Money Follows the Person Working Group

1. Money Follows the Person Working Group March 25th, 2011 1 1

2. Background • MA received a planning grant to prepare for and develop an operational protocol document for a Money Follows the Person (MFP) grant application • Standing Olmstead Advisory Committee was convened – focus on Money Follows the Person (MFP Working Group) • MFP Working Group provided input on many components, including: • Transition Coordination • Transition Services • Self-direction • Outreach and education • Benefits and Services • Housing • New MFP waivers • Massachusetts submitted a grant application in January, 2011 2

3. Grant Award • Massachusetts received MFP grant award letter late February, 2011 • Time period • April 1, 2011 – March 31, 2016 • $110,000,000 • Year 1: April 1, 2011 – March 31, 2012 • $13,486,888 • We are able to begin hiring MFP staff and building MFP infrastructure • Service funding will be available when the operational protocol document (OPD) is approved by CMS • CMS has outstanding questions that must be answered before approving OPD • Yearly funding is dependent on the attainment of all five rebalancing benchmarks 3

4. Review of Grant Application • MFP grant application included a draft operational protocol document (OPD) for the MA demonstration • located on the Mass.gov website: www.mass.gov/hhs/communityfirst • Includes the following components: • 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 4

5. Program Overview Transition Activities Transition Services Demo HCBS Services Other Community Supplemental Services Qualified Individuals/ Institutions Nursing Facilities Rehabilitation Hospitals Intermediate Care Facilities DPH Hospitals IMDs (age limits) Qualified Residences Individual’s or Family’s Home Individual’s leased apartment Community Residential Setting (Max 4 individuals) HCBS Existing Waivers DDS waivers, Frail Elder Waiver, ABI waivers New Waivers State Plan Services 5

6. Who can receive MFP services? • “Eligible individuals” • Medicaid enrollees who have lived in a “qualified institution” (inpatient facility,) for not less than 90 consecutive days • Who, “but for the provision of HCBS long-term care services … would continue to require the level of care provided in an inpatient facility…” • Excludes individuals 21-64 in IMDs (Institutions for Mental Disease) • Who must move to a “qualified residence” in the community • Home / apartment owned / leased by individual or family • Community-based residential setting of no more than 4 unrelated people 6

7. What are MFP Services? • Transition Coordination • Activities to assist an eligible individual to transition • Transition Services • May include: non-recurring set-up expenses, environmental adaptations, adaptive equipment, pre-discharge assessment by an RN and OT, peer support and companion services, activities to assess need, arrange for and procure needed resources, service animals, family support/training, community re-integration, 24 hour services, housing locator/roommate matching, telehealth monitoring or reminders, substance abuse treatment, cognitive adaptive training • Demo Services • Assistive technology, case management, mobility training • HCBS Services • Current waivers: DDS waivers, Frail Elder waiver, ABI waivers • New MFP Waivers: Community Living, Residential Supports • Medicaid state plan (including SCO and PACE) • Medicaid services provided by State agencies 7

8. Mandatory Benchmark #1 • Benchmark: 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 • Measure: Number of unduplicated participants projected to transition in each target group during each calendar year compared to actual number of unduplicated participants projected to transition in each target group during each calendar year • Transitions are projected in terms of CMS-defined Target Groups • These are the minimum targets we must meet 8

9. Mandatory Benchmark #2 • Benchmark: Increase State Medicaid expenditures for HCBS during each calendar year of the demonstration program • Measure: State Medicaid HCBS expenditures during each calendar year of MFP Demo compared to prior calendar year’s State Medicaid expenditures *CY2016 represents a partial year 9

10. State Specific Benchmark #3 Benchmark: Massachusetts will close 3 ICFMR facilities during the Demonstration Measure: Number of ICFMR facilities closed between January 2011 and September 30, 2016 10

11. State Specific Benchmark #4 Benchmark: At least 30% of MFP participants have the option to self-direct a service in their care plan Measure: (1) Number of MFP participants each calendar year that have at least one service that may be self-directed in the list of services that they have access to divided by (2) number of MFP participants each calendar year 11

12. State Specific Benchmark #5 Benchmark: At least 75% of MFP participants indicated that those who receive help are treated by their helpers the way they want them to during the 11 month or 24 month MFP Quality of Life (QoL) Survey QoL question: You said that you have people who help you. Do the people who help you treat you the way you want them to? Measure: (1) Number of MFP participants who indicated Yes on QoL Question during the 11 month or 24 month survey divided by (2) the number of individuals that answered Yes plus the number of individuals that answered No 12

13. Timeline – Year 1 13

14. Role of Stakeholders in Year One Design Timeline • Stakeholders will be invited to provide input on all aspects of design • There will be approximately quarterly stakeholder meetings for obtaining input • Transition and Housing program design • Outreach strategies; member satisfaction • New Waiver applications • Quality measurement

15. MFP Program Office Staffing • MFP positions in MassHealth and MRC will be posted at the following website: https://jobs.hrd.state.ma.us/recruit/public/3111/index.do • We will let stakeholders know as positions are posted and welcome your help in recruiting candidates • Required positions for the grant include: • MFP Project Director • will be posted as Project Director, Community Integration Unit, MFP Project • MFP Assistant Project Director • will be posted as Assistant Project Director, Community Integration Unit, MFP Project • These required positions will be posted soon 15

16. Procurements/Provider Enrollment 16 • Some activities may be procured together (TBD) • Regional Transition Entities (5-6) • Regions to be developed • 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 • Housing Coordination • Quality of Life Surveys 16

17. MFP Waivers - Eligibility • New Waivers will give broad access to HCBS for MFP qualified individuals • Waivers designed for MFP participants: adults aged 18 and over transitioning from institutions to qualified community settings that can not be served by existing Waivers • Not age or diagnosis specific • Financial eligibility at 300% SSI; spousal disregard • New Waivers • Community Living Waiver • Residential Supports Waiver

18. New MFP Waivers MFP Community Living Waiver - potential services • 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 • Transportation • Respite Care 18 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 Individual Support/Community Habilitation Home/Environmental Accessibility Modifications

19. Residential Habilitation Bundled Supportive Home Services Shared Living (24/7 only) 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 Available only for participants utilizing Shared Living: Individual Support and Community Habilitation Respite Care Home Accessibility Modifications New MFP Waivers, cont. MFP Residential Supports Waiver – potential services

20. Next Steps • March 2011 Implementation planning; Staff hiring begins • April - June 2011 Negotiation with & CMS Approval of operational protocol document • July 2011 Demonstration begins • April - July 2012 MFP waivers begin operation • Ongoing Quarterly Stakeholder meetings 20