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Opportunities for Community Living through Home and Community-Based Waiver Services: Acquired Brain Injury, Money Follows the Person and Frail Elder Waivers. March 2014 Updated 10/18/13. MFP Demonstration.

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Opportunities for Community Living through Home and Community-Based Waiver Services: Acquired Brain Injury, Money Follows the Person and Frail Elder Waivers

March 2014

Updated 10/18/13

mfp demonstration
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 2011.

mfp in massachusetts overview
MFP in Massachusetts – Overview

MFP Transition

Services & Supports

  • 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
  • Qualified Residences
  • Individual’s/ Family’s Home
  • Individual’s Leased Apartment
  • Community Residential Setting (Max 4 Individuals)
  • MFP Qualified Facilities
  • Nursing Facilities
  • Rehab & Chronic Hospitals
  • ICF-ID
  • DPH Hospitals
  • Psychiatric Hospitals*
  • *with some exceptions
mfp qualified facilities
MFP Qualified Facilities
  • DPH licensed and Medicaid certified nursing facilities (NFs)
  • Chronic Disease and Rehabilitation Hospitals (CDR)
  • DPH Hospitals
  • Intermediate Care Facilities for individuals with Intellectual Disabilities (ICF/ID)
  • Psychiatric Hospitals including both public and private (also referred to as Institutions for mental disease or IMDs)*

*Excludes individuals aged 22 – 64 in IMDs

mfp demonstration qualifying criteria
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 501.000), 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.
mfp qualified residences
MFP Qualified Residences

A qualified residence includes:

  • a home owned or leased by the person or a family member
  • an apartment with an individual lease
  • or a community-based residential setting in which no more than 4 unrelated individuals reside

MFP requires that tenants must have a lease, lockable entrance/egress, control over sleeping/bathing/cooking space, and that no more than four unrelated persons reside in a group or shared residence.

transition coordination
Transition Coordination

MassHealth has contracted with 33 agencies to provide Transition Coordination. These agencies include Aging Services Access Points (ASAPs) and Independent Living Centers (ILCs)

Transition Coordination Entities are responsible for:

  • Conducting outreach to individuals in MFP Qualified Facilities to inform them about the availability of the MFP Demonstration
  • Enrolling individuals who consent and are eligible in the MFP Demo
  • Assisting enrollees with developing Person Centered Transition Plans and arranging necessary transition services
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MFP Demonstration Services

  • MFP Demonstration services are available for 365 days after the individual transitions to the community. These services include:
    • Demo Case Management (only for MFP Demo enrollees not enrolled in one of the HCBS Waivers)
    • Demo Assistive Technology
    • Orientation & Mobility Services
    • Transitional Assistance Services
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MFP Demo Assistive Technology

  • Assistive Technology includes devices, controls, or appliances that enable an MFP Demo Participant to:
    • increase his or her ability to perform activities of daily living
    • perceive, control, or communicate with the community environment in which he or she lives
    • other durable and non-durable medical equipment not available under the State plan or a HCBS waiver
  • Examples include: communication boards; speech amplifiers; electronic device that produces speech or written output; voice-activated or remote environmental control unit; specialized door opener; customized iPad and specialized alarms.
mfp demonstration orientation and mobility services
MFP Demonstration Orientation and Mobility Services

Services that teach an individual with vision impairment or legal blindness how to move or travel safely and independently in his/her home and community and which include:

Direct Training

Environmental evaluations

Caregiver/Direct care staff training on sensitivity to blindness/low vision

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MFP Demonstration Transitional Assistance Services

  • Transitional Assistance Goods and Services may be available through the MFP Demo or as a component of a waiver in which the member enrolls
  • If Transitional Assistance service is not available through a waiver, the MFP Demo provides the ability to obtain a wide range of Transitional Assistance Services, such as:
    • Furniture, security deposit and/or first month’s rent, overnight companion for a short time, pest eradication, etc.
    • Home modifications to make a home accessible to the participant
    • Can include assistance with locating rental housing
community programs serving mfp demonstration participants
Community Programs Serving MFP Demonstration Participants

MFP Waivers

Frail Elder Waiver

MFP Demonstration Participation

(365 Community Days per Participant)

ABI Waivers

DDS Waivers

MassHealth LTSS

PACE

SCO

One Care

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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
  • Participants in residential or 24-hour waivers must be in need of such services
  • MassHealth is responsible for all HCBS waivers, with one of the sister EOHHS agencies having day-to-day responsibility for oversight and operations
common requirements of all hcbs waivers con t
Common Requirements of all HCBS Waivers (con’t)

MassHealth administers all HCBS waivers, with one of the sister EOHHS agencies having day-to-day responsibility for oversight and operations

The operating agency or their agent:

Conducts the LOC evaluation to determine that the applicant is clinically eligible for the waiver

Provides Case Management to coordinate waiver services

Is primarily responsible for quality oversight, monitoring and reporting

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HCBS WaiverFinancial Eligibility

  • 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 = $2163 a month.
    • assets ≤ $2,000
  • NOTE: If there is a spouse, the spouse’s income and assets are not counted.
waiver case manager
Waiver Case Manager
  • Every participant in an HCBS waiver will have a waiver case manager
  • This case manager is responsible for arranging and overseeing the delivery of their waiver services and other community long-term care services
  • The case manager will work with the participant to develop a person-centered plan that identifies and addresses their individual needs
slide17

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 501.000
  • Aging Services Access Points (ASAPs) conduct Level of Care determinations, provide case management and manage waiver provider enrollment and oversight.
  • Most Frail Elder Waiver participants enroll while living in the community. They do not have to be transitioning out of a facility.
  • The Frail Elder Waiver serves approximately 15,000 elders per year.
frail elder waiver services
Personal Care

Home Health Aide

Supportive Home Care Aide

Homemaker

Respite

Companion

Skilled Nursing

Chore

Environmental Accessibility Adaptations

Grocery Shopping/Delivery Services

Home Delivered Meals

Laundry Services

Supportive Day Program

Transitional Assistance

Non- Medical Transportation

Home Based Wandering Response Systems

Alzheimer’s/Dementia Coaching

Home Delivery of Pre-packaged Medication

Medication Dispensing System

Occupational Therapy

Frail Elder Waiver Services
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Money Follows the Person 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
    • 84-hour per week limit on certain waiver services: Homemaker, Home Health Aide, Personal Care, Adult Companion, Individual Support and Community Habilitation, Supportive Home Care Aide
slide20

Money Follows the Person Waivers

  • MFP Residential Supports (MFP-RS) Waiver
    • Participants who require 24-hour staff availability and/or supervision and receive services in provider-operated and staffed settings
    • Residential supports include: residential habilitation in a group home serving no more than 4 people, assisted living services, and shared living
  • Members participating in one of the two MFP waivers are eligible to receive managed behavioral health services, primarily through enrollment in the Massachusetts Behavioral Health Partnership (MBHP)
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In order to qualify for one of the MFP Waivers an applicant must:

  • Meet the requirements for participation in the MFP Demonstration, including:
    • Living in a nursing home or long-stay hospital for at least 90 consecutive days, excluding Medicare rehabilitation days;
    • Transitioning to an a MFP qualified residence in the community;
    • Last day in the facility paid by MassHealth
  • MFP Waiver Participants must be either:
    • Elders (age 65 and older) or
    • Adults with disabilities age 18 – 64, including those with an acquired brain injury
mfp community living waiver services
MFP Community Living Waiver Services

Adult Companion

Chore Service

Community Family Training

Day Services

Home Accessibility Adaptations

Home Health Aide

Homemaker

Independent Living Supports

Individual Support and Community Habilitation

Occupational Therapy

Peer Support

Personal Care

Physical Therapy

Prevocational Services

Respite

Shared Home Supports

Skilled Nursing

Specialized Medical Equipment

Speech Therapy

Supported Employment

Supportive Home Care Aide

Transportation

Vehicle Modification

Managed Behavioral Health Services

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mfp residential supports waiver services
Residential Habilitation (group home)

Shared Living – 24 Hour Supports

Assisted Living Services

Day Services

Home Accessibility Adaptations

Individual Support and Community Habilitation

Occupational Therapy

Peer Support

Physical Therapy

Prevocational Services

Residential Family Training

Skilled Nursing

Specialized Medical Equipment

Speech Therapy

Supported Employment

Transportation

Managed Behavioral Health Services

MFP Residential Supports Waiver Services

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slide24

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
    • These waivers serve approximately 250 people
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Acquired Brain Injury (ABI) Waivers

  • ABI Waiver eligibility includes:
      • Has been in facility for 90 days or longer;
      • Has an acquired brain injury diagnosis; sustained at age 22 or older
      • Until now eligibility has required that service needs be at or below the entrance cost limit
      • Going forward there will be an 84-hour per week limit on certain waiver services in the ABI-N waiver (Homemaker, Personal Care, Adult Companion and Individual Support and Community Habilitation)
    • UMass Waiver Unit conducts clinical eligibility determinations
abi non residential waiver services
ABI – Non Residential Waiver Services

Adult Companion

Chore Service

Day Services

Home Accessibility Adaptations

Homemaker

Individual Support and Community Habilitation

Occupational Therapy

Personal Care

Physical Therapy

Respite

Specialized Medical Equipment

Speech Therapy

Supported Employment

Transportation

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abi residential habilitation waiver services
Residential Habilitation (group home)

Shared Living – 24 Hour Supports

Assisted Living Services

Day Services

Home Accessibility Adaptations

Individual Support and Community Habilitation

Occupational Therapy

Physical Therapy

Specialized Medical Equipment

Speech Therapy

Supported Employment

Transportation

ABI Residential Habilitation Waiver Services

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transition of case management supports for mfp and abi waivers
Transition of Case Management Supports for MFP and ABI Waivers
  • Case Management for the ABI-RH and MFP-RS waivers is now provided by staff employed by DDS
  • Case Management for the ABI-N and MFP-CL waivers is now provided by staff employed by MRC
  • These Case Management supports had previously been provided through UMass
  • UMass continues to be responsible for waiver eligibility and level of care determinations, as well as Provider Network administration
to apply for one of these waivers
To Apply For One Of These Waivers
  • MFP Waivers:http://www.mass.gov/eohhs/consumer/insurance/more-programs/mfp-demo-and-waivers/money-follows-the-person-waivers.html
  • ABI Waivers:http://www.mass.gov/eohhs/consumer/insurance/more-programs/acquired-brain-injury-waivers.html#
  • Frail Elder Waiver: Contact you local ASAP by calling 1-800-AGE-INFO or at 800AGEINFO.com
mfp resources
MFP Resources

For more information:

MFP Project Office

Email: MFPProjectOffice@state.ma.us

Telephone: (617) 573-1647

Mass. Rehabilitation Commission (MRC)

Email: MRC-MFPABI@MassMail.state.ma.us

Telephone: (617) 204-3747

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