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{\f622\froman\fcharset162\fprq2 Cambria Tur;}{\f625\froman\fcharset186\fprq2 Cambria Baltic;}{\f2028\froman\fcharset238\fprq2 Times CE;}{\f2029\froman\fcharset204\fprq2 Times Cyr;}{\f2031\froman\fcharset161\fprq2 Times Greek;}
{\f2032\froman\fcharset162\fprq2 Times Tur;}{\f2033\fbidi \froman\fcharset177\fprq2 Times (Hebrew);}{\f2034\fbidi \froman\fcharset178\fprq2 Times (Arabic);}{\f2035\froman\fcharset186\fprq2 Times Baltic;}
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\sbasedon0 \snext0 \slink22 \styrsid3877327 heading 8;}{\s9\ql \li5760\ri0\sb200\sl276\slmult1\keep\keepn\widctlpar\jclisttab\tx6120\wrapdefault\aspalpha\aspnum\faauto\ls4\ilvl8\outlinelevel8\adjustright\rin0\lin5760\itap0 \rtlch\fcs1 
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\ts11\tsrowd\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3\tscellwidthfts0\tsvertalt\tsbrdrt\tsbrdrl\tsbrdrb\tsbrdrr\tsbrdrdgl\tsbrdrdgr\tsbrdrh\tsbrdrv 
\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\lang1024\langfe1024\cgrid\langnp1024\langfenp1024 \snext11 \ssemihidden Normal Table;}{\*\cs15 \additive \rtlch\fcs1 
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\b\f41\fs28\cf18\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink2 \slocked \styrsid3877327 Char Char25;}{\*\cs17 \additive \rtlch\fcs1 \ab\af0\afs26\alang1025 \ltrch\fcs0 \b\f41\fs26\cf18\lang1033\langfe1033\langnp1033\langfenp1033 
\sbasedon10 \slink3 \slocked \styrsid3877327 Char Char24;}{\*\cs18 \additive \rtlch\fcs1 \ai\af0\afs24\alang1025 \ltrch\fcs0 \b\fs24\cf17\lang1033\langfe1033\kerning32\langnp1033\langfenp1033 \sbasedon10 \slink4 \slocked \styrsid3877327 Char Char23;}{\*
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\sbasedon10 \slink7 \slocked \styrsid3877327 Char Char20;}{\*\cs22 \additive \rtlch\fcs1 \af0\alang1025 \ltrch\fcs0 \f43\cf21\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink8 \slocked \styrsid3877327 Char Char19;}{\*\cs23 \additive 
\rtlch\fcs1 \ai\af0\alang1025 \ltrch\fcs0 \i\f43\cf20\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink9 \slocked \styrsid3877327 Char Char18;}{\s24\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 
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\ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext26 \styrsid3877327 Level 1;}{\s27\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext27 \slink28 \ssemihidden \styrsid3877327 footnote text;}{\*\cs28 \additive \rtlch\fcs1 \af0\alang1025 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\langfenp1033 
\sbasedon10 \slink27 \slocked \ssemihidden \styrsid3877327 Char Char16;}{\*\cs29 \additive \rtlch\fcs1 \af0 \ltrch\fcs0 \ul\cf18 \sbasedon10 \styrsid3877327 Hyperlink;}{\*\ts30\tsrowd\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 
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\sbasedon0 \snext31 \slink32 \styrsid3877327 body text,bt,body tx,indent,flush;}{\*\cs32 \additive \rtlch\fcs1 \af0\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink31 \slocked \styrsid3877327 
body text Char,bt Char,body tx Char,indent Char,flush Char;}{\s33\ql \li0\ri0\widctlpar
\tx916\tx1832\tx2748\tx3664\tx4580\tx5496\tx6412\tx7328\tx8244\tx9160\tx10076\tx10992\tx11908\tx12824\tx13740\tx14656\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af2\afs20\alang1025 \ltrch\fcs0 
\f2\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext33 \slink34 \styrsid3877327 HTML Preformatted;}{\*\cs34 \additive \rtlch\fcs1 \af2\alang1025 \ltrch\fcs0 \f2\lang1033\langfe1033\langnp1033\langfenp1033 
\sbasedon10 \slink33 \slocked \styrsid3877327 Char Char15;}{\s35\ql \li0\ri0\widctlpar\tqc\tx4320\tqr\tx8640\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext35 \slink36 \styrsid3877327 footer;}{\*\cs36 \additive \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\langnp1033\langfenp1033 
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\af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext38 \styrsid3877327 List Paragraph;}{\*\cs39 \additive \rtlch\fcs1 \af0 \ltrch\fcs0 \ul\cf12 \sbasedon10 \styrsid3877327 FollowedHyperlink;}{
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\sbasedon0 \snext40 \slink41 \styrsid3877327 header;}{\*\cs41 \additive \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink40 \slocked \styrsid3877327 Char Char13;}{
\s42\ql \li0\ri0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\cf1\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \snext42 \styrsid3877327 Default;}{
\s43\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext43 \slink44 \styrsid3877327 endnote text;}{\*
\cs44 \additive \rtlch\fcs1 \af0\alang1025 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink43 \slocked \styrsid3877327 Char Char12;}{\*\cs45 \additive \rtlch\fcs1 \af0 \ltrch\fcs0 \super \sbasedon10 \styrsid3877327 
endnote reference;}{\s46\ql \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \snext46 \styrsid3877327 
Note Level 2;}{\*\cs47 \additive \rtlch\fcs1 \ai\af0 \ltrch\fcs0 \i \sbasedon10 \styrsid3877327 HTML Cite;}{\s48\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext48 \styrsid3877327 Normal (Web);}{\s49\qc \li0\ri0\sl-260\slmult0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 
\ab\af0\afs22\alang1025 \ltrch\fcs0 \b\f41\fs22\cf22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \sautoupd \styrsid3877327 caption;}{\s50\ql \li0\ri0\sa300\widctlpar\brdrb\brdrs\brdrw20\brsp80\brdrcf21 
\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\contextualspace \rtlch\fcs1 \af0\afs52\alang1025 \ltrch\fcs0 \f43\fs52\expnd1\expndtw5\cf23\lang1033\langfe1033\kerning28\cgrid\langnp1033\langfenp1033 
\sbasedon0 \snext0 \slink51 \styrsid3877327 Title;}{\*\cs51 \additive \rtlch\fcs1 \af0\afs52\alang1025 \ltrch\fcs0 \f43\fs52\expnd1\expndtw5\cf23\lang1033\langfe1033\kerning28\langnp1033\langfenp1033 \sbasedon10 \slink50 \slocked \styrsid3877327 
Char Char11;}{\s52\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ilvl1\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \ai\af0\afs24\alang1025 \ltrch\fcs0 
\i\f43\fs24\expnd3\expndtw15\cf21\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \slink53 \styrsid3877327 Subtitle;}{\*\cs53 \additive \rtlch\fcs1 \ai\af0\afs24\alang1025 \ltrch\fcs0 
\i\f43\fs24\expnd3\expndtw15\cf21\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink52 \slocked \styrsid3877327 Char Char10;}{\*\cs54 \additive \rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b \sbasedon10 \styrsid3877327 Strong;}{\*\cs55 \additive 
\rtlch\fcs1 \ai\af0 \ltrch\fcs0 \i \sbasedon10 \styrsid3877327 Emphasis;}{\s56\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \ai\af0\afs22\alang1025 \ltrch\fcs0 
\i\fs22\cf1\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \slink57 \styrsid3877327 Quote;}{\*\cs57 \additive \rtlch\fcs1 \ai\af0\afs22\alang1025 \ltrch\fcs0 \i\fs22\cf1\lang1033\langfe1033\langnp1033\langfenp1033 
\sbasedon10 \slink56 \slocked \styrsid3877327 Quote Char;}{\s58\ql \li936\ri936\sb200\sa280\sl276\slmult1\widctlpar\brdrb\brdrs\brdrw10\brsp80\brdrcf21 \wrapdefault\aspalpha\aspnum\faauto\adjustright\rin936\lin936\itap0 \rtlch\fcs1 
\ab\ai\af0\afs22\alang1025 \ltrch\fcs0 \b\i\fs22\cf21\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \slink59 \styrsid3877327 Intense Quote;}{\*\cs59 \additive \rtlch\fcs1 \ab\ai\af0\afs22\alang1025 \ltrch\fcs0 
\b\i\fs22\cf21\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink58 \slocked \styrsid3877327 Intense Quote Char;}{\*\cs60 \additive \rtlch\fcs1 \ai\af0 \ltrch\fcs0 \i\cf15 \sbasedon10 \styrsid3877327 Subtle Emphasis;}{\*\cs61 \additive 
\rtlch\fcs1 \ab\ai\af0 \ltrch\fcs0 \b\i\cf21 \sbasedon10 \styrsid3877327 Intense Emphasis;}{\*\cs62 \additive \rtlch\fcs1 \af0 \ltrch\fcs0 \scaps\ul\cf24 \sbasedon10 \styrsid3877327 Subtle Reference;}{\*\cs63 \additive \rtlch\fcs1 \ab\af0 \ltrch\fcs0 
\b\scaps\ul\expnd1\expndtw5\cf24 \sbasedon10 \styrsid3877327 Intense Reference;}{\*\cs64 \additive \rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\scaps\expnd1\expndtw5 \sbasedon10 \styrsid3877327 Book Title;}{\s65\ql \li0\ri0\sb480\sl276\slmult1
\keep\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \ab\af0\afs28\alang1025 \ltrch\fcs0 \b\f43\fs28\cf25\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon1 \snext0 \styrsid3877327 TOC Heading;}{
\s66\ql \li0\ri0\widctlpar\tqr\tldot\tx10080\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \b\f41\fs28\cf18\lang1024\langfe1024\cgrid\noproof\langnp1033\langfenp1033 
\sbasedon0 \snext0 \sautoupd \styrsid3877327 toc 1;}{\s67\ql \li240\ri0\widctlpar\tqr\tldot\tx10080\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin240\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\f41\fs24\lang1024\langfe1024\cgrid\noproof\langnp1033\langfenp1033 \sbasedon0 \snext0 \sautoupd \styrsid3877327 toc 2;}{\s68\ql \li270\ri-144\widctlpar\tqr\tldot\tx10080\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-144\lin270\itap0 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \f41\fs24\lang1024\langfe1024\cgrid\noproof\langnp1033\langfenp1033 \sbasedon0 \snext0 \sautoupd \styrsid3877327 toc 3;}{
\s69\ql \li0\ri0\sb100\sa100\sbauto1\saauto1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af36\afs15\alang1025 \ltrch\fcs0 \f36\fs15\cf26\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
\sbasedon0 \snext69 \styrsid3877327 little;}{\s70\qc \li0\ri0\widctlpar\brdrt\brdrs\brdrw15\brsp20 \wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0 \rtlch\fcs1 \af1\afs16\alang1025 \ltrch\fcs0 
\v\f1\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \slink71 \shidden \styrsid3877327 HTML Bottom of Form;}{\*\cs71 \additive \rtlch\fcs1 \af1\afs16\alang1025 \ltrch\fcs0 \v\f1\fs16\lang1033\langfe1033\langnp1033\langfenp1033 
\sbasedon10 \slink70 \slocked \styrsid3877327 Char Char9;}{\s72\qc \li0\ri0\widctlpar\brdrb\brdrs\brdrw15\brsp20 \wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af1\afs16\alang1025 \ltrch\fcs0 
\v\f1\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \slink73 \shidden \styrsid3877327 HTML Top of Form;}{\*\cs73 \additive \rtlch\fcs1 \af1\afs16\alang1025 \ltrch\fcs0 \v\f1\fs16\lang1033\langfe1033\langnp1033\langfenp1033 
\sbasedon10 \slink72 \slocked \styrsid3877327 Char Char8;}{\s74\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
\snext74 \shidden \ssemihidden \styrsid3877327 Revision;}{\s75\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af36\afs16\alang1025 \ltrch\fcs0 \f36\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
\sbasedon0 \snext75 \slink76 \styrsid3877327 Document Map;}{\*\cs76 \additive \rtlch\fcs1 \af36\afs16\alang1025 \ltrch\fcs0 \f36\fs16\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink75 \slocked \styrsid3877327 Char Char7;}{\*\cs77 \additive 
\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \fs16 \sbasedon10 \styrsid3877327 annotation reference;}{\s78\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext78 \slink79 \styrsid3877327 annotation text;}{\*\cs79 \additive \rtlch\fcs1 \af0\alang1025 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\langfenp1033 
\sbasedon10 \slink78 \slocked \styrsid3877327 Char Char6;}{\s80\ql \fi-360\li720\ri0\sa240\widctlpar\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin720\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f37\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext80 \styrsid3877327 bullets;}{\s81\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af2\afs20\alang1025 \ltrch\fcs0 
\f2\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext81 \slink82 \styrsid3877327 Plain Text;}{\*\cs82 \additive \rtlch\fcs1 \af2\alang1025 \ltrch\fcs0 \f2\lang1033\langfe1033\langnp1033\langfenp1033 
\sbasedon10 \slink81 \slocked \styrsid3877327 Char Char5;}{\*\cs83 \additive \rtlch\fcs1 \af0\afs18 \ltrch\fcs0 \f37\fs18\cf1 \sbasedon10 \styrsid3877327 text1;}{\s84\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 
\rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext84 \slink85 \styrsid3877327 Body Text;}{\*\cs85 \additive \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 
\f1\fs24\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink84 \slocked \styrsid3877327 Char Char4;}{\s86\ql \li0\ri0\sa720\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 
\f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon42 \snext42 \styrsid3877327 CM45;}{\s87\ql \li660\ri0\sa100\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin660\itap0 \rtlch\fcs1 \af0\afs22\alang1025 
\ltrch\fcs0 \f41\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \sautoupd \styrsid3877327 toc 4;}{\s88\ql \li880\ri0\sa100\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin880\itap0 \rtlch\fcs1 
\af0\afs22\alang1025 \ltrch\fcs0 \f41\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \sautoupd \styrsid3877327 toc 5;}{\s89\ql \li1100\ri0\sa100\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1100\itap0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f41\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \sautoupd \styrsid3877327 toc 6;}{
\s90\ql \li1320\ri0\sa100\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1320\itap0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f41\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
\sbasedon0 \snext0 \sautoupd \styrsid3877327 toc 7;}{\s91\ql \li1540\ri0\sa100\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1540\itap0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f41\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \sautoupd \styrsid3877327 toc 8;}{\s92\ql \li1760\ri0\sa100\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1760\itap0 \rtlch\fcs1 
\af0\afs22\alang1025 \ltrch\fcs0 \f41\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \sautoupd \styrsid3877327 toc 9;}{\s93\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 
\ab\af0\afs20\alang1025 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon78 \snext78 \slink94 \styrsid3877327 annotation subject;}{\*\cs94 \additive \rtlch\fcs1 \ab\af0\alang1025 \ltrch\fcs0 
\b\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon79 \slink93 \slocked \styrsid3877327 Char Char3;}{\*\cs95 \additive \rtlch\fcs1 \ab\af0\afs20 \ltrch\fcs0 \b\f37\fs20\cf1 \sbasedon10 \styrsid3877327 headerblack1;}{\*\cs96 \additive \rtlch\fcs1 
\af0\afs15 \ltrch\fcs0 \f37\fs15 \sbasedon10 \styrsid3877327 months1;}{\*\cs97 \additive \rtlch\fcs1 \af0\afs14 \ltrch\fcs0 \f37\fs14\cf27 \sbasedon10 \styrsid3877327 footer_copy1;}{
\s98\ql \li1440\ri1440\sa120\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin1440\lin1440\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext98 \styrsid3877327 
Block Text;}{\s99\ql \li360\ri0\sa120\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
\sbasedon0 \snext99 \slink100 \styrsid3877327 Body Text Indent;}{\*\cs100 \additive \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink99 \slocked \styrsid3877327 Char Char2;}{
\s101\ql \li360\ri0\sa120\sl480\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
\sbasedon0 \snext101 \slink102 \styrsid3877327 Body Text Indent 2;}{\*\cs102 \additive \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink101 \slocked \styrsid3877327 Char Char1;}{
\s103\ql \li360\ri0\sa120\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0 \rtlch\fcs1 \af0\afs16\alang1025 \ltrch\fcs0 \fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext103 \slink104 \styrsid3877327 
Body Text Indent 3;}{\*\cs104 \additive \rtlch\fcs1 \af0\afs16\alang1025 \ltrch\fcs0 \fs16\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink103 \slocked \styrsid3877327 Char Char;}{
\s105\ql \fi-187\li302\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin302\itap0 \rtlch\fcs1 \af0\afs14\alang1025 \ltrch\fcs0 \f4\fs14\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext105 \styrsid3877327 ftnotetxt;}{
\s106\qr \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs18\alang1025 \ltrch\fcs0 \f4\fs18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext106 \styrsid3877327 numericnormal;}{
\s107\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \ab\af0\afs20\alang1025 \ltrch\fcs0 \b\f4\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext107 \styrsid3877327 tfigure;}{
\s108\ql \fi-160\li220\ri0\sb14\sa14\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin220\itap0 \rtlch\fcs1 \af0\afs18\alang1025 \ltrch\fcs0 \f4\fs18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext108 \styrsid3877327 
textnormal;}{\s109\ql \li60\ri0\sb86\sa14\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin60\itap0 \rtlch\fcs1 \ab\af0\afs20\alang1025 \ltrch\fcs0 \b\f4\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
\sbasedon0 \snext109 \styrsid3877327 th2;}{\s110\ql \li60\ri0\sb86\sa14\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin60\itap0 \rtlch\fcs1 \ab\af0\afs16\alang1025 \ltrch\fcs0 \b\f4\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
\sbasedon0 \snext110 \styrsid3877327 th4;}{\s111\ql \li0\ri0\sb72\sa72\sl200\slmult0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \ai\af0\afs20\alang1025 \ltrch\fcs0 
\i\f4\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext111 \styrsid3877327 tinwhat;}{\s112\ql \li0\ri0\sb72\sa72\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \ab\af0\afs24\alang1025 
\ltrch\fcs0 \b\f4\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext112 \styrsid3877327 ttitle;}{\s113\ql \li0\ri0\sb58\sa58\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 
\ab\af0\afs18\alang1025 \ltrch\fcs0 \b\f4\fs18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext113 \styrsid3877327 textingray;}{\*\cs114 \additive \rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \fs16\super \sbasedon10 \styrsid3877327 ftnoteltr;}{
\s115\ql \li720\ri72\sb60\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin72\lin720\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f184\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \snext115 \sautoupd \styrsid3877327 
TableSource;}{\s116\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \b\f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \snext116 \styrsid3877327 Table Title 1;}{
\s117\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \snext0 \styrsid3877327 Table SubTitle;}{
\s118\ql \li0\ri0\widctlpar\tqr\tldot\tx10080\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext0 \sautoupd \styrsid3877327 
table of figures;}{\s119\ql \fi-360\li720\ri0\sb100\sa100\sbauto1\saauto1\widctlpar\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin720\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext119 \styrsid3877327 clear formatting;}{\s120\ql \li480\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin480\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext120 \sautoupd \styrsid3877327 bullish;}{\s121\ql \fi-360\li360\ri0\widctlpar\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext121 \sautoupd \styrsid3877327 List Bullet;}{\*\ts122\tsrowd\trqc\trbrdrt\brdrs\brdrw15 \trbrdrl\brdrs\brdrw15 \trbrdrb\brdrs\brdrw15 \trbrdrr
\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 \trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tblind0\tblindtype3\tscellwidthfts0\tsvertalt\tsbrdrt\tsbrdrl\tsbrdrb\tsbrdrr\tsbrdrdgl\tsbrdrdgr\tsbrdrh\tsbrdrv 
\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \snext122 \styrsid3877327 aaatablenew;}{
\s123\ql \li1440\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1440\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f41\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext123 \styrsid3877327 
Title Page;}{\s124\ql \fi-240\li240\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin240\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
\sbasedon0 \snext0 \ssemihidden \styrsid3877327 table of authorities;}{\s125\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang1033\langfe1033\loch\f14\hich\af0\dbch\af14\cgrid\langnp1033\langfenp1033 \snext125 \slink126 \styrsid3877327 No Spacing;}{\*\cs126 \additive \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
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\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid66569\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li2835\jclisttab\tx2835\lin2835 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0
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\jclisttab\tx1800\lin1440 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\'02\'03);}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \li2160\jclisttab\tx2520\lin2160 }{\listlevel
\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\'03(\'04);}{\levelnumbers\'02;}\rtlch\fcs1 \af0 \ltrch\fcs0 \s5\li2880\jclisttab\tx3240\lin2880 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0
\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\'03(\'05);}{\levelnumbers\'02;}\rtlch\fcs1 \af0 \ltrch\fcs0 \s6\li3600\jclisttab\tx3960\lin3600 }{\listlevel\levelnfc2\levelnfcn2\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0
\levelindent0{\leveltext\'03(\'06);}{\levelnumbers\'02;}\rtlch\fcs1 \af0 \ltrch\fcs0 \s7\li4320\jclisttab\tx4680\lin4320 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext
\'03(\'07);}{\levelnumbers\'02;}\rtlch\fcs1 \af0 \ltrch\fcs0 \s8\li5040\jclisttab\tx5400\lin5040 }{\listlevel\levelnfc2\levelnfcn2\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\'03(\'08);}{\levelnumbers\'02;}
\rtlch\fcs1 \af0 \ltrch\fcs0 \s9\li5760\jclisttab\tx6120\lin5760 }{\listname ;}\listid147946838}{\list\listtemplateid-1623671762\listhybrid{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext
\leveltemplateid2087338090\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li720\jclisttab\tx720\lin720 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\leveltemplateid197641
\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li1395\jclisttab\tx1395\lin1395 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers
;}\f10\fbias0 \fi-360\li2115\jclisttab\tx2115\lin2115 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid66569\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 
\fi-360\li2835\jclisttab\tx2835\lin2835 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li3555
\jclisttab\tx3555\lin3555 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li4275
\jclisttab\tx4275\lin4275 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid66569\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li4995
\jclisttab\tx4995\lin4995 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li5715\jclisttab\tx5715\lin5715 }
{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li6435\jclisttab\tx6435\lin6435 }{\listname 
;}\listid401175678}{\list\listtemplateid-977129756\listhybrid{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid2087338090\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 
\fi-360\li765\jclisttab\tx765\lin765 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li1440
\jclisttab\tx1440\lin1440 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li2160
\jclisttab\tx2160\lin2160 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid66569\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li2880
\jclisttab\tx2880\lin2880 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li3600\jclisttab\tx3600\lin3600 }
{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li4320\jclisttab\tx4320\lin4320 }{\listlevel
\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid66569\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li5040\jclisttab\tx5040\lin5040 }{\listlevel\levelnfc23
\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li5760\jclisttab\tx5760\lin5760 }{\listlevel\levelnfc23\levelnfcn23\leveljc0
\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li6480\jclisttab\tx6480\lin6480 }{\listname ;}\listid422461725}{\list\listtemplateid-1662984100
\listhybrid{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\leveltemplateid2087338090\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li765\jclisttab\tx765\lin765 }{\listlevel\levelnfc23
\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li1440\jclisttab\tx1440\lin1440 }{\listlevel\levelnfc23\levelnfcn23\leveljc0
\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li2160\jclisttab\tx2160\lin2160 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0
\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid66569\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li2880\jclisttab\tx2880\lin2880 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0
\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li3600\jclisttab\tx3600\lin3600 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative
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{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li5760\jclisttab\tx5760\lin5760 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext
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\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid2087338090\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li720\jclisttab\tx720\lin720 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0
\levelindent0{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li1440\jclisttab\tx1440\lin1440 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext
\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li2160\jclisttab\tx2160\lin2160 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext
\leveltemplateid66569\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li2880\jclisttab\tx2880\lin2880 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid197641
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\fi-360\li5040\jclisttab\tx5040\lin5040 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li5760
\jclisttab\tx5760\lin5760 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li6480
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\fi-360\li1440\jclisttab\tx1440\lin1440 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li2160
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{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li4320\jclisttab\tx4320\lin4320 }{\listlevel
\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li5040\jclisttab\tx5040\lin5040 }{\listlevel\levelnfc23
\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li5760\jclisttab\tx5760\lin5760 }{\listlevel\levelnfc23\levelnfcn23\leveljc0
\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li6480\jclisttab\tx6480\lin6480 }{\listname ;}\listid1117673081}{\list\listtemplateid545808748
\listhybrid{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\leveltemplateid-346009944\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \s80\fi-360\li720\jclisttab\tx720\lin720 }{\listlevel
\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\leveltemplateid-1815555174\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li1440\jclisttab\tx1440\lin1440 }{\listlevel\levelnfc23\levelnfcn23
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\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li2880\jclisttab\tx2880\lin2880 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0
\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li3600\jclisttab\tx3600\lin3600 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1
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\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li5760\jclisttab\tx5760\lin5760 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext
\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li6480\jclisttab\tx6480\lin6480 }{\listname ;}\listid1178738857}{\list\listtemplateid406124452\listhybrid{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0
\levelstartat1\levelspace0\levelindent0{\leveltext\leveltemplateid2087338090\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li765\jclisttab\tx765\lin765 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative
\levelspace0\levelindent0{\leveltext\leveltemplateid197641\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li1440\jclisttab\tx1440\lin1440 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0
{\leveltext\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0 \fi-360\li2160\jclisttab\tx2160\lin2160 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext
\leveltemplateid66569\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0 \fi-360\li2880\jclisttab\tx2880\lin2880 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid197641
\'01o;}{\levelnumbers;}\f2\fbias0 \fi-360\li3600\jclisttab\tx3600\lin3600 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid328713\'01\u-3929 ?;}{\levelnumbers
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\par 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\f41\insrsid14891063 \tab     Submitted by:}{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\f41\insrsid14891063\charrsid10502335 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063\charrsid3947642 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063 \tab     }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063\charrsid3947642 Robert Mollica, Ed.D.
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063 \tab     }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063\charrsid3947642 {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname PlaceName}}National{\*\xmlclose} 
{\*\xmlopen\xmlns2{\factoidname PlaceType}}Academy{\*\xmlclose}{\*\xmlclose} for State Health Policy
\par 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063 \tab     }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063\charrsid3947642 Leslie Hendrickson, Ph.D.
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063 \tab     }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063\charrsid3947642 Hendrickson Development}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063 
\par 
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\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f41\insrsid14891063 \tab     }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f41\insrsid14891063\charrsid10502335 November 2009
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063\charrsid3947642 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14891063 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063\charrsid3947642 
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14891063 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063\charrsid3947642 
\par 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14891063 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f41\insrsid14891063\charrsid3947642 
\par }\pard\plain \ltrpar\s84\ql \li1560\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1560\itap0\pararsid14891063 \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\ai\af1 \ltrch\fcs0 \i\f41\insrsid14891063\charrsid3947642 This document was developed under Grant}{\rtlch\fcs1 \ai\af1 \ltrch\fcs0 \i\f41\insrsid14891063  CFDA 93.779}{\rtlch\fcs1 \ai\af1 \ltrch\fcs0 \i\f41\insrsid14891063\charrsid3947642  from the 
{\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname country-region}}U.S.{\*\xmlclose}{\*\xmlclose} Department of Health and Human Services, Cent
ers for Medicare and Medicaid Services. The contents of this report do not necessarily represent the policy of the U.S. Department of Health and Human Services or the California H}{\rtlch\fcs1 \ai\af1 \ltrch\fcs0 \i\f41\insrsid14891063 
ealth and Human Services Agency and you should not assume endorsement by the Federal Government or State of California.}{\rtlch\fcs1 \ai\af1 \ltrch\fcs0 \i\f41\insrsid14891063\charrsid3947642 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14891063 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid14891063 
\par }\pard\plain \ltrpar\s1\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid10430516 \rtlch\fcs1 \ab\af1\afs32\alang1025 \ltrch\fcs0 
\b\f41\fs36\cf17\lang1033\langfe1033\kerning32\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid14891063 \page }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid10430516\charrsid4154285 Executive Summary{\*\bkmkend _Toc218840625}
{\*\bkmkend _Toc219032952}{\*\bkmkend _Toc219032974}{\*\bkmkend _Toc219107381}{\*\bkmkend _Toc219107407}{\*\bkmkend _Toc219517371}{\*\bkmkend _Toc219517402}{\*\bkmkend _Toc220307542}{\*\bkmkend _Toc220310245}{\*\bkmkend _Toc220310360}
{\*\bkmkend _Toc220907153}{\*\bkmkend _Toc220918845}{\*\bkmkend _Toc221633462}{\*\bkmkend _Toc222991663}{\*\bkmkend _Toc223399024}{\*\bkmkend _Toc224180310}{\*\bkmkend _Toc227839100}{\*\bkmkend _Toc228022808}{\*\bkmkend _Toc228612482}
{\*\bkmkend _Toc244405522} }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid10430516 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10430516 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid10430516\charrsid10430516 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\brdrt\brdrs\brdrw45\brsp60\brdrcf18 \wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f41\fs32\insrsid3877327\charrsid6315148 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\insrsid3877327 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}
 faces enormous challenges maximizing opportunities for seniors and persons with disabilities of all ages to live independently in the setting of their choice. The c
hallenges are fiscal, geographic and structural. Even when the state does not face unprecedented budget deficits, investments are needed in the services and delivery system to promote informed choice, access to preferred services and adequate financial su
pport. The sheer size of the state makes statewide implementation of a major initiative far more complex, yet \'93pilot\'94 programs that operate in limited areas of the state add to the fragmentation that hampers consumer access. 
\par 
\par The California Community Choices (Choices) project is a five-year grant funded by the Centers for Medicare & Medicaid Services to increase}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid7883241 
 consumer access to home and community-based long-term care services }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 by establishing one-stop resource centers, Aging and Disability Resource Connec
tion (ADRC) programs, in cooperation with the California Department of Aging. ADRCs provide }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid6633328 information, referral}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 ,}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid6633328  and assistance}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  for persons with disabilities, caregivers, family and friends who }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid6633328 seek }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 information about }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid6633328 long-term care services}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 . The Choices 
project also developed the California Care Network (CalCareNet), a website guide to long-term care services in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}
. CalCareNet is being piloted with ADRCs in {\*\xmlopen\xmlns2{\factoidname City}}Orange{\*\xmlclose} and {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname City}}Riverside{\*\xmlclose}{\*\xmlclose}
 counties to provide complementary information and assistance in person or by phone to persons seeking services. 
\par 
\par The Choices project also includes a }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid7883241 financing study }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 to }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid7883241 
examine the laws, regulations, policies and payment methodologies related to long-term care financing in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}. }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid7151957 The study }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 was initiated to }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid7151957 improve the state\rquote 
s understanding of the financial and structural barriers to increasing consumer access to home and community-based services}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 ,}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid7151957  and }{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid3877327 to }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid7151957 provide recommendations that enable the }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\delrsid14748618\charrsid7151957 state}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid7151957  to more effectively manage funding for long-term care }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 in ways}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid7151957  that promote community living options. }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}
 spends more than $10 billion annually on long-term care, and the majority of the funds pay for services in the community. The programs that cover the services for ad
ults with physical disabilities and older adults appear to function independently with separate delivery systems and management structures. Consumers must contact different organizations for each program. Only persons with developmental disabilities are a
ble to contact a single entity, receive information about their options, assess their service needs and access the appropriate service. 
\par 
\par The Choices project and the Department of Aging are developing Aging and Disability Resource Connection (ADRC) programs
 to provide additional centralized sources of information and referral.  ADRCs provide information about programs, services and eligibility requirements to help consumers make informed decisions. Where an ADRC also administers long-term care programs, acc
ess to community services can be expedited. 
\par 
\par The report recommends that {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose} develop a strategic plan }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2847879 
that describes which populations, services and programs will be addressed by the }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 strategic }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2847879 plan}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 ,}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2847879  and describes the mission, values and goals for its long-term }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 living }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2847879 
services and supports}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327  programs}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2847879 . }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 The plan should include a mission and vision statement and }{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2847879 short, medium and long-term goals that include objectives, tasks that will be undertaken to achieve the objectives and the }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 entity}{\rtlch\fcs1 
\af1 \ltrch\fcs0 \insrsid3877327\charrsid2847879  and staff that will be responsible for implementing }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 each one}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2847879 .}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327  
\par 
\par This report includes findings from interviews with state officials, state staff and stakeholders, data obtained from the state and other sources as well as r
eviews of statutes, regulations and previous reports. Appendix A contains a nine-page bibliography that includes these previous reports.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid3877327\charrsid14748618 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 
\b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069 {\*\bkmkstart _Toc244405523}General Findings{\*\bkmkend _Toc244405523}
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327 
\par {\listtext\pard\plain\ltrpar \s84 \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\s84\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327 
Approximately 2.4 million persons in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose} report having }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid12672814 
two or more disabilities}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327  and an estimated 400,000 plus have intellectual or developmental disabilities.\line 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}{\listtext\pard\plain\ltrpar \s84 \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327\charrsid6112861 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid3877327\charrsid6112861 California{\*\xmlclose}{\*\xmlclose} has more persons }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid12672814 age 65 and older}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid6112861 
 than other states}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327  and the population is growing.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid6112861  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid5381243 In 2007, 
{\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose} was home to 4.0 million }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327 persons}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid3877327\charrsid5381243  age 65 and older or 11.0% of the total population. By 2010, the number of Californians age 65}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327  and older}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid5381243 
 will increase to 4.4 million }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327 or 14.7%, }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid5381243 and }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327 will increase }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid3877327\charrsid5381243 to 8.3 million or 17.8% of all Californians in 2030.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f0\insrsid3877327\charrsid10292481 
\par }\pard\plain \ltrpar\s38\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \f0\insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls9\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
The system is organized by program rather than by person. }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid5838384 {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327 {\*\xmlclose}{\*\xmlclose}\rquote s}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid5838384  services for }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 older adults and }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid5838384 
individuals with disabilities}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  are covered through programs managed by }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid12672814 multiple state agencies}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
 and organizations. However, the programs provide a core of similar services that include support with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and health and social needs. Tens of thousands of persons receive se
rvices from multiple programs, while others shift between programs in complex passages resulting in costs and consumer outcomes that are rarely studied since no one department is responsible for the entirety of a person\rquote s care and services. 
\par }\pard \ltrpar\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls15\adjustright\rin0\lin720\itap0\pararsid3877327 {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 In 2009, {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}\rquote 
s DD programs ranked seventh in the nation for the best performing state Medicaid programs in a national study by United Cerebral Palsy which measured 20 factors. 
\par }\pard \ltrpar\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}{\listtext\pard\plain\ltrpar \s84 \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327\charrsid16008433 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s84\ql \fi-360\li720\ri0\widctlpar\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls9\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid16008433 California{\*\xmlclose}{\*\xmlclose} ranks 1st in the nation on the number of }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid12672814 personal care participants}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid3877327\charrsid16008433  per }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327 1,000}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid16008433  population, 19th on home health participants per }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid3877327 1,000}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid16008433  population, }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327 and }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid16008433 
42nd on Home and Community-Based Services (HCBS) }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\delrsid9051882\charrsid16008433 Waiver}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid16008433  participants per }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\insrsid3877327 1,000 population}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid16008433 . }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid12788792 {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}
California{\*\xmlclose}{\*\xmlclose} ranks 6th in total HCBS participants per }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327 1,000}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid12788792 
 population and 17th on total HCBS expenditures per capita in 2005.  
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af0 
\ltrch\fcs0 \b\f0\insrsid3877327\charrsid5838384 
\par {\listtext\pard\plain\ltrpar \s84 \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\cf1\insrsid3877327\charrsid8344735 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\s84\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls16\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\f0\cf1\insrsid3877327\charrsid8344735 For older adults and adults with physical disabilities, {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}
 was ranked 5th nationally in the percentage of HCBS spending with 48% on institutional care and 52% on HCBS in 2007. 
\par }\pard\plain \ltrpar\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 
\ltrch\fcs0 \cf1\insrsid3877327\charrsid8994399 
\par }\pard \ltrpar\ql \li1035\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1035\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \i\insrsid3877327\charrsid3038942 Note}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399 : 
}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327 T}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid145646 he annual table of the percentage of spending on HCBS prepared by Thomson Reuters }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327 
reports }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid145646 all Medicaid State Plan personal care expenditures }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327 (}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid145646 IHSS}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327 )}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid145646  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327 in the data for }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid145646 
aged and disabled beneficiaries}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 . }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399 
Medicaid service expenditures reported on CMS Form 64 are frequently used to rank states on long-term care spending. However, the Form 64 data under-report spending for community services in {\*\xmlopen\xmlns2{\factoidname place}}
{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose} and other states.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid8994399  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid6818022 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid8994399 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls16\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399 In 2007, {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}
California{\*\xmlclose}{\*\xmlclose} was 48th in the nation on}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid12672814  per capita spending}{\rtlch\fcs1 \af1 \ltrch\fcs0 \cf18\insrsid3877327\charrsid6239244  }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid8994399 for waiver exp}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 enditures, 4th on personal care}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399  and 18th overall on total HCBS.}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327 
\par }\pard \ltrpar\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399  
\par }\pard \ltrpar\ql \li1035\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1035\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \i\insrsid3877327\charrsid3038942 Note}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2121747 
: Comparing California\rquote s rank for per capita HCBS spending to other states may be misleading since state expenditures on related Medi-Cal state plan services and services under the Lanterman }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
Developmental Disabilities Services }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2121747 Act }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 (Lanterman Act) }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2121747 funded by state gene
ral revenues are not captured in HCBS data reported on the CMS Form 64.
\par }\pard \ltrpar\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2121747 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid2121747 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls16\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid2121747 In 2007, HCBS acco}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399 unt}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 ed}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399  for 62% of developmentally disabled (DD) spending and 38% for }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 institutional care, which placed}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399  {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose} 32nd among states. }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\cf1\insrsid3877327\charrsid8994399 When spending for targeted case management and clinical services is included, the ratio is 66% HCBS and 34% institutional. 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \cf1\insrsid3877327\charrsid8994399 
\par }\pard \ltrpar\ql \li1035\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1035\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \i\insrsid3877327\charrsid3038942 Note}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399 
: Comparing {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}\rquote s rank for waiver spending for persons with developmental disabilities to other states may be misleading since the s
tate spends such a large amount on IHSS, other Medi-Cal state plan services and services under the Lanterman Act funded by state general revenues. }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
Data on these expenditures are not captured in the CMS Form 64, which is}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8994399  frequently used to rank states on long-term care spending.
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\tx9360\wrapdefault\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 Annual per capita spending presents a different perspective on spending. In FY 2007, 
{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose} exceeded the national average for spending on state plan personal care services (referred to as IHSS in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California
{\*\xmlclose}{\*\xmlclose})\emdash $101.51 versus $34.47. {\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}\rquote 
s spending for HCBS Waivers for aged and disabled beneficiaries is $3.00 per capita per year compared to $21.02 nationally, and for individuals with Mental Retardation/Developmental Disabilities (MR/DD), per capita spending was $35.12 in 
{\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose} compared to $68.04 nationally. The inclusion of targeted case management spending would increase per capita spending. 
\par }\pard \ltrpar\ql \li1035\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1035\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 California spent less annually per capita than the national FY 2007 average on nursing facility care
\emdash $100.04 per day compared to $155.76 per day nationally, and spending for Intermediate Care Facilities for the Mentally Retarded (ICF/MRs) was $21.27 per day in California compared to $39.83 per day nationally. 
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af0 
\ltrch\fcs0 \f0\cf1\insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
Nursing facility spending increased 40.7% between 2001 and 2007}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912  while waiver spending for older adults and individual}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
s with disabilities increased 20.6%}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912  during the same period}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8286492 . Nationally, }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
nursing facility}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8286492  spending increased 10% and waiver spending }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 for older adults and individuals with physical disabilities }{\rtlch\fcs1 \af1 
\ltrch\fcs0 \insrsid3877327\charrsid8286492 rose 85%}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327  during the same period}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid8286492 . 
\par }\pard \ltrpar\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid7801912 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 Medi-Cal spending for all nursing facility and }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327 ICF/MR institutional services rose 46.9% between 2001 and 2007}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 while }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid7801912 spending for }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 community services\emdash In-Home Supportive Services (}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 IHSS), MR}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327 /DD and other waiver services}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 \emdash }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 rose 88.4%.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912  }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid3744069 
\par }\pard\plain \ltrpar\s38\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af0 
\ltrch\fcs0 \f0\cf1\insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
The state does not take full advantage of Medicaid }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid12672814 provider fees}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 . 
\par }\pard\plain \ltrpar\s84\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \f0\insrsid3877327 
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 
\b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 {\*\bkmkstart _Toc244405524}System Design{\*\bkmkend _Toc244405524}
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 
\b\insrsid3877327\charrsid3744069 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}{\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid3744069 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls6\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069 California{\*\xmlclose}{\*\xmlclose} lacks a strategic plan }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327 that would set}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069  priorities for services for the future to maximize the use of finite resources. The Olmstead }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 P}{\rtlch\fcs1 \af1 
\ltrch\fcs0 \insrsid3877327\charrsid3744069 lan offers a framework for developing a strategic plan. }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 \line 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid3744069 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069 
New programs often require a new delivery system because there is no logical infrastructure or }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 singl}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069 e entry point to administer new 
programs. Consumers admitted to a nursing facility do not have access to a central source of information, preadmission screening, }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 or }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069 
assistance and support to access community service options. Consumers living in the community who need assistance do not have access to options counseling to understand what services might be available to them}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327  as better alternatives to}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069  admission to an institution. }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
\par }\pard \ltrpar\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid7801912 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls6\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 While there is no }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 statewide }{\rtlch\fcs1 
\af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 entry point for older adults and individuals with disabilities, ADRCs are being designed to provide information about the multiple services and access points.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 

\par }\pard \ltrpar\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\cf1\insrsid3877327\charrsid198825 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls6\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid198825 The state\rquote 
s budget deficit makes consideration of changes that require investment in services 
or the delivery system more difficult in the short term. However, investments in HCBS programs would likely improve the effectiveness of the overall delivery system and reduce the rate of growth by shifting more resources to community services.}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid198825 
\par }\pard \ltrpar\ql \li360\ri0\widctlpar\jclisttab\tx1440\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls6\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 Collabo
ration between community service organizations and hospital discharge planners to divert admissions to nursing facilities is not well developed. }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
\par }\pard \ltrpar\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid7801912 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls6\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
Previous reports recommended consolidation of agencies and programs serving individuals with disabilities a
nd older adults. However, each program and agency has a long and rich tradition with a strong network of providers, advocates and consumers that seem more comfortable with the system they know, than a new, untested structure that is not clearly defined.}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 
\b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid10430516 {\*\bkmkstart _Toc244405525}\page }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069 In-Home Supportive Services}{\rtlch\fcs1 
\af1 \ltrch\fcs0 \insrsid3877327  (IHSS){\*\bkmkend _Toc244405525}
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid8271989 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 Opinions about the reasons for IHSS caseload growth differed. Persons interviewed}{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327\charrsid2581750  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 attributed the growth to the:
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f2\insrsid3877327 \hich\af2\dbch\af0\loch\f2 o\tab}}\pard \ltrpar\ql \fi-360\li1440\ri0\widctlpar
\jclisttab\tx1440\wrapdefault\aspalpha\aspnum\faauto\ls7\ilvl1\adjustright\rin0\lin1440\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 L}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid2581750 ow}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327  functional eligibility requirements}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid2581750  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f2\insrsid3877327 \hich\af2\dbch\af0\loch\f2 o\tab}W}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid2581750 idespread }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 awareness of }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid2581750 the program }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f2\insrsid3877327 \hich\af2\dbch\af0\loch\f2 o\tab}U}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid2581750 se of family and friends as caregivers }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f2\insrsid3877327 \hich\af2\dbch\af0\loch\f2 o\tab}S}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid2581750 tatewide availability of services }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 

\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f2\insrsid3877327 \hich\af2\dbch\af0\loch\f2 o\tab}D}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid2581750 ifficulty }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 accessing HCBS Waivers 

\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f2\insrsid3877327 \hich\af2\dbch\af0\loch\f2 o\tab}T}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid2581750 he program\rquote s well-established history}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327  and its administrative support structure
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f2\insrsid3877327 \hich\af2\dbch\af0\loch\f2 o\tab}Aging of the population
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
Persons interviewed stated that the low IHSS functional eligibility requirements help prevent further functional decline and that allowing family and friends to be reimbursed (which is becoming more common in state programs) addresses tight labor pools an
d supports family caregiving.  \line 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\tx2235\wrapdefault\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 New IHSS participants have higher assessed }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid12672814 levels of impairment}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  than persons who entered the program eight years ago. \line }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid6499482 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 The IHSS limit on the maximum number of hours of service that may be authorized, }{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid3877327\charrsid12672814 283 hours per month}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
, is higher than almost all other states. However, persons interviewed said exceptions to the cap are warranted for participants with more intensive needs, to reduce the need for supplemental services through HCBS Waivers.
\par }\pard \ltrpar\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 Studies about the impact of wa
ge and benefit increases to personal care workers report that increases have predictable positive impacts on their willingness to work and job turnover.
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 
\b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069 {\*\bkmkstart _Toc244405526}Home and Community-Based Services }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 (HCBS) }{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid3744069 Waiver Programs{\*\bkmkend _Toc244405526}
\par }\pard\plain \ltrpar\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327\charrsid5706588 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \ab\af0 \ltrch\fcs0 \f3\cf1\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327 Recent research found that s}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid15604858 
tates }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327 with }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid15604858 well-established }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \insrsid3877327\charrsid12672814 HCBS programs}{\rtlch\fcs1 \ab\af0 
\ltrch\fcs0 \cf1\insrsid3877327\charrsid15604858  had less overall }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327 l}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid15604858 ong-}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327 t}{
\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid15604858 erm }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327 c}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid15604858 are (LTC) spending growth}{\rtlch\fcs1 \ab\af0 
\ltrch\fcs0 \cf1\insrsid3877327 . }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \cf1\insrsid3877327\charrsid15604858 In contrast, states with low levels of HCBS expenditures had an increase in overall costs, as their institutional costs increased. }{\rtlch\fcs1 
\ab\af0 \ltrch\fcs0 \cf1\insrsid3877327 {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}
 was rated an expanding HCBS state for non-MR/DD services and a low HCBS state for DD Waiver services. }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3744069 
\par }\pard \ltrpar\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3744069 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 The Medi-Cal }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid12672814 level of care}{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid3877327  criteria used to determine eligibility for each HCBS program seems appropriate given the intended populations served and the program services provided. \line }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid10363897 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327\charrsid14748618 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\sb100\sa100\sbauto1\saauto1\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid14748618 Multipurpose Senior Services Program}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  (}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid12672814 MSSP}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
) enrollment is limited by funding but experienced periods of growth. The program primarily provides case management to persons age 65 and older who also receive IHSS services.
 Stakeholders noted that expanding MSSP services to provide more transition assistance to persons wishing to leave institutions would be a useful program development.\line 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid7801912 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 The }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid12672814 Assisted Living }{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\delrsid14748618\charrsid12672814 Waiver}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912  (ALW) }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
expands long-term care settings by providing residential service choices }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 but serves }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 persons in a}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid7801912  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 limited }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 number of }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 counties }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid7801912 and is not available statewide. }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
\par }\pard\plain \ltrpar\s38\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}{\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\ql \fi-360\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327 California{\*\xmlclose}{\*\xmlclose} does not use the special income level eligibility option, which would streamline access for individuals with income below 300% of the federal }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid14748618 Supplemental Security Income (SSI) benefit. }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par }\pard\plain \ltrpar\s38\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327\charrsid1467913 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\ql \fi-360\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid1467913 The cost differences between waiver expenses and institutional costs totaled $3 billion in FY 2006, which suggests that HCBS programs are cost-effective, and delay or substitute for hospital, }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327 nursing facility}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid1467913  and ICF/MR care even if only a modest percentage of persons would have been served in institutions in the absence of the programs. }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par }\pard\plain \ltrpar\s38\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin720\itap0\pararsid3877327 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 The state has not studied the cost effectiveness of its waiver programs.
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \ab\af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin720\itap0\pararsid3877327 {
\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \insrsid3877327 Stakeholders commented that the number of waiver slots is low relative t}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \insrsid3877327\charrsid16523133 
o most other states, and expanding the waiver capacity would be important to address in a strategic plan for long-term care.}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \insrsid3877327\charrsid5580164 
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 
\b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid16523133 {\*\bkmkstart _Toc244405527}Department of Developmental Services{\*\bkmkend _Toc244405527}
\par }\pard\plain \ltrpar\s38\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af0 
\ltrch\fcs0 \f0\insrsid3877327\charrsid16523133 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \ab\af0 \ltrch\fcs0 \f3\insrsid3877327\charrsid16523133 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls10\adjustright\rin0\lin765\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 
\insrsid3877327\charrsid16523133 The {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname PlaceName}}Regional{\*\xmlclose} {\*\xmlopen\xmlns2{\factoidname PlaceType}}Center{\*\xmlclose}{\*\xmlclose} delivery syst}{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327\charrsid5580164 e}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid4551654 m for individuals with developmental disabilities is well developed. It }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 is 
{\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}\rquote s }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid4551654 
only long-term care system that operates as a single entry point that provides access to comprehensive services. }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 \line 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327\charrsid4551654 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid4551654 The growth in the number of persons }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327\charrsid12672814 served in Department of Developmental Services (DDS) programs}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  has been steady throughout the last}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid4551654 
 decade. }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 The caseload has grown from just over 180,000 in 2001 to over 247,001 in July 2009.
\par }\pard \ltrpar\ql \li765\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin765\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls10\adjustright\rin0\lin765\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
The state has made significant progress in helping persons with intellectual and developmental disabilities leave state-operated institutions. DDS stated that the eff
ort to transition individuals out of private facilities focused on relocating persons with developmental disabilities from large facilities to small home-like settings. While the number of persons in private facilities has increased, the number of persons
 in large ICF-MRs has declined and the number of persons in smaller facilities has increased.  
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls10\adjustright\rin0\lin765\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 Prior to July 1, 2008, regional centers }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid12672814 
negotiated rates}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  for nonresidential services. }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid4722631 The extent and depth of negotiated rates}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 ,}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid4722631  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 and the degree to which negoti
ations are used in the cost-based approaches, is not reported by DDS. The uniformity of rate payments across regional centers is not known.
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls10\adjustright\rin0\lin765\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 When}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3611928  implemented, }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 the}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3611928  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 April 2009 }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3611928 settlement of }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 the}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3611928  class action lawsuit (Capitol People First v}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 .}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3611928 
 DDS) will provide more information and choices to live in small community settings to individuals }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 with developmental disabilities }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3611928 
who currently live in government or privately operated facilities.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  
\par }\pard\plain \ltrpar\s38\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \f0\fs22\insrsid3877327\charrsid3611928 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327\charrsid3611928 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls14\adjustright\rin0\lin765\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid3611928 The two main drivers of }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 HYPERLINK \\l "ddwaivercosts"}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid93984 {\*\datafield 
08d0c9ea79f9bace118c8200aa004ba90b02000000080000000e0000006400640077006100690076006500720063006f00730074007300000072}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3611928 DD Waiver costs}}}\sectd 
\pgnrestart\pgnstarts0\linex0\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid3163779\sftnbj\saftnnar {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3611928  are sustained increases in enrollment and utilization. Once a person }{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid3877327 enrolls in the waiver, they tend to remain, although DDS staff indicated that between 5,000-6,000 persons disenroll from the waiver each year. }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3611928 
\par }\pard \ltrpar\ql \li405\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin405\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid3611928 
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 
\b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid10363897 {\*\bkmkstart _Toc244405528}Adult Day Health Care}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327  (ADHC)}{\rtlch\fcs1 \af1 
\ltrch\fcs0 \insrsid3877327\charrsid10363897 {\*\bkmkend _Toc244405528}
\par }\pard\plain \ltrpar\s38\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \f0\insrsid3877327\charrsid10363897 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls11\adjustright\rin0\lin765\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
A study of programs in six states ({\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}, {\*\xmlopen\xmlns2{\factoidname State}}Maryland{\*\xmlclose}, {\*\xmlopen\xmlns2{\factoidname State}}New Jersey{\*\xmlclose}, 
{\*\xmlopen\xmlns2{\factoidname City}}New York{\*\xmlclose}, {\*\xmlopen\xmlns2{\factoidname State}}Texas{\*\xmlclose} and {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}Washington{\*\xmlclose}{\*\xmlclose}
) found that ADHC can save the Medicaid program significant resources by delaying or avoiding inappropriate entry into more costly institutional care.\line 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}A review of Treatment Authorization Requests (TARs) estimated that between 30\endash 40% of all participants would need }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327\charrsid12672814 nursing facility care}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  in the absence of ADHC services. The specific level of nursing facility care\emdash Level A, Level B or Subacute\emdash was not indicated.
\line 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Over 80% of ADHC participants are age 65 and older and fewer than half are age 80 and older, wh
ich is comparable to recipients who receive services in a nursing facility. 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls11\adjustright\rin0\lin765\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
ADHC often serves beneficiaries who receive other services. A review of paid Medi-Cal claims found that 60% also received IHSS services. A state official suggested that ADHC ma
y supplement IHSS for participants who need more hours than can be authorized under IHSS. ADHC also provides skilled services that are not available through IHSS, and the combined services meet a broader range of health and functional needs.\line 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Legislation passed in 2006 made significant changes in the ADHC program and reduced expenditures. \line 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}ADHCs serve two }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid12672814 distinct populations}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327 \emdash one receives temporary rehabilitative services and the other receives longer-term support and medical services.\line 
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 
\b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid10363897 {\*\bkmkstart _Toc244405529}Mental Health}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 {\*\bkmkend _Toc244405529}
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \b\f0\insrsid3877327\charrsid10363897 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}{\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls12\adjustright\rin0\lin765\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
California{\*\xmlclose}{\*\xmlclose} does not operate an }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid9726306 HCBS program}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  that is designed specifically for }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid12672814 persons with mental illness}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 . A package of services for nursing facility residents with a mental illness could be designed under a \'a71915(c) Waiver or a \'a7
1915(i) state plan HCBS amendment.
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 
\b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 {\*\bkmkstart _Toc244405530}Nursing Facilities{\*\bkmkend _Toc244405530}
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \b\f0\insrsid3877327\charrsid10363897 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}{\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid7801912 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\ql \fi-360\li720\ri0\widctlpar\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 
\ltrch\fcs0 \insrsid3877327\charrsid7801912 California{\*\xmlclose}{\*\xmlclose} ranks 43rd among states in the }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid12672814 supply of nursing facility}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid7801912  beds }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 per capita, }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 and 31st with an occupancy rate of 86%. The Medi-Cal }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid10960306 nursing}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912  facility }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 resident }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 census has }{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 declined slightly, 1.4%, over}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912  the past }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 eight}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid7801912  years. However, between December 2001 and }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 December }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 2008, the number of Medicaid residents}{\rtlch\fcs1 \af1 
\ltrch\fcs0 \insrsid3877327  in nursing facilities dropped 8}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 % }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 nationally and 22}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
 states experienced a reduction of 10% or greater, which suggests that further reductions are possible through diversion and transition/relocation initiatives. }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 Although other factors may contribute to 
{\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}\rquote s modest decline, effective diversion and transition programs along with fiscal incentives for counties would continue the trend.
\line }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid6960316 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 From December 2002 to December 2008, the number of }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid14893628 nursing facilities}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}
 declined approximately 6%, slightly above the national average. The numbers of nursing facility residents and nursing facility beds}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid7419145  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
have also declined modestly, although less than the national decline, while the occupancy rate has increased slightly.
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327\charrsid1333231 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid1333231 While there is a perception among persons interviewed that {\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose} has a history of low }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 nursing facility}{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid3877327\charrsid1333231  reimbursement rates, a\~review of national rates from 1998 to 2005 shows that {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}
 ranks in the midrange compared to other states}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  in nominal dollar terms}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid1333231 .
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}{\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
California{\*\xmlclose}{\*\xmlclose} has a higher proportion of residential care and a lower supply of nursing facility beds per 1,000 persons age 65 and older than the other large states.
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327\charrsid14893628 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid14893628 Medicare nursing facility}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  use increased 26% in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}
 and 34% nationally between 2001 and 2008. Nursing facilities have a financial incentive to expand their Medicare and managed care subacute business by its profitable ancillary revenue.
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri198\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin198\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
Increases in }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid14893628 nursing facility Medi-Cal per diems}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327  in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California
{\*\xmlclose}{\*\xmlclose} have been greater than general inflation over the period 2001\endash 2008 and have kept up with medical inflation.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\insrsid3877327\charrsid7101910  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 

\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri468\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin468\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
Operating margins of nursing facilities have increased substantially in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose} since 2000.
\par }\pard \ltrpar\ql \li0\ri198\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin198\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 Only about 55\endash 60 nursing facilities report any }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid14893628 caregiver training}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327  expenses although it is a 100% pass-through cost.
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 
\ltrch\fcs0 \insrsid3877327 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}{\listtext\pard\plain\ltrpar \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
California{\*\xmlclose}{\*\xmlclose}\rquote s nursing facility cost reimbursement methodology does not control for }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid14893628 low occupancy}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
. In per diem reimbursement systems, costs are divided by
 days of service. As the number of days becomes smaller, the cost per day goes up. Unless low occupancy rates are controlled for, the entities receiving the per diem reimbursement will get more money per person as they serve fewer persons. }{\rtlch\fcs1 
\af1 \ltrch\fcs0 \insrsid3877327\charrsid13710088 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid869194 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}{\listtext\pard\plain\ltrpar \rtlch\fcs1 \af186 \ltrch\fcs0 \f3\cf1\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af186 \ltrch\fcs0 \f186\cf1\insrsid3877327 California{\*\xmlclose}{\*\xmlclose} also }{\rtlch\fcs1 \af186 \ltrch\fcs0 
\f186\cf1\insrsid3877327\charrsid10965892 uses }{\rtlch\fcs1 \af186 \ltrch\fcs0 \f186\cf1\insrsid3877327 prospective}{\rtlch\fcs1 \af186 \ltrch\fcs0 \f186\cf1\insrsid3877327\charrsid10965892  }{\rtlch\fcs1 \af186 \ltrch\fcs0 
\f186\insrsid3877327\charrsid14893628 cost-based rates}{\rtlch\fcs1 \af186 \ltrch\fcs0 \f186\cf1\insrsid3877327  that are not adjusted for the acuity of the residents.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327\charrsid4785616 
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \s38 \rtlch\fcs1 \af0 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\s38\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327 If {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}
{\*\xmlclose} had the same }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid14893628 nursing facility usage}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327 
 as the national average, about 42,600 more persons would have their nursing facility stay 
paid for by Medi-Cal. At 2007 costs, if these 42,600 persons had been receiving nursing facility Level B services for 219 days each at a cost of $139.70 (the average number of days and costs in 2007 in California paid by Medi-Cal), the state would have sp
ent an additional $1.4 billion per year. }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f0\insrsid3877327\charrsid14775015 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327 
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 
\b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid10363897 {\*\bkmkstart _Toc244405531}Transition }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\delrsid9908076\charrsid10363897 P}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid10363897 rograms}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 {\*\bkmkend _Toc244405531}
\par }\pard\plain \ltrpar\s38\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \b\f0\insrsid3877327\charrsid10363897 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid6230680 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls13\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid6230680 The state currently }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 operates nursing facility}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid6230680  transition }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
initiatives through the Department of  Rehabilitation, }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid6230680 Centers for Independent Living}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 , 1915(c) Waivers, a program}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid6230680  in San Francisco,}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327  and the new Money Follows the Person (MFP)}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid6230680  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
Rebalancing Demonstration.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\delrsid14748618  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid6230680 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid6230680 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327\charrsid14893628 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar
\jclisttab\tx720\wrapdefault\aspalpha\aspnum\faauto\ls13\adjustright\rin0\lin720\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid14893628 MFP}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
 offers an opportunity to develop and refine strategies that provide transition coordination to nursing facility residents who are interested in moving to the community. The }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 fragmented }{\rtlch\fcs1 \af1 
\ltrch\fcs0 \insrsid3877327\charrsid7801912 delivery system poses additional challenges to transition coordination. The program\rquote s success will depend on the ability of the service network to provide access to the level of service needed by individ
uals who are interested in moving to the community. }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
\par }\pard\plain \ltrpar\s38\ql \li720\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 
\ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls12\adjustright\rin0\lin765\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
Access to affordable housing is a }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid14893628 barrier to transitioning}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327  for persons who want to return to the community but lack a source of housing. 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par This report\rquote s recommendations }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 support }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 five }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 primary goals:}{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid3877327\charrsid1196130 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls12\adjustright\rin0\lin765\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 Define goals for balancing the long-term care system 
\par }\pard \ltrpar\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls12\adjustright\rin0\lin765\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 R}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
educe the rate of growth in spending on institutional care }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
\par }\pard \ltrpar\ql \li360\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin360\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls12\adjustright\rin0\lin765\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 Expand HCBS programs over time as the economy recovers and state revenues increase 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls12\adjustright\rin0\lin765\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 Invest savings from a lower rate of institutional growth in }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid3877327\charrsid7801912 home and community-based services for individuals who are at risk of entering an institution
\par }\pard \ltrpar\ql \li405\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin405\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \af1 \ltrch\fcs0 \f3\insrsid3877327 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\ql \fi-360\li765\ri0\widctlpar
\jclisttab\tx765\wrapdefault\aspalpha\aspnum\faauto\ls12\adjustright\rin0\lin765\itap0\pararsid3877327 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 I}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid7801912 
mprove the management of home and community services programs 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3877327 
\par  The recommendations are grouped by the length of time it might take to implement them and then by category:  Financing, Access and Service Delivery and State-level Organization.
\par 
\par \sect }\sectd \ltrsect\lndscpsxn\pgwsxn15840\pghsxn12240\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid3877327\sftnbj \pard\plain \ltrpar
\s2\ql \li0\ri0\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 \b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid13243763 {\*\bkmkstart _Toc224180311}{\*\bkmkstart _Toc227839101}{\*\bkmkstart _Toc228022809}{\*\bkmkstart _Toc228612483}{\*\bkmkstart _Toc244405532}Summary of the Recommendations}{\rtlch\fcs1 \af1 
\ltrch\fcs0 \insrsid3877327 {\*\bkmkend _Toc224180311}{\*\bkmkend _Toc227839101}{\*\bkmkend _Toc228022809}{\*\bkmkend _Toc228612483}{\*\bkmkend _Toc244405532}
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid330591\charrsid3755952 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trleft-108\trhdr\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth3948\clcbpatraw28 \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth7925\clcbpatraw28 
\cellx11765\clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth1680\clcbpatraw28 \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 Recommendation\cell Brief Description\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 Action\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trleft-108\trhdr\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth3948\clcbpatraw28 \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth7925\clcbpatraw28 
\cellx11765\clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth1680\clcbpatraw28 \cellx13445\row \ltrrow}\trowd \irow1\irowband1\ltrrow
\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11873\clshdrawnil \cellx11765\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445
\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 General Recommendations}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \cell }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow1\irowband1\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11873\clshdrawnil \cellx11765\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row 
\ltrrow}\trowd \irow2\irowband2\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 1. Establish the Philosophy and Legislative Intent\cell }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 The statutes describe the role and purpose of {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}\rquote 
s different long-term care programs but, taken together, they do not establish a framework for making decisions about new programs or services nor do they address the \'93system\'94 as a whole.\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Statute\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow2\irowband2\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 2. Develop a Strategic Plan\cell }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose} should pre
pare a strategic plan that describes which populations, services and programs will be addressed by the plan and describes the mission, values and goals for its long-term services and supports system. The goals should include measurable targets to improve 
balance between HCBS and institutional services for all populations.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Administrative/
\par Statute\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow3\irowband3\ltrrow\ts11\trgaph108\trleft-108\trbrdrt
\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\trowd \irow4\irowband4\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11873\clshdrawnil \cellx11765\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 
\par Short-Term Recommendations\emdash One Year to Implement}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\cf1\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow4\irowband4\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11873\clshdrawnil \cellx11765\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow
}\trowd \irow5\irowband5\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 3. Add a Special Income Level Eligibility Group\cell }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\cf1\insrsid3877327\charrsid10430516 This }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 option enables individuals with
 income below 300% of SSI in the community to become Medi-Cal eligible who would otherwise have to incur expenses equal to the share of cost under the Medically Needy Option. Meeting the spend-down creates a barrier for persons who readily meet the share 
of cost in a nursing facility but cannot afford the share of cost in the community and retain enough income to meet their expenses.\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\cf1\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \trowd \irow5\irowband5\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 4. Increase the Home Maintenance Income Exemption\cell }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Maintaining or establishing a home in the community is a ma
jor obstacle for Medicaid beneficiaries who want to return home after admission to an institution. Medicaid eligibility rules give states the flexibility to support this goal and allow states to exempt income to maintain a home. The existing exemption is 
$209 per month, which is too low to maintain a home in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose}. \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Statute\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow6\irowband6\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 5. Maintain the SSI/SSP Medi-Cal Eligibility Status\cell }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 This option allows beneficiaries to retain their full SSI/SSP during the first 90 days of an institutional stay for beneficiaries who are able to return home. \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow7\irowband7\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 6. Adopt a Case-Mix Reimbursement System for Nursing Facilities\cell }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 This option creates incentives to serve high acuity residents and facilitates community transition for lower acuity residents. The case-mix system would be \'93zero sum\'94
 and not result in additional payments to nursing facilities.\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 Statute\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow8\irowband8\ltrrow
\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 7. Establish a Nursing Facility Occupancy Provision}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid330591 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid330591\charrsid1864119 
\par \cell }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
This option creates an incentive for facilities to reduce their licensed capacity, which ensures that beds will not be back-filled as residents relocate or as new admissions are diverted through preadmission screening/options counseling.\cell 
}\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Statute\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow9\irowband9\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 8. Conver
t the Labor-Driven Operating Allocation to an Incentive to Promote Discharge Planning or Increased Quality of Care\cell }{\rtlch\fcs1 \af186\afs22 \ltrch\fcs0 \f186\fs22\cf1\insrsid3877327\charrsid10430516 
Given the magnitude of the per diem and the fact that the offset does not reimburse an actual cost, we suggest that the state rethink this incentive and exercise policy-related control over it.}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Statute\cell 
}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow10\irowband10\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 
\trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 
9. Review Department of Developmental Services (DDS) Regional Centers Rates for Nonresidential Services\cell }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
Should budget conditions improve and the rate freeze be lifted, before restoring previous rate methodologies DDS should review the use of negotiated rates to avoid concerns about compliance with CMS policy.\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\par Administrative
\par 
\par \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow11\irowband11\ltrrow\ts11\trgaph108\trleft-108\trbrdrt
\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 10. Conduct a Study of Need for Waiver Expansion\cell }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Waivers are cost effective and their use should be expanded. \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \irow12\irowband12\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\trowd \irow13\irowband13\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11873\clshdrawnil \cellx11765\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow13\irowband13\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11873\clshdrawnil \cellx11765\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow
}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 
\par {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname PlaceName}}Medium{\*\xmlclose} {\*\xmlopen\xmlns2{\factoidname PlaceType}}Range{\*\xmlclose}{\*\xmlclose} Recommendations\emdash One to Two Years to Implement\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow14\irowband14\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11873\clshdrawnil \cellx11765\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow
}\trowd \irow15\irowband15\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 11. Establish a Statewide Institutional Transition Program\cell }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
Ideally, the transition program would be part of the single entry point entities and reflect the experience from the California Community Transitions program. Until single entry point entities are established, the State should establish a statewide instit
utional transition program and current MFP programs should continue and be expanded. \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \irow15\irowband15\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl
\tx1182\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 12. Reinvest Savings from Institutional Care in HCBS \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Savings from beneficiaries who transition can be transferred to home and commu
nity-based services program accounts. A reserve fund can be created for savings that may be used for investments in a subsequent fiscal year. The nursing facility appropriation can be used to pay for services in the community for individuals who relocate 
from an institution when waiver programs have reached their maximum capacity and wait lists are established.\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \irow16\irowband16\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 
13. Provide Diversion through Preadmission Screening (PAS)/Options Counseling about Community Alternatives through Single Entry Points and Aging and Disability Resource Connections (ADRCs) and by Working with Hospitals\cell }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 PAS/options counseling is a strategy to inform individuals and family members who apply for admission to an institution about the community services that are available t
o help them remain at home. Options counseling is often mandatory for Medicaid beneficiaries seeking admission to a nursing facility. It may be advisory for individuals who are not eligible for Medicaid but are likely to spend down within six months of ad
mission.\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow17\irowband17\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 
14. Expand Coverage of Residential Options Statewide to Offer More Service Alternatives for Older Adults\cell }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 {\*\xmlopen\xmlns2{\factoidname place}}
{\*\xmlopen\xmlns2{\factoidname State}}California{\*\xmlclose}{\*\xmlclose} currently offers limited coverage of services in Residential Care Facilities for the Elderly (RCFE) throug
h the Assisted Living Waiver Program. Offering a full array of services gives consumers additional residential options besides a nursing facility bed. Residential settings are particularly useful for consumers who do not have a caregiver at night and on w
eekends, need 24-hour supervision or need access to assistance that cannot be scheduled.\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \irow18\irowband18\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 15. Increase the Use of Provider Fees for HCBS Providers\cell }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Federal regulations require that the fees: be broad based; be uniformly imposed throughout a ju
risdiction; and not violate the hold harmless provisions of the regulations. The state should benefit from the financial advantages that are permitted under federal regulations.\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Statute\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow19\irowband19\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 
16. Explore Converting a Portion of State Supplement Program (SSP) Payments to Provide Services in Residential Settings\cell }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
Federal law allows states that increased the SSI State Supplement Program payment since 1983 to reduce the supplement to 1983 levels. Ge
neral revenues saved by lowering the payment could be used to expand Medi-Cal supportive services in RCFEs without reducing the personal needs payment to residents. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \i\fs22\insrsid3877327\charrsid10430516 
Update: The 2009 budget agreement reduced the SSP payment to 1983 levels. This recommendation is retained as a reference. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Statute\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow20\irowband20\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 17. }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 HYPERLINK \\l "rentalassistance"}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid93984\charrsid1864119 {\*\datafield 
08d0c9ea79f9bace118c8200aa004ba90b020000000800000011000000720065006e00740061006c0061007300730069007300740061006e00630065000000ce}}}{\fldrslt {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \cs29\fs22\insrsid3877327\charrsid1864119 
Create a Temporary Rental Assistance Housing Subsidy}}}\sectd \lndscpsxn\pgwsxn15840\pghsxn12240\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid3877327\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 \cell }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 This option converts a portion of the state share of the savings from Medi-Cal payments for individuals who transition from 
an institution to a housing subsidy while they wait for a housing voucher or other federal housing subsidy.\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \irow21\irowband21\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\trowd \irow22\irowband22\ltrrow\ts11\trgaph108\trrh827\trleft-108\trbrdrt\brdrs\brdrw10 
\trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 18. Allow Presumptive Medi-Cal Eligibility for HCBS W}{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\delrsid14748618\charrsid1864119 aiver}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119  Applicants\cell }\pard \ltrpar\ql \li0\ri-1350\widctlpar\intbl
\tx9124\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-1350\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 This option allows case managers in a comprehensive entry point system to fast track }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid7536990 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 or presume}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid7536990  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
Medi-Cal eligibility to enroll applicants in a waiver program and avoid }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid7536990 
\par }\pard \ltrpar\ql \li0\ri-1350\widctlpar\intbl\tx9124\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-1350\lin0\pararsid7536990 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
admission to a nursing facility. This recommendation should be considered in relation }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid7536990 
\par }\pard \ltrpar\ql \li0\ri-1350\widctlpar\intbl\tx9124\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-1350\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 to}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid7536990  the recommendation for co-}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 locating eligibility workers
\par }\pard \ltrpar\ql \li0\ri-1998\widctlpar\intbl\tx9124\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-1998\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow22\irowband22\ltrrow\ts11\trgaph108\trrh827\trleft-108\trbrdrt\brdrs\brdrw10 
\trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\trowd \irow23\irowband23\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 19. Develop HCBS That Address Individuals with Mental Illness\cell }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 A package of services for nursing facility residents with a mental illness could be designed under a \'a71915(c) Waiver or a \'a7
1915(i) state plan HCBS amendment. MFP includes demonstration services that address the needs of persons with mental illness living in nursing facilities. The services should be defined and implemented to improve the project\rquote 
s ability to meet the benchmarks for this population.\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
Administrative\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow23\irowband23\ltrrow\ts11\trgaph108\trleft-108
\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 20. Create Rate and Other Incentives to Reduce Nursing Facility Capacity\cell }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
This recommendation would create rate incentives, perhaps using funds from the labor-driven operating allocation for nursing facility providers, to downsize nursing facilities, and th
e resulting savings can be used for pay-for-performance or to expand affordable housing, adult day health care, and in-home services.\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 
{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Statute\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \trowd \irow24\irowband24\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\trowd \irow25\irowband25\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11873\clshdrawnil \cellx11765\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 
\par Long-Term Recommendations\emdash Two Years or Longer to Implement\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\b\fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow25\irowband25\ltrrow
\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth11873\clshdrawnil \cellx11765\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow
}\trowd \irow26\irowband26\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 21. }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 
Create a Department of Long-Term Services and Supports}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell 
Individuals with developmental disabilities for the most part access services managed by one state agency and a strong comprehensive entry point system operated by 21 regional centers. While some consu
mers receive IHSS services, the majority of home and community-based services are accessed through regional centers. No similar structure is available to serve older adults and individuals with physical disabilities. As a result, new initiatives are often
 built through new structures and administrative arrangements.\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 Statute\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \irow26\irowband26\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 
22. Create Single Entry Points (SEPs) to Access Services for Aged/Disabled Beneficiaries\cell }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
Without a visible entity that offers seamless entry to the system, consumers contact multiple agencies and organizations, complete multiple application forms and apply for programs that have different financial and functional eligibility criteria.\cell 
}\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow27\irowband27\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 
23. Co-Locate Medi-Cal Financial Eligibility Workers in Single Entry Points/ADRCs\cell }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
Determining financial eligibility quickly can mean the difference between entering a nursing facility or returning home.\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \irow28\irowband28\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 24. Create a Unified Long-Term Care Budget\cell }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 This option creates a unified long-term care budget at the county/regional level that includes nursing facility spending, IHSS and selected HCBS Waiver programs.\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Statute\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow29\irowband29\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 
25. Create a Standardized Rate Structure for HCBS Based on the Acuity of Persons Receiving Services\cell }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Long-term care services should be managed as if they are a si
ngle program. Persons with physical impairments and disabilities use multiple programs both over time and at the same time. Eligibility and service delivery changes in one program impact the utilization of other programs.\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow30\irowband30\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 26. Create Incentives for HCBS through Managed Long-Term Care and Capitation
\cell }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\cf1\insrsid3877327\charrsid10430516 
Expand capitated managed long-term care options. A review of managed long-term care programs prepared in 2006 found that managed long-term care programs reduce the use of institutional services and
 increase the use of home and community-based services relative to fee-for-service programs, and that consumer satisfaction is high.
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\cf1\insrsid3877327\charrsid10430516 Administrative\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \irow31\irowband31\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\trowd \irow32\irowband32\ltrrow
\ts11\trgaph108\trleft-108\trftsWidth3\trwWidth13553\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl 
\clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 27. Create Financing Strategies That Improve the Balance Between Community and Institutional Services}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 HYPERLINK \\
l "capitation"}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid93984\charrsid1864119 {\*\datafield 08d0c9ea79f9bace118c8200aa004ba90b02000000080000000b000000630061007000690074006100740069006f006e00000016}}}{\fldrslt }}\sectd 
\lndscpsxn\pgwsxn15840\pghsxn12240\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid3877327\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 \cell }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 Examples of possible strategies from {\*\xmlopen\xmlns2{\factoidname State}}Washington{\*\xmlclose} and {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname State}}Vermont{\*\xmlclose}{\*\xmlclose}
 are described. \cell Statute\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow32\irowband32\ltrrow
\ts11\trgaph108\trleft-108\trftsWidth3\trwWidth13553\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl 
\clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row \ltrrow}\trowd \irow33\irowband33\lastrow \ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 28. Develop a Long-Term Care Data Base\cell }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 Develop a long-term care data base that contains information on the physical and mental c
haracteristics and service utilization history of persons using long-term care services. The purpose of the database is to enable the state to manage long-term care services as though it were one program. The data base will permit the comparison of person
s across programs so the state can understand who uses programs, what services they receive, and what the total costs are. Currently, data are organized by program; what is needed is data organization at the individual level.   }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\cf1\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
Administrative\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \irow33\irowband33\lastrow \ltrrow
\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13553\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid330591\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3948\clshdrawnil \cellx3840\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7925\clshdrawnil \cellx11765\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1680\clshdrawnil \cellx13445\row }\pard \ltrpar
\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 {\rtlch\fcs1 \ab\af1\afs32 \ltrch\fcs0 \b\f41\fs36\cf17\kerning32\insrsid3877327 
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \ab\ai\af1\afs28\alang1025 \ltrch\fcs0 
\b\f41\fs28\cf18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 \page }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327\charrsid931618 Recommendation by Category}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 

\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3877327\charrsid3755952 
\par \ltrrow}\trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trhdr\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth7202\clcbpatraw28 \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat28\cltxlrtb\clftsWidth3\clwWidth1773\clcbpatraw28 \cellx8867\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth2321\clcbpatraw28 \cellx11188\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth1876\clcbpatraw28 \cellx13064\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid1864119 Recommendation\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 Financing\cell Access and Delivery System\cell State-level Organization\cell 
}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trhdr\trbrdrt\brdrs\brdrw10 
\trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth7202\clcbpatraw28 \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat28\cltxlrtb\clftsWidth3\clwWidth1773\clcbpatraw28 \cellx8867\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth2321\clcbpatraw28 \cellx11188\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat28\cltxlrtb\clftsWidth3\clwWidth1876\clcbpatraw28 \cellx13064\row \ltrrow}\trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 1. Establish the Philosophy and Legislative Intent\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \u9679\'3f\cell \u9679\'3f\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 2. Develop a Strategic Plan\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \u9679\'3f\cell \u9679\'3f\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 3. Add a Special Income Level Eligibility Group\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \cell \u9679\'3f\cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\cf1\insrsid3877327\charrsid10430516 
\trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 4. Increase the Home Maintenance Income Exemption\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \cell \u9679\'3f\cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow
\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 5. Maintain the SSI/SSP Medi-Cal Eligibility Status\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \cell \u9679\'3f\cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow
\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 6. Adopt a Case-Mix Reimbursement System for Nursing Facilities\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 7. Establish a Nursing Facility Occupancy Provision\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow
\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 8. Convert the Labor-Driven Operating Allocation to an Incentive to Promote Discharge Planning or Increased Quality of Care\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 9. Review Department of Developmental Services (DDS) Regional Centers Rates for Nonresidential Services\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 10. Conduct a Study of Need for Waiver Expansion\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \cell \u9679\'3f\cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow
\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 11. Establish a Statewide Institutional Transition Program\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \cell \u9679\'3f\cell \u9679\'3f\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\tx1182\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 12. Reinvest Savings from Institutional Care in HCBS \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow
\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 13. Provide Diversion through Preadmission Screening (PAS)/Options Counseling about Community Alternatives through Single Entry Points and Aging and Disability Resource Connections (ADRCs) and by Working with Hospitals
\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell \u9679\'3f\cell \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 14. Expand Coverage of Residential Options Statewide to Offer More Service Alternatives for Older Adults\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell \u9679\'3f\cell \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 15. Increase the Use of Provider Fees for HCBS Providers\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow
\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 16. Explore Converting a Portion of State Supplement Program (SSP) Payments to Provide Services in Residential Settings\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 17. Create a Temporary Rental Assistance Housing Subsidy\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow
\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\trowd \ltrrow\ts11\trqc\trgaph108\trrh548\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 
\trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 18. Allow Presumptive Medi-Cal Eligibility for HCBS W}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\delrsid14748618\charrsid1864119 aiver}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119  Applicants\cell }\pard \ltrpar\qc \li0\ri-1998\widctlpar\intbl\tx9124\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-1998\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar\ql \li1152\ri-1998\widctlpar\intbl\tx9124\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-1998\lin1152\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\u9679\'3f\cell }\pard \ltrpar\qc \li0\ri-1998\widctlpar\intbl\tx9124\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-1998\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trrh548\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 19. Develop HCBS That Address Individuals with Mental Illness\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell \u9679\'3f\cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 20. Create Rate and Other Incentives to Reduce Nursing Facility Capacity\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 
\trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 21. Create a Department of Long-Term Services and Supports\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \cell \cell \u9679\'3f\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow
\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 22. Create Single Entry Points (SEPs) to Access Services for Aged/Disabled Beneficiaries\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell \u9679\'3f\cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 23. Co-Locate Medi-Cal Financial Eligibility Workers in Single Entry Points/ADRCs\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell \u9679\'3f\cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 24. Create a Unified Long-Term Care Budget\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow
\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 25. Create a Standardized Rate Structure for HCBS Based on the Acuity of Persons Receiving Services\cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
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\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 26. Create Incentives for HCBS through Managed Long-Term Care and Capitation\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \u9679\'3f\cell  \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\cf1\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3877327\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid3877327\charrsid1864119 27. Create Financing Strategies That Improve the Balance Between Community and Institutional Services}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 HYPERLINK \\
l "capitation"}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid93984\charrsid1864119 {\*\datafield 08d0c9ea79f9bace118c8200aa004ba90b02000000080000000b000000630061007000690074006100740069006f006e000000cf}}}{\fldrslt }}\sectd 
\lndscpsxn\pgwsxn15840\pghsxn12240\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid3877327\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \u9679\'3f\cell \cell \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\cf1\insrsid3877327\charrsid10430516 \trowd \ltrrow\ts11\trqc\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
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\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row \ltrrow}\trowd \lastrow \ltrrow\ts11\trqc\trgaph108\trrh70\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth13172\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid1864119\tbllkhdrrows\tbllkhdrcols\tblind0\tblindtype3 \clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
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\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid3877327\charrsid1864119 28. Develop a Long-Term Care Data Base\cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3877327 {\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid3877327\charrsid10430516 \cell \cell \u9679\'3f\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\cf1\insrsid3877327\charrsid10430516 \trowd \lastrow \ltrrow\ts11\trqc\trgaph108\trrh70\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
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\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth7202\clshdrawnil \cellx7094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1773\clshdrawnil \cellx8867
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2321\clshdrawnil \cellx11188\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1876\clshdrawnil \cellx13064\row }\pard\plain \ltrpar\s1\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid3877327 \rtlch\fcs1 
\ab\af1\afs32\alang1025 \ltrch\fcs0 \b\f41\fs36\cf17\lang1033\langfe1033\kerning32\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid3877327 {\*\bkmkstart _Toc244405533}
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid15689043 {\shp{\*\shpinst\shpleft12600\shptop10620\shpright12960\shpbottom10800\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr2\shpwrk0\shpfblwtxt0\shpz0\shplid1026
{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fAutoTextMargin}{\sv 0}}{\sp{\sn fRotateText}{\sv 0}}{\sp{\sn fFitShapeToText}{\sv 0}}
{\sp{\sn fFitTextToShape}{\sv 0}}{\sp{\sn fColumnLineOK}{\sv 0}}{\sp{\sn fRecolorFillAsPicture}{\sv 0}}{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fHitTestFill}{\sv 1}}
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{\sp{\sn lineFillShape}{\sv 1}}{\sp{\sn fShadow}{\sv 0}}{\sp{\sn fshadowObscured}{\sv 0}}{\sp{\sn f3D}{\sv 0}}{\sp{\sn fc3DMetallic}{\sv 0}}{\sp{\sn fc3DUseExtrusionColor}{\sv 0}}{\sp{\sn fc3DLightFace}{\sv 1}}{\sp{\sn fc3DConstrainRotation}{\sv 1}}
{\sp{\sn fc3DRotationCenterAuto}{\sv 0}}{\sp{\sn fc3DParallel}{\sv 1}}{\sp{\sn fc3DKeyHarsh}{\sv 1}}{\sp{\sn fc3DFillHarsh}{\sv 0}}{\sp{\sn fCalloutMinusX}{\sv 0}}{\sp{\sn fCalloutMinusY}{\sv 0}}{\sp{\sn fCalloutDropAuto}{\sv 0}}
{\sp{\sn fCalloutLengthSpecified}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fAllowOverlap}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLeftInsetPen}{\sv 0}}
{\sp{\sn fLeftLine}{\sv 0}}{\sp{\sn fLeftHitTestLine}{\sv 1}}{\sp{\sn lineLeftFillShape}{\sv 1}}{\sp{\sn fTopInsetPen}{\sv 0}}{\sp{\sn fTopLine}{\sv 0}}{\sp{\sn fTopHitTestLine}{\sv 1}}{\sp{\sn lineTopFillShape}{\sv 1}}{\sp{\sn fRightInsetPen}{\sv 0}}
{\sp{\sn fRightLine}{\sv 0}}{\sp{\sn fRightHitTestLine}{\sv 1}}{\sp{\sn lineRightFillShape}{\sv 1}}{\sp{\sn fBottomInsetPen}{\sv 0}}{\sp{\sn fBottomLine}{\sv 0}}{\sp{\sn fBottomHitTestLine}{\sv 1}}
{\sp{\sn lineBottomFillShape}{\sv 1}}{\sp{\sn fColumnLine}{\sv 0}}{\sp{\sn fColumnHitTestLine}{\sv 1}}{\sp{\sn lineColumnFillShape}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8192\dprect
\dpx12600\dpy10620\dpxsize360\dpysize180\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinehollow}}}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid11272615 {\*\bkmkend _Toc244405533}
\par }}