Exhibit 8:  Implementation Chart

Exhibit 8 is a graphic illustration of the relationship between the all entities involved in the implementation of the Community Choices project by goal areas (1, 4 and 5) with the Project Team serving as the core entity responsible for implementation for each goal.  The illustration demonstrates the following:

Goal 5 – the LTC Financing Study will be implemented by a contractor.  Technical consultants and the LTC Finance Subcommittee will provide input on further development and implementation of the proposed study.

Goal 1 – the CLRCs will be implemented by selected community-based organizations and technical consultants.  ADRCs and the CLRC (Access) subcommittee will provide input on further development and implementation of the CLRCs.

Goal 4 – the CalCareNET Pilots and Data Storage Warehouse Study will be implemented by an IT vendor and data researcher, respectively.  The IT subcommittee and an IT steering committee will provide input on further development and implementation of the pilots and data storage warehouse study.

The State Department Advisory Group and Community Choices Advisory Committee serves in an advisory capacity to the Project Team during implementation.

The Olmstead Committee serves in an advisory capacity to the California Health and Human service Agency (CHHS).

Information dissemination will take place between the following: 

• The project team and CHHS
• CHHS and the Governor’s Office
• CHHS and the Legislature/Legislative Analyst Office
• CHHS and the Department of Finance

Information will be disseminated (shared back and forth) between the following:

• The Choices Advisory Committee and the Olmstead Advisory Committee
• The Project Team and the Olmstead Advisory Committee

Information from the following related projects will be disseminated to the Project Team, CHHS and the Olmstead Advisory Committee:  the Money Follows the Person Demonstration, the Medicaid Infrastructure Grant, the (SILC) Analysis of the State Medicaid Plan, the Mobility Action Plan Implementation Project, Choices for Independence Grant and AoA ADRC Grant. 

Exhibit 9: Implementation Plan

The Implementation Plan lists all proposed strategies/major action steps and outputs by goal and objective.

Goal 1:  Improved Access to long-term support services: development of one-stop system

Objective 1.1 California will provide awareness, information, and assistance in accessing HCBS.

Strategies/Major Action Steps for Objective 1.1
Build upon the ADRC model to improve capacity for information and referral (this primary strategy complements ADRC and CHIIP efforts):

• Convene current ADRCs, state-level staff, and Access Subcommittee to identify lessons-learned and best practices for information and referral and to explore the possibility of testing and/or piloting CalCareNet at ADRCs.

Develop an RFP to conduct a solicitation process to select community-based organization(s) to operate two new one-stops/CLRCs to reach more Californians needing long-term care information, planning and services:

Minimum RFP criteria to include proposed organizational structure and service delivery model (staff; program services – screening, assessment, counseling, eligibility determination, short-term case management, referrals - including housing and transportation, and assistance; target population), and business plan (budget, timeline); demonstrated existence of existing local Web-based long-term care information database; a letter of support from the local long-term care web-based network; major urban/suburban area; entity can broadly address consumer needs inclusive of California’s diverse ethnic, cultural, language, and identity groups; evidence of commitment to working with CalCareNet in order to inform design, populate database, and test programming and user interface; and letters of support from identified key partner agencies.

Host two bidder conferences: one in northern Calif.; one in southern Calif.

Select and implement CLRCs in two county/regions (expands the ADRC information, referral and assistance model)

Selected CLRC sites to finalize the following:

• Organizational structure and service delivery model
• Develop service implementation plan with viable timeline
• Develop outreach and marketing plan with outreach materials for new service system and structure
• ongoing outreach efforts should include diverse approaches, e.g., print media, radio/TV PSAs, pharmacies

Conduct presentations and other outreach to community-based, advocacy and health organizations to make consumers aware of availability of one-stops and CalCareNet:

• Pilot and field test CalCareNet at CLRC/ADRCs:
• Provide appropriate cross-program training on CalCareNet
• Revise CalCareNet in accordance with field test/pilot feedback from staff/consumers

Improve communication and collaboration among LTC providers:

• Establish local CLRC/ADRC Coalition/Advisory group (provides a critical forum for information exchange and current ADRC mentoring of CLRC sites)
• Establish community connections and collaboration
• Evaluate effectiveness of Community Kiosks established in San Diego’s ADRC (2007) for potential replication in CLRCs as appropriate.

Provide screening for early identification of needs and connection to services:

• Identify and/or create brief screening tool for CLRCs (work with ADRCs)
• Short-term case management with appropriate care plan, if needed
• Create a set of common data elements to be used across ADRC/CLRCs in collaboration with technical consultant.

Explore how opportunities for branding help advance systems’ accessibility

Outputs for Objective 1.1
Identification of lessons-learned and best practices from current ADRCs to inform RFP development
RFP developed
Solicitation process to identify CLRCs conducted.
Organizational structure, service delivery model, and business plan for each CLRC
Service implementation timeline
Two pilot county/regions selected
CLRC policies and procedures revised and/or developed
CLRC education and outreach plan and materials completed, approved, and implemented
#/ type of outreach/marketing activities
# of community partner meetings
CalCareNet implemented in CLRC/ADRCs
Ongoing evaluation and feedback from CLRCs/ADRCs on CalCareNet
# of established Memorandum of Agreements (MOAs) and/or partnerships between CLRCs and community partners, including advocacy organizations
Trained ADRC/CLRC staff on CalCareNet;
Field tested and pilot tested CalCareNet; revised the portal based upon feedback
Verified that prototype meets Section 508 and WC3 federal and industry web-accessible standards
Evidence of ADRC/CLRC coalition activities (# meetings, shared project information/ activities, discussion of opportunities for systems branding, etc.)
Evaluation of San Diego Community Kiosks and recommendations for CLRCs
Completed or identified screening tool
# consumers served (via website and counselor or by phone)
# consumers identified at risk via screening tool
Implementation of common data elements in screening tool

Objective 1.2     Streamline the Multiple Eligibility Processes

Strategies/Major Action Steps for Objective 1.2
Develop and implement screening procedures (work with ADRCs)

• Intake to include range of appropriate information needed (demographics, Medi-Cal/Medicare eligibility, income and assets, LTC needs, etc.)
• Triage to appropriate information, services and programs.

Provide short-term care management to guide client through eligibility process and  multi-level referrals using the comprehensive screening tool

Facilitate the individuals’ transition from one service provider to the next:

• Identify mechanisms for improving consumer access, eligibility, and referral processes.
• Establish referral protocols with key partners
• Identify key information that can be shared with partners to avoid unnecessary duplication.
• Use Eric Coleman’s Care Transitions Intervention Model to educate and empower consumers (potential for replication at ADRCs in the future)

Outputs for Objective 1.2
Completed comprehensive screening tool
Procedures to triage to appropriate resources based on information gathered in screening tool
# Referrals made to appropriate information, services and programs.
Service plan form (to identify set of referrals)
# Follow up/short-term care management contacts regarding service plan
# Consumers trained on Eric Coleman’s Care Transitions Intervention Model

Objective 1.3     Target Individuals who are at Imminent Risk for Institutionalization

Strategies/Major Action Steps for Objective 1.3
Develop and implement effective triage system targeting individuals at risk of institutionalization (potential for replication at ADRCs in the future):

• Conduct community assessment to identify “at-risk individuals at imminent risk of institutionalization”
• Create linkages to critical pathways; building local cross-program infrastructures (including comprehensive health and social services); increasing rapid responses for individuals at imminent risk of institutionalization (especially hospitals)
• Establish functional markers to identify at risk individuals
• Establish and link mechanisms between and among community partners (hospitals/SNFs/CBOs) to provide at-risk individuals community-based LTC options and support (e.g., meals, housing, etc)
• Monitor development of federal-level standardized hospital discharge assessment protocols

Outputs for Objective 1.3
Completed community assessment to identify critical pathways for targeting at risk individuals
Established triage system
# Community partners collaborating on improved triage system
# “Individuals at-risk” for institutionalization” served

Sustainability of Project Activities
The following action steps will support long-term sustainability of ADRC/CLRC activities in CA:

• Produce a final report, with collaboration from CDA and DOR, documenting the success and benefits of the ADRC/CLRC models in CA.  Outcomes from the following related initiatives will be incorporated into the report:
• Conduct a survey of Area Agencies on Aging, County Adult Services programs, IHSS public authorities, Independent Living Centers, etc. to assess potential of organizations to house future ADRC/CLRC sites
• Develop recommendations for expanding flexible and sustainable ADRC/CLRC model(s) that will position California to take advantage of funding opportunities
• Identification of potential avenues for continued funding of ADRC/CLRC expansion
• Educate stakeholders (including private foundations), department policy makers and legislative staff about the success and benefits of ADRC/CLRC models
• Establish a Sustainability Committee, including State Departments, Advisory Committee members and other stakeholders (beginning year 5) to support expansion/sustainability of ADRC/CLRCs and other project goals

Outputs
Final report documenting success and benefits of ADRC/CLRC models in CA – to include outcomes from related initiatives
Documented efforts to educate stakeholders and others regarding the success and benefits of ADRC/CLRC models
Established Sustainability Committee

 

 

Goal 4:    Transformation of Information Technology to Support Systems Change

Objective  4.1    Design Information Technology (IT) applications that will support program practices and processes that are consistent with participant-centered principles and enable consumers to direct their own services.

Strategies/Major Action Steps for Objective 4.1
Build on the CalCareNet Portal Enhancement Project to implement a piloted version of the site at the two Community Link Resource Centers (CLRCs); the piloted prototype, to be completed in a replicable template necessary for statewide expansion, will provide a comprehensive, easy-to-use, fully accessible, consistently updated Web-based aging and long-term care information and assistance system which provides consumers with an opportunity to direct their own services

Convene CalCareNet Portal Enhancement Project Steering & Advisory Committees, with representatives from the IT Subcommittee, to establish a baseline assessment of the CalCareNet Portal Enhancement project; review that project’s final report; and identify support or additional representation needed to evaluate the project’s status and calendaring for next steps

Establish new Steering and Advisory Committees for the California Community Choices CalCareNet pilot project (includes members of CCC IT subcommittee)

Develop an IT procurement plan for the development of CalCareNet pilots at two CLRCs.  Contractor must include the following information as it relates to methodology:

• Proposed approach for expanding existing prototype based on evaluation of CalCareNet Portal Enhancement Project;
• Proposed project management plan;
• Proposed risk management plan;
• Proposed economic analysis and project funding plan;
• Proposed statewide expansion plan with funding assessment;
• Proposed plan/schedule for maintenance (upkeep) of resources and database;
• Proposed quality assurance mechanisms to meet consumer quality needs (to include a feedback mechanism for all site components to assess relevance and quality)
• Proposed plan to make site fully accessible to all persons (consistent with Section 508 federal standards and WC3 industry standards), including architecture which provides alternate text for each information element, and a plan for addressing accessibility needs of persons without computers or who require other technologies to access the site;
• Proposed approach for monitoring, evaluating, and reporting project issues or concerns;
• Proposed plan to create a culturally competent site which supports diversity of all persons (includes language, ability, access, etc.); and
• Proposed plan to make the site secure (includes client information protection)
• Proposed statewide expansion plan with funding assessment in Year 4 of project (plan will be used by Sustainability Committee to explore public-private partnerships and availability of local government funding for CalCareNet expansion)

Conduct competitive solicitation process and award contract to successful vendor
Select vendor
Community Choices Project Director with project Steering and Advisory Committees to monitor contractor progress on all related project plans
Contractor to conduct user testing at the pilot sites to ascertain compliance with WC3 and 508
CLRCs and contractor to establish and train specialists (navigators) to provide in-person assistance to persons with disability seeking access to information on the CalCareNet site

Outputs for Objective 4.1
CalCareNet Portal Enhancement Project Steering and Advisory Committee recommendations (with CCC Information Technology (IT) subcommittee input) regarding expansion of CalCareNet
Newly established Steering committee for California Community Choices CalCareNet project
IT Procurement plan (signed off by the State) – includes management principles
Plan for CalCareNet expansion with funding assessment
Competitive process resulting in selected vendor
Vendor-produced plan for expanding existing prototype to two pilot sites
Implemented CalCareNet at two CLRCs
Trained ADRC/CLRC staff on Web-based applications
Field tested and pilot tested the enhanced CalCareNet with HCBS professionals and consumers and revised the portal based upon feedback and evaluation results; implemented procedures/processes to ensure site quality and consumer satisfaction
Verified that prototype meets Section 508 and WC3 federal and industry web-accessible standards
Conducted and documented formative evaluation of the objectives and IT transformation goal; based on evaluation, determine next steps for statewide implementation of CalCareNet template/architecture system

Objective 4.2     Improve client access to long-term services through the use of integrated IT

Strategies/Major Action Steps for Objective 4.2
Incorporate the various Web-based resources and data depositories already in existence in California:

• Connect State-level program databases
• Vendor to subcontract an experienced consultant in web accessibility to review final prototype for various forms of accessible technology

Outputs for Objective 4.2
Connected and integrated county, community-based, and regional resource databases (into CalCareNet) for two pilot sites
State-level databases incorporated and connected into CalCareNet prototype/template
Completion of all required project deliverables as specified in contract, e.g., completion of plan/schedule for IT system maintenance (updating); implementation of quality assurance mechanisms integrated into finalized CalCareNet system
Monthly (required) progress reports, regularly scheduled meetings with advisory groups, and final summary report; quarterly reports to the full advisory committee
Fully tested prototype for every ability

Objective 4.3   Use integrated IT systems to monitor the quality of services rendered

Strategies/Major Action Steps for Objective 4.3
Commission a modified study to identify barriers to LTC data integration at both the community and state levels and identify parameters for a definition of what a model data storage warehouse would entail for California:

• Identify scope of work associated with the study
• Review access to and availability of local and State information necessary for vendor to complete study
• Select specialist(s) to conduct study

Disseminate the study findings and recommendations to all interested parties

Outputs for Objective 4.3
Selected specialist
Completed study identifying local and state barriers to incorporation of data integration with a definition of what a model data storage warehouse would entail for California
Recommendations for model data storage warehouse
Recommendation for next steps including funding streams and opportunities for data integration

Goal 5:    Creation of a System That More Effectively Manages the Funding For Long-Term Supports That Promote Community Living Options

Objective 5.2     Develop and Implement More Flexible Payment Methodologies
 
Strategies/Major Action Steps for Objective 5.2
Commission a long-term care financing study to examine the laws, regulations, policies, practices and payment methodologies related to long-term care financing in California.  The study shall include recommendations (funding, payment methodology, policy, etc) focused on increasing consumer access to  and funding of  home and community-based services through rebalancing spending on long-term care services in California.  (The study will inform Olmstead Advisory Committee efforts in this area and the MFP Demonstration Project)

Establish a scope of work for the LTC Financing Study contractor.

Include baseline definitions for both institutional and home and community-based long-term care services in CA

Engage Finance Subcommittee, state departments and technical consultants in the refinement of study elements to be incorporated into the LTC Financing study design.  Preliminary study elements may include, but are not limited to:

• Preliminary literature review to identify existing resources, studies and analysis on long-term care in California.
• Examination of the basic structure of state and local administration of long-term care supports
• Demographic indicators for demand for long-term supports; utilization data to indicate the levels of services currently available; historical and political factors that influence systems change
• Identification of current long-term care services in California and funding streams for each long-term care service.
• A historical analysis of long-term care Medi-Cal expenditures in California, including:
• Total Medi-Cal long-term care spending on home and community-based services compared to institutional services.
• The rate of change for Medi-Cal long-term care spending compared to the national average.
• Medi-Cal long-term care per capita spending on home and community-based services and institutional services
• The rate of change for Medi-Cal long-term care spending compared to other states for both home and community-based and institutional services.
• The change in the number of institutional beds and the number of Medi-Cal waiver slots.
• An analysis of projected future long-term care needs, expenditures and trends in California.
• A comprehensive analysis of laws and regulations (or lack of laws and regulations) that impact consumer access to home and community-based services, including identification of structural barriers and recommendations to eliminate those barriers.   
• An analysis of fiscal incentives and disincentives that would encourage institutionalization and recommendations to remove any institutional bias in payment/reimbursement practices.
• A charting of the laws, regulations, policies for each LTC service by funding source.
• An examination of rates paid for HCBS and to providers/vendors across programs, including an analysis of the differences and (historical) rationale for establishment of various rates.
• Identify how current rate structure impacts access to home and community-based services.
• Examination of payment/fiscal constraints prescribed by control agencies.
• Identification of payment strategies that can more effectively manage funding and increase access to home and community-based services, including an examination of the potential to establish a standardized rate structure for HCBS across target populations and among providers (that would incorporate geographic cost of living adjustments):
• Analyze the cost of a standardized HCBS rate structure to both the state and federal government.
• Analyze the cost of expanding HCBS waiver and State Plan services (including both new and expansion of underutilized existing services) and any potential savings from preventing or reducing hospital or nursing home stays.
• Examine the potential for establishing the structural and financial mechanisms that would allow presumptive Medi-Cal eligibility and fast track assessment for individuals (at risk of institutionalization) to access HCBS.
• Examination of the potential for establishing global budgeting for all LTC services (institutional and HCBS).
• Analyze the potential benefits and opportunities for “downsizing funding”, e.g. Developmental Services.

 

Work with State departments to ensure access to data and information necessary to complete financing study.

Establish criteria for recruitment and selection of expert researcher to conduct financing study.

Select and contract with researcher to conduct LTC financing study.  

Initiate LTC Financing study activities.

Engage stakeholder involvement (including consumers, advocates, caregivers, families, long-term care services providers, long-term care labor workforce, state departments and policymakers) in the LTC Financing study.

Require researcher to provide bi-monthly progress reports to Advisory subcommittee; quarterly reports to the full Advisory committee.

Disseminate the long-term care financing study findings to all interested parties.  An important strategy for system-wide transformation in California is the completion of the study by January 2009.   This will enable current project staff and the Advisory Committee to promote reform efforts (with activities detailed below) before the end of the current Administration in December 2010.

Advisory Committee will adopt and ratify preferred recommendations and present them as a desired reform agenda to the Administration and Legislature.

Actively engage and dialogue with stakeholders, including the California Community Choices and Olmstead Advisory Committees, department policy makers and legislative staff in reform discussions.

Function as a resource for the State Legislature and stakeholders seeking to implement legal and regulatory reform and changes in policy and practice that would increase access to and use of HCBS.

Explore possibility of establishing a staff position beyond grant period to: (1) continue coordination of efforts across state departments; (2) facilitate incremental statewide expansion of ADRCs/CLRCs and the CalCareNet website; and (3) actively engage stakeholders, department policy makers, and legislative staff in finance reform discussions and goal formation.

 

Outputs for Objective 5.1

• LTC Financing Study Scope of Work defined
• Elements of LTC Financing Study defined (with input from Finance Subcommittee, state departments, and technical consultants)
• Evidence of access to State department authorization for Study Researcher
• Contract with researcher to conduct the study
• LTC Financing study design and timeline for completion finalized
• Recorded stakeholder involvement in LTC study, e.g., meetings, input, review of findings, etc.
• Bi-monthly study progress reports to the Advisory Committee
• A completed comprehensive study and analysis of funding management reforms that will help increase use of HCBS and encourage rebalancing of the long-term care system
• Recommendations on how to implement long-term care funding management reform
• Broad dissemination of study findings and recommendations

 

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