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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
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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)
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■ 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)
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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
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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
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* 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
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– 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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⚠
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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
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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
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■ 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
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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
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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
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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