Carey Appold

1
Carey Appold Technical Director, Money Follows
the Person Centers for Medicare Medicaid
Services Presentation to NASUA--June 24
2
Goals of MFP

• Transition individuals from qualified
  institutions to qualified community-based
  residences
• Rebalance the long-term care system by
  right-sizing our institutional and
  community-based system
• Eliminate barriers or mechanisms that restrict
  the use of Medicaid funds so that individuals
  receive support for LTC services in settings of
  their choice
• Goal of increasing HCBS rather than
  institutional, long-term care services
• Assure HCBS quality procedures are in place and
  provide for continuous quality improvement

3

Individuals to be Transitioned

• Projected Number 37,731 Individuals
• Of these
• 16,694 are elderly
• 9,900 are people with physical disabilities
• 7,422 are people with MR/DD
• 2,282 are people living with mental illness
• 433 have dual diagnoses

4
MFP Fundamentals

• Enhanced FMAP for 12 months for home and
  community based services for each person
  transitioned from an institution to a
  community-setting
• Self-direction encouraged
• Rebalancing Benchmarks required
• States must participate in CMS national
  evaluation

5
MFP Fundamentals Qualified Individuals

• Reside in an institution(s) for at least 6
  months.
• Institutions include hospital, nursing facility,
  or ICF/MR. IMDs are also included to the extent
  that medical assistance is available under the
  State plan for service in the IMD.
• Is receiving Medicaid benefits for inpatient
  services furnished by such inpatient facility.
• Would need HCBS services in order to successfully
  reside in community based settings.

6
MFP Fundamentals Qualified Services

• Qualified HCB Program Services
• Enhanced FMAP
• Must be continued at the conclusion of the
  demonstration via waivers or State Plan.
• HCB Demonstration Services
• Enhanced FMAP
• No requirement to continue beyond the
  demonstration.
• Supplemental Demonstration Services
• Regular FMAP
• Cannot receive Federal reimbursement beyond the
  demonstration.

7
MFP Fundamentals Qualified Residence

• Where can eligible individuals move?
• A home owned or leased by the individual or the
  individuals family member
• An apartment with an individual lease, with
  lockable access and egress, and which includes
  living, sleeping, bathing, and cooking areas over
  which the individual or the individuals family
  has domain and control and
• A residence, in a community based residential
  setting, in which no more than 4 unrelated
  individuals reside.

8
Project Status

• Single largest investment in Medicaid LTC
• 31 States have been awarded 1,435,709,479
• Two-phased grant award
• Developmental Period
• Implementation Period
• 22 States have been approved for implementation
• MO, MD, NH, TX, WI, WA, IA, NY, SC, AR, KS, PA,
  IN, OR, LA, OK, HI, CT, NE, PA, VA, MI, ND.

9
Grantees
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Grantees

• CA 2000 130,387,500
• IN 1039 21,047,402
• TX 2616 142,700,353
• SC 192 5,768,496
• MO 250 17,692,006
• IA 528 50,965,815
• OH 2231 100,645,125
• LA 760 30,963,664
• NJ 590 30,300,000
• NC 552 16,897,391
• ND 110 8,945,209
• OR 780 114,727,864

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Grantees

• PA 2600 98,196,439
• VA 1041 28,626,136
• DE 100 5,372,007
• DC 1110 26,377,620
• GA 1,347 34,091,671
• HI 415 10,263,736
• IL 3,357 55,703,078
• KS 934 36,787,453
• KY 431 49,831,580

12

Project Period and Scope

• All grants were authorized through September 30,
  2011.
• Grantees have flexibility to establish the scope
  and focus of transition efforts during the MFP
  developmental period and beyond.
• Opportunity for creativity Offering additional
  HCB demonstration services and supplemental
  demonstration services to facilitate transition
  and successful integration. Using self-directed
  service delivery system.

13
Operational Protocols

• To be completed during the developmental period
  and approved before grantees may begin to provide
  services at the enhanced match.
• Serves as the contract between the grantee and
  CMS.
• Anyone should be able to read a grants OP and
  see exactly how their MFP demonstration operates.
  Case study is particularly valuable.
• Once approved, any potential revisions must be
  formally submitted and approved by CMS.

14
Operational Protocols

• Must include information on
• Benchmarks
• Recruitment and Enrollment
• Benefits and Services
• Informed consent and guardianship
• Outreach, Marketing and Education
• Stakeholder Involvement
• Quality and consumer supports
• Housing
• Administration

15
Quality

• MFP grantees must incorporate the same level of
  quality assurance (QA) and quality improvement
  (QI) activities found in the new 1915c HCBS
  waiver application.
• This requirement applies to all MFP State plan
  and supplemental services offered under the
  demonstration.

16
Quality

• The QMS under MFP must demonstrate how the new
  1915c waiver application Appendix H assurances
  will be met for these areas
• i. Level of care determinations
• ii. Service plan description
• iii. Identification of qualified HCBS providers
• iv. Health and Welfare
• v. Administrative authority
• Vi. Financial accountability

17
Quality

• In addition to waiver quality requirements, the
  following must also be part of the States MFP
  QMS
• Risk assessment and mitigation process for MFP
  participants
• An emergency backup system and
• Incident report management system which includes
  discovery, remediation, and improvement
  procedures.

18
Benchmarks

• Statutorily Mandated
• The projected number of eligible individuals in
  each target group of eligible individuals to be
  assisted in transitioning from an inpatient
  facility to a qualified residence during each
  fiscal year of the demonstration.
• Increase in qualified expenditures for HCBS
  during each year of the demonstration program.

19
Benchmarks

• Potential Additional Benchmarks
• Utilization rates for a system for accessing
  information and services (i.e., the establishment
  or expansion of one-stop shops).
• Progress directed by the State to achieve
  flexible financing strategies, such as global or
  pooled financing that allow money to follow the
  person.
• Increases in available and accessible supportive
  services in the States HCBS menu.

20
Role of Consumers

• Consumers and consumer-run organizations will
  have a role in the design, development, and
  implementation of the demonstration.
• Consumers and/or consumer-run organizations must
  participate in ways that go beyond advice giving
  (advisory committees).
• CMS will be looking for evidence of consumers
  involved in a decision making capacity.

21
Housing, Housing, Housing

• Number one need for technical assistance as
  identified by participating states
• Evaluation will examine the role of housing in
  the success/failure of program
• No direct funding for housing under the MFP grant
  but extensive opportunities for housing supports

22
Housing, Housing, Housing

• Housing Requirements
• States must describe existing or planned
  inventories of accessible and affordable housing.
• Explain how housing shortages will be addressed
  for MFP participants.
• Explain how State Medicaid will work with housing
  finance agencies and PHAs.
• Document the types of qualified residences to
  which individuals transition.

23
Evaluation and Data

• Intended to be a heavily researched project.
• Information will be collected on participant
  demographics, service utilization, cost, length
  of institutional stay, change in level of care
  and quality of life.
• Additionally, data will be collected on program
  features such as use of the emergency back-up
  system, types of community housing, barriers to
  participant recruitment, etc.

24
Information Sources

• MFP Rebalancing Demonstration Funding
  Announcement July 24, 2007
• Series of MFP Outreach Calls with Interested
  Stakeholders
• Upcoming 2009 MFP Conference
• MFP Reference Manual
• MFP Resources Website
• CMS website http//www.cms.hhs.gov/DeficitReducti
  onAct/20_MFP.asp All final documents.