Marylands Home and CommunityBased Services Waivers

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Marylands Home and Community-Based Services
Waivers

• Medicaid Advisory Committee
• June 2006

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Overview

• Review of Marylands Waivers
• Waiver Services Registry
• New Directions
• Money Follows the Individual/Options Counseling
• Waiver Tracking Systems
• Waiver Quality Assurance
• Reportable Event Policy
• Participant Experience Survey (PES)

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Review of Marylands Waivers

• Maryland has seven home and community-based
  services (HCBS) waivers.
• HCBS waivers provide support services in
  community settings to individuals traditionally
  served in long term care facilities.
• In FY07, Maryland will serve more than 15,800
  individuals in waivers.
• Many waivers are out of slots and not accepting
  new community applicants.
• There is a high demand for waiver services.

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Review of Marylands WaiversFunded Waiver Slots
FY07
Funded Waiver Slots - FY07
Waiver
Older Adults Waiver
3,750
Living at Home Waiver
500
Waiver for Children with Autism Spectrum Disorder
900
Waiver for Individuals with Developmental
Disabilities
10,288
New Directions Waiver (Developmental Disabilities)
200
Model Waiver for Medically Fragile Children
200
Waiver for Individuals with Traumatic Brain Injury
30
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Review of Marylands WaiversFunded Waiver Slots
FY07
Funded Waiver Slots - FY07
Waiver
Older Adults Waiver
3,750
Living at Home Waiver
500
Waiver for Children with Autism Spectrum Disorder
900
Waiver for Individuals with Developmental
Disabilities
10,288
New Directions Waiver (Developmental Disabilities)
200
Governor Ehrlich included 2 million for both
Older Adults and Living at Home Waivers in FY2007
budget.
Model Waiver for Medically Fragile Children
200
Waiver for Individuals with Traumatic Brain Injury
30
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Review of Marylands WaiversFunded Waiver Slots
FY07
Funded Waiver Slots - FY07
Waiver
Older Adults Waiver
3,750
Living at Home Waiver
500
Marylands newest HCBS Waiver.
Waiver for Children with Autism Spectrum Disorder
900
Waiver for Individuals with Developmental
Disabilities
10,288
New Directions Waiver (Developmental Disabilities)
200
Model Waiver for Medically Fragile Children
200
Waiver for Individuals with Traumatic Brain Injury
30
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Waiver Services Registry

• The Older Adults, Living at Home and Autism
  Waiver are closed to community applicants.
• DHMH developed a Waiver Services Registry for
  people who are interested in receiving waiver
  services.
• Individuals may place themselves on the Registry
  by calling a toll-free number.
• Individuals can find out their place (or number)
  on the Registry by calling the Registrys
  toll-free number and providing their SSN.

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Waiver Services Registry

• As of May 2006, the Waiver Services Registry has
• 7,000 individuals interested in OAW
• 1,400 individuals interested in LAH
• 1,600 individuals interested in AUT
• Nearly 6,000 individuals from the Registry have
  received the opportunity to apply for the Older
  Adults Waiver.
• Department began mailing applications for new
  FY07 OAW and LAH in May 2006.

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New Directions Waiver

• Waiver Target Population
• For individuals with developmental disabilities
  of all ages who live in their own or family home
• New Directions is an Independence Plus Waiver
  based on values of self-determination.
• More control over their services and supports
• Person Directed planning process produces
  individualized plan budget
• Participants use a Support Broker and Fiscal
  Management Service to obtain, manage and
• Pay for services provided by individuals,
  agencies, businesses of their choice
• No new money - opportunity to use the current
  in a new way.
• Began enrolling individuals for services
  beginning April 2006.

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Money Follows the Individual

• In December 2002, DHMH developed a Money Follows
  the Individual Policy.
• This means that individuals in nursing facilities
  whose service are paid by Medicaid may apply to
  the OAW or LAH waiver, regardless of the number
  of available slots.
• Participants who have transitioned from a NF
• Older Adults Waiver 1,220 total 622 active
• Living at Home Waiver 182 total 136 active

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Options Counseling

• SB620 (2004) required DHMH to use MDS information
  to identify and assist people who want to move to
  the community.
• DHMH expanded Delmarvas role during quarterly
  reviews.
• Nurses discuss HCBS options with nursing home
  residents identified in MDS data.

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Options Counseling

• If a resident would like to apply to a waiver,
  the nurse will make a referral to the agency.
  Nurses will counsel any resident even if they did
  not indicate yes on MDS.
• As of April 2006
• 624 individuals received options counseling.
• LAH 158 referrals OAW 189 referrals
• Not interested in waiver services 277

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Options Counseling
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Waiver Tracking Systems

• DHMH and UMBC developed web-based application
  tracking system for the Older Adults Waiver.
• Implemented in May 2004.
• All users can follow an application as it flows
  through the eligibility process.
• Living at Home Waiver tracking system in
  development.
• System will improve overall customer service by
  reducing paperwork (faxing and mailing).
• Will complete development late this summer
• Pilot testing will begin by end of summer.
• Plans of care are included in tracking system.

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Waiver Quality Assurance

• GAO Report published in June 2003 highlighted
  CMSs lack of quality oversight in waiver
  programs.
• In response, CMS has developed tools to assist
  states in developing better quality assurance
  programs.
• DHMH has been working to strengthen the waiver
  quality assurance systems by developing a
  consolidated approach to quality assurance for
  all the waivers.

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Waiver Quality AssuranceQA Initiatives

• Establish Waiver Quality Council
• Meets quarterly
• State agency representatives from waiver programs
• Continue to monitor participants through the
  Inspection of Care Team.
• Increased and focused trainings for providers and
  case managers.
• Survey participants on access to care, choice and
  control, respect and dignity, and community
  integration.
• Monitor financial accountability using data
  reports.

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Reportable Event Policy and Procedure

• Policy and procedures for identifying, reporting
  and timely resolution of complaints and incidents
  for OAW, LAH and AUT participants and providers
• Mechanism for DHMH and agencies to monitor and
  track
• Effective August 1, 2005
• Focus groups over summer to discuss policy, forms
  and effectiveness with stakeholders

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Participant Experience Survey (PES)

• In 2005 DHMH surveyed OAW and LAH waiver
  participants using the CMS-developed PES in 16
  jurisdictions.
• 15 minute in-home survey measured overall
  experience in waiver programs in 4 areas
• Access to care, choice and control, respect and
  dignity and community integration.
• First PES survey was in 2004
• Focus groups developed some improvement
  strategies
• Waiver-improvement strategies were not fully
  implemented from 2004 when 2005 PES completed
  (due to grant time constraints)

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Participant Experience Survey (PES)

• Results comparison
• Worked with UB to determine statistical
  meaningfulness (9 change in either direction)
• Good baseline 2004 and 2005 results congruous
• Improved results seen particularly in LAH
  (respect/dignity, awareness of consumer
  direction, ability to reach CM)
• Fewer participants could name CM
• Question changed in 2005, CM turnover, level of
  cognition
• Ability to contact CM ultimately more important

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Marylands Home and Community-Based Services
Waivers

• Medicaid Advisory Committee
• June 2006