Money Follows the Person (MFP) Stakeholder Meeting

1. Money Follows the Person (MFP) Stakeholder Meeting December 3, 2010

2. Today’s Agenda • Recap of MFP Context • Review of Projected Populations • Update regarding Transitional Services • Discussion of New 1915c Waivers for MFP Eligible Participants • Brief discussion of outreach & education • Next Steps • December 20th Meeting • Final January Review

3. Qualified Individuals/ Institutions Nursing Facilities Rehabilitation Hospitals Intermediate Care Facilities DPH Hospitals IMDs (age limits) Transition Activities Transition Svcs Demo HCBS Svcs Other Community Supplemental Svcs Money Follows the Person Overview 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, TBI Waiver, ABI waivers New Waivers State Plan Services

4. Projected MFP Participants • Assessing currently planned transition activities • Participant estimates are very preliminaryprojections • Subject to change; resources are a significant consideration

5. Non-recurring set-up expenses security deposits for lease on an apartment or home essential household furnishings moving expenses window coverings, food preparation items, and bed/bath linens set-up fees or deposits for utility or service access, including: telephone electricity heating water services necessary for health and safety Necessary home/vehicle accessibility modification Adaptive equipment, assistive technology Peer support Activities to assess need, arrange for and procure needed resources Service animals Individual or Family support/training MFP Transition Service Components

6. MFP Transition Service Components (con’t.) • Community re-integration, including: • pre-discharge community visits • specialized services • 24-hour personal care or companion services • Care Transition Counseling • Housing locator or roommate matching services • trial visits to res hab • telehealth monitoring or reminders • substance abuse treatment • cognitive adaptive training

7. Proposed New MFP 1915c Waivers

8. 1915c MFP Waivers Two MFP waivers will support MFP-qualified individuals post transition. These 1915c waivers will provide home and community based services for MFP participants who do not currently have a waiver option.

9. Waiver Gaps • Current 1915c waivers cover individuals at certain institutional levels of care and specifically target elders, individuals with brain injury, and individuals with intellectual disabilities. • Under MFP, we anticipate that the two proposed MFP Waivers would cover individuals including those with: • Physical disabilities • Adult onset disabilities • Mental illness • Developmental disabilities • Technology dependence • Medical frailty • HIV/AIDS

10. Populations to be Served in New MFP Waivers • MFP qualified – transitioning from a facility • MassHealth eligible • Adults age 18 and over • Disabled (if < 65) • No specific diagnosis

11. MFP Waivers • MFP Residential Supports Waiver • Providing services to individuals who need 24/7 oversight and other HCBS • MFP Community Living Waiver • HCBS, will not include 24/7 services • MRC will be operating agency; Administrative oversight by Office of Medicaid

12. MFP Waivers Eligibility Applicants: • Must be in a qualified setting at least 90 days at time of entrance to the waiver (excludes rehab days and at least one day must be paid by Medicaid) • Hospital, Chronic and or Rehabilitation or Acute or Psychiatric, Nursing Facility, Intermediate Care Facility and IMD in limited circumstances • Must have income at or below 300% SSI FBR • Must have $2,000 or less in countable assets • Spousal disregard will apply • Must meet MassHealth disability criteria if < 65 • Must be in need of waiver services

13. Eligibility Re-determination Annual clinical and financial re-determination • Clinical • Must be at NF LOC or a hospital LOC • Financial • Income at 300% SSI; • Assets can not exceed $2,000; • Spousal disregard applicable

14. Potential services offered in both waivers • Assistive Technology • Behavioral Health (multiple services) • Day Services • Expanded Substance Abuse Services  • Family Support and Training • Maintenance Therapies – OT, PT, Speech • Medication Support/Management • Peer Counseling • Skilled Nursing • Supported Employment • Transitional Assistance Services • Transportation

15. Potential services unique to each waiver Residential Supports Waiver • Environmental Modifications (N/A in provider operated settings) • Residential Habilitation • Bundled Supportive Home Services • Shared Living • Community Living Waiver • Agency Personal Care • Chore Service • Companion Service • Environmental Modifications • Grocery Shopping/Home Delivery • Home-Delivered Meals • Homemaker • Home Health Aide • Individual Support and Community Habilitation • Laundry • Respite Care  • Supportive Home Care Aide • Shared Living (less than 24/7)

16. Self Direction Option • MFP Waivers will include Self Direction • Services that may be self directed include: • Assistive Technology • Chore Service • Companion Service • Family Support and Training • Grocery Shopping/Home Delivery • Home-Delivered Meals • Homemaker • Environmental Modifications • Individual Support and Community Habilitation • Laundry • Transportation • Peer Counseling • Agency Personal Care • Respite care • Supported Employment • Supportive Home Care Aide Services may not be duplicative

17. Self Direction Option • Participants who self-direct must engage with a Fiscal Intermediary/Fiscal Management Service • Participants will be assessed to determine their need for a surrogate • Support Brokerage will be provided

18. Outreach Issues for OPD • Marketing & education strategy • What information is needed by: • enrollees, families • participating providers, including facilities • caseworkers • Others • What existing efforts need to be augmented? • What media should be used? • Should state forums be held to educate the public? • What types of alternate materials are needed for diverse populations and consumers?

19. Questions?

20. Appendix

21. 1915c Waivers • General Requirements • Waiver services complement/supplement the services available through the Medicaid State plan as well as other Federal, State and local programs and informal care provided by family/friends • Waiver participants receive Case Management • Waivers must be “cost neutral” as compared to institutional services • Have an approved Quality Improvement Strategy; and • Must demonstrate compliance in six key areas: • Level of Care • Service Plans • Qualified Providers • Health and Welfare • Administrative Authority • Financial Accountability