Exhibit 1 - Details of Project Components.docx

DoAS System - Exhibit 1 Details of Project Components

Table of Contents

DoAS Concepts Section 4.2 Functional Requirements Funding:

Federal and state funds are distributed among the AAAs/ADRCs and other providers through Area Plan Contracts (APCs) and other grants in SAGE. DoAS often refers to programs as either falling into the category of Area Plan Contract (APC)/Older Americans Act (OAA) programs OR State Funded programs. APC/OAA programs include services provided by the AAA/ADRC or by their subcontracted providers. State Funded programs include SRCP, AADSP, CHSP, JACC which include services provided by community-based organizations and sometimes directly by the AAA/ADRC.

Area Plan Contracts:

· Area Plan Contracts between DoAS and AAAs/ADRCs outline the services and budgets required to administer various programs and services.

· The AAAs/ADRCs draw up contracts with community provider agencies, based on budgets and units of service.

· The AAAs/ADRCs also partner with other provider organizations without funding or contracts involved.

· The Area Plan Contract is in SAGE, once the information in SAGE is approved by DoAS staff, the AAA/ADRC will enter units of service in the System based on that approval.

Service Delivery:

The AAAs/ADRCs administer programs and services to individuals directly and through a number of providers. Providers include government organizations and community-based organizations. The system will track units of service provided to individuals by providers including the AAA/ADRC. AAAs/ADRCs, government organizations and community-based organizations are all examples of Providers in the system.

Adult Protective Services (APS):

AAAs/ADRCs from a few select counties also provide Adult Protective Services (APS). Other counties contract with Provider Agencies to render APS related services to the individuals. The System will receive de-identified data from the APS system to record units of service in the System for federal tracking purposes.

MLTSS and JACC Clinical Assessments:

Counties send referrals to OCCO to perform clinical assessments for individuals who may be eligible for MLTSS or JACC. The referrals to OCCO will occur in the System but the clinical assessment process occurs in NJCHOICE.

Consumer Flow Through the System Section 4.2.1 Intake and Maintenance of Individual Records Table 1 – Intake Requirements Intake Basic Information Gathering:

The intake process begins when an individual approaches the AAAs/ADRCs, Providers, or sub-contracted agencies to obtain information and assistance, and if necessary, services. An individual can either visit any of these locations in person or contact them via phone. The intake worker will access the System to check if the individual’s record exists.

Existing Individual:

· The intake worker will access the individual’s record and begin updating it with additional information.

· The record would indicate the services received by the individual from any of the programs within the System. (Access to this information will be restricted based on user roles) New Individual:

· An individual’s record will be created and basic demographic information (such as name, age, date of birth, gender, race, ethnicity etc.) will be captured.

Information and Assistance Based on the interactions with the individual and the basic information provided, the intake worker will try to determine the provider and program which could best serve the individual’s needs.

For individuals seeking information and assistance only:

· The intake worker will obtain relevant information regarding Providers and services from the DoAS web portal (linked to the System) and advise the individual of available options.

· If applicable, the intake worker will also facilitate registration to relevant DoAS programs. This includes filling out applications to services provided by any units within DoAS (e.g. NJSave Application).

· If applicable, a referral will be sent to a Provider for the required services indicating that the service delivery process can be performed by the Provider for this individual.

· Depending on the services and needs identified, the intake worker will capture the ‘classification of service’ (i.e. if the services required are JACC, APC, SHIP services, etc.) and the ‘units of service’ (any information given to the individual or any service provided is captured as a unit of service)

Individuals seeking further assistance and support and who have met the criteria for setting off any DoAS triggers, will require further processing, typically a screen for community services (SCS).

Triggers Triggers are pre-determined statements/information gathered from the individual that raises a flag requiring further investigation, e.g., Statements such as ‘I am house bound’, ‘I live alone’, etc.

· The intake worker will capture any triggers that occur during conversations with the individual.

· Triggers will determine if a Screen for Community Services is required for the individual. Individuals that do not trigger any requirement for a detailed screen are advised of available service options and a referral is sent to the relevant Providers, if required.

· For information on the Level 1 Screen for Community Services (SCS), see Assessments section.

Options Counseling for Programs and/or Services The initial options counseling is an interactive decision support process whereby individuals, family members and/or significant others are supported in their deliberations to determine appropriate long-term services and supports in the context of the individual’s assessment results, needs, preferences, values and individual circumstances.

· The system user presents service options to the individual based on their Level of Service, determined by the SCS.

· All discussions with the individual are captured in the System.

Assessments Section 4.2.2 Assessment Table 2 – Assessment Requirements Multiple Assessments are completed in the System. They include but are not limited to:

Screen for Community Services (Level 1) Individuals who meet any DoAS triggers are screened via SCS which is an assessment in the System. The goal of the SCS is to serve as a predictor of those individuals at risk of nursing home placement and determines the most appropriate Level of Service to determine if the individual can benefit from a comprehensive care needs assessment.

· The outcome of the SCS determines which of the 5 levels of service the individual will be classified as.

· Subsequently, the levels of service guide the next steps for the individual. An individual who receives a Level 1 or 2 (that do not require extensive nursing level of care or extensive personal care) are typically counseled on their options available through Older Americans Act and certain State Funded programs (this process is referred to as Options Counseling). An individual who receives a level 3, 4 or 5 (that require a higher level of assistance and care) are sent to OCCO or an assessor county to receive a NJ CHOICE assessment. The result of that assessment may make them clinically eligible for MLTSS.

· In addition, the screen includes a set of financial questions that give an indication of potential Medicaid financial eligibility.

Nutrition Screen This is an assessment that determines an individual's nutrition need for services under the Area Plan Contract.

Case Management & Service Delivery Section 4.2.3 Case Management & Service Delivery Table 3 – Case Management and Service Delivery Requirement

The delivery of services to individuals is performed by Providers associated with programs in the System.

The Case Management function of the System is utilized for individuals enrolled in State-funded programs and OAA programs. Case Management & Service Delivery may be performed by DoAS or providers in the System.

APC & OAA Programs For individuals enrolled in programs funded by the APC, a referral is sent to the Provider indicating that service delivery for the individuals can begin. A separate ISA or PA is not required because the services are provided under the APCs.

Upon receipt of a referral from another System user, Providers associated with APC services will record units of service delivered to an individual. Additional features include ability to create and maintain rosters, routes and other Provider related functionality.

State Funded Programs For individuals enrolled in programs funded directly by state (State-Funded programs) authorization for services is required by means of an ISA or PA. These programs include SRCP, AADSP, CHSP, JACC. Authorization must be completed ahead of any service unit recording for State Funded Programs.

Without FI Interaction: The service delivery details for these programs will be entered directly into the System by the Providers of the service. Aggregate units of service recorded will be sent to the SAGE System, via an interface. Presently, these programs include SRCP, AADSP, CHSP, and APC/OAA programs.

Care Management DoAS often uses the term Care Management to describe certain functions within the System that fall within the “Case Management & Service Delivery” requirements. Care Management may include searching, creating, and updating Individual records; making referrals; receiving referrals and assignments; conducting Assessments; creating and modifying Plans of Care; writing narrative notes; entering units of services performed; managing budgets of Individuals for services; and managing wait lists.

Plan of Care Once an individual is enrolled a program that offers Care Management, the user selects a care management agency (provider) to perform the care management functions for the individual. Care Management occurs under APC and State Funded Programs. The selection of the agency is based on multiple criteria such as program enrolled in, proximity to the individual, capacity of the agency, existing budget, wait lists for the availability of services, etc. The care management agency then assigns a Care Manager to oversee the individual’s record and manage the services.

The Care Manager visits the individuals in person and develops the Plan of Care in association with the individuals and their family members. The PoC provides detailed information about the service options available to the individual, the frequency of service and the hours of services. The Care Manager will confirm that Providers are available to provide the necessary services. The final draft of the PoC is prepared and the Care Manager calculates the PoC budget for the individuals. For JACC, the copay amounts are calculated using the ‘copay calculation worksheet’.

The final PoC is signed off by the individual, the Care Manager and the care manager’s Supervisor. In certain JACC cases, the PoC requires additional review and approval by the state, accompanied with a Prior Authorization.

For JACC, an Individual Service Agreement (ISA) is then generated and sent to the Provider. The ISA is also sent to the FI via an interface.

On-going Care Management The ongoing care management for an individual involves the following actions:

· The PoC is reviewed periodically and updated (or re-written in circumstances such as reduction in service) as required.

· The monitoring record is used to maintain a log of the changes in the individual’s condition or any changes opted for in the PoC.

· Reassessments (annual or in case of significant change in condition) are conducted by Care Managers.

· For JACC, Care Management agencies generate monthly ISAs and bill the FI for providing case management services to the individuals.

Interfaces with the System Section 4.3.10 Interface Plan Table 7 – System Interfaces Adult Protective Services System Interaction with the System Adult Protective Services (APS) are social services provided to abused, neglected, or exploited individuals over 18 years of age. The System will need to interface with the DoAS APS Client Information System to obtain service units and general program statistics.

NJ Choice Portal Interaction with the System The NJ Choice Portal Assessment for Clinical Eligibility for MLTSS is an assessment completed by the Office of Community Choice Options (OCCO) or other stakeholders which occurs outside of the System but results are shared with users in the System. This assessment is sometimes referred to as the Level 2 Functional.

The assessment process begins when referring agencies (AAA/ADRC or their providers) send a referral to OCCO for determination of clinical eligibility. OCCO staff will have access to the individual’s record in the System, including their assessment history. An Assessor is assigned who will visit the individual in person, perform the assessment and enter the details of assessment into the NJ Choice Portal. The outcome of the assessment will be sent back to the System through an interface in the following format.

Assessment outcome will be entered as

Fiscal Intermediary (FI) Interaction with the System Upon receipt of the ISAs from the Care Managers, Providers can begin service delivery, in accordance with the services identified in the ISA. Once services are delivered, Providers bill the FI for the services provided. The FI sends service delivery information back to the System via an interface. The Care Managers can thus verify if services provided were in accordance with the PoC. In addition, expenditure data received from the FI will be sent to the SAGE the System, providing DoAS with an aggregate view to the overall expenditure for each State-funded program.

Providers for State-funded Programs (interacting with FI) Providers for certain State-funded programs will not have access to the System since they will send data related to service delivery directly to the FI. The ISAs generated and sent by the Care Manager to the Providers and the FI are the basis for service delivery. Upon provision of services, Providers bill the FI and the FI will then send information regarding the service delivery to the System. Aggregate data regarding services provided (dollar amount) will be sent from the System to SAGE via an interface.

Integrated Eligibility System Interaction with the System (Medicaid) A system or group of systems to support eligibility determination. 1. Real-time interface to check the Medicaid Eligibility of Individuals (API/ Web Services) 2. Weekly batch download of list of Individuals who have recently been determined eligible for Medicaid. Receive information on Medicaid Eligibility of Individuals Salesforce.

DoAS Eligibility System Interaction with the System (DES) Eligibility system for NJSave and other Federal and State programs. The System shall interface with the DoAS Eligibility System (DES) for State-funded programs in C/CMAS will be handled by and administered by SHIAD. Real-time interface to check the Medicaid Eligibility of Individuals (API/ Web Services) Daily batch updates Financial Eligibility and eligibility status for State and federally funded programs.

Federal Reporting System (OAAPS) interaction with the System OAAPS is the software tool used by SUAs to submit the annual State Performance Report (SPR) to ACL Review and approve the submissions. The OAAPS software includes features for data entry, validation, quality analysis, and approval The SPR is the annual report on State formula grants under Titles III and VII (Chapters 3 & 4) of the Older Americans Act Salesforce SAGE Interaction with the System All State-funded programs will be set up in SAGE similar to the existing System structure for Area Plan Contracts.

Providers for certain State-funded programs (such as JACC) bill through the Fiscal Intermediary.

Providers for APC and OAA programs receive payment for services directly from the grantee agency/sponsor agency/AAA and do not interact with an FI. Providers associated with APCs will have access to the System. The area plan contracts with these Providers are set up in SAGE which captures details such as the Contract IDs, Service Codes, Fund IDs and Unit Rates. Once a Provider is selected in the System to deliver services to an individual, the existing contract details from SAGE will be displayed in the System via an interface. Upon selection of the relevant contract and service codes, the contract details are linked to the service being provided to the individuals. Subsequently, when the Provider enters units of service delivered in the System, the information will be transferred back to SAGE, to the relevant contract, via the interface. The transfer of the aggregate service delivery data to SAGE will be on a user defined basis. (e.g., weekly, monthly, etc.)

State Health Insurance Assistance Program Tracking and Reporting System (STARS) Interaction with the System Real time download of assessments completed for contacts involving Medicare or Medicare Savings Program assistance from forms completed in system into ACL STARS system using API to comply with federal ACL reporting requirements for the SHIP program API- Application Programming Interface with ACL STARS system AGIS (ADRC Website) Interaction with the System Real time uploads of information of providers and services including contact, location, service area, eligibility, languages spoken, etc. Share with public the provider information listed with in the system

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