-23).
Interestingly, over the past decade, the number of Medi-Cal (California Medicaid) paid nursing facility days has stayed virtually the same (1.7% increase), despite the fact that the number of Medi-Cal eligible individuals over age 65 has increased almost 25% (USC/UCLA 2003). The control in nursing home utilization is due in part to a substantial increase in the availability of home and community-based services that allow adults with functional limitations to remain in their homes. The availability of California’s In Home Supportive Services program, home and community-based waiver programs, home health, adult day health care and other home and community-based services have helped reduce average utilization from almost 44 days per Medi-Cal eligible aged 65+ in 1991 to just over 36 days per eligible in 2001 (Ibid).
California has chosen this goal to meet the continuing need of rebalancing its spending for long-term care services and supports. It is estimated that the population requiring long-term care services is growing at a rate of 3 percent per year as evidenced by the last five years. (LAO, 2005-06: C-25). While California has increased the share of spending going to community-based care mainly by providing greater consumer choice for community-based care and by diverting individuals from institutional care, California must more effectively manage long-term care funding in order to continue this trend, to meet the challenge of the ever-increasing demand for long-term care, and to help financial resources go farther to meet real human health and social needs. In order to more effectively manage its long-term care funding, California’s policymakers and stakeholders need an in-depth understanding of the specific fiscal, legal, structural, and policy measures that will encourage and support community care living options—as well as, the specific mechanisms that discourage and prevent individual choice and selection of community care options. Increasing the state’s capacity to serve individuals in the community does not necessarily require more resources, but it clearly does require a better understanding of what resources California has, how best to spend them, and what steps are needed to bridge the gap from current resource expenditure systems to a new, more flexible budget and reimbursement system of integrated service delivery. California needs to examine its payment methodologies across the long-term care continuum and ensure that incentives are appropriately aligned to increase access to HCBS, which ultimately will lead to a rebalancing of the financing structure. To build political support for broad changes that will truly transform California’s enormous long-term care system, CHHSA must develop a clear understanding of the relevant funding management structures and what policies, laws, and regulations impact the choice of HCBS and it must set forth well-researched recommendations for change.
California stands ready to develop of a system that more effectively manages the funding resources for long-term supports. CHHSA has worked hard to position California for continued rebalancing through seven current HCBS waiver programs, each serving a distinct disability group (see Readiness Assessment, Question 8).
The very size, complexity, and fragmentation of California’s long-term care system presents a barrier to long-term care financing reform. The State’s administrative framework for administering long-term care services is large and complex. Under the direction of applicant CHSSA, the State’s Medicaid agency (the Department of Health Services) both administers programs and disburses federal Medicaid funds to other CHSSA departments who also administer programs providing long-term care services, such as the departments of Aging, Social Services, Mental Health, and Developmental Services. Depending upon the department and the origin of program funding, there is a different payment methodology. Due to the various payment methodologies and reimbursement systems, resources for long-term care in general cannot be transferred to the area of need as between HCBS and institutional care programs.
In addition, the acute and long-term care system has long been plagued with system fragmentation stemming from two sources: (1) a multiplicity of funding streams and programs operating in “silos” and (2) a lack of coordination between the medical and social systems of care. Categorical long-term care programs offered to seniors and persons living with disabilities in California are provided by a variety of local and state health and social services agencies with multiple funding sources. Each home and community-based program is designed with its own unique state and/or federal requirements, eligibility criteria, and assessment procedures. Because system fragmentation is characterized by a lack of coordination between primary, acute, and long-term care systems, it often results in higher-than-necessary rates of hospitalization and nursing home placement.
Another potential barrier is the concern of stakeholders over protecting wages and benefits in the event of any restructuring that impacts the In Home Supportive Services (IHSS) program. IHSS is the cornerstone of California’s home and community-based services system. At present, approximately 375,000 individuals rely on the IHSS program for assistance, as compared to less than 100,000 relying on institutional care (LAO, 2005-06: C-23-24). IHSS and two other Medicaid funded programs—nursing facilities, and Regional Centers serving the developmentally disabled—constitute 71% of California’s long-term care spending (Ibid). While most stakeholders recognize the importance of developing a more integrated system for consumers, there is much disagreement on how this can be achieved and at what costs. Stakeholder groups, such as the Olmstead Advisory Committee, have made real progress in addressing stakeholder concerns regarding changes that may impact individual programs that have become so important to so many consumers.
Flat funding rates for certain programs also present a barrier to reforming funding management. For example, in the Multipurpose Senior Services Program (MSSP), a 1915(c) HCBS waiver program, flat funding rates render it difficult to fill all slots and meet consumer demand for services. The consequence of steadily rising costs and flat reimbursement is higher caseloads, staff layoffs, and fewer services purchased—all of which has made it difficult for MSSP providers to meet program capacity. Therefore, some MSSP program slots remain unfilled despite the demand for services from consumers.
Another barrier to long-term care funding management reform is a lack of consistent data collection across agencies and programs. As discussed in Goal 4, Objective 3, page 40, data is critical to understanding population needs, gaps in services and areas of duplication. However, no single department or agency uniformly collects and reports all long-term care data. In some situations, there may be available data but little analytical information, or there may be significant gaps in available information or incomplete data. For example, at present the total caseload in community-based care cannot be determined because many individuals use multiple services making it impossible to provide an unduplicated count (LAO, 2005-06: C-24). Although it is generally accepted from existing data that on average, institutional care costs nearly $55,000 per case annually in California and community-based care costs are on average lower per case ($10,000 per case for In Home Supportive Services care per year) because of the great variation in the nature of community services, a meaningful cost average cannot be computed (Ibid). Lacking this information, it is difficult to uncover what the system needs to “rebalance” and provide sufficient alternatives to nursing home placement.
Although a state as large as California always faces sizeable barriers in instituting broad systems reform, California is ready for this systems transformation and, in fact, is making progress toward overcoming these barriers. Several existing and developing assets will help lead to successful systems change through more effectively managing funding. These include the current efforts to integrate acute and long-term care funding and services. Governor Arnold Schwarzenegger’s 2006-07 proposed Budget outlines a long-term care integration pilot project intended to improve the continuity of care by integrating coverage of acute and primary care service as well as home and community-based services. This proposal is discussed in the Readiness Assessment.
As part of the 2006-07 Budget, Governor Schwarzenegger has also presented a proposal to develop the Coordinated Care Management project to meet the needs of the high-end users of the Medi-Cal fee-for-service system, using a case management model. The goal of this demonstration program is to maintain access to medically necessary and appropriate services, improve health outcomes, and provide care in a more cost effective manner for two populations enrolled in the fee for service Medi-Cal program who are not on Medicare: (1) seniors and persons with disabilities who have chronic conditions, or who may be seriously ill and near the end of life; and (2) persons with chronic health conditions and serious mental illnesses. This project allows the State to test targeted approaches for meeting the needs of high-end users of the medical system in a cost effective manner that will inform funding management changes.
Integration of this goal with California’s other chosen goals.
Recognizing the importance of integrated systems change, goal 5 is integrated with, and into, goal 1 (increasing access to long-term supports) in several ways. More effective funding management and the development of a flexible budget and reimbursement system with reformed payment methodologies will:
Goal 5 connects to Goal 4 (IT to support system change) as the consumer’s ability to acquire information about available HCBS and programs is inextricably tied to the consumer’s ability to obtain those services that will be improved through goal 5 strategies. Consumers will be able to learn about the services for which they may be eligible, along with improved payment methodologies that will help them obtain these services—and remove the almost automatic referral to nursing home care. In addition, helping consumers access information through Goal 4 IT transformation will increase awareness of options for available HCBS through waiver and other programs, and in turn, help rebalance the system of long-term supports.
The interest in this objective is focused on creating a system that more effectively and efficiently manages the funding for long-term supports that promote community living options. As indicated in the systems readiness assessment, California has multiple HCBS programs and a lower rate of institutionalization than most states. However, system fragmentation prevents many consumers from accessing the services they need. With greater flexibility in state budgeting, experts anticipate that the rates of institutionalization will further decrease and use of HCBS will increase.
To develop a system that is more flexible in its funding of HCBS as an alternative to institutionalization, California must first build an understanding of what is needed to effectively rebalance the system. This requires a comprehensive analysis of the laws and regulations that impact the delivery of the state’s HCBS, as well as an understanding of the payment strategies that can more effectively manage funding. While the specific strategies to achieve this objective will be developed through the project strategic planning process, a crucial and significant first step is the systematic analysis of the laws, regulations, policies, and practices related to long-term care financing. Such a study will provide the data and analysis necessary to move forward with broad financing management reform and will enable CHHSA and others to effectively advocate for the necessary changes. Whatever specific measures are recommended for reform, completing the study of long-term care financing in California will tremendously increase the likelihood of successful achievement of goal 5 and its objectives.
Many programs employ federal, State, county and private funds that serve to keep people living in community settings, including monies from Independent Living Centers, Area Agencies on Aging, Regional Centers, Medicaid, local Community Development Block Grants, and many others. It is important that the long-term financing study chart the laws, policies, and regulations for each major funding source, collect data in one place, and present it in a comprehensible manner to allow for determination of the similarities, differences, potential conflicts, gaps, and barriers to increase use of HCBS by seniors and persons with disabilities. Federal, State, and local financing structures, as well as state regulations and policies that impact the delivery of HCBS need to be examined and analyzed. In addition to other source information, the findings of the Money Follows the Person/California Pathways project will be incorporated as the project develops cost and encounter data that form the basis for one or more financing model(s).
The study will gather information upon which decisions will be made regarding options for creating a State system that will more effectively manage the funding and payment methodologies for long-term supports that promote community living options. It will include recommendations for budget restructuring and very specific funding management reforms—their advantages and disadvantages, and potential venues or modes of realization, (e.g., by Medicaid State Plan Amendment, new or modified Home and Community-Based waivers, State legislation, proposed federal legislation, or a combination). Such restructuring may mean amending the Medicaid State Plan, adding a number of slots to an existing waiver, implementing an integrated Medicare and Medicaid delivery system (similar to as proposed in the Acute and Long-term Care Integration projects), and/or developing or restructuring waivers that allow money to follow the person. It is anticipated that some recommendations will center on changes to payment methodologies, reimbursement systems, and other measures to allow transfer of funds between HCBS and institutional programs. The study should be completed at approximately the project mid-point. Project staff and stakeholders will widely disseminate the study findings and recommendations. Thereafter, project staff will respond and provide further information and data to the Administration, stakeholders (the Olmstead Advisory Committee), and the Legislature on implementation issues.
At the end of the 5 year project period, California will have accomplished the following toward more effectively managing its funding to promote community living options:
Project staff will perform both process and formative evaluations of the study strategy objective. The process objectives will involve meeting the project timeline for completion of the long-term financing study, obtaining meaningful stakeholder involvement, and conducting numerous dissemination activities. The formative or outcome indicators will measure: the extent to which the data and information collected is comprehensive and accurate; the extent to which the study provides the data and information needed to support recommended changes to more effectively manage the funding resources for long-term supports; the extent to which the study is readable and useable as a tool to educate stakeholders and others on the areas of needed reform; and the extent to which it sets forth recommendations for systems change that are supported, integrated, realistic, and will achieve the intended result.
Although the specific reform measures to be implemented as a result of the study are presently unknown, California will evaluate the impact of implementation by examination of the following questions:
1) What has been (or will be over time) the proportional change in total Medicaid long-term care spending on home and community-based services compared to institutional services?
2) What has been (or will be over time) the proportional change in Medicaid long-term care per capita spending on home and community-based services and institutional services?
3) What has been (or will be over time) the rate of change for Medicaid long-term care spending compared to the national average?
4) What has been (or will be over time) the proportional change in the number of institutional beds and the number of Medicaid waiver slots?
Each suggested recommendation for funding management reform will be viewed in light of its expected effect on the indicators listed above. The assessment methodology for all the questions will involve analysis of either the actual data after implementation or, if time within the grant period does not allow for a reasonable implementation period to have elapsed before analysis, data based upon projections.
Main stakeholder groups whose support will be critical to success of this goal include the following:
Rebalancing the funding of California’s long-term care system will likely be a contentious policy issue at the state level, requiring a great deal of consensus building and stakeholder involvement led by the project staff. This became apparent in 2004 when the nursing home industry and the labor union representing the direct care workers sought to change the reimbursement structure for the State’s nursing homes through Assembly Bill 1629, the Long-term Care Reimbursement Act of 2004. The Act sought to implement a new rate structure for nursing homes, with the goal of basing reimbursement on actual costs for care as opposed to the previous flat rate structure. While many stakeholders agreed that the rate system was in need of reform, there were several objections as to how these reforms should be achieved. The bill was strongly supported by the health care labor workers represented by the Service Employees International Union, as well as the state’s nursing home industry. It also gained support from the Older Women’s League, the Gray Panthers of California, and the Congress of California Seniors. The bill was opposed by the California Advocates for Nursing Home Reform (CANHR), Protection and Advocacy, the Alzheimer’s Association of California, and the Association for Independent Living Centers. CANHR argued that the bill fell short on accountability and lacked any tangible quality of care improvements. Other advocates, including Protection and Advocacy and the Coalition of Californians for Olmstead, argued that the bill sent the state in the wrong direction for purposes of Olmstead implementation by focusing on provision of enhanced rates for institutions without looking at the need for reimbursement in the home and community-based services system.
As this example illustrates, stakeholders bring many perspectives to rate and reimbursement issues, and change can be difficult to achieve without extensive consensus building and agreement from labor unions, the nursing home industry, the legislative and executive branches, as well as advocates. CHHSA will develop a level of commitment on the part of the identified stakeholders and acquire the buy-in needed to implement the recommended reforms in funding management through the already established Olmstead Advisory Committee, a diverse and influential group respected for its work and commitment to the issues. With CHHSA leading the way, California Community CHOICES is in a strong position to be able to recommend systems change. As the policy coordinating and oversight entity for the state’s health and human service programs, CHHSA has the capacity to work with all departments, stakeholders, Administration leaders, and legislative representatives to analyze and implement the recommendations presented by the long-term care financing study, and convenes the Olmstead Advisory Committee of key stakeholder representatives. For this reason no organizational changes to achieve stakeholder collaboration and cooperation are needed at this time. In fact, in its 2006-07 report on health and social services crosscutting issues the California Legislative Analyst’s Office stated that the Olmstead Advisory Committee… made up of representatives selected by the Secretary of CHHSA, “continues to meet and provide advice to the administration on improving California’s long-term care system. The Olmstead Advisory Committee appears to be functioning reasonably well as a forum for discussion of long-term care issues among citizens, organizations, and administration officials with an interest in these policy issues. We believe this committee serves the broader purpose intended by the Legislature of fostering collaboration among various long-term care programs.” (LAO, 2005-06: C-33-34).
“There are times that process is almost more important than product.
It does no good to have a Cadillac version of a strategic plan
if the process to develop it did not create a commitment to its implementation . . .
including the willingness to review and make adjustments along the way.”
--Toby Ewing, Program Manager, Little Hoover Commission
Testimony to the Joint Committee on Long Term Care, December 2005
Applicant CHHSA will partner with Sonoma State University/California Institute on Human Services (SSU/CIHS) to conduct a strategic planning process inclusive of all stakeholders: consumer organizations, individuals, caregiver organizations, State departments, healthcare providers and other interested parties. CHHSA believes that stakeholder involvement is the most critical component to strategic planning. SSU/CIHS has extensive experience over the last 27 years in human service planning and delivery and specific experience in strategic planning and implementing systems change that is broadly based across California communities and in connecting to governmental service delivery systems. Two specific examples of successful planning processes are described here.
In 2005, the California Health Incentives Improvement Project, California’s Medicaid Infrastructure Grant administered by SSU/CIHS, launched an aggressive effort to solicit public input to the Comprehensive Strategy for the Employment of People with Disabilities together with the California Governor’s Committee on Employment of people with Disabilities. Both organizations had a responsibility to their funders, if you will, to develop such a plan. The Governor’s Committee had a state-legislated mandate it had not completed in two years, and the SSU/CIHS had a new, corresponding responsibility under its grant from CMS. Both organizations collaboratively committed to building a single Comprehensive Strategy around evidence-based practices and extensive input from people with disabilities, their families, employers, service providers, and other stakeholders during the 2005 calendar year.
The planning process for the Comprehensive Strategy actually took place over the past five years, when tracking back to the policy platform developed by the California Work Group, a grassroots effort funded by a Systems Change grant from the California Endowment and staffed by the World Institute on Disability in Oakland, California in 2000. Perhaps the strongest model of systems change, it started with grassroots advocacy and led to legislative leadership (Assembly Bill 925, Aroner, Statutes of 2002) and a directive that maintained the State’s attention across tumultuous administrative changes and tight budgetary constraints. The Governor’s Committee approved the strategy in January 2006, and CMS approved a full report of the strategy in February 2006. The process to write the comprehensive strategy took just over one year. The process to develop the comprehensive strategy took much longer, and the process to build and support its implementation is ongoing with support from SSU/CIHS and the Medicaid Infrastructure Grant.
In addition, SSU/CIHS has a long-standing relationship with the California Department of Education and the State’s improvement plans for Special Education services. In that role, the Institute established and worked with the Partnership Committee for Special Education (PCSE) to develop and monitor implementation of the “State Improvement Plan” for education services to children/youth with disabilities. This process began with a planning group of key State agencies, consumers, provider groups and staff developing a full 2-day working meeting, organizing materials for PCSE members’ homework prior to the meeting, delineating methodology and responsibility for gaining widespread input from all stakeholders statewide, and creating detailed timelines for conducting the process. The process resulted in a Plan endorsed by virtually all stakeholders, accepted by the US Dept of Education and monitored/modified annually; the plan has provided implementation funding for the past 8 years.
Both processes described above evidence SSU/CIHS’ ability to reach out and bring forth consumer and stakeholder voices and involvement in planning and guiding new paths for government business. California is ready to plan for Real Choices in long-term care transformation: consumers, advocates and community organizations are seeking ways to address services across aging and disability funding streams through Olmstead Advisory Committee appointments, Committee sessions and workgroup products. Additionally, legislators have held hearings inviting states who are ahead of California to share information about their systems (12/2005). It is a good time to pull these voices together to plan strategically.
Upon receipt of detailed instructions from CMS, the team will create a detailed timeline to include the following:
Activity |
Begin |
Period |
|---|---|---|
Interagency Agreement and staffing designations |
Month 1 |
1-2 months |
Begin study for IT development of CalCareNet enhancements: proposed solutions and costs |
Month 1 |
|
Initial public meeting of the Olmstead Grant Advisory Group to support planning process and draft plan key elements |
Month 2 |
|
Legislative informational hearing |
Month 3 |
|
Aggressive public input solicitation process including website posting and data collection of stakeholder comments; webcasts seeking specific input from Independent Living Centers & Area Agencies on Aging; focus groups; key informant interviews with facility leaders and healthcare system leaders |
Month 3 |
3-6 |
Second public meeting of Olmstead Advisory Group reviewing and incorporating stakeholder input into the key elements |
Month 7 |
|
Finalize report of IT development needed for CalCareNet enhancements: proposed solutions and estimated costs |
Month 7 |
|
Second legislative informational hearing |
Month 7 |
|
Staff drafting of a Strategic Plan |
Month 7 |
|
Third public meeting of the Olmstead Advisory Group to amend/adopt |
Month 8 |
|
Final report and Strategic Plan submittal to CMS |
Month 9 |
|
Strategies for obtaining broad stakeholder input: The team understands that inclusive stakeholder input is essential to the production of a Plan that can be successfully implemented. Based on previous experience, initial strategies for obtaining broad-based statewide input include the following:
Project Advisory Group: a project advisory group founded as a subcommittee of the Olmstead Advisory Committee will ensure alignment between the developing elements to the work of the Olmstead Committee. This advisory group will also be open to other stakeholders and members of the public who are interested in participating and providing input to the process. The Olmstead Advisory Committee is comprised of 32 members, including seven consumers, nine providers, four government providers, two researcher/academics, one legislative representative, one family member, and eight advocates.
Principle contractor: SSU/CIHS will develop the process and coordinate activities soliciting broad public input for development and comments on draft; draft Strategic Plan with direction from advisory committee, participate with CHHSA at meetings with CMS. SSU/CIHS has identified contracted staff to ensure an immediate start to strategic planning upon award, see resumes in Appendix V. The planning team of strong and diverse credentials include: Linda Blong, planning design oversight; Monique Parish, information technology development planning consultant; Tony Sauer, home-based services expertise in aging and disability services; and Eric Glunt, research and evaluation expertise.
Elements of the Strategic Plan
The Strategic Plan will include all of the elements outlined by CMS. These key elements, summarized below will be disseminated for public comment in month 3 and then used by SSU/CIHS to write the plan draft. The advisory committee will review and make recommendations and the committee’s input will be incorporated to produce a final plan.
Mission: The mission statement will follow the Harvard University Strategic Planning model that uses the following basic, clear format: The mission of the _____ Initiative, as (insert unique nature), is to (insert the goals/purpose) by (insert the methodology).
Goals: the strategic planning process will begin with the State’s three chosen transformation goals:
Objectives and Strategies supporting the selected Goals will be reviewed and refined during the grant planning phase but are shown here as projected in Section III.
Improved access to long-term support services: Development of one-stop system.
CLRCs will use an enhanced version of CalCareNet to access information and services; act as an intermediary developing linkages across home and community-based service providers; provide screening and offer needs assessments, including self assessments to help individuals determine resource and information needs.
Objective 1: California will provide awareness, information, and assistance in accessing HCBS.
Strategy 1: Build Information and Referral Systems Capacity
Strategy 2: Improving Communication and Collaboration among LTC providers: establishing community connections/collaborations; community kiosks; establishing an ADRC/CLRC coalition
Strategy 3: Provide screening for early identification of needs and connection to services
Strategy 1: Intake Process Development
Strategy 2: Formal Assessment
Strategy 3: Comprehensive Care plans
Strategy 4: Service Authorization for Outside Agencies – facilitating the individuals’ transition from one service provider to the next.
Strategy 1: Triage system to create linkages to critical pathways… building local cross-program infrastructures for rapid response for individuals at imminent risk of institutionalization.
Transformation of information technology to support systems change
Create a useful and comprehensive webportal for use by individuals, family members and service and healthcare providers.
Objective 1: Design IT applications that will support program practices and processes that are consistent with participant-centered principles and enable consumers to direct their own services.
Strategy 1: Transform the CalCareNet portal so that it provides a comprehensive, easy-to-use, consistently updated Web-based system providing information and assistance in HCBS allowing all California consumers to direct their own services.
Objective 2: Improve client access to long-term services through the use of integrated IT systems
Strategy 1: Incorporate the various Web-based resources and data depositories already in existence in California. (Note: The IT subcontractor will be selected through a competitive bid process.)
Objective 3: Use integrated IT systems to monitor the quality of services rendered.
Creation of a system that more effectively manages the funding for long-term supports that promote community living options
Objective 1: Develop and Implement More Flexible Payment Methodologies
Strategy 1: Long-Term Care Financing Study
The Strategic Plan will present in detail the steps involved in the implementation of each of the strategies listed above, as they are modified by the strategic planning process. The implementation plan will include:
The SSU/CIHS will provide TA to the project, hiring or contracting particular expertise as needed based upon the strategic planning process. The Technical Assistance Plan will be incorporated in the Strategic Plan itself.
The team will incorporate both formative and summative evaluation into the strategic plan. Key to the success of the project is the quarterly formative evaluation that will be conducted by the Advisory Group with support of SSU/CIHS contracted staff. The CHHSA will ensure the external evaluator is involved in the strategic planning process to develop an evaluation plan that includes both process and outcome evaluations. The external evaluator will implement the plan, including analysis of informal and formal data related to process and outcomes. The evaluator will also work with the CMS evaluator to ensure consistency of summative evaluation strategies.
Aging & Disability Resource Center Development in California: A Work in Progress. California Department on Aging. 2006.
ADRCs Technical Assistance Exchange, Fact Sheet on Short-Term Case Management for ADRCs:National Vision and the Wisconsin Experience. June 2005; http://www.adrc-tae.org/tiki-index.php?page=CaseManagementPublic.
Black, W. and Brown, R., Mathematica Policy Research, Inc. 2004;
http://www.mathematica-mpr.com/publications/pdfs/shoringup.pdf.
Burwell, B., Sredl, K., and Eiken, S., 2005. Medicaid Long Term Care Expenditures in FY 2004 http://www.hcbs.org/moreInfo.php/nb/doc/1260/Medicaid_Long_Term_Care_Expenditures_in_FY_2004. See also http://www.hcbs.org/files/71/3543/FY2004InstComm.pdf.
California Department of Aging, The Aging Baby Boomers: Influence on the Growth of the Oldest Old; http://www.aging.state.ca.us/html/stats/oldest_old_population.html
California Health Care Foundation, 2005. Medi-Cal Beneficiaries with Disabilities
http://www.chcf.org/topics/medi-cal
California Policy Research Center, Strategic Planning Framework for an Aging Population, University of California at Berkeley, 2001; http://www.ucop.edu/cprc/agingreport.pdf
Eiken, S., Promising Practices in Long Term Care Systems Reform: Common Factors of Systems Change, U.S. Department of Health and Human Services, 2004; http://www.cms.hhs.gov/PromisingPractices/Downloads/commonfactors.pdf
Gage, B., Khatutsky,G., Osber, D., Moore, A., Wiener, J., 2004. Redesigning Long-Term Care Systems Through Integrated Information Systems. Waltham, MA, RTI International: 44.
LAO, Cal Facts, 2004; http://www.lao.ca.gov/2004/cal_facts/2004_calfacts_econ.htm.
LAO, Health & Social Services, 2006-07 Analysis; http://www.lao.ca.gov/PubDetails.aspx?id=1420
Long, 2001. Cost Effectiveness of Case Management Programs for the Elderly. Geriatric Times May/June 2001 Vol. II Issue 3
Lutzky, S., The Lewin Group: Aging and Disability Resource Center: Business Plan Template 2004. http://www.hcbs.org/moreInfo.php/nb/doc/984
Parrish, M., Western Blue Corp. (2005). Aging and Long-Term Care Integrated Information Systems: A Summary Report for California; California Department of Health and Human Services: 10-16.
Shugarman, L. R., Wilber, K.H., Meiners, M.R. (2005). Building Integrated Information Systems for Chronic Care: The California Experience, California Health Care Foundation; California Department of Health and Human Services Office of Long Term Care: 13.
USC/UCLA Center for Long-Term Care Integration, Policy Issue Brief: Medi-Cal LTC: Shift from Nursing Home to HCBS. 2003.