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selected as a complex model project. The project catchment area is Rennselaer County, New York. The project began serving clients in May 1982. Currently, the site has approximately 100 clients. The project hopes to reach a caseload of 159 by the end of June 1983.

Grantee: Ohio Department of Public Welfare, Columbus, Ohio.

Status: The Cuyahoga County Board of Commissioners has been designated as the agency responsible for implementing the Ohio project. The project site is administered by the Western Reserve Area Agency on Aging. The project catchment area covers Cuyahoga County, which consists of the City of Cleveland and 59 suburbs. The project began serving clients in May 1982. Currently, the site has approximately 200 clients. The project hopes to reach a caseload of 354 clients by the end of June 1983.

Funding: $2,235,982.
Contractor: Pennsylvania Department of Public Welfare.
Grantee: Harrisburg, Pa.

Status: The Pennsylvania Channeling project is operated through a subcontract with the Philadelphia Corporation for Aging. This site is a fully centralized complex model project site. The catchment area covers more than 129 sites and includes the city and county of Philadelphia. The project began serving clients in May 1982. Currently, the projet has an active caseload of 350 clients. The project estimates that its active caseload will reach 500 clients by the end of June 1983. The major project referral sources are hospitals, senior centers, and home health agencies. Multipurpose senior services project

Period: October 1979-September 1983.
Grantee: State of California Health and Welfare Agency, Sacramento, Calif.

Description: The purpose of this project is to reduce client hospital and skilled nursing facility days, to reduce total expenditures by social and health services for clients, and to improve clients' functional abilities. Service delivery is administered through eight separate demonstration sites located throughout the State. Each site has an average of 60 organizations with which they contract for the provision of direct services to clients. A wide range of waivered health and social services are provided under the project.

Status: The project is in its fourth and final year. Full caseload (1,900 clients) was reached in the second year of the project. The comparison group (2,500 clients) was recruited without major problems and continues to be interviewed and assessed. Also, a computerized management information system has been developed, and extensive evaluation efforts have been performed. During this fourth year, the focus of the project is shifting from maintenance to wind-down. A special task force of Multipurpose Senior Services Project State and site staff has been formed to identify issues relating to project closure. Demonstration of community-wide alternative long term care model

Period: July 1976-July 1983.
Funding: $960,938.
Grantee: New York State Department of Social Services, Albany, N.Y.

Description: The New York State Department of Social Services is demonstrating alternative approaches to delivering and financing long-term care to the adult disabled and elderly Medicaid population of Monore County, New York. The project has developed the Assessment for Community Care Services (ACCESS) model as a centralized unit responsible for all aspects of long-term care for Monroe County residents 18 years of age or over who are eligible for Medicaid and have long-term health care needs. ACCESS staff provides each client with comprehensive needs-assessment and case-management services.

Status: the project received waivers to permit provision of certain community long-term care services not normally provided under Medicaid in New York. Since the project became operational in 1977, more than 18,000 people with potential longterm care needs have received assessments under this program. Continued demonstration of a long-term care center through inclusion and expansion

Period: August 1980-July 1984.
Funding: $1,802,768.
Grantee: Monore County Long-Term Care Program, Inc., Rochester, N.Y.

Description: The purpose of tis demonstration is to expand the alternative longterm care delivery model Assessment for Community Care Services (ACCESS) developed for the Medicaid population in Monroe County, New York to include the county's Medicare population. The addition of this Medicare project is for the purpose of working toward an integration of Medicare and Medicaid long-term care services.

Status: The development phase of this demonstration was completed, and the project began operations in October 1982. HCFA has contracted with New York Blue Cross to serve as Medicare fiscal intermediary for the demonstration. Thus far, more than 500 Medicare beneficiaries with potential long-term care needs have received assessments from the oject. Home services for functionally disabled adults

Period: June 1980-June 1983.
Funding: $488,075.
Grantee: Community Service Society, New York, N.Y.

Description: Functionally disabled, low-income adults will be followed for 12 months after acute hospitalization to determine the impact of ongoing home service programs. Access to services, quality of services delivered, participation of informal supports, quality of circumstances, durability of independent living arrangements, and public costs will be examined.

Status: The data collection for the baseline period has been completed. Plans for a follow-up survey are underway. The project is in the process of obtaining patientspecific Medicare and Medicaid utilizaiion data. New York State's long-term home health care program

Period: September 1978-September 1983.
Funding: $225,688.
Grantee: New York State Department of Social Services, Albany, N.Y.

Description: This program provides an alternative to institutionalization for Medicaid clients who meet the medical criteria for SNFs or ICFs. A maximum expenditure for home care has been set at 75 percent of the going rate in a locale for SNF or ICF levels of care for which the client is eligible. The program objectives include promoting cost containment by reducing fragmentation in the provision of home care services through a single entry system that coordinates and provides these services.

Status: By the end of the fourth project year, 17 provider sites were operating and the caseload had reached 983 patients. HČFA approved the project's fifth and final year through September 29, 1983. The final year allows time to complete reassessments, prepare a final report, transmit data to the evaluator, and expand the program statewide under the authority of Section 2176 (Home and Community-Based Services Program). In December 1982, the program began statewide expansion. Evaluation of New York State's Long-Term Home Health Program

Period: September 1979-September 1983. Funding: $742,694. Contractor: Abt Associates, Inc., Cambridge, Mass. Description: The Long-Term Home Health Care Program (LTHHCP) is designed to offer coordinated comprehensive home health care services through a single health care provider to Medicaid eligible aged or disabled individuals in need of skilled nursing or health-related facility care. The major evaluation objective is to determine whether or not the LTHHCP provides an alternative to institutional care in terms of cost, service use, and quality of care. The research is designed to identify 700 program participants and 700 matched comparison participants, and follow the individuals for at least one year by collecting cost and utilization data and applying a health assessment instrument at three points in time. The data being collected are Medicare, Medicaid, Title XX, food stamps, energy assistance, public assistance, and Supplemental Security Income. The final analysis will compare total public expenditures for the program participants to those of the comparison population, with measures of health status outcome for both groups.

Status: A case study qualitative analysis was completed after one year of oper-
ation. The case study report was completed in March 1983 and will be combined
with the quantitative analysis at the end of the study. The resulting final report is
expected in September 1983.
South Carolina Community Long-Term Care Project

Period: September 1979-September 1984.
Grantee: Department of Social Services, Columbia, S.C.

Description: Through Medicaid and Medicare waivers, the State conducting a demonstration in three counties to test community-based client assessment, coordination of services, and provision of alternative services. It is anticipated that these waivers will increase the use of home care services, thereby reducing reliance on hospitals and lowering the incidence of conversion from Medicare to Medcaid in nursing homes. The major project objective is to gather information to determine client impact, cost effectiveness, and strategies for implementation in the State's long-term care system.

Status: The project currently has 616 experimental clients and 501 control group clients. In December 1982, HCFA approved the State's request for a two-year continuation through September 1984. The State expects to begin implementation of the Medicare waivers in Spring 1983. The project has completed two reports-one on project activities in fiscal year 1980-81 and another on nursing home utilization in the project area. A final evaluation report is expected in Fall 1984. Modifications of the Texas system of care for the elderly: Alternatives to the institu

tionalized aged Period: January 1980-December 1985. Grantee: Department of Human Resources, Austin, Tex.

Description: The purpose of this project is to reduce the growth of nursing homes in Texas and, at the same time, expand access to community care services for needy Medicaid indiv als. It is being accomplished by directly changing the operating policies of the State's Titles XIX and XX programs; in particular, by eliminating the State's lowest level of institutional care-intermediate care facility (ICF) II. Existing organizations responsible for the State's Titles XIX and XX programs are responsible for project implementation.

Status: The project is in its fourth year and progress thus far has been good. Of the 15,486 individuals in the "Intermediate Care Facility-II Cohort” group in March 1980, only 7,455, or 48 percent, were still receiving ICF-II services in March 1982. The institutional population decreased 8 percent from March 1980 to March 1982, from 64,876 to 59,747, and monthly expenditures for the institutional population decreased 6 percent, after adjusting for inflation. In fiscal year 1982, a monthly average of 42,491 individuals were receiving community-based services, up 11 percent

from fiscal year 1980.
| Long-term care demonstration project of north San Diego County

Period: September 1979-December 1983.
Funding: $1,063,463.
Grantee: Allied Home Health Association, Inc., San Diego, Calif.

Description: The purpose of the project is to demonstrate that a Medicare-certified provider of home health services is an appropriate and cost-effective resource for the administration of a long-term care system. The project is comparing client benefits and costs between existing long-term care services and those provided under the project for 500 Medicare beneficiaries. Case-management and client-assessment services are provided by the grantee and waivered services are provided by 19 suppliers of health and social services.

Status: The project is in its fourth and final year. As of September 30, 1982, there were 433 experimental and 206 control patients. During the project's first two years, major efforts involved computerizing the Management Information System, developing and field-testing the assessment instrument, negotiating contracts with providers and suppliers, and training project personnel. During the third year, emphasis was placed on service delivery and preliminary evaluation activities. During the fourth year, emphasis will be placed on evaluation activities and winding down the project. Delivery of medical and social services to the homebound elderly: A demonstration of

intersystem coordination
Period: November 1979-September 1983.
Funding: $599,358.
Grantee: New York City Department for the Aging, New York City, N.Y.

Description: The purpose of the project is to document the characteristics of a homebound elderly population in New York City, assess their health care needs, and estimate the costs of delivering needed care. A coordinated health care delivery model has been established to carry out this project on behalf of the 400 experimental Medicare clients. The project includes a project advisory committee that is comprised of representatives of relevant city departments, and four neighborhood-based service delivery sites.

Status: The project is its final year. It reached its full caseload of 400 clients in March 1982. Staff at the four service sites perform case management. Each site also has agreements with various providers to directly render the waivered services and

with other agencies to facilitate the coordination of service delivery for clients.
During the final year, emphasis is focusing on service delivery, evaluation activities,
and efforts relating to the wind-down of the project.
Long-term care demonstration design and development

Period: September 1978-September 1983.
Funding: $1,243,368.
Grantee: Mt. Zion Hospital and Medical Center, San Francisco, Calif.

Description: The Mt. Zion Hospital and Medical Center is conducting this Medi. care demonstration to implement a hospital-based, long-term care services delivery system in a designated service area in San Francisco, California. This model builds upon components of Mt. Zion's existing geriatric services program. A consortium of five service providers under the direction of Mt. Zion cooperate to provide a range of health and social services to the frail elderly in the designated catchment area.

Status: The project has received waivers to permit provision of certain health-re lated and social services that are not otherwise provided under Medicare. The project became operational in August 1980, and by August 1981 had reached its pro jected caseload of 200 experimental group members and 100 control group members. The operational phase of the project is scheduled to end on June 30, 1983. The final report is expected in September 1983. Ancillary community care services: A health care system for chronically impaired el

derly persons Period: October 1979-September 1983. Grantee: Department of Health and Rehabilitation, Tallahassee, Fla.

Description: The State is conducting a Medicaid demonstration project in five counties. The purpose of the project is to develop and test ancillary community care services for the chronically impaired elderly 60 years of age and over. All eligible clients receive a comprehensive medical-social assessment administered by a physician and social worker. The participating counties are responsible for developing client-care plans based on the assessment, conducting case management, and contracting for services with local providers.

Status: The total number of project participants is 971, with 761 randomly assigned to the experimental group and 210 assigned to the control group. All sites reached full caseload by June 1982. The project is currently in its fourth and final year. Beginning in April 1983, the project sites will work with community agencies to develop an orderly plan for transferring clients from the project to the existing service delivery system. The final project and evaluation reports will be submitted in Fall 1983. Home health aides

Period: January 1982-June 1986.

Description: Recipients of Aid to Families with Dependent Children (AFDC) will be trained and employed as homemakers/home health aides to provide services to elderly or disabled individuals who, without this support, would require institutionalization. The objectives of the demonstration are to reduce welfare dependency and to prevent or delay the institutional placement of the eligible service clients. This study will measure the costs and benefits of the program, including its contribution to the improvement in employment and earnings capacity of the AFDC recipient and the reduction in the need for institutional care of the functionally impaired home care service client.

Status: The implementation phase of the project began January 1, 1983. Seven States are involved in the project. At this time, some of the States are recruiting and training the AFDC recipients selected to participate in the demonstration. However, the States are at various stages of development. The States involved are Arkansas, Kentucky, New Jersey, New York, Ohio, South Carolina, and Texas. Design development and evaluation of the AFDC homemaker/home health aid dem.

onstration project
Period: June 1982-June 1986.
Funding: $454,174.
Contractor: Abt Associates, Inc., Cambridge, Mass.

Description: The purpose of this project is to develop a research design to evaluate the Aid to Families with Dependent Children (AFDC)/Homemaker Home Health Aid demonstration and to provide technical assistance to the seven States participating in the demonstration. Following the design, the actual evaluation will occur

under separate contracts with the seven participating States. The three major evaluation objectives are to:

Assess the costs and effectiveness of the training and employment of AFDC recipients as homemaker/home health aides on subsequent, continued, and nonsubsidized employment.

Assess the costs and outcome of providing home health aide services to persons at risk of institutionalization who would otherwise not receive these services.

Assess the net cost effectiveness and provide policy-relevant projections on largescale implementation.

Status: The contractor has completed three major deliverables: a data resources report; a report on issues in the design implementation; and the final research design. Comparison of the cost and quality of home health and nursing home care

Period: June 1980-January 1985.
Funding: $1,225,359.
Grantee: University of Colorado, Denver, Colo.

Description: The study assesses the cost, quality, and cost-effectiveness of nursing home and home health care provided by free-standing agencies and hospital-based facilities. Detailed data on patient conditions and services are being collected for a national sample of nursing home and home health patients. A subset of patients will be tracked over time to observe outcomes.

Status: Major research design and data collection activities have been completed.
The third-year activities include initial cost-effectiveness comparisons among the
various care modalities.
Pursuit of institutional alternatives

Period: December 1982-December 1983.
Funding: $242,478.
Grantee: North Carolina Health Care Facilities Association, Raleigh, N.C.

Description: This study explores the potential participation of North Carolina nursing homes in alternative institutional programs that provide services to the elderly. Alternative programs to be examined for ambulatory and nonambulatory patients are home health care, adult day care, meals on wheels, restorative services, and outpatient services (physical and psychosocial). The legal, organizational, financial, and facility resource requirements will be identified.

Status: This project was initiated in December 1982.


Project description

HCFA is planning a demonstration project to develop and test alternative methods of paying HHĂs on a prospective basis for services furnished to Medicare beneficiaries and Medicaid recipients. Objectives

The purpose of the demonstration is to determine whether prospective payment mechanisms would reduce Medicare and Medicaid expenditures for HHAs without deterioration in the quality of care by removing disincentives to cost efficiency in the existing retrospective cost reimbursement system. Demonstration design

HCFA will solicit proposals and select a contractor to develop the demonstration design, including recommendations as to the number and location of States and HHĂs to participate in the project. HCFA will probably test between two and five payment methodologies. After HCFA selects the final demonstration design and participating sites, the contractor will help HCFA monitor the ongoing status of the program. Current status

HCFA is currently preparing the Request for Proposals to develop the demonstration. HCFA anticipates that a contrct will be awarded in late 1983. Evaluation

After the initial demonstration design is established, HCFA will solicit proposals and award a separate contract to evaluate the demonstrations.

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