No Wrong Door System Management Tool-Track 83D
0062 NWD_ADRC_COVID_Grant_Reporting_Tool_Fillable_Form_tracked changes.docx
No Wrong Door System Management Tool
No Wrong Door System Management Tool-Track 83D
OMB: 0985-0062
ADRC/COVID Grant
Second Semi-Annual Reporting Tool
Fillable Form
OMB
# 0985-0062 Expires:
04/30/2022
TABLE OF CONTENTS
INTRODUCTION ..............................................................................................2
Contact Information .........................................................................................................................................3
Data Collection Questions ..............................................................................................................................3
Person-Centered Counseling.........................................................................................................................4
Total Number of Contacts...............................................................................................................................6
ADRC/NWD System Legislation7...................................................................................................................
Activities Paid for by Grant Funds............................8....................................................................................
ADRC/NWD System Involvement in Vaccine Rollout.9...............................................................................
Question/Comments (Optional) ....................................................................................................................9
Validation and Final Submission ................................................10.................................................................
Introduction
This version of the No Wrong Door (NWD) System Management Tool (referenced as “the Tool”) serves as the second semi-annual reporting requirement for states and territories receiving ADRC COVID-19 grant funds. The grant lead agency at the state/territory level is to complete one submission to cover activities from October 1, 2020 through March 31, 2021. Responses shall represent all services and support provided by the state/territory’s Aging and Disability Resource Centers (ADRCs) or NWD System. This means the data reported in this Tool is not limited to grant-specific activities or budgets and instead shall represent statewide activity as best as possible.
The reporting Tool has been formatted into a fillable form on Smartsheet which can be accessed here [insert link]. An account in Smartsheet is not required to access the Tool. Respondents may have a copy of their submission sent to them by checking the “Send me a copy of my responses” checkbox at the bottom of the form.
Please note: States/territories shall not submit data to the Tool until after April 1st. Further instructions and reminders will be shared as we get closer to the reporting period.
This document allows states/territories to collect responses in advance for entry into Smartsheet, as the platform does not allow a submission to be saved for later completion.
Please reach out to nowrongdoor@acl.hhs.gov with any questions.
Contact Information
State/Territory
Agency
Name
Contact
First
and
Last
Name
Contact
Email
Contact
Phone
Number
Data Collection Questions
1. If your state/territory has one publicly searchable and accessible website for public and private LTSS resources, programs, and services, October 1, 2020 and March 31, 2021neetweb eitsbewem tsSy DWC/NRDA s’ytorirret/etats eth dessecc asortisive uqinuy nma woh please indicate?
2. Answer the following questions for the individuals that your state/territory’s ADRC/NWD System organizations assisted with applications and/or financial and functional assessments between October 1, 2020 and March 31, 2021.
a. Application Assistance
i.
How
many
individuals
were
assisted
with
applications
for
Medicaid
LTSS
Programs?
ii.
How
many
individuals
were
assisted
with
applications
for
VA
Programs?
iii. How many individuals were assisted with applications for other Federal or
State/Territory
Funded
LTSS
Programs?
b. Financial Assessments
i. How many individuals were supported with completing financial assessment(s)
for
Medicaid
LTSS
Programs?
ii. How many individuals were supported with completing financial assessment(s)
for
VA
Programs?
iii. How many individuals were supported with completing financial assessment(s)
for
other
Federal
or
State/Territory
Funded
LTSS
Programs?
c. Functional Assessments
i.
How
many
individuals
were
supported
with
completing
functional
assessment(s)
for
Medicaid
LTSS
Programs?
ii.
How
many
individuals
were
supported
with
completing
functional
assessment(s)
for
VA
Programs
iii.
How
many
individuals
were
supported
with
completing
functional
assessment(s)
for
other
Federal
or
State/Territory
Funded
LTSS
Programs?
Person-Centered Counseling
Person-centered counseling, thinking, and practice empowers individuals to make informed choices about their LTSS options, consistent with their personal goals and needs, and assists individuals with navigating the various organizations, agencies, and other resources in their communities. The skills and knowledge base of person-centered counseling includes:
• A personal interview to discover strengths, values, and preferences and the utilization of screenings and assessments necessary to determine potential program eligibility.
• A facilitated decision-making process that explores resources and support options, and provides tools to the individual in weighing pros and cons.
• Developing action steps toward a goal or a long term support plan and assistance in applying for and accessing support options when requested.
• Quality assurance and follow-up to ensure supports are working for the individual. The person- centered counseling function within an ADRC/NWD System embeds the state-of-the art practice for promoting individual choice, self-determination, and supportive decision-making and can be used in a variety of settings.
Note: “Person-centered counseling” used in this document is intended to describe system structures, functions, and job duties, but not intended to serve as a brand that all states/territories may use in labeling their access functions or job titles. For instance, states/territories are implementing person- centered planning in various ways, including through training programs designed to bolster and upgrade the skills of their existing Options Counselors and other staff who use different titles. It is expected that many states/territories will continue to use the term “Options Counselor” and other such job titles.
3. How many individuals received Person-Centered Counseling through your state/territory’s
ADRC/NWD
System
between
October
1, 2020
and March 31, 2021?
4woProvide the best estimate of h . many marketing and outreach activities occurred specific to COVID-19 in your state/territory between October 1, 2020 and March 31, 2021?
Examples
of marketing and
outreach
activities
may
include
virtual
meetings,
communication
with
local
partners,
such
as
VAMCs,
webinars,
billboards,
and
TV,
radio,
newspaper
ads,
and
social
media
postings.
5.
How
many
individuals
did
your
state/territory’s
ADRC/NWD
System
organizations
transition
from
an
acute
care
hospital
to
their
home
or
other
community
setting
between
October
1,
2020
and March 31, 2021?
6. How many individuals were transitioned from a nursing home to home or other community setting with the help of staff in your state/territory’s ADRC/NWD System between October 1, 2020 and March 31, 2021?
6a. How many individuals were transitioned from a nursing home through the Money Follows the Person (MFP) program between October 1, 2020 and March 31, 2021?
7.
How
many
Veterans
were
transitioned
from
a VA
Medical
Center
to
home
or
other
community
setting
with
the
help
of
staff
in
your
state/territory’s
ADRC/NWD
System
between
October
1,
2020
and March 31, 2021?
Total Number of Contacts
The total number of individuals served or total number of contacts shall include any type of contacts made with your state/territory’s ADRC/NWD System organizations, regardless of which program or service the individual encountered first or regardless of whether the contact was a simple information and referral or information and assistance encounter.
8.
How
many
unduplicated
individuals
did
your
state/territory’s
ADRC/NWD
System
serve
between
October
1,
2020
and March 31, 2021?
9. Enter the total number of contacts between October 1, 2020 and March 31, 2021 for each of the listed demographics in questions 9.a.i - 9.a.vi. Enter the number of those contacts that received person-centered counseling between October 1, 2020 and March 31, 2021 in questions
9.b.i. - 9.b.vi. Individuals that meet multiple demographic categories should be counted in all applicable categories. For example, a 65-year-old with a disability should be counted in both the “Age 60+” row and the “Individuals with Disabilities” row.
a. Total number of individuals served
i.
Total
number
of
individuals
served
(Age
60+)
ii.
Total
number
of
individuals
served
(Aged
21
to
59)
iii.
Total
number
of
individuals
served
(Age
20
and
below)
iv.
Total
number
of
individuals
served
(Unknown
age)
v.
Total
number
of
individuals
served
(Individuals
with
disabilities)
vi.
Total
number
of
individuals
served
(Caregivers
and
informal
supports)
b. Total number of individuals that received person-centered counseling
i. Total number of individuals that received person-centered counseling (Age
60+)
ii.
Total
number
of
individuals
that
received
person-centered
counseling
(Aged
21
to
59)
iii.
Total
number
of
individuals
that
received
person-centered
counseling
(Age
20
and
below)
iv. Total number of individuals that received person-centered counseling
(Unknown
age)
v. Total number of individuals that received person-centered counseling
(Individuals
with
disabilities)
vi. Total number of individuals that received person-centered counseling
(Caregivers
and
informal
supports)
ADRC/NWD System Legislation
1in place? ) Public Outreach Access, d PCC, Streamlinei.e., Governance,and/or Gubernatorial actions (e.g., executive orders) that support any of the four main ADRC/NWD functions (Does your state/territory have ADRC/NWD System legislation . 0
Yes
No
a. If no, are there any legislation or Gubernatorial actionsplanned or in progress?
Yes
No
b. legislation and/or Gubernatorial actions. If yes, please select all of the following that apply to your state/territory
Defines No Wrong Door
Defines Person Centered Counseling or Options Counseling
Defines services under No Wrong Door
Designates a governing body
Designates organizations as ADRCs or NWD System entities
Addresses sustainability
Isupports for workforcencludes
Designates funding
Legislation was part of an Executive Order
Additional legislation and/or Gubernatorial actions in progress
c. [email protected] HYPERLINK "mailto:[email protected]"
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Vangeloff, Kristen |
| File Modified | 0000-00-00 |
| File Created | 2021-04-02 |
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