Centers for Medicare & Medicaid Services State Implementation of Money Follows the Person: A National Perspective Jeff Clopein, M.A., Project Officer Money Follows the Person Demonstration Grant Program Center for Medicaid, CHIP and Survey & Certification Disabled and Elderly Health Programs Group Division of Advocacy and Special Initiatives 1Jeff Clopein

What’s this program called the MFP? Jeff Clopein2 Principal Aims:: Reduce reliance on institutional care Develop community-based long-term care opportunities Enable people with disabilities to participate fully in their communities

MFP FACTS 30 grantees (29 States and DC)-started in 2007 As a result of the Planning Grant opportunity & the Money Follows the Person Rebalancing Demonstration Grant opportunity, 15 States have provided notice for intent to apply for a MFP Rebalancing Demonstration Grant by January 7, The following States are in the process of developing the Draft Operational Protocol as the major product of the MFP grant application: Rhode Island, Massachusetts, Maine, West Virginia, Tennessee, Florida, Alabama, Mississippi, Minnesota, New Mexico, Colorado, Utah, Nevada and Idaho, and American Samoa. The extension of the MFP Demonstration Program through 2016 offers States substantial resources and additional program flexibilities to remove barriers and improve people's access to community supports and independent living arrangements Size of awards –Total awards to date: $1.44 billion/Total budget 4.0 billion –Wide range of state commitments, from $5.4 million to $142 million Each state is implementing two programs –Transition program –Rebalancing program Jeff Clopein3

Deficit Reduction Act of 2005 (DRA) The MFP Rebalancing Demonstration Program was authorized by Congress in section 6071 of the Deficit Reduction Act of 2005 (DRA) and was designed to provide assistance to States to balance their long-term care systems and help Medicaid enrollees transition from institutions to the community. The MFP Demonstration Program reflects a growing consensus that long-term supports must be transformed from being institutionally-based and provider-driven to "person-centered" consumer directed and community-based. Congress initially authorized up to $1.75 billion in Federal funds through fiscal year (FY) 2011 to: 1) Increase the use of HCBS and reduce the use of institutionally-based services; 2) Eliminate barriers and mechanisms in State law, State Medicaid plans, or State budgets that prevent or restrict the flexible use of Medicaid funds to enable Medicaid-eligible individuals to receive long-term care in the settings of their choice; 3) Strengthen the ability of Medicaid programs to assure continued provision of HCBS to those individuals who choose to transition from institutions; and, 4) Ensure that procedures are in place to provide quality assurance and continuous quality improvement of HCBS. Ronald Hendler4

MFP Funding On July 26, 2010, the Centers for Medicare & Medicaid Services (CMS) issued a new MFP grant solicitation to encourage states not yet part of the Money Follows the Person Rebalancing (MFP) Demonstration to apply for grant funds. The Affordable Care Act included an extension of the MFP demonstration program for an additional 5 years (the funding was scheduled to expire at the end of FY 2011). The extension of the MFP Demonstration Program through 2016 offers States substantial resources and additional program flexibilities to remove barriers and improve people's access to community supports and independent living arrangements Ronald Hendler5

MFP FACTS Program Statutory Requirements: Participants must be Medicaid beneficiaries in institutional care for at least 6 months(recent policy change to 90 days/3months effective May 17, 2010) –Nursing homes, hospitals, intermediate care facilities for the mentally retarded (ICF-MR), institutions for mental diseases (IMD); Medicaid Eligible on the last day institutionalized whom have at least the last day in the institution covered by Medicaid reimbursement for the inpatient day. –A person needs only one day (last day of the 90 days) on Medicaid and 90 consecutive days in the IMD, Hospital, ICF-MR, or nursing home (eligible institutions). The patients must transition to an eligible residence Transition to “qualified” residence -Home, apartment, or group home with 4 or fewer people. -Lease with the participant or family, lockable egress and access, and living, sleeping, cooking and bathing areas. As of December 2009, almost 6,000 individuals have returned to the community as a result of these demonstrations. Jeff Clopein6

MFP Services –Eligible for 1 year – 365 days –Package of home and community-based services (HCBS) Qualified HCBS Demonstration HCBS Supplemental Services Continuity of services -Qualified HCBS continues after MFP eligibility ends based on beneficiary eligibility Enhanced matching funds –Qualified HCBS –Demonstration HCBS Ronald Hendler7

MFP a “Laboratory” for Innovative Long-term Care Services for State Programs MFP Demonstration Services- Expanding the Menu : These are optional services that States can choose to cover but have not done so yet under their HCBS waivers or state Medicaid plan. These are a few of the demonstration services which receive the enhanced FMAP and were developed by States specifically for the demo: –24-Hour Nurse Helpline, –24/7 In-home Monitoring –Telemedicine –Intense Transitional Management –Social habilitation/community integration counseling –Consumer/family/caregiver education on HCBS –Intensive home modification & assistive technology –Transition Service (start up costs) –Behavioral Crisis management services These services are defined in ways that are not found in existing waivers in the amount, scope, duration and frequency of existing waiver services in those States. Jeff Clopein8

MFP a “Laboratory” for Innovative Long-term Care Services for State Programs MFP Supplemental Services: These one-time or limited-duration services are associated with transitioning to the community and normally would not be covered by Medicaid. Housing coordination Trial visits Rent deposits, Security deposits, Household goods, Household set-up, Moving expenses Housecleaning, Food stocking Housing cost subsidy Roommate location services Problem solving services Vehicle repair, Utility deposits, Payoff of existing debt (HUD public housing; utility companies) Storage charges, Lock and key replacement Internet installation, Peer counseling and facilitation services, Services proposed by the state that are essential for successful transition to the community Not covered by Medicaid Only available during the 12 month demonstration period Explain billable unit and the rate Describe any medical necessity criteria Describe provider qualifications Jeff Clopein9

MFP has been a catalyst for State and Federal Infrastructure Development –MFP has led to the development of: Working relationships between departments, divisions and services at the State Level and Federal Level. Bringing service systems from multiple populations together in many cases for the first time. Integration of systems of long-term care access, information systems and addressing individuals with multiple diagnosis Jeff Clopein10

Introduced national individual performance indicators for participant satisfaction of Home & Community Based Services and Quality of Life Quality of Life Survey- Using individual performance indicators to assess services and satisfaction –Using that data to improve the quality of services, the types of services and the quality of the performance of the service delivery system –Quality of Life Survey being administered to every MFP participant three intervals: – before leaving institution –1 year later –2 years after leaving institution Jeff Clopein11

Introducing national individual performance indicators for Participant Satisfaction of Home & Community Based Services and Quality of Life The survey includes questions concerning the participants: –Living situation –Access to personal care –Choice and control –Respect and dignity –Community integration and inclusion and Satisfaction –Health status What the program wants to learn? –How do MFP participants fair in the community. –Which types of individuals do better in the community; and is Quality of Life associated with program characteristics. Jeff Clopein12

Program Benchmarks The Program holds States accountable for rebalancing though the demonstration by the establishment of benchmarks for each demonstration year such as: –The projected number of eligible individuals transitioned from an inpatient facility to a qualified residence. –Increase in qualified expenditures for HCBS. –Utilization rates for a screening, identification, and assessment process for persons who are candidates for transitioning to the community. –Progress directed by the State to achieve flexible financing strategies, such as global or pooled financing or other budget transfer strategies that allow “money to follow the person”. –Increases in available and accessible supportive services (i.e., including the use of “one-time” transition services, purchase and adaptation of medical equipment, housing and transportation services beyond those used for MFP transition participants). Jeff Clopein13

MFP a National Perspective The MFP Program is helping to rebalance and redesign the long-term care system: Creating Innovative Long-term Care Services for State Programs through expanding the Menu of long-term care services through demonstration and supplemental services Developing State and Federal Infrastructure for sustainability of the program Introducing national individual performance indicators for consumer satisfaction of Home & Community Based Services using MFP Quality of Life data Collecting and analyzing Maintenance of Effort & the Rebalancing Fund Data. Requiring Program Benchmarks to measure program progress and success CMS also is investing in national programs that will interconnect with the MFP program and provide a laboratory for piloting and implementing these innovations. –HCBS Taxonomy Project will help collect and analyze HCBS data for improved decision making. –Development of national indicators of a balanced long-term care system through the National Balancing Indicator Contract and Grantees –Looking forward to the future of long-term care HITECH as an opportunity for measuring and improving quality. \ Jeff Clopein14

Additional Information MFP Technical Assistance Website – – MFP.asp#TopOfPagehttp:// MFP.asp#TopOfPage CMS Contact Information: Jeff Clopein, Project Officer – Jeff Clopein15

Jeff Clopein16

Balancing Incentive Program Effie R. George, Ph.D. 17

 Established by the Affordable Care Act Section  Goal is to provide financial incentives to increase access to community-based services  Required structural changes Balancing Incentive Program

 States in which percent are for non-institutionally-based LTSS - eligible 2% enhanced FMAP  States in which less than 25 percent are for non-institutionally based LTSS, are eligible for 5 percent enhanced FMAP

Balancing Incentive Program  Required structural changes NWD/SEP System Conflict-free case management Core standardized assessment instruments

Balancing Incentive Program Enhanced FMAP begins 10/1/2011 – 9/30/2015 Cap of 3 billion dollars CMS will release formal guidance early summer 2011