+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   Medicaid buy-in  | -   CMS will issue a |
|                      |     improvements and |     Notice of        |
| Coherent,            |     spousal benefits |     Proposed Rule    |
| Cost-Effective       |     protection: In   |     Making (NPRM)    |
| Structure,           |     the *NFI         |     that will        |
| Administration and   |     Medicaid         |     include the      |
| Financing            |     Demonstrations   |     option for       |
|                      |     Act* that HHS    |     states to add a  |
| *\[Emp               |     transmitted to   |     minimum          |
| loyment/Workforce\]* |     Congress, a      |     employment       |
|                      |     provision was    |     threshold to the |
|                      |     included to      |     Medicaid buy-in. |
|                      |     protect spouses  |                      |
|                      |     of 1619(b)       |                      |
|                      |     recipients who   |                      |
|                      |     increase their   |                      |
|                      |     earnings from    |                      |
|                      |     the loss of      |                      |
|                      |     Medicaid         |                      |
|                      |     benefits due to  |                      |
|                      |     deeming of       |                      |
|                      |     income.          |                      |
|                      |                      |                      |
|                      | -   CMS issued a     |                      |
|                      |     contract to      |                      |
|                      |     bring together   |                      |
|                      |     an expert group  |                      |
|                      |     on comprehensive |                      |
|                      |     employment       |                      |
|                      |     infrastructures. |                      |
|                      |     They will make   |                      |
|                      |     recommendations  |                      |
|                      |     on the essential |                      |
|                      |     elements         |                      |
|                      |     necessary to     |                      |
|                      |     build            |                      |
|                      |     comprehensive    |                      |
|                      |     systems in       |                      |
|                      |     states that will |                      |
|                      |     be used to guide |                      |
|                      |     future Medicaid  |                      |
|                      |     *Infrastructure  |                      |
|                      |     Grant*           |                      |
|                      |     solicitation     |                      |
|                      |     design and       |                      |
|                      |     evaluation       |                      |
|                      |     criteria.        |                      |
|                      |                      |                      |
|                      | -   Demonstration to |                      |
|                      |     maintain         |                      |
|                      |     independence and |                      |
|                      |     employment       |                      |
|                      |     redesign: CMS    |                      |
|                      |     has released an  |                      |
|                      |     updated version  |                      |
|                      |     of this request  |                      |
|                      |     for clarifies    |                      |
|                      |     the tremendous   |                      |
|                      |     flexibility for  |                      |
|                      |     states in        |                      |
|                      |     providing all    |                      |
|                      |     the support      |                      |
|                      |     services needed  |                      |
|                      |     by individuals   |                      |
|                      |     struggling to    |                      |
|                      |     maintain         |                      |
|                      |     economic         |                      |
|                      |                      |                      |
|                      |    self-sufficiency. |                      |
|                      |     Proposals are    |                      |
|                      |     due to CMS on    |                      |
|                      |     July 15, 2004.   |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   Collaboration    | -   CMS anticipates  |
|                      |     for direct       |     jointly hosting  |
| Coherent,            |     service workers: |     an Open Door     |
| Cost-Effective       |     CMS contracted   |     Forum with ASPE  |
| Structure,           |     with the         |     in September     |
| Administration and   |     Paraprofessional |     2004 on          |
| Financing            |     Healthcare       |     workforce        |
|                      |     Institute (PHI)  |     issues.          |
| *\[Emp               |     to create a      |                      |
| loyment/Workforce\]* |     return on        |                      |
|                      |     investment model |                      |
|                      |     that can be used |                      |
|                      |     by states to see |                      |
|                      |     the effect of a  |                      |
|                      |     wage increase    |                      |
|                      |     for direct       |                      |
|                      |     service workers  |                      |
|                      |     on the state's   |                      |
|                      |     economy.         |                      |
|                      |     Additionally,    |                      |
|                      |     PHI developed a  |                      |
|                      |     supervisory      |                      |
|                      |     training         |                      |
|                      |     curriculum to be |                      |
|                      |     used to assist   |                      |
|                      |     in training      |                      |
|                      |     consumers to     |                      |
|                      |     supervise their  |                      |
|                      |     own care as well |                      |
|                      |     as several       |                      |
|                      |     promising        |                      |
|                      |     practices on     |                      |
|                      |     workforce        |                      |
|                      |     topics.          |                      |
|                      |                      |                      |
|                      | ```{=html}           |                      |
|                      | <!-- -->             |                      |
|                      | ```                  |                      |
|                      | -   CMS collaborated |                      |
|                      |     with ASPE to     |                      |
|                      |     host the         |                      |
|                      |     *Employment,     |                      |
|                      |     Medicaid, and    |                      |
|                      |     Social Security: |                      |
|                      |     Collaborations   |                      |
|                      |     at Work*         |                      |
|                      |     national         |                      |
|                      |     conference in    |                      |
|                      |     May 2004.        |                      |
|                      |                      |                      |
|                      | ```{=html}           |                      |
|                      | <!-- -->             |                      |
|                      | ```                  |                      |
|                      | -   A national       |                      |
|                      |     clearinghouse of |                      |
|                      |     technical        |                      |
|                      |     assistance       |                      |
|                      |     products related |                      |
|                      |     to home and      |                      |
|                      |     community based  |                      |
|                      |     services,        |                      |
|                      |     including        |                      |
|                      |     materials        |                      |
|                      |     concerned with   |                      |
|                      |     addressing       |                      |
|                      |     worker shortage  |                      |
|                      |     issues, is       |                      |
|                      |     maintained at    |                      |
|                      |                      |                      |
|                      |    [www.hcbs.org](ht |                      |
|                      | tp://www.hcbs.org/). |                      |
|                      |                      |                      |
|                      | -   CMS has awarded  |                      |
|                      |     a contract to    |                      |
|                      |     design a         |                      |
|                      |     national         |                      |
|                      |     evaluation of    |                      |
|                      |     its              |                      |
|                      |     Demonstration to |                      |
|                      |     Improve the      |                      |
|                      |     Direct Service   |                      |
|                      |     Workforce as     |                      |
|                      |     well as produce  |                      |
|                      |     analyses of      |                      |
|                      |     promising        |                      |
|                      |     practices        |                      |
|                      |     developed by     |                      |
|                      |     grantees under   |                      |
|                      |     this initiative. |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   Direct service   | -   The President's  |
|                      |     worker national  |     budget proposes  |
| Coherent,            |     demonstration:   |     an additional    |
| Cost-Effective       |     CMS funded \$6   |     \$2.9 million    |
| Structure,           |     million in FY    |     for this         |
| Administration and   |     2003 and \$3     |     demonstration in |
| Financing            |     million in FY    |     FY 2005.         |
|                      |     2004 for a       |                      |
| *\[Emp               |     *Demonstration   |                      |
| loyment/Workforce\]* |     to Improve the   |                      |
|                      |     Direct Service   |                      |
|                      |     Community        |                      |
|                      |     Workforce* to    |                      |
|                      |     support states   |                      |
|                      |     and              |                      |
|                      |     community-based  |                      |
|                      |     providers in     |                      |
|                      |     improving the    |                      |
|                      |     recruitment,     |                      |
|                      |     training,        |                      |
|                      |     support and      |                      |
|                      |     retention of     |                      |
|                      |     direct service   |                      |
|                      |     workers. The     |                      |
|                      |     demonstration    |                      |
|                      |     enables the      |                      |
|                      |     funded states    |                      |
|                      |     and other        |                      |
|                      |     entities to test |                      |
|                      |     strategies to    |                      |
|                      |     recruit and      |                      |
|                      |     retain direct    |                      |
|                      |     service workers. |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   Services for     | -   CMS will release |
|                      |     persons with     |     a technical      |
| Coherent,            |     mental illness:  |     assistance guide |
| Cost-Effective       |     Full             |     on six evidence  |
| Structure,           |     *(ex-officio)*   |     based practices  |
| Administration and   |     participation in |     (EBPs). The      |
| Financing            |     President's *New |     guide will       |
|                      |     Freedom          |     clarify what is  |
| *\[Community         |     Commission on    |     billable under   |
| Integration\]*       |     Mental Health*). |     Medicaid.        |
|                      |     Resulted in      |                      |
|                      |     specific         |                      |
|                      |     recommendations, |                      |
|                      |     including        |                      |
|                      |     creating a       |                      |
|                      |     demonstration to |                      |
|                      |     test the         |                      |
|                      |     provision of     |                      |
|                      |     home and         |                      |
|                      |     community based  |                      |
|                      |     services (HCBS)  |                      |
|                      |     as an            |                      |
|                      |     alternative to   |                      |
|                      |     Institutions for |                      |
|                      |     Mental Disorders |                      |
|                      |     (IMDs), to       |                      |
|                      |     expand the use   |                      |
|                      |     of supported     |                      |
|                      |     employment and   |                      |
|                      |     other            |                      |
|                      |     evidence-based   |                      |
|                      |     practices, and   |                      |
|                      |     to further       |                      |
|                      |     define the use   |                      |
|                      |     of               |                      |
|                      |     self-direction   |                      |
|                      |     for mental       |                      |
|                      |     health services. |                      |
|                      |                      |                      |
|                      | ```{=html}           |                      |
|                      | <!-- -->             |                      |
|                      | ```                  |                      |
|                      | -   CMS proposed a   |                      |
|                      |     demonstration to |                      |
|                      |     test the         |                      |
|                      |     provision of     |                      |
|                      |     community-based  |                      |
|                      |     treatment        |                      |
|                      |     alternatives for |                      |
|                      |     children in      |                      |
|                      |     psychiatric      |                      |
|                      |     residential      |                      |
|                      |     treatment        |                      |
|                      |     facilities,      |                      |
|                      |     which was        |                      |
|                      |     included in the  |                      |
|                      |     *New Freedom     |                      |
|                      |     Initiative       |                      |
|                      |     Medicaid         |                      |
|                      |     Demonstrations   |                      |
|                      |     Act of 2003* and |                      |
|                      |     the President's  |                      |
|                      |     FY 2005 budget.  |                      |
|                      |                      |                      |
|                      | -   CMS offered a    |                      |
|                      |     *Mental Health:  |                      |
|                      |     Systems          |                      |
|                      |     Transformation*  |                      |
|                      |     grant            |                      |
|                      |     opportunity      |                      |
|                      |     under the FY     |                      |
|                      |     2004 Real Choice |                      |
|                      |     Systems Change   |                      |
|                      |     Grants to        |                      |
|                      |     improve the      |                      |
|                      |     ability of       |                      |
|                      |     States to offer  |                      |
|                      |     evidence-based   |                      |
|                      |     and              |                      |
|                      |                      |                      |
|                      |    recovery-oriented |                      |
|                      |     services to      |                      |
|                      |     consumers with   |                      |
|                      |     mental illnesses |                      |
|                      |     with support of  |                      |
|                      |     the Medicaid     |                      |
|                      |     system.          |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   *The Living with |                      |
|                      |     Independence,    |                      |
| Coherent,            |     Freedom, and     |                      |
| Cost-Effective       |     Equality* (LIFE) |                      |
| Structure,           |     *Account*        |                      |
| Administration and   |     savings program, |                      |
| Financing            |     proposed in the  |                      |
|                      |     President's FY   |                      |
| *\[Community         |     2005 budget,     |                      |
| Integration\]*       |     would disregard  |                      |
|                      |     assets held in a |                      |
|                      |     LIFE Account in  |                      |
|                      |     determining      |                      |
|                      |     eligibility or   |                      |
|                      |     benefit level    |                      |
|                      |     for Medicaid or  |                      |
|                      |     any Federal      |                      |
|                      |     assistance       |                      |
|                      |     program.         |                      |
+----------------------+----------------------+----------------------+
|                      | -   HCBS (Home and   | -   This proposal is |
|                      |     Community Based  |     also included in |
|                      |     Services) State  |     the FY 2005      |
|                      |     Plan Option to   |     President's      |
|                      |     remove           |     Budget.          |
|                      |     eligibility      |                      |
|                      |     uncertainty and  |                      |
|                      |     delays in the    |                      |
|                      |     transition from  |                      |
|                      |     institutions.    |                      |
|                      |     Presumptive      |                      |
|                      |     eligibility for  |                      |
|                      |     individuals who  |                      |
|                      |     are              |                      |
|                      |     transitioning    |                      |
|                      |     from institution |                      |
|                      |     to the community |                      |
|                      |     was included in  |                      |
|                      |     the New Freedom  |                      |
|                      |     Initiative       |                      |
|                      |     Medicaid         |                      |
|                      |     Demonstrations   |                      |
|                      |     Act of 2003 and  |                      |
|                      |     transmitted to   |                      |
|                      |     Congress.        |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   Services for     | -   This proposal is |
|                      |     children in      |     also included in |
| Coherent,            |     residential      |     the FY 2005      |
| Cost-Effective       |     treatment: The   |     President's      |
| Structure,           |     *Demonstration   |     Budget.          |
| Administration and   |     of Community     |                      |
| Financing            |     Alternatives to  |                      |
|                      |     Psychiatric      |                      |
| *\[Community         |     Residential      |                      |
| Integration\]*       |     Treatment for    |                      |
|                      |     Children* was    |                      |
|                      |     included by HHS  |                      |
|                      |     in the *New      |                      |
|                      |     Freedom          |                      |
|                      |     Initiative       |                      |
|                      |     Medicaid         |                      |
|                      |     Demonstrations   |                      |
|                      |     Act* of 2003 and |                      |
|                      |     transmitted to   |                      |
|                      |     Congress.        |                      |
|                      |                      |                      |
|                      | -   Funding for      |                      |
|                      |     States to        |                      |
|                      |     conduct          |                      |
|                      |     feasibility      |                      |
|                      |     studies to       |                      |
|                      |     participate in a |                      |
|                      |     demonstration of |                      |
|                      |     community        |                      |
|                      |     alternatives to  |                      |
|                      |     Psychiatric      |                      |
|                      |     Residential      |                      |
|                      |     Treatment        |                      |
|                      |     Facilities       |                      |
|                      |     (PRTF) was       |                      |
|                      |     awarded through  |                      |
|                      |     the FY 2003      |                      |
|                      |     *Systems Change* |                      |
|                      |     rubric. This     |                      |
|                      |     funding enables  |                      |
|                      |     States to plan   |                      |
|                      |     the              |                      |
|                      |     infrastructure   |                      |
|                      |     changes, package |                      |
|                      |     of services and  |                      |
|                      |     enrollment       |                      |
|                      |     mechanisms for   |                      |
|                      |     such a           |                      |
|                      |     demonstration.   |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   Medicaid         | -   CMS plans to     |
|                      |     Services Reform  |     continue the     |
| Coherent,            |     Taskforce: *NFI  |     *Open Door       |
| Cost-Effective       |     Open Door Forum  |     Forum* series,   |
| Structure,           |     Series*, which   |     as a mechanism   |
| Administration and   |     provides a       |     for public input |
| Financing            |     mechanism for    |     on               |
|                      |     public input on  |     community-based  |
| *\[Health\]*         |     community-based  |     services policy. |
|                      |     services policy  |     The frequency of |
|                      |                      |     forums will be   |
|                      | ```{=html}           |     reduced to       |
|                      | <!-- -->             |     quarterly.       |
|                      | ```                  |                      |
|                      | -   March: Overview  |                      |
|                      |     of the           |                      |
|                      |     President's 2004 |                      |
|                      |     Budget and       |                      |
|                      |     selected NFI     |                      |
|                      |     initiatives      |                      |
|                      |                      |                      |
|                      | -   April: The       |                      |
|                      |     \$1.75 billion   |                      |
|                      |     *Money Following |                      |
|                      |     the Person*      |                      |
|                      |     initiative       |                      |
|                      |                      |                      |
|                      | -   May:             |                      |
|                      |     Self-Directed    |                      |
|                      |     Services: tenets |                      |
|                      |     of self          |                      |
|                      |     direction;       |                      |
|                      |     issues related   |                      |
|                      |     to quality,      |                      |
|                      |     consumer         |                      |
|                      |     protections;     |                      |
|                      |     payment to       |                      |
|                      |     family members;  |                      |
|                      |     the new CMS      |                      |
|                      |     *Independence    |                      |
|                      |     Plus* waiver.    |                      |
|                      |                      |                      |
|                      | -   June: Briefing   |                      |
|                      |     on CMS's Quality |                      |
|                      |     Framework for    |                      |
|                      |     HCBS (Home and   |                      |
|                      |     Community Based  |                      |
|                      |     Services)        |                      |
|                      |                      |                      |
|                      | -   July: HCBS:      |                      |
|                      |     Facilitating     |                      |
|                      |     community        |                      |
|                      |     integration      |                      |
|                      |                      |                      |
|                      | -   August: Mental   |                      |
|                      |     health issues    |                      |
|                      |     and initiatives  |                      |
|                      |     related to the   |                      |
|                      |     President's *New |                      |
|                      |     Freedom          |                      |
|                      |     Commission on    |                      |
|                      |     Mental Health*   |                      |
|                      |                      |                      |
|                      | -   September:       |                      |
|                      |     Advancing the    |                      |
|                      |     employment of    |                      |
|                      |     people with      |                      |
|                      |     disabilities     |                      |
|                      |                      |                      |
|                      | -   October:         |                      |
|                      |     Workforce        |                      |
|                      |     Shortage         |                      |
|                      |     Solutions for    |                      |
|                      |     recruitment and  |                      |
|                      |     retention        |                      |
|                      |                      |                      |
|                      | -   November: HCBS   |                      |
|                      |     improvements     |                      |
|                      |                      |                      |
|                      | -   December:        |                      |
|                      |     Facilitating     |                      |
|                      |     coordination of  |                      |
|                      |     services with    |                      |
|                      |     accessible and   |                      |
|                      |     affordable       |                      |
|                      |     housing          |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   CMS's *National  | -   All three prongs |
|                      |     Technical        |     of the National  |
| Coherent,            |     Assistance       |     Technical        |
| Cost-Effective       |     Strategy* has 3  |     Strategy will    |
| Structure,           |     components:      |     continue.        |
| Administration and   |                      |                      |
| Financing            | ```{=html}           |                      |
|                      | <!-- -->             |                      |
| *\[Health\]*         | ```                  |                      |
|                      | -   Since 2002, CMS  |                      |
|                      |     has provided a   |                      |
|                      |     coherent         |                      |
|                      |     national program |                      |
|                      |     of technical     |                      |
|                      |     assistance to    |                      |
|                      |     States through   |                      |
|                      |     its *National    |                      |
|                      |     State-to-State   |                      |
|                      |     Technical        |                      |
|                      |     Assistance for   |                      |
|                      |     Community        |                      |
|                      |     Living* grant    |                      |
|                      |     opportunity      |                      |
|                      |     under Real       |                      |
|                      |     Choice System    |                      |
|                      |     Change.          |                      |
|                      |                      |                      |
|                      | -   A repository of  |                      |
|                      |     "promising       |                      |
|                      |     practices,"      |                      |
|                      |     descriptions of  |                      |
|                      |     State activities |                      |
|                      |     that strengthen  |                      |
|                      |     their            |                      |
|                      |     community-based  |                      |
|                      |     long term        |                      |
|                      |     support systems, |                      |
|                      |     is maintained on |                      |
|                      |     the CMS website  |                      |
|                      |     at               |                      |
|                      |                      |                      |
|                      | [www.cms.hhs.gov/pro |                      |
|                      | misingpractices](htt |                      |
|                      | p://www.cms.hhs.gov/ |                      |
|                      | promisingpractices). |                      |
|                      |                      |                      |
|                      | -   A national       |                      |
|                      |     clearinghouse of |                      |
|                      |     technical        |                      |
|                      |     assistance       |                      |
|                      |     products related |                      |
|                      |     to home and      |                      |
|                      |     community based  |                      |
|                      |     services,        |                      |
|                      |     including        |                      |
|                      |     employment, is   |                      |
|                      |     maintained at    |                      |
|                      |                      |                      |
|                      |    [www.hcbs.org](ht |                      |
|                      | tp://www.hcbs.org/). |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   Clarification of | -   CMS is           |
|                      |     Medicaid         |     developing       |
| Coherent,            |     policies         |     technical        |
| Cost-Effective       |     affecting        |     assistance       |
| Structure,           |     individuals with |     materials for    |
| Administration and   |     psychiatric and  |     both State       |
| Financing            |     co-occurring     |     Medicaid program |
|                      |     disorders: CMS   |     directors and    |
| *\[Health\]*         |     has approved one |     State Mental     |
|                      |     peer support     |     Health           |
|                      |     program          |     Commissioners to |
|                      |     (Georgia) for    |     clarify          |
|                      |     reimbursement    |     Medicaid's       |
|                      |     under Medicaid   |     support for the  |
|                      |     and is           |     use of           |
|                      |     developing       |     evidence-based   |
|                      |     guidelines for   |     practices and    |
|                      |     other states.    |     the components   |
|                      |                      |     of the practices |
|                      | -   CMS has          |     that Medicaid    |
|                      |     contracted with  |     will reimburse.  |
|                      |     Lewin to provide |     The materials    |
|                      |     technical        |     should help      |
|                      |     assistance and   |     states           |
|                      |     guidance to      |     understand the   |
|                      |     States and CMS   |     relevant         |
|                      |     regions to       |     questions that   |
|                      |     improve State    |     must be          |
|                      |     understanding of |     addressed when   |
|                      |     existing options |     submitting a     |
|                      |     under Medicaid   |     Medicaid state   |
|                      |     using both       |     plan amendment.  |
|                      |     waivers and      |                      |
|                      |     State Plan       |                      |
|                      |     services to      |                      |
|                      |     improve access   |                      |
|                      |     to               |                      |
|                      |     community-based  |                      |
|                      |     services for     |                      |
|                      |     both children    |                      |
|                      |     and adults with  |                      |
|                      |     mental illness   |                      |
|                      |     or co-occurring  |                      |
|                      |     mental illness   |                      |
|                      |     and substance    |                      |
|                      |     use disorders.   |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   Center for       | -   Implementation   |
|                      |     Medicaid and     |     of the *Action   |
| Coherent,            |     State Options    |     Plan for         |
| Cost-Effective       |     (CMSO) developed |     Quality*,        |
| Structure,           |     a multi-pronged  |     including the    |
| Administration and   |     strategy to      |     development and  |
| Financing            |     improve quality  |     dissemination of |
|                      |     of care issues   |     tools and        |
| *\[Health\]*         |     in HCBS. The     |     technical        |
|                      |     *CMS Action Plan |     assistance to    |
|                      |     for Quality*     |     assist States in |
|                      |     details multiple |     improving        |
|                      |     actions CMSO     |     quality, and     |
|                      |     will take to     |     changes in       |
|                      |     assure and       |     procedure for    |
|                      |     improve quality  |     CMS Regional     |
|                      |     and strengthen   |     Offices to       |
|                      |     state and        |     establish an     |
|                      |     federal          |     on-going         |
|                      |     oversight of     |     dialogue about   |
|                      |     quality.         |     quality with the |
|                      |                      |     States, *i.e.*,  |
|                      | ```{=html}           |     a continuous     |
|                      | <!-- -->             |     quality          |
|                      | ```                  |     improvement      |
|                      | -   CMS developed    |     process as       |
|                      |     the *Quality     |     opposed to       |
|                      |     Framework,* a    |     intermittent     |
|                      |     guide to provide |     reviews          |
|                      |     States with a    |                      |
|                      |     uniform national | -   CMS will         |
|                      |     format to        |     continue         |
|                      |     describe the key |     on-going         |
|                      |     components of    |     dialogues with   |
|                      |     their HCBS       |     major state      |
|                      |     quality          |     associations     |
|                      |     assurance and    |     about necessary  |
|                      |     quality          |     requirements for |
|                      |     improvement      |     quality and best |
|                      |     programs. The    |     ways to meet     |
|                      |     *Quality         |     those            |
|                      |     Framework*       |     requirements.    |
|                      |     provides a       |                      |
|                      |     common frame of  |                      |
|                      |     reference for    |                      |
|                      |     CMS and States   |                      |
|                      |     to communicate   |                      |
|                      |     about quality    |                      |
|                      |     goals and        |                      |
|                      |     activities.      |                      |
|                      |                      |                      |
|                      | -   CMS disseminated |                      |
|                      |     the *HCBS        |                      |
|                      |     Quality Brief*,  |                      |
|                      |     a collection of  |                      |
|                      |     6 "best          |                      |
|                      |     practices"       |                      |
|                      |     evidenced by     |                      |
|                      |     States in        |                      |
|                      |     quality          |                      |
|                      |     improvement      |                      |
|                      |     activities.      |                      |
|                      |                      |                      |
|                      | -   CMS provided     |                      |
|                      |     funding for      |                      |
|                      |     States to        |                      |
|                      |     conduct research |                      |
|                      |     and for          |                      |
|                      |     demonstration    |                      |
|                      |     grants in        |                      |
|                      |     quality          |                      |
|                      |     assurance and    |                      |
|                      |     improvement in   |                      |
|                      |     HCBSs under the  |                      |
|                      |     FY 2003 *Real    |                      |
|                      |     Choice Systems   |                      |
|                      |     Change*          |                      |
|                      |     initiative.      |                      |
|                      |     These grants     |                      |
|                      |     assisted States  |                      |
|                      |     to analyze and   |                      |
|                      |     test new         |                      |
|                      |     approaches to    |                      |
|                      |     ensure and       |                      |
|                      |     improve quality, |                      |
|                      |     and implement    |                      |
|                      |     new quality      |                      |
|                      |     assurance and    |                      |
|                      |     quality          |                      |
|                      |     improvement      |                      |
|                      |     systems uniquely |                      |
|                      |     suited for       |                      |
|                      |     services in      |                      |
|                      |     one\'s own home. |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   CMSO developed a |                      |
|                      |     multi-pronged    |                      |
| Coherent,            |     strategy to      |                      |
| Cost-Effective       |     improve quality  |                      |
| Structure,           |     of care issues   |                      |
| Administration and   |     in HCBS,         |                      |
| Financing            |     *continued*:     |                      |
|                      |     CMSO executed a  |                      |
| *\[Health\]*         |     national         |                      |
|                      |     contract to      |                      |
|                      |     provide on-site  |                      |
|                      |     technical        |                      |
|                      |     assistance and   |                      |
|                      |     other            |                      |
|                      |     consultation to  |                      |
|                      |     States and CMS   |                      |
|                      |     Regional Offices |                      |
|                      |     to enhance their |                      |
|                      |     capabilities for |                      |
|                      |     quality          |                      |
|                      |     improvement.     |                      |
|                      |                      |                      |
|                      | -   CMSO             |                      |
|                      |     disseminated the |                      |
|                      |     HCBS *Quality    |                      |
|                      |     Tools*, a CD ROM |                      |
|                      |     including survey |                      |
|                      |     tools and a      |                      |
|                      |     quality          |                      |
|                      |     improvement      |                      |
|                      |     workbook to      |                      |
|                      |     enhance the      |                      |
|                      |     States' ability  |                      |
|                      |     to conduct       |                      |
|                      |     quality          |                      |
|                      |     improvement      |                      |
|                      |     activities.      |                      |
+----------------------+----------------------+----------------------+
|                      | -   Action           |                      |
|                      |     Reinvestment for |                      |
|                      |     Quality: CMS has |                      |
|                      |     revised its      |                      |
|                      |     waiver review    |                      |
|                      |     process from a   |                      |
|                      |     cycle of reviews |                      |
|                      |     every 5 years to |                      |
|                      |     an annual        |                      |
|                      |     dialogue with    |                      |
|                      |     States on issues |                      |
|                      |     of quality. This |                      |
|                      |     has increased    |                      |
|                      |     the prospect for |                      |
|                      |     prompt and       |                      |
|                      |     effective remedy |                      |
|                      |     of identified    |                      |
|                      |     problems.        |                      |
+----------------------+----------------------+----------------------+
|                      | -   Adequate         |                      |
|                      |     Management       |                      |
|                      |     Infrastructure:  |                      |
|                      |     CMS developed    |                      |
|                      |     web-based        |                      |
|                      |     on-line          |                      |
|                      |     reporting        |                      |
|                      |     formats for all  |                      |
|                      |     of its grants    |                      |
|                      |     programs that    |                      |
|                      |     fund community   |                      |
|                      |     systems          |                      |
|                      |     improvement.     |                      |
|                      |     Data collected   |                      |
|                      |     from these       |                      |
|                      |     reports will be  |                      |
|                      |     used to identify |                      |
|                      |     priority areas   |                      |
|                      |     for future       |                      |
|                      |     funds.           |                      |
|                      |                      |                      |
|                      | -   CMS invested     |                      |
|                      |     staff and        |                      |
|                      |     financial        |                      |
|                      |     resources to     |                      |
|                      |     improving our    |                      |
|                      |     data collection, |                      |
|                      |     management and   |                      |
|                      |     analysis         |                      |
|                      |     capacity with    |                      |
|                      |     regard to the    |                      |
|                      |     home and         |                      |
|                      |     community-based  |                      |
|                      |     waiver program   |                      |
|                      |     and state plan   |                      |
|                      |     services.        |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 1:           | -   In FYs 2001,     | -   In FY 2004, CMS  |
|                      |     2002, and 2003   |     anticipates      |
| Coherent,            |     the Congress     |     awarding 46-76   |
| Cost-Effective       |     appropriated     |     new Real Choice  |
| Structure,           |     funds for Real   |     Systems change   |
| Administration and   |     Choice Systems   |     Grants.          |
| Financing            |     Change Grants,   |                      |
|                      |     specifically to  |                      |
| *\[Health\]*         |     improve          |                      |
|                      |                      |                      |
|                      | community-integrated |                      |
|                      |     services and CMS |                      |
|                      |     awarded grants   |                      |
|                      |     totaling         |                      |
|                      |     approximately    |                      |
|                      |     \$158 million to |                      |
|                      |     49 states, the   |                      |
|                      |     District of      |                      |
|                      |     Columbia, and    |                      |
|                      |     two territories. |                      |
|                      |     With this        |                      |
|                      |     support, States  |                      |
|                      |     are continuing   |                      |
|                      |     to address       |                      |
|                      |     issues such as   |                      |
|                      |     personal         |                      |
|                      |     assistance       |                      |
|                      |     services, direct |                      |
|                      |     service worker   |                      |
|                      |     shortages,       |                      |
|                      |     transitions from |                      |
|                      |     institutions to  |                      |
|                      |     the community,   |                      |
|                      |     respite service  |                      |
|                      |     for caregivers   |                      |
|                      |     and family       |                      |
|                      |     members, and     |                      |
|                      |     better           |                      |
|                      |     transportation   |                      |
|                      |     options.         |                      |
+----------------------+----------------------+----------------------+
| Chapter 2:           | -   Self-directed    | -   CMS requested    |
|                      |     services waiver: |     comments on the  |
| Promoting            |     The initial      |     original         |
| Independence,        |     *Independence    |     Independence     |
| Responsibility, and  |     Plus* templates  |     Plus templates,  |
| Consumer-Driven      |     were announced   |     which will be    |
| Services             |     in May 2002. The |     used to issue    |
|                      |     templates guide  |     revisions.       |
| *\[Health\]*         |     states in        |                      |
|                      |     developing       |                      |
|                      |     either 1115 or   |                      |
|                      |     1915(c) waivers  |                      |
|                      |     offering         |                      |
|                      |     families or      |                      |
|                      |     individuals      |                      |
|                      |     greater          |                      |
|                      |     opportunities to |                      |
|                      |     take charge of   |                      |
|                      |     their own health |                      |
|                      |     and direct their |                      |
|                      |     own services.    |                      |
|                      |                      |                      |
|                      | -   Technical        |                      |
|                      |     assistance       |                      |
|                      |     materials were   |                      |
|                      |     developed by CMS |                      |
|                      |     technical        |                      |
|                      |     assistance       |                      |
|                      |     providers and    |                      |
|                      |     posted on        |                      |
|                      |                      |                      |
|                      |    [www.hcbs.org](ht |                      |
|                      | tp://www.hcbs.org/). |                      |
|                      |                      |                      |
|                      | -   CMS provided     |                      |
|                      |     funding for      |                      |
|                      |     States to        |                      |
|                      |     develop          |                      |
|                      |     *Independence    |                      |
|                      |     Plus* waiver or  |                      |
|                      |     demonstration    |                      |
|                      |     applications     |                      |
|                      |     under the FY     |                      |
|                      |     2003 *Real       |                      |
|                      |     Choice Systems   |                      |
|                      |     Change*          |                      |
|                      |     initiative.      |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 3:           | -   Aging and        |                      |
|                      |     Disability       |                      |
| Assistance to        |     Resource Center  |                      |
| Families and         |     grant program:   |                      |
| Informal Caregivers  |     In FY 2003, CMS  |                      |
|                      |     and AoA jointly  |                      |
| *\[Health\]*         |     funded an Aging  |                      |
|                      |     and Disability   |                      |
|                      |     Resource Center  |                      |
|                      |     grant program.   |                      |
|                      |     This grant       |                      |
|                      |     program assists  |                      |
|                      |     States develop   |                      |
|                      |     single points of |                      |
|                      |     entry for home   |                      |
|                      |     and community    |                      |
|                      |     based services   |                      |
|                      |     and insures that |                      |
|                      |     individuals have |                      |
|                      |     clear pathways   |                      |
|                      |     to determining   |                      |
|                      |     Medicaid         |                      |
|                      |     eligibility.     |                      |
|                      |     Twelve States    |                      |
|                      |     received grant   |                      |
|                      |     awards in FY     |                      |
|                      |     2003 and 12 more |                      |
|                      |     grants to States |                      |
|                      |     were made in FY  |                      |
|                      |     2004 under this  |                      |
|                      |     program.         |                      |
+----------------------+----------------------+----------------------+
|                      | -   Medicaid respite | -   This proposal is |
|                      |     service for      |     also included in |
|                      |     adults:          |     the FY 2005      |
|                      |     Authorization    |     President's      |
|                      |     and funding for  |     Budget.          |
|                      |     a 10-year        |                      |
|                      |     demonstration to |                      |
|                      |     provide respite  |                      |
|                      |     services for     |                      |
|                      |     adults was       |                      |
|                      |     included in the  |                      |
|                      |     New Freedom      |                      |
|                      |     Initiative       |                      |
|                      |     Medicaid         |                      |
|                      |     Demonstration    |                      |
|                      |     Act that was     |                      |
|                      |     transmitted to   |                      |
|                      |     Congress.        |                      |
|                      |                      |                      |
|                      | -   Funding from the |                      |
|                      |     FY 2003 *Systems |                      |
|                      |     Change* grant    |                      |
|                      |     solicitation was |                      |
|                      |     specifically set |                      |
|                      |     aside for        |                      |
|                      |     feasibility      |                      |
|                      |     study grants to  |                      |
|                      |     states to        |                      |
|                      |     prepare for the  |                      |
|                      |     demonstration    |                      |
|                      |     above.           |                      |
+----------------------+----------------------+----------------------+
|                      | -   Demonstration of | -   This proposal is |
|                      |     respite service  |     also included in |
|                      |     for caregivers   |     the FY 2005      |
|                      |     of children:     |     President's      |
|                      |     Authorization    |     Budget.          |
|                      |     and funding for  |                      |
|                      |     a 10-year        |                      |
|                      |     demonstration to |                      |
|                      |     provide respite  |                      |
|                      |     services for     |                      |
|                      |     children was     |                      |
|                      |     included in the  |                      |
|                      |     New Freedom      |                      |
|                      |     Initiative       |                      |
|                      |     Medicaid         |                      |
|                      |     Demonstration    |                      |
|                      |     Act that was     |                      |
|                      |     transmitted to   |                      |
|                      |     Congress.        |                      |
|                      |                      |                      |
|                      | -   Funding from the |                      |
|                      |     FY 2003 *Systems |                      |
|                      |     Change* grant    |                      |
|                      |     solicitation was |                      |
|                      |     specifically set |                      |
|                      |     aside for        |                      |
|                      |     feasibility      |                      |
|                      |     study grants to  |                      |
|                      |     states to        |                      |
|                      |     prepare for the  |                      |
|                      |     demonstration    |                      |
|                      |     above.           |                      |
+----------------------+----------------------+----------------------+
| #### NFI Chapte      | **2003 Update of NFI | **2004-2005 Next     |
| r: Solution Category | Activity**           | Steps**              |
|                      |                      |                      |
| ***\[NFI Domain\]*** | **and Funding**      |                      |
+----------------------+----------------------+----------------------+
| Chapter 5:           |                      | -   CMS is working   |
|                      |                      |     with the         |
| Accountability and   |                      |     *Community       |
| Fulfillment of Legal |                      |     Living Exchange  |
| Obligations          |                      |     Collaborative*,  |
|                      |                      |     funded from the  |
| Section D:           |                      |     *Systems Change* |
|                      |                      |     appropriation to |
| Specialized          |                      |     enhance and      |
| Technical Assistance |                      |     launch a         |
| and Related          |                      |     redesigned       |
| Activities           |                      |     clearinghouse    |
|                      |                      |     for all          |
| Part 1:              |                      |     stakeholders     |
|                      |                      |     involved with    |
| Applied Knowledge    |                      |     community        |
|                      |                      |     systems          |
| *\[Health\]*         |                      |     development at   |
|                      |                      |                      |
|                      |                      |    [www.hcbs.org](ht |
|                      |                      | tp://www.hcbs.org/). |
|                      |                      |     This website     |
|                      |                      |     will include     |
|                      |                      |     contributions    |
|                      |                      |     from technical   |
|                      |                      |     assistance       |
|                      |                      |     centers,         |
|                      |                      |     university       |
|                      |                      |     researchers,     |
|                      |                      |     grantees,        |
|                      |                      |     states, and      |
|                      |                      |     contractors.     |
+----------------------+----------------------+----------------------+

##