MDS: Overview

1. MDS 3.0 Section Q Revisions Coming on April 1, 2012 and Overview of Medicaid Affordable Care Act ProvisionsMarybeth Ribar MS, RNTechnical Director, Division of Community Systems Transformation/CMCSOctober 26,2011

2. MDS: Overview • Minimum Data Set (MDS) 3.0 • Why Changes are needed • Results of Process & Pilot Test • Side-by-side Comparison - Current vs. New Items • Description of Changes • Expected Impacts

3. Minimum Data Set 3.0 • Nursing Facility Resident Assess Instrument • Used for all nursing facility residents • Primarily used for rate setting & quality assurance • Version 3.0 implemented on October 1, 2011 • CMS used the opportunity to improve the functionality of Section Q –Participation in Assessment and Goal Setting • More person-centered -- interview resident/family • Action Steps – Connection to Local Contact Agency

4. Need for Change Identified • CMS conducted an open dialog as part of the Section Q implementation process • Open Forum teleconferences • Monthly State Medicaid Agency teleconferences • Discussion sessions at conferences • Posting Questions & Answers on CMS website • Posting Pilot Test Results • Posting Local Contact Agencies & State coordinator Points of Contact • Ongoing input from Improving Transitions Work Group (States and other Stakeholders)

5. Results of the Dialog • Many program operation issues were resolved • Suggestions for improving the functioning of Section Q were made • Skip patterns may preclude resident choice • Feasibility of discharge question may exclude potential candidates for transitioning • Need to better accommodate residents with cognitive impairments, dementia, mental illness • Some residents need to explore more options • Some residents/families were upset by being asked about returning to the community

6. Changes -- • Feasibility of discharge item was dropped • Individuals can opt-out of being asked if they want to speak to someone about returning to the community • Some clarifying language changes were made

7. Intent of Changes • Adopts a more person-centered approach • Places resident/family at center of decision-making • Gives individual residents a voice and a choice while being sensitive to those who may be upset by the assessment process • Is more targeted about who gets queried

8. Results of the Process • Suggested changes were incorporated into new draft Section Q and discussed with Improving Transitions Work Group • Proposed Language Changes were Pilot Tested in six States (9 facilities) in February 2011 • Results are being incorporated in MDS revisions to be implemented in April 2012

9. Side-by-Side Comparisons --

10. Changes to Section Q, cont’d

11. Changes to Section Q, cont’d

12. Changes to Section Q, cont’d

13. Changes to Section Q, cont’d

14. Changes to Section Q, cont’d

15. Changes to Section Q, cont’d

16. Expected Impacts(based on Pilot Test Results; big caveats) • By eliminating the Determination of Feasibility of Discharge item, many more residents were asked the question, “Do you want to talk with someone about the possibility of leaving this facility and returning to live and receive services in the community?” • And many more said Yes

17. Expected Impacts • By giving residents/families an opt-out provision (for those who cannot or do not want to move out), on subsequent quarterly assessments about talking to someone about returning to the community, they likely will be less upset • Should reduce the number of residents for whom the question is not appropriate • Works better than the feasibility-of-discharge question in targeting who should be asked the return to community question

18. Expected Impacts • More clarity about referrals • But key is communication at the local level For more information: • Send questions to: www.MDSforMedicaid@cms.hhs.gov

19. Medicaid Overview of Medicaid Affordability Care Act Provisions and care transitions

20. Top 5% in Medicaid Expenditures Source: CMS Analysis of MSIS data FY2008

21. CMS Medicaid Programs • States’ community long term care (LTC) programs provide home and community based services for Medicaid eligible individuals including case management and an array of supports • Most 1915c waiver programs offer transition services

22. Medicaid ACASection 2403: Money Follows the Person • Now extends through 2019-transitions individuals from institutions to community based care and adds resources to balance LTC • Enhanced Federal match for community services for first year following transition from facility • 43 States and the District of Columbia now participating in the demonstration

23. Medicaid ACA Section 2703: Health Homes for Individuals with Chronic Conditions • States are able to offer health home services for individuals with multiple chronic conditions or serious mental illness effective January 1, 2011 • Coordinated, person-centered care • Primary, acute, behavioral, long term care, social services = whole person • Enhanced FMAP (90%) is available for the health home services (first 8 quarters)

24. Medicaid ACA Section 2401: Community First Choice Option • Adds Section 1915(k) • Optional State Plan benefit to offer Attendant Care and related supports in community settings, providing opportunities for self-direction • Does not require institutional LOC under 150% FPL • Includes 6% enhanced FMAP

25. Medicaid ACA Section 10202: Balancing Incentive Payments Program • Participating States must commit to three structural changes: • Implement a No Wrong Door/Single Entry Point system • Use a Core Standardized Assessment Instrument • Implement Conflict Free Case Management standards

26. Resources CMS: Community Services and Long-Term Supports • http://www.cms.gov/CommunityServices/01_Overview.asp#TopOfPage State Medicaid Director Letters • http://www.cms.gov/SMDL/SMD/list.asp#TopOfPage MFP Technical Assistance Website • http://mfp-tac.com/ For more information: