hawaii presentation for hcbs meeting 102207 stakeholders_presentation

8/14/2019 Hawaii Presentation for HCBS Meeting 102207 Stakeholders_presentation

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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

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