Presentation on theme: "Money Follows the Person (MFP) Demonstration and Home and Community-Based Services Waivers Options Counselor Training June 2014."— Presentation transcript:
Money Follows the Person (MFP) Demonstration and Home and Community-Based Services Waivers Options Counselor Training June 2014
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
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 Individual’s/ Family’s Home Individual’s Leased Apartment Community Residential Setting (Max 4 Individuals) Qualified Residences Individual’s/ Family’s Home Individual’s 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 3
4 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 ), 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.
Options Counselor Role If you identify someone who: ■Has been in a nursing facility or long-stay hospital for at least 90 days (or who is likely to be there at least 90 days) ■May qualify for MassHealth ■Is interested in moving to the community Refer them to a Transition Entity for assistance. MassHealth has contracts with 33 Transition Entities, including all ASAPs and 9 Independent Living Centers 5
Transition Entity Functions Transition Entities are responsible for outreach and enrollment including the following functions: Outreach out to staff and to individuals living in MFP Qualified Facilities to explain the MFP Demonstration Enrolling eligible participants in the MFP Demo Assisting potential enrollees in applying for MassHealth if they aren’t already enrolled Explaining community service options to MFP enrollees and assisting individuals in applying for the identified HCBS waivers and/or state plan options 6
Transition Entity Functions ENROLLMENT Clarify the individual is eligible for MFP Demo Have individual sign the Informed Consent Form If the individual has not submitted a MassHealth financial application, help them to complete the application, gather necessary documentation and submit to MassHealth. If individual has applied, provide ongoing support for any additional information or documentation requested. Assist the individual in identifying service needs in the community and discuss HCBS waivers and state plan options to meet those needs Assist the individual in applying for the identified HCBS waivers and/or state plan options 7
Benefits of the MFP Demonstration Additional services are available to MFP Demonstration Participants during their first 365 days in the community. These services include: Demo Assistive Technology Orientation & Mobility Services Transitional Assistance Services Enrollment in the MFP Demonstration is one of the eligibility requirements for the MFP Waivers 8
Options available for MFP Demonstration Participants MFP Demonstration Participants may access services through the MassHealth State Plan (including One Care, SCO, PACE or access to other State Plan services) or through one of the following HCBS waivers: Frail Elder Waiver MFP Community Living Waiver MFP Residential Supports Waiver ABI Residential Habilitation Waiver ABI Non-Residential Habilitation Waiver DDS Intensive Supports Waiver DDS Community Living Waiver DDS Adult Supports Waiver 9
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 10
11 HCBS Waivers A 1915(c) waiver allows the State to waive certain requirements that otherwise apply to the Medicaid program. This gives States the flexibility to define: –The target group of Medicaid beneficiaries to be served –The maximum number of participants who may be served –The services available to the target group. Waiver services are always in addition to what is already available through the Medicaid State Plan.
12 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 ■MassHealth is responsible for all HCBS waivers, with one of the sister EOHHS agencies having day-to-day responsibility for oversight and operations
13 ■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 = $2,163 a month. assets ≤ $2,000 ■NOTE: If there is a spouse, the spouse’s income and assets are not counted. Waiver Financial Eligibility
Money Follows the Person Waivers MassHealth has two new 1915(c) Home and Community Based Service (HCBS) 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 MFP Residential Supports (MFP-RS) Waiver Participants who require supervision and staffing 24/7 and receive services in provider-operated and staffed settings Residential supports include: residential habilitation in a group home serving no more than 4 individuals, assisted living services, and shared living-24 hour supports 14
15 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 ■Waiver eligibility includes: have been in a nursing facility or chronic disease or rehabilitation hospital for 90 days or longer at time of application; – Has an acquired brain injury diagnosis; and – Sustained the brain injury at age 22 or older
16 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 ■Aging Services Access Points (ASAPs) conduct Level of Care determinations, provide case management and manage waiver provider enrollment and oversight. ■FEW participants can choose to enroll in SCO to receive all waiver and state plan services. This is the only waiver that allows enrollment in both an HCBS waiver and in SCO. This option is used to allow participants needing the expanded income rules of the waiver to access SCO.
17 Department of Developmental Services (DDS) Waivers DDS operates three HCBS waivers for adults with intellectual disability age 22 and older who are at an ICF-ID Level of Care DDS Intensive Supports Waiver For participants with high, intensive need for supports due to the severity of their functional limitations, behavioral, and/or medical needs DDS Community Living Waiver For participants with moderate level of support needs, i.e. less than 24 hour supervision or support per day DDS Adult Supports Waiver For participants with less intensive need for supports These waivers offer opportunities for participant directions (both budget and employer authority)
Traumatic Brain Injury Waiver ■The Massachusetts Rehabilitation Commission (MRC) is operating agency ■Serves participants age 18 and over at a nursing facility or hospital level of care ■Participants must have a traumatic brain injury (i.e. a brain injury caused by external force) ■Waiver is limited to 100 participants per year 18
Waivers that only serve participants being discharged from facilities: ■MFP-Community Living (MFP-CL) ■MFP-Residential Supports (MFP-RS) ■ABI-Residential Habilitation (ABI-RH) ■ABI-Non-Residential Habilitation (ABI-N) Waivers that serve participants who are either being discharged from facilities or are currently living in the community: ■Frail Elder Waiver ■DDS-Intensive Supports ■DDS-Community Living ■DDS-Adult Supports ■Traumatic Brain Injury (TBI) 19
Waiver Services ■Waiver services are authorized by the waiver case manager in the Individual Service Plan ■Waiver services complement the services available through the Medicaid state plan ■The services in each waiver varies and is designed to meet the particular needs of the population served in that waiver 20
21 Waiver Resources For more information regarding the Waivers: Frail Elder Waiver Call the local ASAP. Money Follows the Person Waivers (includes brochures and applications) and-waivers/money-follows-the-person-waivers.html and-waivers/money-follows-the-person-waivers.html Acquired Brain Injury Waivers (includes brochures and applications) brain-injury-waivers.html Department of Developmental Services Waivers (includes brochures and applications) Traumatic Brain Injury Waiver and Brain Injury and Statewide Specialized Community Services services/services-by-type/head-injury/bisscs.htmlhttp://www.mass.gov/eohhs/consumer/disability- services/services-by-type/head-injury/bisscs.html