“Real Choice” in Flexible Supports and Services A Pilot Project

1. “Real Choice” in Flexible Supports and ServicesA Pilot Project Kim Wamback, UMMS Center for Health Policy and Research (Grant Staff) Michael O’Neill, Department of Mental Health (Collaborative Team) Keith Jones, Consumer Planning and Implementation Group (Collaborative Team) Theresa Eckstrom, Elder Services of Worcester Area (Pilot Subcontractor)

2. Purpose of Presentation • Provide a brief history of the “New Freedom Initiative” and the Real Choice Grant. • Provide an overview of the Real Choice Pilot. • Provide information on opportunities for sustainability. • Open discussion.

3. Systems Change and the“New Freedom” Initiative • The “New Freedom” Initiative was announced by President Bush in 3/01, followed by Executive Order 13217 in 6/01. • New Freedom is a nationwide effort to remove barriers to community living for people of all ages with disabilities and long-term illnesses http://www.cms.gov/newfreedom/. • Federal “listening sessions” were held 8/01-9/01. • Various types of grants (including this one) were awarded by the Centers for Medicare and Medicaid Services (CMS) 2001-2005 under the “New Freedom Initiative”.

4. State Partners Executive Office of Health & Human Services Executive Office of Elder Affairs MassHealth Office of Disabilities and Community Services Department of Mental Retardation Massachusetts Rehabilitation Commission Department of Mental Health Community Partners Elders and people with disabilities Advocates and advocacy organizations Families and caregivers Service providers Real Choice Grant Partners Real Choice is funded by the Centers for Medicare and Medicaid Services (CMS) and is administered by UMASS Medical School, Center for Health Policy and Research (UMMS/CHPR).

5. Executive Office of Health and Human Services,Office of Disability and Community Services,and Executive Office of Elder Affairs Consumer Planning and Implementation Group Collaborative Team State Partners Staff Support and Coordination provided by UMASS Medical School

6. 2001 Real Choice Grant • $1.3 million administered by UMMS/CHPR in collaboration with state and community partners (over a total of 5 years). • Goal of the grant is to enhance the quality and accessibility of the present array of community-based long-term supports. • Implemented a cross-disability Consumer Planning and Implementation Group (CPIG). • Implemented a Collaborative Team of consumer and state partners. • Developed a uniform functional assessment process through an integrated workgroup of state and community partners (building off of MDS-Home Care). • Developed and currently implementing a pilot project to test the use of flexible supports and individual budgets (Cash and Counseling model).

7. Based on Robert Wood Johnson Foundation’s Cash and Counseling Demonstration and Evaluation Project (now in expansion phase). Individuals participate in the Real Choice functional assessment process to identify their level of need. Individuals receive an individual budget based on their needs. Individuals design a spending plan through support from a fiscal intermediary and a community liaison. Budgets are up to $36,000 (estimated cost of a nursing home). Services and supports are provided in a cost-effective method that best meets the individual's needs. Real Choice Pilot Overview

8. Pilot Target Population • Adults diverse in disability, age, ethnicity, and level of need who are Medicaid eligible (but not eligible for the MassHealth PCA Program). • Individuals who reside in southeastern or central Massachusetts. • Individuals who require assistance with two or more unmet needs relating to activities of daily living (ADLs) and/or instrumental activities of daily living (IADLs).

9. Pilot Specifics • Goals are to increase the quality of life and independence of participants through flexible funding. • Systems are designed to be applicable across disability and ages. • Pilot components: • uniform functional assessment process; • individualized budgets & spending plans; • fiscal intermediary support; • community liaison support (support in designing & monitoring spending plans); • representative (also known as surrogate) option; and • consumer-driven quality component in addition to a traditional quality system.

10. Pilot Subcontractors Process • RFP developed through Review Committee and released in January of 2003. • Review Committee had state agency, consumer, and UMMS/CHPR representation. Consumer-Directed Support Agencies • Elder Services of Worcester Area • Southeast Center for Independent Living Fiscal Intermediary • Stavros Center for Independent Living • Serving both central and southeastern regions

11. Worcester Area • Profiles of pilot participants and their Community Liaisons • Services and supports being purchased • Assisting people to transition from a facility setting • Challenges we have faced • Lessons Learned • Questions and Answers

12. Pilot Sustainability • The Independence Plus grant is a $500 thousand grant administered by UMASS Medical School Center for Health Policy and Research (UMMS/CHPR) in collaboration with state and community partners. • Goal of the grant is to develop a waiver that will allow individuals with disabilities to direct their own individual budget and choose the services and supports that best meet their needs in the community. • Model planned to be implemented as part of “Community First”.

13. For More Information… Please visit www.massrealchoices.org Or…. Contact Erin Barrett, Project Director 508-856-8496 & erin.barrett@umassmed.edu