A Meeting of 
the Standing Olmstead 
Advisory Committee 

October 22, 2010

Purpose of this Meeting
Community First Olmstead Plan
•	Commonwealth’s response to Olmstead v. L.C.

•	Vision: to maximize the extent to which people with disabilities and elders are able to live  successfully in their homes and communities.

•	Six major goal areas:
–	Help individuals transition from institutional care
–	Expand access to community-based long-term supports
–	Improve the capacity & quality of community-based long-term supports
–	Expand access to affordable and accessible housing with supports
–	Promote employment of persons with disabilities and elders
–	Promote awareness of long-term supports

What is the Standing Olmstead Advisory Committee?
•	Outgrowth of CMS Systems Transformation Grant

•	Purpose:
–	To provide ongoing monitoring of the Commonwealth’s progress in meeting the goals of the Olmstead Plan
–	To provide input for evolving strategies

•	Immediate focus: 
–	Money Follows the Person (MFP) Rebalancing Demonstration;
–	Other opportunities available through the Patient Protection and Affordability Care Act (ACA)

Money Follows the Person 
Rebalancing Grant
MFP Planning Grant
•	Money Follows the Person Demonstration
–	Three-month, $200,000 planning grant in collaboration with UMass led by OOM
•	In preparation for 5 year demonstration

•	Requires MA to:
–	Draft the Operational Protocol
–	Assure involvement, collaboration and guidance from stakeholders
–	Conduct a thorough analysis of MA’s readiness to participate
–	Identify budgetary impact
–	Determine if a Demonstration is sustainable
–	Determine need for legislative, regulatory, or administrative changes necessary to remove barriers to rebalancing

What is Money Follows the Person?
MFP Operational Protocol Elements
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
–	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 21-64 in IMDs (Institutions for Mental Disorders: Worcester, Taunton, Fuller)

•	Who must move to a “qualified residence” in the community
–	Home / apartment owned / leased by individual or family
–	Community-based residential setting of no more than 4 unrelated people 

How does the MFP Match Work?
MFP Services
Additional MFP Features
What have other states done with their 
MFP resources?
•	Demonstration Services
–	TX developed cognitive/adaptive support service for people with brain injuries & mental illness
–	GA developed transition case management that supported individuals for one year after leaving the facility
–	D.C. developed enhanced primary care coordination (EPCC) to provide intensive care coordination between PCPs, nursing staff and specialty care providers
–	AK and HI offer telehealth services to collect and transmit clinical information

•	Supplemental Services
–	OH provides transition coordination, community transition services, communication aids and service animals.  This service package includes housing navigation and coordination of benefits, as well as purchase of items such as a bed, towels and utensils.
–	D.C. developed community integration support which provides community inclusion and integration opportunities such as memberships to gyms or public organizations.
States have also used MFP
Demos to implement broader reforms
•	Several states developed comprehensive educational materials, outreach and training curricula

•	CT and other states developed IT infrastructure to support Demonstration management

•	Some states developed services in response to housing shortage barriers

–	IN provides incentives to developers to build new units for MFP participants
–	WA and MD pay for or subsidize rent until the MFP participant qualifies for a Section 8 housing voucher

A Model for MA
The MA Fiscal Environment Sets the Stage for MFP Options
•	MassHealth’s SFY11 budget has a projected shortfall

•	Phase out of enhanced 
FMAP in FY12 removes
$1.2B from FY12 state 
revenue projections 
compared to FY11 

•	MassHealth enrollment 
continues to exceed 
projections – higher costs 
MFP Planning is taking place within certain limits and uncertainties
Looking at Current Transition in MA: 
Process & Settings
•	Settings: Hospitals; NFs; ICFs/MR; IMDs
•	Process:
–	Client Identification (In-reach)
•	Entities: State agencies (DDS; DMH), ASAPs, ILCs, NFs

–	Options / Transition Counseling, Assessment, Clinical Eligibility
•	State agencies; UMass; NFs (discharge planning); ADRCs: ASAPs (CSSM), ILCs (not clinical)    

–	Transition Service Provision; Prior Authorization
•	DDS contracts; UMass
Looking at Transition in MA
•	Given potential new resources,
–	What are the priorities?
–	What are the right services?
–	Who are the providers?
–	Where are there opportunities for integrated strategies?
MFP IT Tools for Transition
•	Current resources
–	1-800-AGE-INFO
–	MADIL
–	PCA & Homecare Registries
–	Housing Registry

•	Planned resources
–	MDS 3.0 / Section Q Info

•	Needed improvements / other capacity?
Thinking about MFP Housing Support
•	Current Capacities
–	Housing registry
–	Provider / agency-based housing locators / support 
–	Bond development funds
–	Some modification capacity
–	Limited support for first / last

•	Extensive needs documented in STG Housing Report

•	New developments
–	Memorandum w/ DHCD / PHAs; Set-aside vouchers (~200 just in to 3 PHAs; 250 more requested for people leaving institutions)
–	Diverse strategies under MFP

•	Priorities for grant?

HCBS Opportunities in MFP
•	Some HCBS development priorities identified through the Olmstead Plan
–	Cueing / monitoring support for brain injured, developmentally disabled, & people with mental illness
–	Medication management options
–	Peer Support 
–	Respite
–	Self-direction / individual budgets

•	Challenges
–	Building cross-disability support
–	Identifying mechanisms for creating / managing access

•	Priorities for MFP?

MFP Timeline
•	October 2010
–	Begin CMS TA
–	Hold Olmstead Meeting
–	Begin MFP Workgroups
•	November 2010
–	Continue MFP Workgroups
–	Complete Population & Budget Analyses
•	December 2010
–	Complete Operational Protocol
•	January 2010
–	Re-convene Olmstead Group
–	Submit OPD
•	July 2011
–	Start Demo

MFP Information Available Online
•	Additional MFP information will be available on the Community First website located at:

www.mass.gov/hhs/communityfirst