Growth and Prevalence of Participant Direction: Findings from the - - PowerPoint PPT Presentation

Growth and Prevalence of Participant Direction: Findings from the National Survey of Publically Funded Participant-Directed Services Programs

Mark Sciegaj PhD Mark Sciegaj, PhD Associate Professor of Health Policy and Administration Pennsylvania State University Pe sy va a State U ve s ty

Overview

 NRCPDS database project

Ch i f d l li l d l i

 Changes in federal policy, law, and regulations

 Impact of these changes on Participant-Directed (PD)

Long Term Services and Supports (LTSS) program Long-Term Services and Supports (LTSS) program growth

 State of PD LTSS in 2010-11  State of PD LTSS in 2010 11

 Program characteristics  Funding mechanisms  Funding mechanisms  PD Models

 The future is now  The future is now

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Creating a National Data Base of Publically Funded Participant-Directed Services Programs Funded Participant Directed Services Programs

Data Fields  Program Characteristics  Year Start  Population Served  Funding Mechanism  Program Size  Program Costs  Medicaid State Plan  Medicaid Waiver  Financial Management Services  State Revenue Only  Other  Model of FMS  Cost of FMS  Availability  Model /  Cost of FMS  Selection Process  State-Wide or PSA(s)  Employer/Budget Authority  Services/Supports  Level of Participant Involvement  Information and Assistance  Worker Registries  Representatives  Involvement procedures and intensity

3

p p y

Watershed Moment: Cash & Counseling Demonstration and Evaluation

10 Years of Changes in Federal Law, Regulation, and Policy

2001 New Freedom Initiative 2005 Deficit Reduction Act 2010 Affordable Care Act 2010 Affordable Care Act 2006 Reauthorization of Older Americans Act 2007 Aging and Disability Resource Center Program 2007 Aging and Disability Resource Center Program 2010 Affordable Care Act 2008 Veterans-Directed Home and Community -Based Services Program

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The 2000s: Decade of Significant Growth

2000

New Program Growth

100 120 2003 2002 2001 2000 80 2005 2004 2003 PD LTSS 60 PD LTSS P 2008 2007 2006 20 40 Programs 5 10 15 2010 2009 1970s 1980s 1990s 2000s

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5 10 15 1970s 1980s 1990s 2000s

Majority of States have more than one PD LTSS Program

WA AK OR MT ND MN NY

NH VT ME

OR NV ID WY NE SD IA IL WI MI IN PA NY

NJ RI MA

OH

CT

Hawaii CA AZ CO NM OK KS MO AR TN KY IL

WV

SC NC VA

DC MD DE

States with 1-2 PD Programs

NM TX LA MS AL GA FL

States with 3-5 PD Programs States with 6-10 PD Programs States with 10+ PD Programs States with 10+ PD Programs

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Program Populations (n=154)

 Elders

 20% (n=30)

( )

 Adults with physical disability

 11% (n=17)

 Elders and adults with physical disability  Elders and adults with physical disability

 35% (n=54)

 Adults with ID, MH, HIV/AIDS, etc

 13% (n=20)

 Children

 9% (n=14)

( )

 All ages

 12% (n=19)

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Program Size (n=233)

 Total enrollment: Approximately 747,000

C lif i t f 65% f ll t

 California accounts for 65% of enrollments

 Average program size (n=232) approximately 1100

r ll t enrollments

 Majority (53%) of programs have 500 or fewer

participant participant

 Approximate program costs (2010-11): 7.7 Billion

dollars dollars

 California accounts for 56%

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Majority of States have 1000 – 5000 PD LTSS Participants

WA AK OR MT ND MN NY

NH VT ME

OR NV ID WY NE SD IA IL WI MI IN PA NY

NJ RI MA

OH

CT

Hawaii CA AZ CO NM OK KS MO AR TN KY IL

WV

SC NC VA

DC MD DE

States with less than 1 000 PD participants

NM TX LA MS AL GA FL

States with less than 1,000 PD participants States with 1,000 but less than 5, 000 PD participants States with 5,000 but less than 10, 000 PD participants States with more than 10, 000 PD participants

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PD-LTSS Funding Sources

 Medicaid is the major funding source (n=237)

 77% Medicaid Waiver/State Plan  11% State Revenues  7% VA  3% Other (Tobacco funds, gaming revenue)

 CMS recognizes two basic models of PD-LTSS

 Employer Authority  Budget Authority

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States with Employer Authority Programs

WA AK

ME

Hawaii OR ID MT WY SD ND MN IA WI MI PA NY

RI MA NH VT CT

CA NV CO KS NE IA MO KY IL IN

WV

NC VA PA

DC MD DE NJ

OH AZ NM TX OK AR LA MS TN AL GA SC TX FL

Employer Authority

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Employer Authority Characteristics

 Employer of Record (n=177)

 Participant 72% (n=126)  Participant 72% (n=126)  Agency 28% (n=51)

 Who sets rate of pay (n=185)  Who sets rate of pay (n=185)

 Participant 47% (n=87)  Program 39% (n=72)  Program 39% (n=72)  Other 14% (n=26)

 Designated pay range

Designated pay range

 General assembly or other entity

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Employer Authority Characteristics

 Are there restrictions on who the participant may

hire? (n=182): hire? (n 182):

 90% (n=165): Yes

 Spouse

p

 Legal guardian  Pass criminal background check

 Criminal background check required (n=185):

 84% (n=155): Yes

 Does the state have a worker registry? (n=159):

 20% (n=33): Yes; 77% (n=122): No

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States with Budget Authority Programs

WA AK MT ND MN

NH VT ME

Hawaii OR NV ID WY NE SD IA WI MI IN PA NY

NJ RI MA NH

OH

CT

CA NV AZ CO OK KS MO AR TN KY IL

WV

SC NC VA

DC MD DE

NM TX LA MS AL GA FL

15 Cash & Counseling States 19 Additional States with Budget Authority Programs

FL

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Budget Authority Characteristics (N=77)

 The size of the budget is determined by a

professional needs assessment and a formula p that converts the assessment into a monthly budget allocation g

 Varied

 Purchasing restrictions

g

 Cannot exceed approved budget  Categorical restrictions

g

 Can carry forward funds into new fiscal year

 82% (n=62): No  82% (n 62): No

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States with VD-HCBS Programs

WA AK OR MT ND MN NY

NH VT ME

Hawaii NV ID WY NE SD IA IL WI MI IN

WV

VA PA

DE NJ RI MA

OH

CT

CA AZ CO NM OK KS MO AR TN KY

WV

AL GA SC NC VA

DC MD DE

TX LA MS AL GA FL

States currently enrolling Veterans (1/19/11) States developing Provider Agreements States in the early stages of VD HCBS development States in the early stages of VD-HCBS development

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Components of VD-HCBS

 Individual Budget

g

 Person-Centered Planning  Spending Plan including Goods and Services  Spending Plan including Goods and Services  Systems of support:

V Di d l

 Veteran-Directed counselor  Financial Management Services (FMS)

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Individual Budget

 Several methods to determine amount  For VD-HCBS VACO provides range  For VD HCBS, VACO provides range

 VAMC/Aging Network Agency work out method to

determine individual amount

 AN recommends  VAMC recommends  Established case mix tiers

 Exceptions to range approved by VACO

I l b d h ld i h

 In general budget amount should approximate what

would be authorized for needed services by an n agency

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Level of Participant Involvement (n=160)

 Participant involvement in program design  Participant involvement in program design,

implementation, and evaluation

 86% (n=139): Yes  86% (n 139): Yes

 86% (n=120): Persons with disability  67% (n=93): Persons with Intellectual Disability  65% (n=90): Persons with brain injury  79% (n=110): Elders  90% (n=125): Caregivers  90% (n=125): Caregivers

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Methods for Participant Involvement (n=139)

 Individual Interview: 61% (n=85)  Individual Interview: 61% (n 85)  Surveys: 73% (n=101)  F

Gr p 56% (n=72)

 Focus Groups: 56% (n=72)  Advisory Board: 78% (n=108)

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Summary

 By the end of 2011 there are over 240 PD-LTSS

programs

 Majority being developed and implemented since 2000  Every state has one employer authority program offering the

participant the opportunity to select and hire their own participant the opportunity to select and hire their own worker

 43 states also have at least one program where the participant

h l h i i b d has control over their service budget

 NRCPDS will continue to collect program information

and to analyze this information to learn about and to analyze this information to learn about differences in PD program structure, financing, and

• perations across the states.

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The Future is Now

 Participant Direction is increasingly becoming a

standard program offering to individuals in publically standard program offering to individuals in publically funded long-term services and support programs

 Patient Protection and Affordable Care Act  Patient Protection and Affordable Care Act

 2401: Community First Choice Option  2402a: Common Framework Supporting PD

w pp g

 2403: Money follows the person  2405: ADRC expansion

p

 Title VIII: CLASS ACT

 AoA LTSS workforce development initiative

p

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