No Wrong Door Milestones

No Wrong Door Timeline 2018 NWD will expand to 120 DSS offices 2015 Virginia establishes governance structure; Virginia receives 1 yr planning grant 2011 Virginia develops statewide standards 2006 Grant received to launch NWD; DMAS receives related grant 2001 2016 - 2017 NWD launches marketing campaign 2012 Virginia develops online training 2010 Virginia receives 4 grants; NWD becomes local contact 2005 Legislative study 1999 Olmstead decision

1999 - Olmstead Decision affirms right of individuals with disabilities to live in their communities.

2001 - Senior Navigator launches as statewide database for long term services and supports.

2005 - Legislative study identifies the benefits of establishing a “No Wrong Door” philosophy in Virginia.

2006 - Virginia Department for Aging receives Virginia’s first Aging and Disability Resource Center (ADRC) grant to launch a No Wrong Door (NWD) system.

2006 - Department of Medical Assistance Services (DMAS) (Medicaid) receives systems transformation grant tied to NWD.

2010 - Virginia receives four grants in coordination with ADRC (options counseling, Money Follows the Person, Virginia Insurance Counseling and Assistance Program (VICAP), and Alzheimer’s).

2010 - No Wrong Door becomes local contact agency for Section Q.

2011 - Virginia develops statewide options counseling standards.

2012 - Virginia develops online training and reimbursement model for options counseling for Centers for Independent Living and Area Agencies on Aging.

2015 - Virginia establishes a governance structure to guide the policy and administration of No Wrong Door.

2015 - Virginia receives a one year planning grant to develop a three-year No Wrong Door statewide expansion plan.

2016-17 - No Wrong Door launches marketing campaign with new logo, website, and videos.

2018 - NWD plans expansion to Department of Social Service offices for Adult Protective Services and Adult Services statewide.

No Wrong Door – Virginia’s Road to Success

A National Vision to Support Individuals in Home and Community

 With a vision to streamline access to services and supports for older adults and individuals with disabilities, the Administration for Community Living, ACL (former Administration on Aging) developed an initiative called No Wrong Door (formerly Aging and Disability Resource Connections). Building on Olmstead, a decision by the Supreme Court, which recognized the right of individuals with disabilities to live and receive services in their home and community, recognizing the complexity of multiple funding sources and bureaucratic requirements to access home and community-based supports, and prompted by the undeniable projections of aging Boomers who will likely need long term services and supports, ACL and the Centers for Medicare & Medicaid Services, CMS, came together in 2003 to develop the idea for what would become a national initiative called No Wrong Door.

Identifying the Need on a State Level

 In 2004, an AARP study examined the status of Virginia’s Long-term Care (LTC) system. Findings indicated that while Virginia had many strong programs to address long-term care needs, it also faced challenges including the absence of a single-point-of-entry system for LTC services. The report cited inefficiencies, decreased consumer choice of services, and delays/prevention in getting the appropriate care as a result of not having this type of system.

Shortly thereafter, House Joint Resolution #657 of the 2005 Virginia General Assembly Session requested that the Secretary of Health and Human Resources study the development of a No Wrong Door (NWD) approach for Virginia’s long-term support service system and report the findings. In accordance, Secretary Jane Woods convened a task force to evaluate the feasibility of developing a No Wrong Door System for Virginia’s long-term services and supports.

The task force met through the Summer of 2005 to explore No Wrong Door efforts occurring nationally and in the Commonwealth, to seek possible avenues for funding the development of this approach, and to develop tasks for the creation of a No Wrong Door System.

Community Vision and Leadership

 While studies were being conducted on the state and nationals levels, communities and local providers were also realizing that a more collaborative approach could streamline access and strengthen coordination of services. Three communities across Virginia emerged to pave the way, thanks to strong local leadership and a network of public-private partners with a shared vision. Initially, each community effort was led by the local Area Agency on Aging: Peninsula Agency on Aging, focused on Williamsburg and James City County; Senior Connections, The Capital Area Agency on Aging, focused on the greater Richmond area; and Valley Programs for Aging Services, focused on Harrisonburg. Each of these agencies partnered with SeniorNavigator, a statewide non-profit with a high-tech/high-touch approach to helping Virginians find long term services and supports. SeniorNavigator took the lead in working with a technology partner to develop software which was fully integrated with SeniorNavigator’s database of over 26,000 programs and services, in order to create a tool for professionals to easily search for local services, automate referrals and securely share client-level data

Opportunity Knocks on Virginia’s Door

 In 2005, Virginia used the Task Force findings as the platform to apply for and receive its first federal grant from ACL for No Wrong Door. The three-year grant leveraged previous accomplishments achieved through the partnership between SeniorNavigator and three pilot communities and called for the expansion to an additional six communities. The grant also leveraged significant private sector investments made by SeniorNavigator and Dominion and support from local government and private funders in the pilot regions.

In 2006, Virginia received a Systems Transformation grant through CMS, which dedicated one of the grant goals to enhancing the development of the No Wrong Door System, providing additional seed money over a four-year period.

The “Early Years”

 With these grants, No Wrong Door leadership shifted from exclusively private sector to a public/private partnership between SeniorNavigator and the Virginia Department for Aging. Another significant shift helped to broaden No Wrong Door’s focus to move beyond strictly serving older adults to also include individuals with disabilities. A merger on the state level between the Virginia Department for Aging and the State Disability Agency, created the Department for Aging and Rehabilitative Services (DARS), which serves as No Wrong Door’s Public-Sector “Lead.” Likewise, as “Lead” for the Private Sector, SeniorNavigator created an umbrella called VirginiaNavigator and added thousands of disability-related supports to its provider database to support this expansion. “Lead” responsibilities include statewide promotion of No Wrong Door, training, administrative and help-desk support.

Another major change occurred when Virginia procured the services of a new technology partner for No Wrong Door, prompting the retooling of the system. The process led to the development of CRIA (pronounced CREE-YAH, which stands for Communication, Referral, Information and Assistance), the technology cornerstone of No Wrong Door.

Patience and Persistence

 It has been a tall order to understand providers’ diverse needs and develop the technology and coordinated network to best address challenges such as fragmented service delivery, duplicate data entry, and siloed systems. Security was also a major hurdle to overcome in order to ensure that both the system and business practices of partners, abide by HIPAA as well as the Commonwealth’s strict interpretations of Federal funding guidelines related to sharing information. It has taken years, but it has been well worth the investment of time and dollars.

Today, No Wrong Door Partners utilize CRIA to securely share client-level data (with consent), to better understand what is happening with an individual across multiple providers, to automate the referral process and ensure that nobody “falls through the cracks” when moving from one provider to another. With No Wrong Door, individuals and families don’t have to retell their story over and over again. Instead the system captures these details, saving time and money for providers and the individuals they serve.

Virginia is proud to be a National leader in the development of No Wrong Door, with “Best Practices” that provide valuable guidance for other states as they develop No Wrong Door technology, public/private partnerships, good governance, and person-centered practices.