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Department of Human Services
Going Home Plus
Money Follows the Person Demonstration Grant
Stakeholders MeetingMonday October 22, 2007
Se ct i o n 6 0 7 1 o f t h e
Def i ci t Reduc t ion Act 20 05
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Stakeholder Meeting Objectives
Provide an overview of the grant and
national trends Provide an overview of the benchmarks
Provide an overview of the Guidelines fordrafting the Operational Protocol
Discuss timelines Form workgroups to draft areas of the
Operational Protocol
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Stakeholder Objectives
The Objectives of the Stakeholder Committee are to:
Provide input as draft processes, guidelines, andcriteria are developed for structuring the project
Provide input on policy and technical matters to theDepartment of Human Services
The Stakeholder Group is comprised of community subjectmatter experts and State subject matter experts.
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Nursing Facility Characteristics-
2005
Hawaii Rank U.S.
Total Number of Nursing Facility Residents 3,691 47 1,460,185
% of Residents with Medicaid as Primary Payer 75% 5 65%
Nursing Facility Occupancy Rate 94% 2 85%Note: The highest data value within each ranking is indicated by a rank of "1".Source: AARP (2006) Across the States: Profiles of Long-Term Care and Independent Living
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Trends in Home and Community-
Based Services (HCBS)Number of Medicaid
HCBS Participants per1,000 State Residents,
2003
Annual HCBS WaiverSpending per State
Resident, 2006
HCBS Waiver SpendingPercent Change, 2001 to
2006
U.S. 8.8 $64.30 73%
Hawaii 5 $60.72 131.80%
State with Lowest 2.7 (Virginia) $20.48 (Texas) 15.5% (Michigan)
State with Highest 13.8 (Missouri) $201.44 (New York) 2279.6% (D.C.)
Source: Mathematica Policy Research, Inc (2007) Summary of State MFP Program Applications
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Medicaid Spending on Long-Term Care
Services, by Type of Service, 2005Hawaii Nation
Source: AARP (2006) Across the States: Profiles of Long-Term Care and Independent Living
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CMS Awards
Money Follows The Person
31 States have been awarded $1,435,709,479 Tier I: 17 states Tier 2 13 states and D.C.
Since the beginning of Medicaid, this is the Single Largest Investment inMedicaid LTC (Ever)
Long Term Care target populations: Elders, individuals with Developmental
Disabilities, Physical Disabilities, Traumatic Brain Injury and Mental Illness Higher percentage of federal matching dollars x 12 months after an individual
moves out of an institution and into the community to help cover the costs ofmoving people out of nursing homes and into community settings
State Maintenance of Effort required. States must continue to providecommunity services after that period as long as the person needs communityservices and is Medicaid eligible
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Going Home Plus (GHP)
Hawaiis Award: $10,263,736 federal funding over 5years
Dates: May 3, 2007 through September 30, 2011.
The Hawaii Going Home Plus demonstration will bringtogether the States resources to support persons who
have resided in a health care institution for at least 6months but no longer than 2 years as they transitionback to community living.
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Objectives
Rebalancing1) Increase use of home and community based, rather than
institutional services
Flexible Funding2) Eliminate barriers or mechanisms (state law/budget/state plan)
that prevent or restrict the flexible use of Medicaid funds
Sustainability3) Increase the ability of the state Medicaid program to assure
continued provision of community-based services
Quality4) Ensure quality assurance strategies and procedures are in place
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Medicaid Funding
Federal State partnership
Hawaii matching rates: Federal 56.5%
State 43.5% HCBS enhanced match for 12 months
84.75% Federal (15.25% State)
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GHP Funding Method
PerformanceBased Funding-
The State will onlybeing reimbursedfor persons who
have successfullymoved into thecommunity
The State isreimbursed on aper person basis
Enhanced Match for 12
months after transition
Regular Match untilperson no longer requires
HCBS services
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Timeline for ParticipantsDay of Discharge
6 months 365 days day 366 - ?
Mechanism Medicaid Going Home Plus Demonstration Existing or modified1915(c) waiver
Services
Funding56.5% Fed/43.5% State
84.75% Fed/15.25% State [HCBS]
56.5%Fed/43.5 State [Supplemental]
56.5% Fed/43.5% State [HCBS]
InstitutionalCare
1.Qualified Home and CommunityBased Services (HCBS) Package2. Demonstration OnlySupplemental Services
Qualified Home andCommunity BasedServices (HCBS)Package
After 365 days in demonstration, the qualified HCBS package must
continue through a waiver, managed care plan or State Plan Amendment
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Pre Implementation Phase
3 12 months planning period, must include formalstakeholder process [Hawaii- 5months]
Development of operational protocol
Identify target populations, participant selection mechanism,
detailed delivery service plan, quality management system
Must be approved by CMS before implementation
Pre-implementation phase: costs for project manager, staff &transition coordinators paid at regular administrative match
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Implementation Phase
Qualified HCB Program Services Enhanced Match
Must be continued at the conclusion of the demonstration viawaivers or State Plan.
HCB Demonstration Services
Enhanced Match No requirement to continue beyond the demonstration; waiver or
state plan amendment would be needed.
Supplemental Demonstration Services Regular FMAP Cannot receive Federal reimbursement beyond the demonstration;
short term non-waiver services; fill gaps.
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Restrictions
Cannot use money for housing or bridge funds
Residents of Psychiatric ResidentialTreatment Facilities (RTFs) not eligible
Group housing only where no more than 4 unrelatedindividuals reside
Cost effectiveness for waivers is required
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Qualified Participants
Reside in an inpatient facility (nursing home,ICF-MR or hospital) for a minimum of 6 months to a
maximum of 2 years
Facility costs must have been paid by Medicaid for atleast one month prior to transitioning
Must meet nursing facility level of care
Require HCBS services in order to successfully reside in
a community based setting.
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Qualified Residence
A home owned or leased by the individual or
family member
An apartment with an individual lease, with lockable
access & egress, and includes living, sleeping,
bathing and cooking areas over which the individual or familymember has domain and control
A residence in a community based residential
setting where a maximum of 4 unrelated individuals reside.
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Benchmarks
2 Statutory Benchmarks
Projected #s transitioned in each target group foreach demonstration year
Qualified Expenditures for HCBS during each of the 5years of the program
Limited to state spending on HCBS (not versus
institutional spending) Include all Medicaid HCBS spending not just
Going Home Plus expenditures
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Hawaiis Proposed Transitions
Elderly
Individualswith
Physical
Disabilities
Individualswith
MR/DD
Individualswith Mental
IllnessOther TOTAL
FY 2007 0 0 0 0 0 0
FY 2008 30 30 0 0 0 60FY 2009 45 40 0 0 0 85
FY 2010 55 55 10 0 0 120
FY 2010 55 55 40 0 0 150
TOTAL 185 180 50 0 0 415
Projection: 90% of discharges will remain in community for one year or more
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Additional Benchmarks
Benchmark #3: Combine Medicaid State Plan and HCBS Budgets
Benchmark:* Processes for screening, identifying and assessing
transition candidates
Benchmark:* Use of Transition Coordinators
Benchmark:
Technology to support a virtual care team Benchmark:*
Improve quality management system for HCBS
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Going Home Plus Key Points
Oahu: Year 2 (2008) and Year 3 (2009)
Statewide expansion during Years 3 (2010)& 4 (2011) or earlier
Use of Transition Coordinators
One-time Transitional Costs:
Training Institute Virtual Care Team
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Timeline for Operational Protocol
Hawaii must submit its Operational Protocol to CMSno later than May, 2008.
CMS has 45 days from receipt of our OperationalProtocol to respond.
The implementation phase can begin when Hawaiireceives approval form CMS.
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Operational Protocol
The objectives of the Operational Protocol are:
Provide CMS with an understanding of theoperation of the demonstration project
Serve as a resource for CMS to prepare for site
visits Serve as a manual to State staff for demonstration
project implementation
Provide stakeholders with an understanding of theoperation of the demonstration project
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Operational Protocol (cont)
State must submit detailed financial statusreports and semi annual progress reports
State must participate in a national
evaluation
State must submit Maintenance of Effortstatements annually
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Required Contents of the Operational Protocol
A. Project Introduction 1. Case Study 2. Benchmarks
B. Demonstration Policies and Procedures 1. Participant Recruitment and Enrollment 2. Informed Consent and Guardianship 3. Outreach/Marketing/Education 4. Stakeholder Involvement 5. Benefits and Services 6. Consumer Supports 7. Self-Direction 8. Quality 9. Housing 10. Continuity of Care Post Demonstration
C. Organization and Administration D. Evaluation E. Final Budget
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Work groups
Workgroup #1: Participant Recruitment andEnrollment
Workgroup #2: Informed Consent and Guardianship
Workgroup #3: Outreach/Marketing/Education
Workgroup #4: Benefits & Services/Consumer
Supports Workgroup #5: Housing
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Workgroup cont.
Workgroup Composition:
ConsumersProviders, and
State Staff
Workgroup members shall have subjectmatter expertise
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Workgroup #1
Recruitment and Enrollment Workgroup
Participant selection criteria and policies
Development of recruitment and enrollmentmaterials
Training for participants
Transition Coordinators
W k
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Workgroup #2
Consent and Guardianship
Informed Consent for enrollment
Forms Procedures for involving guardians
Guardianship issues and policies
W k #3
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Workgroup #3
Outreach/Marketing/Education
Information for enrollees, providers andcase workers
Distribution of materials
Staff Training/public training
Media Translation of materials
W k #4
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Workgroup #4
Benefits & Services/Consumer Supports
Identification of services for each population
Service delivery system for each population
HCBS demonstration Services
Supplemental Services
24hr back up system
Complaint/resolution process for backup & supportservices
W k #5
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Workgroup #5
Housing
Identify types of qualified of residences availablein state
Existing or planned inventories and shortages
How Medicaid will work with Housing Finance,Public Housing Authorities
Strategies to promote availability, affordabilityaccessibility
U i M ti
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Upcoming Meetings
Meeting dates:
Stakeholder group: 2 meetings Monday, January 7, 2008
Monday, March 3, 2008
Workgroups: 4 meetings per workgroup
To be scheduled