NCI-AD Overview. Quality of life survey focused on older adults and adults with physical disabilities Assess outcomes of state LTSS systems

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1 NCI-AD Overview June 22, 2016 What is NCI-AD? Quality of life survey focused on older adults and adults with physical disabilities Assess outcomes of state LTSS systems Skilled nursing facilities Medicaid waivers Medicaid state plans Gathers information directly from consumers through faceto-face interviews State-developed initiative MLTSS populations State-funded programs, and Older Americans Act programs Relative of the ID/DD systems National Core Indicators (NCI) 1

2 Measures Community Participation Choice and Decisionmaking Relationships Satisfaction Service and Care Coordination Access Self-Direction of Care Work/Employment Rights and Respect Health Care Medications Safety and Wellness Everyday Living and Affordability Planning for the Future Control Adult Consumer Survey Pre-survey Form Used to setup interviews, for use by the interviewers only Background Information (21 questions) Demographics and personal characteristics: gathers data about the consumer from agency records and/or the individual Consumer Survey (90 (51 proxy) questions) Includes subjective satisfaction-related questions that can only be answered by the consumer, and objective questions that can be answered by the consumer or, if needed, their proxy Interviewer Feedback Sheet Asks interviewer to evaluate the survey experience and flag concerns 2

3 What Sets NCI-AD Apart? States own and have immediate access to their own data Can be used across settings and funding sources States can add questions to the survey tool Can provide state, program, and regional comparisons Crosswalks to NCI (ID/DD) measures Focuses on how consumers experience services and how services impact their quality of life Goes beyond service satisfaction Provides transparency and accountability State and National reports are publicly available online Provides timely and actionable data over time Funding Mechanisms Medicaid Administrative Match 50% reimbursement Older Americans Act Administrative funds Using the State s External Quality Review Organization 75% reimbursement Balancing Incentive Program (BIP) Money Follows the Person (MFP) Grant Funding State funding mandated by statute 3

4 7 History and Development Project Development and Launch Steering Committee established and survey dev. began NCI-AD survey finalized Mid-Year Report released; NCI-AD.org website launched 13 statespecific reports for will be available Dec 2012 Jun 2013 Jan 2014 Mar 2015 Jun 2015 Jun 2016 Jun 2016 Dec 2016 Jan 2017 NASUAD Board voted to begin work on NCI-AD Pilot survey in GA, OH, and MN 1 st year of surveying launched in 13 states 2 nd year of surveying began June 1 st with 3 new states national report will be available 4

5 Validity and Reliability - Extensive revision and testing - Validity Face validity Content validity Concurrent validity Cognitive testing - Reliability Internal consistency Inter-rater State Participation

6 How States Use Data Using NCI-AD Data Quality improvement efforts (CQI framework) Quality assurance in managed care Process measures: choice, control, access to community and safety Pre-MLTSS data can be used as a baseline before the transition Compliance Olmstead planning, BIP, MFP Benchmarking and comparing data nationally Identifying service needs and gaps Allocating services Budget justifications to state legislatures Communicating with family and advocates 6

7 New HCBS Requirements Many states are using NCI-AD data to demonstrate compliance with the new HCBS Settings Requirements Data may also be useful for quality management activities with the Person-Centered Service Planning Requirements Tennessee State Transition Plan (1115 CHOICES): Annual surveys to demonstrate ongoing compliance Compare to Individual Experience Assessment to identify trends or variances 7

8 HCBS Person-centered Service Plan Process Requirements* Service planning process is driven by the individual Includes people chosen by the individual Provides necessary information and support to ensure that the individual directs the process to the maximum extent possible Is timely; occurs at times and locations convenient to the individual Reflects cultural considerations Plan discussions are in plain language. Information is available in a manner that is accessible to individuals. Includes strategies for solving disagreement within the process, including clear conflict-of-interest guidelines for all planning participants Offers choices to the individual regarding the services and supports the individual receives and from whom Provides a method for individual to request updates May include whether and what services are self-directed Signed by all individuals and providers responsible for its implementation. A copy of plan must be provided to individual and his/her representative. Includes individually identified goals and preferences related to relationships, community participation, employment, income and savings, healthcare and wellness, education and others Identifies the strengths, preferences, needs (clinical and support), and desired outcomes of individual Includes risk factors and plans to minimize them Conducted to reflect what is important to the individual to ensure delivery of services in a manner reflecting personal preferences and ensuring health and welfare NCI-AD Data Available Not addressed Not addressed Not addressed Not addressed Not addressed *Applicable to 1915(c) waivers and 1915(i) state plan options. 8

9 NCI-AD Process Timeline 6+ months June 1 st May 30 th December Planning Survey Year Begins Data Due State-by- State and National Reports Issued 9

10 Expectations for Incoming States Commit to technical assistance year and 1 year of surveying Develop a project team and contact state agency partners (Medicaid, Aging, and Disability) Monthly technical assistance calls Determine target populations and sample design Contract with vendor or develop team to conduct interviews Gather pre-survey and background information from administrative records In-person interviewer training Send data to HSRI through ODESA Review state report Data are published on Mid-Year Results Six State Report 10

11 National Report Categories for State Samples State Combined Medicaid program Aging PD Medicaid BI Medicaid Medicaid program program program Colorado EBD Waiver (N=312) N/A N/A N/A* Georgia CCSP Waiver (N=331) N/A N/A N/A OAA OAA (N=88) HCBS (N=470) SNF N/A N/A Maine** Consumer Directed PC Services; Elder and Adults with Disabilities Waiver; Private Duty Nursing; (N = 261) N/A N/A N/A OAA (N=90) N/A MaineCare Day Health Mississippi Assisted Living Waiver; Elderly and Disabled Waiver (N=52 9) N/A IL Waiver (N=293) TBI/SCI Waiver (N=113) N/A N/A North Carolina MFP (N=56) PACE (N=57) CAP/DA (N=224) N/A HCCBG (N=296) SNF (N=331) New Jersey NJ Family Care (4 MCOs) (N=415) PACE (N=101) N/A N/A OAA (N=104) SNF FFS (N=104) Total N Type of residence 22 State Own or Family Home Group Home Adult Family Home, Foster or Host Home Assisted Living Facility Nursing Facility Homeless Other Don t Know CO 82% 0% 1% 8% 1% 0% 2% 5% GA 43% 9% 1% 2% 2% 0% 0% 44% ME 72% 0% 0% 27% 0% 0% 1% 0% MS 93% 0% 0% 6% 0% 0% 1% 0% NC 59% 0% 0% 2% 36% 0% 2% 0% NJ 51% 0% 1% 7% 39% 0% 1% 1% NCI-AD Average 67% 2% 0% 8% 13% 0% 1% 8% 11

12 Satisfaction 23 Everyday Activities 24 12

13 Self-care 25 Community Participation 26 13

14 Transportation 27 Choice and Decision Making 28 14

15 Choice and Decision Making 29 Choice and Decision Making 30 15

16 Choice and Decision Making 31 Safety 32 16

17 Safety 33 Safety 34 17

18 Safety 35 Rights and Respect 36 18

19 NCI-AD Website Houses: Project overview Reports Webinars Presentations Staff contacts State-specific project information Data powered by HSRI Project managed by NASUAD For Additional Information: Kelsey Walter, NCI-AD Project Director, NASUAD Julie Bershadsky, NCI-AD Project Director, HSRI 19