1. Opportunities for Community Living through Home and Community-Based Waiver Services: Acquired Brain Injury, Money Follows the Person and Frail Elder Waivers
March 2014
Updated 10/18/13
Gail to introduce/moderate

2. MFP Demonstration
MFP is a Demonstration Grant from the Centers for Medicare and Medicaid Services (CMS) awarded to MassHealth. A goal of this MFP Demonstration, is to “rebalance” the Massachusetts service system – effectively moving funding from facility based settings to home and community based settings. The Demonstration began in July 2011.
Amy to present

3. MFP in Massachusetts – Overview
MFP Transition
Services & Supports
MFP Demonstration
Participants may access
services in the community through the following:
HCBS Waivers
MFP
ABI
Frail Elder
DDS; or
One Care/SCO/PACE; or
MassHealth State Plan services
MFP Qualified Facilities
Nursing Facilities
Rehab & Chronic Hospitals
ICF-ID
DPH Hospitals
Psychiatric Hospitals*
*with some exceptions
Qualified Residences
Individual’s/ Family’s Home
Individual’s Leased Apartment
Community Residential Setting (Max 4 Individuals)
Amy to present

4. MFP Qualified Facilities
DPH licensed and Medicaid certified nursing facilities (NFs)
Chronic Disease and Rehabilitation Hospitals (CDR)
DPH Hospitals
Intermediate Care Facilities for individuals with Intellectual Disabilities (ICF/ID)
Psychiatric Hospitals including both public and private (also referred to as Institutions for mental disease or IMDs)*
*Excludes individuals aged 22 – 64 in IMDs
Amy to present

5. MFP Demonstration Qualifying Criteria
In order to qualify for the MFP Demonstration a participant must:
be living in a nursing facility or long-stay hospital for at least 90 consecutive days, excluding Medicare rehabilitation days;
be 18 years old or older and be disabled (disabled as defined in Title XVI of the Social Security Act and MassHealth regulation 130 CMR ), or be age 65 or older;
be eligible for MassHealth Standard or CommonHealth and whose last day in the facility is a Medicaid-paid inpatient day;
be a resident of Massachusetts;
have signed a Consent Form; and
transition to an MFP qualified residence in the community.
Amy to present

6. MFP Qualified Residences
A qualified residence includes:
a home owned or leased by the person or a family member
an apartment with an individual lease
or a community-based residential setting in which no more than 4 unrelated individuals reside
MFP requires that tenants must have a lease, lockable entrance/egress, control over sleeping/bathing/cooking space, and that no more than four unrelated persons reside in a group or shared residence.

7. Transition Coordination
MassHealth has contracted with 33 agencies to provide Transition Coordination. These agencies include Aging Services Access Points (ASAPs) and Independent Living Centers (ILCs)
Transition Coordination Entities are responsible for:
Conducting outreach to individuals in MFP Qualified Facilities to inform them about the availability of the MFP Demonstration
Enrolling individuals who consent and are eligible in the MFP Demo
Assisting enrollees with developing Person Centered Transition Plans and arranging necessary transition services
Nina to present

8. MFP Demonstration Services
MFP Demonstration services are available for 365 days after the individual transitions to the community. These services include:
Demo Case Management (only for MFP Demo enrollees not enrolled in one of the HCBS Waivers)
Demo Assistive Technology
Orientation & Mobility Services
Transitional Assistance Services
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9. MFP Demo Assistive Technology
Assistive Technology includes devices, controls, or appliances that enable an MFP Demo Participant to:
increase his or her ability to perform activities of daily living
perceive, control, or communicate with the community environment in which he or she lives
other durable and non-durable medical equipment not available under the State plan or a HCBS waiver
Examples include: communication boards; speech amplifiers; electronic device that produces speech or written output; voice-activated or remote environmental control unit; specialized door opener; customized iPad and specialized alarms.
Nina to present

10. MFP Demonstration Orientation and Mobility Services
Services that teach an individual with vision impairment or legal blindness how to move or travel safely and independently in his/her home and community and which include:
Direct Training
Environmental evaluations
Caregiver/Direct care staff training on sensitivity to blindness/low vision
Nina to present 10

11. MFP Demonstration Transitional Assistance Services
Transitional Assistance Goods and Services may be available through the MFP Demo or as a component of a waiver in which the member enrolls
If Transitional Assistance service is not available through a waiver, the MFP Demo provides the ability to obtain a wide range of Transitional Assistance Services, such as:
Furniture, security deposit and/or first month’s rent, overnight companion for a short time, pest eradication, etc.
Home modifications to make a home accessible to the participant
Can include assistance with locating rental housing
Nina to present

12. Community Programs Serving MFP Demonstration Participants
MFP Waivers
Frail Elder Waiver
MFP Demonstration Participation
(365 Community Days per Participant)
ABI Waivers
DDS Waivers
Mass Health LTSS
PACE
Amy to present
SCO
One Care 12 1 12

13. Common Requirements of all HCBS Waivers
Participants must be at a facility level of care (LOC), the specific LOC varies by waiver
Participants must have an ongoing need for waiver services and must receive waiver services at least once a month
Participants must be able to be safely served in the community with available waiver and state plan services
Participants in residential or 24-hour waivers must be in need of such services
MassHealth is responsible for all HCBS waivers, with one of the sister EOHHS agencies having day-to-day responsibility for oversight and operations
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14. Common Requirements of all HCBS Waivers (con’t)
MassHealth administers all HCBS waivers, with one of the sister EOHHS agencies having day-to-day responsibility for oversight and operations
The operating agency or their agent:
Conducts the LOC evaluation to determine that the applicant is clinically eligible for the waiver
Provides Case Management to coordinate waiver services
Is primarily responsible for quality oversight, monitoring and reporting
Amy to present 14

15. HCBS Waiver Financial Eligibility
HCBS Waiver participants must be eligible for MassHealth Standard, using the special financial eligibility rules for waiver participants.
Financial eligibility guidelines for the adult HCBS waivers are:
income ≤ 300% SSI Federal Benefit Rate (FBR) which is currently = $2163 a month.
assets ≤ $2,000
NOTE: If there is a spouse, the spouse’s income and assets are not counted.
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16. Waiver Case Manager
Every participant in an HCBS waiver will have a waiver case manager
This case manager is responsible for arranging and overseeing the delivery of their waiver services and other community long-term care services
The case manager will work with the participant to develop a person-centered plan that identifies and addresses their individual needs
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17. Frail Elder Waiver (FEW)
The Executive Office of Elder Affairs (EOEA) is operating agency
Serves participants age 60 and over at a nursing facility level of care
Participants age 60 thru 64 must be disabled as defined in MassHealth regulation 130 CMR
Aging Services Access Points (ASAPs) conduct Level of Care determinations, provide case management and manage waiver provider enrollment and oversight.
Most Frail Elder Waiver participants enroll while living in the community. They do not have to be transitioning out of a facility.
The Frail Elder Waiver serves approximately 15,000 elders per year.
Mary to present

18. Frail Elder Waiver Services
Personal Care
Home Health Aide
Supportive Home Care Aide
Homemaker
Respite
Companion
Skilled Nursing
Chore
Environmental Accessibility Adaptations
Grocery Shopping/Delivery Services
Home Delivered Meals
Laundry Services
Supportive Day Program
Transitional Assistance
Non- Medical Transportation
Home Based Wandering Response Systems
Alzheimer’s/Dementia Coaching
Home Delivery of Pre-packaged Medication
Medication Dispensing System
Occupational Therapy
Mary to present

19. Money Follows the Person Waivers
MFP Community Living (MFP-CL) Waiver
Participants who do not need 24 hour supports or supervision
Access to a variety of community-based waiver services that support the participant to live safely in the community
84-hour per week limit on certain waiver services: Homemaker, Home Health Aide, Personal Care, Adult Companion, Individual Support and Community Habilitation, Supportive Home Care Aide
Nina to present

20. Money Follows the Person Waivers
MFP Residential Supports (MFP-RS) Waiver
Participants who require 24-hour staff availability and/or supervision and receive services in provider- operated and staffed settings
Residential supports include: residential habilitation in a group home serving no more than 4 people, assisted living services, and shared living
Members participating in one of the two MFP waivers are eligible to receive managed behavioral health services, primarily through enrollment in the Massachusetts Behavioral Health Partnership (MBHP)
Nina or Randy to present

21. In order to qualify for one of the MFP Waivers an applicant must:
Meet the requirements for participation in the MFP Demonstration, including:
Living in a nursing home or long-stay hospital for at least 90 consecutive days, excluding Medicare rehabilitation days;
Transitioning to an a MFP qualified residence in the community;
Last day in the facility paid by MassHealth
MFP Waiver Participants must be either:
Elders (age 65 and older) or
Adults with disabilities age 18 – 64, including those with an acquired brain injury
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22. MFP Community Living Waiver Services
Adult Companion
Chore Service
Community Family Training
Day Services
Home Accessibility Adaptations
Home Health Aide
Homemaker
Independent Living Supports
Individual Support and Community Habilitation
Occupational Therapy
Peer Support
Personal Care
Physical Therapy
Prevocational Services
Respite
Shared Home Supports
Skilled Nursing
Specialized Medical Equipment
Speech Therapy
Supported Employment
Supportive Home Care Aide
Transportation
Vehicle Modification
Managed Behavioral Health Services 22 1 1 22

23. MFP Residential Supports Waiver Services
Residential Habilitation (group home)
Shared Living – 24 Hour Supports
Assisted Living Services
Day Services
Home Accessibility Adaptations
Individual Support and Community Habilitation
Occupational Therapy
Peer Support
Physical Therapy
Prevocational Services
Residential Family Training
Skilled Nursing
Specialized Medical Equipment
Speech Therapy
Supported Employment
Transportation
Managed Behavioral Health Services 23 1 1 23

24. Acquired Brain Injury (ABI) Waivers
ABI Non-Residential Habilitation (ABI-N) Waiver is for those individuals who do not require 24 hour supports and supervision in the community but need community-based waiver services
ABI Residential Habilitation (ABI-RH) Waiver is for those individuals who require 24 hour supervision and staffing in a provider-operated and staffed setting
These waivers serve approximately 250 people
Nina or Randy to present

25. Acquired Brain Injury (ABI) Waivers
ABI Waiver eligibility includes:
Has been in facility for 90 days or longer;
Has an acquired brain injury diagnosis; sustained at age 22 or older
Until now eligibility has required that service needs be at or below the entrance cost limit
Going forward there will be an 84-hour per week limit on certain waiver services in the ABI-N waiver (Homemaker, Personal Care, Adult Companion and Individual Support and Community Habilitation)
UMass Waiver Unit conducts clinical eligibility determinations
Nina to present

26. ABI – Non Residential Waiver Services
Adult Companion
Chore Service
Day Services
Home Accessibility Adaptations
Homemaker
Individual Support and Community Habilitation
Occupational Therapy
Personal Care
Physical Therapy
Respite
Specialized Medical Equipment
Speech Therapy
Supported Employment
Transportation 26 1 1 26

27. ABI Residential Habilitation Waiver Services
Residential Habilitation (group home)
Shared Living – 24 Hour Supports
Assisted Living Services
Day Services
Home Accessibility Adaptations
Individual Support and Community Habilitation
Occupational Therapy
Physical Therapy
Specialized Medical Equipment
Speech Therapy
Supported Employment
Transportation 27 1 1 27

28. Transition of Case Management Supports for MFP and ABI Waivers
Case Management for the ABI-RH and MFP-RS waivers is now provided by staff employed by DDS
Case Management for the ABI-N and MFP-CL waivers is now provided by staff employed by MRC
These Case Management supports had previously been provided through UMass
UMass continues to be responsible for waiver eligibility and level of care determinations, as well as Provider Network administration

29. To Apply For One Of These Waivers
MFP Waivers:
ABI Waivers:
Frail Elder Waiver: Contact you local ASAP by calling AGE-INFO or at 800AGEINFO.com
Randy to present

30. MFP Resources For more information: MFP Project Office
Telephone: (617)
Mass. Rehabilitation Commission (MRC)
Telephone: (617) 30