Home and Community-Based Waivers:

Opportunities for Community Living

for ABI Survivors

BIA-MA Brain Injury Conference March 30, 2017

Amy Bernstein Director, Community Based Waivers MassHealth

Dorothée Alsentzer Manager, Community Based Waivers MassHealth

Alternative LTSS programs for individuals who otherwise require

care in a facility

Overview: HCBS Waivers

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HCBS / 1915(c) Waivers

CMS can waive certain requirements that otherwise apply

to the Medicaid program, giving the state flexibility to define:

– The target group of Medicaid beneficiaries to be

served, subject to certain requirements

– The maximum number of participants who may be

served in a given HCBS waiver program

– The services available to the waiver target group

(in addition to what is already available through the

Medicaid State Plan)

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HCBS Waiver Operations

■ MassHealth

– Receives authority from CMS to administer each HCBS waiver

– Responsible for required cost neutrality reporting

■ EOHHS agencies, or their agents, have day-to-day

responsibility for waiver oversight and operations

– Level of Care (LOC) evaluation

– Waiver Plan of Care (POC)

– Person-centered planning

– Case management/service coordination

– Incident oversight and resolution

– Waiver quality monitoring, measurement, and reporting

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Requirements

For All HCBS Waivers

■ Waiver Participants must be financially eligible and

Require a facility level of care (LOC)

Have an ongoing need for, and receive waiver services at

least once a month

Be able to be safely served in the community with available

waiver and State Plan services

■ Waiver services must be authorized through a person-

centered waiver Plan of Care (POC)

■ Person-centered planning process results in a POC that

Acts as the authorization for waiver services

Specifies amount, frequency, and type of provider

for each waiver service the participant will receive

■ Service plans must be reviewed and updated

At least annually, and

Whenever necessary due to a change in the

participant’s needs or circumstances

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Waiver Plan of Care (POC)

Overview:

Waiver Eligibility

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■ Two parts to waiver eligibility

Clinical eligibility is

determined by the waiver

operating agency or its agent

Financial eligibility is

determined by MassHealth

■ Both types of eligibility must

be reviewed annually

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Clinical Eligibility

Determinations

Waiver(s) Agency/Agent

DDS Adult ID

Waivers DDS

Children’s

Autism Waiver DDS

TBI Waiver MRC

Frail Elder

Waiver ASAPs

ABI Waivers UMass

MFP Waivers UMass

Waiver Eligibility

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■ HCBS Waiver participants must be eligible for

MassHealth Standard

■ Special financial eligibility guidelines apply for HCBS

adult waivers

Applicant’s income ≤ 300% SSI Federal Benefit Rate

(FBR, which is currently $2,205 a month)

Countable assets of applicant ≤ $2,000

Countable assets of applicant’s spouse ≤ $120,900

Waiver Financial Eligibility

Massachusetts HCBS Waivers

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10 Massachusetts HCBS Waivers

TBI Traumatic Brain Injury

ABI-RH Acquired Brain Injury –

Residential Habilitation

DDS-Intensive Supports ABI-N Acquired Brain Injury –

Non-residential Habilitation

DDS-Adult Supports MFP-RS Money Follows the Person –

Residential Supports

DDS-Community Living MFP-CL Money Follows the Person –

Community Living

Children’s

Autism Spectrum Disorder FEW Frail Elder Waiver

* Some examples of ABIs that qualify are brain injuries resulting from stroke, brain trauma,

infection of the brain, brain tumor, or anoxia. Dementia-type conditions alone do not qualify.

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ABI/MFP Waiver Eligibility

To qualify for the waiver, an individual must... ABI

Waivers

MFP

Waivers

Have an ABI* that was sustained at age 22 or older

Be a disabled adult or be aged 65 or older

Have been living in a facility for at least 90 days

Meet clinical level of care requirements

Need available waiver services

Qualify financially for MassHealth Standard

Be able to be safely served in the community

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■ ABI Non-Residential Habilitation (ABI-N) Waiver (MRC)

• Participants do not need 24 hour supports or supervision

• MRC Case Managers coordinate waiver services

• Includes a limit of 84 hours per week of in-home supports,

e.g., personal care services, homemaking, etc.

■ ABI Residential Habilitation (ABI-RH) Waiver (DDS)

• Participants require supervision and staffing 24/7 and

receive services in provider-operated and staffed settings

• DDS Service Coordinators coordinate waiver services

ABI Waivers For individuals aged 22 and older

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MFP Waivers For individuals aged 18 and older

MFP Community Living (MFP-CL) Waiver (MRC)

• Participants do not need 24 hour supports or supervision

• MRC Case Managers coordinate waiver services

• Includes a limit of 84 hours per week of in-home supports,

e.g., personal care services, homemaking, etc.

MFP Residential Supports (MFP-RS) Waiver (DDS)

• Participants require supervision and staffing 24/7 and

receive services in provider-operated and staffed settings

• DDS Service Coordinators coordinate waiver services

– Both MFP Waivers are continuing!

■ MFP Demonstration is winding down

– Enrollment closed 8/31/16

– Transitions ended 12/31/16

■ Corresponding updates to the MFP Waivers include

– Remove Demonstration-related eligibility language

– Add Transitional Assistance services formerly

provided through the MFP Demonstration

Recent Changes to the MFP Waivers

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Frail Elder Waiver Eligibility

To qualify for the waiver, an individual must... FEW Waiver

Be a disabled adult aged 60-64 or be aged 65 or older

Require a nursing facility Level of Care

Need available waiver services

Qualify financially for MassHealth Standard

Be able to be safely served in the community

The FEW serves individuals who are transitioning out of a

facility setting and those who already live in the community ⚠

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■ Operated by the Executive Office of Elder Affairs (EOEA)

■ Aging Services Access Points (ASAPs) conduct Level of Care

determinations, provide case management, and manage waiver

provider enrollment and oversight

■ Serves individuals living in their own home or with family, but not in

provider-operated residential settings

■ Key services include homemaker, personal care, home-delivered

meals, companion, medication dispensing system and transportation

■ FEW participants can choose to enroll in SCO to receive all waiver

and state plan services

Frail Elder Waiver (FEW) For individuals aged 60 and older

Choosing and Applying for an HCBS

Waiver

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Where does the applicant reside?

The Waiver serves individuals

who...

...are being discharged

from a facility

...already live in

the community

ABI – Non-Residential

Habilitation

ABI – Residential Habilitation

MFP – Community Living

MFP – Residential Supports

Frail Elder Waiver

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Past or current affiliation with the agency providing case management for the waiver may help applicants to select the waiver that will best meet their needs

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Agency Affiliation

HCBS Waiver Case Management Agency

ABI-N Massachusetts Rehabilitation Commission

(MRC)

ABI-RH Department of Developmental Services

(DDS)

MFP-CL MRC

MFP-RS DDS

FEW Aging Service Access Points (ASAPs)/

Senior Care Options (SCO) Plans

■ ABI and MFP Waivers

– State agency case managers/service coordinators discuss

waiver opportunities and assist in filling out the application form

– Peer/family outreach volunteers share personal stories about

making the decision to enroll and transitioning to the community

– Fact Sheet for Professionals helps facility administrators and

staff to better understand the ABI/MFP Waivers

■ Frail Elder Waiver

– Local ASAP

– SHINE counselors

– Long Term Care Ombudsman

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Resources for Individuals Considering HCBS Waivers

What happens after submitting an ABI or MFP waiver application form?

MassHealth financial eligibility determination

Clinical eligibility assessment and determination

Eligible applicant assigned to MRC or DDS Case Manager or Service Coordinator

Transition planning and development of a waiver plan of care

Transition to community and initiation of home- and community-based services

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NOTE: Not all waiver services are included in every waiver

Waiver Services

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■ Residential Habilitation

– Care, supervision, and skills training in a provider-operated

group setting (typically 4-5 residents)

■ Shared Living

– Participant lives with a caregiver who provides skills training,

personal care assistance, and household tasks with oversight

by a provider agency

■ Assisted Living Services

– Participant resides in a certified assisted living residence that

includes assistance with personal care, homemaking, meals,

and access to 24-hour on-site staff

Residential Services

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■ Day Services

– Structured, site based, group programs provide socialization,

assistance with functional and prevocational skills, etc.

■ Prevocational Services

– Prepare a participant for paid or unpaid employment, e.g. attention

span, task completion, attendance

■ Supported Employment Services

– Training and ongoing support to maintain paid employment

Day & Employment Services

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■ In-Home Supports

– Personal care

– Homemaker, chore, laundry, and grocery shopping services

– Home delivered meals

■ Skills training services

– Individual Support and Community Habilitation

– Peer support

■ Occupational, Physical, and Speech Therapies

■ Transportation services

Additional Waiver Services

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■ Home Modifications

■ Vehicle Modifications

■ Assistive Technology and Specialized Medical Equipment

■ Orientation and Mobility Services

■ Transitional Assistance Services

– Set-up expenses for individuals moving from a nursing facility or

other facility to the community, including essential household

furnishings, security deposits, etc.

Additional Waiver Services

Questions?

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Contact Information

For ABI and MFP Waivers

■ For questions about the ABI or MFP Waivers or the

application process

– Call the UMass Medical School ABI/MFP Waiver Unit

• 855-499-5109 / TTY 800-696-1746

■ To arrange an in-person visit by a state agency case

manager and/or peer/family outreach volunteer for

individuals considering an ABI or MFP waiver

– Call Mass. Rehabilitation Commission (MRC)

• 617-204-3747

Money Follows the Person (MFP) Waivers www.mass.gov/eohhs/consumer/insurance/more-programs/mfp-demo-and-waivers/money-follows-the-person-waivers.html

Acquired Brain Injury (ABI) Waivers www.mass.gov/eohhs/consumer/insurance/more-programs/acquired-brain-injury-waivers.html

Frail Elder Waiver (FEW) https://contactus.800ageinfo.com/FindAgency.aspx (call the local ASAP)

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Helpful Links

Application forms for ABI and MFP Waivers

ABI-RH: English / Spanish ABI-N: English / Spanish

MFP-RS: English / Spanish MFP-CL: English / Spanish

Waiver Participant Videos

ABI-RH: Michael https://youtu.be/Nf8WttoqvWo

ABI-N: Susan https://youtu.be/14zsz72Zu1Q