Presentation on theme: "Acquired Brain Injury Home & Community-Based Services Waivers"— Presentation transcript:
1Acquired Brain Injury Home & Community-Based Services Waivers June 2011
2The ABI WaiversMassHealth and Mass Rehab Commission developed the waivers to serve persons with ABI who are in long-stay facilities.MRC is the operating agency for these waivers, responsible for:Oversight of case management activities,Operation of certain services andQuality measurement activities.UMass is contracted to implement the waivers, and provides:Eligibility processingCase managementProvider network administration2
3The ABI Waivers Two distinct waivers: Residential Habilitation Waiver (ABI-RH)Non Residential Waiver (ABI-N)The waivers provide home and community-based services to help Medicaid-eligible persons with ABI move from nursing homes or chronic or rehabilitation hospitals to the community.The waivers offer ongoing services in the community.
4What is an Acquired Brain Injury? For these waivers, an ABI is defined as all forms of brain injuries that occur after attaining the age of 22, including, without limitation, brain injuries caused by external force, which are often referred to as “traumatic brain injuries” (TBI).ABI does not include Alzheimer’s Disease and similar neuro-degenerative diseases whose primary manifestation is dementia.4
5ABI-RH WaiverThe ABI-RH Waiver is for individuals who need a residence that has supervision and staffing 24 hours a day, 7 days a week.Residences are group settings usually serving 4 people.The homes are owned or leased by the provider of these services.
6ABI-N WaiverThe ABI-N Waiver is for individuals who are able to move to their own home/apartment or to the home of family or someone else. This can also include people who move to Adult Foster Care (AFC) settings.Allows for access to a variety of community-based waiver services that support the waiver participant to live safely in the community.
7ABI Waiver Services Service ABI-RH ABI-N Adult Companion X Chore ServicesCommunity Based Substance Abuse TreatmentDay ServicesHome Accessibility AdaptationsHomemakerIndividual Support and Community HabilitationPersonal CareResidential HabilitationRespite ServicesSpecialized Medical EquipmentSupported EmploymentTherapies – OT, PT, SpeechTransitional Assistance ServicesTransportation
8Total # in ABI-RH Waiver - 100 ABI Waiver CapacityABI-RHYearYearYearABI-RHYearYear additionalYear additionalTotal # in ABI-RH Waiver - 100ABI-NYearYear additionalYear additionalTotal # in ABI-NWaiver - 200ABI-NYearYearYear8
9The next Open Application period will be held June 13 – July 1, 2011. Applications must be postmarked during an Open Application period.Additional Open Application periods for both waivers will occur periodically. This information will be posted on the MassHealth ABI website:
10ABI Eligibility Criteria Applicant must:Be a MassHealth member or eligible for MassHealth Standard once in the community (based on special waiver financial rules);Have sustained an ABI at the age of 22 or older;Be currently residing in a nursing facility, chronic disease or rehabilitation hospital for at least 90 days when applying for the waiver;Have expected annual care costs that do not exceed the individual cost limit for the waiver to which they applied.Be in need of waiver services, and able to be safely served in the community with the services available in the waiver.Additionally, there must be open slots in the waiver.
11Once Accepted in the Waiver, What are the Next Steps ? Every waiver participant will be assigned a UMass ABI Unit Case Manager. The Case Manager will:Work with the participant through a person centered process to identify services needed for a successful transition to the community.After discharge to the community the CM will meet with the participant at least quarterly to review the service plan and make any necessary changes.
12Person-Centered Planning Ensures that the participant is at the center of all planning. The planning process reflects the goals and values of the participant.The process is designed to be cognitively accessible to ensure full participation by the participant.The Case Manager facilitates the Person-Centered planning process.The Case Manager develops the Individual Service Plan from the information gathered through the PCP process.
13ABI Waiver Service Delivery Mechanisms Agencies or individuals interested in offering most ABI waiver services must enroll as MassHealth Providers.Providers submit applications to UMass for review.UMass ABI Waiver staff review the applications to ensure that potential providers meet the requirements outlined in the ABI provider regulations and MRC standards.Residential Habilitation, Transitional Assistance and Home Accessibility Adaptation providers do not use this enrollment process. These providers are enrolled by MRC through open procurements of the Commission.13
14Regulations, Standards & Rates ABI Waiver Provider Regulations:MassHealth regulations define each ABI Waiver Service and establish requirements for these providers. (130 CMR )Rates for ABI Waiver Services are established by the Division of Health Care Finance and Policy (DHCFP) (114.3 CMR 54.00)MRC Provider Standards: MRC establishes the policies and standards for ABI providers (www.mass.gov/mrc under “what we do” select “brain injury”)ABI Member Eligibility Regulations:MassHealth regulations 130 CMR (G)
16ABI Waiver Participants As of 6/1/11 ABI-RHABI-NTotalDetermined eligible to participate in waiver upon facility discharge (engaged in care planning process)2448Enrolled Participant (in Community)12172936417716
17Money Follows The Person (MFP) The MFP Rebalancing Demonstration Program was authorized by the Deficit Reduction Act of 2005 (DRA) and expanded as part of the Affordable Care Act (ACA).MFP was designed to assist States in rebalancing their long-term care systems and help Medicaid members transition from institutions to the community.Massachusetts received an MFP Grant Award in late February 2011 from the Centers for Medicare and Medicaid Services (CMS); the Demonstration is expected to begin in July, 2011.17
18MFP Program Overview 18 Qualified Individuals/ Institutions Nursing FacilitiesRehabilitationHospitalsIntermediate CareFacilitiesDPH HospitalsIMDs (age limits)TransitionActivitiesTransition ServicesDemo HCBS ServicesOther Community Supplemental ServicesQualifiedResidencesIndividual’s or Family’s HomeIndividual’s leased apartmentCommunity Residential Setting (Max 4 individuals)HCBSExisting WaiversDDS waivers,Frail Elder Waiver,ABI waiversNew WaiversState Plan Services181818
19Who can receive MFP services? “Eligible individuals”Medicaid enrollees who have lived in a “qualified institution” (inpatient facility,) for not less than 90 consecutive days, excluding rehabilitation daysWho, “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 in IMDs (Institutions for Mental Disease)Who must move to a “qualified residence” in the communityHome/apartment owned or leased by individual or familyCommunity-based residential setting of no more than 4 unrelated people1919
20What are MFP Services? Transition Coordination Transition Services Activities to assist an eligible individual to transitionTransition ServicesIncludes individualized services to qualified members prior to and immediately following dischargeDemonstration ServicesAssistive technology, case management, mobility trainingHCBS ServicesCurrent waivers: DDS waivers, Frail Elder waiver, ABI waiversNew MFP Waivers: Community Living, Residential SupportsMedicaid state planSCO and PACE2020
21For more information about the ABI Waivers UMASS Medical SchoolDisability and Community ServicesABI Waiver Program333 South StreetShrewsbury, MA 01545(866)For more information about MFPContact us by ator by phone at (617)21