5023 System Structure | ACCESS-TO-SERVICES-5200-MANUAL

The Area Agency is required to provide information and assistance services directly, including intake and assessment for all services provided through the Area Agencies’ contracts with service providers.

The Area Agency may, through the negotiation of subcontracts, delegate any and all components of client assessment and care coordination but must be able to document that the subcontract arrangement is the more efficient and effective model of service delivery.

Case management/care coordination are terms used interchangeably and refer to the more extensive assistance component of an access system. (See §5024(g) for guidance on the duration of information and assistance services.]) The Area Agency may elect to phase in the provision of case management assistance, including client assessment and service planning, and may use any and all allowable fund sources in support of the delivery of these services. Guidelines and standards for case management are addressed in a separate policy issuance. See Chapter 210 in the Non-Medicaid Home and Community Based Services manual.

The Area Agency will provide documentation in a format specified or approved by the Division that demonstrates that the integration of the services has occurred or will occur as a result of the agency’s leadership and strategic planning. The required documentation shall be submitted at the time of submission of a proposed area plan, area plan amendment or update; and at the time of program review by the Division; or upon request of the Division.

Ideally inquirers will have their needs for information, referral and assistance services and assessment for potential admission to services, if indicated, met by a single trained staff person, who will manage all aspects of service provision at the ADRC level. Inquirers will know the name of the person assisting them and how to contact them for additional assistance and follow up.

All initial call data will be recorded in the DAS Data System, regardless of whether the call results in assessment for admission to services. Staff will enter basic inquirer identifying information and other pertinent call data into DAS Data System as calls are received. Unless the caller refuses to provide information, staff will complete all data elements on the Basic Client Screen in DAS Data System. (See 5032 Accountability and Quality Improvement for guidance on data entry.)

All access system staff shall have a working knowledge of programs and services provided through their regional aging networks, as well as basic knowledge of other public and privately funded community resources.

Waiting list management: Staff shall manage the HCBS waiting list using the DAS Data System application and/or any other applications which may be developed in the future for this purpose. Data to be considered for waiting list management and admission criteria are discussed in 5038 Waiting List Management and Criteria for Admission to Services.

Interaction with the ADRC will provide all callers a seamless, “no wrong door” experience, characterized by prompt handling of all correspondence and verbal communications and by interactions by inquirers with as few staff as possible. The preferred operational model is depicted in Appendix 5060-C. The Division may consider alternatives from this model, which the AAA can address through the Area Plan development and approval processes.