Transcript Waivers - Typepad

Money Follows the Person (MFP)
Demonstration and
Home and Community-Based
Services Waivers
Options Counselor Training
June 2014
MFP Demonstration
■ MFP is a Demonstration Grant from the Centers
for Medicare and Medicaid Services (CMS)
awarded to MassHealth. A goal of this MFP
Demonstration, is to “rebalance” the
Massachusetts service system – effectively
moving funding from facility based settings to
home and community based settings. The
Demonstration began in July 2011.
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MFP in Massachusetts – Overview
MFP Transition
Services &
Supports
MFP Qualified
Facilities
 Nursing Facilities
 Rehab & Chronic
Hospitals
ICF-ID
 DPH Hospitals
 Psychiatric
Hospitals*
*with some
exceptions
Qualified
Residences
 Individual’s/
Family’s Home
 Individual’s
Leased
Apartment
 Community
Residential
Setting
(Max 4
Individuals)
MFP Demonstration
Participants may access
services in the community
through the following:
 HCBS Waivers
 MFP
 ABI
 Frail Elder
 DDS; or
 One Care/SCO/PACE; or
 MassHealth State Plan services
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MFP Demonstration Qualifying Criteria
In order to qualify for the MFP Demonstration a participant must:
■ be living in a nursing facility or long-stay hospital for at least 90
consecutive days, excluding Medicare rehabilitation days;
■ be 18 years old or older and be disabled (disabled as defined in Title
XVI of the Social Security Act and MassHealth regulation 130 CMR
501.000), or be age 65 or older;
■ be eligible for MassHealth Standard or CommonHealth and whose last
day in the facility is a Medicaid-paid inpatient day;
■ be a resident of Massachusetts;
■ have signed a Consent Form; and
■ transition to an MFP qualified residence in the community.
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Options Counselor Role
If you identify someone who:
■ Has been in a nursing facility or long-stay hospital for at
least 90 days (or who is likely to be there at least 90 days)
■ May qualify for MassHealth
■ Is interested in moving to the community
Refer them to a Transition Entity for assistance.
MassHealth has contracts with 33 Transition Entities,
including all ASAPs and 9 Independent Living Centers
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Transition Entity Functions
Transition Entities are responsible for outreach and enrollment
including the following functions:
 Outreach out to staff and to individuals living in MFP
Qualified Facilities to explain the MFP Demonstration
 Enrolling eligible participants in the MFP Demo
 Assisting potential enrollees in applying for MassHealth if
they aren’t already enrolled
 Explaining community service options to MFP enrollees
and assisting individuals in applying for the identified
HCBS waivers and/or state plan options
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Transition Entity Functions
ENROLLMENT
 Clarify the individual is eligible for MFP Demo
 Have individual sign the Informed Consent Form
 If the individual has not submitted a MassHealth financial application,
help them to complete the application, gather necessary documentation
and submit to MassHealth.
 If individual has applied, provide ongoing support for any additional
information or documentation requested.
 Assist the individual in identifying service needs in the community and
discuss HCBS waivers and state plan options to meet those needs
 Assist the individual in applying for the identified HCBS waivers and/or
state plan options
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Benefits of the MFP Demonstration
Additional services are available to MFP Demonstration
Participants during their first 365 days in the community.
These services include:
 Demo Assistive Technology
 Orientation & Mobility Services
 Transitional Assistance Services
Enrollment in the MFP Demonstration is one of the
eligibility requirements for the MFP Waivers
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Options available for
MFP Demonstration Participants
MFP Demonstration Participants may access services through the
MassHealth State Plan (including One Care, SCO, PACE or access to
other State Plan services) or through one of the following HCBS waivers:
 Frail Elder Waiver
 MFP Community Living Waiver
 MFP Residential Supports Waiver
 ABI Residential Habilitation Waiver
 ABI Non-Residential Habilitation Waiver
 DDS Intensive Supports Waiver
 DDS Community Living Waiver
 DDS Adult Supports Waiver
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Community Programs Serving
MFP Demonstration Participants
MFP
Waivers
Frail
Elder
Waiver
ABI
Waivers
DDS
Waivers
MFP Demonstration Participation
(365 Community Days per Participant)
Mass
Health
LTSS
PACE
SCO
One
Care
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HCBS Waivers
A 1915(c) waiver allows the State to waive
certain requirements that otherwise apply to the
Medicaid program. This gives States the
flexibility to define:
– The target group of Medicaid beneficiaries to be
served
– The maximum number of participants who
may be served
– The services available to the target group. Waiver
services are always in addition to what is already
available through the Medicaid State Plan.
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Common Requirements
of all HCBS Waivers
■ Participants must be at a facility level of care (LOC), the specific
LOC varies by waiver
■ Participants must have an ongoing need for waiver services and
must receive waiver services at least once a month
■ Participants must be able to be safely served in the community
with available waiver and state plan services
■ MassHealth is responsible for all HCBS waivers, with one of the
sister EOHHS agencies having day-to-day responsibility for
oversight and operations
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Waiver Financial Eligibility
■ HCBS Waiver participants must be eligible for
MassHealth Standard, using the special financial
eligibility rules for waiver participants.
■ Financial eligibility guidelines for the adult HCBS
waivers are:
 income ≤ 300% SSI Federal Benefit Rate (FBR)
which is currently = $2,163 a month.
 assets ≤ $2,000
■ NOTE: If there is a spouse, the spouse’s income and
assets are not counted.
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Money Follows the Person Waivers
MassHealth has two new 1915(c) Home and Community Based Service
(HCBS) waivers.
 MFP Community Living (MFP-CL) Waiver
• Participants who do not need 24 hour supports or supervision
• Access to a variety of community-based waiver services that
support the participant to live safely in the community
 MFP Residential Supports (MFP-RS) Waiver
• Participants who require supervision and staffing 24/7 and receive
services in provider-operated and staffed settings
• Residential supports include: residential habilitation in a group
home serving no more than 4 individuals, assisted living services,
and shared living-24 hour supports
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Acquired Brain Injury (ABI) Waivers
■ ABI Non-Residential Habilitation (ABI-N) Waiver is for those
individuals who do not require 24 hour supports and supervision in
the community but need community-based waiver services
■ ABI Residential Habilitation (ABI-RH) Waiver is for those individuals
who require 24 hour supervision and staffing in a provider-operated
and staffed setting
■ Waiver eligibility includes: have been in a nursing facility or chronic
disease or rehabilitation hospital for 90 days or longer at time of
application;
– Has an acquired brain injury diagnosis; and
– Sustained the brain injury at age 22 or older
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Frail Elder Waiver (FEW)
■ The Executive Office of Elder Affairs (EOEA) is operating agency
■ Serves participants age 60 and over at a nursing facility level of care
■ Participants age 60 thru 64 must be disabled as defined in
MassHealth regulation 130 CMR 501.000
■ Aging Services Access Points (ASAPs) conduct Level of Care
determinations, provide case management and manage waiver
provider enrollment and oversight.
■ FEW participants can choose to enroll in SCO to receive all waiver
and state plan services. This is the only waiver that allows enrollment
in both an HCBS waiver and in SCO. This option is used to allow
participants needing the expanded income rules of the waiver to
access SCO.
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Department of Developmental Services
(DDS) Waivers
DDS operates three HCBS waivers for adults with intellectual disability
age 22 and older who are at an ICF-ID Level of Care
DDS Intensive Supports Waiver
 For participants with high, intensive need for supports due to the
severity of their functional limitations, behavioral, and/or medical
needs
DDS Community Living Waiver
 For participants with moderate level of support needs, i.e. less
than 24 hour supervision or support per day
DDS Adult Supports Waiver
 For participants with less intensive need for supports
These waivers offer opportunities for participant directions (both budget
and employer authority)
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Traumatic Brain Injury Waiver
■ The Massachusetts Rehabilitation Commission (MRC) is
operating agency
■ Serves participants age 18 and over at a nursing facility or
hospital level of care
■ Participants must have a traumatic brain injury (i.e. a
brain injury caused by external force)
■ Waiver is limited to 100 participants per year
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Waivers that only serve
participants being
discharged from facilities:
■ MFP-Community Living
(MFP-CL)
Waivers that serve
participants who are either
being discharged from
facilities or are currently
living in the community:
■ MFP-Residential Supports
(MFP-RS)
■ Frail Elder Waiver
■ ABI-Residential
Habilitation (ABI-RH)
■ DDS-Community Living
■ ABI-Non-Residential
Habilitation (ABI-N)
■ DDS-Intensive Supports
■ DDS-Adult Supports
■ Traumatic Brain Injury
(TBI)
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Waiver Services
■ Waiver services are authorized by the waiver
case manager in the Individual Service Plan
■ Waiver services complement the services
available through the Medicaid state plan
■ The services in each waiver varies and is
designed to meet the particular needs of the
population served in that waiver
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Waiver Resources
For more information regarding the Waivers:
Frail Elder Waiver
Call the local ASAP. http://contactus.800ageinfo.com/FindAgency.aspx
Money Follows the Person Waivers (includes brochures and applications)
http://www.mass.gov/eohhs/consumer/insurance/more-programs/mfp-demoand-waivers/money-follows-the-person-waivers.html
Acquired Brain Injury Waivers (includes brochures and applications)
http://www.mass.gov/eohhs/consumer/insurance/more-programs/acquiredbrain-injury-waivers.html
Department of Developmental Services Waivers (includes brochures and
applications) http://www.mass.gov/eohhs/gov/departments/dds/
Traumatic Brain Injury Waiver and Brain Injury and Statewide Specialized
Community Services http://www.mass.gov/eohhs/consumer/disabilityservices/services-by-type/head-injury/bisscs.html
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