Form CMS-10398 #60 CMS-10398 #60 State Technical Assistance Needs Assessment Survey

STATE TECHNICAL ASSISTANCE NEEDS ASSESSMENT -- Regarding housing-related supports and services and care coordination services under Medicaid to individuals with substance use disorders

April 2020

PRA Disclosure Statement - The information you provide in this data collection is completely voluntary. All data will be used only by the Centers for Medicare and Medicaid Services to inform technical assistance activities, regarding housing-related supports and services and care coordination services under Medicaid to individuals with substance use disorders. No data will be shared in any capacity or posted in the public domain. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1148 (CMS-10398 # 60). The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

Section 1018 of the SUPPORT for Patients and Communities Act authorizes the Secretary of Health and Human Services to “provide technical assistance and support to states regarding the development and expansion of innovative state strategies to provide housing-related supports and services and care coordination services under Medicaid to individuals with substance use disorders.” Mathematica and the Technical Assistance Collaborative (TAC) have been contracted by the Centers for Medicare & Medicaid Services (CMS) to conduct a Needs Assessment survey to support this work.

Finding safe and stable housing that promotes or enables recovery is essential for many Medicaid enrollees with substance use disorders (SUD). In the context of the opioid crisis, this work is critical. CMS estimates that nearly 12 percent of Medicaid beneficiaries over the age of 18 years have a SUD, and the Henry J. Kaiser Family Foundation estimates that 4 out of 10 non-elderly adults with opioid use disorder (OUD) are covered by Medicaid. Housing alone may not be sufficient to help individuals with SUD who have more complex and co-occurring conditions achieve successful tenancy. Services and supports are needed to enable individuals to obtain and retain housing, promote long-term stability, recovery, and improved health.

This survey will collect information from states on their current activities to support individuals with SUD in this area, as well as assess areas of need for technical assistance. CMS will use this information to guide technical assistance efforts to states for effectively designing housing-related supports and services and care coordination services under Medicaid for individuals with SUD.

Federal financial participation (FFP) is not available to state Medicaid programs for room and board (except in certain medical institutions). However, FFP is available under certain federal authorities for housing-related supports and services that promote health and community integration. These activities may include: a) linking individuals to assistance in finding and securing housing, b) offering services that support Medicaid eligible individuals in maintaining tenancy, and c) providing one-time moving expenses when individuals transition from certain medical institutions to the community. Housing-related supports and services are authorized based on an assessment of need and are identified in a person-centered service plan. The person-centered planning process reflects any needed services including non-Medicaid community resources.

CMS, Mathematica, and TAC are planning various types of technical assistance activities to support state Medicaid programs in expanding their work in this area. These activities may include: developing issue briefs that document lessons learned and best practices; conducting presentations and webinars; providing one-on-one consultation; and facilitating interactions among state stakeholders. We will also coordinate a learning collaborative for interested states to explore their work. The specific nature and timing of these activities will reflect the results of this needs assessment and the experiences of the learning collaborative.

INSTRUCTIONS

• All of the questions in the Needs Assessment ask about "your state." By "your state," we mean the specific state name printed on the front cover. Please answer ONLY for the specific state printed on the front cover.

• The Needs Assessment should be completed by staff knowledgeable about your state’s housing-related services and supports under Medicaid for individuals with SUD.

• We ask that you please complete the Needs Assessment and return it to Mathematica by June 30, 2020.

• Terms that appear underlined in blue in the Needs Assessment are included in the attached Glossary of Terms.

• If you have any questions while you are completing the Needs Assessment, please contact our toll-free helpline at 1-844-595-0513, or email us at: [email address].

• Please keep a copy of your completed Needs Assessment for your records.

• If submitting the completed Needs Assessment electronically using the fillable PDF provided, please return the completed Needs Assessment via email to [email address]. A scanned paper copy of the completed assessment can also be emailed.

• If you would prefer to submit a completed paper copy via fax, please fax it to: 1-609-799-0005.

• If you prefer to submit a scanned, completed copy via US mail, please send it to:

MATHEMATICA

ATTN: RECEIPT CONTROL - Project 50890

P.O. Box 2393

Princeton, NJ 08543-2393

A. Status of Housing-Related Activities Under your State’s Medicaid Program

A1. Which of the following describes your state’s level of interest or activity in developing and/or expanding strategies to provide housing-related supports and services under Medicaid to individuals with substance use disorders (SUD)?

MARK ALL THAT APPLY

1 □ Governor’s priority

2 □ Actively implementing a program offering housing-related supports and services

a □ State-wide

b □ Within selected regions or localities

3 □ Not currently implementing such a program

4 □ Currently receiving technical assistance from CMS or another organization supported by CMS to develop strategies

5 □ Interested in learning more within the next two years

6 □ At this time our state has other priorities

7 □ Other (specify)

A2. Has your state previously worked on or completed a formal needs assessment to identify gaps in housing-related supports and services for Medicaid beneficiaries with SUD?

1  Yes

0  No SKIP TO A5

A3. Briefly describe the major gaps in housing-related supports and services for Medicaid beneficiaries with SUD that were identified through this assessment and when applicable. Please include information about gaps by sub-populations and geographic areas including rural vs. urban areas.

A4. Do you have any written documents related to assessed needs in this area and/or efforts to address them, either planned or underway, that you would be willing to share?

1  Yes PLEASE ATTACH ALONG WITH SURVEY RESPONSE

0  No

A5. Has your state been engaged in any recent efforts to address the housing-related needs of Medicaid beneficiaries with SUD?

1  Yes

0  No SKIP TO D1

A6. What lessons have you learned from your state’s efforts to provide housing-related supports and services under Medicaid to individuals with SUD, if applicable?

MARK ALL THAT APPLY

1 □ Leadership support (e.g., governor’s office, state agency leadership, state commissions, legislature) is critical

2 □ Ability to analyze, share and/or match data is important

3 □ Cross-agency partnerships, particularly with state or local housing providers, are essential

4 □ Stakeholder involvement at a local/community level is needed

5 □ Medicaid and non-Medicaid resources to offer the range of supports needed to help individuals access and maintain housing is useful

6 □ Limitation of housing resources for individuals with SUD is a challenge

7 □ Availability of qualified providers to deliver housing related-supports and services is a challenge

8 □ Other (specify)

9 □ None

A7. Efforts to address the housing-related needs of Medicaid beneficiaries with SUD were initiated by:

MARK ALL THAT APPLY

1 □ State Opioid Response Grant Activities

2 □ Medicaid Innovation Accelerator Program (IAP)

3 □ State Interagency Council on Homelessness

4 □ Other SAMHSA Grants

5 □ Another interagency working group (specify)

6 □ Other (specify)

B. Partnerships to Address Housing-Related Supports and Services under your State’s Medicaid Program

B1. Does your state Medicaid agency have partnerships with any entities to identify and/or address the housing-related needs of Medicaid beneficiaries with SUD?

1  Yes

0  No SKIP TO C1

B1a. With which of the following entities is your state Medicaid Agency working in partnership to identify and/or address the housing-related needs of Medicaid beneficiaries with SUD?

Medicaid Agency/Health Care:

1 □ Single State Agency for Substance Abuse Services

2 □ State Mental Health Agency

3 □ Long-term Services and Supports Agency

4 □ Federally Qualified Health Care Centers (FQHCs), Community Health Centers, and/or Rural Health Clinics

5 □ Local Public Health Agencies

6 □ Managed Care Organizations (MCOs)

7 □ Health and Behavioral Health Providers

8 □ Hospitals

9 □ Other (specify)

Housing:

10 □ State Housing Finance Agency

11 □ HUD Continuums of Care

12 □ Other State Agencies that Administer Affordable Housing and/or Homelessness Programs

13 □ U.S. Department of Agriculture (USDA)

14 □ Local Public Housing Authorities

15 □ Supportive Housing Providers

16 □ Affordable and Supportive Housing Developers and Owners/Landlords

17 □ Recovery Housing Providers

18 □ Other (specify)

Other:

19 □ County/City Human Services Agencies

20 □ Other State Disability Service Agency or Agencies

21 □ State/Local Corrections

22 □ Community-Based Organizations

23 □ Philanthropic Entities

24 □ Other (specify)

B2. Are these partnerships:

MARK ONE ONLY

1  Governed by a cross-agency group that meets regularly?

2  Specifically aimed at addressing the housing-related needs of individuals with SUD?

3  Addressing the needs of a broader target population that includes individuals with SUD? (Specify the broader target population):

B3. Have these partnerships resulted in any of the following accomplishments?

MARK ALL THAT APPLY

1 □ Strategic planning to address housing-related needs among Medicaid beneficiaries with SUD

2 □ Dedication of increased funding for housing-related needs among Medicaid beneficiaries with SUD

3 □ Formal or informal agreements and working relationships to facilitate access to existing and new housing resources for Medicaid beneficiaries with SUD

4 □ Cross-systems data sharing (e.g., Medicaid, Homeless Management Information System, etc.) to identify the target population and/or prioritize them for housing and services or examine costs and outcomes

5 □ Increased availability or quality of housing support services

6 □ Development of Medicaid strategies (e.g., changes in authorities used) to address the housing-related support and services needs of individuals with SUD

7 □ An increase in housing opportunities specifically targeted to Medicaid beneficiaries with SUD

8 □ Other (specify)

B4. How does your state Medicaid agency partner with other state and local entities and coordinate across funding streams to create/increase housing opportunities for individuals with SUD?

C. State Strategies to Provide Housing-Related Supports and Services to Individuals with SUD under Medicaid

C1. Is your state currently implementing a state strategy to provide housing-related supports and services to individuals with SUD under a state Medicaid program?

1  Yes

0  No SKIP TO D1

C2. Which of the following housing-related supports and services are covered under Medicaid for individuals with SUD?

MARK ALL THAT APPLY

1 □ Linking individuals to assistance in finding and securing housing (e.g. assessing housing needs, identifying appropriate housing options, and assisting with applications and other administrative processes)

2 □ Offering services that support Medicaid eligible individuals in maintaining tenancy (e.g. education about responsibilities as a tenant, helping to maintain a good relationship with landlords or property managers, and planning and support to avoid potential housing problems or eviction)

3 □ Providing one-time moving expenses when individuals transition from certain medical institutions to the community

C3. In what geographic areas are these Medicaid-covered supports and services available for Medicaid eligible individuals with SUD?

MARK ALL THAT APPLY

1 □ Statewide

2 □ In multiple geographic regions:

a □ This is a pilot

b □ State plans to expand these services statewide

3 □ In one sub-state region (e.g. county, metropolitan area):

a □ This is a pilot

b □ State plans to expand these services statewide

4 □ Other (specify)

C4. Which Medicaid beneficiaries with SUD are these services intended for?

MARK all applicable subpopulations of individuals with SUD

1 □ Individuals with opioid use disorders (OUD)

2 □ Individuals at risk of homelessness

3 □ Individuals experiencing homelessness

4 □ Individuals experiencing chronic homelessness

5 □ Youth transitioning out of foster care

6 □ Individuals leaving correctional settings (jail, prison)

7 □ Individuals involved with community corrections (probation, parole)

8 □ Individuals being discharged from behavioral health facilities

9 □ Frequent users of emergency departments and other public services (individuals with high costs/ high need)

10 □ Pregnant and postpartum women

11 □ Pregnant women with OUD

12 □ Individuals transitioning from medical institutions

13 □ Individuals with co-occurring mental health and substance use disorders

14 □ Individuals with co-morbid physical health conditions and SUD

15 □ Individuals living with HIV/AIDS

16 □ American Indian/Alaska Native

17 □ A broader population than individuals with SUD (specify)

18 □ Other (specify)

C5. Under what Medicaid authorities is your state Medicaid program covering the housing-related supports and services as indicated in question C4?

MARK ALL THAT APPLY

1 □ Section 1115 Demonstration

2 □ Section 1915(b) Managed Care Waiver

3 □ Section 1915(c) Home and Community-Based Services Waiver

4 □ Section 1915(i) State Plan Home and Community-Based Services (HCBS) Benefit

5 □ Section 1915(k) Community First Choice Optional State Plan Benefit

6 □ Health Home State Plan Benefit (Section 1945)

7 □ Other (specify)

C6. What role, if any, have managed care organizations had in addressing the housing-related needs of Medicaid beneficiaries with SUD?

MARK ALL THAT APPLY

1 □ Provision of care coordination for health, behavioral health, housing, and/or other supports

2 □ Contracting with housing-related supports and services providers

3 □ Employment of housing navigators

4 □ Investing in housing development/acquisition, construction, and/or debt financing

5 □ Providing on-going rental assistance

6 □ Providing one-time community transition costs (i.e. security deposit/utility deposit/necessary household furnishings, etc.)

7 □ Other (specify)

na □ Not applicable

C7. Are housing-related supports and services reimbursed using any of the following payment models?

MARK ALL THAT APPLY

1 □ Fee for service

2 □ Per member per month

3 □ Pay for performance

4 □ Bundled payments

5 □ Shared savings/risk

6 □ Global or capitated payments

7 □ Value based purchasing

8 □ Other (specify)

C8. Which of the following strategies is your state employing to better use data, track outcomes, or evaluate housing-related supports and services?

MARK ALL THAT APPLY

1 □ Data use agreements between Medicaid and other agencies that involve housing data

2 □ Data matching between Medicaid data and other data sources, such as Homeless Management Information System data

3 □ Data sharing strategies with hospitals and/or SUD treatment providers for program referral

4 □ Use of screening tools, assessment tools, and/or algorithms to assess risk, need, or eligibility for housing-related supports and services

5 □ Development of integrated information systems with health, human services, and public service providers such as correctional systems

6 □ Systematic reporting of quality or outcome measures specific to housing or housing-related supports and services

7 □ Evaluation of local Medicaid-funded housing related supports and services program(s)

8 □ Evaluation of state-level housing related supports and services initiatives involving Medicaid

9 □ Use of service utilization data and outcome data to support individual care coordination

10 □ Identifying Medicaid-covered housing-related services in Transformed-Medicaid Statistical Information System (T-MSIS)

11 □ Referral tracking systems

12 □ Other (specify)

D. Planning Efforts Related to State Strategies to Provide Housing-Related Supports and Services to Individuals with SUD under Medicaid

D1. Is your state considering changes to its existing Medicaid program to support housing-related supports and services for individuals with SUD?

1  Yes

0  No SKIP TO E1

D2. Which Medicaid authorities are being considered?

MARK ALL THAT APPLY

1 □ Section 1115 Demonstration

2 □ Section 1915(b) Managed Care Waiver

3 □ Section 1915(c) Home and Community-Based Services Waiver

4 □ Section 1915(i) State Plan Home and Community-Based Services (HCBS) Benefit

5 □ Section 1915(k) Community First Choice Optional State Plan Benefit

6 □ Health Home State Plan Benefit (Section 1945)

7 □ Other (specify)

D3. Where are you in the process of seeking Medicaid coverage for these services?

MARK ONE ONLY

1  Early stages of consideration

2  Planning and development of state plan amendment or waiver

If known, planned submission date to CMS for requested changes:

4  Submitted and awaiting CMS approval

D4. Which of the following housing-related supports and services are you seeking to have reimbursed by Medicaid for individuals with SUD?

MARK ALL THAT APPLY

1 □ Linking individuals to assistance in finding and securing housing (e.g. assessing housing needs, identifying appropriate housing options, and assisting with applications and other administrative processes)

2 □ Offering services that support Medicaid eligible individuals in maintaining tenancy (e.g. education about responsibilities as a tenant, helping to maintain a good relationship with landlords or property managers, and planning and support to avoid potential housing problems or eviction)

3 □ Providing one-time moving expenses when individuals transition from certain medical institutions to the community

D5. Which Medicaid beneficiaries with SUD are these planned services intended for?

MARK all THAT APPLY

1 □ Individuals with OUD

2 □ Individuals at risk of homelessness

3 □ Individuals experiencing homelessness

4 □ Individuals experiencing chronic homelessness

5 □ Youth transitioning out of foster care

6 □ Individuals leaving correctional settings (jail, prison)

7 □ Individuals involved with community corrections (probation, parole)

8 □ Individuals being discharged from behavioral health facilities

9 □ Frequent users of emergency departments and other public services (individuals with high costs/ high need)

10 □ Pregnant and postpartum women

11 □ Pregnant women with OUD

12 □ Individuals transitioning from medical institutions

13 □ Individuals with co-occurring mental health and substance use disorders

14 □ Individuals with co-morbid physical health conditions and SUD

15 □ Individuals living with HIV/AIDS

16 □ American Indian/Alaska Native

17 □ A broader population than individuals with SUD (specify) _________________________

18 □ Other (specify)

E. Capacity of Resources to Provide Housing-Related Supports and Services

E1. Does your state use any of the following non-Medicaid funding sources to fund housing-related supports and services for Medicaid individuals with SUD?

MARK ALL THAT APPLY

1 □ State general funds

2 □ City/county general funds

3 □ SAMHSA Substance Abuse Block Grant

4 □ State Opioid Response Grant

5 □ HUD Continuum of Care Grant

6 □ Other state or local housing program funds

7 □ Other (specify)

8 □ None of the above

E2. How would you rate your state’s Medicaid provider capacity to deliver housing-related supports and services?

	SELECT ONE RESPONSE PER ROW
	LIMITED	ADEQUATE	EXCELLENT	DON’T KNOW	NOT APPLICABLE
a. In urban areas?	1 □	2 □	3 □	d □
b. In suburban areas?	1 □	2 □	3 □	d □
c. In rural areas?	1 □	2 □	3 □	d □	na □
d. In frontier areas?	1 □	2 □	3 □	d □	na □

E3. In which of the following areas does your state need to build capacity related to use of data, tracking outcomes, or evaluating housing-related supports and services?

MARK ALL THAT APPLY

1 □ Data use agreements between Medicaid and other agencies that involve housing data

2 □ Data matching between Medicaid data and other data sources, such as Homeless Management Information System data

3 □ Data sharing strategies with hospitals and/or SUD treatment providers for program referral

4 □ Use of screening tools, assessment tools, and/or algorithms to assess risk, need, or eligibility for housing-related supports and services

5 □ Development of integrated information systems with health, human services, and public service providers such as correctional systems

6 □ Systematic reporting of quality or outcome measures specific to housing or housing-related supports and services

7 □ Evaluation of local Medicaid-funded housing related supports and services program(s)

8 □ Evaluation of state-level housing related supports and services initiatives involving Medicaid

9 □ Use of service utilization data and outcome data to support individual care coordination

10 □ Identifying Medicaid-covered housing-related services in T-MSIS

11 □ Referral tracking systems

12 □ Other (specify)

13 □ None of the above

E4. Are Medicaid providers in your state partnering with any of the following types of housing models or programs to deliver housing-related supports and services under Medicaid to individuals with SUD?

MARK ALL THAT APPLY

1 □ Permanent supportive housing

2 □ Permanent supportive housing with Housing First orientation

3 □ Clean and sober/recovery housing

4 □ Transitional supportive housing

5 □ Rapid Rehousing

6 □ Other (specify)

7 □ Don’t know

8 □ None of the above

E5. Is your state currently seeking to develop or strengthen partnerships to increase the capacity of any of the housing models mentioned in E4?

1  Yes

0  No SKIP TO E6

E5a. Please briefly describe how your state is seeking to develop or strengthen partnerships to increase the capacity of any of the housing models mentioned in E4?

E6. Has your state identified any of the following as a challenge to address the housing-related supports and service needs of Medicaid beneficiaries with SUD?

MARK ALL THAT APPLY

1 □ Partnering with federal, state, and/or local housing providers

2 □ Coverage of housing-related supports and services under Medicaid

3 □ Coverage for outreach and engagement activities under Medicaid

4 □ Coordinating multiple funding sources to address supports and service needs

5 □ Data collection and/or sharing with other state/local entities

6 □ Provider qualifications and network capacity

7 □ Limited range of housing options or insufficient housing capacity

8 □ Housing access barriers as a result of federal housing program eligibility and/or issues with housing landlords/owners

9 □ Lack of resources in rural areas

10 □ Other (specify)

na □ None of the above

F. Technical Assistance Needs

F1. In which of the following areas could your state benefit from technical assistance to address housing-related supports and service needs of Medicaid beneficiaries with SUD?

On a scale from 1 to 5, where 1 represents the lowest level of need, and 5 represents the highest level of need, please check the appropriate box for each response.

	SELECT ONE RESPONSE PER ROW
	1	2	3	4	5
a. Developing and strengthening Medicaid and housing partnerships	1 □	2 □	3 □	4 □	5 □
b. Medicaid authorities used for coverage and targeting of services	1 □	2 □	3 □	4 □	5 □
c. Working with managed care organizations	1 □	2 □	3 □	4 □	5 □
d. Developing or strengthening care coordination models	1 □	2 □	3 □	4 □	5 □
e. Payment models, including value-based purchasing strategies	1 □	2 □	3 □	4 □	5 □
f. Identifying and coordinating with non-Medicaid funding sources to support housing access and stability among individuals with SUD	1 □	2 □	3 □	4 □	5 □
g. Making a range of housing options available to individuals at various stages of recovery	1 □	2 □	3 □	4 □	5 □
h. Coordinating resources, treatment, and supports with housing and housing-related services	1 □	2 □	3 □	4 □	5 □
i. Building provider network capacity to deliver housing-related services	1 □	2 □	3 □	4 □	5 □
j. Data strategies to identify and prioritize individuals for housing and services, including establishing data use agreements and cross-system data matching	1 □	2 □	3 □	4 □	5 □
k. Evaluation methods and measurement of outcomes specific to individuals with SUD	1 □	2 □	3 □	4 □	5 □
l. Approaches in rural areas	1 □	2 □	3 □	4 □	5 □
m. Scaling up existing pilot or geographically-based programs	1 □	2 □	3 □	4 □	5 □
n1. Other (Specify as many as necessary)	1 □	2 □	3 □	4 □	5 □
n2.	1 □	2 □	3 □	4 □	5 □
n3.	1 □	2 □	3 □	4 □	5 □
n4.	1 □	2 □	3 □	4 □	5 □

F2. CMS will host a Learning Collaborative in 2020 that will bring together states interested in addressing common challenges and pursuing innovative state strategies to address the housing-related support and services needs of Medicaid beneficiaries with SUD. Would you be interested in participating in this state Learning Collaborative?

1  Yes

0  No

F3. Which of the following other methods of technical assistance provision on this topic would be most helpful to your state?

MARK ALL THAT APPLY

1 □ Webinars

2 □ Informational briefs

3 □ Matching with peer state(s)

4 □ Facilitate small group discussions

5 □ Affinity groups (connecting individuals with similar interests across states)

6 □ Other (specify)

G. Contact Information

G1. Please provide the name and contact information for someone we can contact in case there are any clarifying questions.

Name:

Job Title:

Organization:

Email:

Phone Number: | | | | - | | | | - | | | | |

Area Code Number

Thank you very much for taking the time to complete this survey.

Prepared by Mathematica/TAC March 19, 2020