1. Quarterly Stakeholder Meeting March 28, 2013 Money Follows the Person

2. Agenda ■Demonstration Data ■Efforts to Date ■Current Challenges ■Goals ■Revised Proposal ■Proposed Performance Incentive Payment Model ■Upcoming Conversations ■Discussion 2

3. 3 Demonstration Data

4. As of 3/1/2013 4 MFP Demonstration Data Participants (transitioned) by Population

5. MFP Demonstration Data 5 As of 3/1/2013 Number of MFP Participants by type of community residence

6. MFP Demonstration Data Number of MFP participants (transitioned) by qualified facility As of 3/1/2013 6

7. 77 Money Follows the Person Demonstration – Efforts to Date ■Created Online MFP Tracking System –Web-based application –Collects, tracks and manages required data on qualified individuals enrolled in MFP and subsequently transitioned to the community ■Developed and received CMS approval for 2 new 1915(c) HCBS waivers –MFP Community Living (MFP-CL) Waiver Participants who do not need 24 hr 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 need 24 hour supervision and staffing and receive services in a provider- operated and staffed setting Residential supports include: residential habilitation in a group home serving no more than 4 individuals, assisted living services and shared living

8. 8 Money Follows the Person Demonstration – Efforts to Date ■Developed and received CMS approval for new 1915(b) Waiver –MFP Behavioral Health Managed Care Waiver Members participating in one of the two MFP waivers will be enrolled into the managed behavioral health plan Work is on-going to finalize contract amendment with MBHP This is to address the significant role that behavioral health issues play in causing institutional placement and undermining community stability ■Collaborated with the Department of Housing and Community Development (DHCD) on HUD Section 811 Project Rental Assistance Demonstration Program award –$5.4m awarded to DHCD to provide 100 long-term project-based rental assistance affordable housing units specifically for low-income persons with disabilities –DHCD will match with 50 additional units –MFP Demonstration participants are the highest priority group identified for use of these units ■Procured Housing Search Entities –Open RFQ issued to create pool of qualified housing search entities to identify housing for people served by the MFP Demonstration –MRC has qualified 6 housing search entities (HSEs) to date –HSEs will be available to work with MFP qualified members who are seeking housing

9. Money Follows the Person Demonstration – Efforts to Date ■Developed administrative infrastructure necessary to support this federal demonstration including: –Configuring the claiming system to accept new MFP services –Expanding provider enrollment systems –Developed 10 training modules for transition coordinators, including MFP 101, HCBS Waiver Services, Why Work? Benefits of Working and Administering the Quality of Life Survey –Ensuring MFP reporting capability consistent with CMS requirements –Wrote regulations, including MFP Demonstration Service Rate Regulations MFP Waiver Service Rate Regulations MFP Waiver Eligibility Regulations MFP Waiver Program Regulations 9

10. 10 Money Follows the Person Demonstration – Current Challenges ■Improve efforts to meet our commitment to transition an additional 1800 qualified individuals to the community over the next 3 years ■Develop an operational model more in synch with you, our stakeholders’ view and create an alternative to the RCO model ■Leverage existing community-based organizations and their relationships with state agencies and each other ■Expand relationships across a broad range of community partners that interact with and have expertise in meeting the needs of MFP Enrollees

11. 11 Money Follows the Person Demonstration – Goals ■Strengthen our support for MFP qualified individuals to significantly increase the number of transitions from facilities to community settings ■Increase the distribution of MFP funding directly to community-based agencies that have a demonstrated track record in transitioning people to the community ■Establish a performance incentive structure for distribution of funding for Transition Coordination ■Efficiently and accurately record and track MFP Enrollees, Participants and MFP requirements ■Ensure accountability for MFP expenditures and comply with state and federal reporting requirements

12. 12 Money Follows the Person Demonstration – Revised Proposal ■Direct funding for MFP Transition Coordination to ASAPs and ILCs through an RFA and direct contracts ■These agencies have demonstrated partnerships with key community resources and state agencies serving MFP Enrollees ■Payment will be tied to MFP results ■Ensure audit trail of all MFP expenditures

13. 13 Transition Coordination - Proposed Performance Incentive Payment Model Payment Category Payment Indicator/sourcePayment Conditions 1Start-up funding Tied to the projected number of MFP Enrollees to be served by the ASAP or ILC Paid once contract is signed and the agency has access to and training on use of the MFP Tracking System 2Payment per Enrollee For Transition CoordinationUpon entering an Enrollee into the MFP Tracking System with specific qualification elements (e.g. 90+ days in facility, MassHealth eligible, signed informed consent form, etc.) and confirmed by the MFP Project Office Bundled payment for goods and/or services that support the individual’s transition 3Specialty Goods and Services Payment Specialty transitional goods/services, such as a service dog, large scale home modification, or need for housing search As the Transition Coordinator identifies specific needs in the transition plan 4Payment per MFP Transition Tied to the transition of an MFP-qualified person to an MFP qualified-residence in the community Post transition, with appropriate recording of all necessary data in the MFP Tracking System, including linkage with community-based case manager

14. 14 Transition Coordination - Proposed Performance Incentive Payment Model 1. Start-up Funding ■Provided to each ASAP or ILC based on the organization’s response to the RFA - tied to the projected number of MFP Enrollees/Participants the respondent expects to serve ■Payment linked to timing of contract signing, obtaining access and training for the MFP Tracking System

15. 15 2. Transition Coordination ■Lump sum payment for administrative costs associated with coordinating the Enrollee’s transition ■Paid upon confirmation the member is MFP-qualified and entered into the MFP Tracking System – including the necessary specific qualification elements (e.g. 90+ days in facility, MassHealth eligible, signed informed consent form, etc.) Transition Coordination - Proposed Performance Incentive Payment Model

16. 16 2. Transition Coordination (con’t) ■Transition Coordination functions include, but are not limited to: –Engage individuals to encourage them to take advantage of MFP Demonstration opportunities –Develop Person-Centered Transition Plans –Execution/collection of MFP Informed Consent Forms –Conduct MFP Quality of Life Surveys –Ensure the Enrollee understands array of community services/waivers –Assist the Enrollee to apply for MassHealth, HCBS waiver or state plan services –Undertake functions/activities such as escorting an Enrollee to visit housing, community service or employment or volunteer options –Provide housing search assistance in collaboration with Housing Search Entities –Collaborate with community-based case managers –Purchase/provide MFP Demo Transitional Assistance Services Transition Coordination - Proposed Performance Incentive Payment Model

17. 17 3. Goods and Services ■Bundled payment for transition goods and services for each Enrollee ■Paid upon confirmation that the member is MFP-qualified and entered into the MFP Tracking System – including the necessary specific qualification elements (e.g. 90+ days in facility, MassHealth eligible, signed informed consent form, etc.) ■Goods and Services may include such components as: Non-recurring set- up expenses (security deposits, essential furnishings, etc.), minor home modification, peer support and companion services, activities to assess need, arrange for and procure needed resources (individual support, transportation), family support/training, community re-integration, work incentive counseling Transition Coordination - Proposed Performance Incentive Payment Model

18. 18 4. Specialty Goods and Services Payment ■Transitional assistance goods and services that are not routinely needed for all Enrollees ■Payment based on specific goods/services, identified by the Transition Coordinator and included in the transition plan ■Specialty Goods and Services may include such components as: service dogs, 24 hour services (i.e. personal care services and/or peer/companion support for a specified post-transition period) or large- scale home modification, and use of housing search entities through MRC Transition Coordination - Proposed Performance Incentive Payment Model

19. 19 5. Payment per MFP Transition ■Paid for the transition of an MFP-qualified Enrollee to a qualified residence in the community – i.e. the transitioned individual must meet all conditions for participation in the MFP Demonstration. ■Payment will be made post transition, upon appropriate recording of all necessary data in the MFP Tracking System, including identification of the community-based case manager, either Demonstration Case Management or as associated with a waiver into which the MFP Participant has enrolled. Transition Coordination - Proposed Performance Incentive Payment Model

20. 20 Upcoming Conversations ■Transition Coordination RFA and contracts ■Fully leveraging new and existing waivers ■MFP outreach strategy ■Maximizing housing opportunities ■Proposed more frequent meeting schedule

21. 21 Discussion