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Acquired Brain Injury Home & Community-Based Services Waivers June 2011.

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Presentation on theme: "Acquired Brain Injury Home & Community-Based Services Waivers June 2011."— Presentation transcript:

1 Acquired Brain Injury Home & Community-Based Services Waivers June 2011

2 The ABI Waivers MassHealth 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 and –Quality measurement activities. UMass is contracted to implement the waivers, and provides: –Eligibility processing –Case management –Provider network administration 2

3 3 The 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.

4 What 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

5 5 ABI-RH Waiver The 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.

6 6 ABI-N Waiver The 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.

7 7 ABI Waiver Services ServiceABI-RHABI-N Adult CompanionX Chore ServicesX Community Based Substance Abuse TreatmentXX Day ServicesXX Home Accessibility AdaptationsX HomemakerX Individual Support and Community HabilitationX Personal CareX Residential HabilitationX Respite ServicesX Specialized Medical EquipmentXX Supported EmploymentXX Therapies – OT, PT, Speech XX Transitional Assistance ServicesXX TransportationXX

8 8 ABI Waiver Capacity 8 ABI-RH Year 1 - 35 Year 2 - 40 additional Year 3 - 25 additional Total # in ABI-RH Waiver - 100 ABI-N Year 1 - 70 Year 2 - 75 additional Year 3 - 55 additional Total # in ABI-N Waiver - 200 ABI-RH Year 1 - 35 Year 2 - 75 Year 3 - 100 ABI-N Year 1 - 70 Year 2 - 145 Year 3 - 200

9 9 Application 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: The next Open Application period will be held June 13 – July 1, 2011.

10 10 ABI 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.

11 Once 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. 11

12 Person-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. 12

13 ABI 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

14 14 Regulations, Standards & Rates ABI Waiver Provider Regulations: –MassHealth regulations define each ABI Waiver Service and establish requirements for these providers. (130 CMR 630.400) 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 ( under “what we do” select “brain injury”) ABI Member Eligibility Regulations: –MassHealth regulations 130 CMR 519.007(G)

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16 ABI Waiver Participants As of 6/1/11 ABI-RHABI-NTotal Determined eligible to participate in waiver upon facility discharge (engaged in care planning process)24 48 Enrolled Participant (in Community)121729 Total364177 16

17 Money 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

18 18 MFP Program Overview Qualified Individuals/ Institutions Nursing Facilities Rehabilitation Hospitals Intermediate Care Facilities DPH Hospitals IMDs (age limits) Transition Activities Transition Services Demo HCBS Services Other Community Supplemental Services 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 18

19 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, excluding rehabilitation 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 or leased by individual or family –Community-based residential setting of no more than 4 unrelated people 19

20 What are MFP Services? Transition Coordination –Activities to assist an eligible individual to transition Transition Services –Includes individualized services to qualified members prior to and immediately following discharge Demonstration 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 –SCO and PACE 20

21 Contact us by email at or by phone at (617) 573-1822 For more information about MFP For more information about the ABI Waivers UMASS Medical School Disability and Community Services ABI Waiver Program 333 South Street Shrewsbury, MA 01545 (866) 281-5602 21

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