A Meeting of the Standing Olmstead Advisory Committee 
October 22, 2010

Purpose of this Meeting
•	Convene the Standing Olmstead Advisory Committee to review aging & disability-related efforts under the Affordable Care Act

•	Provide an overview of the Money Follows the Person (MFP) Rebalancing Demonstration
–	opportunities & challenges

•	Review the timeline and the work process for the MFP planning effort over the next two months

•	Address questions

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)

Olmstead Plan Opportunities in ACA
•	Expanding home & community-based care options
–	New Medicaid Rebalancing initiatives
–	Changes to Medicaid state plan options
–	CLASS

•	Integrating Financing & Care Strategies	
–	Primary Care Medical Home
–	Care Transitions
–	<65 Duals Innovation
–	Integrating behavioral health & primary care
–	Medicare independence at home demo

•	Improving disability care outcomes
–	Information, referral & data collection
–	Cultural competency training
–	Wellness access
–	Health care facility / equipment physical access
–	Nursing home & community care outcomes projects
–	Workforce development

ACA Olmstead Efforts Underway in MA
Grants for improving information, 
Referral, & care transitions

•	Serving the Health Information Needs of Elders  - $1M
–	Insurance & services counseling for elders & people with disabilities (Medicare Outreach & Assistance in Low Income Programs & Prevention) 

•	ADRC Options Counseling - $500,000
–	Strengthen 11 Aging & Disability Resource Consortiums 
–	Expand elder & disabled counseling regarding community- based care options

•	Evidence-based Care Transitions - $200,000
–	New North Shore ADRC / hospital / nursing home transition services 

ACA Olmstead Efforts Underway in MA
Grants to Improve the Direct Care Workforce

•	Massachusetts Healthcare Advisory Committee (EOLWD) - $150,000
•	Includes long term / direct care workforce planning

•	Personal & Home Care Statewide Training Grant -  $2.3M
•	PHCAST National Goal: Develop core competencies for direct care workforce
•	MA Model
–	Two-pronged curriculum development & training
•	MA Home Care Council; proprietary curriculum
–	agency-based care model
•	PCA Community College (Bristol) certificate program
–	Self-directed care model; incorporates disabled workers

–	Cross-Secretariat strategy
•	Direct care typology; core curricula; education-to-career path; certification(s)

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 Rebalancing Demonstration funded by CMS to provide assistance to states to rebalance their long-term care systems by:
–	increasing the use of home and community-based services (HCBS)
–	decreasing the use of institutional care 
–	eliminating barriers that restrict flexible use of Medicaid funds
–	ensuring quality assurance and quality improvement

•	Helps Medicaid enrollees transition from institutions to the community

•	29 states and DC currently have MFP programs

MFP Operational Protocol Elements
•	Organization and Administration
–	Systems readiness assessment / gap analysis; grant administrative structure
•	Benchmarks (2 mandatory; 3 additional)
•	Participant Recruitment and Enrollment
•	Informed Consent and Guardianship
•	Outreach/Marketing/Education
•	Stakeholder Involvement
•	Benefits and Services
•	Consumer Supports
•	Self-Direction
•	Quality
•	Housing
•	Continuity of Care Post-Demonstration
•	Evaluation

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 Diseases: 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?
•	Historic Federal Match for MA: 50%
•	MFP enhanced match includes:
–	75% for most HCBS for a one-year period (365 days) for each individual transitioned from an institution
•	Rate could be higher if implemented during an enhanced FMAP period
–	50% for certain HCBS only available in the 365 days post-transition
–	75% - 90% for IT and external quality reviews
–	Up to 100% available for certain administrative costs

MFP Services
•	Qualified Home & Community Based Services 
–	HCBS that can be covered under Medicaid (state plan or waiver) and must continue to be provided to the individual once the Demonstration program has ended (after 365 days)

•	Demonstration services 
–	Additional HCBS that can be covered under Medicaid and are not required to continue after an individual’s one-year transition period

•	Supplemental services 
–	One-time / limited duration services to ensure successful community transition, such as housing access & supports, including security and utility deposits & basic furnishings; environmental, home & vehicle modifications; other

Additional MFP Features
•	Preference for transitioning multiple population groups

•	Opportunities to develop transition support, care coordination, & self-direction models

•	Expectations regarding providing housing assistance, needed HCBS service development, & support for ADRC structures

•	Considerable data collection & evaluation

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

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