Transcript Money Follows the Person (MFP) Demonstration, Transition

Opportunities for Community Living
through Home and Community-Based
Waiver Services: Acquired Brain
Injury, Money Follows the Person and
Frail Elder Waivers
March 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 Qualified Facilities
■ DPH licensed and Medicaid certified nursing facilities
(NFs)
■ Chronic Disease and Rehabilitation Hospitals (CDR)
■ DPH Hospitals
■ Intermediate Care Facilities for individuals with Intellectual
Disabilities (ICF/ID)
■ Psychiatric Hospitals including both public and private
(also referred to as Institutions for mental disease or
IMDs)*
*Excludes individuals aged 22 – 64 in IMDs
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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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MFP Qualified Residences
A qualified residence includes:
 a home owned or leased by the person or a family
member
 an apartment with an individual lease
 or a community-based residential setting in which no
more than 4 unrelated individuals reside
MFP requires that tenants must have a lease, lockable
entrance/egress, control over sleeping/bathing/cooking
space, and that no more than four unrelated persons reside
in a group or shared residence.
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Transition Coordination
MassHealth has contracted with 33 agencies to provide
Transition Coordination. These agencies include Aging
Services Access Points (ASAPs) and Independent Living
Centers (ILCs)
Transition Coordination Entities are responsible for:
 Conducting outreach to individuals in MFP Qualified
Facilities to inform them about the availability of the MFP
Demonstration
 Enrolling individuals who consent and are eligible in the
MFP Demo
 Assisting enrollees with developing Person Centered
Transition Plans and arranging necessary transition services
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MFP Demonstration Services
MFP Demonstration services are available for 365 days
after the individual transitions to the community. These
services include:
 Demo Case Management (only for MFP Demo
enrollees not enrolled in one of the HCBS Waivers)
 Demo Assistive Technology
 Orientation & Mobility Services
 Transitional Assistance Services
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MFP Demo Assistive Technology
■ Assistive Technology includes devices, controls, or appliances
that enable an MFP Demo Participant to:
– increase his or her ability to perform activities of daily living
– perceive, control, or communicate with the community
environment in which he or she lives
– other durable and non-durable medical equipment not
available under the State plan or a HCBS waiver
■ Examples include: communication boards; speech amplifiers;
electronic device that produces speech or written output;
voice-activated or remote environmental control unit;
specialized door opener; customized iPad and specialized
alarms.
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MFP Demonstration
Orientation and Mobility Services
■ Services that teach an individual with vision
impairment or legal blindness how to move or
travel safely and independently in his/her home
and community and which include:
– Direct Training
– Environmental evaluations
– Caregiver/Direct care staff training on
sensitivity to blindness/low vision
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MFP Demonstration
Transitional Assistance Services
■ Transitional Assistance Goods and Services may be
available through the MFP Demo or as a component of a
waiver in which the member enrolls
■ If Transitional Assistance service is not available through a
waiver, the MFP Demo provides the ability to obtain a wide
range of Transitional Assistance Services, such as:
 Furniture, security deposit and/or first month’s rent,
overnight companion for a short time, pest eradication, etc.
 Home modifications to make a home accessible to the
participant
 Can include assistance with locating rental housing
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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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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
■ Participants in residential or 24-hour waivers must be in need of
such 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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Common Requirements
of all HCBS Waivers (con’t)
■ MassHealth administers all HCBS waivers, with one of the
sister EOHHS agencies having day-to-day responsibility
for oversight and operations
■ The operating agency or their agent:
– Conducts the LOC evaluation to determine that the
applicant is clinically eligible for the waiver
– Provides Case Management to coordinate waiver
services
– Is primarily responsible for quality oversight, monitoring
and reporting
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HCBS 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 = $2163 a month.
 assets ≤ $2,000
■ NOTE: If there is a spouse, the spouse’s income and
assets are not counted.
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Waiver Case Manager
■ Every participant in an HCBS waiver will have a
waiver case manager
■ This case manager is responsible for arranging
and overseeing the delivery of their waiver
services and other community long-term care
services
■ The case manager will work with the participant
to develop a person-centered plan that identifies
and addresses their individual needs
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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.
■ Most Frail Elder Waiver participants enroll while living in the
community. They do not have to be transitioning out of a facility.
■ The Frail Elder Waiver serves approximately 15,000 elders per year.
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Frail Elder Waiver Services
■ Personal Care
■ Laundry Services
■ Home Health Aide
■ Supportive Day Program
■ Supportive Home Care Aide
■ Transitional Assistance
■ Homemaker
■ Non- Medical Transportation
■ Respite
■ Home Based Wandering
Response Systems
■ Companion
■ Skilled Nursing
■ Chore
■ Environmental Accessibility
Adaptations
■ Grocery Shopping/Delivery
Services
■ Home Delivered Meals
■ Alzheimer’s/Dementia
Coaching
■ Home Delivery of Prepackaged Medication
■ Medication Dispensing
System
■ Occupational Therapy
Money Follows the Person 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
– 84-hour per week limit on certain waiver services:
Homemaker, Home Health Aide, Personal Care, Adult
Companion, Individual Support and Community
Habilitation, Supportive Home Care Aide
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Money Follows the Person Waivers
■ MFP Residential Supports (MFP-RS) Waiver
– Participants who require 24-hour staff availability
and/or supervision and receive services in provideroperated and staffed settings
– Residential supports include: residential habilitation in
a group home serving no more than 4 people, assisted
living services, and shared living
■ Members participating in one of the two MFP waivers are
eligible to receive managed behavioral health services,
primarily through enrollment in the Massachusetts
Behavioral Health Partnership (MBHP)
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In order to qualify for one of the
MFP Waivers an applicant must:
■ Meet the requirements for participation in the MFP
Demonstration, including:
 Living in a nursing home or long-stay hospital for at least 90
consecutive days, excluding Medicare rehabilitation days;
 Transitioning to an a MFP qualified residence in the
community;
 Last day in the facility paid by MassHealth
■ MFP Waiver Participants must be either:
 Elders (age 65 and older) or
 Adults with disabilities age 18 – 64, including those with
an acquired brain injury
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MFP Community Living
Waiver Services
■
■
■
■
■
■
■
■
■
■
■
■
Adult Companion
Chore Service
Community Family Training
Day Services
Home Accessibility
Adaptations
Home Health Aide
Homemaker
Independent Living Supports
Individual Support and
Community Habilitation
Occupational Therapy
Peer Support
Personal Care
■
■
■
■
■
■
■
■
■
■
■
■
Physical Therapy
Prevocational Services
Respite
Shared Home Supports
Skilled Nursing
Specialized Medical
Equipment
Speech Therapy
Supported Employment
Supportive Home Care Aide
Transportation
Vehicle Modification
Managed Behavioral Health
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Services
MFP Residential Supports
Waiver Services
■ Residential Habilitation
(group home)
■ Shared Living – 24 Hour
Supports
■ Assisted Living Services
■ Day Services
■ Home Accessibility
Adaptations
■ Individual Support and
Community Habilitation
■ Occupational Therapy
■ Peer Support
■ Physical Therapy
■ Prevocational Services
■ Residential Family
Training
■ Skilled Nursing
■ Specialized Medical
Equipment
■ Speech Therapy
■ Supported Employment
■ Transportation
■ Managed Behavioral
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Health Services
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 communitybased 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
■ These waivers serve approximately 250 people
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Acquired Brain Injury (ABI) Waivers
■ ABI Waiver eligibility includes:
– Has been in facility for 90 days or longer;
– Has an acquired brain injury diagnosis; sustained at
age 22 or older
– Until now eligibility has required that service needs
be at or below the entrance cost limit
– Going forward there will be an 84-hour per week limit
on certain waiver services in the ABI-N waiver
(Homemaker, Personal Care, Adult Companion and
Individual Support and Community Habilitation)
■ UMass Waiver Unit conducts clinical eligibility
determinations
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ABI – Non Residential Waiver Services




Adult Companion
Chore Service
Day Services
Home Accessibility
Adaptations
 Homemaker
 Individual Support and
Community Habilitation
 Occupational Therapy




Personal Care
Physical Therapy
Respite
Specialized Medical
Equipment
 Speech Therapy
 Supported Employment
 Transportation
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ABI Residential Habilitation
Waiver Services
 Residential Habilitation
(group home)
 Shared Living – 24 Hour
Supports
 Assisted Living Services
 Day Services
 Home Accessibility
Adaptations
 Individual Support and
Community Habilitation
 Occupational Therapy
 Physical Therapy
 Specialized Medical
Equipment
 Speech Therapy
 Supported Employment
 Transportation
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Transition of Case Management
Supports for MFP and ABI Waivers
■ Case Management for the ABI-RH and MFP-RS
waivers is now provided by staff employed by DDS
■ Case Management for the ABI-N and MFP-CL
waivers is now provided by staff employed by MRC
■ These Case Management supports had previously
been provided through UMass
■ UMass continues to be responsible for waiver
eligibility and level of care determinations, as well as
Provider Network administration
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To Apply For One Of These Waivers
■ MFP Waivers:
http://www.mass.gov/eohhs/consumer/insurance/moreprograms/mfp-demo-and-waivers/money-follows-theperson-waivers.html
■ ABI Waivers:
http://www.mass.gov/eohhs/consumer/insurance/moreprograms/acquired-brain-injury-waivers.html#
■ Frail Elder Waiver:
Contact you local ASAP by calling
1-800-AGE-INFO or at 800AGEINFO.com
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MFP Resources
For more information:
 MFP Project Office
Email: [email protected]
Telephone: (617) 573-1647
 Mass. Rehabilitation Commission (MRC)
Email: [email protected]
Telephone: (617) 204-3747
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