Money Follows the Person
Demonstration Grant

Overview 
Demonstration Grant & MFP Waivers
August 15, 2012

Overview:  Money Follows the Person Rebalancing Demonstration
■	The MFP Demonstration Program was authorized by Congress in 2005 (Deficit Reduction Act) and then rolled into the Affordable Care Act. 
■	MFP is part of a comprehensive, coordinated federal strategy to help states change their approach to serving individuals needing long-term care by expanding Medicaid-funded options for elders and individuals with disabilities that allow them to receive care in the community. 
■	April 2011- Massachusetts was awarded a five (5) year MFP Demonstration Grant. We are now one of 43 states plus the District of Columbia with MFP.

■	MFP Demonstration Grant allows Massachusetts to: 
•	expand its existing commitment to support community living for frail elders and people with disabilities across their lifespan   
•	provides Massachusetts with federal funding to increase the use of home and community based services (HCBS),  ensure quality assurance and quality improvement, and 
•	provide individuals choosing to transition from MFP Qualified Facilities with a range of demonstration and transitional assistance services

Two Overarching Goals
■	Increase the number and proportion of institutionalized Medicaid enrollees who can be transitioned into the community.

■	Rebalance the state’s LTC system by developing the infrastructure and increasing the % of total LTSS spending for HCBS.

MA Community First Olmstead Plan

■	MFP uses “Community First” as its foundation
■	Established 2008 by the Patrick Administration
■	Objectives: 
1. Help individuals transition from institutional care.
2. Expand access to community-based long-term supports.
3. Improve the capacity and quality of community-based long-term supports.
4. Expand access to affordable and accessible housing with supports.
5. Promote employment of persons with disabilities and elders.
6. Promote awareness of long-term supports (LTS)

Massachusetts’s MFP Program
■	Strengthening functions and services to support those who wish to transition out of facilities, 
■	Create broad and comprehensive information about and access to transitional assistance, 
■	Promote availability and utilization of state plan services for those transitioning, and 
■	Develop two new HCBS waiver programs for elders and people with disabilities not currently eligible for one of the existing waiver programs.

Who Can Participate?  
Individuals: 
■	18 years of age or older (excluding people 21-64 in an IMD);
■	Medicaid eligible (last day paid by Medicaid); 
■	Who are in or will be in an MFP Qualified Facility for 90 consecutive days; and
■	Who wish to participate in the Demonstration and transition to a qualified residence and sign an MFP Informed Consent 

What Types of Facilities Qualify? 

■	DPH licensed and Medicaid certified nursing facilities (NFs)
■	Chronic Disease and Rehabilitation Hospitals (CDR)
■	DPH Hospitals
■	Intermediate Care Facilities for people with mental retardation (ICF/MR)
■	Institutions for mental diseases (IMDs)

Required Demonstration Elements 
■	Informed consent
■	24 hour back-up plan in place prior to moving into the community
■	Quality of Life Survey (administered prior to leaving MFP Qualified Facility and at 11 and 24 months post transition)
■	Risk Assessment
■	Person Centered Transition Plan (Individual Service Plan once in the community)

Human Service Partners
■	EOHHS
•	MassHealth (Lead)
•	Massachusetts Rehabilitation Commission
•	Department of Developmental Services
•	Department of Mental Health
•	Others: DPH, MCB, MCDHH
■	Executive Office of Elder Affairs
■	University of Massachusetts

Qualified Residence
■	Home/apartment owned or leased
■	Community-based residential setting – no more than 4 individuals 
■	 Assisted Living Facilities
–	Must be a residence with living, sleeping, bathing and cooking areas (does not require an oven)
–	Unit must have lockable access and egress
–	Cannot require that services must be provided as a condition of tenancy
–	Must not require notification of absences from the residence
–	Aging in place must be a common practice 
–	Leases may not reserve the right to assign or change apartments

24 Hour Back-up
■	All MFP participants must have a 24 hour back-up plan in place prior to moving into the community
■	Back-up plan must include a 24-hour contact number that will connect to an On-call Case Manager who is able to intercede and arrange for urgent care or authorize services to be immediately delivered
■	The plan must be tested and demonstrate effectiveness once the individual is ready to transition to the community

Serving MFP Participants

■	Currently MFP Participants are accessing services through current waivers or State Plan Services
–	ABI Waivers-MRC
–	Frail Elder Waiver-EOEA
–	Adult Residential Waiver-DDS
–	Community Living Waiver-DDS
■	Plan for late 2012 
–	MFP participants will also be served through:
•	2 New 1915 (c) MFP Waivers 
•	New 1915 (b) MFP Behavioral Health Waiver
•	State Plan Services including PACE & SCO
–	Demonstration Services (must not be duplicative)

New MFP Waivers

•	EOHHS submitted to CMS three new HCBS waivers
•	MFP Community Living Waiver
•	MFP Residential Supports Waiver
•	MFP Behavioral Health Services Waiver

•	MassHealth administers waivers 
•	MRC will be the Operating Agency
•	The waivers will provide HCBS to enable 
•	MFP-eligible persons move from nursing facilities, chronic, rehabilitation or psychiatric hospitals to the community

MFP Community Living Waiver
■	The MFP-CL Waiver is for individuals who do not need 24 hour supports or supervision 
–	Can move to their own home/apartment or to the home of family or someone else
–	Also includes individuals who may move to Adult Foster Care settings 
■	Allows for access to a variety of community-based waiver services that support the waiver participant to live safely in the community

Examples of Community Living Supports 
•	Adult companion
•	Personal Care Attendant
•	Assistive technology
•	Behavioral Health
•	Chore Service
•	Substance Abuse treatment
•	Day Services
•	Grocery shopping
•	Home Modifications
•	Home Health Aide
•	Homemaker
•	Home delivered meals
•	Laundry
•	Medication Management
•	Non-Medical Transportation
•	Occupational Therapy
•	Peer Counseling Physical Therapy
•	Respite
•	Shared Living
•	Skilled Nursing
•	Speech Therapy
•	Supported Employment
•	Case Management

MFP Residential Supports Waiver
■	The MFP-RS Waiver is for Individuals who: 
–	Require supervision and staffing 24 hours/day, 7days/week
–	Receive services in a provider-operated and staffed setting

■	Residential Supports services include:
–	Residential Habilitation in a group home serving no more than 4 individuals
–	Assisted Living Services
–	Shared Living 
•	Participant must require hospital level of care

MFP Regional Coordinating Offices
■	MassHealth will procure 5 MFP Regional Coordinating Offices (RCO) across the state
■	Operational target date-December 2012
■	RCOs will utilize Transition Coordinators, Case Managers and a Regional Housing Coordinator to assist with transitioning people from DPH and CDR Hospitals 
■	RCOs will provide access to Demo Services for Existing Transition Entities e.g. DMH

Demonstration Services
•	Orientation & Mobility Training
•	Assistive Technology
•	Demonstration Case Management
•	Transitional Assistance Services
•	Must not be duplicative

Orientation & Mobility
■	Services that teach individuals with vision impairment or legal blindness how to move or travel safely and independently in his/her home and community and which includes direct training, environmental evaluations and caregiver/direct care staff training on sensitivity to blindness/low vision.  O&M Services are tailored to the individual’s need and may extend beyond residential settings to other community settings as well as public transportation systems. 

Assistive Technology 
■	Assistive Technology includes: 
•	devices, controls, or appliances, that enable an MFP Demonstration Participant to increase his or her ability to perform activities of daily living; 
•	devices, controls, or appliances that enable an MFP Demonstration Participant to perceive, control, or communicate with the community environment in which he or she lives;
•	items necessary for life support or to address physical conditions along with ancillary supplies and equipment necessary to the proper functioning of such items
•	such other durable and non-durable medical equipment not available under the State plan or 1915(c) Home and Community Based Services waiver that is necessary to address an MFP Demonstration Participant’s functional limitations; 

Case Management
■	A service that provides an MFP Demonstration Participant with care coordination and assistance with obtaining necessary  MFP Demonstration and other State plan services, as well as other medical social, or educational services, regardless of the funding source, and that support the MFP Demonstration Participant’s ability to reside in a community setting. 
■	MFP Demonstration Case Management includes:

•	comprehensive assessments and periodic reassessments of an MFP Demonstration Participant to determine the need for any medical, educational, social, or other services;
•	development of an MFP Demonstration Case Management care plan that is based on the comprehensive assessments; 
•	referral and related activities (such as scheduling appointments for the MFP Demonstration Participant) to help him or her obtain necessary services and identified needs specified in the care plan; 
•	development of a back-up plan of care and provision of a 24-hour on-call support line to implement the back-up plan of care if such a need arises; 
•	monitoring and follow-up activities that are necessary to ensure that the MFP Demonstration Case Management care plan is effectively implemented and adequately addresses the needs of the MFP Demonstration Participant. 

Transitional Assistance
	Services that support an individual’s transition from long term care to a home in the community. Allowable expenses are those that are necessary to enable a person to establish a basic household and do not constitute room and board.

	These may include:  
•	non-recurring set-up expenses (security deposits, essential furnishings, pest eradication, etc.); home modification; 
•	pre-discharge assessment by an RN and OT (related to home navigation, medication self-management, chronic disease self-management, need for Care Transition Counseling); 
•	peer support and companion services; 
•	pre-discharge activities to assess need, arrange for and procure needed resources (individual support, transportation, etc.); 
•	service dog;
•	 family support/training;
•	 community re-integration; 
•	24 hour services (i.e. personal care services and/or peer/companion support for a specified post-transition period); 

Housing
■	Collaboration with statewide and local housing organizations and networks including Citizens Housing and Planning Assn., Community Economic Development Assistance Corporation
■	Partnership with DHCD on HUD NOFA Grants
■	Procurement of Qualified Housing Search Entities
■	Ensure sustainability of housing search and placement process beyond the MFP demo

Statewide Housing Coordination
•	Collaboration with EOHHS Housing Lead
•	Dept. of Housing and Community Development
•	MassHousing
•	Mass. Housing Partnership
•	Regional HUD Office
•	Mass National Assoc. of Housing Rental Organizations

Statewide Housing Coordinator
■	Develop marketing and outreach strategies to increase available housing
■	Provide housing expertise and work closely with Regional Housing Coordinators
■	Create Tools for Regional Housing Search & Network Coordinators and housing education materials for MFP Participants 
■	Participation in statewide housing organizations
■	Coordinate new HUD housing units

Regional Housing Search and Network Coordinator

•	Outreach and awareness to local Public Housing Authorities, developers and private landlords
•	Collaboration with Regional Housing networks, providers of housing services Community Development Corporations, regional planning housing associations private
•	Work with individuals who have challenging housing barriers in concert with Housing Search Entities
•	 Seek housing information from staff engaged in nursing home transition
•	Manage Qualified Housing Search Entities
Housing Search Entities
•	Assist MFP Participants to identify appropriate housing opportunities that meet their needs and preferences
•	Secure application materials for housing options preferred by MFP Participant
•	Review applications to ensure accurate completion and inclusion of required attachments
•	Coordinate with MFP Participant and case manager to view units and meet with potential landlords
•	Assist clients to follow up on applications

More Information on MFP 
■	MFP Website: http://www.mass.gov/eohhs/consumer/disability-services/living-supports/community-first/money-follows-the-person-rebalancing-grant.html
■	Information you will find:
–	MFP Planning Grant documents
–	MFP Project Summary and Operational Protocol
–	Past MFP Presentations (PPT and RTF)
–	Upcoming meeting announcements

Please contact MFP@state.ma.us if you have further questions or would like to be added to our mailing list for announcements of future MFP meetings