1. DRAFT Michigan’s Proposed Nursing Facility Transition (NFT) Program
Stakeholder Feedback Session

2. DRAFT Michigan’s Process improvement Initiative to ReDesign the NFT program
Welcome!!!!
At this session we will cover:
Why a re-design was needed
How initial input was sought
Action Team process improvement progress
New idealized NFT process
Recommendations to eliminate identified barriers
Getting your input about other potential barriers and additional ideas for improvement
First-round Action Team pilots to test improvement ideas
Future stakeholder input sessions – please sign up to be invited

3. DRAFT Why was A Redesign of NFT Needed?
Providers felt that the program needed to be more consumer focused and directed.
Federal Money Follows the Person funding is ending on October 1,
The State is obligated to uphold Olmstead requirements. NFT is an important program and sustainable funding must be found to continue it.
Federal and State Requirements were cumbersome.
NFT is Michigan’s Only Rebalancing Effort.

4. DRAFT Why was A Redesign of NFT Needed
Value Stream Mapping of three different sets of duties for providing the current program included:
Outreach Specialist
Process Steps - 66
Identified Barriers/Delays - 110
Ideas for Improvement - 121
Transition Coordinators
Process Steps - 44
Identified Barriers/Delays - 64
Ideas for Improvement – 69
Housing Coordinators
Process Steps - 51
Identified Barriers/Delays - 91
Ideas for Improvement – 68

5. DRAFT Nft Redesign Needed (cont)
Total for the Entire Transition Process
Process steps – 161
Identified Barriers/Delays – 265
Ideas for Improvement - 258

6. DRAFT How Initial input was sought
Value Stream Maps – Subject Matter Experts (Now Action Team Members)
We asked the question: “What would you like to see in a new NFT program?” Among those we consulted, were:
Medicaid Quality Collaborative Consumers and Providers
CIL/DN Directors
Waiver Directors
ILS/HH Design Team
NFT Design Team (state level)
PACE Directors
NFT Outreach, Transition and Housing Specialists
Leading Age
Reviewed State NFT programs in California, Connecticut and Ohio

7. State Level NFT Design and Action Teams
NFT Design Team
Mary Ablan
Rod Auton
Brian Barrie
Dave Bulkowski
Linda Burqhardt
Sarah Cagney
Elizabeth Gallagher
John Grib
Sara Grivetti
Lisa Hansen
Wendi Middleton
Pre-Transition
Action Team
Rachel Burdette-Comer
Laurie Dykstra
Robin Mossbarger
Erin Poindexter
Transition Implementation
Cynthia Cotter
Tracy James
Mary Lockhart
Gail Wejrowski
Dee Wilkinson
Post-Transition Experience Action Team
Martha Anderson
Weylin Douglas
Gayle Haven
Victoria Humble
Kathy McGeathy
Policy Collaboration
Cheryl Decker
Laurie Ehrhardt
Karen Leppek
Melissa Machac
Angela Westbrook

8. List of design/action team members
State Level NFT Design Team
Mary Ablan – Consultant, Area Agency on Aging Association of Michigan (AAAAM)
Rod Auton – Executive Director, PACE Organization
Brian Barrie – BOLD Council Member, Division Director, Medicaid/LTC, MDHHS
Dave Bulkowski – Executive Director, Disability Advocates of Kent Country
Linda Burqhardt – Executive Director, AAAAM
Sarah Cagney – NFT Mentor
Elizabeth Gallagher – MI Choice Section Manager, MDHHS
John Grib – Deputy Director, Senior Services Inc.
Sara Grivetti – CEO,Disability Network of Michigan
Lisa Hansen – NFT Mentor
Wendi Middleton – BOLD Council Coordinator, Division Director, AASA/MDHHS
Dick Miles, Medicaid, MDHHS
Pre-Transition Action Team
Rachel Burdette–Comer – Disability Network Capital Area
Sarah Cagney – Senior Services Inc.
Laurie Dykstra – Reliance Community Care Partners
Robin K. Mossbarger - Medicaid/LTC, MDHHS
Erin Poindexter – Disability Advocates of Kent County
Post-Transition Action Team
Martha Anderson – Area Agency on Aging, Western Michigan (AAA WM)
Weylin Douglas – Medicaid/LTC, MDHHS
Gayle Haven – Medicaid/LTC, MDHHS
Victoria Humble - Region VII AAA
Kathy McGeathy – The Disability Network
Policy Action Team
Cheryl Decker – Medicaid/LTC, MDHHS
Laurie Ehrhardt – A&D Home Care
Lisa Hansen – Disability Network Southwest Michigan
Karen Leppek – AAA WM
Melissa Machac – Disability Network Oakland & Macomb
Angela Westbrook – Medicaid/LTC, MDHHS
Implementation Action Team
Cynthia Cotter – Senior Services Inc.
Elizabeth Gallagher, Medicaid/LTC, MDHHS
Tracey James – Region 2 AAA
Mary Lockhart – Disability Network Mid Michigan
Dee Wilkinson – AAA of Northwest Michigan
Gail Wejrowski – The Senior Alliance

9. DRAFT NFT Values and Recommendations
Nursing Facility Transition (NFT) Program Redesign Values
 The program must:
Be based on providing a continually better customer experience for people who are transitioning.
Be built on a person-centered foundation that promotes maximum personal choice.
Recommendation: Build in continual quality improvement.
Recommendation: Build in standardized customer feedback process.
Recommendation: Develop a Statewide Customer Center.
Recommendation: Person Centered Planning will be required by agencies that provide NFT services.
Recommendation: Partner with Person Centered Planning Design Team to build standardized person centered planning to be required through policy as part of NFT program.
Recommendation: Transition Coordinators will now be called “Transition Navigators.” Transition Navigators will provide options counseling on all aspects of transition services where choices are made, so that transitionees have maximum choice. The Transition Navigator should be independent from other HCBS Programs.

10. DRAFT NFT Values and recommendations(cont.)
3. Design a process, such that participants communicate with only one person, to eliminate confusion.
4. Respect the person’s right to take risks.
Recommendation: The Transition Navigator will be lead contact with consumer during the transition process and will assume the role immediately following acceptance of the referral. The Transition Navigator will initiate preliminary contact with the consumer, develop a person-center transition plan, deliver an array of resources and options available to the consumer, and deliver coordination between the core team activities of housing coordinator, service program staff and any other team members needed.
Recommendation: Transition Navigator will provide post-transition follow-up with the participant, as determined through the person centered plan, to ensure continued success once the participant has transitioned. Transition Navigator will be involved even if additional HCBS are in place.
Recommendation: Person Centered Planning training will focus on recognition and removal of personal biases and the right of the consumer to take risks.

11. DRAFT NFT Values and recommendations(cont.)
Include flexible timelines – each person needs their own individual timeline to transition.
Respect participants’ need to try multiple times to transition successfully.
Recommendation: Arbitrary timelines in current policy will be removed to allow individuals the time they need to transition.
Recommendation: There are no limits to number of times a person can participate in the NFT process.
Recommendation: Transition service array will be expanded to include new services needed.
Recommendation: Add Occupational Therapy (OT) to transition services, at a minimum on the day of transition, to ensure the consumer’s new home is configured in a way that allows for maximum mobility, accessibility and a quality transition.
Recommendation: Add bridge services to service array which will be identified and in place beginning the day of transition (such as home help) to ensure that there is no gap in service provision. This will facilitate enrollment in chosen services/programs which cannot be initiated until the person is officially out of the nursing home. The Transition Navigator will be assisting with this.
Recommendation: Arrangements will be made with Home and Community-Based Services (HCBS) services to ensure NFT transitionees are given the highest priority for start of services on day one.

12. DRAFT NFT Values and recommendations (cont)
Include additional support for the person so that they can be successful in their transition through such efforts as a mentoring program and others.
Include well-trained and qualified staff at all levels, using a reimbursable training system for aides, caregivers and Transition Navigators.
Recommendation: Establish and support transition peer mentoring program, to be available at any point during the entire transition process. Solicit and train previous transitionees to provide support to new transitionees.
Recommendation: Connect transitionees to social and community activities, to encourage engagement and promote integration back into the community, as determined by preferences in their person centered plan.
Recommendation: Develop minimum training requirements for Transition Navigators, Housing Coordinators and others involved in transition activities, including service program staff.
Recommendation: Payment for training of staff and hands-on caregivers will be included in the new service array.
Recommendation: Online resources for collaboration, cooperation, and sharing will be developed.

13. DRAFT NFT Values and Recommendations (CONT)
Respect and trust providers to make good and responsible decisions.
10. Include clear, concise and consistent two-way communication.
Recommendation: Eliminate requirement for state approval to initiate transition services and other pre-approvals. Expand acceptable uses of funds to reduce number of potential exception requests. Policy will presume competence of providers and lack of competence/compliance will be handled on a case-by-case basis, as needed, through program audits.
Recommendation: Allow transition agencies to obtain authorization through CHAMPS instead of NFT Portal.
Recommendation: A written protocol for communication between the state and providers will be developed, tested and implemented using a quality improvement process. This will include a feedback loop, put in place to ensure consistent messaging and communication between the state, providers and transitionees.
Recommendation: Develop the idea of “one NFT program” state-wide for marketing and materials which would include standardizing assessment tools, evaluations, and forms. All standardized materials should be endorsed by the State.

14. DRAFT NFT Values and Recommendations (CONT)
11. Ensure collaboration over competition.
Recommendation: NFT will become a State Plan service and will no longer belong to the MI Choice waiver program.
Recommendation: All providers that choose to participate in the new NFT program will be required to perform the newly defined Transition Navigator role, providing the full array of newly defined Transition Navigator duties needed.
Recommendation: New NFT Transition Navigator roles and responsibilities are in development and will be piloted.
Recommendation: An operational definition of “quality transition” will be developed and piloted.
Recommendation: Centers for Independent Living and Disability Network agencies will be given access to CHAMPS, if they choose to become Medicaid Providers.
Recommendation: Consumers can choose which organization to provide their Transition Navigator services and which organization will provide in-home services needed in the community.
Recommendation: Foster increased communication between providers, MDHHS, and participants.

15. DRAFT NFT Values and Recommendations (CONT)
Include consensus on operational definitions for terms, data, metrics and measurements.
Include continual, two-way feedback loop into the system.
Recommendation: Workgroups, including representatives of aging and disability networks, will be established to develop and reach consensus on standardized operational definitions.
Recommendation: Feedback from transition participants to providers and providers to the state will be included in required program requirements.

16. DRAFT NFT Values and Recommendations (CONT)
14. Include purposeful reporting.
15. Be cost-effective and cost-saving overall, with an eye to low administrative costs.
Recommendation: Workgroups mentioned above in #12 will also include development of reporting requirements to include customer satisfaction and other data to demonstrate effectiveness, cycle time improvements, cost savings and general benefits of the program to customer health and well-being, among other factors.
Recommendation: Purposeful, standardized reporting, standardized operational definitions, quality improvement built into the system and monitoring of measurements of customer satisfaction, will provide data needed to demonstrate cost effectiveness and positive customer satisfaction.

17. DRAFT NFT Values and Recommendations (CONT)
16. Build continual quality improvement into the system.
17. Promote rebalancing of funding from institutional to community-based living.
Recommendation: State level staff and front line subject matters experts implementing the new and improved NFT program will serve with the BOLD Council in an oversight capacity. When barriers arise and improvements are needed, Design/Action Teams, using subject matter experts, will be initiated to identify barriers and ideas for change and improvement over time.
Recommendation: The improved NFT process will result in an increase of more quality transitions. Metrics will be established to measure, over time, the decrease in the number of people living in nursing homes and increase in people choosing to leave the nursing home and who are successfully (per customer definition) living and receiving services in the community, statistically attributable to NFT.

18. DRAFT NFT Values and Recommendations (CONT)
18. Create a future where it is as easy to get out of a nursing home as it is to get into one.
Recommendation: Measurement over time using customer experience and satisfaction data, nursing home admission and discharge data and other variables, will determine when we have achieved the goal of this value.
Recommendation: Partner with Nursing Facility staff and NFT service providers.
Recommendation: Encourage relationship building at the local level between transition agencies and nursing facilities by focusing on mutual goals such as reducing NF recidivism, assisting individuals who do not want to be in a nursing facility with becoming re-established in the community, learn more about NFT participants to assure successful community life.

19. Pilot Schedule

20. Future stakeholder input sessions
September 2017 – To share results of pilots as part of spread plan and new or amended recommendations

21. THANK YOU!!!