4/16/2007
6-15-07
State Medi-Cal Director Endorsement:
Stan Rosenstein
Format: Name, Organizational Affiliation, Organization Type
Laura Williams, Californians for Disability Rights, Inc., Advocacy
Teddi-Joy Remhild, Personal Assistance Services Council of LA County, In-Home Support Services
Joan B. Lee, Gray Panthers, Aging
Wesley Mukoyama, Yu-Ai Kai/Japanese American Community Senior Services, Community-Based Advocate Organization
Vicki Farrell, Association of California Caregiver Resource Centers, Caregiver Association
Eldon Luce, Placer County In-Home Supportive Services Public Authority , Paid Caregiver
Format: Name, Organizational Affiliation, Organization Type
Barbara Biglieri, California Association for Health Services at Home, Home Health
Mivic Hirose, California Hospital Association, Hospital Association
Deborah Doctor, Protection & Advocacy, Inc, Disability Advocate
Evalyn Greb, San Diego County Aging and Independence Services, Area Agency on Aging/ADRC
Kimberly Martinson, Transportation Management Association of San Francisco, Transportation
Sharon Turner, Sierra Nevada Home Care, Home Health
June Simmons, Partners in Care Foundation, Community-Based Health Organization
Allison Ruff, Assembly Committee on Aging and Long-Term Care, Legislative Staff
Robert Petty, Alliance on Aging, Information and Assistance
Format: Name, Role and Grant Activity/Affiliation
State Contacts
Karol Swartzlander, Project Director: provides project management and oversight; leads strategic planning process; coordinates activities across state departments; facilitates state processes; communication-liaison with CMS/ California Health and Human Services Agency
Eileen Kostanecki, Assistant Secretary (acting for Sarah Steenhausen, Asst. Secretary for LTC), Project Supervisor: provides project oversight and technical assistance/ California Health and Human Services Agency
Linda Blong, CIHS Director of Projects and Subcontractor Lead: supervises all contract activities: budget and reporting; development and implementation of strategic planning; contracted services for research; staff supervision; and project planning/ Sonoma State University
Megan Juring, Technical Assistant: provides technical assistance throughout development and implementation/ Sonoma State University
Kimberly Carey, Administrative Analyst: coordinates all meeting and travel logistics, reimbursement procedures, and invoices; tracks contracts and maintains records and correspondence/ Sonoma State University
Eric Glunt, Research Evaluator: lead project evaluator – develops evaluation plan; works closely with project team/ Sonoma State University
CIHS Contractors
Tony Sauer, Senior Policy Analyst: coordinates stakeholder and public outreach efforts; assists with development and implementation of project grant; provides policy consultation on long term-care and disability issues/ Consultant
Monique Parrish, Strategic Planning and Long-Term Care Policy Specialist: facilitates strategic planning process; conducts policy analysis; develops and writes reports/Consultant
Format: Name and Title, Department
Kathleen J. Billingsley, R.N., Deputy Director, Licensing and Certification Program/ Health Services (Public Health)
Lora Connolly, Deputy Director, Aging
Jim Knight, Assistant Chief, Federal Programs, Developmental Services
Ben Harville, Chief, Independent Living Section, Rehabilitation
Mark Helmar, Chief, Office of Long Term Care, Health Services (Health Care Services)
Eva Lopez, Deputy Director, Adult Services Division, Social Services
Dave Neilsen, Chief, Community Services and Supports Policy Section, Mental Health
Doug Robins, Chief, Home and Community-Based Services Branch, Health Services (Health Care Services)
California Community Choices Strategic Plan, represents a dynamic and “living” document reflective of and responsive to California consumers with long-term support needs. Feedback from the public, stakeholders, state departments, and subcommittees of the California Community Choices Advisory Committee will inform the ongoing strategic plan review process. Members of the California Community Choices Advisory Committee will evaluate project feedback and progress toward achieving identified goals and objectives quarterly. The Committee will recommend updates and revisions to the Strategic Plan accordingly; changes to the plan will be made available to the public on the project website.
Exhibit 2 is a graphic illustration of how the key participants in the Community Choices project strategic planning process relate to each other. Please note the following page lists the legend for all exhibits in the Strategic Plan.
The core of the graph is each goal area addressed by the Community Choices project. Goal 1 – Improved access to long-term care supports, Goal 4 – Transformation of IT, and Goal 5 – Funding Reform of Reform of long-term care support system. Under each goal is a list of organizations represented on each respective subcommittee. Goal 1 - Access Subcommittee members represent the following organizations: ADRC; CA Hospital Assoc.; Caregiver Resource Centers; Gray Panthers; Sierra Nevada. Goal 4 - IT Subcommittee members represent the following organizations: Japanese-American Community Senior Services; Personal Assistance Services Council; Californians for Disability Rights, Inc., Alliance on Aging; Transportation Management Association of San Francisco. Goal 5 – Finance Subcommittee members represent the following organizations: Protection and Advocacy, Inc.; CA Association for Health Services at Home; IHSS Public Authority; Partners in Care Foundation; Assembly Committee on Aging/LTC.
Arrows from each goal area link upward to the Community Choices Advisory Committee. The Advisory Committee links upward to the Community Choices Project Team to illustrate the subcommittee and overall Committee helped revise the strategies, outputs and outcomes of the project. The graph also shows that the public provided input in each of the goal areas (and thus input to the Advisory Committee) and that technical consultants provided input on Goal 5. The graph links the State Department Advisory Group to the Project team and the three goals areas to indicate the State Department Advisory Group provided input on each goal and advice to the project team. A box with the Medicaid Infrastructure Grant in linked to the Project Team to show that grant staff provided technical assistance to the project team during strategic planning. Finally, the project team is linked to the Health and Human Services Agency to show that information and input was shared back and forth between agency and the project. Agency links upward to the Governor.
The following is a list of titles/phrases/etc. with corresponding acronyms that are used in the strategic planning document.
Title / (Acronym):
California Health and Human Services Agency (CHHS)
California Community Choices Project (CCC)
California Community Choices Project Team (CCC PT)
California Community Choices Advisory Committee (CCC AC)
California Department of Aging (CDA)
California Department of Mental Health (DMH)
California Department of Rehabilitation (DOR)
California Department of Developmental Services (DDS)
California Department of Social Services (DSS)
California Department of Health Services (DHS)
California Department of Public Health (DPH)
Department of Health Care Services (DHCS)
Long-Term Care (LTC)
California Department of Finance (DOF)
California State Independent Living Council (SILC)
Home and Community-Based Services (HCBS)
Community Link Resource Centers (CLRCs)
Aging and Disability Resource Centers (ADRCs)
Goal #1: Improved Access to Long-Term Support Services: Development of One-Stop System (Goal 1)
Goal #4: Transformation of Information Technology to Support Systems Change (Goal 4)
Goal #5: Creation of a System That More Effectively Manages the Funding For Long-Term Supports That Promote Community Living Options (Goal 5)
Subcommittee (of the Advisory Committee) for Goal # 1 (Access Subcommittee)
Subcommittee (of the Advisory Committee) for Goal # 4 (IT Subcommittee)
Subcommittee (of the Advisory Committee) for Goal # 5 (Finance Subcommittee)
In-Home Support Services (IHSS)
Home Health (H/H)
Community-Based Organizations (CBOs)
Medication Infrastructure Grant – CA Health Incentives Information Project (MIG)
University of Southern California (USC)
University of California, San Francisco (UCSF)
Supplemental Security Income (SSI)
State Supplementary Payment Program (SSP)
Money Follows the Person Grants (MFP)
Information & Referral (I & R)
Mobility Action Plan Implementation Project (MAP)
Area Agency on Aging (AAA)
Independent Living Center (ILC)
Administration on Aging (AoA)
Long-Term Care: represents a continuum of supports and services which could include but are not limited to personal services, rehabilitation therapies, home health care, and acute care. These services can be delivered in a variety of settings such as inpatient (rehabilitation facility, nursing home, mental hospital) or outpatient basis, or at home, depending on the recipient's needs and preferences, the availability of informal support, and the source of reimbursement.
Critical Pathways: refers to the referral and triage channels between health and long-term care facilities and the home and community-based network system to promote comprehensive health and social service supports on behalf of individuals at-risk for institutionalization.
At-Risk Populations: in the context of the aging and LTC field, generally refers to individuals with unmet long-term care needs and/or barriers to access, who are vulnerable to unnecessary institutionalization.
Home and Community-Based Services (HCBS): generally refers to programs, services, and providers/vendors in the community. A more refined definition for the purpose of this project will be developed during the project’s implementation period.
In-Home Support Services (IHSS): provides personal care and domestic services to aged, blind, and disabled individuals in their own homes. The purpose of the program is to allow these individuals to live safely at home rather than in costly and less desirable out-of-home placement facilities. IHSS is a consumer-directed entitlement program, with specific eligibility criteria.
Olmstead Decision: the 1999 U.S. Supreme Court Olmstead Decision affirmed the right of individuals with disabilities to receive public benefits and services in the most integrated setting appropriate to their needs.
Medi-Cal: the Medicaid program in California
The Coleman Care Transitions Intervention Model: references a consumer empowerment model designed to stimulate change in practice and care delivery systems to improve transitions from one care setting to another – the term “Care Transitions” refers to the movement consumers make between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness.
The California Health and Human Services Agency (CHHS) is the lead state agency facilitating the California Community Choices grant. As the state’s umbrella agency for health and human services, CHHS has oversight responsibility for 11 state departments, and one state board. CHHS is dedicated to promoting access to essential health and human services for California’s most disadvantaged and at-risk residents through its administration of a wide variety of critical projects and initiatives, including the Community Choices project. Project Director, Karol Swartzlander, is responsible for managing the grant with the project’s Advisory Committee (California Community Choices Advisory Committee) and project partners.
The California Community Choices Advisory Committee was formed through a public application process. Members were selected based on their background, expertise, and ability to substantively contribute to the oversight of the project during the grant period. A diverse group of participants represents the current Advisory Committee. The committee includes a combination of both consumer and non-consumer stakeholders representing the following types of organizations: consumer advocacy groups; disability advocacy organizations; community-based health organizations; community-based organizations; aging advocates; and caregiver advocacy and service support groups. From the Advisory Committee, subcommittees for each of the three goal areas were formed. Subcommittees meet to review specific objectives, strategies, outputs and outcomes for each respective goal area and report back to the larger Advisory Committee. Subcommittee members played a fundamental role in revising proposed strategies to achieve specific objectives. A parallel State Department Advisory Group was also created to provide additional project support and guidance. Representatives from the following state departments serve on this group: Mental Health, Public Health, Health Care Services, Social Services, Aging, Developmental Disabilities, and Rehabilitation. During project implementation, representatives from housing and transportation departments will be invited to participate on the State Department Advisory Group.
Advisory Committee members have participated in the strategic planning process through a series of strategic planning public meetings and subcommittee meetings. These key participants actively interacted with project staff, and each other, throughout the strategic planning process. All of the input processes were characterized by open discussion and debate, with majority opinion as the ultimate arbiter of disagreement. Information about the project was disseminated via e-mail, phone contacts, conference calls, and state department presentations. The public contributed their feedback to the formation of the strategic plan through these mechanisms as well as through a series of scheduled public meetings and the project website, which solicited input through two online surveys. As part of a feedback loop, the public was informed about developments to the strategic plan, including changes made based on findings from the California Community Choices: Public Input Survey Findings Strategic Planning Phase, via the project website.
Exhibit 3 is a graphic illustration (flowchart) summarizing the relationship between project inputs, goals, strategies and processes, outputs, and short, medium and long-term outcomes of the Community Choices project. All information in Logic Model is derived from Exhibits 7 and 9.
The flowchart begins with a list of all project inputs (column one): Project Staff, Project Partners, California Community Choices Advisory Committee, ADRCs, State Department Advisory Group, Olmstead Advisory Committee, Advocacy Organizations, Partner Agencies, Special Consultants, I.T. Steering Committee. These project inputs are linked to all goal areas.
The second column lists the three project goals; the third column lists a summary of strategies and process that will be implemented to achieve each goal; the fourth column lists outputs for the strategies of each goal area; the fifth column lists the short-term (consumer) outcomes by goal; the sixth column lists the medium (provider) outcomes by goal, and the seventh column lists the long-term (systems) outcomes.
Below is the information provided in each column by specific goal.
Goal 1: Improved access to long-term support services: development of one stop system
Strategies/Processes for Goal 1
Outputs for Goal 1
Short-term (Consumer) Outcomes for Goal 1
Medium-term (Provider Outcomes for Goal 1
Long-term (System) Outcomes for Goal 1
Goal 4. Transformation of information technology to support systems change
Strategies/Processes for Goal 4
Outputs for Goal 4
Short-term (Consumer) Outcomes for Goal 4
Medium-term (Provider Outcomes for Goal 4
Long-term (System) Outcomes for Goal 4
Goal 5. Creation of a system that more effectively manages the funding for long-term supports that promote community living options
Strategies/Processes for Goal 5
Outputs for Goal 5
A completed comprehensive study and analysis of funding management reforms, with recommendations, that will help increase use of HCBS and encourage rebalancing of the long
Short-term (Consumer) Outcomes for Goal 5
Medium-term (Provider Outcomes for Goal 5
Long-term (System) Outcomes for Goal 5
The following mission and vision statements were developed by the California Community Choices Advisory Committee, January 23, 2007.
We are a statewide partnership committed to developing an infrastructure that will increase access to, capacity of, and funding for home and community-based services to provide all Californians with greater choice in how and where they receive long-term care services, in accordance with the Olmstead Principles.*
*The 1999 U.S. Supreme Court Olmstead Decision affirmed the right of individuals with disabilities to receive public benefits and services in the most integrated setting appropriate to their needs.
California will have strategies and recommendations for its long-term care system, featuring replicable and sustainable models that empower individuals through enhanced opportunities for choice and independence.
Exhibit 5 updates the Systems Readiness Information provided in the original grant application.
Format: Category, Current Status (for each specific item), Citation for Information Supporting Assessment
Category: Political and State Agency Leadership
CHHS – Statewide implementation of California Community Choices will begin 7/1/07 and will be completed by 9/30/11.
Money Follows the Person (MFP) Demonstration Project – awarded to California, January 2007, to provide approximately 2000 persons residing in health care institutions (including seniors and persons with disabilities of all ages) the opportunity to return to the community. The project period is January 1, 2007 through December 31, 2011. The MFP project will develop infrastructure and resources necessary to facilitate a viable transition process. A significant component of infrastructure development includes the establishment of local Community Transition Teams, whose effectiveness and long-term viability will be evaluated during the project period. Where physically possible, depending on geographic location, the MFP project will coordinate with ADRCs /CLRCs to establish a linkage that will facilitate ADRC/CLRC referrals to appropriate MFP Community Transition Teams. The MFP project will also identify and address a number of barriers older adults and persons with disabilities encounter living in the community. These barriers, such as limited access to services and supports as well as inadequate, or nonexistent, services and supports that promote community living options, are of interest to the California Community Choices project. Community Choices is dedicated to assisting older adults and persons with disability live in the most integrated setting possible in the community. As a result, Community Choices will closely follow both MFP findings and developments in this area. The second component of the MFP project will entail working with state partners and other stakeholders to identify and address barriers to long-term care systems rebalancing. This component will rely on the LTC Financing study that will be conducted as part of the Community Choices project. Citation for Information Supporting Assessment: Money Follows the Person Rebalancing Demonstration Project (MFP) – California Department of Health Services
The Governor’s Proposed Budget 2007-2008 proposes the following:
SB 162 establishes a Department of Public Health (DPH) within the existing California Health and Human Services Agency and provides statutory authority to transfer responsibilities from the California Department of Health Services (CDHS) to the new DPH, effective July 1, 2007. CDHS will be renamed the Department of Health Care Services (DHCS).
Category: Stakeholder Support / Mediation
Advisory Committees: Members of the California Community Choices Advisory Committee provide input and guidance to the development and implementation of the project. The committee’s first meeting, addressing the Strategic Plan, was held on January 23, 2007. A second meeting to finalize the draft Strategic Plan was held on April 11, 2007. Citation for Information Supporting Assessment: Public meeting attendee list
Subcommittee meetings addressing three goals: Goal 1 (Improved access to LTC support services), Goal 4 (Transformation of Information Technology), and Goal 5 (System that effectively manages funding for LTC supports and promotes community living options) met throughout the strategic planning process and will continue to meet to provide further development and monitor related project activities during project implementation. Citation for Information Supporting Assessment: Schedule of Project sub-committee meetings
Forums/Focus Groups/Surveys – a combination of public input sessions, targeted organization/state department presentations, key informant interviews with state department representatives, and online surveys were conducted during the strategic planning process to gather stakeholder feedback on the Community Choices project priorities. Several ongoing themes emerged from the California Community Choices Survey findings: (1) accessibility; (2) diverse and effective information dissemination; (3) comprehensive assistance and service delivery; and (4) Medi-Cal flexibility with increased options for financing home and community-based services.
Citation for Information Supporting Assessment: See Appendix A “California Community Choices: Public Input Survey Findings Strategic Planning Phase”
Post-White House Conference on Aging for California held November 29-30. Attendees identified action objectives for the following issues: Disease Management, Rural Healthcare Access, Transitional Care, Health Promotion; Cultural Diversity, Intergenerational Activities, Mobility; Housing; Access to Employment Opportunities, Workforce Capacity, and Direct Care Workers. Forum attendees identified the housing and mobility objectives as most urgent and recognized cultural diversity as an essential element of all the priority objectives. Citation for Information Supporting Assessment: Post-White House Conference on Aging report (2/07)
Category - Progress with System Reform
Olmstead Advisory Committee – The Committee is responsible for the following: providing input to CHHS regarding its efforts to implement the California Olmstead Plan; recommending actions to improve California's long-term care system; and, creating opportunities to fund expanded or new activities to support individuals with disabilities in their community. Members of the committee continue to actively participate in systems reform on behalf of promoting home and community based long-term support services and options. On March 23, 2007, the committee held a LTC/Olmstead Education Briefing to educate legislative staff on California’s long-term care system, the Olmstead decision, changing dynamics, and critical issues to address related to choice and independence for persons with disabilities.
The first Olmstead Stakeholder Meeting to address LTC Rebalancing will be held in summer 2007. The meeting will initiate discussion between state departments, policy makers, and stakeholders to establish what LTC Rebalancing means to CA and where the state should be with respect to this issue. It will also provide an opportunity for committee members to identify potential short-term rebalancing goals focused on achievable, measurable results. The State is committed to reviewing this work as well as recommendations from the Community Choices LTC Financing study. Citation for Information Supporting Assessment: none listed.
Nursing Facility/Acute Hospital Waiver program (NF Waiver Program) stakeholder meeting (first) to address reform of the Department of Health Services will begin processing Waiver Personal Care Services timesheets twice a month, effective March 2007 and is currently researching waiver-related options, based on the stakeholder feedback.
Two Aging and Disability Resource Centers (ADRCs), established by the California Department of Aging (CDA), are in operation in California, in San Diego and Del Norte counties. Both act as “coordinated points of entry” for providing information and enabling consumers, caregivers and providers to make informed choices about long-term support services. Recently, CDA enhanced the ADRC model in San Diego to serve persons with disabilities of all ages – not just seniors- through a newly defined partnership between the San Diego Area Agency on Aging (AAA) and the local Independent Living Center (ILC). Due to the success of this collaborative model, CDA is planning to submit a proposal to the Administration on Aging (AoA) (June 2007) to establish two new ADRCs. The new ADRCs will continue to build on and create additional linkages between the AAA and ILC network to: (1) provide consumer information and assistance; (2) assist the public in navigating the long-term service support system; and (3) advocate for expanded resources and systems change. If funded, the new AoA grant, along with the Community Choices project, will enable California to realize six ADRC/CLRC pilot sites over the next few years. The six centers will be dedicated to providing information, referrals and assistance for all Californians navigating the long-term care system. Equally important, the centers will increase access to home and community-based services. To integrate the efforts of the ADRCs and CLRCs, an ADRC/CLRC Coalition, part of the Community Choices project, will be developed to enhance synergy among and between the centers. The primary purposes of the Coalition include the following: exchanging information on lessons-learned and best practices; identifying a standard screening tool and procedures for client intake and assessment; and creating a set of common data elements to be used across ADRCs/CLRCs. Lessons-learned from the unique practices of the CLRCs, such as targeting individuals at risk of institutionalization and use of the Eric Coleman Care Transitions Intervention Model, may provide a foundation for beta testing and replication in the ADRCs. As such, the Community Choices project will work closely with CDA to ensure these grant efforts result in a more coordinated system of care that effectively assists consumers to remain in or return to the most integrated living environment possible. Citation for Information Supporting Assessment: Nursing Facility/Acute Hospital Waiver program (NF Waiver Program) Stakeholder Meeting
Mobility Action Plan Implementation Project: The Department of Transportation has initiated the Mobility Action Plan Implementation Project and has invited participation of a wide range of representatives from agencies administering human service transportation programs and consumer advocacy organizations to participate in an advisory capacity. The goal of the project is to coordinate human services transportation programs to simplify access, reduce duplication, and enhance cost efficiencies. The first advisory committee meeting will be held in April 2007. The project period will run through April 2008. CHSSA Assistant Secretary Eileen Kostanecki will act as co-chair of the MAP Advisory Committee. Choices Advisory Committee members, Kimberly Martinson and Teddie-Joy Remhild, will participate on the MAP Advisory Committee, ensuring a bidirectional flow of information between the MAP and Choices Advisory Committees. Citation for Information Supporting Assessment: none listed.
The Community Options and Assessment Protocol (COAP), proposed by Assembly Bill (AB) 3019 (Daucher, 2006) would have authorized CHHS to work with specified state departments, a technical contractor and interested stakeholders to develop a protocol whereby multiple home and community-based programs can share core consumer data and make cross-referrals in order to improve consumer access to critical services. AB 3019 was not approved by the Legislature. Citation for Information Supporting Assessment: none listed.
AB 2979 (Richman, 2006) would have authorized implementation of two types of Medi-Cal managed care plans: Medicare HMO Wraparound and Integration Plus Community Choices. Both plans would have coordinated Medi-Cal and Medicare benefits to improve the continuity of acute care, primary care and long-term care and to simplify health care access for consumers. AB 2979 was not approved by the Legislature. Citation for Information Supporting Assessment: none listed.
Continue to second half of Final Strategic Plan CORE ELEMENTS