REVISED 8-18-04
2001 Real Choices Systems Change Grant Work Plan
(7/1/02—9/30/05)
[Text version]

PURPOSE:  Remove the institutional bias in Iowa’s service system and afford Iowans with disabilities and Iowans who are elderly real choices about living in the community.
 
GOALS:

• Prevent institutionalization of people with mental retardation, developmental disabilities, mental illness, brain injury, or other disabilities and people who are elderly by developing a coordinated system of community supports and transition services that make life in the community possible for persons in Iowa.  To the extent possible, these efforts shall include people with disabilities who currently reside in correctional facilities.
  
• Increase consumer choice in identifying and securing community supports and services for those who could live more successfully in the community with appropriate supports.
  
• Facilitate development of a broader range of services for persons with disabilities in Iowa and stronger linkages for information about those services.

SERVICES/OBJECTIVES:
 
I. Obtain stakeholder commitment for the Real Choices project.

A. By 1/15/03, the Contractor will work with the Olmstead Real Choices Consumer Taskforce to secure an Executive Order from the Governor mandating that the directors of key state agencies work with the Olmstead Real Choices Consumer Taskforce to identify barriers to community living and develop coordinated interagency plans to overcome them.

B. By 2/15/03, develop linkages between the Real Choices project and the Iowa Mental Health/Mental Retardation/Developmental Disabilities/Brain Injury Commission (MH/MR/DD/BI Commission) so that policy and service system restructuring initiatives relating to Iowa’s disability services will be coordinated. Upon completion of initial steps and ongoing throughout the project, provide reports to DHS and the Olmstead Real Choices Consumer Taskforce on implementation.

C.  By 6/15/03, develop linkages between the Real Choices project, the Department of Elder Affairs, and the Senior Living Coordinating Unit so that policy and service system restructuring initiatives relating to Iowa’s long-term care services will be coordinated. Upon completion of initial steps and ongoing throughout the project, provide reports to DHS and the Olmstead Real Choices Consumer Taskforce on implementation.

D. By 1/31/03, identify and link with all related federal and state systems change initiatives [e.g. Medicaid Infrastructure Grant, Department of Elder Affairs Seamless Systems and Aging and Disability Resource Center grants, Bridge to Employment (DHS cooperative agreement with SSA), Iowa PATHS (DVRS’ RSA Systems Change grant), Iowa Workforce Development’s Work Incentive grant from DOL, Black Hawk CIL’s Project IMPACT (SSA Benefits Counseling grant), Iowa Consortium for Mental Health, “Meeting the Needs of Iowans with Traumatic Brain Injury (TBI)” (IDPH), Think COMPETENCE! (DD Council’s community capacity building project), Living Well with a Disability (IDPH Prevention of Secondary Conditions grant from CDC), and the Core Indicators Project]. Upon completion of initial steps and ongoing throughout the project, provide reports to DHS and the Olmstead Real Choices Consumer Taskforce on implementation.

E. By 1/31/03, link the Olmstead Real Choices Consumer Taskforce with all key stakeholders needed to accomplish the project’s goals. Upon completion of initial steps and ongoing throughout the project, provide reports to DHS and the Olmstead Real Choices Consumer Taskforce on implementation.

II. Compile descriptive data (e.g. occupancy rates, length of stay, acuity levels) about Iowans with disabilities and elderly Iowans living in institutional settings to develop an aggregate analysis of placement appropriateness.

A. By 9/15/02, clarify the populations and settings to be targeted.

B. By 6/30/04, conduct surveys (mail, with phone follow-up) of selected settings to ascertain estimates of basic demographics, occupancy rates, length of stay, and payer sources.

C. By 7/31/04, conduct focus groups on-site in a sample of settings to identify primary reasons for stay, barriers to less restrictive settings, and financial implications.
NOTE:   A sub-sample of these residents will be asked to participate in the piloting of the assessment protocols to be developed under Objective IV.

D. Quarterly reports to DHS and the Olmstead Real Choices Consumer Taskforce will address updates and outcomes for each of these steps.

III.  Identify and prioritize policy barriers to community living and strategies for overcoming them. 

A. By 10/31/02, work with the Olmstead Real Choices Consumer Taskforce to identify issues to be addressed through the project’s Policy Agenda.

B. By 3/31/03, develop action plans to address the Taskforce’s policy priorities:

•  Implement Executive Order 27 by assisting state agencies to identify and remove barriers to community living, and assisting the legislature to understand the implications of Olmstead for public policy.

  1. On-going through 9/30/05, provide technical assistance to the 19 state agencies identified in Executive Order 27 to help them incorporate Olmstead implementation into their agency’s strategic planning activities.

  2. Complete quarterly reports to the Lt. Governor on the progress of this initiative.

• Use the Independence Plus template to begin the process of incorporating self-direction into all six of Iowa’s Home and Community-Based Waivers.

See Attachment B, Iowa’s Infrastructure Development for Self-Direction.  The activities for which 2001 Real Choices grant no-cost extension resources are requested are coded with the letter A.  They are also highlighted in yellow with timelines identified.

• Advise the Iowa MH/MR/DD/BI Commission on the redesign Iowa’s disability service systems for adults and children by integrating an Olmstead perspective into redesign recommendations.
  
  1. Participate in the bi-monthly Commission work group meetings to ensure an Olmstead perspective is integrated into DHS planning for service system redesign.  (Work groups include Universal Access, System Financing, Functional/Diagnostic Eligibility Standards, Core Services, State Institutions, and Residency.)
     
  2. Serve as a member of the Oversight Committee that will oversee the redesign of Iowa’s Developmental and Behavioral System for children and families.
     
  3. Report to the MH/MR/DD/BI Commission as requested.
     
     
• Assist the Department of Elder Affairs and the Senior Living Coordinating Unit in rebalancing Iowa’s long-term care system.
  
  1. Participate as a member of Iowa’s team in the National Governors Association Best Practices Academy on Long-Term Care redesign.
     
  2. Incorporate Iowa Agency on Aging representation on the Olmstead Real Choices Consumer Taskforce to ensure self-direction planning meets the needs of Iowans on the HCBS Elderly waiver who choose to self-direct.

C. By 6/30/05, implement action plans and report quarterly to the Taskforce and Department of Human Services.

IV. Develop a comprehensive screening and assessment process that prevents unnecessary, premature, or inappropriate institutionalization and assists consumers in identifying the supports and services necessary for community living.  The process would also continue subsequent to needed institutionalization to ensure the individual could be returned to their community should this become possible.

A. By 1/31/03 and on-going, gather information from Iowa, other states and national experts about screening and assessment protocols appropriate for the populations to be addressed through the Real Choices project.

B. By 8/31/04, select and/or develop screening instruments and conduct retrospective feasibility studies with appropriate groups.

C. By 4/1/05, refine the screening tools based on the feasibility studies and conduct prospective evaluations with individuals in institutional settings.

D. By 9/1/05, refine the assessment protocols based on the prospective evaluations and complete scoring and interpretation protocols.

E. By 9/30/05, provide technical assistance to the MH/MR/DD/BI Commission’s work group on functional screening and assessment to facilitate the adoption of the tools in Iowa’s redesigned adult system.

F. By 9/30/05, provide technical assistance to the Department of Human Services, Department of Elder Affairs and Senior Living Coordinating Unit to facilitate the adoption of the tool for the elderly in the Iowa Elderly Medicaid Waiver.  In addition, prepare legislative and regulatory proposals that would facilitate the implementation of the tool in a greater array of venues outside the Elderly Waiver.

V.  Provide individuals with disabilities, family members, providers, policy makers, and other stakeholders with information to make choices on accessing needed resources, services, and supports in the community.

A. By 1/31/03, develop in conjunction with the Olmstead Real Choices Consumer Taskforce a comprehensive plan--specific to particular audiences--for disseminating information about the Olmstead Supreme Court decision, the Real Choices project, and community resources, services and supports.  The plan will include a process for developing and continually updating presentation materials and tracking conferences/meetings to identify opportunities to keep key stakeholders informed of project activities. The plan must also present strategies for enhancing Iowa’s current information and referral system to assist all stakeholders with accessing information that would be helpful in preventing institutionalization.  It will also include strategies for identifying and utilizing others’ delivery mechanisms (e.g. newsletters, conferences, meetings, web-based housing registry) for dissemination.

B. Implement the plan in accordance with the timelines approved by the Olmstead Real Choices Consumer Taskforce.

C. Throughout the project, periodically update the plan as progress is made addressing barriers to community living; implement additional information initiatives.

VI. Develop knowledge and skills in individuals with disabilities, family members, providers, policymakers, and other stakeholders so they can implement self-direction in Iowa’s HCBS waiver programs.

A. By 12/31/04, develop in conjunction with the Olmstead Real Choices Consumer Taskforce training curricula that will assist in building the infrastructure to implement self-direction in Iowa’s HCBS waivers. The curricula will include:

•  Training for Independent Support Brokers who will assist individuals with disabilities and Iowans who are  elderly in making their own choices about how best to use individualized budgets to achieve their goals.
                Again, See Attachment B, Goal 3, Tasks 3.2.1-3.2.3
  
•  Training for Fiscal Management Services to support self-direction. 
            Again, see Attachment B, Goal 4, Tasks 4.2.1-4.2.3

B. Through 6/30/05, conduct training for individuals with disabilities interested in self-directing, for potential independent support brokers, for potential fiscal management service providers, and other stakeholders. 
See Attachment B, Goal 7, Tasks 7.3.1-7.3.5

VII. Evaluate the success of the Real Choices project using parameters approved by the Olmstead Real Choices Consumer Taskforce and the Department of Human Services.

A. By 3/15/03, subcontract with a neutral third party to develop and implement an evaluation protocol for the project.  The evaluation will include the development of performance measures and outcomes mutually agreed upon by the Contractor, DHS, the Olmstead Real Choices Consumer Taskforce and the evaluator for ongoing measures of accomplishment throughout the implementation of the contract. 

NOTE:  This subcontract will be extended through 9/30/05 so that an evaluation component will be operational during the no-cost extension period.

Quarterly reports will be submitted to DHS regarding achievements of efforts outlined in this work plan.  Reports will be written in the same format as the final and approved Work Plan and shall address progress under each topic area.  As tasks are completed, they will be identified in the quarterly progress reports.  Any tasks not accomplished by the identified time frames will be reported to DHS and the Olmstead Real Choices Consumer Taskforce and any modifications or extensions to the time frames will be approved by DHS with knowledge of the Olmstead Real Choices Consumer Taskforce.  (8-18-04)