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2005 Survey Instrument HTML
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Funding Amounts
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 Summary - Total, All Reported Funding Sources (TOTALFUNDS)
Total OAA Federal Funds (TOTALOAAFUNDS)
Total Medicaid Waiver Funds (TOTALMEDICAID)
Total Medicare Funds (TOTALMEDICARE)
Total Other HHS Federal Funds (TOTALHHSFED)
Total Other Federal Funds (TOTALOTHERFED)
Total State Funds (TOTALSTATE)
Total Local Public Funds (TOTALPUBLIC)
Total Private Program Funds (TOTALPRIVATE)
Funding Sources
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Does the AAA administer Medicaid Waiver or other Medicaid long term care funds? (MEDWAIVER)
Does the AAA receive funds from Medicare (e.g., grant to promote drug benefits, other Medicare funds, etc.)? (MEDICARE)
Does the AAA receive other funds from the U.S. Department of Health and Human Services? (HHSOTHER)
Does the AAA receive other federal funds (e.g., from USDA, USDOT, USDOL, HUD, etc.)? (OTHERFED)
Does the AAA receive State funds for services (e.g., nonfederal matching funds)? (STATEFUNDS)
Does the AAA receive local public (governmental) funds for services (e.g., county, city, town, etc.)? (LOCALPUBFUNDS)
Does the AAA receive private funds or participant contributions? (PRIVFUND)
Does the AAA have formal cost sharing agreements to charge clients for the cost of services? (COSTSHAREAGREE)
Consumer Directed Care Models
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Is AAA involved in a program that uses Vouchers? (VOUCHERS)
Is AAA involved in a program that uses Cash and Counseling? (CASHCOUNSEL)
Is AAA involved in a program that uses Defined Budgets (capitated amounts of funding)? (DEFINED)
Is AAA involved in a program that uses Other? (CONSUMEROTHER)
In the AAA, are any of these consumer directed care options currently being provided using OAA funds? (CONSUMER)
Summary: Existing AAA Partnerships
Adult Protective Services
Public Health Service/Comm Health Center
Hospital Discharge Planning/ER Care
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Partnership with hospital discharge planning, ER care, and other services - Conference Planning (HOSPCPC)
Partnership with hospital discharge planning, ER care, and other services - Program Development (HOSPPDC)
Partnership with hospital discharge planning, ER care, and other services - Joint Grant Writing (HOSPGRANTC)
Partnership with hospital discharge planning, ER care, and other services - Jointly Fund Programs (HOSPFUNDC)
Partnership with hospital discharge planning, ER care, and other services - Inter-Agency Referral (HOSPREFC)
Partnership with hospital discharge planning, ER care, and other services - Board of Directors (HOSPBODC)
Partnership with hospital discharge planning, ER care, and other services - Advocacy/Sponsor (HOSPADC)
Partnership with hospital discharge planning, ER care, and other services - Outreach (HOSPOUTC)
Partnership with hospital discharge planning, ER care, and other services - Public Education (HOSPPEC)
Partnership with hospital discharge planning, ER care, and other services - Training (HOSPTRAINC)
County or City Social Services Agency
Social Security and Medicaid Offices
SSI, Food Stamps, and Medicaid Offices
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Partnership with SSI, Food Stamps, and Medicaid offices - Conference Planning (SSICPF)
Partnership with SSI, Food Stamps, and Medicaid offices - Program Development (SSIPDF)
Partnership with SSI, Food Stamps, and Medicaid offices - Joint Grant Writing (SSIGRANTF)
Partnership with SSI, Food Stamps, and Medicaid offices - Jointly Fund Programs or Services (SSIFUNDF)
Partnership with SSI, Food Stamps, and Medicaid offices - Inter-Agency Referral (SSIREFF)
Partnership with SSI, Food Stamps, and Medicaid offices - Board of Directors (SSIBODF)
Partnership with SSI, Food Stamps, and Medicaid offices - Advocacy/Sponsor Legislation (SSIADF)
Partnership with SSI, Food Stamps, and Medicaid offices - Outreach (SSIOUTF)
Partnership with SSI, Food Stamps, and Medicaid offices - Public Education (SSIPEF)
Partnership with SSI, Food Stamps, and Medicaid offices - Training (SSITRAINF)
Low Income Home Energy Assistance Programs
Homemaker and Home Health Care Providers
Public Housing Agency
Senior Housing Facilities
Center for Independent Living
Public Transit and Para-transit Programs
Religious Organizations
Council of Government or Regional Planning Agency
University
Mental Retardation/Developmental Disabilities
Mental Health
Police/Fire/EMS
Senior Centers
Medicaid/Medicare Partnership
Single Entry Point Access
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Does the AAA operate a single coordinated system, where persons age 60 and older can access multiple programs? (SEP)
Does the single entry point cover OAA-funded programs? (SEPOAA)
Does the single entry point cover programs administered by your AAA that are not funded by the OAA? (SEPOAAOTHER)
Does the single entry point cover programs administered by other agencies? (SEPPROGOTHER)
If the AAA does not operate a single entry point system, does it participate in such a system? (SEPAGENCY)
Does AAA Administer Programs with Service?
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Medicaid Waiver programs (e.g., home care, adult day care, etc.) (MWP)
Other State and Local In-home Services or Other Community-based Long-term Care Programs (INHOME)
Medicaid State Plan Long-term Care Services (e.g., nursing home care) (MSTATE)
Other Medicaid Acute Health Coverage (MACUTE)
Primary Health Care (e.g., public health programs) (PRIMARYHC)
Housing (e.g., Section 8/Housing Choice Vouchers, congregate housing, and public housing) (HOUSING)
Transportation (e.g., ADA paratransit services) (TRANSPORTATION)
Low Income Home Energy Assistance (e.g., LIEAP) (LIEAP)
SSI (SSI)
Mental Health (MHADMIN)
MR/DD (MRDD)
Food Stamps (FOODSTAMPS)
Adult Protective Services (APSADMIN)
AAA Provides Referrals for Service?
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Medicaid Waiver programs (e.g., home care, adult day care, etc.) (MWPREFA)
Other State and Local In-home Services or Other Community-based Long-term Care Programs (INHOMEREFB)
Medicaid State Plan Long-term Care Services (e.g., nursing home care) (MSTATEREFC)
Other Medicaid Acute Health Coverage (MACUTEREFD)
Primary Health Care (e.g., public health programs) (PRIMARYHCREFE)
Housing (e.g., Section 8/Housing Choice Vouchers, congregate housing, and public housing) (HOUSINGREFF)
Transportation (e.g., ADA paratransit services) (TRANSPORTATIONREFG)
Low Income Home Energy Assistance (e.g., LIEAP) (LIEAPREFH)
SSI (SSIREFI)
Mental Health (MHADMINREFJ)
MR/DD (MRDDREFK)
Food Stamps (FOODSTAMPSREFM)
Adult Protective Services (APSADMINREFN)
AAA Provides Other Assistance to Obtain Service?
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Medicaid Waiver programs (e.g., home care, adult day care, etc.) (MWPOTHERASSTA)
Other State and Local In-home Services or Other Community-based Long-term Care Programs (INHOMEOTHERASSTB)
Medicaid State Plan Long-term Care Services (e.g., nursing home care) (MSTATEOTHERASSTC)
Other Medicaid Acute Health Coverage (MACUTEOTHERASSTD)
Primary Health Care (e.g., public health programs) (PRIMARYHCOTHERASSTE)
Housing (e.g., Section 8/Housing Choice Vouchers, congregate housing, and public housing) (HOUSINGOTHERASSTF)
Transportation (e.g., ADA paratransit services) (TRANSPORTATIONOTHERASSTG)
Low Income Home Energy Assistance (e.g., LIEAP) (LIEAPOTHERASSTH)
SSI (SSIOTHERASSTI)
Mental Health (MHADMINOTHERASSTJ)
MR/DD (MRDDOTHERASSTK)
Food Stamps (FOODSTAMPSOTHERASSTM)
Adult Protective Services (APSADMINOTHERASSTN)
AAA Colocated with Other Agency if Not Adminstrator?
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Medicaid Waiver programs (e.g., home care, adult day care, etc.) (MWPCOLOCATEDA)
Other State and Local In-home Services or Other Community-based Long-term Care Programs (INHOMECOLOCATEDB)
Medicaid State Plan Long-term Care Services (e.g., nursing home care) (MSTATECOLOCATEDC)
Other Medicaid Acute Health Coverage (MACUTECOLOCATEDD)
Primary Health Care (e.g., public health programs) (PRIMARYHCCOLOCATEDE)
Housing (e.g., Section 8/Housing Choice Vouchers, congregate housing, and public housing) (HOUSINGCOLOCATEDF)
Transportation (e.g., ADA paratransit services) (TRANSPORTATIONCOLOCATEDG)
Low Income Home Energy Assistance (e.g., LIEAP) (LIEAPCOLOCATEDH)
SSI (SSICOLOCATEDI)
Mental Health (MHADMINCOLOCATEDJ)
MR/DD (MRDDCOLOCATEDK)
Food Stamps (FOODSTAMPSCOLOCATEDM)
Adult Protective Services (APSADMINCOLOCATEDN)
Other Services Offered
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Does the AAA operate a Single Entry Point system, where persons younger than 60 can access multiple programs? (SEPLT60)
Regardless of client age, does the AAA act as a single entry point for private pay clients the AAA doesn’t fund? (SEPPRIVATE)
Regardless of client age, does the AAA have responsibility for screening for Medicaid Waiver eligibility? (SCREENWAIVER)
Regardless of client age, does the AAA have resp for screening for Medicaid nursing home placements? (PREADMINSCREEN)
Computerized Client Tracking Capabilities
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Does agency have a computerized tracking system that collects data on individual OAA service clients? (COMPTRACKING)
If AAA has computerized client tracking system, does it have Intake/Registration capability? (TRACKINTAKE)
If AAA has computerized client tracking system, does it have Assessment capability? (TRACKASSESS)
If AAA has computerized client tracking system, does it have Referral capability? (TRACKREF)
If AAA has computerized client tracking system, does it have Case Management capability? (TRACKCM)
If AAA has computerized client tracking system, does it have the capability to Track Units of Service? (TRACKUNITS)
If AAA has computerized client tracking system, does it have Provider Billing capability? (TRACKPROVBILL)
Does the information system produce an unduplicated count of OAA participants? (UNDUPCOUNT)
Does the system collect data on a person once, which is then accessible to multiple service providers? (DEMODATA)
Other Data Tracked
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Did agency develop its own in-house computerized MIS system to track clients and the services they receive? (INHOUSEMIS)
Does agency use a commercial vendor or software package to track clients and the services they receive? (VENDOR)
In addition to OAA services, does system track clients/expenditures for State-funded Programs? (MISSYSTRACKSTATE)
In addition to OAA services, does system track clients/expenditures for Medicaid Waiver Programs? (MISSYSTRACKWAIVER)
In addition to OAA services, does system track clients/expenditures for Other programs? (MISSYSTRACKOTHER)
Quantitative Performance Measures Used
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If AAA does not have its own MIS system, does it use information from providers to track clients and services? (PROVIDERS)
Does agency use Uniform Cost Accounting as a tool to assure continuous quality improvement? (UNIFORMCOST)
Does agency use Cost Per Unit of Service as a tool to assure continuous quality improvement? (COSTPERUNIT)
Does agency use Performance Outcomes Data as a tool to assure continuous quality improvement? (PERFOUTCOMES)
Does agency use Performance-based Budgeting/Contracting to assure continuous quality improvement? (PERFBUDGET)
Does agency use Targeting Services to Vulnerable Populations to assure continuous quality improvemt? (TARGETSERV)
Does agency use Consumer Assessment of Services as a tool to assure continuous quality improvement? (PROGIMPACTS)
Does agency use Other qualitative performance measurement to assure continuous quality improvement? (PROGEFFIC)
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