Actual 2013 Actual 4 7 0 0 4 15 2014 Actual 6 11 0 0 7 24 2015 4 12 0 0 10 26 2016 2 5 0 0 13 20 2017 2 5 0 0 13 20 2018 2 5 0 0 13 20 TOTAL 20 46 0 0 60 126 #2 MEDICAID EXPENDITURES FOR HCBS Increase in Qualified HCBS expenditures for each year of the demonstration Maine assumes flat funding for waiver services through the grant period, with the exception of increases related to implementation of the ORC waiver. All other increases in expenditures will be due to transition of MFP participants to waiver services after one year on the MFP program. The 1915c waiver expenditure increase is based on qualified HCBS costs being added for MFP participants moving to the Elder and Adults with Disabilities and ORC Waivers each year. This table is completed using an estimated annual projection according to the budget. It does not show cumulative representation of total expenditures. There is some fluctuation from year to year related to a change in the number of people projected to transition each year. Calendar Year 1915c Waivers State Plan HCBS (Personal Care & Home Health) MFP (Qualified, Demo & Supplemental) Total Annual Percentage Increase
Maine has designated the Long Term Care Ombudsman Program (LTCOP) as the Local Contact Agency (LCA). When a resident indicates a preference for living in the community, the Nursing Facility will follow the Section Q Protocol detailed in FIGURE 3, page 28. The role of LTCOP as the LCA is to make in person contact and provide general information about community living services and supports upon receipt of the referral. LTCOP will in turn make referrals to the Center for Independent Living (Alpha One) and or the local ADRC as per individual needs. For individuals who appear to meet threshold eligibility (the individual is currently or likely to become eligible for Medicaid, and the individual is currently or likely to meet the 90-day residency requirement), a referral will be initiated for HOMEWARD BOUND. Supported by ADRC supplemental funds, Maine’s Long Term Care Ombudsman Program will work in partnership with the Office of Aging and Disability Services, the ADRCs and Alpha One to support full implementation of the MDS Section Q protocol to include development of a tracking system in order to monitor compliance and address challenges. ACCESS TO RESIDENTS AND PATIENTS IN NURSING FACILITIES AND HOSPITALS The Department will conduct an education and outreach campaign targeting nursing facilities, working with their provider association and the Maine Long Term Care Ombudsman to deliver the message. This training will provide information about the MFP Demonstration and its processes as well as introduce the revisions to the Section Q referral protocols incorporating referrals to Homeward Bound. Persons whose activities involve contacting participants or potential participants in nursing facilities will, if needed, have access to a Provider Letter describing the MFP Demonstration, their roles and responsibilities, the fact that they are agents of the Department, and have the authority to meet with residents to determine their interest in MFP. ENROLLMENT AND TRANSITION PROCESS The enrollment process will take place in three stages: Participation in the Preliminary Assessment Process Enrollment into the Transition Planning Process Enrollment into the Transition Process 2: THE PRELIMINARY ASSESSMENT PROCESS Upon referral the Referral Manager initiates the Preliminary Assessment Process. The purpose of the Preliminary Assessment process is to capture information about the potential Homeward Bound participant. The information collected will help determine if the individual is a likely candidate for Homeward Bound and, if so, what type of Transition Coordinator is needed. This information will also help the Transition Coordinator build an Individualized Transition Plan.
Table 9: Quality Assurance Monitoring The Demonstration Director will have responsibility for monitoring performance measures. Sampling will be 100% for all measures. CMS Assurance MFP Quality Indicator Step in Process Process Details Monitoring method Data Source Document Performance Measure Frequency of Data Collection Frequency of data aggregation and analysis CMS-Appendix B: Participant Access and Eligibility MFP-Participant Eligibility The Medicaid Agency retains ultimate administrative authority and responsibility for the operation of the waiver program by exercising oversight of the performance of waiver functions by other state and local/regional agencies (if appropriate) and contracted entities Preliminary Assessment Process Transition Planning Process Transition Process TM keeps track of referrals by facility /by region and report to Office of Aging and Disability Services (OADS); TM verifies eligibility threshold criteria for MFP Demonstration TM keeps track of first assessment, timelines and outcomes and report to OADS TM reviews reports and follows up as necessary Tracking form # of referrals by region and by surrogate or legal guardian # and % of individuals at each step in process based on status and choice # Appeals or complaints related to eligibility within process Average time from start of process to transition discharge Continuous Quarterly
CMS-Appendix B.6: Evaluation & Reevaluation of Level of Care MFP-Waiver, State Plan, Complex Case Level of Care Sub-assurance a. - An evaluation for LOC is provided to all applicants for whom there is reasonable indication that services may be needed in the future. Preliminary Assessment Process Transition Planning Process Transition Process Determine NF LOC at time of transition; TC assigns to appropriate Assessing Services Agency (ASA) based on service needs (waiver or complex case services) TM reviews LOC, MDS, readiness assessment, and self-assessment Tracking form # enrolled by target group (type of needs (ADLs, nursing, complex) Reason for Continuous Monthly CMS-Appendix D: Participant-Centered Planning and Service Delivery MFP-Individual Transition Plan (ITP) Sub-assurance a. - Service plans address all participant needs and personal goals either by provision of waiver services or through other means Transition Planning Process TC develops comprehensive Individual Transition Plan (ITP) that includes Risk Assessment, Backup Plan, and all support services needed; Convenes MDT as needed; ITP documented in a tracking system TM reviews and approves transition plan. TM documents approval in tracking system. ITP % of plans that meet needs and personal goals; # where needs cannot be met, reasons needs cannot be met % of services by category (HCBS, informal, Medicare, MFP Demonstration services, etc.) Ongoing Monthly and Quarterly Sub-assurance b. - State monitors service plan development in accordance with its policies and Transition Planning Process Transition Process TC follows checklist procedure for completing all aspects of transition plan, including timeline for transition, service delivery, and follow-up TM reviews checklist, service plan and risk assessment prior to discharge. Transition checklist ITP # and % by transition outcome Ongoing Monthly and Quarterly
procedures evaluation. Sub-assurance c. - Service plans updated/revised at least annually or when warranted by waiver participant needs Transition Process Post Transition CC conducts reevaluation of plan prior to day 365 of MFP Demonstration for all participants. Additionally, the CC reviews the ITP, at least quarterly, and updates the plan as needed, based on a change in the participant's needs. Document any unmet needs. Develop plan to address unmet needs. All requests for change in ITP go through TM Change Request form Health & Welfare Case Review form # and % of service plan change requests # and % increases, reductions, terminations due to change in needs Reasons for termination from MFP Ongoing Quarterly Sub-assurance d. - Services are delivered in accordance with the service plan, including the type, scope, amount, duration and frequency specified in the service plan. Transition Process Post Transition TC follows up with participant on a monthly basis for first year to determine if all needs are being met and transition plan is working. TM follows-up with participant by phone at least quarterly. OADS tracks claims data for MFP participants TM verifies discharge plan with all services in place Compare authorized plan to services delivered. Discharge Plan QoL survey Health & Welfare Case Review form Total number of participants within given time frame QoL analysis Claims analysis QoL and Health & Welfare = Ongoing Claims =Quarterly Quarterly Sub-assurance e. - Participants are afforded choice: Between waiver services and institutional care; and between /among waiver services and Preliminary Assessment Process Transition Planning Process Transition Process TM or TC will describe MFP process and receive informed consent at each step in MFP process; at initial meeting; at time of transition planning process; and at time of transition process. TC will receive choice TM and TC offer choice as indicated in process steps. TC documents participant’s choice of provider. Choice letters # and % by choice at each step in process Choice of provider documented on ITP Ongoing Quarterly
providers. letter at time of enrollment into transition process. TC solicits participant’s choice in selecting services and providers. CMS-Appendix G: Participant Safeguards – Health & Welfare MFP-Risk Mitigation and Health & Welfare Case Review Sub-assurance a. - The State, on an ongoing basis, identifies, addresses and seeks to prevent the occurrence of abuse, neglect and exploitation. Transition Planning Process Transition Process Post Transition Documentation of backup plan in ITP CC completes Health and Welfare Case Review form (or equivalent) at every home visit and case review once person in community. Form documents action taken when unmet need or risk identified. All reportable events are logged on Reportable Event Form. Verify adequate backup plan in ITP TM reviews Health & Welfare Case Review forms ITP Backup Plan Health & Welfare Case Review forms # and % of Health & Welfare form by action items. # and % of MFP participants referred to APS # and % referrals, complaints handled by LTCOP for MFP population Aggregate data from H & W form provided to TM on quarterly basis. Request quarterly report from MAPSIS of all MFP referrals from Care Coordination Agencies Quarterly Annual qualitative summary of sources of backup support Abbreviations APS - Adult Protective Services ASA – Assessing Services Agency CC – Community Coordinator ITP - Individual Transition Plan LOC – Level of Care LTCOP – Long Term Care Ombudsman Program MDS – Minimum Data Set (nursing facility assessment tool) NF – Nursing Facility OADS – Office of Aging and Disability Services QM – Quality Management