MassHealth Housing, Homelessness, and Health Policy Webinar Series – Long Term Services and Supports
Shields, Julia C (EHS)
So Emily, you can take it away.
Cooper, Emily (ELD)
Great and thanks, Julia.
Hi everybody.
My name is Emily Cooper, and I work at MassHealth and Elder Affairs on issues related to homelessness and housing.
This webinar series came about because we have heard from a fair amount of providers who are working with people experiencing homelessness that, not surprisingly, MassHealth is complicated, and you know, hard to navigate and hard to understand. And so, we want to make the information, you know as easy to access as possible.
So as Julia mentioned, this is the second in a series.
The first webinar covered things related to applying for MassHealth. One of the things we talked about was when you apply, depending on your circumstances, you might be assigned different types of coverage.
MassHealth coverage from sort of limited coverage to more comprehensive coverage and the more comprehensive coverage, the more services you have access to.
We also talked about how some people are, everybody is given the choice, or some people are given the choice to enroll in what's called a Managed Care health plan, that's an insurance plan, and we have multiple different kinds and multiple different names.
And depending on whether you are enrolled in one of those health plans, also dictates whether or not you can get access to some services.
So, I'm going to start with some background just to queue up what Susan and Jess are going to share with us when they talk about coverage and plans and things like that.
I also want to just say that this webinar came about because we've been hearing a lot from people about people who are experiencing homelessness or who are previously homeless, that they have a need for services that we call Long Term Services and Supports.
So, needs for help going to the bathroom or showering or getting around or needing grab bars or needing to go to a day program or things that often are associated with people with disabilities or older adults.
And sometimes people experiencing homelessness may be chronologically young, but their body, from living on the streets, is clinically older and their health is older. So, they often need access to these services maybe earlier than some other folks.
So we want to make sure you know how to help somebody access these services and know how to navigate them.
They are not often things that homeless providers are well versed in.
It's like you don't, you're not really familiar with personal care attendants and durable medical equipment and activities of daily living.
So we wanted to make sure that information was available to you.
So I'm just going to share my screen for a second here and get us started.
MassHealth Housing, Homelessness, and Health Policy Webinar Series – Long Term Services and Supports (Slide 1)
Cooper, Emily (ELD)
This is the webinar on Long Term Services and Supports and as I mentioned, you're going to hear from Susan about different LTSS long term services and supports services that are available through MassHealth.
But whether or not someone can get those services is going to vary based on a couple of things, and one is their MassHealth coverage.
MassHealth Coverage Types (Slide 2)
Cooper, Emily (ELD)
So MassHealth has a variety of different coverage types, with the top being Standard.
On Standard, like that is the most comprehensive MassHealth coverage type you can have, down to and you'll see either the Health Safety Net, or if you're an older adult, which is say SACA, that means older adult, you would have access to the Medicare Saving Program.
So the people on the bottom of these tiers, if you have that coverage, it entitles you to the least services and at the top, the Standard entitles you to the most.
So you're going to hear from Susan that some things are available to people on MassHealth Standard or Common Health, but they might not be for MassHealth Care Plus for example.
I just want to say that these coverage types aren't always static.
They are dictated by the person's income and characteristics.
So if you're pregnant or you are a person with a disability or you need help with activities of daily living or something like that, if you let MassHealth know those things, your coverage type would change.
So for example, if you are on Care Plus, and that's because when you applied, you told us certain things and we said, oh, your eligible for Care Plus. If you told us other things like I'm medically frail, I need help, I need these LTSS supports, these long-term services and supports, and you told us that then we would be able to say, oh well, really you should be on MassHealth Standard or Common Health.
So these are not static coverage types in that you can have a conversation with MassHealth if something in your life has changed or something in your ability to navigate the world and see if that changes your coverage, type.
But it's important when you're working with people to know are they on MassHealth and what kind of coverage type do they have. If you don't know, we can put in the chat or at the end of this the MassHealth customer service line and you can call.
The person we call, that Members can call anytime that is the MassHealth customer service line is open and say “hey, I’m Emily Cooper, and I don't understand. I went to this webinar, can you tell me what coverage type I have” and they will let you know and then you can also have that discussion saying “they said that you know I should let you know that I'm experiencing homelessness, that I need help with LTSS” and you can see if that coverage type would change.
The other thing that plays a role into whether or not you have access to LTSS as Susan is going to talk about and Jess is going to talk about things that are for people who are in Managed Care.
MassHealth Managed-Care Eligible Members (Slide 3)
Cooper, Emily (ELD)
So, we have lots of Managed Care plans.
And there are different types.
You see them on the screen.
The Accountable Care Partnership plan, the Primary Care ACO, the Managed Care, the PCC plan, a whole bunch of acronyms that you're not that familiar with. Most people under 65 are automatically assigned to one of these plans if you haven't chosen one yourself.
So, most people under 65 on MassHealth are in one of these plans.
And if you're in one of these plans, you may have access to some of the things that Jess and Susan are going to talk about.
So again, when you are working with a MassHealth Member, you're going to want to know if they are on MassHealth, what type of coverage they have, and if they are enrolled in a plan, what type or name of the plan. This may all be on their card.
You know, they might have a MassHealth card or a plan card, but again, if you don't know, this is easily something that that MassHealth customer service can help with.
So we have these types of plans here.
OneCare (Slide 4)
Cooper, Emily (ELD)
We also have something called One Care.
That's another type of plan. This is for people who are under 65 as well, but they are on Medicare and MassHealth. So, you are going to hear a little bit about One Care from Susan.
Senior Care Options (Slide 5)
Cooper, Emily (ELD)
We also have something that's called Senior Care Options, or SCO. Those are for people 65 and older.
Note: for One Care or SCO, we don't automatically put you in those plans.
So if we don't, if you're not in a plan because we don't put you in one or you haven't chosen to be in one, you're in what's called fee-for-service.
About 80-90% of people on MassHealth are in a plan.
We have like 10-20% that are in, and I'm making up those numbers by the way, are in fee-for-service. Which means they just work with, they go to their doctor, and we pay their doctor.
There's no plan in the middle that gives them access to care coordination or gym memberships or transportation, or all those different things.
Something to be aware of when you are listening and again when you're working with folks:
Are they in a plan?
What's the plan's name?
What type of coverage do they have?
Program of All-inclusive Care for the Elderly (PACE) (Slide 6)
Cooper, Emily (ELD)
PACE being another one of the plans.
We're going to give these PowerPoints out at the end.
But if what I said to you sounded really confusing, you can go to My Ombudsman and say I have somebody here who needs, you know, some of these long-term services and supports.
Can you help us navigate how to get that?
You can also, with the Member, can set up a My Services portal where they can put their information in and they can get information back about their MassHealth coverage and we have a self-service system where you can go in as a member and just put in your information or call the phone number and we will get you all the information that you have.
This is also where you would let them know if anything has changed: like I now need help with LTSS or I'm experiencing homelessness which might change one of those coverage types.
So I'm going to stop sharing and I'm going to send this over to Susan Ciccarello and Susan, can you introduce yourself for the crowd, too, before you get started?
Section I. MassHealth Office of Long Term Services and Supports (OLTSS): Overview (Slide 7)
Ciccariello, Susan (EHS)
I sure can. Hi everyone.
I'm Susan Ciccariello.
I work at the Office of Long Term Services and Supports at MassHealth.
I'm really excited to be here and present to you all about a little bit of our offerings at the Office of Long Term Services and Supports.
I am also going to share my screen.
Before I start, can folks can folks see my screen?
Shields, Julia C (EHS)
Yes, we can see it.
Ciccariello, Susan (EHS)
Cool. Awesome.
Thank you.
OK.
So I'm going to be touching on a lot of what Emily just walked us through.
Thank you, Emily.
That was super, super helpful. Super perfect stage setting.
MassHealth is committed to a robust long-term services and supports program that delivers person-centered care, promotes independent living, and uses a “community first” approach (Slide 8)
Ciccariello, Susan (EHS)
So here at the office of Long Term Services and Supports, our goal is to serve individuals who require support to stay either in the community or in the setting of their choice.
And of the folks who are served by us at LTSS have disabilities or chronic medical conditions, many require assistance with activities of daily living.
We use this term a lot.
Those are things like dressing, bathing, grooming, mobility or IADLs, which are the Instrumental Activities of Daily Living like, laundry, shopping, housekeeping, to meet their daily needs, to promote independence and improve the quality of our Member's lives.
At LTSS, we serve approximately three hundred thousand individuals.
And again, in the scheme of MassHealth, that's pretty tiny.
There are two million members on MassHealth, but these are very, very important subset of our members.
At MassHealth, we offer a giant array of LTSS services, the broadest array of any state in the country.
Those include community-based services like, as Emily said, we have some day programs, Adult Day Health and Day Habilitation.
Also, some programs that come to a member's home, like Group Adult Foster Care, personal care attendants, home health, continuous skilled nursing.
We also have facility-based programs at MassHealth, including our chronic disease and rehab, hospitals and nursing facilities.
In addition to all of these programs, we have ten waivers offered through the Office of Long Term Services and Supports.
These are referred to as our Home and Community-Based waivers.
I am not going to speak to the waivers today and I'm not going to speak to every single program we offer at LTSS.
I'm going to speak to the ones that I think are important to this group, but happy to share information about any of the other programs if folks have questions or would like more information.
Who Qualifies for LTSS Services? (Slide 9)
Ciccariello, Susan (EHS)
So who qualifies for MassHealth?
I'm not going into that because I can't speak to who qualifies for MassHealth as well as others can.
But who qualifies for LTSS?
It would depend upon a Member's MassHealth coverage type, as Emily just spoke to, and also whether the individual would meet clinical eligibility for those services.
So for each service that we walk through, I'm going to highlight the MassHealth coverage types that a person would be able to receive these services for, I'm going to point you guys to where the clinical eligibility is.
How does a member start the process to get needed Long Term Services and Supports? (Slide 10)
Ciccariello, Susan (EHS)
And the other question that I feel like is going to be really helpful for you all is understanding how a member starts the process of getting Long Term Services and Supports. Oftentimes the process will start with a primary care physician referral.
Certainly for home health, that is typically the way the process will start.
Oftentimes a member will call the MassHealth customer service center, and the number is here, that's the eight hundred eight four nine two nine zero zero, to not only confirm their MassHealth coverage type, but also to find out what LTSS providers are in their area.
We additionally have another call center that can help members navigate through the long-term services and support system, which is MassOptions. They are able to speak to not only the MassHealth covered LTSS services but also other state agency’s services that a person may be eligible for, and that number is here also eight zero zero two four three four six three six.
And for Members who are enrolled in a health plan as Emily just spoke to this includes ACO, MCO, One Care, SCO and PACE, the health plan should help the Member with accessing LTSS services.
What are the things LTSS can help an eligible member with? (Slide 11)
Ciccariello, Susan (EHS)
This is just broadly what are some of the things that Long Term Services and Supports can help a member, an eligible member with.
Again, assistance with the activities of daily living, assistance with instrumental activities of daily living.
But there's also skilled care that can be provided through LTSS services such as wound care and therapies. This could be like post hospital skilled care, or also we have continuous skilled care that could be offered to folks if they meet eligibility requirements.
Additionally, medical equipment and supplies are offered through long term services and supports and this this could range from a wheelchair to very simple medical supplies including like absorbent products or a personal emergency response system for members.
I'll give you more information on that.
Group Adult Foster Care Services (Slide 12)
Ciccariello, Susan (EHS)
So the first service I wanted to talk through that I think is going to be of interest to this group is the Group Adult Foster Care program.
This program provides daily assistance with activities of daily living, instrumental activities of daily living to members who are enrolled in MassHealth Standard or MassHealth Common Health, where a direct a nurse will come out, provide case management, meet with a member, determine the members care needs and direct care workers will come to a member's place of residence.
So, generally in their home to provide care to the member and nurses and case managers monitor the member’s care.
This is our like lowest threshold LTSS services.
So the clinical eligibility requirements can be found at this this regulatory link here 130 CMR 408.506. I didn't actually put the live link there just in case it sometimes those links break.
But you can just drop that into the into any browser and it will bring up the Group Adult Foster Care clinical eligibility requirements.
Group Adult Foster Care Services (Slide 13)
Ciccariello, Susan (EHS)
This program serves individuals who are twenty two or older, and again it has lower care needs than most of our other LTSS services.
The service does require a clinical eligibility assessment be conducted, and one interesting unique thing about the Group Adult Foster Care program is we do have assisted living residences that are Group Adult Foster Care providers.
And Members are able to access Group Adult Foster Care at an assisted living who is providing Group Adult Foster Care services.
And there also is a subsidy, a rental subsidy that's provided to those Members through the Social Security Administration.
For someone who is interested in Group Adult Foster Care, this probably won't be a service that a primary care physician would say, oh, this is a great one just because they wouldn't know about it.
I would recommend first figuring out if a person is on Standard and then reaching out to Mass Options for a list of Group Adult Foster Care providers in the member’s area.
And again, this this is a community-based program where the direct care planning is provided in a Member's residence.
Personal Care Attendant Services (Slide 14)
Ciccariello, Susan (EHS)
The next program I'm going to talk about is the Personal Care Attendant program.
This is definitely our most widely used program at the Office of Long Term Services and Supports, and this program is for our MassHealth Members with permanent or chronic disabilities who require hands on care with activities of daily living and instrumental activities of daily living.
What's super unique about this program is it is a consumer directed program, meaning our MassHealth Members act as the employers of their own personal care attendants.
So, our Members have the responsibility for recruiting, hiring, training and supervising their own PC and just as an aside, no other insurance covers PCA, and there's no other insurance that covers Group Adult Foster Care services either in the same ways for PCA Member must have either MassHealth Standard or MassHealth Common Health and the clinical eligibility regulations are just here at the bottom here.
So, the personal care attendant program, as I described a member, is recruiting, hiring, training their own PCA.
We do have a network of personal care management agencies who will go out to a Member's place of residence, evaluate a member to determine how much personal care attendant time they need, and they also train a member on how to be an employer of a PCA.
Personal Care Attendent Services (Slide 15)
Ciccariello, Susan (EHS)
There are seventeen of those personal care management agencies.
And we do also, this program is a little a little complicated, have a fiscal intermediary, a single fiscal intermediary who is Tempest, who acts as the employer agent for our members.
So, they are the ones who actually process payroll and time sheets and cut the checks.
I don't think there's actual physical checks anymore.
They deposit into the PCA accounts so our Members, as employers, they don't have to deal with all of the taxes and the payroll that goes along with being the employer.
PCA is available to eligible Members of all ages and all disability types.
For the program, it is not a super quick turn around to get on.
It takes a bit between an eligibility assessment and training folks on how to be an employer takes at least 45 days for a person to start PCA services.
And to get started with this program, you might hear from a physician that this would be a good program for a Member, but generally starting the outreach with a PCA in the Member’s area is probably the best way to go and of course confirming that a person is eligible for Standard or Common Health.
Home Health (HH) Services (Slide 16)
Ciccariello, Susan (EHS)
Ok, next service I'm going to talk about is Home Health Services.
This is probably a service that most folks have heard about.
It is covered by other insurance. It's covered by Medicare.
And we do have a big network of home health agencies in Massachusetts, and they provide nursing visits, home health aide services, physical therapy, speech therapy and occupational therapy to mass health members in their homes and community.
To receive home health services, and have MassHealth pay for them, a Member would have to be on Standard, Common Health, Family Assistance, or Care Plus and the Member Clinical Eligibility Regulation is listed here also and there is also Member medical necessity criteria that's listed on our mass.gov web page.
Generally, for home health services a primary care physician would make a referral for home health services.
Home Health Services (Slide 17)
Ciccariello, Susan (EHS)
And again, home health is provided to members of all ages.
As long as the Member has a skilled need or a need for therapy services.
Durable Medical Equipment (DME) (Slide 18)
Ciccariello, Susan (EHS)
Our next service durable medical equipment.
This again is a really broad service covering lots of different kind of equipment and supplies.
And we do have again a really broad network of durable medical equipment providers.
One other just highlight is a bit of durable medical equipment and supplies are supplied through pharmacies, and again, generally it is purchased for some of the smaller dollar items, but also rental repair of customized equipment and mobility equipment and also MassHealth does cover absorbent products.
Let me say, to be eligible to receive durable medical equipment through MassHealth, Member’s must have Standard, Common Health, Family Assistance or Care Plus, and the Member must meet the eligibility requirements described here at these regs.
I do want to point you guys to something here on this next slide.
Durable Medical Equipment (DME) (Slide 19)
Ciccariello, Susan (EHS)
Again, DME is supplied to folks of all ages and disabilities.
But one thing that is a really neat tool that we have on our mass.gov website, is we have a DME and oxygen payment and coverage guideline tool. So, you can look up and see what kind of DME is covered. If a person needs like a a bed rail or a grab bar, you can look and see exactly what is covered and generally your primary care physician would make the referral or write a prescription for durable medical equipment.
Hospice Services (Slide 20)
Ciccariello, Susan (EHS)
And the last service I'm going to talk to you guys a little bit more in depth about is Hospice. Our Hospice service is covered by other insurances. I'm sure folks have heard of this service before. It's an all inclusive benefit offered to Members at end of life, and it meets all the needs of a Member related to their terminal illness and also provides services to a family who's taking care of the members psychosocial, spiritual and emotional needs.
A person must voluntarily elect Hospice, and during that election time, a physician must certify the member as being terminally ill with a life expectancy of six months or less.
Hospice is covered under MassHealth Standard, Common Health, Family Assistance and Care Plus.
And again, clinical eligibility requirements there needs to be the certification of terminal illness and in the regs are here that point to that.
And the Hospice program serves folks of all ages who are certified by a physician as having a terminal illness.
Hospice Services (Slide 21)
Ciccariello, Susan (EHS)
And one other just highlight when a Member does elect to receive Hospice benefits, they waive the right to receive some other benefits.
However, if a person is receiving PCA benefits prior to selecting Hospice, they would be able to continue to receive those benefits.
And to access Hospice services, you should definitely start with a discussion with your primary care physician.
And those are my slides for MassHealth LTSS.
I'm going to stop sharing.
And hand over to Jessica.
Plante, Jessica (EHS)
Susan, let me share my screen.
Community Partners Program 2023-2027 (Slide 22)
Plante, Jessica (EHS)
Hi everyone. Can you guys see my screen?
Just want to make sure.
Thank you.
My name is Jess Plante.
I am the policy program manager for the Community Partners program here at MassHealth.
What is the Community Partners Program? (Slide 23)
Plante, Jessica (EHS)
A lot of what has been touched on already is lumped into the Community Partners program.
So just going to dive right into it.
The Community Partners program is a program where community-based organizations are contracted by MassHealth to provide enhanced care coordination for MassHealth Members with really complex needs. This program is available to Members who are enrolled in those Managed Care Organizations and Accountable Care Organizations that Emily mentioned earlier in the presentation.
Along with certain Members who are working with the Department of Mental Health for their adult community clinical services or have previously access adult community clinical services.
There are two types of CPs. We have our Behavioral Health Community Partners and our Long-Term Services and Supports Community Partners.
Both can provide each other services.
So, Long Term Services and Supports CP can provide behavioral healthcare and vice versa.
However, which program a MassHealth Member is enrolled in just depends on which of those needs take precedent.
So, if a member has stronger LTSS needs, they'll be enrolled in an LTSS.
If they have stronger behavioral health needs, they'll be enrolled in a BH CP Specifically for our LTSS Members, we serve members aged three through sixty four.
We do not serve enrollees who are a member of One Care, ACO, and PACE, those additional programs that Emily and Susan had mentioned previously.
Our LTSSC CPs can specifically support up to nine thousand ACO/MCO members.
So it's a bit smaller of a patient population.
However, we do help with kids' management and coordination for those Members.
Providers who want to enroll their members into a Community Partners program should reach out specifically to the ACO or MCO that your Member is a part of.
You can also refer to their patients ACCS program if receiving adult community clinical services or if your patient is working with a provider that also happens to already be a community partner.
You can just reach out to that office itself and they can help with enrolling a member into the CP program.
CP Supports (Slide 24)
Plante, Jessica (EHS)
So, the supports that we offer are very tailored to the patient themselves.
We start off with a fairly comprehensive assessment and a health-related social lead screening, and this specifically tailors what is necessary for the member themselves.
We can provide things such as connections to options counselling, medication review, connection to social services, connections to primary care and other health needs.
For example, Community Partners will help connect people to dentists, they'll connect people to specialty care if they have something like sleep apnea that's impacting their health in multiple ways. We can coordinate home based care for those who are homebound.
We visited an LTSS CP yesterday who actually helped connect one of their enrollees to home based dental care because focusing on increasing dental appointments was something that they wanted to focus on for their patient population.
For specifically your younger population, since these CPS work with children as young as three, they do also help with IEPs and other educational needs, as well as the needs of the family in order to help provide comprehensive care.
Because obviously for LTSS needs for minors, it's not just an individual, it is their entire family and support the entire family, whether it's medical devices, connecting to food and transportation vouchers, etc., and also making sure that they have all their appointments lined up. They can arrange transportation to those appointments and also just checking in and making sure that the enrollees are receiving the care that they need help transitioning in and out of.
Nursing homes, inpatient stays, behavioral health stays and providing wellness and health and wellness coaching.
Specifically, for LTSS CPs, there are eight organizations across Massachusetts that are specifically LTSS CPs that for the entirety of the state, including the Cape and Islands and that's pretty much it.
They focus very much on providing and coordinating all of this care, so they are not necessarily providers, but they will help coordinate enrollees to the services that they need and that works a lot with, for example, a LTSS work with, they'll work with other.
Community based organizations who can help provide certain services, and they do coordinate with each other when it comes to providing behavioral health or long-term support services needs.
That's pretty much all I had. In the appendix that I have, I will be sending out a list of CPs, what their partner organizations are and what areas of the state they serve.
So you can figure out if a member wants to be referred to as community partner, or if there's a need to refer them.
It depends on which service area they are in, so I provided that list as well.
Shields, Julia C
Great. Thank you so much. Susan, Jess and Emily for that informative information. I'm going to stop the recording now.