The Westchester Consulting Group uses qualitative and quantitative research and policy analysis techniques and provides research, consulting, and technical assistance services to execute a range of long-term care and disability finance, policy and program, and quality assurance engagements. Our goal is to deliver practical, measurable, and high value-added results to public and private sector clients. We work closely with clients to understand their business environment, identify issues and opportunities, develop and execute innovative policies, programs and solutions to problems and evaluate their effectiveness. No matter how complex the issue - from strategic planning, policy and program development and implementation to technical assistance, policy analysis and program evaluation - our skills and experience effectively link research to results.
The following client engagement examples illustrate this approach.
RESEARCH AND POLICY ANALYSIS
CMCS Medicaid Innovation Accelerator Program (IAP) Medicaid Delivery System Reform Framework Project
- October 2017 - Present
Subject matter expert supporting the CMCS Task Order to provide support to CMS’ Center for Medicaid and Children’s Health Insurance Program Services (CMCS) in identifying and understanding state Medicaid agencies’ Delivery System Reform (DSR) activities as part of the Medicaid Innovation Accelerator Program’s (IAP) goal of supporting states’ ongoing innovation and DSR efforts in the Medicaid program. Tasks include assisting with refinement of previously drafted framework, indicators and definitions, conducting meetings with CMCS and project workgroup membership to solicit feedback on refinements, developing a framework test plan, conducting reviews of Medicaid DSR activities, testing refinements to framework, planning and hosting four web-based training sessions to assist CMCS staff with using the framework to review DSRs.
Veterans Affairs VD-HCBS Program
- December 2015 - Present
Subject matter expert, technical assistance (TA) consultant and Financial Management Services Lead supporting the Department of Veterans Affairs (VA) with the roll-out of the Veterans-directed Home and Community-based Services (VD-HCBS) Program nationally by 2019 with the Lewin Group and Atlas Research. She has conducted research and prepared several ad hoc reports for VHA including: “Report to Inform the VD-HCBS Market Research and Communications Plan” S. Flanagan, J. Rollison, M. Williams, G. Zimmerman and T. Waterman (2016); “Veteran Spending Under VD-HCBS” S. Flanagan, M. Williams and J. Anthony (2017); and “VA LTSS Needs Assessment for Veterans Residing in Rural and Highly Rural Areas” J. Anthony, S. Flanagan, A.J. Damian & M. Williams (2017).
CMS National Balancing Indicators Project
- July 2013 - May 2014
As project director at IMPAQ International in Columbia, MD, refined and expanded upon 18 core national balancing indicators (NBIs) to be used by CMS and states to examine state’s long-term support system (LTSS) balancing. Tasks included conducting Technical Expert Panel meetings to obtain feedback on the NBIs, refining and expanding upon existing NBIs, and revising a state self-assessment survey tool for data collection purposes and a Technical Assistance Guide to NBIs, and preparing reports.
Kansas Department of Social and Rehabilitation Services, Topeka, KS
- August 2008 - March 2009
Under the Kansas Self Direction/Budget Authority Study, as project director, assisted the Kansas Department of Social and Rehabilitation Services, in collaboration with the Kansas Departments of Aging and Health Policy Authority, in conducting an environmental scan of five Medicaid §1915(c) HCBS waiver programs and the WORK Program as they relate to the provision of participant-directed support services (PDS) and researching and reporting on promising practices related to the provision of PDS and Financial Management Services (FMS). Environmental scan activities included a review of waivers and Work Program documentation, interviewing waiver and Work Program managers, conducting focus groups with FMS providers, program participants and families in six regions of the state; developing, conducting a mail survey of FMS providers regarding key operations features and issues, and analyzing and summarizing findings. Prepared a final report summarizing study findings and recommendations for reforming policy the provision of PDS and FMS under the state's Medicaid §1915(c) HCBS waivers and Work Program that was presented to key government and private sector stakeholders.
Maryland Department of Health and Mental Hygiene, Baltimore, MD
- May 2005 - March 2006
As a subject matter expert, assisted the Maryland Department of Health and Mental Hygiene in conducting an analysis of the Personal Assistance Services (PAS) programs in Maryland and PAS Programs for nonworking and working adults with disabilities in 10 selected states under a consulting agreement with Abt Associates.
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, DC
- October 2004 - December 2005
As a subject matter expert, assisted in preparing a National Compendium on Medicaid-funded Home Modification and Assistive Technology Policy and Practices in 50 states under a consulting agreement with Abt Associates.
- January 2003 - June 2004
Under a sub-contract with the Boston College Graduate School of Social Work, conducted a national research study entitled: Accessing Workers' Compensation Insurance for Consumer-Employed Personal Assistance Service Workers: Issues, Challenges and Promising Practices. This 50 state and six territory study identified issues related to access, affordability, promising practices and analyzed relevant case law. Initiated contact with national workers' compensation insurance organizations and associations to raise their awareness of the key issues and to identify opportunities for systems change with the goal of making workers' compensation insurance more accessible and affordable to household employers.
- June - October 2001
While at EP&P Consulting, Dr Flanagan was the project director responsible for conducting the research and preparing a national inventory of 131 Medicaid and state-funded consumer-directed support service programs entitled, National Inventory of Consumer-Directed Support Service Programs. Tasks included identifying programs, collecting, verifying and analyzing contact and program information, overseeing the development of a database in Microsoft Access 97 and preparing a report summarizing key program and FMS information.
Under a contract with the US DHHS/OASPE while at the Medstat Group, was project director for a 10 state research and a policy analysis of the tax, legal and quality assurance issues experienced by Medicaid and state-funded consumer-directed service programs and prepared a final report entitled: How States Address Tax, Legal and Quality Assurance Issues (1997) with Pamela Green, Esq.
Under a contract with the US DHHS/OASPE while at the Medstat Group, was project director, conducted an 11 state research and policy analysis of Medicaid and state-funded consumer-directed service programs using Financial Management Services and prepared a report entitled: Facilitating Consumer-directed Personal Assistance Services (1994).
POLICY AND PROGRAM DEVELOPMENT AND IMPLEMENTATION
Veterans Affairs VD-HCBS Program
- December 2015 – Present
Subject matter expert, technical assistance (TA) consultant and Financial Management Services Lead supporting the Department of Veterans Affairs (VA) with the roll-out of the Veterans-directed Home and Community-based Services (VD-HCBS) Program nationally by 2019 with the Lewin Group and Atlas Research. As a member of the Project Team provide training and TA to Aging and Disability Network (ADNA) sites, VA Medical Centers, and VA Central Office (VACO) staff; analyze and develop program policies, as necessary, conduct FMS Readiness Reviews for ADNA sites implementing VD-HCBS Programs and conduct and prepare selected ad hoc evaluation reports.
Indiana LTSS Redesign Project
- February – December 2016
Subject matter expert assisting the Indiana Family and Social Services Administration, Division of Aging (FSSA/DA) redesign its LTSS delivery system with a focus on the provision of participant-directed services (PDS). Tasks included reviewing the State’s Medicaid §1915(c) Aging and Disability Waiver, and PDS program rules and operation; assessing PDS usage by waiver participants and providing recommendations for PDS program improvement that meet CMS expectations and increases choice and authority for program participants.
DC Department of Health Care Finance Participant Directed Service Program Project
- July 2014 - June 2015
Project director responsible for designing and providing technical assistance to implement the District of Columbia’s Services My Way participant-directed service (PDS) program. Tasks included the development of standards and business rules, forms and agreements, a Request for Proposals for FMS and I&A services; a Services My Way Program flyer, Services My Way Participant Guide and PDS operations manual for the DC Department of Health Care Finance.
DC Department of Disability Services, Washington, DC
- February - September 2015
As the project director under a consulting agreement with Atlas Research in Washington, DC, assisting DC Department of Disability Services staff in completing activities for its Administration on Community Living’s No Wrong Door Planning Grant. Tasks include facilitating Leadership Council and Workgroup meetings and assisting with the drafting of required reports and the District’s 3-Yr No Wrong Door Implementation Plan.
Self-directed Services Review and Recommendations - Maryland Developmental Disabilities Administration, Baltimore, MD
- August 2014 - March 2015
As project director and technical assistance consultant, assisted the Maryland DDA by reviewing and making recommendations for improvement of its self-directed service options and policies and procedures under the State’s Medicaid §1915(k) Community First Choice HCBS SPA and §1915(c) Community Pathways waiver. Tasks included preparing an analysis of broad design aspects, detailed service definitions and related policies; reviewing DDA, and as appropriate broader DHMH statute, regulations, §1915(k) Community First Choice HCBS SPA and §1915(c) Community Pathways Waiver against Federal regulations for HCBS and pertinent Federal guidance; preparing for and participating in meetings with advocates and provider representatives; and providing technical advice and support related to any additional waiver and state transition plan submission.
Pennsylvania Department of Public Welfare, Office of Mental Retardation (Now Office of Developmental Programs), Harrisburg, PA
- July 2002 - June 2012
As project director, assisted Pennsylvania Office of Developmental Programs in developing and implementing participant-directed services (PDS) using Vendor Fiscal/Employer Agent and Agency with Choice FMS and evaluating program effectiveness. Activities have included, developing and implementing Vendor F/EA FMS and Agency with Choice FMS bulletins, Vendor F/EA FMS Readiness Review and Ongoing Performance Review Protocols, an Agency with Choice FMS Self-Assessment Readiness Review Protocol, Individual and Representative Satisfaction Survey, drafting IFB/RFA documents, conducting in-service education seminars for Office and county administrator staff, preparing a PDS Employer Handbook and providing ongoing technical assistance to Policy and Operations Divisions staff.
Granite State Independent Living, Concord, New Hampshire
- October 2001 - March 2005
As project director, assisted Granite State Independent Living through the receipt of a CMS Real Choice C-PASS and Medicaid Infrastructure Grants, in designing and implementing Agency with Choice FMS for the state's Medicaid §1915(c) HCB-ECI Waiver-funded participant-directed personal care services. Tasks included developing regulations, preparing a training manual and related materials and conducting training, presenting testimony to the state legislature and providing additional technical assistance, as needed.
Minnesota Department of Human Services, St. Paul, MN
- September 2002 - June 2004
As project director, assisted the Minnesota Department of Human Services in developing a comprehensive system for providing Financial Management Services and Supports Brokerage services to elders and individuals with disabilities of all ages eligible who use Medicaid-funded participant-directed support services. Tasks included assisting in designing the system, preparing a Request for Information and standards for Fiscal Support Entities (FSEs); and conducting a series of training sessions for Department and provider staff.
TRAINING AND TECHNICAL ASSISTANCE
Technical Assistance for Self-Directed and HCBS Research Project, Centers for Medicaid and Medicare Services, Baltimore, MD
- December 2008 – August 2017
Technical assistance consultant to states related to the development and implementation of Medicaid §1915(c) HCBS waivers and §1915(i) and (j) state plan amendments that offer the participant-directed service option, Financial Management Services and Information & Assistance Services in support of self-direction with New Editions Consulting and Acumen, LLC.
Direct Service Worker Resource Center, Centers for Medicaid and Medicare Services, Baltimore, MD
- October 2005 – September 2014
Technical assistance consultant to the CMS National Direct Service Workforce Resource Center with the Lewin Group. A primary goal of the Center was to provide information, resources and direct assistance to state and local governments, not-for-profit organizations, employers and CMS grantees seeking to improve the recruitment, training and retention of direct support professionals.
Technical Assistance to the Money Follows the Person Demonstration Project, Centers for Medicaid and Medicare Services, Baltimore, MD
- October 2010 – August 2015
Technical assistance consultant to the CMS Money Follows the Person Demonstration Project with New Editions Consulting, Inc. Provided technical assistance to MFP grantees, CMS and New Editions Consulting, Inc. (prime contractor) with a focus on developing and implementing Medicaid HCBS waivers and state plan amendments that offer participant-directed services; participant-directed care planning, systems transformation and rebalancing activities.
Robert Wood Johnson Foundation Cash and Counseling Demonstration and Evaluation and Next Steps Projects for Boston College Graduate School of Social Work, Chestnut Hill, MA
- Next Steps Project
October 2004 - September 2008
Provided consulting and technical assistance services to the RWJ Cash & Counseling National Program Office and 12 Cash & Counseling replication state grantees (AL, IA, IL, KY, MS, MN, NM, PA, RI, VT, WA State, WV) on developing and implementing participant-directed support service programs using Government and Vendor Fiscal/Employer Agent FMS.
- Cash and Counseling Demonstration and Evaluation
January 1999 - September 2004
Provided consulting and technical assistance services to the three original demonstration states (AK, FL, NJ) on designing, implementing and evaluating the effectiveness Government and Vendor F/EA FMS for their participant-directed support service programs. Provided ongoing training and technical assistance on federal and state labor and employment tax and worker's compensation insurance rules and regulations and CMS policies and procedures related to Government and Vendor Fiscal/Employer Agent FMS to grantees and the RWJ Foundation Cash & Counseling National Program Office. Participated with staff from the US Department of Human Services Office of the Assistant Secretary for Planning and Evaluation on an IRS Workgroup on Government and Vendor F/EA FMS.
Minnesota Department of Human Services, St. Paul, MN
- October - November 2006
Assisted the Minnesota Department of Human Service staff in reviewing and modifying its Fiscal Support Entity (FSE) Medicaid provider re-certification protocol and providing training to Department staff in performing Medicaid re-certification reviews of 18 FSE entities.
Technical Assistance to States and Private Sector Organizations
- January 1998 - Present
Conducted training and in-service technical assistance seminars on developing and implementing participant-directed services and FMS and I&A services. Clients include:
- Abilities in Motion, Reading, PA
- Bucks County PA Department of Mental Health/Mental Retardation
- Centers for Medicare and Medicaid Services, Baltimore, MD
- Community Action Unlimited, Elizabeth, NJ
- Concepts of Independent Choices, Inc. NYC, NY
- Connecticut Department of Mental Retardation, Hartford, CT
- Consumer Direct, Missoula, MT
- District of Columbia Health and Finance, Office of Chronic and Long-term Care, DC
- Delaware Division of Mental Retardation, Dover, DE
- First Data Government Solutions, Cincinnati, OH
- Gateways Community Services, Nashua, NH
- Georgia Department of Human Services, Division of Aging Services, Atlanta, GA
- Georgia Governor's Council on Developmental Disabilities, Atlanta, GA
- Jewish Board of Family & Children's Services, Inc. New York, New York
- Kansas Department of Social and Rehabilitation Services, Division of Community Supports and Services, Topeka, KS
- Idaho Department of Health and Welfare, Division of Medicaid, Boise, ID
- Illinois Department of Human Services, Division of Developmental Disabilities, Springfield, IL
- Maine Department of Human Services, Augusta, ME
- Maryland Association of Community Services, Baltimore, MD
- Maryland Department of Health and Mental Hygiene, Developmental Disabilities Administration
- Massachusetts Division of Medical Assistance (MassHealth) , Boston, MA
- Minnesota Department of Human Services, Division of Aging and Adult Services, Minneapolis, MN
- Minnesota Department of Human Services (Division of Developmental Disability Services), Minneapolis, MN
- Missouri Department of Mental Health, Division of Developmental Disabilities, Jefferson City, MO
- Nebraska Division of Agency and Disability Services, Lincoln, NE
- New York State Office of Mental Retardation and Developmental Disabilities, Albany, NY
- Ocean State Community Resources, East Providence, Rhode Island
- Ohio Department of Aging, Columbus, OH
- Ohio Department of Developmental Disabilities, Columbus, OH
- Oregon Department of Human Services, Seniors and People with Disabilities, Salem, OR
- Pennsylvania Department of Public Welfare, Office of Administration, Harrisburg, PA
- Pennsylvania Department of Public Welfare, Office of Mental Retardation, Harrisburg, PA
- Public Partnerships, LLC, Boston, MA
- Robert Wood Johnson Foundation Cash and Counseling Demonstration and Evaluation National Program Office (including original C&C Project (AR, FL and NJ) and Replication Project (AL, IL, IA, KY, MI, MN, NM, PA, RI, VT, WA, WV), Chestnut Hills, MA
- SAM, Inc., Reading, PA
- Seven Hills Foundation, Worcester, MA
- Texas Department of Aging and Disability Services, Austin, TX
- University of Iowa, Center for Disabilities and Development, Des Moines, IA
- Venango County Office of Mental Health- Mental Retardation, Franklin, PA
- Vermont Department of Developmental and Mental Health Services, Waterbury, VT
- Wisconsin Department of Health Services, Madison, WI
- West Virginia University Center for Excellence in Disabilities, Morgantown, WV
- Wyoming Developmental Disabilities Division, Cheyenne, WY
Rutgers University Center for Health Policy, New Brunswick, New Jersey
- January 2004 - December 2005
Member of the National State-to-State Technical Assistance Program's consulting staff responsible for providing technical assistance to FY 2003 CMS Real Choice Systems Change grantees on designing, implementing and evaluating FMS for participant-directed support service programs.
ILRU, Houston, Texas
- October 2004 - September 2007
Member of the National State-to-State Technical Assistance Program's consulting staff responsible for providing technical assistance to FY 2004 CMS Real Choice System Change grantees on FMS issues.
PROGRAM EVALUATION AND QUALITY ASSURANCE
Centers for Medicare and Medicaid Services, Baltimore, MD
- October 2007 - September 2011 and July 2013 - 2014
Subject matter expert and member of the CMS National Balancing Indicators (NBIC) Project team developing the NBIC Conceptual Framework, an initial set of indicators to assess states efforts in balancing their long-term services and supports (LTSS) delivery system (institutional and home and community-based services) and a scoring system with Abt Associates, Inc. and IMPAQ International (2007-2011).
As project director, refined and expanded upon 18 NBIs developed for use by CMS staff and states to examine states’ LTSS delivery system rebalancing. Tasks included reviewing literature and relevant research, conducting Technical Expert Panel, Federal Partners and Stakeholders meetings to obtain feedback on NBIs, refining a state self-assessment survey tool for data collection purposes and a Technical Assistance Guide to NBIs and preparing required reports for CMS with IMPAQ International.
- October 2005 - September 2011
As a subject expert, site visit leader and member of the CMS RCSC Systems Transformation Evaluation Project Team, assisted in evaluating the systems and impacts of the FY 05 Real Choice Systems Change (RCSC) Grants in Louisiana and Massachusetts, and FY 06 RCSC Grants in New York and Virginia; providing technical assistance to these grantees regarding strategic planning, evaluation strategies and outcome measures; evaluating their Grant activities and outcomes and preparing required reports with Abt Associates, Inc.
- October 2006 - September 2011
Project director for the CMS RCSC Person-Centered Planning Implementation Grants Evaluation Project evaluating 18 grantees’ activities and outcomes and preparing required reports with Abt Associates.
Robert Wood Johnson Foundation Cash and Counseling Demonstration and Evaluation National Program Office, Boston College Graduate School of Social Work, Chestnut Hill, MA
- January 1999 – December 2002 and October 2004 - September 2008
Developed Vendor Fiscal/Employer Agent Readiness Review template and conducted Reviews for the initial three state grantees (AR, FL and NJ) and 12 replication state grantees (AL, IA, IL, KY, MS, MN, NM, PA, RI, VT, WA State, WV).
Massachusetts Executive Office of Elder Affairs, MassHealth, Boston, MA
- March - December 2005
Conducted an agreed upon procedures review of the operations of four Vendor Fiscal/Employer Agent FMS providers serving individuals enrolled in the Massachusetts Medicaid PCA Program with DVallis, PC and assisted with the development and implementation of a phase-out plan to terminate operations of one entity by December 31, 2005.
Minnesota Department of Human Services, St. Paul Minnesota
- September - December 2004 and July - August 2005
Conducted Fiscal Service Entity (FSE) initial readiness reviews of 20 FSE applicants for the Minnesota Department of Human Services.
Alpha One Independent Living Center, Portland, Maine
- February - April 2003
Conducted an agreed upon procedures review of Alpha One's operations policies, procedures and internal controls as an Agency with Choice FMS provider and evaluated the feasibility of the organization becoming a Vendor Fiscal/Employer Agent FMS provider under Section 3504 of the IRS code and Revenue Procedure 70-6.