m oney f ollows the p erson r ebalancing d emonstration : p rogram i nitiatives legislative office...
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MONEY FOLLOWS THE PERSONREBALANCING DEMONSTRATION:PROGRAM INITIATIVES
Legislative Office Long-Term Care Planning Committee Meeting
12/09/2014
DSS/Money Follows the Person-Karri Filek, MPA
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AGENDA Testing Experience and Functional Tools
(TEFT) Balancing Incentive Program (BIP) Right Sizing & Rebalancing Community First Choice (CFC) Presumptive Eligibility (PE) Money Follows the Person – Demo services Reorganization Comments & Questions Contact Information Rightsizing & Rebalancing Plans (3)
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TESTING EXPERIENCE AND FUNCTIONAL TOOLS (TEFT)Paul Ford
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TEFT-ENCOMPASSES FOUR AREAS
DSS is contracting with two Centers at the University of Connecticut Health Center, namely:
the Center on Aging (CoA) and
Biomedical Informatics Center (BMIC) at Connecticut Institute for Clinical and Translational Science
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TEFT
Together with stakeholders in the State of Connecticut, the Department of Social Services,
Division of Health Services aims to:
Field test a beneficiary experience survey for validity and reliability; (COA)
Field test a modified set of Continuity Assessment Record and Evaluation (CARE) functional assessment measures (COA)
Center on Aging (CoA)-Dr. Julie Robison
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TEFT
Demonstrate use of personal health record (PHR) systems with beneficiaries of CB-LTSS (BMIC)
Identify, evaluate and harmonize an electronic Long Term Services and Supports (e-LTSS) standard in conjunction with the Office of National Coordinator’s (ONC) Standards and Interoperability (S&I) Framework (BMIC)
Biomedical Informatics Center (BMIC)-Dr. Minakshi Tikoo
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TEFT
Current Activities
Stakeholder meetings regarding use of Personal Health Records
Field testing consumer experience
• FOLLOW US ON:
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BALANCING INCENTIVE PROGRAM (BIP)Karen Law
Tamara Lopez
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BALANCING INCENTIVE PROGRAM
Centers for Medicare and Medicaid Services (CMS) awarded Connecticut a grant for $72,780,505 to; Expand community Long-
Term Services and Supports
Develop necessary infrastructure for a more streamlined process for clients seeking community LTSS
No Wrong Door (NWD)
Conflict-Free Case Management Services
Core Standardized Assessment Instrument
Overview Initiatives
Implementing the BIP vision enhances and supports the delivery of LTSS from the consumer’s point of entry to the delivery of services.
IMPLEMENTING THE BIP VISION
Pre-Screen
Agency
Application
Medicaid Applicatio
n
Universal Assessmen
t
Service Plan
Self-service tool that allows consumers to identify potential service options
Electronic form that allows consumers to submit an Agency Application online
Electronic form that allows consumers to submit the Medicaid Application online
Automated process that finalizes consumer’s functional level of need and financial eligibility determination.
Integrates with partner systems to display the agreed upon service arrangement for consumer
Eligibility Determinatio
n
Standardized assessment tool that calculates consumer’s level of need
Key Components of BIP Vision
Point of entry Delivery of services
Connecticut’s “No Wrong Door” partners will implement a standardized process and integrated system solution to
support Connecticut’s achievement of the BIP goals.
As provided by Deloitte: State of CT Balancing Incentive Program: Vision Validation Session
HIGH-LEVEL TECHNICAL SYSTEM DIAGRAM
ImpaCTWorker Portal
ImpaCT System
ConneCT Consumer Portal BIP Portal
Worker/Assessor
Secure Access: (ISIM/ISAM & Multi-Factor
Authentication)
Citizen/Advocate
MyPlace CT
State Agency
Websites
Service Provider Websites
LTSS Websites
Pre-ScreenAgency
Application
ShoppingUniversal
Assessment
Worker Dashboard
Reports
Financial Eligibility Tracking
Data Exchange
Case Management Systems
Data Warehouse
MMIS System
InterRAI System
PHR System
LogistiCare System
Partner Systems
Legend
Existing System
BIP System
Shopping
Pre-Screen
Agency Applicatio
n
My Account Apply for Benefits
Am I Eligible?
LTSS Module
Consumer Dashboard
As provided by Deloitte: State of CT Balancing Incentive Program: Vision Validation Session
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RIGHT-SIZING & REBALANCINGMairead Painter
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RIGHTSIZING & REBALANCING: NURSING HOME DIVERSIFICATION
$40 million in grant and bond funds through SFY 2015
Utilized reports that outlined town-level projections of need for long-term service and supports & associated workforce
Applicant nursing facilities must tailor services to local need
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RIGHTSIZING & REBALANCING: NURSING HOME DIVERSIFICATION
Completed Request for Proposals (RFPs)
23 proposals submitted Governor Malloy
awarded $9 million in Rebalancing grants
Seven proposals selected*
Underway! Procurement Schedule:
RFP Released: October 16, 2014 RFP Conference: 10/27/2014 Deadline for Questions:
10/30/2014, 2:00 p.m. Eastern Time
Answers Released: 11/05/2014 Clarifying Questions: 11/12/14 Responses to Clarifying
Questions: 11/19/14 Mandatory Letter of Intent Due:
12/01/2014, 2:00 p.m. Eastern Time
Proposals Due: 01/15/2015, 2:00 p.m. Eastern Time
Round 1 Round 2
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RIGHTSIZING & REBALANCING: NURSING HOME DIVERSIFICATION
Southington Care Center ( Central Connecticut Senior Health Services ): $2,051,148.00 award
Mary Wade Home, Inc.: $2,001,730.00 award
Jewish Home for the Elderly of Fairfield County, Inc.: $81,260.00 award
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COMMUNITY FIRST CHOICE (CFC)Christine Weston
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COMMUNITY FIRST CHOICE (CFC)
An optional State Plan program created under the Affordable Care Act (ACA) allowing states to implement a new Medicaid entitlement
States would receive a 6% enhanced FMAP
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COMMUNITY FIRST CHOICE
Open to individuals that meet Level Of Care (LOC)
Participants do not need to meet budget neutrality*
Does not create a new eligibility group, open to all Medicaid participants that meet LOC
Slots are not limited in CFC
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COMMUNITY FIRST CHOICE
Allows states to offer multiple supports and services to eligible individuals; Personal Assistance Personal Emergency Response Systems (PERS) Voluntary training for participants Transition Services Services that increase independence or substitute
human assistance CFC will be entirely person-centered and self
directed
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COMMUNITY FIRST CHOICE
Drafted the State Plan Amendment (SPA) to include all allowable services
Built capacity at our Access Agencies, includes creating training for the assessors
Created procedure codes for accurate billing
Created a Development Council of key community stakeholders
Submit SPA to CMS and receive approval on the SPA from CMS
Launch CFC statewide on April 1, 2015
Accomplished to date Next Steps
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PRESUMPTIVE ELIGIBILITY
Karri Filek
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PRESUMPTIVE ELIGIBILITY
Would allow for Home and Community Based (HCBS) clients to quickly gain access to care in the community while their Medicaid applications are being processed
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PRESUMPTIVE ELIGIBILITY Pilot program in MFP Targets clients
applying for Medicaid waivers
& Needing a financial
review (look-back) Incorporates new
processing techniques and working closely with functional staff
Tests the effectiveness of new process
To see if it is a viable option for Connecticut
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PRESUMPTIVE ELIGIBILITY
Allows more clients to access services and supports in the community Leave long-term care facilities sooner Divert hospital discharges to the community
rather than facilities Continue living in the community
Cost-savings alternative to long term care facilities
Supports careers in the healthcare field
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MFP DEMONSTRATION SERVICESDeanna Clark
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MFP DEMONSTRATION SERVICES
Peer Support Informal Caregiver’s Support Addiction Services and Supports
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MFP DEMONSTRATION SERVICES
Using personal experiences, peer support workers engage participants in order to reinforce and maintain skills
Peer support workers can be self-hire or agency based
5 currently enrolled with the service
Peer Support
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MFP DEMONSTRATION SERVICES
Provides informal caregivers with a flexible individual budget which they may use for: Paid care that allows for a brief period of rest or
relief for caregivers; or 1:1 or group caregiver education or training in
managing the MFP participant’s chronic conditions.
Caregivers can select their respite provider and/or trainer from an agency or from their own network.
Informal Caregiver’s Support
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MFP DEMONSTRATION SERVICES
• Community Support Services (CSS)
• Peer Support Specialist• Transportation• Transitional Supported
Employment
Requires referral to Advanced Behavioral Health (ABH) after completion of the ASSIST tool, which determines participant’s level of need
Service Consumers
Community Support Services
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Peer Support Specialist
5
Transportation 17
Transitional Supported
Employment
4
Addiction Services & Supports
Enrollment Numbers
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REORGANIZATIONDane Lustila
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REORGANIZATION
MFP application received at Central Office
Application referred to a Transition Coordinator (TC)
TC meets client and refers him/her to a waiver
Client is assessed by waiver staff
If client is not waiver eligible, TC refers client to another Home and Community Based Services (HCBS) package
Duplication of efforts Delay between referral to
waiver staff and actual assessment
Delay when client is deemed ineligible for initial waiver
Client disengagement TCs unable to regularly
take new clients
MFP Waiver Assessment Process Then
Disadvantages
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REORGANIZATION
MFP application received at Central Office
Application referred to Specialized Care Manager (SCM)
SCM meets client and assesses him/her for waiver eligibility
If client is not waiver eligible, SCM refers client to another Home and Community Based Services (HCBS) package
TC assigned after waiver assessment
Decrease in duplicative efforts
Waiver staff (SCM) are the first to meet the client
Waiver staff are able to refer clients to other HCBS packages more accurately
Increased client engagement
TCs able to regularly receive new clients
MFP Waiver Assessment Process Now
Advantages
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REORGANIZATION: IMPACT ON CARE PLANS
01/01/2012 through 02/20/2014
02/21/2014 through 12/01/2014
0102030405060708090
47
85
Average Monthly Care Plans Approved
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REORGANIZATION: IMPACT ON REFERRALS TO TRANSITION COORDINATORS
0
100
200
300
400
500
600
700
800
257
188
123
180163
193
119
220
317
159194 231
325 341 327 311
373331
313
226 213
604
711
Referrals to Transition Coordinatorsᵗ: Q1 2009 to Q3 2014
ᵗExcludes nursing home closures *Increase in referrals reflects the ongoing adjustment to MFP reorganization
Data taken from the CT MFP Quarterly Report 2014: Quarter 3.
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REORGANIZATION: IMPACT ON TRANSITIONS
2009 1
2009 3
2010 1
2010 3
2011 1
2011 3
2012 1
2012 3
2013 1
2013 3
2014 1
2014 3
0 20 40 60 80 100 120 140 160 180
1938
436260
7498
8366
107152
109114
120110
166132
168147
165120
115156
Number of transitions by quarter: 12/2008 - 9/30/2014
Number of consumers who transitioned
Data taken from the CT MFP Quarterly Report 2014: Quarter 3.
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COMMENTS & QUESTIONS
Thank you!
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CONTACT INFORMATION
Dawn LambertProject DirectorDepartment of Social Services-Money Follows the [email protected]
Karen Law
Public Assistance Consultant
Department of Social Services-Money Follows the Person
860-424-5971
Tamara Lopez
Health Program Associate
Department of Social Services-Money Follows the [email protected]
860-424-5535
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CONTACT INFORMATION
Paul FordHealth Program AssistantDepartment of Social Services-Money Follows the [email protected]
Deanna Clark
Health Program Assistant
Department of Social Services-Money Follows the Person
860-424-4984
Dane Lustila
Eligibility Services Worker
Department of Social Services-Money Follows the [email protected]
860-424-5078
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CONTACT INFORMATION
Karri FilekEligibility Services WorkerDepartment of Social Services-Money Follows the [email protected]
Christine Weston
Social Worker
Department of Social Services-Money Follows the Person
860-424-5521
Mairead Painter
Social Worker
Department of Social Services-Money Follows the [email protected]
860-424-5844
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CONTACT INFORMATION
CT Department of Social Serviceswww.ct.gov/dss
CT MFP online applicationwww.ctmfp.gov
Community Care and Support Informationwww.myplacect.org
Nursing Home Rebalancing Grants Press Releasewww.governor.ct.gov/malloy/cwp/view.asp?A=4010&Q=542054
CT Money Follows the Person Quarterly Report: Quarter 3, 2014: July 1, 2014-September 30, 2014http://www.uconnaging.uchc.edu/2014%20Q3%20MFP%20report.pdf
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Rightsizing & Rebalancing: Southington Care Center (Central Connecticut Senior Health Services)
Southington Care Center (Central Connecticut Senior Health Services) – maximum award: $2,051,148. The grant funds the increase in CTCHAs capacity to promote the utilization of home and community based service (HCBS) and long term services and supports (LTSS) by Medicaid recipients and in coordination with the Department’s strategic rebalancing plan. This is a 2 year contract.
This grant is funding:
• opening a CTCHA satellite site at Southington Care Center and expanding existing services at CTCHA hospital sites
• working collaboratively, with Connecticut’s comprehensive phone-based service that provides information and referrals to community services (that service, “211”)
• developing and disseminating a free, user friendly, patient and family centered resource toolkit to help seniors learn about HCBS and LTSS,
• expanding the service offerings in collaboration with the Hartford HealthCare (HHC) system and HCBS providers that are responsive to the needs of the Medicaid recipients and other low-income seniors(as defined by the CHCPE financial requirements)
• implementing a Geriatric Care Management program for Medicaid recipients and other low-income seniors
• implementing a CTCHA person-centered education and engagement program
• increasing the use of CTCHA services that promote utilization of community LTSS by Medicaid recipients and seniors by raising awareness of the CTCHA
• a 1.4% decrease in admissions to the Skilled Nursing Facilities when discharged from HHC Hospitals (only MidState Medical Center and The Hospital of Central Connecticut)
• expanding choice and improve health outcomes
• person-centered education and engagement program
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Rightsizing & Rebalancing: Mary Wade Home, Inc.
Mary Wade Home, Inc. (New Haven) – maximum award: up to $2,001,730, including up to $200,000 in pre-development funds and $1 million in capital funds. The grant will fund the opening of the Mary Wade Community Home Care, a Homemaker Companion Care Agency office at the 83 Pine Street, New Haven, Connecticut 06513. This Agency will provide for the catchment area including the towns of; New Haven, East Haven, North Haven, West Haven, and Hamden. The grant will increase Mary Wade’s capacity to promote the utilization of home and community based service (HCBS) and long term services and supports (LTSS) by Medicaid recipients to live in the Community and in coordination with the Department’s strategic rebalancing plan. This is a two year contract.
This grant is funding:
• a Community Navigator and Homemaker Companion Care Company (HCCC) called “Mary Wade Community Home Care (MWCHC)
• a Community Navigator who will develop an outreach initiative that interacts with all organizations and stakeholders that serve and support individuals that may need home care services
• strategies to alleviate, and/or significantly reduce, the amount of emergency room readmissions
• strategies to identify and assist eligible individuals in need of home care at discharge
• assistance to families during transition within forty-eight (48) hours of discharge
• an Electronic Home Care Record in collaboration with the States “No Wrong Door” initiative so that the two (2) systems to work jointly.
• choice for Medicaid recipients in where they receive long term supports and services
• additional services that build community based case capacity to meet increased demand for LTSS in the greater New Haven area
• a decrease in 1.4% of admissions to Greater New Haven Skilled Nursing Facilities. The State will decrease by 1% and Mary Wade will decrease by .4% for the first two years
• an increase in supply of direct-care workers in New Haven
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Rightsizing & Rebalancing: Jewish Home for the Elderly of Fairfield County, Inc.
Jewish Home for the Elderly of Fairfield County, Inc. (Fairfield) – maximum award: $81,260
The grant funds the development of a protocol for affordable, community-based living in an adult family living home as an option so that seniors can remain in or return to the community from a nursing home. Formal Business Plan (FBP) and budget for the creation of Adult Family Living Homes (AFLH) approved by the Department, for the elderly, blind or disabled individuals who would otherwise require institutionalization in the Southwestern Connecticut region. This is a nine month contract
This grants funds will develop:
• FBP that establishes and implements a prototype for affordable, community-based living in an AFLH model in the region. The model will serve Medicaid eligible older-adults who cannot safely live by themselves, cannot afford round-the-clock live-in assistance and are qualified or at risk of nursing home level of care
• FBP will utilize a process to inform consumers/clients of their choices regarding all long term services and supports that are available while providing approximate supervision and socialization for lower-and middle-income, Medicaid-eligible adults so that they can remain in the community longer utilizing its Person–Centered Approach
• FBP will look to develop and implement an increases in the number of housing units that are affordable to Medicaid recipients
• FBP that decreases the number of nursing facility beds in an orderly fashion in its region that currently have, or are projected to have, a surplus of beds with a reduction of seventy-six (76) nursing facility licensed beds at this SNF.
• FBP that provides to all clients the services required to assist each in reaching their highest possible quality of life
• FBP that develops and implements an approach that evidences the ability to serve multicultural multilingual populations in a culturally sensitive and linguistically competent way
• FBM will align with other providers that provide a range of personal, supports and health services provided to individuals in a person’s home in the community to help the person stay at home and live as independently as possible
• FBP will support coordination with other integrated care and home health initiatives
• FBP will create an implementation roadmap with a finalized budget for the creation of an AFLH in Southwest Connecticut region