Arkansas
Money Follows the Person (MFP)

 
money follows the person horizontal rule
Program Highlights
 

The Arkansas Money Follows the Person application has transitioned 436 individuals who have resided in institutions 90 days or longer into qualified home and community-based programs. The following populations residing in nursing homes and ICF-MRs will be served: Individuals with developmental disabilities/mental retardation; individuals 19 to 64 with physical disabilities; and individuals age
65+.

Number of people targeted for transition through 2013: 440

Minimum Eligibility prior to transition:
A period of 90 days that includes hospitalization and current receipt of Medicaid benefits for in-patient services for at least 1 day.

Populations targeted for transition:
Elderly; adults (18 and over) with physical disabilities, individuals with developmental disabilities; and individuals with mental illness.

Qualified Facilities:
Licensed nursing homes, the Arkansas Health Center under the administration of the Division of Behavioral Health and ICF/MRs.

Qualified Residence in Community:
A home leased or owned by the individual or the individual's family member; and apartment with an individual lease; or a residence, in a community-based residential setting in which no more than 4 unrelated individuals reside. test

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  Operational Protocol

The Operational Protocol, Phase One of the Money Follows the Person Initiative, will address key issues such as target population(s), participant selection mechanisms, a detailed service delivery plan, and a quality management system. This document will be submitted in December to the Centers for Medicare and Medicaid Services for review and revised as needed each January thereafter.

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Benchmarks
 

Purpose: To measure progress in transitioning individuals to the community and rebalancing its long-term care system.

Mandatory:

1. Arkansas will assist individuals, from four target groups of eligible individuals, in transitioning from institutional settings to qualified community based settings, as shown below.

 

Aged

MRDD

Physically Disabled

Adults with MI

Total

FY 2007

0

0

0

0

0

FY2008

5

0

14

0

19

FY2009

13

2

12

2

29

FY2010

20

16

15

2

53

FY2011

6

83

26

1

116

FY2012

11

59

35

0

105

FY2013

13

65

39

0

117

FY2014

15

72

44

0

131

FY2015

17

79

53

0

149

FY2016

19

87

58

0

164

Estimated Transitions

119

463

296

5

883

2. Arkansas will demonstrate an increase in qualified expenditures for HCBS during each year of the demonstration program.

Benchmark*
SFY 2007

2008

2009

2010

2011 2012 2013 2014 2015

2016

AR HCBS Expenditures

$291,274,455

$305,838,178

$307,294,550

 $308,750,922

 $310,207,295

 $325,717,659

 $342,003,542

 $359,103,719

 $377,058,905

 $395,911,851

* Note: Benchmark expenditures include the following services: Private Duty Nursing, Independent Choices, Home Health, ElderChoices Waiver, DD ACS Waiver, Targeted Case Management, Alternatives Waiver, Personal Care, and Transportation.

Optional Goal I:

Goal Statement: Arkansas will have a coordinated process of providing resource information on long term care services.

1. Arkansas will staff and manage a fully operational Aging and Disability Resource Center (ADRC), named Choices in Living Resource Center.

Outcome Statements

2011
Outcome Measure

2012
Outcome Measure

2013
Outcome Measure

2014 Outcome Measure

2015 Outcome Measure

2016 Outcome Measure

Hospital D/C planners and/or social workers are aware of ADRC

60%

65%

70%

75%

80%

85%

Responsibility: The Division of Aging and Adult Services (DAAS) is the recipient of a Systems Transformation Grant (STG), funded in part through CMS. The staff involved in this goal consists of the following positions and expertise: One (1) Software Engineer, three (3) Social Service Workers and one (1) Supervisor. In addition to the grant funded positions, the Transition Coordinators (2) and an Options Counseling RN will be center resources.

Optional Goal II:

Goal Statement: There will be a measurable increase in the availability and accessibility of supportive services to transition persons from institutional to the HCBS long term care system.

Outcome Statements

2011 Outcome Measure

2012 Outcome Measure

2013 Outcome Measure

2014 Outcome Measure

2015  Outcome Measures

2016 Outcome Measures

Increase the number of AFH beds by 50% annually starting with a baseline of 11 beds in 2011.

11 beds

17 beds

26 beds

39 beds

59 beds

88 beds


Responsibility: DAAS will act as lead agency
Estimated savings from Enhanced Federal Match Rate received during the MFP demonstration project will be directed into Goal 2 through direct service provision and program development. Arkansas will amend existing waivers to include aforementioned service expansion on a permanent basis.

Optional Goal III:

Goal Statement: There will be a measurable increase in the availability of Self Directed Opportunities in waivers and State Plan optional services, through growth and revisions in existing programs and development of new programs/services.

1. Increase availability of self-directed opportunities to HCBS waiver recipients.

Outcome Statements

2011
Outcome Measure

2012
Outcome Measure

2013
Outcome Measure

2014
Outcome Measure

2015
Outcome Measures

2016
Outcome Measures

Independent Choices State Plan service

3541 Participants

 

3895 Participants

 

4285
Participants

 

4714
Participants

5185
Participants

5015
Participants

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  Participant Recruitment and Enrollment

The Operational Protocol requires a detailed description of the methods used to inform, recruit and enroll potential participants into the MFP project. It is anticipated that several methods will be incorporated into this project, including:

Direct Recruitment: The MDS (Minimum Data Set), a federally mandated Resident Assessment Instrument (RAI), collects vital information on nursing home residents and could be utilized to identify individuals living in institutions who want to return to a home and community residence. The data could also be used to identify those individuals who have similar characteristics to individuals who transitioned out of nursing homes under a previous demonstration grant called Passages. Once these individuals are identified, a personal letter can be sent outlining the project and allowing them the opportunity to request further information.

Indirect Recruitment: The Department of Human Services will conduct a social marketing campaign to inform the public as well as professionals working with the MFP targeted populations about the specifics of the MFP Initiative. Presentations will be conducted throughout the state to facility Family Councils, Arkansas Advocates for Nursing Home Residents, professional organization conferences and workshops, and various local agency venues.

Referral: An individual can self refer or be referred by a variety of sources. Once identified, the potential participant will be screened to determine general eligibility. If eligible, and if the potential participant wishes to continue the process, a more detailed assessment will be completed and a transitional coordinator will discuss their needs, desires and expectations regarding the transitioning process and service plan components of MFP. Each potential participant, and his/her guardian or responsible party, should fully understand all aspects of the project, their rights and responsibilities, and, risks and benefits in order to give informed consent to enroll and participate in the MFP project.

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  Informed Consent
 

Informed Consent should be (1) clearly explained (2) completely understood (3) absolutely voluntary. Informed Consent is a process of information exchange that discloses the intent and elements about the MFP program, including the services and supports provided both during and after the demonstration year; aspects of the transition process; participants rights and responsibilities; criteria for who can provide consent as well as the requirements for someone to "represent" an individual in this manner; and question and answer opportunity.

The Consent Form serves as a written summary of the information that is presented to a potential participant and/or responsible party. The MFP Transition Coordinator is responsible for ensuring that the Informed Consent document is obtained from each participant or responsible party before any transition activities begin.

Rights and Responsibilities

Statement of Rights of MFP Participants

  1. To live as independently, actively and fully as desired.

  2. To have personal information treated confidentially.

  3. To be treated in a courteous and respectful manner and to be free from mental, physical, and financial abuse.

  4. To live safely in a healthy environment.

  5. To be dealt with in a manner that recognizes your individuality and that responds to your needs and preferences. This includes preferences based on ethnic, spiritual, linguistic, familial and cultural factors.

  6. To have information about community services provided to you and to choose the manner in which the services will be provided.

  7. To participate in the assessment of your requirements, development of your service plan, review of your requirements, evaluation and revision of your service plan.

  8. To give or refuse consent to the provision of any community service.

  9. To raise concerns or recommend changes in connection with the community services provided to you and in connection with policies and decisions that affect your interests, to your service provider, government officials or any other person, without fear of interference, coercion, discrimination or reprisal.

  10. To know of any changes to the Money Follows the Person (MFP) Program in a timely manner.

  11. To appeal decisions, actions or conflicts to Division of Aging and Adult Services (DAAS) by calling Toll-Free 866-801-3435 or by formally writing to DAAS to appeal decisions received in writing from DAAS.

Statements of Responsibilities of MFP Participants

  • To know about your rights, and to understand what each right means and how it applies to you.

  • To make your needs and expectations known.

  • To give your consent only when you understand fully what you are agreeing to.

  • To be honest and respectful toward the people who provide your services.

  • To participate in planning and reviewing your services.

  • To let your service provider know if you are having problems with your service or if you feel that your rights are not being respected.

  • To provide true and complete information to any person, associated with the Money Follows the Person (MFP) program, specific to the assessment process, transition planning and implementation and ongoing care, through an authorized plan of care.

  • To ask questions or request the information in an alternative format to ensure full understanding of the process and information being presented.

  • To follow the plan of care and rules governing the programs and services you are enrolled in.

  • To notify your primary care medical provider of any health or medical changes or concerns, in a timely manner.

  • To know and review your Back Up Plan, in the event of need, to ensure service is not interrupted, and to notify the appropriate personnel when the need to implement the Back Up Plan occurred.

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  Benefits and Services
 

The Operation Protocol must detail the services to be made available to the MFP participants; the delivery mechanism (fee-for service, self-directed care, agency directed services, managed care); and the Medicaid mechanism through which the services will be continued at the termination of the demonstration period (Medicaid Section 1915 waivers, Medicaid Demonstration, Section 1115, waivers, State Plan amendments, etc.).

Home and Community Based Services will be provided to each participant through the existing system of Medicaid Waivers and the State Plan services. Each participant will be enrolled into the specific waiver and/or plan service that best addresses their service needs and desires to self-direct their care. Following are charts depicting Medicaid waiver and state plan services available to the MFP participant.

Waiver Characteristics

Waiver
Eligibility
Self
Direct
Option
Services
ElderChoices (EC)
1915 (c)
Income:  300% SSI
Age: 65+
Medical: NF LOC
No, but can self-direct Adult Companion Services and State Plan Personal Care through the IndependentChoices program. Adult Day Care; Adult Day Health Care; Adult Family (Foster) Home; Chore, Companion; Homemaker; Home Delivered Meals; Personal Emergency Response System; Respite.
Amendment requested to add
1. Transitional costs such as utility and security deposits, household goods and other necessary services to establish community living;
2. Home modifications
Developmentally Disabled
(ACS) 1915 (c)
Income: 300% SSI
Age: birth death (dz Prior to age 21)
Medical: ICF-MR LOC
Yes, will be available by end of '08 Adaptive Equipment; Case Management; Community Experiences; Consultative Services; Counseling Service; Crisis Center; Environmental Accessibility Adaptations/Modifications; Non-medical Transportation; Respite; Respite Care Child Support; Specialized Medical Equipment and Supplies; Supplemental Support; Supported Employment; Supportive Living
Independent Choices (IC)
1115 (a)
Full Medicaid eligibility required Yes Companion Service; Consultative Service; Fiscal Support; Individual Directed Goods and Services; Personal Attendant
Adults with
Physical Disabilities (APD)
1915 (c)
Income: 300% SSI;
Age: 21+
Medical: NF LOC
Yes Adaptive Equipment; Case management; Environmental Accessibility Adaptations/Modifications; Fiscal Support; Personal Attendant.
Amendment request to add:
  1. Working Disabled (Medicaid Buy-In participants)
  2. Spousal Impoverishment
  3. Case management and counseling support
  4. Agency attendant
  5. Increasing age limit
  6. Transitional costs such as utility and security deposits, household goods and other  necessary services to establish community living

State Plan Services Available to MFP Participant

Service
Eligibility
Self Direct Option
Case Management
 
No
Personal Care
   

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  Self-Directed Care vs. Agency Directed
 

Self-direction of Medicaid services means that the participant (or representative) has the decision making authority over some or all of his/her services and takes responsibility for taking the direct role in managing them with the assistance of needed supports. Self-direction is an alternative to provider management of services wherein a service provider has the responsibility for managing all aspects of service delivery in accordance with a person-centered planning process.

Self-direction promotes personal choice and control over the delivery of services, including who provides services and how they are delivered. While participant choice is a fundamental construct within Medicaid, participants may need assistance and support in order to effectively exercise this freedom. It is the responsibility of the Medicaid program to ensure the provision of the necessary supports (either paid or unpaid) to people who are eligible to self-direct within the state.

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  Demonstration Services
 

In addition to these programs and services, MFP will introduce several demonstration services that will be made available to the MFP participants during their demonstration period of 12 months. They include:

  1. Telemedicine - "Telemedicine" means the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications. Telemedicine is not a consultation provided by telephone or facsimile machine.

  2. Intense Transitional Coordination - Individuals transitioning from institutions often need more community support than is offered through traditional waiver services. Intense Transitional Management, similar to case management, includes activities such as information and assistance; assistance with linkage with appropriate resource(s), including contact and follow-up with provider(s); and more frequent follow-up with the client to ensure expectations are met regarding outcome of action(s) taken and any need for further services.

  3. In-Home Monitoring Technology - 24/7 personal monitoring system that identifies developing health problems and alerts for potential emergencies by detecting changes in key behaviors. These changes are tracked through a patented technology. It detects prolonged inactivity, extreme temperatures, and other activity and captures this to a web-based program that is monitored by around the clock emergency response operators.

  4. Therapeutic Interventions - An array of medical, health, and other therapeutic activities designed to assess potential risks and identify plans of care for risk mitigation, including:

    Assessments: The application of assessment instruments to evaluate participants' status specific to Nutrition, Depression, Continence, Wound Care, and Medication Management.

  5. Community Transition Services - Items, goods, or services necessary to allow an institutionalized individual to transfer into a community setting. May be provided 60 days prior to discharge from NF up to 60 after discharge and may include:

    Environmental Modifications; Assistive Devices; Security Deposits; Rental and Utility Deposits; Essential furniture, appliances, and household items; other items, goods, or services approved by DAAS as necessary for the health and welfare of the participant.

  6. Supported Living - Supported living is an array of individually tailored services and activities provided to enable eligible persons to reside successfully in their own homes or in an alternative living setting. Services are delivered over a 24-hour period delivered in a protected supervised environment to persons needing this level of supervision on a short-term basis.

  7. 24-Hour Attendant Care - The provision of assistance to a medically stable and/or physically disabled person to accomplish those tasks of daily living that the person is unable to complete independently. Services may include companion services, transportation assistance, accompanying participant to assist with shopping and errands, and incidental housekeeping as necessary. This service is provided on a time-limited basis, in conjunction with other waiver and state plan services to provide around the clock coverage for persons with that level of need.

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  Housing
 

Transitioning to a community residence will be dependent on having a sufficient supply of qualified residences in the service area of the potential participant. Keeping in mind the projected number of participants for each year, the MFP project encompasses the entire state of Arkansas and will require a concerted effort between the State Department of Human Services, Arkansas Development Finance Authority, Public Housing Authorities (PHAs) and other related organizations.

Alfonzo Johnson, the Secretary of the U.S. Department of Housing and Urban Development, sent letters to all public housing authorities (PHAs) requesting their active support and participation in MFP. In addition, the State Director of Public Housing for Arkansas's HUD office sent a similar appeal for support. In essence, the request was made for each existing authority to set local preferences, to use Public Housing units, to set aside Housing Choice vouchers, and Mainstream Vouchers for participants in the MFP project.

An inventory of available units and other housing resources (such as the Choice vouchers), as specified by local PHAs and other related organizations, will be developed for use by the transitional coordinators and/or case managers.

Other housing initiatives include, but are not limited to:

  1. The development of Adult Family Homes;

  2. The development of affordable assisted living facilities for individuals with low incomes;

  3. The Tenant Based Bridge Rental Assistance (TBRA), developed with HOME funds from the Arkansas Development Finance Authority (ADFA). The fund provides rental assistance for up to two years for an individual wishing to divert or transition from an institution. The funds are currently contracted to community service providers, who in turn assist individuals with the completion of the application and assists the client in working with the local Public Housing Authority to make application for a Section Eight voucher.

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Quality

 

Arkansas is using a Systems Change grant to implement a new Comprehensive Quality Management System, which will be based on the CMS HCBS Quality Framework and Procedural Guidance. This revised system will add program staff to the Quality Management Unit and add capacity to the system to evaluate and disseminate reports about all waiver programs. The grant will also be used to write an Advanced Planning Document to enhance funding of MMIS to automate solutions.

We are to outline the Quality Management System (QMS) applicable to each existing waiver and any additional measures put into effect for MFP. The QMS must address the Level of Care determinations, Service Plan descriptions, identification of qualified home and community based service providers, health and welfare or participants, administrative authority, and financial accountability. In addition, MFP will be subject to two levels of program evaluation. Nationally, a review will be completed across the states participating in the program. Internal to Arkansas, a more detailed assessment will be conducted to determine cost effectiveness, cost benefit, quality of life, and other identified outcomes to determine the program success.

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  Consumer Support
 

Each MFP participant will be enrolled into an existing HCBS waiver which best suites the participant's desires and needs. Agency directed providers of waiver HCBS services are required to maintain emergency access and back up plans specific to their service. Self Directed (SD) care options empower the participant at the direct care provider/employer with the associated responsibilities of that role, including the development of back-up plans.

Some of the consumer support that we have been asked to put into place for MFP participants will provide the participant consistent access to assistance and supportive services. Examples of these are:

1. Educational materials that will spell out what services are available to the participant.

2. A description of the 24-hour back up systems that the participants will have access to for things such as:

a. Transportation

b. Direct services workers

c. Repair and replacement of durable medical equipment or other medical equipment

d. Access to medical care

3. A copy of the compliant and resolution process when the backup system fails.

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  Stakeholder Involvement
 

Consumers, agencies, providers, non-profits, and others are invited to assume an active role in development of the Operational Protocol and the MFP program design through a variety of opportunities, including:

Stakeholder meetings such as GIST (Governor's Integrated Services Taskforce).

Personal presentations at area conferences and workshops for organizations that serve the various target populations. Examples of annual conferences and workshops targeted for presentation of MFP information are included below:

Conferences/Workshops
DD Annual Conference
Arkansas Nurses Association
AR Health Care Association
ARALA
Arkansas Chapter of American Case Management Association (ACMA)
Arkansas Gerontological Society
Mental Health
AR Ombudsmen Annual Training
Arkansas Waiver Assn

For more information or to request a presentation, please contact:

Ramona Sangalli
Program Coordinator
Money Follows the Person
Department of Human Services
Division of Aging & Adult Services
PO Box 1437 Slot S530
Little Rock AR  72203-1437
Phone: 501-320-6579
Fax: 501-682-6658

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mfp website created by Aging Services and updated on 7/6/2010