11

Money Follows the Person

Working GroupJanuary 5, 2011

222

Operational Protocol Document• Components of OPD include:• Organization and Administration• Benchmarks• Participant recruitment and enrollment• Informed consent and guardianship• Outreach/marketing/education• Stakeholder involvement• Benefits and Services• Consumer Supports• Self-direction• Quality• Housing• Continuity of care• Evaluation

3

Organization and Administration• LTSS system includes multiple agencies, providers and stakeholders working

within the “Community First” policy framework• DDS, DMH, DPH, EOEA, MCB, MCDHH, MRC, OOM, VET• Community-based and facility-based providers• Consumers and advocates

• MassHealth covers broad array of LTSS through Medicaid state plan and eight HCBS waivers

• Recent activities/initiatives promoting rebalancing and MFP objectives include:• Chapter 211 of the Acts of 2006 • Chapter 268 of the Acts of 2006 – PCA Quality Home Care Workforce Council• Facility closure plans• Aging and Disability Resource Consortia (ADRC) development• Expansion of HCBS Waivers

4

Organization and Administration (2)• LTSS System gaps • Uneven access to LTSS depending on diagnosis, age or income

• MFP will address gaps by:• strengthening functions and services to support those who wish

to transition out of facilities,• creating broader and comprehensive information about and

access to transitional assistance,• Promoting availability and utilization of state plan services for

those transitioning, and• Developing two new HCBS waivers for people with disabilities not

currently eligible for one of the existing waivers.• Projected MFP participants

Projected MFP Participants SFY12 SFY13 SFY14 SFY15 SFY16 MFP New Each Year 471 623 441 441 441 MFP Cumulative 471 1,094 1,535 1,976 2,417

5

Benchmarks

• Mandatory Benchmarks• Meet the projected number of eligible individuals transitioned in

each target group from an inpatient facility to a qualified residence during each calendar year of the demonstration.

• Increase State Medicaid expenditures for HCBS during each calendar year of the demonstration program.

• Optional Benchmarks• Number of unduplicated participants served in HCBS by # each

year (equal to MFP projected transitions). • Percentage of MFP participants that have the option to self-

direct a service in their care plan.

6

Participant Recruitment & Enrollment• Transition service providers will include entities involved in

current transition services, such as ASAPs, ILCs and state agency staff.

• Enhancements to transition services will include competitively procured entities with independent living, behavioral health and disability expertise and will seek to support further development of ADRCs.

• MFP Participant identification will include on-site, face-to-face visits in facilities.

• Qualified institutional settings include Nursing Facilities, Rehabilitation Hospitals Intermediate Care Facilities, DPH Hospitals and IMDs (age limits).

• Case managers to provide educational materials and information about abuse, neglect and exploitation and how to report it.

7

Informed Consent & Guardianship• All MFP participants or their legally authorized representative will

be informed of their rights and options under MFP.• Information will include:• rights and responsibilities;• information on the range of services and supports available;• supports necessary to carry out the service plan.

• MFP demonstration participants will be informed that:• they can withdraw from MFP at any time;• the MFP demonstration period is one year;• after the demonstration period, coverage of state plan and HCBS waiver

services will continue as long as they meet the eligibility requirements.

• Chapter 201 of the MGL describes the discretion and powers of the MA Probate court to appoint guardians and their legal authority and obligations.

8

Outreach/Marketing/Education• Brochures and educational materials will be created and distributed

through current networks• Including ADRCs (ASAPS and ILCs), AAAs, Recovery Learning

Communities, CSSM nurses, LTC Options Counselors, Ombudsmen• Distributed in MFP-qualified institutions and community settings

• Success stories will be highlighted. Example, UMMS Nursing Home Initiative video, “Community Living: Growing Opportunities and Experiences.”

• Online resources:• MFP website• MADIL• New England Index• 800AgeInfo (and 1-800-Age-Info by phone)

• CMs, transition coordinators and options counselors to provide information about options, programs and waivers available to participants.

• Materials will be in multiple languages, Braille and large print.

9

Stakeholder Involvement• Community First Olmstead Plan is the policy platform for the state’s

rebalancing activities, of which MFP is a crucial component.• The MFP Working Group, a sub-group of the Standing Olmstead Advisory

Committee, meets at least semi-annually. The group includes consumers, providers, and advocates and MFP-related activities will include:• Outreach• Providing ongoing input into the demonstration implementation and operation

activities

• MA state agency consumer advisory boards will also provide MFP review and support through information provided by contracted providers and through consumer surveys.

• Direct services will be provided by consumers and consumer run organizations• Peer support workers• Independent Living Centers• Recovery Learning Communities

10

Potential services offered in both waivers• Assistive Technology• Behavioral Health (multiple services) • Day Services• Expanded Substance Abuse Services • Family Support and Training • Maintenance Therapies – OT, PT, Speech• Peer Counseling• Skilled Nursing• Supported Employment• Transportation

In the Res Hab Waiver, the following are only available for participants utilizing Shared Living:•Individual Support and Community Habilitation •Respite Care•Home/Environmental Accessibility Modifications

*Administrative case management and transitional assistance services will be available to participants in both waivers, although these won’t be considered

“waiver services.”

11

Potential services unique to each waiver

•Residential Supports Waiver•Residential Habilitation•Bundled Supportive Home Services•Shared Living (24/7 only)

Community Living Waiver•Agency Personal Care•Chore Service•Companion Service•Grocery Shopping/Home Delivery•Home-Delivered Meals•Homemaker•Home Health Aide•Laundry•Medication Management•Supportive Home Care Aide•Shared Living (less than 24/7)•Vehicle Modification

12

Potential Demonstration Services

• Available for 365 days post-transition

• MFP Transition Services (post-transition from facility)• For all MFP Participants who use State Plan only• All MFP Participants in new MFP waivers

• For all MFP Participants who use State Plan only• Demonstration Case Management• Mobility Training• Assistive Technology

13

Consumer Supports - Educational Materials• Educational materials will be developed that describe:• the MFP program and contact information,• eligibility,• benefits and services,

• state plan services• home and community-based waivers (current and new waivers)

• resources for assistance with transitioning, and• opportunities for self-direction.

• State agency staff and contracted entities involved in transition coordination will convey information to residents of facilities.

• The MFP website, online resources, and outreach sessions will complement these efforts. 13

14

Consumer Supports – Back-up Plans

• All participants will have a CM through a waiver, agency targeted case management or as a MFP demonstration service.

• Case managers will:• work with the participant to develop an individualized back-up plan;• ensure the participant clearly understands the plan;• have 24/7 access to the back-up plan to respond to issues.• Distribute information about complaint process

• MFP office will respond to complaint within 24 hours and resolve complaint within 15 business days

• Complaint information, and any reasons for delay in resolving complaints, documented in complaint log which is reviewed monthly by the MFP Program Director

• Enhancements to PCA Directory

14

15

Self-Direction• Opportunities available within current and new 1915c waivers and state

plan personal care attendant program• State’s goals for percentage of participants enrolling in new MFP waivers

who will choose to self-direct services • Voluntary termination of self-direction• CM and support broker will:

• make efforts to sustain self-direction,• ensure services/supports are arranged via providers to meet the needs outlined in the

plan of care.

• Involuntary termination of self-direction can occur if participant:• refuses to participate in development and implementation of plan of care; • authorizes payment for unauthorized services and supports; • commits fraudulent or criminal activity associated with self-direction;• declines surrogate when informed one is necessary.

• If this occurs, individual and support team develop transition plan and CM coordinates transition of services and assists in choosing provider(s).

15

16

Quality• Quality assurance and quality improvement standards for MFP

services provided through 1915(c) waivers will be equal to or greater than version 3.5 of the 1915(c) waiver application guidance

16

17

Housing

• Participants may choose to live in any of the types of MFP-qualified residences• Housing Supply Strategy over-arching framework:

1.Assure high-level joint planning, resource identification & development capacity between EOHHS & DHCD

2.Support statewide housing capacity identification and client linkage

3. Improve existing housing search / access capacity

• Background• TAC report, MassHousing, DHCD, EOHHS Steering Committee

& STG documents• Inventories; supply mapping; needs assessments; search tools;

17

1818

1. Support EOHHS / DHCD Planning & Capacity Development• Establish EOHHS MFP State Housing Coordinator• Oversee implementation of MFP Housing Action Plan,

including regional coordination support

• Build on existing DHCD / local housing authority collaborations• Joint Housing Steering Committee• Ongoing development & administration of Home Modification

Program• Ongoing housing unit selection under CBH & FCF • Training for DHCD architects re: accessibility requirements

1919

1. Support EOHHS / DHCD Planning & Capacity Development (2)• Joint development of Housing opportunities for MFP

participants• Planned ABI & DDS housing development• Pending Category 2 non-elder Section 8 vouchers (215)• Ongoing bond cap planning to expand CBH, FCF as resources

permit• Expanded universal design training & unit development• Determination of new opportunities regarding:

• Improved affordability of MassHousing set-aside, FCF units; Project-based & MRVP Value Vouchers

• Increased preferences / improved targeting for individuals leaving institutions for MassHousing set-aside, Supportive Housing, Home Modification, CBH, Rural Housing Sec 515, & Alternative & Housing Choice Voucher programs; potential QAP inclusion

2020

2. Support statewide housing capacity identification and client linkage• Purchase Regional Housing Assistance• Support local efforts• Help the consumer identify appropriate housing• Assist in collection of any required documentation • Ensure housing applications are obtained and completed

2121

3. Improve existing housing search capacity

• Enhance MassAccess (Massachusetts Accessible Housing Registry) • Improve the functionality to conduct housing searches for

specific groups including elderly only and family;• Improve functionality for sorting developments with open wait

lists versus developments with current vacancies;• Conduct complete review of the entire site for updates/upgrades

with current web technology (current site is now two years old);• Update the Help and Resource Section of the Registry including

fact sheets on housing search, reasonable accommodations and fair housing laws; and

• Provide support for ongoing training for property managers and end users.

22

Continuity of Care Post Demonstration• Continuity of care provided through the use of existing

1915(c) waivers and state plan services and two new 1915(c) waivers will supplement existing waivers

• Waivers will have capacity available or specifically reserved for transitioning individuals

22

23

Anticipated Procurements• Regional Transition Coordinators

• Case Management• Demo Case Management for State Plan only MFP Participants• Administrative Case Management for new MFP Waivers• 24-Hour Back-Up System capabilities

• Direct Service Providers• For Demo and new MFP Waiver Services

23

24

MFP Infrastructure and Resources• Massachusetts Rehabilitation Commission (MRC)

Infrastructure and Resources• Operate new MFP Waivers• Quality Oversight of Case Management and Waiver Services

• Office of Medicaid/MassHealth Infrastructure and Resources• MFP Program leadership• Housing connection• Data and IT System reconfigurations: MFP tracking, reporting,

quality data, claiming of enhanced FMAP

• Progress on rebalancing strategy• Shifting resources from facilities to home/community services• Reinvesting in Medicaid community service infrastructure

24

25

Evaluation• Participation in national evaluation including Quality of Life

surveys• No Massachusetts-specific evaluation

25

26

Budget Assumptions and Projections

• Begin MFP eligible transitions in July 2011 (SFY12)• Requires transition services, IT changes for reporting, 24-hour back-up system; State Plan only:

case management, additional assistive tech

• New waivers approved by January 2012 – transitions begin April 2012

• Discount transition estimates (including spending impact) by 15% for MFP application

• Non-MFP LTC spending still must meet MOE requirements

• $3.9M in up front appropriations for SFY12

MFP Demo SFY11 SFY12 SFY13 SFY14 SFY15 SFY16SFY2011 - SFY2016

Without DemoSpending $0.0 $20.9 $68.1 $109.0 $149.5 $191.0 $538.4FFP $0.0 $10.1 $32.3 $52.0 $72.2 $92.8 $259.3

Without Demo Net State Cost $0.0 $10.8 $35.8 $57.0 $77.3 $98.2 $279.1

With DemoSpending $2.3 $32.8 $70.2 $88.8 $112.4 $136.9 $443.3FFP $2.3 $22.0 $39.6 $52.5 $61.0 $72.6 $249.9

With Demo Net State Cost $0.0 $10.8 $30.6 $36.3 $51.4 $64.3 $193.4

Net Cost/(Savings) to MA $0.0 $0.0 ($5.1) ($20.7) ($25.9) ($33.9) ($85.7)

27

Letters of Endorsement• Association for Behavioral Healthcare• Boston Center for Independent Living• Boston Resource Center• Citizens’ Housing and Planning Association, Inc.• Consumer Quality Initiatives, Inc.• Mass Home Care• Massachusetts Association of Behavioral Health Systems• Massachusetts Law Reform Institute• Metro Boston Recovery Learning Community• MetroWest Center for Independent Living• National Empowerment Center• Stavros (ILC)• Vinfen• MA Council for Home Care Aide Services

28

Next Steps• January 7 Draft Submitted to CMS

• January – February Draft amended through conversations with CMS

EOHHS begins development of implementation plan for stakeholder

review / input

• February 28 Notice of grant approval

• March Regular implementation planning initiated; Staff hiring begins;

procurement development begins

• July Demonstration begins

• January 2012 New waivers begin