Presentation is loading. Please wait.

Presentation is loading. Please wait.

Acquired Brain Injury Home & Community-Based Services Waivers

Similar presentations

Presentation on theme: "Acquired Brain Injury Home & Community-Based Services Waivers"— 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 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 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 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 ABI Waiver Services Service ABI-RH ABI-N Adult Companion X
Chore Services Community Based Substance Abuse Treatment Day Services Home Accessibility Adaptations Homemaker Individual Support and Community Habilitation Personal Care Residential Habilitation Respite Services Specialized Medical Equipment Supported Employment Therapies – OT, PT, Speech Transitional Assistance Services Transportation

8 Total # in ABI-RH Waiver - 100
ABI Waiver Capacity ABI-RH Year Year Year ABI-RH Year Year additional Year additional Total # in ABI-RH Waiver - 100 ABI-N Year Year additional Year additional Total # in ABI-N Waiver - 200 ABI-N Year Year Year 8

9 The 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:

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.

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.

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 Regulations, 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 ( under “what we do” select “brain injury”) ABI Member Eligibility Regulations: MassHealth regulations 130 CMR (G)

15 15

16 ABI Waiver Participants
As of 6/1/11  ABI-RH ABI-N Total Determined eligible to participate in waiver upon facility discharge (engaged in care planning process) 24 48 Enrolled Participant (in Community) 12 17 29 36 41 77 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 MFP Program Overview 18 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 18 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 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 19

20 What are MFP Services? Transition Coordination Transition Services
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 20

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

Download ppt "Acquired Brain Injury Home & Community-Based Services Waivers"

Similar presentations

Ads by Google