Draft for Public Review and Comment
Prepared by the Illinois Executive Committee for NWD System Planning with funding from the Administration for Community Living
August 31, 2016

Table of Contents
- Executive Summary
- Development and Framework for the NWD Three-Year Plan
- The NWD System Planning Executive Committee
- Defining LTSS and the No Wrong Door System in Illinois
- Mission Statement
- Vision Statement
- System Background
- The Aging and Disability Resource Center Network
- The Coordinated Entry Point Initiative
- The Balancing Incentive Program
- Additional Key Programs
- Current System Capacity Assessment
- System Capacity Assessment: Factors Impacting Access and Services
- Stakeholder Listening Sessions
- NWD System Capacity Assessment
- SWOT Analysis and Review of Each Key Element
- Public Outreach and Links to Key Referral Services
- Person-Centered Counseling
- Streamlined Access to Public Programs
- Governance and Administration of NWD System
- Planned Activities to Achieve Illinois' No Wrong Door System
- Governance and Administration - Background
- Defining our Governing Body
- Stakeholder Engagement and Advisement
- Funding and Sustainability Plan
- Governance and Administration - Outcomes by 2019
- Public Outreach and Links to Key Referral Sources - Background
- Illinois NWD Entry Points
- Illinois' Current NWD System Entry Points:
- Potential Access Points:
- BIP NWD System Marketing Campaign
- Public Outreach and Links to Key Referral Sources - Outcomes by 2019
- Person-Centered Counseling - Background
- PCC Training and Statewide Development Plan
- Person-Centered Counseling (PCC) - Outcomes by 2019
- Streamlined Access to Public Programs - Background
- Streamlined Access to Public Programs - Outcomes by 2019
- Conclusion
Three-Year Plan Appendix A: NWD Planning Executive Committee Membership
Three-Year Plan Appendix B: NWD Listening Session Findings Final Report
Executive Summary
The Illinois No Wrong Door (NWD) System Plan provides a road map for three years of development and implementation to transform the state's long term services and supports (LTSS) system to improve people's access to information and assistance. Under the current system, options are limited and access points are not-well-known by potential service participants and the general public. The vision for this plan is as follows:
Illinois' No Wrong Door (NWD) System will be an integrated, person-centered access service delivery system for consumers who are looking for and need long-term services and supports (LTSS) as well as quality, affordable and accessible independent living options. The NWD System will comprise a robust network of public and private organizations across the state that will collaborate and coordinate to provide accurate and comprehensive information in a timely manner to all Illinois residents, but with focus on underserved and unserved populations. The NWD System will help people learn about the full range of options so they can live in the community as long as possible. Across the state, the System will be highly visible, inviting, and accessible. The NWD System will be organized, streamlined, and efficient with each state agency and local organization understanding the vision for the System and their specific roles and responsibilities.
This vision will be achieved with support from federal funding through the Balancing Incentive Program (BIP) and the Administration for Community Living (ACL) and state funding and oversight from the Illinois Department on Aging (IDOA), the Illinois Department of Human Services (DHS), and the Illinois Department of Healthcare and Family Services (DHFS). The Executive Committee is comprised of leadership from these state agencies.
To develop the plan, the state engaged stakeholders from all key levels of the LTSS system: people and families/caregivers who may need or who use services; providers of services (organizations and personnel); and policy makers. To do this, we conducted the following activities:
- Held 6 listening sessions around the state with consumers and stakeholder representatives;
- Sought guidance and input from the BIP policy group's state-level partners;
- Conducted in-person meetings with organizations already involved in operating Aging and Disability Resource Networks;
- Fielded a web-based survey designed to assess current capacity of the existing Aging and Disability Resource Network partners to carry out key NWD System functions; and
- Convened a state-level NWD System Planning Executive Committee.
Several themes emerged from the information-gathering activities across all stakeholders that are presented as areas of strength and challenges below.
Areas of Strength
- Shared Vision
- Shared commitment to deinstitutionalization and promotion of home- and community-based services
- Shared commitment to support people who need services to the greatest extent possible
- Partnership/Coordination/Management Across Networks
- Partnerships across networks at the local level
- Nursing Home Transition and Deflection projects
- State level BIP Policy Group has guided planning and policy-making at the programmatic level
- NWD Infrastructure and System Capacity
- Information and Assistance system statewide, 1-800 phone line at IDOA, well-established and expanding
- Referrals locally between partnering organizations are working well in most areas
- NWD Service Standards
- Coordinated entry process standards, such as standards for intake, already established Standardized Level One Screen and Uniform Assessment Tool (in development through BIP)
Challenges
- Ongoing state budget impasse (stop gap budget was passed on June 30, 2016 for six months)
- Shared Vision
- More buy-in, leadership and ownership from all disability services providers and agencies at state and local levels
- Partnership/Coordination/Management Across Networks
- Stronger, permanent state-level management structure
- Stronger linkages between mental health and other community-based providers
- Stronger linkages between hospitals/acute care providers and community-based providers
- Access to supportive housing and stronger awareness and understanding of supportive housing resources that exist in order to provide accurate and timely information to individuals in need
Broad-based stakeholder input assisted project leadership in identifying gaps in the current LTSS access structure while allowing leadership to develop strategies for streamlining access and transforming the LTSS system into a person-centered, NWD access system for all populations, programs and payers. Over the next three years, the state intends to streamline fragmented, multiple, and duplicative processes into a coordinated NWD System by working to achieve 15 goals that will build capacity in the four domains of a NWD System: Governance and Administration, Public Outreach, Person-Centered Counseling and Streamlined Access to Public Programs.
Development and Framework for the NWD Three-Year Plan
The NWD System Planning Executive Committee
As part of its NWD Three-Year Plan development process, the Illinois Department on Aging convened a multi-agency workgroup to serve as its NWD System Steering Committee (the Executive Committee).
Committee members included representatives from the Department on Aging, the Department of Human Services and the Department of Healthcare and Family Services. Within the Department of Human Services, staff from the Divisions of Rehabilitation Services, Mental Health and Developmental Disabilities were included. The complete membership of the NWD System Executive Committee is presented in Appendix A.
Early in the process, the Committee outlined some principles or rules of engagement to guide their work together; they are presented below:
-
What to be:
- Patient
- Inclusive
- Transparent
- Accountable
-
How to work together:
- Take time to understand each other's language, terminology and values
- Agree upon a shared set of goals, mission, and vision
- Clearly define roles and responsibilities
- Leverage and strengthen relationships that have been built over the years through other initiatives
- Bring people with different perspectives and experiences to the table
- Pool resources to be more successful
- Document and share protocols so that legacy information is not lost due to staff turnover
- Facilitate ongoing communication among NWD System organizations to prevent/reduce silos
The Executive Committee first met in October 2015 and plans to meet monthly through at least October 2016. The Lewin Group provided facilitation and support through a contract with the Illinois Department on Aging. Each meeting of the Committee had a specific focus related to the NWD Three-Year Plan, listed in Exhibit 1.
Exhibit 1: Illinois NWD System Planning Executive Committee Goals and Activities
Meeting Month |
Goals and Activities |
October 2015 |
Develop Mission and Vision of the NWD System in Illinois |
November 2015 |
Identify Goals for the NWD Three-Year Plan |
December 2015 |
Prioritize Goals for the NWD Three-Year Plan |
January 2016 |
Develop Tasks and Timelines for the NWD Three-Year Plan |
February 2016 |
Consider Sustainability of the NWD Three-Year Plan |
March 2016 |
Identify Action Steps for NWD Three-Year Plan Goals |
April 2016 |
Finalize Action Steps for NWD Three-Year Plan Goals |
May - August 2016 |
Gather and Review Stakeholder Feedback on the NWD Three-Year Plan |
September 2016 |
Finalize the NWD Three-Year Plan and Submit to the Administration for Community Living |
October 2016 |
Begin Implementation the NWD Three-Year Plan |
Defining LTSS and the No Wrong Door System in Illinois
The Illinois NWD System Planning Executive Committee developed the mission and vision statements presented below so that everyone can operate from a consistent understanding.
Please note: there are many different terms used in the long term services and supports (LTSS) system in Illinois to refer to individuals who need or use LTSS: consumers, customers, clients, peers. For the purposes of this report, the term consumer will be used to reference consumers served by, or in need of, LTSS through the NWD System.
Mission Statement
Illinois's mission is to develop an integrated and streamlined No Wrong Door (NWD) System with front door entry points available in all communities that will serve as highly visible and trusted places where people of all ages can readily access information and person-centered counseling about the full range of long term service and supports and independent living options.
Vision Statement
Illinois' No Wrong Door (NWD) System will be an integrated, person-centered access service delivery system for consumers who are looking for and need long-term services and supports (LTSS) as well as quality, accessible and affordable independent living options. The NWD System will be comprised of a robust network of public and private organizations across the state that will collaborate and coordinate to provide accurate and comprehensive information in a timely manner to all Illinois residents, but with focus on underserved and unserved populations. The NWD System will help people learn about the full range of options so they can live in the community as long as possible. Across the state, the System will be highly visible, inviting, and accessible. The NWD System will be organized, streamlined, and efficient with each state agency and local organization understanding the vision for the System and their specific roles and responsibilities.
System Background
Illinois' NWD System Plan builds on the work and history of several initiatives as outlined below.
The Aging and Disability Resource Center Network
In 2003, the federal government made a significant investment in community-based LTSS, also referred to as home- and community-based services (HCBS). During that time, the federal Administration for Community Living (ACL) and Centers for Medicare and Medicaid Services (CMS) partnered to offer state governments funds to develop and maintain Aging and Disability Resource Centers (ADRCs). These entities were a new concept for many states and were designed to support states in developing single points of entry into the LTSS system for older adults and people with disabilities of all ages. Through integration or coordination of existing aging and disability service systems, ADRC programs raise visibility about the full range of options that are available, provide objective information, advice, counseling and assistance, empower people to make informed decisions about their long term supports, and help people more easily access needed public and private long term services and supports, including behavioral health services and employment services. ACL and CMS originally funded 43 states and territories to develop ADRC programs between 2003 and 2005, including Illinois.
Through these dollars, the state of Illinois and local Area Agencies on Aging (AAAs) developed its Aging and Disability Resource Center Network (ADRN), with the active involvement of Centers for Independent Living (CILs) and other local partners. These organizations provide many key functions, which include but are not limited to information and referral, person-centered counseling/options counseling (PCC/OC) and independent living skills training. Currently, the Illinois Department on Aging is the state oversight agency for the ADRNs.
These collaborative networks have contributed much of the foundation upon which the Illinois Department on Aging, the Department of Human Services and the Department of Healthcare and Family Services hope to build upon through the NWD Three-Year Plan.
The Coordinated Entry Point Initiative
In 2004, the Older Adult Services Act (Public Act 93-1031) was enacted "to promote a transformation of Illinois' comprehensive system of older adult services from funding a primarily facility-based service delivery system to primarily a home-based and community-based system, taking into account the continuing need for 24-hour skilled nursing care and congregate housing with services." This act mandated a statewide coordinated point of entry with a uniform name, identity, logo, and toll-free number. The Older Adult Services Act defines Coordinated Point of Entry (CPoE) as an "integrated access point where consumers receive information and assistance, assessment of needs, care planning, referral, assistance in completing applications, authorizations of services where permitted and follow-up to ensure that referrals and services are accessed."
Implementing CPoE standards is an objective to improve access to long term services through pre- admission screening and options counseling under this act. To reach this goal, the CPoE Workgroup was established to provide direction to the development of CPoE standards and expectations. The workgroup determined that a CPoE may be an AAA, a Senior Center, a Case Coordination Unit, an Information and Assistance provider, or an Aging and Disability Resource Network.
The Balancing Incentive Program
The Balancing Incentive Program (BIP) is a federal initiative funded through the CMS designed to support states, rebalance their Medicaid-funded LTSS systems and improve access to HCBS. Authorized by the Affordable Care Act (ACA), the BIP provides financial incentives to states through enhanced Federal Medical Assistance Percentage (FMAP) on eligible services. In exchange, states participating in BIP must meet three requirements:
- Undertake structural changes, including a NWD System, a Core Standardized Assessment (CSA), and conflict-free case management
- Spend BIP funds to enhance community-based LTSS
- Meet the "Balancing Benchmark," i.e., spend a certain percentage of total LTSS dollars on community LTSS, (25 or 50 percent depending on the 2009 starting point)
As of December 2015, 18 states are participating in BIP. Illinois has received BIP funding since 2013 and received slightly over $90 million in FMAP dollars1 from the federal government through this program.
States have considerable flexibility in how they approach the first two requirements. Illinois is meeting these requirements through developing and implementing a new Level 1 Screening Tool, or the IL BIP Initial Screen, and Uniform Assessment Tool (UAT) to meet the BIP requirement of developing core standardized assessment instruments for determining eligibility for non-institutionally based LTSS, restructuring its ADRC system to align with the federal NWD vision and adding a new dedicated BIP 1- 800 Call Center number and BIP website to provide information on HCBS, as required by the BIP initiative as a key deliverable. The Department of Healthcare and Family Services has worked with the Department of Human Services and Department on Aging to identify the NWD sites that will complete the Initial Screen and UAT for consumers needing LTSS.
States participating in BIP need to demonstrate meeting the Balancing Benchmark requirement through increasing the proportion of Medicaid LTSS dollars that are directed towards HCBS. The baseline for this benchmark is 2009 LTSS spending. States that directed less than 25 percent of LTSS dollars towards HCBS in 2009 must reach 25 percent by the end of the BIP award period, December 31, 2016. Similarly, states that directed more than 25 percent but less than 50 percent of LTSS dollars towards HCBS in 2009 must reach 50 percent during the same time period. Illinois spent $3.3 billion on LTSS in 2009, with 27.8 percent of these dollars spent on HCBS.2 Thus, Illinois must reach the 50 percent benchmark for LTSS rebalancing by the end of the BIP award period.
1 BIP Program Application - Illinois. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By- Topics/Long-Term-Services-and-Supports/Balancing/Downloads/Illinois-BIP.pdf
2http://aspe.hhs.gov/sites/default/files/pdf/111766/BIPbase.pdf
Additional Key Programs
In addition to the ADRNs, the CPoE Initiative and the BIP award, several other organizations, programs and initiatives have launched in Illinois that have advanced Medicaid-funded HCBS, helped rebalance the state's LTSS system and will inform the state's NWD Three-Year Plan. Some of these organizations, programs and initiatives are listed in Exhibit 2.
Exhibit 2: Additional Key Organizations, Programs and Initiatives in Illinois
- Area Agencies on Aging
- Case Coordination Units
- Centers for Independent Living
- Community Mental Health Centers
- Community Integration - Long Term Services and Supports Medicaid Innovation Accelerator Program (IAP)
- Dementia-Capable HCBS
- IL Housing Development Authority
- Money Follows the Person
- Nursing Home Deflection Pilot Projects
- Colbert Consent Decree
- Ligas Consent Decree
- Williams Consent Decree
In addition to the foundation set by these organizations and initiatives, the NWD Three-Year Plan will include many of these entities as NWD Entry Points.
Current System Capacity Assessment
System Capacity Assessment: Factors Impacting Access and Services
Illinois' current population has a median age of 35.4 and a disability rate of 11.1 percent3, ranked 40th and 41st nationally, respectively. Illinoisans with disabilities are more likely to be older than the general population, and 35.2 percent of its population over age 65 has some type of disability, 29th in the nation.4
Progress has been made in recent years towards addressing the institutional bias embedded in the LTSS system. For fiscal year 2014, the latest year for which national LTSS data are available, 43.7 percent of Medicaid-funded LTSS in Illinois was directed towards HCBS. However, DHFS estimates that that percent could be as high as 45 percent in 2016. Although improving, Illinois' institutional LTSS is costly, an average of is $214.48 per person the 24th highest per-resident cost nationally. Illinois' rank was 31st in 2012.5
With the budget shortfall currently facing the state, there is significant pressure on the state agencies involved in administering Medicaid and other health and human service programs to operate as efficiently as possible.
3 http://disabilitystatistics.org/reports/acs.cfm?statistic=1 (downloaded 2/16/15)
4 http://www.statemaster.com/graph/peo_med_age-people-median-age (downloaded 2/16/16)
5 https://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/downloads/ltss-expenditures-fy2013.pdf (Tables C and D)
Stakeholder Listening Sessions
Between December 2014 and September 2015, The Lewin Group assisted the state to host six listening sessions: five in-person meetings at different locations around the state and one virtual session with participants from across the state. Stakeholders included staff from community agencies across the aging and disability networks, the VA, older consumers, younger people with disabilities, and family members. These sessions identified Illinois LTSS strengths and challenges from the perspectives of both service providers and users. Much of the feedback from the listening sessions dovetailed with what had been previously communicated by state agency leaders and ADRN lead organizations.
Lewin identified several common themes that listening session participants representing all populations and roles raised with high frequency. Participants across all populations and roles indicated that community-level partnerships are an area of strength in Illinois' current system. Among providers, many noted that building personal relationships with staff across service agencies facilitates referring people to and from those organizations. Another identified strength is referral capacity between providers, including both cross-population referrals (e.g., an aging services provider referring an individual to community- based mental health services) as well as referrals between providers of NWD System functions and providers of direct services. Exhibit 3 shows the most frequently mentioned areas of strength by the listening session participants.
Exhibit 3: Strengths Identified with High Frequency across All Populations and Roles
Response Categories- Strengths |
Comment Frequency |
Community Level Collaboration and Networking |
56 |
Referrals between Providers |
47 |
Person-Centered Counseling /Options Counseling |
17 |
Listening session participants also noted some areas upon which Illinois' current system could improve. The most frequently cited area for improvement included training and education, particularly increasing and improving training and education for staff who work with people with disabilities. In addition, participants mentioned the need to train provider and state agency staff in how to work with anyone needing LTSS rather than one specific population, cultural competency towards disability and how to navigate Medicaid, including eligibility and application systems. Awareness, marketing and outreach for LTSS options were other frequently mentioned areas for improvement. Participants indicated that people often enter the LTSS system with almost no knowledge of what services and supports are available to them. At the same time, they acknowledged limited marketing budgets and consumer input in outreach efforts. Exhibit 4 shows the most frequently mentioned areas of improvement by the listening session participants.
Exhibit 4: Areas for Improvement Identified with High Frequency across All Populations and Roles
Response Categories- Areas for Improvement |
Comment Frequency |
Training and Education |
51 |
Awareness, Marketing and Outreach for LTSS Options6 |
48 |
Medicaid Eligibility Determination/Navigation Issues7 |
42 |
Collaboration among State Agencies |
36 |
Suggestions for a Statewide Resource Database |
36 |
6 Includes multiple response categories related to issues with advertising, marketing and outreach.
7 Includes multiple response categories related to issues with Medicaid.
Complete findings from the Listening Sessions can be found in the Listening Session report distributed to stakeholders in January 2016 (Appendix B).
Stakeholders who participated in listening sessions, BIP Policy Group members and ADRN lead organizations expressed concerns regarding lack of coordination at the state level, fragmentation in the current LTSS system (especially at the state level) and variability in standards and policies that guide how people learn about and access public and private services. Multiple factors contribute to access difficulties such as: lack of formal partnerships and agreements between governing agencies at the state level, variability in the strength of partnerships between aging, disability and behavioral health networks at the local level, lack of statewide comprehensive database of community resources across all populations, challenges sharing data across agencies about consumers and the services they receive, and a lack of consistent expectations and training opportunities for staff across different networks.
NWD System Capacity Assessment
In July 2015, The Lewin Group conducted a web-based capacity assessment survey of the state's 13 AAAs that lead the ADRN activities in their areas. As lead ADRN organizations, the AAA's were asked to provide contact information for the ADRN Core Partners in the service area and select the populations served by their network. Forty-seven organizations identified by the AAAs as Core Partners and 22 additional NWD Entry Point organizations completed a similar survey in November and December 2015. In addition to aging services, responding organizations included Centers for Independent Living, Independent Service Coordination agencies, mental health services, public health agencies, and faith- based organizations. Data from these two surveys have been aggregated and stratified by Illinois' 13 Planning and Service Areas (PSAs).
Exhibit 5 shows the NWD System populations served by the existing ADRNs as reported by the AAAs in the web-based capacity assessment survey fielded in July 2015. Please note that there may be additional populations served that were not reported by the AAAs.
Exhibit 5: NWD System Populations Served by ADRNs (data reported by AAAs)
PSA |
Caregivers & Informal Supports |
Older Adults |
People with Dementia |
People with I/DD |
People with Mental Illness and/or Substance Use Disorders |
People with Physical Disabilities |
People with Traumatic Brain Injury |
Veterans |
1 |
X |
X |
|
|
|
|
|
|
2 |
X |
X |
X |
|
|
X |
|
X |
3 |
X |
X |
X |
X |
X |
X |
X |
X |
4 |
X |
X |
X |
X |
X |
X |
X |
X |
5 |
X |
X |
X |
X |
X |
X |
X |
X |
6 |
X |
X |
X |
X |
|
X |
|
X |
7 |
|
X |
|
|
|
X |
|
|
8 |
X |
X |
X |
X |
X |
X |
X |
X |
9 |
X |
X |
X |
X |
X |
X |
X |
X |
10 |
X |
X |
X |
|
X |
X |
X |
X |
11 |
X |
X |
X |
X |
X |
X |
X |
X |
12 |
X |
X |
X |
X |
X |
X |
X |
X |
13 |
X |
X |
X |
|
|
X |
|
X |
In November 2015, all the ADRN Core Partners identified by the AAAs and other organizations that were identified by the state as NWD Entry Point organizations were asked to complete the survey. These organizations were asked to select the populations they served under the NWD System functions of Public Outreach & Coordination with Other Partners and Key Referral Sources, Person-Centered Counseling/Options Counseling (PCC/OC), and Assistance Accessing Public LTSS Programs and Private LTSS Programs. Exhibit 6 shows our preliminary assessment of NWD System functions coverage across the PSAs by population.
- An area was identified as having strong coverage for a population and function if at least one organization in each PSA reported offering the function for the population and the staffing and contacts from people within that population reported in the PSAs were at expected levels given the number of residents in the area.
- An area was identified as having some coverage for a population and function if at least one organization in each PSA reported offering the function for the population, but the staffing and number of contacts in the PSAs were lower than expected.
Because not every organization across the state responded to the survey and because not all of those who responded answered all the staffing and services questions, the assessment is based on incomplete information. However, we have more confidence about the assessment in areas where the response rates were highest. Exhibit 6 also notes our degree of confidence in the assessment.
- If the estimate of capacity for a PSA is based on responses representing most types of organizations, we indicate a fairly high level of confidence (†) in our assessment of capacity.
- Alternatively, if there was a low response rate without representation from most types of organizations, we note a low confidence level (?). The lack of coverage in these areas may be more reflective of a lack of information than a true lack of capacity.
Exhibit 6: NWD System Functions Capacity by Population across Planning and Service Areas
Population |
Outreach |
Person-Centered Counseling |
Access Public LTSS |
Access Private LTSS |
Caregiver |
Strong coverage † |
Some coverage† |
Strong coverage† |
No coverage in PSA 12† |
Older Adults |
Strong coverage† |
Strong coverage† |
Strong coverage† |
No coverage in PSA 12? |
Dementia |
Some coverage† |
Some coverage† |
Some coverage† |
No coverage in PSA 12 ? |
Intellectual/ Developmental Disabilities |
Some coverage? |
No coverage in PSA 4 &, 12 ? |
No coverage in PSA 10 ? |
No coverage in PSA 4, 10 & 12 ? |
Mental Illness/Substance Use Disorders |
No coverage in PSA 6? |
No coverage in PSA 6? |
No coverage in PSA 6 ? |
No coverage in PSA 6, 10 & 12 ? |
Physical Disabilities |
Strong coverage† |
Some coverage ? |
Some coverage ? |
No coverage in PSA 10 & 12 ? |
Traumatic Brain Injury |
No coverage in PSA 6? |
No coverage in PSA 4 & 6? |
No coverage in PSA 4 & 6 ? |
No coverage in PSA 4, 6, 10 12 ? |
Veterans |
Some coverage ? |
Some coverage ? |
Some coverage ? |
Some coverage ? |
† Capacity assessment reflects representation and responses from most types of organizations
? Capacity assessment reflects a low response rate without representation of all organization types
Assistance in accessing private LTSS lacks coverage for all populations except Veterans in at least one PSA. Intellectual/ Developmental Disabilities, Mental Illness /Substance Use Disorders, and Traumatic Brain Injury populations lack coverage in three or more PSAs. Mental Illness /Substance Use Disorders and Traumatic Brain Injury populations lack coverage in at least one PSA for all NWD System functions. PSA 4 had only two organizations complete the survey (one in addition to the AAA) and PSA 6 and 12 had only three organizations complete the survey (two in addition to the AAA). Low response, rather than actual lack of capacity may be the reason for the coverage deficit in these PSAs. Exhibit 7 shows the response rate for each PSA based on the list of ADRN Core Partners provided by the AAAs and the NWD Entry Point organizations received from the Illinois Department on Aging and the Illinois Department of Healthcare and Family Services.
Exhibit 7: Response Rates by Planning and Service Areas (PSAs)
PSA |
Response Rate |
Type of Organizations/Populations Served by Non-responding Organizations |
1 |
35% |
Aging (10), Community Action Agency (1), Faith Based (1), Center for Independent Living (1), Independent Service Coordinator (10), other (1) |
2 |
50% |
Independent Service Coordinator (4), Faith Based (1), Aging (1) |
3 |
35% |
Aging (7), Center for Independent Living (3), ISC (2), Mental Health (1), Other (1), Community Action Agency (1) |
4 |
50% |
Center for Independent Living (2), ISC (1) |
5 |
63% |
Independent Service Coordinator (3), Other (2), Aging (1), Public Health (1) |
6 |
50% |
Aging (3), Independent Service Coordinator (1) |
7 |
63% |
Center for Independent Living (2), ISC (1) |
8 |
33% |
Aging (4), Center for Independent Living (2), Other (2), ISC (1), Community Action Agency (1), Faith Based (1) |
9 |
60% |
Aging (4) |
10 |
44% |
Aging (9), Center for Independent Living (1) |
11 |
67% |
Independent Service Coordinator (1) |
12 |
27% |
Aging (5), Community Action Agency (3), Other 2, Faith Based (1) |
13 |
48% |
Aging (6), ISC (3), Mental Health (1), Other (1) |
Total |
45% |
82 out of 184 organizations submitted survey responses |
Organizations were asked to report their total number of annual contacts as well as sub-groups of contacts (e.g. consumers age 60 or older, Veterans, caregivers, etc.). The Exhibit 8 displays the number of contacts per 100,000 residents in each PSA for Veterans and caregivers. Although Veterans were reported to receive full coverage of NWD System functions (as show in Exhibit 2), there appears to be a lack of Veteran contacts reported by the surveyed organizations. This may be due to record keeping capabilities, but could also be caused by a lack of outreach to Veterans.
Exhibit 8: Total Contacts, Veterans, and Caregivers Receiving Services per 100,000 Residents in Planning and Service Area
Planning and Service
Area (PSA) |
Number of Contacts
per 100,000 Residents
in PSA: Caregivers |
Number of Contacts per
100,000 Residents I
n PSA: Veterans |
Number of Contacts
per 100,000 Residents
in PSA: Total |
1 |
66.8 |
12.1 |
2214.9 |
2 |
30.4 |
0.1 |
660.1 |
3 |
1265.3 |
13.6 |
2648.1 |
4 |
131.7 |
57.4 |
4751.1 |
5 |
188.2 |
16.4 |
2302.7 |
6 |
137.5 |
48.1 |
1472.3 |
7 |
117.1 |
33.0 |
1905.3 |
8 |
303.7 |
181.6 |
1121.9 |
9 |
1048.3 |
226.1 |
8507.3 |
10 |
14.3 |
0.0 |
421.1 |
11 |
119.9 |
17.6 |
1820.7 |
12 |
7.3 |
0.2 |
1212.2 |
13 |
35.2 |
39.4 |
1141.3 |
Responding organizations were asked to report their staffing numbers for NWD System functions. Full- time, part-time, and occasional (less than 15 hours a week) staff totals were provided. Organizations also reported on the number of staff with specialized expertise and staff with training in person-centered practices and/or options counseling. Lewin used this data to assess the capacity in each area to provide this service given the estimated annual demand for person-centered counseling/options counseling (PCC/OC) in each PSA. The results are shown in Exhibit 9.
The number of residents estimated to need PCC/OC each year is based on the number of Illinois residents who are Medicare beneficiaries, Veterans, current Medicaid HCBS waiver participants or those waiting enrollment, Money Follows the Person participants, and families with a 17 year old child with a developmental disability aging out of the school supports. Some percentage of these groups (the percentage varies by population) is estimated to need PCC/OC each year. Lewin estimates that 457,500 Illinois residents will need PCC/OC per year. This figure was distributed across PSAs based on the most recent census figures. This figure does not include the demand for person-centered planning for Medicaid HCBS waiver enrollees, but rather is based on an assumption that only 10 percent of current HCBS waiver participants need PCC/OC in any given year beyond what they would receive from their case manager.
Based on historical reporting by ADRCs from across the country using data from ADRC's Semi-Annual Reporting to the ACL, Lewin estimates that each full-time options counselor can serve 462 people per year. Across the country, full-time options counselors provide PCC/OC to an average of 56 consumers per month. Based on 1,920 available labor hours each year (2,080 minus holidays and vacation), this translates into 160 labor hours available each month or an average of 2.85 hours spent each month dedicated to each consumer. This estimate is based on the assumption that at most ADRCs, 50 percent of PCC/OC consumers received services during one month only, 20 percent for two months, 15 percent for three months, and 15 percent for four months. Keeping an average case load of 56 consumers per month, with some of these people receiving services for longer than one month as described above, each full-time options counselor could theoretically serve 462 people a year.
Exhibit 9 shows the difference between Lewin's estimate of the number of full-time counselors needed and the number of staff trained in PCC/OC reported in the capacity assessment survey. Based only on the response from organizations that completed a capacity assessment, we estimate that 513 additional options counselors either need to be identified within existing organizations in the network or hired to meet the demand for PCC/OC.
Please note there are some important limitations to this assessment so the numbers presented here likely over or underestimate actual need and further data collection will be needed to develop more complete estimates.
- The response rate for the overall survey was too low to provide good estimates of staff capacity.
- We do not know whether the staff with training that were reported are providing PCC/OC services full time, part time, or not at all. They may have received training to provide PCC/OC but spend most of their time performing other functions.
- Some of the staff reported as having received PCC/OC training may be Medicaid waiver case managers who need this training to develop person-centered plans. If Medicaid case managers who do not work with people outside of the Medicaid program were reported here, that would produce an overestimate of the area's capacity because the estimate of demand does not include the demand for person-centered planning as part of Medicaid case management.
- PSAs 7, 9, and 11, which appear to have a surplus of staff needed to meet the estimated demand for PCC/OC, each had one organization that reported higher numbers of PCC/OC trained staff than the other organizations in their PSA. For example, Effingham City/County Committee on Aging reported 30 staff members trained in PCC/OC, whereas the other organizations in PSA 9 all reported less than 10 staff. The wide range in trained staff may reflect different interpretations of the question, which asked:
"How many staff employed by your organization have received any type of training (on-line or in-person) in options counseling, person-centered practices or person-centered planning? Please provide the number of individual people who have received training including part-time and full- time staff. Person-centered planning is a process directed by the person with LTSS needs. The person-centered planning approach identifies the person's strengths, goals, preferences, needs (medical and HCBS), and desired outcomes. The role of staff, family, and other team members is to enable and assist the person to identify and access a unique mix of paid and unpaid services to meet their needs, and to provide support during planning and implementation."
Exhibit 9: Lewin's Estimate of Capacity to Meet Annual PCC/OC Demand by Planning and Service Area
PSA |
Estimated # Residents Needing PCC/OC |
Number of FT Options Counselors Needed to Meet Demand * |
Staff Trained in PCC/OC (FT/PT Status Unknown) |
Minimum Need (-) or Maximum Surplus (+) of Staff to Meet Estimated PCC/OC Demand |
1 |
24,249 |
52 |
61 |
9 |
2 |
123,623 |
268 |
24 |
-244 |
3 |
11,684 |
25 |
14 |
-11 |
4 |
14,947 |
32 |
23 |
-9 |
5 |
30,085 |
65 |
60 |
-5 |
6 |
4,336 |
9 |
12 |
3 |
7 |
16,318 |
35 |
52 |
17 |
8 |
24,011 |
52 |
44 |
-8 |
9 |
5,274 |
11 |
56 |
45 |
10 |
4,274 |
9 |
19 |
10 |
11 |
10,215 |
22 |
48 |
26 |
12 |
97,804 |
212 |
27 |
-185 |
13 |
90,680 |
196 |
37 |
-159 |
Total |
457,500 |
990 |
477 |
-513 |
*Each full time options counselor is estimated to be able to work with 462 consumers a year. SOURCE: The Lewin Group 2013
SWOT Analysis and Review of Each Key Element
The Lewin Group analyzed all of the input gathered from the BIP Policy Group, the Executive Committee and other stakeholders to identify areas of strength, weaknesses, opportunities, and threats/barriers (SWOT) relative to the state's NWD vision and the four key elements of a NWD System (Exhibit 10).
Exhibit 10: Illinois' SWOT for the Essential NWD System Elements
Strengths
Shared Vision
- Shared commitment to deinstitutionalization and promotion of home- and community-based services and independent living options
- Shared commitment to support people who need services to the greatest extent possible
Partnership/Coordination/Management Across Networks
- Partnerships across networks at the local level
- Nursing Home Transition and Deflection projects
- State level BIP Policy Group has guided planning and policy-making at the programmatic level
NWD Infrastructure and System Capacity
- Information and Assistance system statewide, 1-800 phone line at IDOA, well-established and expanding
- Referrals locally between partnering organizations are working well in most areas
NWD Service Standards
- Coordinated entry process standards, such as standards for intake, already established Standardized Level One Screen and Uniform Assessment Tool (in development through BIP)
Weaknesses
Shared Vision
- More buy-in, leadership and ownership from all disability services providers and agencies at state and local levels
Partnership/Coordination/Management Across Networks
- Stronger, permanent state-level management structure
- Stronger linkages between mental health and other community-based providers
- Stronger linkages between hospitals/acute care providers and community-based providers
Opportunities
Shared Vision
- Encourage Cabinet level leadership within Illinois executive agencies to include NWD principles and practices in their overall LTSS rebalancing and transformation activities
NWD Service Standards
- Standard definitions for NWD terms
- Shared standardized resources and tools
Threats
NWD Infrastructure and System Capacity
- More staffing to provide person-centered counseling/ options counseling to all populations
- Need staff capacity - generalists and specialists
- Need comprehensive, accessible databases for resource and consumer data, better data sharing capacity
- Streamline assessment and eligibility determination
State Budget Impasse
- Unpredictability of state funding available could limit implementation activities
Public Outreach and Links to Key Referral Services
Illinois' statewide Information and Assistance system is already helping link consumers to the services they need. The 1-800 phone line through the Illinois Department of Aging is already well-established and continues to grow. Additionally, partner organizations are making referrals to one another at the local level.
While partner organizations are working with each other locally, there is a need to strengthen linkages across mental health, hospital/acute care providers, and other community-based providers. There is also a need for a comprehensive, accessible database to improve data sharing capacity. Developing such a database would allow for the sharing of standardized resources and tools to continue to improve this element of the Illinois NWD System.
Person-Centered Counseling
Illinois already has a strong commitment to self-direction and to helping meet their unique goals, through consideration of options and selection of services that meet people's preferences and needs as much as possible. This shared vision to promote person-centered services creates a strong foundation for building Illinois' NWD System.
Improving staff capacity to deliver person-centered counseling is an opportunity. Listening session participants identified staffing levels and staff training as a challenge to the provision of options and person-centered counseling to all populations.
Streamlined Access to Public Programs
Listening session participants noted that coordinated entry process standards are already established which may improve access to public programs. Also, projects like the Nursing Home Transition and Deflection project are working to improve streamlined access to public programs and services for its participants.
Challenges with streamlining assessment and eligibility determination are an area that Illinois should prioritize. Sharing standardized tools and resources, growing staff and system capacity may assist in improving this area.
Governance and Administration of NWD System
In addition to Illinois' shared vision and commitment to supporting people that need services, the state has a number of systems capacities and structures in place to successfully implement a NWD System. The state-level BIP Policy Group has guided planning and policy-making at the programmatic level. The standardized BIP Initial Screen and Uniform Assessment Tool are already established.
Leadership and ownership from all disability service providers and agencies at state and local levels is crucial to the Illinois NWD System. Efforts should focus on gaining more buy-in to the system through continued partnerships and collaborations. An opportunity for this lies with cabinet level leadership, who must set a vision for agencies and guide policy development for the NWD System. This is particularly true in relation to the Human Services Transformation Effort, with leadership collaborating strongly to support the vision and execution of the NWD System and Three Year Plan.
Planned Activities to Achieve Illinois' No Wrong Door System
Having collected information from a diverse set of stakeholders around the state and using the SWOT analysis focused on the four key elements of a NWD System as the framework, the Executive Committee identified a set of 18 NWD System Three-Year Plan Goals. These are categorized into one of three Tiers.
Tiers 1 and 2 include 15 goals that were identified by stakeholders and the Executive Committee as being highest priority. The difference between Tier 1 and 2 goals relates to the availability of funding, which is not as certain for the Tier 2 goals. Tier 3 goals were identified as important but lower priorities, and are not included as part of the detailed Three-Year Plan presented in Appendix C. If the budget situation resolves and/or funding becomes available, the Tier 3 goals may be reconsidered for action.
- Tier 1- Goals for which funds have already been identified and/or have relatively low new cost associated
- Tier 2- Goals for which funding will need to be identified and/or have relatively higher new cost associated
- Tier 3- Goals for which funding will need to be identified and/or have relatively higher new cost associated, and that were identified as lower priority than Tier 1 and 2 goals
Exhibit 11 lists the NWD System Three-Year Plan Goals, with numbering for Tier 1 and 2 goals that corresponds to numbering in Appendix C. The table below also identifies whether the goal is in Tier 1, 2 or 3 and identifies the primary sources of potential funding. Funding sources include federal awards, including BIP, NWD and the Medicaid Innovation Accelerator Program (IAP) and state funds. State funds refer to both general operating budgets as well as in-kind support such as staff time.
A detailed timeline of action items for Tier 1 and Tier 2 goals per function and responsible agency is contained in Appendix C.
Exhibit 11: List of Illinois NWD System Three-Year Plan Goals (organized by NWD System Function)
NWD System Function: Governance and Administration
(In alignment with Health and Human Services Transformation efforts underway)
Goal# |
Goal
NOTE: The 15 goals in Tiers 1 and 2 have numbers corresponding to Three-
Year Work Plan in Appendix C. The three goals in Tier 3 are not numbered. |
Tier |
Potential Funding |
1 |
Identify and formalize permanent state level governance structure with representatives from all participating agencies. Identify existing management processes that could support ongoing governance, convene new management team, develop and execute MOUs outlining each agencies roles and responsibilities for dedicating staff, commitments from leadership to coordinate policy in areas related to accessing LTSS. |
1 |
State |
2 |
Develop and institute standard policies across agencies setting expectations and requirements for community-based organizations in the NWD System funded by each agency. Includes establishing common criteria for designation as NWD entry point, changing administrative rules as needed, issuing rule amendments, issuing mandates from each state agency (tied to funding or contracts), and/or establish shared standards and defined roles set by the state agency or agencies. |
1 |
State |
3 |
Establish standing statewide advisory group with stakeholders from all populations, including significant representation of consumers and family members, providers, and payers to inform and shape policy. |
1 |
State |
NWD System Function: Public Outreach
Goal # |
Goal
NOTE: The 15 goals in Tiers 1 and 2 have numbers corresponding to Three- Year Work Plan in Appendix C. The three goals in Tier 3 are not numbered. |
Tier |
Potential Funding |
4 |
Strengthen and standardize partnership agreements and mutual referral protocols between aging, disability, behavioral health, homelessness, housing, employment resources, transportation, and other services organizations at the community level (e.g., ISCs, AAAs, CILs, CMHCs, COCs, and CCUs). |
1 |
State |
5 |
Develop statewide brand and marketing strategies to increase visibility and communicate effectively with all target populations. |
2 |
BIP/ State |
6 |
Increase capacity of existing 1-800 number call center to serve all populations through increased staffing and enhanced staff training. |
2 |
BIP/NWD/State |
7 |
Develop and implement the BIP Initial Screen screening tool and processes to identify and refer people for further person-centered counseling and/or to initiate the Uniform Assessment Tool for multiple HCBS programs. |
2 |
BIP |
8 |
Help people access information and resources about affordable and accessible housing and build better awareness of existing housing resources including the housing locator. |
2 |
State |
N/A |
Strengthen and standardize partnership agreements and mutual referral protocols between community-based services organizations and medical and institutional providers (e.g., hospitals, VAMCs, nursing facilities, ICFs/IDD). |
3 |
State |
N/A |
Develop one statewide shared searchable database of community resources and services, including transportation services and housing information and services, available in each local area for use by organizations, person- centered counselors, consumers and caregivers, leveraging pre-existing databases and tools wherever possible. |
3 |
State |
NWD System Function: Person-Centered Counseling
Goal
# |
NOTE: The 15 goals in Tiers 1 and 2 have numbers corresponding to Three- Year Work Plan in Appendix C. The three goals in Tier 3 are not numbered. |
Tier |
Potential
Funding
|
9 |
Increase and expand staff capacity across organizations in the network to provide one-on-one counseling using person-centered processes for all populations.
- Align with principles and philosophy of independent living and self- direction
- Align with federal regulations for person-centered planning and person-centered counseling
- Ensure providers are developing and writing service plans with the involvement of consumers and families
|
1 |
NWD/
State
|
10 |
Develop standardized "toolkit" of resources, processes, formal guidance, and performance expectations to make available to all organizations in network providing person-centered counseling. |
1 |
NWD/State |
N/A |
Increase capacity of organizations in the network to support "private paying" consumers through person-centered processes to make best use of existing resources and accessing private services. |
3 |
State |
NWD System Function: Streamlined Access
Goal # |
NOTE: The 15 goals in Tiers 1 and 2 have numbers corresponding to Three- Year Work Plan in Appendix C. The three goals in Tier 3 are not numbered. |
Tier |
Potential funding |
11 |
Connect people who are eligible for LTSS to housing services for which they are also eligible, and for which they need in order to remain independent (e.g. accessible and affordable or supportive housing). |
1 |
BIP, IAP, |
12 |
Promote consistency in messaging and instructions about LTSS options across the state. Use the same language and terminology across all programs and agencies. |
1 |
State |
13 |
Develop and implement uniform assessment tool (UAT) for identification of need, eligibility determination and service planning. |
2 |
BIP |
14 |
Develop common client tracking system accessible to all organizations in the network (as part of UAT). |
2 |
BIP |
15 |
Improve transitions and data sharing between initial entry point person- centered counselor and Medicaid eligibility staff, Medicaid case managers, and Medicaid or private managed care organizations. |
2 |
NWD/State |
Exhibit 12 provides a high-level overview of action items per year, per key element.
NWD Function |
2016 |
2017 |
2018 and beyond |
Governance & Administration |
- Ongoing NWD System Planning Executive Committee meetings
- Interagency leadership meetings and decision points
- Convene stakeholder committee
|
- NWD System Governance Committee convenes
- Ongoing NWD Stakeholder Committee meetings
- Develop MOUs and IGAs
|
- Ongoing NWD System Governance Committee meetings
- Ongoing NWD Stakeholder Committee meetings
|
Public Outreach & Links to Referral Sources |
- Branding and marketing planning activities
- Planning for improved call center access
|
- Improve branding and marketing for NWD System, including housing
- Streamline call center processes
|
- Improve branding and marketing for NWD System, including housing
- Streamline call center processes
|
Person- Centered Counseling |
- PCC training for provider staff
- Convene PCC workgroup
|
- Continued PCC training for provider staff
- Increase PCC trainer capacity
- Ongoing NWD PCC meeting
|
- Continued PCC training for provider staff
- Increase PCC trainer capacity
- Ongoing NWD PCC meetings
|
Streamlined Access to Public Programs |
- BIP implementation, including the UAT
- Planning for common client tracking system
|
- Use of the UAT
- Implementation of common client tracking system
|
- Use of the UAT
- Use of common client tracking system
|
The section below presents more detail about the state's plan for each function:
- Background about work done to date or planned related to the function;
- Key outcomes for the function; and
- Performance indicators for each outcome.
Governance and Administration - Background
This three-year plan was developed through the work of the NWD Planning Executive Committee that has been meeting since October 2015 and continues to meet, with facilitation support from The Lewin Group through a contract with the Department on Aging.
Defining our Governing Body
The NWD System Executive Committee will continue to oversee the NWD System in Illinois over the course of the Three-Year Plan implementation period. The committee may reduce in size; however, membership will represent multiple state agencies that serve all populations. To support the governance of the NWD System, the NWD System Executive Committee may convene a meeting or series of meetings with leadership across state agencies to build consensus and reach decisions on key aspects of NWD System implementation. This buy-in from agency leadership will empower the NWD System Executive Committee to continue implementation of Illinois' NWD System.
Stakeholder Engagement and Advisement
Stakeholder engagement begins at the state level, with state agencies serving as the drivers towards better local collaboration. Below are steps the state agencies on the Executive Committee will seek to take to facilitate healthy collaboration between state and local partners and the development of a strong NWD System.
Establish or engage an existing stakeholder/consumer advisory board - The state agencies overseeing the program will engage with representatives from all the consumer populations served by the NWD System regularly. If one agency already has an active stakeholder advisory group, building on that to bring in representatives from other populations could work well. Meeting quarterly allows for meaningful input without imposing a high burden on participants. Consumer representatives from all populations will have opportunities to weigh in on and shape policy in meaningful ways, review draft policies and tools, providing insight and guidance to the decision-makers about where and how to prioritize resources and improve access. Make sure necessary supports, such as transportation or preparation calls, are available to facilitate consumer input. Dedicate time of a state staff person or contractor to recruit and engage members, ensure diverse representation, ensure meeting accessibility, support active participation, develop agendas and establish mechanisms for rotating in new membership over time.
Communicate project information consistently across all state agencies - Clearly communicate project goals across agencies by designating lead contacts within each agency to receive and then disseminate information about the project. Ensure all state agencies receive information about decisions made by the governing body. They need to understand and then be able to explain the roles and responsibilities of the networks they oversee and fund.
Make specific types of collaboration a funding requirement - To foster collaboration, the lead contracting state agencies must identify key local partners to be included in the NWD System and require that they be part of the collaboration. State agencies that require organizations in their networks to submit area plans will consider requiring collaboration in the development of those plans, or encourage the network of organizations operating in that area to develop one plan to fulfill multiple requirements. The state will provide template MOUs / Agreements to local organizations with specific clauses related to data sharing, staff training, use of common tools and processes to help the lead local agency solidify their partnerships. Make proof of collaboration part of any program audit processes.
Communicate requirements and expectations consistently -State agencies will collaborate to establish protocols and standards of operation for the key functions of a NWD System (public outreach, one-on-one person-centered counseling, assistance connecting with private services, assistance applying for public programs) and apply as consistently as possible across the different services networks. Then work to ensure that policy decisions, program requirements, and expectations are disseminated to the service networks by the state agency that oversees and funds them. By doing this, local agencies will be more attentive and more aware of their role in the system and their potential impact. Plus, they will also know they can receive support from their respective state agencies.
Engage associations that represent key partners - There are strong associations that can serve as an additional source of knowledge and project support. Communicating and collaborating with associations (e.g., Illinois Association of Rehabilitation Facilities, the Arc of Illinois, Illinois Network of Centers for Independent Living ) can provide state agencies with critical feedback, especially if the engagement occurs during the project development phase. Such dialogues can help identify project pitfalls and/or areas of opportunity. These associations can also nominate representatives from local organizations and consumers to serve on the stakeholder advisory board.
Provide funding/resources to local organizations to support collaboration - Many local agencies are stretched thin fulfilling their organizational mission with little time and/or resources to invest in building and strengthening their operations. State agencies will explore opportunities to help local partners acquire the tools needed to build strong collaborations. This support might come in a variety of ways:
- Making local state agency offices available as meeting locations;
- Allowing the use of state video conferencing capabilities to bring partners together from long distances;
- Supporting the purchase of licenses for online conferencing tools such as WebEx or GoToMeeting;
- Supporting agency purchases of equipment such as conference phones, upgraded phone systems, or video conferencing equipment; and
- Hosting grant writing workshops on capacity building to give local agencies the chance to improve their infrastructure.
Whenever possible, recognize partners - Recognize those partners who made collaboration a priority and provided critical feedback, especially if the feedback leads to success or innovation. This is especially important when the state seeks input from community agencies during the project development phase. If and when funding is received; find a way to acknowledge the input of partners who were instrumental in making the project materialize.
Below are some strategies that the Executive Committee would like to recommend to local NWD entry point organizations tasked with bringing community partners to the table:
Work together to establish a shared vision for the NWD System in the area - While some policies and procedures will apply statewide, there must be flexibility to account for variations in capacity and need at the local level. When working on an area plan or other plans, developing a staff training plan, or updating referral protocols, community organizations should engage their local partners that work with different populations with every step and ask them for their input and support. Encourage and be responsive to their input on the goals and objectives and tools.
Communicate clearly the goals and objectives to all partners - Leading local agencies that ask partners to perform tasks must explain how the work fits into the overall system and accomplishes the overall goal. No agency wants more work without knowing the goal.
Be open to input and feedback - Partners should not be dismissed when they have suggestions or input on how the project can better accomplish its goals. The suggestion might not be a priority for the people in one organization, but it may be critically important to their partners with and therefore worthy of attention and resources. When partners provide feedback, it shows their willingness to see the project succeed. Listen to that feedback and, whenever possible, implement their suggestions.
Make meetings accessible to all - Make meetings accessible in terms of time, location, resources, etc. Identify the local resources that can help meet any accommodation needs required.
Make organization available to partners beyond the scope of the project - Including partnering agencies in other opportunities shows they are true partners, not just temporary co-workers on a project. Proactively seek opportunities for collaboration and ways to leverage each other's strength. Join forces on a public outreach effort. Consider ways to collaborate with your local partners on grant proposals so the funding can be shared.
Recognize some partnerships take time to develop - Sometimes collaboration is as simple as making a phone call. For those partnerships that require more work to get started, make clear the benefits and commit to executing these benefits. They can include:
- Cross training / support;
- New joint grant opportunities / amending existing agreements / fundraising support;
- Increased community awareness through cross-branding materials;
- Sharing agency resources in times of need and/or crisis; and
- Designating consistent points of contacts to facilitate cross-agency communication.
Treat partnering agencies as customers - If there is a standard for responding to agency consumers, use that same standard (at minimum) when partners need help. Communicate this standard to staff. Make sure they know who your organization's partners are and why they are important.
Funding and Sustainability Plan
Securing and sustaining funding are a critical component of any successful NWD System. While most NWD System activities are funded by public sources, there may be opportunities to secure private funding streams for certain components of the NWD System in Illinois. Potentially available public and private sources include:
Medicaid Administrative Claiming for NWD System- CMS published guidance for administrative claiming for state Medicaid agencies conducting NWD System functions. NWD System functions eligible for Medicaid reimbursement are listed in Exhibit 13.
Exhibit 13: NWD System Functions Eligible for Medicaid Administrative Claiming
NWD System Function |
Medicaid Administrative Function |
Public Outreach and Links to Key Referral Sources related to enrollment in
Medicaid, or accessing Medicaid services. |
Outreach |
Person-Centered Counseling related to enrollment in Medicaid, or accessing Medicaid services. |
Outreach
Referral, Coordination and Monitoring
Eligibility
|
Streamlined Eligibility to Public Programs related to enrollment in Medicaid |
Outreach |
Eligibility State Governance and Administration related to training
employees engaged in the NWD to be certified application counselors
or otherwise have training to assist in accessing or applying for supports
and services, and in administrative case management techniques. |
Staff Training Provider outreach
Coordination with other programs
MMIS development |
States pursuing NWD System administrative claiming must complete the following six step process:
- Step 1: State Medicaid Agency and NWD System Engagement- The state Medicaid agency must develop a proposal for claiming FFP for NWD System to reflect NWD activities.
- Step 2: Identify Permissible Sources of Non-Federal Funds for Match Purposes- This refers to non- Federal funds that the state must identify in order for CMS to match with Federal dollars.
- Step 3: Identify NWD System Activities Potentially Eligible for Federal Medicaid Administrative Funding- Only expenditures directly related to the Medicaid program are eligible for federal funding. NWD System activity related to privately funded services is likely ineligible for FFP. Any expenditure claimed by the state as Medicaid administration, including NWD System activities, must be for activities to administer the approved Medicaid State plan that are either undertaken by the state Medicaid agency itself, by a contractor, or pursuant to an interagency agreement.
- Step 4: Identify Costs of Allowable and Allocable Activities- The state and its partners must develop a valid administrative claiming methodology that identifies eligible and non-eligible activities and includes procedures to identify, allocate, document, and report the costs of all of those activities.
- Step 5: Establish Contractual Agreements- Any entity other than the state Medicaid agency administering claimed NWD System activities must enter in an interagency agreement (IAA), memorandum of understanding (MOU) or other contractual arrangement with the Medicaid agency.
- Step 6: Secure CMS/DCA Review and Approval- States need to submit their administrative claiming methodology to the CMS Regional Office for review and approval before funding can be provided.
Illinois could consider pursuing NWD System dollars through Medicaid and partner with the state's Medicaid agency (DHFS) to develop a proposal to this end for CMS review and approval.
Older Americans Act Title IIIB Funds - The Title IIIB Supportive Services Program enables older adults to access services that address functional limitations, promote socialization, continued health and independence, and protect elder rights. Together, these services promote older adults' ability to maintain the highest possible levels of function, participation and dignity in the community. Illinois could consider examining whether funds received through Title IIIB of OAA could be applied to NWD System Activities. These funds could be available for, among other functions, providing in-service trainings that call center staff and NWD sites can participate in through program development and coordination administrative-related services performed by the Area Agencies on Aging.
Private Nonprofit Organization Dollars - Illinois could consider partnering with private nonprofit organizations to develop, maintain and license access to two databases that the NWD System Executive Committee identified as important parts of the NWD System- a common client tracking system and an integrated and centralized intake and assessment database. Under this approach, nonprofit organizations would develop these systems and be responsible for maintenance and updating the systems. In return, they would be able to generate revenue through licensing access to other organizations. This approach would require close partnerships with a private entity (or entities), and could cause access issues for organizations unable to afford the licensing fee, but would allow Illinois NWD System providers to have these needed databases without using state funds.
Medicaid Innovation Accelerator Program (IAP) - Members of the NWD System Executive Committee and other groups have suggested the possibility of Illinois requesting housing support from Medicaid. Illinois, led by the Department of Healthcare and Family Services, applied to CMS for a Medicaid Innovation and Accelerator Program technical assistance opportunity late in 2015. Illinois was one of 12 states awarded this technical assistance in order to explore providing supportive housing services and supports (pre-tenancy and tenancy) within the Illinois Medicaid system. The Medicaid IAP
Team should consider creating Supportive Housing Supports and Services for vulnerable aging and disability populations. It is important to note that this program does not come with funding, only support and technical assistance but it could potentially lead to more opportunities for the state to help people to access supportive housing and remain or return to the community.
Governance and Administration - Outcomes by 2019
Goal/Outcome 1: Identify and Formalize Permanent State Level Governance Structure
Performance Indicators/Measurement:
- Development of an interagency MOU;
- Finalization of an interagency MOU; and
- Convening of an interagency leadership meeting(s).
Goal/Outcome 2: Standard Policies across Agencies
Performance indicators/Measurement:
- Identify best practices/policies across agencies.
Goal/Outcome 3: Convene Stakeholder/Consumer Advisory Committee
Performance Indicator/Measurement
- Development of a stakeholder committee membership with significant consumer representation;
- Development of a stakeholder charter;
- Specific accommodations in place to support the participation of people with disabilities; and
- Number of stakeholder committee meetings and percent attendance of members in each meeting.
Public Outreach and Links to Key Referral Sources - Background
Public outreach and links to key referral sources are also critical to the success of the NWD System. Stakeholders consistently noted that consumers who may need LTSS are not aware of their options or how to learn about and gather more information. The NWD System needs to be well-known and recognized, not just in the service sector, but in the broader public sector as well. The Information and Referral portion of the overall NWD System serve as the central referral point for organizations that interact with people who may need information about or access to LTSS. Additionally, consumers seeking information about services and supports on their own should know how and where they can access the NWD System for assistance.
Illinois NWD Entry Points
State agency partners, statewide and regional providers and local community services will all serve as access points to the NWD System. Currently, one of the Information and Referral entities in Illinois is the statewide network of regional ADRNs, known collectively as the Aging and Disability Resource Network (ADRN). ADRNs are sponsored by the Department on Aging and Area Agencies on Aging. In the planned IL NWD System, the function of Information and Referral may begin with any of the access points; followed by a coordinated "warm handoff" to a person-centered counselor if that is the person's need or interest. There are numerous organizations across our system that can help someone connect with a person-centered counselor. Known as NWD Entry Points, the following organizations currently and
routinely work with people in need of information, counseling, and assistance accessing public programs and/or private services. The challenge facing the state and the goal of this three-year plan is to improve how well these entry point organizations coordinate and collaborate with each other.
Illinois' Current NWD System Entry Points:
- Area Agencies on Aging
- Centers for Independent Living
- Case Coordination Units
- Department on Aging Senior Help Line
- Independent Service Coordinators (in some areas)
- Community Mental Health Centers (in some areas)
- Local Medicaid Offices
- Adult Protective Services (APS)
- LTC Ombudsman's Office
- Managed Care Organizations
- Veterans Affairs Offices
- Hospitals
- Physicians' offices and outpatient clinics
- Rehabilitation services providers
- Home health and hospice provider agencies
- Homeless service system
Beyond existing entry points, there are multiple other potential access points that could be developed. These types of organizations often engage with people who may need services and supports but they may not know where to refer people for further information and counseling.
Potential Access Points:
- Public schools
- Local housing authorities
- Free or low cost health clinics
- The corrections and regional jail systems
- Police officers and other first responders
- University and college systems including community colleges (student disability services, health clinics, including behavioral health)
- Career and Technical Education Programs
- Transit programs
- AARP
- Community nutrition services, such as Meals on Wheels and food pantries
As demonstrated during the listening sessions, many Illinois citizens do not know where to turn when they look for services and supports. Many adults and family members have experience with "assisted living" or a "nursing home" but are not aware of the availability of alternative options. In our listening sessions, one woman shared her experience of going through the phone book and cold calling multiple facilities because she had no idea that the option to stay in her own home and community existed.
Through formal agreements, Illinois will seek to develop protocols where nursing facilities must offer a NWD System referral to anyone seeking LTSS information. The NWD System will also partner with the state Long-Term Care Ombudsman and Olmstead programs and CILs to best reach consumers in nursing facilities.
BIP NWD System Marketing Campaign
Through the BIP initiative and the BIP Policy Workgroup, plans are underway to develop a statewide name and logo with input from stakeholders around the state. In conjunction with the larger NWD committee, DHFS is considering a variety of other marketing activities to be determined based on availability of marketing funds from the BIP initiative. The NWD Planning Executive Committee will develop a plan to evaluate the efficacy of marketing and communication as part of the external marketing plan and ongoing evaluation of overall performance.
Public Outreach and Links to Key Referral Sources - Outcomes by 2019
Goal/Outcome 4: Standardize Partnership Agreements between Providers across Populations Performance Indicators/Measurement:
- Field survey to providers across populations and areas of focus (e.g. housing services, employment services, in-home supports) to assess current practices; and
- Analyze survey data.
Goal/Outcome 5: Develop Statewide Branding and Marketing Strategies Performance Indicators/Measurement:
- Convene a marketing working group with membership from multiple state agencies;
- Continue work with marketing contractor;
- Develop and implement branding and marketing campaign(s); and
- Develop guidance for NWD regional networks to coordinate marketing materials.
Goal/Outcome 6: Increase Capacity of Existing 1-800 Number Performance Indicators/Measurement:
- Develop Staff capacity at 1-800 call center; and
- Develop and implement training curriculum for call center staff.
Goal/Outcome 7: Develop and implement "BIP Initial Screen" screening tool Performance Indicators/Measurement
- Coordinate with BIP implementation;
- Develop training curriculum for relevant staff on screening tool; and
- Assess the screening tool's efficacy.
Goal/Outcome 8: Increase Housing-Specific Awareness Performance Indicators/Measurement
- Use of existing state resources (e.g., IL Housing Locator, "Heads Up on Housing" newsletter, DHS and IHDA websites);
- Development of new resources; and
Person-Centered Counseling - Background
PCC Training and Statewide Development Plan
The Administration for Community Living (ACL) established Key Elements and indicators of a fully functioning NWD System. One of the Key Elements is "person-centered counseling," an outgrowth of options counseling that includes complimentary parallels in skills and planning to the 2014 Home and Community Based Services (HCBS) rule on community living. Illinois has existing options counseling protocols and, as part of the Nursing Home Deflection project, protocols for person-centered counselling, which build off of the options counseling standards that were suggested by ACL. The state has done a crosswalk comparing existing options counseling standards for ADRNs and person-centered counseling and the two services are closely aligned.
The skills and tools of person-centered counseling are useful with anyone who may need some type of support or services. Around the world, organizations are using person-centered practices to support people who experience homelessness, people with complex health needs, older adults living at home, transitioning back home and/or transitioning to facility-based care, people with disabilities, people using behavioral health services, correctional services, people who have survived trauma, etc.
In the United States, the principles and values of person-centered practices have been a foundation of disability services since the 1970s, beginning with the Independent Living movement and the anchoring concept of "nothing about me without me." Since that time, more formal planning processes and structured sets of skills and tools have been tested and are widely used in communities of people with intellectual and developmental disabilities diagnoses, behavioral health diagnoses, and aging and older adult services. Many people who presently work as options counselors, social workers, and discharge or transition planners have some, if not significant experience with the core values and principles of person- centered practices. When designing training, it is important to recognize the skill set that many training participants already have and ensure that training serves as an opportunity not only for participants to learn, but also to share their own experiences and expertise with their peers. The purpose of any training that Illinois will develop will be twofold:
- Introduce skills, tools, and concepts to people who have not previously been exposed
- Provide an opportunity for additional learning and sharing of expertise for people who are familiar with and/or skilled in person-centered practices
As part of its on-going effort to build a statewide NWD System and promote home and community-based options, Illinois intends to increase capacity for developing person-centered counselling skills and in-state training opportunities. Core strategies to achieve that goal include plans to implement person-centered thinking and planning trainings.
Illinois has already committed to hosting two, single day interactive trainings for Case Coordination Units in 2016, followed by a third day of trainer-preparation, as well as two (2) additional webinars to support new trainers and two (2) additional check-in opportunities for new trainers. The anticipated start date for these trainings is late September, 2016.
The framing and core values and skills of the person-centered approaches that will be covered in these trainings include:
Acknowledge - See people through the person-centered lens
- The concept "nothing about me without me "
- Respect and dignity at all times for the person (Credo for Support)
- Incorporation of housing information into broader marketing/campaign efforts.
- Recognition that the person is the expert on his/her life
Believe - Come to the person with a set of strongly held beliefs
- Engagement starts with a presumption of competency and capability
- Finding balance between what is "important to" a person with what is "important for" the person. A belief that "behavior is communication"
- A belief that how people who use services live (not necessarily 'where') and are supported impacts how they engage with us
Equity - Understand that you are one of two equal parties in this discussion
- Negotiation around things the person needs and things the person wants
- Consider:
- What the system can provide
- What non-paid supporters/caregivers, systems and organizations can provide.
Understand - The role that "the system" as well as family/friends can play
- Understanding the role of families, loved ones and friends in supporting someone (or not, depending upon what the person's wishes are)
- Understand what the system can provide
Balance - There are limits to this process
- Choice and control have boundaries for everyone[i] - whether one uses of a system of supports or not
- Being person-centered is not a panacea. People may still engage in actions and behavior that loved ones and systems have concerns about. Implementation of person-centered practices has shown to reduce the incidence of such actions as people who know and care about the person better understand the "why" behind the actions; and as people who have historically been in a powerless position are supported to assert control over their own lives .
- Person-centered practices can be implemented differently from agency to agency, and likely from "person to person" or "groups of people" to other "groups of people." That is, the implementation of person-centered practices in mental health services looks different than implementation with people using I/DD services, which looks different than implementation in the aging network, which looks different than implementation with people who have physical disabilities, etc.
Person-Centered Counseling (PCC) - Outcomes by 2019
As follow up to the September 2016 person-centered practices and approaches training, Appendix C includes a detailed action plan for Goals # 14 and 15 of implementing the NWD System function of Person-Centered Counseling. The initial training in September 2016 supports the action steps in Goal 14 of identifying a curriculum and increasing trainer capacity.
Goal/Outcome 9: Increase and Expand Provider-Level Staff Capacity across Organizations and Populations Served
Performance Indicators/Measurement:
- Identify both foundational skills and specific (e.g., cultural-specific, diagnosis-specific) skills for both Person-Centered Counseling and Person-Centered Planning;
- Build a standard, foundational training curriculum to use across state agencies; and
- Develop sustainability approach for training and ongoing capacity building.
Goal/Outcome 10: Develop Standardized Toolkit of PCC/PCP Resources Performance Indicators/Measurement:
- Step-by-step guidance (written and web-based) for use by person-centered counselors when conducting person-centered counseling that includes input from people using services and PCCs; and
- Develop a set of "standards of practice" for person-centered counselors; using input and feedback from current person-centered counselors, aligned with ACL expectations.
Streamlined Access to Public Programs - Background
As described in the background section of this plan, Illinois plans to build on efforts that have been underway for many years to help people understand their options and access public programs that will help them meet their LTSS needs. These include the Aging and Disability Resource Center initiative, the Coordinated Entry Point Initiative, and the BIP. In addition to these, there is a Health and Human Services Transformation effort underway that will be coordinated across multiple state agencies involved in delivery and oversight of LTSS programs.
Streamlined Access to Public Programs - Outcomes by 2019
Goal/Outcome 11: Connect People Who Are Eligible for LTSS to Housing Services (e.g. affordable and accessible and/or supportive housing)
Performance Indicators/Measurement:
- Inclusion of housing Items on BIP Initial Screen;
- Use of findings from IL Supportive Housing Workgroup's reports; and
- Coordination with other relevant federal awards (BIP, Medicaid IAP).
Goal/Outcome 12: Develop and Implement Uniform Assessment Tool (UAT) Performance Indicators/Measurement:
- Contract with a software vendor;
- Software testing;
- Wave One UAT Rollout; and
- Statewide UAT Rollout.
Goal/Outcome 13: Promote Consistency in Messaging and Instructions about LTSS Options Performance Indicators/Measurement:
- Inventory of common acronyms, words and definitions;
- MOA/IGA across agencies to use common terms; and
- Identified points of accountability for MOA/IGA.
Goal/Outcome 14: Develop Common Client Tracking System Performance Indicator/Measurement
- Inventory of Existing Tracking Systems;
- Contract with a software vendor;
- Software testing; and
- Software deployment.
Goal/Outcome 15: Improve Transitions and Data Sharing Performance Indicator/Measurement
- Use of client tracking system for data sharing;
- Protocols and MOUs for data sharing; and
- Help desk content and support for front-line (e.g., call center) staff.
Conclusion
In conclusion, the Illinois NWD System Planning Executive Committee is excited about the opportunities before us. We recognize that transformational change takes a long time and in many ways never ends, if we are to continually strive to demonstrate best practices. We understand we will experience setbacks and at times, the pace of change will likely seem slow. Our stakeholders and this Three-Year Plan will guide us and we are committed to moving ahead with everything outlined in this plan, as best we can, even in the face of budget shortfalls and resource constraints. The citizens of Illinois who currently use LTSS or will eventually need LTSS deserve nothing less.