CHARTING THE COURSE FOR WAIVER INDEPENDENCE

1
CHARTING THE COURSE FOR WAIVER INDEPENDENCE

• Moving Cash and Counseling from the Traditional
  Waiver Program to the New State Plan Option

Alabama Department of Senior Services
2
Planning the Voyage

• During Olmstead Planning, focus groups indicated
  strong desire to have self-direction in Alabama
• Much discussion on how to accomplish
• Possibly combine with efforts of other grants in
  Alabama Real Choice, Medicaid Infrastructure,
  etc.
• Application made for Cash and Counseling
  Project/RWJ Grant

Alabama Department of Senior Services
3
The Launching

• RWJ Grant received in 2004
• Alabama was in 2nd round of grant awards
• Received 250,000 for assistance in start-up
• Formulation of a plan
• Coordination with Medicaid and other state
  agencies on workplan for project
• Determination of need for consultant
• New concept for Alabama
• Uniqueness of program no two states alike
• Concept Paper developed
• Recommendation to operate program as an 1115
  Research and Development project

Alabama Department of Senior Services
4
Complicated Course The 1115 vs. 1915c
Amendment Route

• Issues with the 1915c Elderly and Disabled Waiver
  
• Concern over implementing a new concept in a
  large waiver
• Ability for one agency to test as a pilot
• Rationale for the 1115
• Could accomplish a small pilot program under the
  1115 waiver
• Could carve out certain services for the program
• Wanted ability to give cash to participants
• Wanted to include Independent Living Waiver
  participants from the Rehab department without
  having to do a separate waiver

Alabama Department of Senior Services
5
Leaving The Port

• Workgroups formed
• Concept paper submitted
• 1st goal to meet achievement of budget
  neutrality

Alabama Department of Senior Services
6
Sailing Along

• National Program Office (NPO) Involvement
• Attending Cash/Counseling meetings
• Participating in conference calls
• Consumer Directed Module Software Project
• Selected as one of three states to participate
• Involved in selection of vendor, development of
  software design, and testing

Alabama Department of Senior Services
7
Rough Seas Ahead

• Budget Neutrality
• Ongoing nightmare
• Lengthy work sessions with numerous state and NPO
  staff
• Took over a year to resolve
• Passage of 2005 Deficit Reduction Act
• Potential impact for our program

Alabama Department of Senior Services
8
The Calm Before the Storm

• 1115 Waiver submitted 4/06
• Initial questions of whether CMS would approve as
  an 1115 waiver because of the DRA
• Numerous conversations with CMS
• Were finally told by CMS that they would process
  as 1115
• Received list of questions 9/06

Alabama Department of Senior Services
9
The Storm Approaches

• Waiting for word on approval
• CMS conference call 11/06
• Question/Answer clarification
• Told approval forthcoming

Alabama Department of Senior Services
10
The Storm Hits

• Received e-mail from CMS
• Stated proposal could not be approved as program
  could be accomplished under the new state plan
  option of the DRA
• Told to withdraw proposal and submit draft
  pre-print for 1915(j) or waiver would be
  disapproved.
• Much concern - what to do?
• No final regulations regarding the DRA
• Too much work on project to just throw away

Alabama Department of Senior Services
11
The Sun Peaks Out

• After several agonizing weeks decision made to
  move forward with SPA option under the 1915(j)
  section
• 1915(j) would allow Alabama to operate program as
  designed under the 1115 plan

Alabama Department of Senior Services
12
Approaching Land

• Worked closely with CMS in completion of the
  State Plan Amendment
• Had numerous conference calls to work through the
  application issues
• Submitted in 3/07 almost a year after the
  original waiver submitted

Alabama Department of Senior Services
13
Docking Complete

• CMS
• final approval received
• on
• May 24, 2007!!!

Alabama Department of Senior Services
14
Disembarking

• Within a period of four months
• Established Advisory Committees
• Developed Operational Protocol
• Developed an RFP and Selected a Financial
  Management Agency
• Started planning for Implementation
• Training
• Enrolling clients

Alabama Department of Senior Services
15
Journey on Land Begins

• Start Date of August 2007
• 1st Clients enrolled in September
• Started managing budgets in November

Alabama Department of Senior Services
16
Trip Expectations

• Goals of Program
• Increase access to paid personal care
• Increase satisfaction with services
• Increase overall quality of life
• Meet more day-to-day needs
• Decrease stress of families and informal
  caregivers

17
Trip Status

• Extension of RWJ Grant
• October 2007 - March 2008
• Current Participants
• Success reports
• Same amount of services received
• Money left over for special purchases/savings
• Purchase Examples lift chair, air conditioner,
  ceiling fan with remote, etc.

Alabama Department of Senior Services
18
Last Leg of the Journey

• Final CMS rules/regulations
• Financial impact of program
• Conduction of program evaluation

Alabama Department of Senior Services
19
Contact Information

• Alabama Department of Senior Services770
  Washington Avenue
• RSA Plaza Suite 470Montgomery, Alabama
  36130(334) 242-5743 1-(877)-425-22431-800-AGELIN
  E (1-800-243-5463)Fax [phone]
• Irene B. Collins, Commissioner
• Irene.Collins_at_adss.alabama.gov
• Or
• Jean Stone, Division Chief
• Long Term Care Programs
• Jean.Stone_at_adss.alabama.gov