MONEY FOLLOWS THE PERSON REBALANCING DEMONSTRATION:

MONEY FOLLOWS THE PERSON REBALANCING DEMONSTRATION: PROGRAM INITIATIVES 1 Legislative Office Long-Term Care Planning Committee Meeting 12/09/2014 DSS/Money Follows the Person-Karri Filek, MPA

AGENDA Testing Experience and Functional Tools (TEFT) Balancing Incentive Program (BIP) Right Sizing & Rebalancing Community First Choice (CFC) Presumptive Eligibility (PE) Money Follows the Person – Demo services Reorganization Comments & Questions Contact Information Rightsizing & Rebalancing Plans (3) 2

TESTING EXPERIENCE AND FUNCTIONAL TOOLS (TEFT) 3 Paul Ford

TEFT-ENCOMPASSES FOUR AREAS DSS is contracting with two Centers at the University of Connecticut Health Center, namely: the Center on Aging (CoA) and Biomedical Informatics Center (BMIC) at Connecticut Institute for Clinical and Translational Science 4

TEFT Center on Aging (CoA)-Dr. Julie Robison Together with stakeholders in the State of Connecticut, the Department of Social Services, Division of Health Services aims to: Field test a beneficiary experience survey for validity and reliability; (COA) Field test a modified set of Continuity Assessment Record and Evaluation (CARE) functional assessment measures (COA) 5

TEFT Biomedical Informatics Center (BMIC)-Dr. Minakshi Tikoo Demonstrate use of personal health record (PHR) systems with beneficiaries of CB-LTSS (BMIC) Identify, evaluate and harmonize an electronic Long Term Services and Supports (e-LTSS) standard in conjunction with the Office of National Coordinator’s (ONC) Standards and Interoperability (S&I) Framework (BMIC) 6

TEFT Current Activities Stakeholder meetings regarding use of Personal Health Records Field testing consumer experience FOLLOW US ON: 7

BALANCING INCENTIVE PROGRAM (BIP) 8 Karen Law Tamara Lopez

BALANCING INCENTIVE PROGRAM Overview Centers for Medicare and Medicaid Services (CMS) awarded Connecticut a grant for 72,780,505 to; Expand community LongTerm Services and Supports Develop necessary infrastructure for a more streamlined process for clients seeking community LTSS Initiatives No Wrong Door (NWD) Conflict-Free Case Management Services Core Standardized Assessment Instrument 9

IMPLEMENTING THE BIP VISION Implementing the BIP vision enhances and supports the delivery of LTSS from the consumer’s point of entry to the delivery of services. Key Components of BIP Vision PreScreen Self-service tool that allows consumers to identify potential service options Point of entry Agency Application Electronic form that allows consumers to submit an Agency Application online Medicaid Application Electronic form that allows consumers to submit the Medicaid Application online Universal Assessment Standardized assessment tool that calculates consumer’s level of need Eligibility Service Plan Determination Automated process that finalizes consumer’s functional level of need and financial eligibility determination. Integrates with partner systems to display the agreed upon service arrangement for consumer Delivery of services Connecticut’s “No Wrong Door” partners will implement a standardized process and integrated system solution to support Connecticut’s achievement of the BIP goals. As provided by Deloitte: State of CT Balancing Incentive Program: Vision Validation Session

HIGH-LEVEL TECHNICAL SYSTEM DIAGRAM Secure Access: (ISIM/ISAM & Multi-Factor Authentication) ImpaCT System Worker/Assessor ConneCT Consumer Portal My Account Citizen/ Advocate Consumer Dashboard Apply for Benefits Am I Eligible? LTSS Module LTSS Websites Shopping MyPlace CT State Agency Websites Pre-Screen Agency Application Shopping Universal Assessment Worker Dashboard Financial Eligibility Tracking Reports Data Exchange Agency Application Partner Systems Case Managemen t Systems Data Warehouse InterRAI System MMIS System Pre-Screen PHR System Service Provider Websites Legend BIP Portal ImpaCT Worker Portal Existing System BIP System LogistiCare System As provided by Deloitte: State of CT Balancing Incentive Program: Vision Validation Session

RIGHT-SIZING & REBALANCING 12 Mairead Painter

RIGHTSIZING & REBALANCING: NURSING HOME DIVERSIFICATION 40 million in grant and bond funds through SFY 2015 Utilized reports that outlined town-level projections of need for long-term service and supports & associated workforce Applicant nursing facilities must tailor services to local need 13

RIGHTSIZING & REBALANCING: NURSING HOME DIVERSIFICATION Round 1 Round 2 Completed Request for Proposals (RFPs) 23 proposals submitted Underway! Procurement Schedule: RFP Released: October 16, 2014 RFP Conference: 10/27/2014 Deadline for Questions: 10/30/2014, 2:00 p.m. Eastern Time Answers Released: 11/05/2014 Clarifying Questions: 11/12/14 Responses to Clarifying Questions: 11/19/14 Mandatory Letter of Intent Due: 12/01/2014, 2:00 p.m. Eastern Time Proposals Due: 01/15/2015, 2:00 p.m. Eastern Time Governor Malloy awarded 9 million in Rebalancing grants Seven proposals selected* 14

RIGHTSIZING & REBALANCING: NURSING HOME DIVERSIFICATION Southington Care Center ( Central Connecticut Senior Health Services ): 2,051,148.00 award Mary Wade Home, Inc.: 2,001,730.00 award Jewish Home for the Elderly of Fairfield County, Inc.: 81,260.00 award 15

COMMUNITY FIRST CHOICE (CFC) 16 Christine Weston

COMMUNITY FIRST CHOICE (CFC) An optional State Plan program created under the Affordable Care Act (ACA) allowing states to implement a new Medicaid entitlement States would receive a 6% enhanced FMAP 17

COMMUNITY FIRST CHOICE Open to individuals that meet Level Of Care (LOC) Participants do not need to meet budget neutrality* Does not create a new eligibility group, open to all Medicaid participants that meet LOC Slots are not limited in CFC 18

COMMUNITY FIRST CHOICE Allows states to offer multiple supports and services to eligible individuals; Personal Assistance Personal Emergency Response Systems (PERS) Voluntary training for participants Transition Services Services that increase independence or substitute human assistance CFC will be entirely person-centered and self directed 19

COMMUNITY FIRST CHOICE Accomplished to date Next Steps Drafted the State Plan Amendment (SPA) to include all allowable services Built capacity at our Access Agencies, includes creating training for the assessors Created procedure codes for accurate billing Created a Development Council of key community stakeholders Submit SPA to CMS and receive approval on the SPA from CMS Launch CFC statewide on April 1, 2015 20

PRESUMPTIVE ELIGIBILITY 21 Karri Filek

PRESUMPTIVE ELIGIBILITY Would allow for Home and Community Based (HCBS) clients to quickly gain access to care in the community while their Medicaid applications are being processed 22

PRESUMPTIVE ELIGIBILITY Pilot program in MFP Targets clients applying for Medicaid waivers & Needing a financial review (look-back) Tests the effectiveness of new process To see if it is a viable option for Connecticut Incorporates new processing techniques and working closely with functional staff 23

PRESUMPTIVE ELIGIBILITY Allows more clients to access services and supports in the community Leave long-term care facilities sooner Divert hospital discharges to the community rather than facilities Continue living in the community Cost-savings alternative to long term care facilities Supports careers in the healthcare field 24

MFP DEMONSTRATION SERVICES 25 Deanna Clark

MFP DEMONSTRATION SERVICES Peer Support Informal Caregiver’s Support Addiction Services and Supports 26

MFP DEMONSTRATION SERVICES Peer Support Using personal experiences, peer support workers engage participants in order to reinforce and maintain skills Peer support workers can be self-hire or agency based 5 currently enrolled with the service 27

MFP DEMONSTRATION SERVICES Informal Caregiver’s Support Provides informal caregivers with a flexible individual budget which they may use for: Paid care that allows for a brief period of rest or relief for caregivers; or 1:1 or group caregiver education or training in managing the MFP participant’s chronic conditions. Caregivers can select their respite provider and/or trainer from an agency or from their own network. 28

MFP DEMONSTRATION SERVICES Addiction Services & Supports Community Support Services (CSS) Peer Support Specialist Transportation Transitional Supported Employment Requires referral to Advanced Behavioral Health (ABH) after completion of the ASSIST tool, which determines participant’s level of need Enrollment Numbers Service Community Support Services Peer Support Specialist Transportation Transitional Supported Employment Consumers 23 5 17 4 29

REORGANIZATION 30 Dane Lustila

REORGANIZATION MFP Waiver Assessment Process Then MFP application received at Central Office Application referred to a Transition Coordinator (TC) TC meets client and refers him/her to a waiver Client is assessed by waiver staff If client is not waiver eligible, TC refers client to another Home and Community Based Services (HCBS) package Disadvantages Duplication of efforts Delay between referral to waiver staff and actual assessment Delay when client is deemed ineligible for initial waiver Client disengagement TCs unable to regularly take new clients 31

REORGANIZATION MFP Waiver Assessment Process Now MFP application received at Central Office Application referred to Specialized Care Manager (SCM) SCM meets client and assesses him/her for waiver eligibility If client is not waiver eligible, SCM refers client to another Home and Community Based Services (HCBS) package TC assigned after waiver assessment Advantages Decrease in duplicative efforts Waiver staff (SCM) are the first to meet the client Waiver staff are able to refer clients to other HCBS packages more accurately Increased client engagement TCs able to regularly receive new clients 32

REORGANIZATION: IMPACT ON CARE PLANS Average Monthly Care Plans Approved 85 80 60 40 20 0 12 0 /2 1 /0 1 0 47 r th o h g u 4 1 20 / 20 / 02 14 0 /2 1 /2 2 0 r th o h g u 4 1 20 / 01 / 12 33

REORGANIZATION: IMPACT ON REFERRALS TO TRANSITION COORDINATORS Referrals to Transition Coordinators ᵗ: Q1 2009 to Q3 2014 800 711 700 604 600 500 400 373 341 327 325 311 317 300 257 188 200 180 163 123 231 220 193 194 331 313 226 213 159 119 100 0 * 14 20 q3 4* 1 20 q2 4 1 20 q1 3 1 20 q4 3 1 20 q3 3 1 20 q2 3 1 20 q1 2 1 20 q4 2 1 20 q3 2 1 20 q2 2 1 20 q1 1 1 20 q4 1 1 20 q3 1 1 20 q2 1 1 20 q1 0 1 20 q4 0 1 20 q3 0 1 20 q2 0 1 20 q1 9 0 20 q4 9 0 20 q3 9 0 20 q2 9 0 20 q1 34 ᵗExcludes nursing home closures *Increase in referrals reflects the ongoing adjustment to MFP reorganization Data taken from the CT MFP Quarterly Report 2014: Quarter 3.

REORGANIZATION: IMPACT ON TRANSITIONS Number of transitions by quarter: 12/2008 - 9/30/2014 2014 2014 2014 2013 2013 2013 2013 2012 2012 2012 2012 2011 2011 2011 2011 2010 2010 2010 2010 2009 2009 2009 2009 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1 0 156 115 120 165 147 168 132 166 110 120 114 109 152 107 66 83 98 74 60 62 43 38 19 20 40 60 80 100 120 140 160 180 Number of consumers who transitioned Data taken from the CT MFP Quarterly Report 2014: Quarter 3. 35

COMMENTS & QUESTIONS Thank you! 36

CONTACT INFORMATION Dawn Lambert Project Director Department of Social Services-Money Follows the Person [email protected] 860-424-4897 Karen Law Public Assistance Consultant Department of Social Services-Money Follows the Person [email protected] 860-424-5971 Tamara Lopez Health Program Associate Department of Social Services-Money Follows the Person [email protected] 860-424-5535 37

CONTACT INFORMATION Paul Ford Health Program Assistant Department of Social Services-Money Follows the Person [email protected] 860-424-5376 Deanna Clark Health Program Assistant Department of Social Services-Money Follows the Person [email protected] 860-424-4984 Dane Lustila Eligibility Services Worker Department of Social Services-Money Follows the Person [email protected] 860-424-5078 38

CONTACT INFORMATION Karri Filek Eligibility Services Worker Department of Social Services-Money Follows the Person [email protected] 860-424-5895 Christine Weston Social Worker Department of Social Services-Money Follows the Person [email protected] 860-424-5521 Mairead Painter Social Worker Department of Social Services-Money Follows the Person [email protected] 860-424-5844 39

CONTACT INFORMATION CT Department of Social Services www.ct.gov/dss CT MFP online application www.ctmfp.gov Community Care and Support Information www.myplacect.org Nursing Home Rebalancing Grants Press Release www.governor.ct.gov/malloy/cwp/view.asp?A 4010&Q 542054 CT Money Follows the Person Quarterly Report: Quarter 3, 2014: July 1, 2014-September 30, 2014 http://www.uconnaging.uchc.edu/2014%20Q3%20MFP%20report.pdf 40

Southington Care Center (Central Connecticut Senior Health Services) – maximum award: 2,051,148. The grant funds the increase in CTCHAs capacity to promote the utilization of home and community based service (HCBS) and long term services and supports (LTSS) by Medicaid recipients and in coordination with the Department’s strategic rebalancing plan. This is a 2 year contract. This grant is funding: opening a CTCHA satellite site at Southington Care Center and expanding existing services at CTCHA hospital sites working collaboratively, with Connecticut’s comprehensive phone-based service that provides information and referrals to community services (that service, “211”) developing and disseminating a free, user friendly, patient and family centered resource toolkit to help seniors learn about HCBS and LTSS, expanding the service offerings in collaboration with the Hartford HealthCare (HHC) system and HCBS providers that are responsive to the needs of the Medicaid recipients and other lowincome seniors(as defined by the CHCPE financial requirements) implementing a Geriatric Care Management program for Medicaid recipients and other lowincome seniors implementing a CTCHA person-centered education and engagement program increasing the use of CTCHA services that promote utilization of community LTSS by Medicaid recipients and seniors by raising awareness of the CTCHA a 1.4% decrease in admissions to the Skilled Nursing Facilities when discharged from HHC Hospitals (only MidState Medical Center and The Hospital of Central Connecticut) expanding choice and improve health outcomes person-centered education and engagement program Rightsizing & Rebalancing: Southington Care Center (Central Connecticut Senior Health Services) 41

Mary Wade Home, Inc. (New Haven) – maximum award: up to 2,001,730, including up to 200,000 in pre-development funds and 1 million in capital funds. The grant will fund the opening of the Mary Wade Community Home Care, a Homemaker Companion Care Agency office at the 83 Pine Street, New Haven, Connecticut 06513. This Agency will provide for the catchment area including the towns of; New Haven, East Haven, North Haven, West Haven, and Hamden. The grant will increase Mary Wade’s capacity to promote the utilization of home and community based service (HCBS) and long term services and supports (LTSS) by Medicaid recipients to live in the Community and in coordination with the Department’s strategic rebalancing plan. This is a two year contract. Rightsizing & Rebalancing: Mary Wade Home, Inc. This grant is funding: a Community Navigator and Homemaker Companion Care Company (HCCC) called “Mary Wade Community Home Care (MWCHC) a Community Navigator who will develop an outreach initiative that interacts with all organizations and stakeholders that serve and support individuals that may need home care services strategies to alleviate, and/or significantly reduce, the amount of emergency room readmissions strategies to identify and assist eligible individuals in need of home care at discharge assistance to families during transition within forty-eight (48) hours of discharge an Electronic Home Care Record in collaboration with the States “No Wrong Door” initiative so that the two (2) systems to work jointly. choice for Medicaid recipients in where they receive long term supports and services additional services that build community based case capacity to meet increased demand for LTSS in the greater New Haven area a decrease in 1.4% of admissions to Greater New Haven Skilled Nursing Facilities. The State will decrease by 1% and Mary Wade will decrease by .4% for the first two years an increase in supply of direct-care workers in New Haven 42

Jewish Home for the Elderly of Fairfield County, Inc. (Fairfield) – maximum award: 81,260 The grant funds the development of a protocol for affordable, community-based living in an adult family living home as an option so that seniors can remain in or return to the community from a nursing home. Formal Business Plan (FBP) and budget for the creation of Adult Family Living Homes (AFLH) approved by the Department, for the elderly, blind or disabled individuals who would otherwise require institutionalization in the Southwestern Connecticut region. This is a nine month contract This grants funds will develop: FBP that establishes and implements a prototype for affordable, community-based living in an AFLH model in the region. The model will serve Medicaid eligible older-adults who cannot safely live by themselves, cannot afford round-the-clock live-in assistance and are qualified or at risk of nursing home level of care FBP will utilize a process to inform consumers/clients of their choices regarding all long term services and supports that are available while providing approximate supervision and socialization for lower-and middle-income, Medicaid-eligible adults so that they can remain in the community longer utilizing its Person–Centered Approach FBP will look to develop and implement an increases in the number of housing units that are affordable to Medicaid recipients FBP that decreases the number of nursing facility beds in an orderly fashion in its region that currently have, or are projected to have, a surplus of beds with a reduction of seventy-six (76) nursing facility licensed beds at this SNF. FBP that provides to all clients the services required to assist each in reaching their highest possible quality of life FBP that develops and implements an approach that evidences the ability to serve multicultural multilingual populations in a culturally sensitive and linguistically competent way FBM will align with other providers that provide a range of personal, supports and health services provided to individuals in a person’s home in the community to help the person stay at home and live as independently as possible FBP will support coordination with other integrated care and home health initiatives FBP will create an implementation roadmap with a finalized budget for the creation of an AFLH in Southwest Connecticut region Rightsizing & Rebalancing: Jewish Home for the Elderly of Fairfield County, Inc. 43