Presentation on theme: "Opportunities for Community Living through Home and Community-Based Waiver Services: Acquired Brain Injury, Money Follows the Person and Frail Elder Waivers."— Presentation transcript:
Opportunities for Community Living through Home and Community-Based Waiver Services: Acquired Brain Injury, Money Follows the Person and Frail Elder Waivers March 2014 Updated 10/18/13
2 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.
3 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 MFP Qualified Facilities Nursing Facilities Rehab & Chronic Hospitals ICF-ID DPH Hospitals Psychiatric Hospitals* *with some exceptions Qualified Residences Individuals/ Familys Home Individuals Leased Apartment Community Residential Setting (Max 4 Individuals) Qualified Residences Individuals/ Familys Home Individuals 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 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
4 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
5 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.
6 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.
7 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
8 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
9 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.
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 10
11 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 months 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
Community Programs Serving MFP Demonstration Participants MFP Demonstration Participation (365 Community Days per Participant) PACE SCO One Care ABI Waivers MFP Waivers Frail Elder Waiver DDS Waivers Mass Health LTSS 12
13 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
Common Requirements of all HCBS Waivers ( cont) 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 14
15 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 spouses income and assets are not counted. HCBS Waiver Financial Eligibility
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 16
17 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.
Frail Elder Waiver Services Personal Care Home Health Aide Supportive Home Care Aide Homemaker Respite Companion Skilled Nursing Chore Environmental Accessibility Adaptations Grocery Shopping/Delivery Services Home Delivered Meals Laundry Services Supportive Day Program Transitional Assistance Non- Medical Transportation Home Based Wandering Response Systems Alzheimers/Dementia Coaching Home Delivery of Pre- packaged Medication Medication Dispensing System Occupational Therapy
19 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
20 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 provider- operated 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)
21 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
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 Services 22
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 Health Services MFP Residential Supports Waiver Services 23
24 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 These waivers serve approximately 250 people
25 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
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 26
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 ABI Residential Habilitation Waiver Services 27
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 28
To Apply For One Of These Waivers MFP Waivers: http://www.mass.gov/eohhs/consumer/insurance/more- programs/mfp-demo-and-waivers/money-follows-the- person-waivers.html http://www.mass.gov/eohhs/consumer/insurance/more- programs/mfp-demo-and-waivers/money-follows-the- person-waivers.html ABI Waivers: http://www.mass.gov/eohhs/consumer/insurance/more- programs/acquired-brain-injury-waivers.html# http://www.mass.gov/eohhs/consumer/insurance/more- programs/acquired-brain-injury-waivers.html# Frail Elder Waiver: Contact you local ASAP by calling 1-800-AGE-INFO or at 800AGEINFO.com800AGEINFO.com 29