1. Key Building Blocks in Designing a System in Which Money Can Follow the Person Steven Lutzky, Ph.D. Director, Division for Community Systems Improvement Disabled and Elderly Health Programs Group Center for Medicaid and State Operations Center for Medicare and Medicaid Services

2. 2 CMSO/DEHPG Money Follows the Person Represents a New Paradigm for Delivery Long Term Supports  Currently, most support delivery systems are built around services  MFP requires designing systems around the needs and preferences of the individual receiving the supports  Two major tenets  Philosophy of Self-Direction and Individual Control  Community Integration

3. 3 CMSO/DEHPG Key Building Blocks of a System in Which Money Can Follow the Person PERSON Philosophy of self-direction and individual control in legislation, policies, and practices Community Life Coherent Systems Management Access Comprehensive information, simplified eligibility, and single access points Financing A seamless funding system supporting individual choice Services Responsive supports across settings and provider types Quality Improvement Comprehensive systems that assure quality of life and services

4. 4 CMSO/DEHPG Philosophy of Self-direction and Individual- Control Incorporated into:  Mission statement  Policy guidelines  Published rules or regulations  Executive order  Legislation

5. 5 CMSO/DEHPG Coordinated Planning and Management of LTC Systems at the State level  Combine separate agencies into one agency  Create interagency agreements or other cooperative efforts between agencies  Obtain key stakeholder involvement

6. 6 CMSO/DEHPG Access to Long Term Supports  Integrate access to multiple services, including the use of single point of entry systems  Administratively streamline eligibility for Medicaid and/or HCBS  Expand eligibility for Medicaid and/or HCBS  Transition/divert individuals either currently in or at risk of entering institutions  Assure informed consumer choices (e.g., through educational efforts, options counseling)

7. 7 CMSO/DEHPG Finance – State Budgeting  Consolidate funds for multiple long term care programs into one budget  Shift funds from institutional care to home and community services

8. 8 CMSO/DEHPG Finance - Reimbursement Rates and Methodologies  Modify payment methodologies for individual services to meet individuals’ needs and preferences  Allow individual flexible HCBS budgets (e.g., Independence Plus, Cash & Counseling)  Use of capitated budgets to cover home and community services as well as institutional and/or acute care costs.

9. 9 CMSO/DEHPG Service Creation/Modification  Add new services to existing programs  Modify current services to meet individuals’ needs and preferences  LTC Workforce  Wage increases  Health insurance  Career path  Backup systems  Training/Education/Marketing  Worker organizations  Culture change

10. 10 CMSO/DEHPG Quality Improvement  Modify quality assurance systems to assure consistent with goal of self-direction  Modify licensure/survey systems to assure consistent with goal of self-direction  Build data-driven quality improvement systems