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pdfMoney Follows the Person (MFP)
Semi-Annual Progress Report User Guide and Help File
CONTENTS
CMS-10249
OMB 0938-1053 (Expires: TBD)
Section I. Technical Guidance for Completing the PDF Report.................................................................... 1
Section II. Detailed Content Guidance for Entering Grantee Program Data ................................................ 4
1
A.
General Information ...................................................................................................... 4
B.
Transitions .................................................................................................................... 5
C.
Qualified HCBS Expenditures .................................................................................... 10
D.1.
Additional Benchmarks ............................................................................................... 12
D.2.
Rebalancing Efforts .................................................................................................... 13
E.1.
Recruitment and Enrollment ....................................................................................... 13
E.2.
Informed Consent and Guardianship ......................................................................... 17
E.3.
Outreach/Marketing/Education ................................................................................... 18
E.4.
Stakeholder Involvement ............................................................................................ 19
E.5.
Benefits and Services - Medicaid Program and Policy Issues ................................... 21
E.6.
Participant Access to Services ................................................................................... 23
E.7.
Self-Direction .............................................................................................................. 24
E.8.
Quality Management and Improvement ..................................................................... 25
E.9.
Housing for Participants ............................................................................................. 29
E.10.
Employment Supports and Services .......................................................................... 31
F.
Organization and Administration ................................................................................ 32
G.
Challenges and Developments .................................................................................. 33
H.
Independent Evaluation .............................................................................................. 34
I.
State-specific Technical Assistance ........................................................................... 34
J.
Overall Lessons & MFP-related LTC System Change ............................................... 35
Section I. Technical Guidance for Completing the PDF Report
This PDF is to be used by grantees for semi-annual reporting of MFP program data. The information
provided in this report will allow CMS to monitor grantee progress and identify challenges and
improvement opportunities.
ACCESSING THE PDF REPORT
•
The PDF can be obtained from your CMS project officer or from http://www.mfp-tac.com.
•
Ensure you are opening the PDF on a PC and in Adobe Acrobat PDF Reader.
o
Grantees must use Adobe Acrobat Reader (as opposed to other PDF reader brands).
o
A free version of Adobe Acrobat Reader is available for download here:
https://get.adobe.com/reader/.
o
It is also recommended that grantees use a PC rather than Macintosh brand computer. Do
not use an iPhone or other smart phone devices to complete the form.
o
If a grantee has Adobe Acrobat Standard or Pro, it is recommended that they use Adobe
Acrobat Reader. In Adobe Acrobat Standard or Pro, if you “Save as a Copy” this will destroy
the formatting of the PDF and convert it to a flat file with no fillable fields.
o
Grantees should consult their internal IT departments if they encounter issues downloading
or opening Adobe Acrobat PDF Reader.
SAVING AND SUBMITTING THE REPORT
•
Please save the file to your local PC using the following naming convention State
Initials_reporting year (YYYY)_Reporting Period (1 or 2) (for example, AL_2017_Period1). While
completing the reporting form, please save your work often by selecting File >>> Save in the
upper left hand corner of the PDF.
•
Grantees can save data typed into the form, exit the report, and then continue entering data at a
later time.
•
To submit your completed form to CMS, save the file with the correct file name and submit the
completed PDF form to your CMS project officer via email.
NAVIGATING THE FORM
•
The fillable PDF reporting form contains all of the same questions and response options as the
former MFP web-based reporting system (DEHPG.net).
•
There is additional functionality to keep in mind as you navigate the PDF form:
o
Green cells - The PDF will auto-calculate fields outlined in green.
o
Red cells - The previous MFP web-based system auto-calculated these fields. Grantees now
will need to calculate the data points in these fields, which are indicated with a red border
around the data cell. Instructions for calculating these fields are included in the PDF report
and in Section II of this Help File.
o
Hidden response fields – Some response fields are hidden but become available to the
grantee, depending on the grantee’s response to a related question. For example, in the
question below, grantees will be prompted to enter a response in the text field only if “yes” is
selected.
1
•
Entering Targets and Benchmarks – The first time grantees complete the PDF report (July –
August 2017 for Period 1 2017 data), they will need to enter their targets and descriptions of their
additional benchmarks for 2017 and each year after:
o
Transition targets should align with the most recent CMS-approved supplemental budget
worksheet.
o
Additional benchmark targets should align with the most recent CMS-approved Operational
Protocol.
o
HCBS expenditure targets should align with the most recent CMS-approved Operational
Protocol.
Please contact your CMS Project Officer if you have any questions about the source of your
benchmark targets.
•
Historical Data – Grantees will not be required to enter program data (transitions, expenditures
etc.) for reporting periods before Period 1 (January-June) 2017, except for Section D.2.
Rebalancing Efforts, which is cumulative from the start of the MFP grant program.
•
Entering period 1 and period 2 data into the PDF – Grantees will continue to report program
data twice a year through June 30, 2020. Period 1 (January – June) data will be reported during
July and August. Period 2 (July – December) will be reported in January and February of the
following year. During Period 1 reporting, grantees should leave all Period 2 fields blank. The
“total (period 1 + period 2)” fields will reflect Period 1 only. During period 2 reporting, please add
period 2 data below the existing period 1 data, and the form will calculate the “total.”
•
Building on previous period reports – Grantees are not asked to enter historical data (pre2017) in the report. However, after Period 1, 2017, grantees should not start with a blank report
each period. Rather, after Period 1, 2017, grantees should start with the previous period’s report,
save it under a new name to preserve the previous period’s reported data, and update all data
fields throughout the report as applicable. For questions that contain multiple years of data (i.e.,
additional benchmarks and HCBS expenditures) grantees should enter the current period’s data
after the previous period’s data.
•
Updating the report for each reporting period – Grantees only need to update the fields that
have changed since the previous reporting period. For example, if the state continues to have the
2
same challenges with recruitment and enrollment (Section E.1), the grantee can leave in the
previous period’s text and note that the challenge continues during the current period.
•
Making updates to data from previous reporting periods – If a grantee wants to revise data
submitted during a previous reporting period (for example because an error was discovered)
please notify your CMS Project Officer.
•
Completing Cells that are Not Applicable – If a Question or Section of the report is not
applicable for a particular grantee (for example, the Tribal Initiative questions) please note this in
the open text field (i.e., “Use this box to explain missing, incomplete, or other qualifications to the
data reported in this section.”) by writing N/A or noting that this is not applicable.
3
Section II. Detailed Content Guidance for Entering Grantee Program
Data
A.
General Information
General information is the information that provides readers the critical information on the organization of
the grant and key personnel.
Items in this section do not need to be updated after the first report, unless any of the information has
changed. Please contact your CMS Project Officer if you have any questions about the content in this
report.
Organization Information
1. Full Name of Grantee Organization
2. Program's Public Name
3. Program's Website
Project Director
4. Project Director Name. The name of the individual responsible for the day-to- day operation of the
grant
5. Project Director Title
6. Project Director Phone [numeric response here]
7. Project Director Fax [numeric response here]
8. Project Director Email
9. Project Director Status Date: Change date if status is different from last report [check the
appropriate box here]
o
o
o
o
Full Time
Acting
Vacant
New Since Last Report
10. Project Director Status Date: Change date if status is different from last report. [If there is any
change in status since last report, a date must be provided.]
Grantee Signatory
11. Grantee Signatory Name. The name of the individual empowered by the state to receive and sign
(approve) grant agreements between CMS and the state receiving the grant
12. Grantee Signatory Title
13. Grantee Signatory Phone [numeric response here]
14. Grantee Signatory Fax [numeric response here]
15. Grantee Signatory Email
16. Has the Grantee Signatory changed since last report? [check the appropriate box here]
o
o
Yes
No
4
Other State Contact
17. Other State Contact Name
18. Other State Contact Title
19. Other State Contact Phone [numeric response here]
20. Other State Contact Fax [numeric response here]
21. Other State Contact Email
Independent State Evaluator
22. Independent State Evaluator Name
23. Independent State Evaluator Title and Organization
24. Independent State Evaluator Phone [numeric response here]
25. Independent State Evaluator Fax [numeric response here]
26. Independent State Evaluator Email
Report Preparer
27. Report Preparer Name. The name of the person who is responsible for the content of this report.
This is the person whom CMS will contact with questions about a particular report.
28. Report Preparer Title
29. Report Preparer Phone [numeric response here]
30. Report Preparer Fax [numeric response here]
31. Report Preparer Email
CMS Project Officer
32. CMS Project Officer Name
B.
Transitions
Note: Entering Targets and Benchmarks – The first time grantees complete the PDF report (July –
August 2017 for Period 1 2017 data), they will need to enter their targets for 2017 and each year
after.
1. Specify Other Population: Please specify your MFP program’s “other” target population(s)
here, if applicable. Throughout the PDF report, this target population will be referred to as
“Other.”
The target populations already designated in the report are: Older Adults, PD (Physically
Disabled), ID/DD (Individuals with Intellectual or Developmental Disabilities), and MI (Mental
Illness).
2. Please note the characteristics and/or diagnoses of your MFP program’s “other” target
population(s).
3. Number of people assessed for MFP enrollment during this reporting period. Definition:
“Number of people assessed for MFP enrollment” refers to those people that have signed
an informed consent form indicating their desire to transition to the community and enroll
in the State’s MFP program. The number assessed includes individuals who are determined to
be candidates for MFP enrollment because they: 1) expressed interest in leaving the institution
and returning to a home or community residence, 2) are eligible for MFP by virtue of having been
institutionalized in a qualified institution under Medicaid coverage (i.e., includes hospitals, nursing
facilities, intermediate care facility for people with intellectual disabilities (ICF-ID), and institutions
5
for mental diseases (IMDs)) for three months or more, and 3) met with a MFP transition
coordinator or other individual to begin or complete a full assessment of transition service needs
and housing options.
The number assessed for MFP enrollment consists of three groups: (a) those assessed but did
not yet transition because arrangements were not yet complete; (b) those who were assessed
and made the transition during the reporting period, and (c) Those who were assessed but
cannot be transitioned (for reasons that are recorded in Question #7 on the Recruitment and
Enrollment section (E.1).
The number assessed for MFP enrollment does not include people who: 1) were provided
general information about the MFP program, 2) were screened and found not to meet MFP
eligibility criteria, i.e. have not been (or are not expected to be) in an institution for at least 90
days or are not (or not likely to be) Medicaid-eligible for at least one day prior to discharge from
an institution.
Please note: If a participant was assessed for MFP enrollment during the reporting period, and
then re-assessed for enrollment after a re-institutionalization that lasted longer than 30 days,
count this as one assessment to avoid double counting.
Source of data: State MFP programs may track the number assessed in a variety of ways,
including referral forms to the state MFP program office, signed MFP informed consent forms
indicating the individual’s desire to transition to the community and enroll in the state’s MFP
program, or transition coordinator assessments recorded in program files or databases.
■
Number of people assessed for MFP enrollment. [please provide a number for each
target population (if applicable for this reporting period) in the appropriate box; if reporting
for January-June, complete the First Period row; if reporting for July-December, complete
the Second Period row]
□
First Period (Jan 1 – June 30)
□
Second Period (July 1 – Dec 31)
□
Total (period 1 + period 2)
■
Cumulative Number Assessed (cumulative assessed during the previous reporting period
+ total assessed during the current reporting period) [grantee must perform calculation]
■
Transition Target, all grant years (by population and total) [Review the most recent CMSapproved transition targets, and enter or confirm the target]
■
Cumulative Number Assessed as a Percent of Total Transition Target. (Number
assessed as a percent of number proposed to be transitioned overall. To obtain this
number, divide the cumulative number of individuals assessed by the transition targets
for each population.)
■
Please indicate what constitutes an assessment for MFP versus any other transition
program. [please use the provided text box to explain further –if necessary]
4. Number of institutional residents who transitioned during this reporting period and
enrolled in MFP. Definition: The number of transitions includes people who were discharged
from an institution to the community during the reporting period, formally enrolled in MFP, and
began using HCBS during the 365-day MFP transition period.
Please note: If a participant was enrolled in MFP during the reporting period, and then re-enrolled
into the program after a re-institutionalization that lasted longer than 30 days, count this as one
enrollment to avoid double counting.
It does not include those who (a) were transitioned in a previous reporting period (unless their
enrollment into MFP was not recorded in a previous report, in which case you can add them to
the current report) and (b) have yet to complete their 365 days of MFP enrollment (these
individuals are recorded in Question #6 in this section).
6
■
■
Number of institutional residents who transitioned during this reporting period and
enrolled in MFP. [please provide a number for each target population (if applicable for
this reporting period) in the appropriate box; if reporting for January-June, complete the
First Period row; if reporting for July-December, complete the Second Period row]
□
First Period
□
Second Period
Total For This Year [grantee must perform calculation]
■
Annual Transition Target [Grantee must update transition targets as applicable]
■
% of Annual Transition Target Achieved (Number who transitioned as a percent of
number proposed to be transitioned for the year. To obtain this number, divide the
number of individuals transitioned by the annual target for each population)
5. Cumulative Number of MFP transitions to Date. Definition: The cumulative number of MFP
transitions to date includes all people ever transitioned and enrolled in MFP since the program
was implemented, regardless of current enrollment status (i.e., re-institutionalized, died, etc.).
■
Add the current period transitions to the previous period’s transitions [grantee must
perform calculation]. If you need to adjust the cumulative MFP transitions to date, please
enter the positive and/or negative adjustment value in the corresponding cell of the table
below.
□
If applicable - Please provide an explanation as to why your cumulative transition
counts do not match those in the table below in the text box.
■
Adjustment value [***only if necessary*** numeric response here]
■
Adjusted cumulative total (after any adjustments)
■
Transition Targets, all grant years (by population and total) [Review the most recent
CMS-approved transition targets, and enter or confirm the target]
6. Total number of current MFP Participants. Definition: Current MFP participants consists of
people who are currently enrolled in the MFP demonstration as of the last day of the reporting
period, including those who: (a) transitioned during this reporting period (from Question #4 on this
section), b) transitioned during an earlier reporting period, and continued to be eligible for 365
days of MFP covered HCBS during the current reporting period, and c) re-enrolled into the MFP
program after an institutional stay of 30 days or more.
It does not include those who: a) completed their 365 days of MFP eligibility, b) died before they
exhausted 365 days of eligibility; c) were institutionalized for 30 days or more.
■
Total number of current MFP Participants. Current MFP participants excludes individuals
whose enrollment in the MFP demonstration ended because they completed their 365
days of MFP eligibility, died before they exhausted their 365 days of eligibility, or were
institutionalized for 30 days or more and did not subsequently re-enroll in the MFP
program. [please provide a number for each target population (if applicable for this
reporting period) in the appropriate box; if reporting for January-June, complete the First
Period row; if reporting for July-December, complete the Second Period row]
□
First Period (Jan 1 – June 30)
□
Second Period (July 1 – Dec 31)
7. Number of MFP participants re-institutionalized during the reporting period. Definition: The
term “re-institutionalized” means admission to an inpatient facility, such as a hospital, nursing
home, ICF-IDD, or institution for mental disease, for a stay of less than or more than 30 days. If
an MFP participant is admitted for more than 30 days, CMS guidance requires that the individual
be dis-enrolled from MFP. Former MFP participants that were dis-enrolled prior to the completion
of 365 days in the demonstration may re-enroll in MFP without meeting the 90 consecutive days
institutional residency requirement, provided they meet any applicable state requirements for re7
enrollment. That participant is eligible to continue to receive MFP services for any remaining days
up to the maximum 365 days of demonstration participation. Note that CMS does permit a
participant to be re-enrolled in the MFP demonstration once their 365 days of eligibility have been
used provided they are a “qualified individual” who has been in a “qualified institution” for at least
90 consecutive days less any short term rehabilitative days, and he/she is transitioning into MFP
“qualified housing.” Before re-enrolling a former participant into the MFP demonstration program,
a state must develop and maintain a process to re-evaluate the former MFP participant’s post
MFP Program Plan of Care. If an MFP participant had two or more admissions involving less than
30 days AND more than 30 days, please record them only once in the more than 30 day
category.
■
Number of MFP participants re-institutionalized. [please provide a number for each target
population (if applicable for this reporting period) in the appropriate box]
□
For less than or equal to 30 days:
□
For more than 30 days: Dis-enrolled from MFP, but may re-enroll in MFP without
meeting the 90 day institutional residency requirement if they have not used all 365
days of eligibility and meet your state’s qualifying conditions for re-enrollment.
□
Length of stay as yet unknown.
■
Total re–institutionalized for any length of time (total of above).
■
Number of MFP participants re-institutionalized as a percent of all current MFP
participants. To obtain this number, divide the number of individuals
reinstitutionalized this period by the number of current participants (for each
population and the total) (Question #6).[grantee must perform calculation]
■
Number of MFP participants re-institutionalized as a percent of cumulative transitions.
■
Please indicate any factors that contributed to re-institutionalization. [please use the
provided text box to explain further –if necessary]
8. Number of MFP participants re-institutionalized for longer than 30 days, who were reenrolled in the MFP program during the reporting period. This refers to the number of MFP
participants who were re-institutionalized for a stay of more than 30 days, dis-enrolled from MFP,
and then subsequently re-enrolled in MFP during the reporting period, upon returning to a
community setting.
■
Number of MFP participants re-institutionalized for longer than 30 days, who were reenrolled in the MFP program during the reporting period. [please provide a number for
each target population (if applicable for this reporting period) in the appropriate box; if
reporting for January-June, complete the First Period row; if reporting for July-December,
complete the Second Period row]
□
First Period
□
Second Period
□
Total For This Year
9. Number of MFP participants -who ever transitioned -who completed the 365-day transition
period during the reporting period. Definition: This refers to the number of people who ever
transitioned and enrolled in MFP (from Cumulative Transitions reported in Question #5 in this
section), and completed 365 days of MFP enrollment during the reporting period.
Note: [Cumulative transitions (Question #5)] minus [MFP participants who were reinstitutionalized (Question #7)] minus [MFP participants who completed the 365-day transition
period (Question #9)] should be approximately equal to [Current Participants (Question #6)] -not taking into account MFP participants who died during the reporting period, or dis-enrolled at
their choice, or for other reasons.
■
Number of MFP participants -who ever transitioned -who completed the 365-day
transition period. [please provide a number for each target population (if applicable for
8
this reporting period) in the appropriate box; if reporting for January-June, complete the
First Period row; if reporting for July-December, complete the Second Period row]
■
□
First Period
□
Second Period
□
Total For This Year
Please indicate any factors that contributed to participants not completing the 365-day
transition period. [please use the provided text box to explain further –if necessary]
10. Did your program have difficulty transitioning the projected number of persons it
proposed to transition in the Operational Protocol? If yes, please check the target
populations that apply.
■
■
Yes
□
Please indicate target population(s) by checking appropriate box.
□
Please describe your difficulties for each target population.
No
11. Does your state have other nursing home transition programs that currently operate
alongside the MFP program? This refers to transition programs (other than MFP) that are
currently in place to help eligible nursing home residents re-locate from the nursing home to a
community setting with the support of home and community-based services. Eligibility
requirements for these programs may be different than MFP eligibility requirements.
■
■
Yes
□
Please approximate the number of individuals who transitioned to the community
through other transition programs during this reporting period.
□
Please explain how these other transition programs differ from MFP, e.g. eligibility
criteria.
No
12. Does your state have an ICF-IDD transition program that currently operates alongside the
MFP program? This refers to transition programs (other than MFP) that are currently in place to
help eligible ICF-IDD residents re-locate from the ICF-IDD to a community setting with the
support of home and community-based services. Eligibility requirements for these programs may
be different than MFP eligibility requirements.
■
■
Yes
□
Please approximate the number of individuals who transitioned to the community
through other transition programs during this reporting period.
□
Please explain how these other transition programs differ from MFP, e.g. eligibility
criteria.
No
13. Do you intend to seek CMS approval to amend your annual or total Demonstration period
transition benchmarks in your approved OP?
■
Yes
■
No
□
Please explain the proposed changes to your transition benchmarks.
9
14. Tribal Initiative Only
Report the number of people assessed, transitioned and re- institutionalized during the
report period by population served, i.e., Older Adults, ID/DD, MI, PD, Other. Reported
numbers are a subset of the total numbers reported in questions 3, 4 and 7. Of the counts
provided above in questions 3, 4, and 7 (Section B), please provide the subset of these counts
that are the number of individuals considered part of your state’s Tribal Initiative.
■
For the first row, provide the number of individuals assessed during the reporting period.
See definition and instructions provided above for Section B, question 3 for additional
detail about how to determine the number of individuals assessed. [please provide a
number for each target population (if applicable for this reporting period) in the
appropriate box]
■
For the second row, provide the number of individuals that transitioned during the
reporting period. See definition and instructions provided above for Section B, question 4
for additional detail about how to determine the number of individuals transitioned.
[please provide a number for each target population (if applicable for this reporting
period) in the appropriate box]
■
For the third row, provide the number of individuals re- institutionalized for greater than
30 days. See definition and instructions provided above for Section B, question 7 for
additional detail about how to determine the number of individuals re-institutionalized.
[please provide a number for each target population (if applicable for this reporting
period) in the appropriate box]
■
Total For This Reporting Period
Did the Tribal Initiative have any difficulty transitioning the projected number of
individuals it proposed in the Operational Protocol during the reporting period? Please
describe your difficulties for the Tribal Initiative target population. [please use the provided text
box]
Use this box to explain missing, incomplete, or other qualifications to the data reported in
this section. [text box provided]
C.
Qualified HCBS Expenditures
Note: This page should be completed every 2nd reporting period (reporting of July – December
program data during January and February of the following calendar year)
1. Do you require modifying the Actual Level of Spending for last period?
■
Yes
■
No
□
Please describe why the changes were necessary and update in the table below.
Grantees may wish to modify the Actual Level of Spending in order to provide more accurate
qualified HCBS expenditure data for the previous reporting period. This may occur in instances
when qualified HCBS expenditure data were updated in response to additional claims run-out, or
if qualified HCBS expenditure data reported in the previous reporting period are outdated or
inaccurate. Grantees need to calculate the percentages.
Qualified expenditures are total Medicaid HCBS expenditures (federal and state funds) for all
Medicaid recipients (not just MFP participants), including: expenditures for all 1915c waiver
programs, home health services, and personal care if provided as a State Plan optional service,
as well as HCBS spending on MFP participants (qualified, demonstration and supplemental
10
services), and HCBS capitated rate programs (to the extent that HCBS spending can be
separated from the total capitated rate).
Qualified HCBS Expenditures: Actual level of spending for each Calendar Year (CY) or State
Fiscal Year (SFY) (column 4) is the sum of: 1) HCBS expenditures for all 1915c waivers and state
plan HCBS services -- from CMS 64 data and 2) MFP expenditures -- from MFP Financial
Reporting Forms A and B.
Grantees should enter total annual spending ONCE each year during the January/February
reporting period:
Please specify the period (CY or SFY) and the dates of your SFY in the text box below the chart.
When making updates or corrections to actual spending amounts reported for the previous year,
please check the 'yes' box at the top of this page to flag such changes.
Enter numeric Qualified HCBS Expenditures data in the box for the appropriate year.
■
Target level of spending (from budget worksheet)
■
Percent annual growth projected ([2017 Target – 2016 Target] / 2016 Target) [grantee
must perform calculation for 2017 reporting only. Note that the cell will automatically
multiply the number entered by 100 to convert it to a percentage. Therefore, please enter
the decimal in the cell.]
Example:
2016 Target
500
Calculation:
2017 Target
505
(505-500)/500 = .01
Enter .01 in the cell
■
Total spending for the calendar year
■
Percent annual change (from previous year) ([2017 Spending – 2016 Spending] / 2016
Spending) [grantee must perform calculation for 2017 reporting only. Note that the cell
will automatically multiply the number entered by 100 to convert it to a percentage.
Therefore, please enter the decimal in the cell.]
Example:
2016 Spending
1,000
Calculation:
2017 Spending
1,020
(1,020-1,000)/1,000 = .02
■
Percent of target reached (Total spending/ target level of spending)
■
Please explain your Year End rate of progress.
Enter .02 in the cell
2. Do you intend to seek CMS approval to amend your annual benchmarks for Qualified
HCBS Expenditures in your approved OP?
■
Yes
□
■
Please explain the proposed changes to your Qualified HCBS Expenditures
benchmark
No
Please specify the period (CY or SFY) and the dates of your SFY here: [text box provided]
3. Use this box to explain missing, incomplete, or other qualifications to the data reported in
this section. [text box provided]
11
D.1.
Additional Benchmarks
Note: Please enter text on the additional benchmarks and measures the first time you access the
report.
•
This section requests information and data on progress made towards achieving the state’s
additional MFP benchmarks, at least one of which reflects the state’s reinvestment of savings
generated under MFP to rebalance the state’s long-term care system. The information below
reflects each state’s additional benchmarks as described in the CMS-approved Operational
Protocol. If your state has not achieved the benchmark measure for this reporting period, please
use the provided text box to explain the barriers or challenges that have hindered progress, and
plans to address them. If you have more than three active additional benchmarks or more than 3
active measures for each benchmark, please send a separate attachment with this information. A
blank worksheet is available upon request from your project officer. This worksheet includes the
auto-calculation fields and can be submitted to your CMS project officer as a separate attachment.
•
Benchmarks for grantees participating in the Tribal Initiative can be added here.
For Quantitative Additional Benchmarks
•
Review the most recent CMS-approved benchmark targets, and enter or confirm the measure
target.
•
For the Period 1 Semi-Annual Report completed in July/August, please provide data under the
“Measure: First Period” column for the appropriate year and Measure.
•
For the Period 2 Semi-Annual Report completed in January/February, please provide data under
the “Measure: Second Period” column for the appropriate year and Measure.
•
The “Measure Entire Year” field will be auto-calculated.
•
The “% Achieved First Period” will be auto-calculated by dividing “Measure First Period” by
“Measure Target.”
•
The “% Achieved Second Period” will be auto-calculated by dividing “Measure Second Period” by
“Measure Target.”
•
The % achieved entire year” will be auto-calculated by dividing “Measure entire year” by
“Measure target.”
•
Complete the “Please explain your Year End rate of progress” text box provided at the bottom of
each measure to enter additional information on the measure or reported progress.
For Qualitative Additional Benchmarks
•
For each qualitative benchmark, please enter the qualitative measure goal in the “Measure
Target” column and leave the rest of the table blank. Describe your progress in the field that asks
“Please explain your Year-end rate of progress.”
Do you intend to seek CMS approval to amend your Additional Benchmarks in your approved OP?
•
•
Yes
o
Please explain the proposed changes to your additional benchmarks.
No
12
D.2.
Rebalancing Efforts
Note: This section should be completed every 1st reporting period (reporting of January – June
program data during July and August of that same year calendar year)
All MFP grantees are required to complete this section during this period to report on the cumulative
amount spent to date and use of rebalancing funds. MFP "Rebalancing Funds" refers to the net revenue
each state receives from the enhanced FMAP rate (over the state's regular FMAP) for qualified and
demonstration HCBS services provided to MFP participants. MFP grantees are required to reinvest the
rebalancing funds in initiatives that will help to rebalance the long-term care system. The rebalancing fund
amount is calculated on your annual Worksheet for Proposed Budget --- see "Rebalancing Fund
Calculation" box in the middle of the Excel Worksheet.
Rebalancing funds being used for specific Tribal Initiatives can be added here by participating
grantees. Add a separate rebalancing initiative for efforts that are specifically related to your state’s Tribal
Initiative.
In the table below, enter information on expenditures and activities, whether continuing from prior
reporting periods or initiated during this current reporting period, for each rebalancing initiative. If there
are more than 6 rebalancing initiatives, please combine related programs and initiatives so that there are
no more than 6.
For each rebalancing initiative, enter the Total Actual Expenditures for this initiative (that is, cumulative
spending from the start of MFP grant program through end of last calendar year) in the Total Actual
Expenditures text box.
If you have not spent any rebalancing funds to date, enter "$0.00" in the Total Actual Expenditures box,
and in the text box, describe how your state intends to spend rebalancing funds, and indicate when the
state expects to begin spending these funds. If one or more rebalancing initiatives ended in the past or
are currently inactive, enter the cumulative amount of expenditures in the Total Actual Expenditures box
and explain the current status of the initiative in the right most column.
Sample Rebalancing Initiative:
Rebalancing
Initiative Name
1. [text field]
E.1.
Brief Description of Initiative
[text field]
Total Actual Expenditures
for this initiative
(cumulative spending
from start of MFP grant
program through end of
last calendar year).
Explain any missing or
incomplete data.
[numeric field]
[text field]
Recruitment and Enrollment
Note: For the following questions, please update the previous period’s report as applicable.
1. Did anything change during the reporting period that made recruitment easier? Choose
from the list below and check all target populations that apply. Check "None" if nothing
has changed from the last reporting period. For all selected changes: i) Please indicate target
population(s) by checking appropriate box; and ii) Please describe changes by target population.
■
Type or quality of data available for identification
13
■
How data are used for identification
■
Obtaining provider/agency referrals or cooperation
■
Obtaining self referrals
■
Obtaining family referrals
■
Assessing needs
■
Other, specify below
■
None
2. What significant challenges did your program experience in recruiting individuals?
Significant challenges are those that affect the program’s ability to transition as many
people as planned. Choose from the list below and check all target populations that apply.
For all selected challenges: i) Please indicate target population(s) by checking appropriate box;
ii) Please describe challenges by target population; iii) Please describe what you are doing to
address the challenges; and iv) For the selected status, [“resolved,” “in progress” (still working on
it), or “abandoned” (not resolved and no longer pursuing it)], please describe the current status of
the challenge: (1) If resolved, please describe how was it resolved, e.g. received CMS approval to
change approach, revised strategy/developed a work around; or (2) If not resolved and no longer
pursuing it, please describe why are you no longer pursuing it.
■
Type or quality of data available for identification
■
Obtaining provider/agency referrals or cooperation
■
Obtaining self referrals
■
Obtaining family referrals
■
Assessing needs
■
Lack of interest among people targeted or the families
■
Unwilling to consent to program requirements
■
Other, specify below
■
None
3. Did anything change during the reporting period that made enrollment into the MFP
program easier? These changes may have been the result of changes in your state’s
Medicaid policies and procedures. For all selected changes: i) Please indicate target
population(s) by checking appropriate box; and ii) Please describe changes by target population.
■
Determination of initial eligibility
■
Re-determination of eligibility after a suspension due to re-institutionalization
■
Other, specify below
■
None
4. What significant challenges did your program experience in enrolling individuals?
Significant challenges are those that affect the program’s ability to transition as many
people as planned. For all selected challenges:
i) Please indicate target population(s) by checking appropriate box; ii) Please describe challenges
by target population; iii) Please describe what you are doing to address the challenges; and iv)
For the selected status, [“resolved,” “in progress” (still working on it), or “abandoned” (not
resolved and no longer pursuing it)], please describe the current status of the challenge: (1) If
resolved, please describe how was it resolved, e.g. received CMS approval to change approach,
revised strategy/developed a work around; or (2) If not resolved and no longer pursuing it, please
describe why are you no longer pursuing it.
■
Determining initial eligibility
14
■
Reestablishing eligibility after a suspension due to re-institutionalization
■
Other, specify below
■
None
5. Total number of MFP candidates assessed in this period, or a prior reporting period, who
are currently in the transition planning process, that is, "in the pipeline," and expected to
enroll in MFP.
■
Total [numeric response here]
6. Total number of MFP eligible individuals assessed in this period for whom transition
planning began but were unable to transition through MFP. The total reported below in
Question #7 must equal the number reported here in Question #6.
Included in this count should be those individuals who were assessed for MFP enrollment during
this reporting period, and could not transition to the community through MFP.
■
Total [numeric response here]
7. How many individuals could not be enrolled in the MFP program for each of the following
reasons: [please provide numbers by category] (For individuals with more than one reason
contributing to failure to transition, please pick only one below, corresponding to the most
important, so that individuals are only counted once.) The sum of reported number of individuals
who could not be enrolled in the MFP program (Question #7) should equal the number reported
above in Question #6.
■
Individual transitioned to the community, but did not enroll in MFP
■
Individual's physical health, mental health, or other service needs or estimated costs
were greater than what could be accommodated in the community or through the state's
current waiver programs
■
Individual could not find affordable, accessible housing, or chose a type of residence that
does not meet the definition of MFP qualified residences
■
Individual changed his/her mind about transitioning, did not cooperate in the planning
process, had unrealistic expectations, or preferred to remain in the institution
■
Individual's family member or guardian refused to grant permission, or would not provide
back-up support
■
Other, please specify. [This option may be modified with a brief explanation–if necessary.
Examples of other reasons include individuals died before transitioning to the community
or they were not eligible for waiver services in the community (even though they were
determined eligible for MFP.)]
■
If necessary, please explain further why individuals could not be transitioned or enrolled
in the MFP program. [please use the provided text box to explain further]
8. Number of MFP participants transitioned during this period whose length of time from
assessment to actual transition took: [please provide a number for each option (if applicable
for this reporting period) in the appropriate box]
■
Less than 2 months.
■
2 to 6 months.
■
6 to 12 months.
■
12 to 18 months.
■
18 to 24 months.
■
24 months or more.
15
Please indicate the average length of time required from assessment to actual transition. [please
use the provided text box to explain further –if necessary]
Percentage of MFP participants transitioned during this period whose length of time from
assessment to actual transition took.
■
Less than 2 months.
■
2 to 6 months.
■
6 to 12 months.
■
12 to 18 months.
■
18 to 24 months.
■
24 months or more.
9. Total number of individuals who were referred to the MFP program through MDS 3.0
Section Q referrals during the reporting period. Please report an unduplicated count.
■
Total [numeric response here]
10. Of the MDS 3.0 Section Q referrals ever received by the MFP program, number of
individuals who subsequently enrolled in MFP and transitioned to the community during
this reporting period.
■
Total [numeric response here]
11. What types of activities were supported by ADRC/MFP Supplemental Funding Opportunity
C grant funds during this reporting period, awarded in 2010 to 25 MFP grantee states to
support activities that help to expand the capacity of ADRCs as part of a wrong no door
(NWD) system to assist with MFP transition efforts, and partner in utilizing the revised
Minimum Data Set (MDS) 3.0 Section Q referrals? Choose from the list below. Check “Not
Applicable” if your state did not receive this funding.
■
Develop or improve Section Q referral tracking systems–electronic or other
■
Education and outreach to nursing facility or other LTC system staff to generate referrals
to MFP or other transition programs
■
Develop or expand options counseling or transition planning and assistance
■
Train current or new ADRC staff to do transition planning in MFP or other transition
programs
■
Expansion of ADRC program in State
■
Other activities – Please describe in the provided text box
■
Not applicable – state did not receive this grant
12. Please describe progress in implementing the activities identified in Question #11 during
this past reporting period, and how they have helped your state achieve MFP goals. In
addition, describe the results or outcomes of these activities; if you specified numerical
targets in your grant proposal, please provide counts during the reporting period.
[Please use the provided text box]
13. Please describe any barriers or challenges in implementing the identified activities
proposed in your grant application and the steps you are taking to resolve them.
[Please use the provided text box]
16
14. Tribal Initiative Only
E.2.
■
Changes that made recruitment and/or enrollment easier. Identify challenges that
the program had recruiting and/or enrolling individuals during this reporting
period. Describe changes that occurred during this reporting period and whether they
(1) made recruitment and/or enrollment easier or (2) provided a challenge to recruitment
and/or enrollment for individuals considered part of your state’s Tribal Initiative. [please
use the provided text box]
■
Total number of MFP candidates under the Tribal Initiative assessed in this period,
or a prior reporting period, who are currently in the transition planning process
and expected to enroll in MFP (a subset of the total in question 5). This count should
be a subset of Section E.1, question 5. [numeric response here]
■
Total number of MFP eligible individuals under the Tribal Initiative assessed in this
period for whom transition planning began but were unable to transition through
MFP (a subset of the total in question 6). See instructions provided above for Section
E.1, question 6 for additional detail about who is considered in the transition planning
process. [numeric response here]
■
Provide reasons why tribal members in the Tribal Initiative could not enroll in MFP
and the average length of time from assessment to actual transition. Identify any
barriers or challenges in implementing the activities proposed in your grant
application and steps you are taking to resolve them. [please use the provided text
box]
Informed Consent and Guardianship
Note: For the following questions, please update the previous period’s report as applicable.
1. What changed during the reporting period that made obtaining informed consent easier?
For all selected changes: i) Please indicate target population(s) by checking appropriate box; and
ii) Please describe changes by target population.
■
Revised inform consent documents and/or forms
■
Provided more or enhanced training for transition coordinators
■
Improved how guardian consent is obtained
■
Other, specify below
■
Nothing
2. What changed during the reporting period that improved or enhanced the role of
guardians? For all selected changes: i) Please indicate target population(s) by checking
appropriate box; and ii) Please describe changes by target population.
■
The nature by which guardians are involved in transition planning
■
Communication or frequency of communication with guardians
■
The nature by which guardians are involved in ongoing care planning
■
The nature by which guardians are trained and mentored
■
Other, specify below
■
Nothing
3. What significant challenges did your program experience in obtaining informed consent?
For all selected challenges: i) Please indicate target population(s) by checking appropriate box;
ii) Please describe challenges by target population; iii) Please describe what you are doing to
address the challenges; and iv) For the selected status, [“resolved,” “in progress” (still working on
17
it), or “abandoned” (not resolved and no longer pursuing it)], please describe the current status of
the challenge: (1) If resolved, please describe how was it resolved, e.g. received CMS approval to
change approach, revised strategy/developed a work around; or (2) If not resolved and no longer
pursuing it, please describe why are you no longer pursuing it.
E.3.
■
Ensuring informed consent
■
Involving guardians in transition planning
■
Communication or frequency of communication with guardians
■
Involving guardians in ongoing care planning
■
Training and mentoring of guardians
■
Other, specify below
■
None
Outreach/Marketing/Education
Note: For the following questions, please update the previous period’s report as applicable.
1. What notable achievements in outreach, marketing or education did your program
accomplish during the reporting period? For all selected achievements: i) Please indicate
target population(s) by checking appropriate box; and ii) Please describe achievements by target
population.
■
Development of print materials
■
Implementation of localized/targeted media campaign
■
Implementation of statewide media campaign
■
Involvement of stakeholder state agencies in outreach and marketing
■
Involvement of discharge staff at facilities
■
Involvement of ombudsman
■
Training of frontline workers on program requirements
■
Other, specify below
■
None
2. What significant challenges conducting outreach, marketing, and education activities did
you experience during this reporting period? For all selected challenges: i) Please indicate
target population(s) by checking appropriate box; ii) Please describe challenges by target
population; iii) Please describe what you are doing to address the challenges; and iv) For the
selected status, [“resolved,” “in progress” (still working on it), or “abandoned” (not resolved and no
longer pursuing it)], please describe the current status of the challenge: (1) If resolved, please
describe how was it resolved, e.g. received CMS approval to change approach, revised
strategy/developed a work around; or if not resolved and no longer pursuing it, please describe
why are you no longer pursuing it.
■
Development of print materials
■
Implementation of a localized / targeted media campaign
■
Implementation of a statewide media campaign
■
Involvement of stakeholder state agencies in outreach and marketing
■
Involvement of discharge staff at facilities
■
Involvement of ombudsman
■
Training of frontline workers on program requirements
18
■
Other, specify below
■
None
3. Tribal Initiative Only - Describe any outreach, marketing and education activities and
challenges during this reporting period specific to the Tribal Initiative. [please use the
provided text box]
E.4.
Stakeholder Involvement
1. How are consumers and families involved in MFP during this period and how did their
efforts contribute to MFP goals and benchmarks, or inform MFP and LTC policies?
Check the appropriate boxes in the Stakeholder Involvement table provided:
Provided
input on
MFP
policies or
procedures
Helped to
promote
or market
MFP
program
Involved in
Housing
Development
Involved in
Quality of
Care
assurance
Attended
MFP
Advisory
Meeting(s)
Other
(describe)
Consumers
Families
Advocacy
Organizations
HCBS
Providers
Institutional
Providers
Labor/Worker
Association
Public Housing
Agency(ies)
Other State
Agencies
(except
Housing)
Non-profit
Housing Assn.
Other: (specify)
Please explain the nature of consumers’ and families’ involvement in MFP during this period and
how it contributed to MFP goals and benchmarks, or informed MFP and LTC policies. [Please
explain in provided text box.]
Please explain the nature of others’ (non-consumers) involvement in MFP during this period and
how it contributed to MFP goals and benchmarks, or informed MFP and LTC policies. [Please
explain in provided text box.]
19
2. On average, how many consumers, family members, and consumer advocates attended
each meeting of the MFP program's advisory group (the group that advises the MFP
program) during the reporting period? Choose one option of the three provided. If the MFP
program’s advisory group met during the reporting period, choose “Specific Amount” and provide
the average number of attendees.
■
Specific Amount:
□
Please Indicate the Amount of Attendance
■
Advisory group did not meet during the reporting period
■
Program does not have an advisory group
3. What types of challenges has your program experienced involving consumers and
families in program planning and ongoing program administration? For all selected
challenges, please describe what you are doing to address the challenge.
■
Identifying willing consumers
■
Identifying willing families
■
Involving them in a meaningful way
■
Keeping them involved for extended periods of time
■
Communicating with consumers
■
Communicating with families
■
Other, specify below
■
None
4. Did your program make any progress during the reporting period in building a
collaborative relationship with any of the following housing agencies or organizations?
For all selected please describe any new developments.
■
State agency that sets housing policies
■
State housing finance agency
■
Public housing agency(ies)
■
Non-profit agencies involved in housing issues
■
Other housing organizations (such as landlords, realtors, lenders and mortgage brokers)
■
None
5. Has your program experienced significant challenges in building a collaborative
relationship with any of the agencies involved in setting state housing policies, financing,
or implementation of housing programs?
■
Yes
□
■
Please describe.
No
6. Tribal Initiative Only – Describe the nature of the stakeholder efforts within the Tribal
Initiative during this reporting period that include the role of the MFP advisory group in
relationship to the initiative; any new advisory groups or efforts specific to this initiative;
number of tribal members that are actively involved in an advisory capacity and any
challenges that face stakeholder involvement in the initiative. [please use the provided text
box]
20
E.5.
Benefits and Services - Medicaid Program and Policy Issues
This section asks about progress pertaining to state Medicaid policies and rules that allow people needing
long-term services and supports to choose the setting and types of services they wish to receive. The
next set of questions in E.6 concern changes in the availability or accessibility of home and communitybased services and providers.
Note: For the following questions, please update the previous period’s report as applicable.
1. What progress was made during the reporting period regarding Medicaid programmatic
and policy issues that increased access to home and community-based services DURING
the one-year transition period? For all selected progress: i) Please indicate target population(s)
by checking appropriate box; and ii) Please describe by target population.
■
Increased capacity of HCBS waiver programs to serve MFP participants
■
Added a self-direction option
■
Developed State Plan Amendment to add or modify benefits needed to serve MFP
participants in HCBS settings
■
Developed or expanded managed LTC programs to serve MFP participants
■
Obtained authority to transfer Medicaid funds from institutional to HCBS line items to
serve MFP participants
■
Legislative or executive authority for more funds or slots or both.
■
Improved state funding for pre-transition services (such as targeted case management)
■
Other, specify below
■
None
2. What significant challenges or barriers did your program experience in guaranteeing MFP
participants have access to Medicaid HCBS DURING the one-year transition period? For all
selected challenges: i) please indicate target population(s) by checking appropriate box; ii) Please
describe challenges by target population; iii) Please describe what you are doing to address the
challenges; and iv) For the selected status, [“resolved,” “in progress” (still working on it), or
“abandoned” (not resolved and no longer pursuing it)], please describe the current status of the
challenge: (1) If resolved, please describe how was it resolved, e.g. received CMS approval to
change approach, revised strategy/developed a work around; or (2) If not resolved and no longer
pursuing it, please describe why are you no longer pursuing it.
■
Efforts to increase capacity of HCBS waiver programs to serve more individuals are
delayed or disapproved
■
Efforts to add a self-direction option are delayed or disapproved
■
State Plan Amendment to add or modify benefits needed to serve people in HCBS
settings are delayed or disapproved
■
Plans to develop or expand managed LTC programs to serve or include people needing
HCBS are delayed or disapproved
■
Efforts to obtain authority to transfer Medicaid funds from institutional to HCBS line items
to serve people transitioning out of MFP are delayed or disapproved.
■
Legislative or executive authority for more funds or slots are delayed or disapproved
■
State funding for pre-transition services (such as targeted case management) have been
delayed or disapproved
■
Other, specify below
■
None
21
3. What progress was made during the reporting period on Medicaid programmatic and
policy issues to assure continuity of home and community based services AFTER the oneyear transition period? For all selected progress: i) Please indicate target population(s) by
checking appropriate box; and ii) Please describe by target population.
■
Increased capacity of HCBS waiver programs to serve more Medicaid enrollees
■
Added a self-direction option
■
Developed State Plan Amendment to add or modify benefits needed to serve more
Medicaid enrollees in HCBS settings
■
Developed or expanded managed LTC programs to serve more Medicaid enrollees
■
Obtained authority to transfer Medicaid funds from institutional to HCBS line items to
serve more Medicaid enrollees
■
Legislative or executive authority for more funds or slots or both
■
Improved state funding for pre-transition services, such as targeted case management
■
Other, specify below
■
None
4. What significant challenges or barriers did your program experience in guaranteeing
continuity of care for MFP participants in Medicaid HCBS AFTER the one-year transition
period? For all selected challenges: i) Please indicate target population(s) by checking
appropriate box; ii) Please describe challenges by target population; iii) Please describe what you
are doing to address the challenges; and iv) For the selected status, [“resolved,” “in progress”
(still working on it), or “abandoned” (not resolved and no longer pursuing it)], please describe the
current status of the challenge: (1) If resolved, please describe how was it resolved, e.g. received
CMS approval to change approach, revised strategy/developed a work around; or (2) If not
resolved and no longer pursuing it, please describe why are you no longer pursuing it.
■
Efforts to increase capacity of HCBS waiver programs to serve more individuals are
delayed or disapproved
■
Efforts to add a self-direction option are delayed or disapproved
■
State Plan Amendment to add or modify benefits needed to serve people in HCBS
settings is delayed or disapproved
■
Plans to develop or expand managed LTC programs to serve or include people needing
HCBS are delayed or disapproved
■
Efforts to obtain authority to transfer Medicaid funds from institutional to HCBS line items
to serve people transitioning out of MFP are delayed or disapproved
■
Legislative or executive authority for more funds or slots are delayed or disapproved
■
State funding for pre-transition services have been delayed or disapproved.
■
Other, specify below
■
None
5. Tribal Initiative Only – What progress was made during the period toward addressing any
programmatic and/or policy issues as well as any specific challenges that might affect the
availability of home and community-based services during and after the one-year
transition period. Please describe the efforts by populations affected. For individuals
enrolled under the Tribal Initiative, provide any updates by target population about (1) progress
towards increasing the availability of home and community- based services and (2) challenges
related to the availability of these services both during and after the one-year MFP transition
period. [please use the provided text box]
22
E.6.
Participant Access to Services
This section concerns the supply and availability of home and community based services, or the ease of
receiving HCBS covered by Medicaid programs and policies.
Note: For the following questions, please update the previous period’s report as applicable.
1. What steps did your program or state take during the reporting period to improve or
enhance the ability of MFP participants to receive home and community based services?
For all selected steps: i) Please indicate target population(s) by checking appropriate box; and ii)
Please describe the steps taken.
■
Increased the number of transition coordinators
■
Increased the number of home and community-based service providers contracting with
Medicaid
■
Increased access requirements for managed care LTC providers
■
Increased payment rates to HCBS providers
■
Increased the supply of direct service workers
■
Improved or increased transportation options
■
Added or expanded managed LTC programs or options
■
Other, specify below
■
None
2. What are MFP participants' most significant challenges to accessing home and
community-based services? These are challenges that either make it difficult to transition
as many people as you had planned or make it difficult for MFP participants to remain
living in the community. For all selected challenges: i) Please indicate target population(s) by
checking appropriate box; ii) Please describe challenges by target population; iii) Please describe
what you are doing to address the challenges; and iv) For the selected status, [“resolved,” “in
progress” (still working on it), or “abandoned” (not resolved and no longer pursuing it)], please
describe the current status of the challenge: (1) If resolved, please describe how was it resolved,
e.g. received CMS approval to change approach, revised strategy/developed a work around; or
(2) If not resolved and no longer pursuing it, please describe why are you no longer pursuing it.
■
Insufficient supply of HCBS providers
■
Insufficient supply of direct service workers
■
Preauthorization requirements
■
Limits on amount, scope, or duration of HCBS allowed under Medicaid state plan or
waiver program
■
Lack of appropriate transportation options or unreliable transportation options
■
Insufficient availability of home and community-based services (provider capacity does
not meet demand)
■
Other, specify
■
None
3. Tribal Initiative Only – What steps did your program take to improve access to home and
community-based service during this reporting period? What challenges exist to accessing
services and what efforts are underway to address these challenges under the Tribal Initiative?
(see questions 1 and 2 for examples of some activities and challenges) For individuals enrolled
under the Tribal Initiative, provide any updates about (1) progress towards increasing access to
23
home and community-based services and challenges related to accessing these services. [please
use the provided text box]
E.7.
Self-Direction
Note: For the following questions, please update the previous period’s report as applicable.
Did your state have any self-direction programs in effect during this reporting period? [please
check the appropriate box]
■
Yes
■
No –Please skip this section if your state did not have any self-direction programs in
effect during the reporting period.
1. How many MFP participants were currently in a self-direction program as of the last day of
the reporting period? Please provide a number for each target population (if applicable for this
reporting period) in the appropriate box.
2. Of those MFP participants in a self-direction program how many: Please provide a number
for each target population (if applicable for this reporting period) in the appropriate box.
■
Hired or supervised their own personal assistants during the reporting period.
■
Managed their allowance or budget during the reporting period.
3. How many MFP participants in a self-direction program during the reporting period
reported abuse or experienced an accident? Please provide a number for each target
population (if applicable for this reporting period) in the appropriate box.
■
Reported being abused by an assistant, job coach, or day program staff.
■
Experienced an accident (such as a fall, burn, medication error).
■
Other, please specify. [this option may be modified with a brief explanation – if
necessary]
4. How many MFP participants in a self-direction program dis-enrolled from the self-direction
program during the reporting period? Please provide a number for each target population (if
applicable for this reporting period) in the appropriate box.
5. Of the MFP participants who were dis-enrolled from a self-direction program, how many
were dis-enrolled for each reason below? Please provide a number for each target population
(if applicable for this reporting period) in the appropriate box.
■
Opted-out.
■
Inappropriate spending.
■
Unable to self-direct.
■
Abused their worker.
■
Other, please specify. [this option may be modified with a brief explanation – if
necessary]
6. Tribal Initiative Only – Provide the number of tribal members by population that directed
their own service, reported abuse or experienced an accident, dis-enrolled in self-directed
services during the reporting period. Of the counts provided above in questions 1-5, please
provide the subset of these counts that are the number of individuals considered part of your
state’s Tribal Initiative.
24
■
For the first row, provide the number of individuals that directed their own services by
either hiring or supervising their own personal assistants, or managing their allowance or
budget during the reporting period. This count should be a subset of Section E.7 question
2. [please provide a number for each target population (if applicable for this reporting
period) in the appropriate box]
■
For the second row, provide the number of individuals that reported abuse or
experienced an accident during the reporting period. This count should be a subset of
Section E.7 question 3. [please provide a number for each target population (if applicable
for this reporting period) in the appropriate box]
■
For the third row, provide the number of individuals that dis- enrolled from self-directed
services during the reporting period. This count should be a subset of Section E.7
question 4. [please provide a number for each target population (if applicable for this
reporting period) in the appropriate box]
■
Total For This Reporting Period
Please describe your efforts within the Tribal Initiative to offer self-directed services and as a
subset of the numbers reported in questions in 1-5.
Use this box to explain missing, incomplete, or other qualifications to the data reported in this
section. [text box provided]
E.8.
Quality Management and Improvement
Note: For the following questions, please update the previous period’s report as applicable.
Do you want the information on critical incidents in Questions #6 through #10 in this section to
appear in the print version of the report? If not, please uncheck the box.
The checkbox above will be checked by default. States wishing to print the report but not print
sensitive information contained in Questions #6 though #10 should uncheck the box. The
questions will still appear in the printed version of the report, but the fields will be blank.
1. What notable improvements did your program make to your HCBS quality management
systems that affect MFP participants? These improvements may include improvements to
quality management systems for your state’s waiver programs. For all selected
improvements. Please indicate target population(s) by checking appropriate box; and ii) Please
describe the improvement.
■
Improved intra/inter departmental coordination.
■
Implemented/Enhanced data collection instruments.
■
Implemented/Enhanced information technology applications.
■
Implemented/Enhanced consumer complaint processes.
■
Implemented/Enhanced quality monitoring protocols DURING the one-year transition
period (that is, methods to track quality-related outcomes using identified benchmarks or
identifying participants at risk of poor outcomes and triggering further review at a later
point in time).
■
Enhanced a critical incident reporting and tracking system. A critical incident (e.g., abuse,
neglect and exploitation) is an event that could bring harm, or create potential harm, to a
waiver participant.
■
Enhanced a risk management process.
■
Other, specify below.
25
■
None.
2. How many calls did your program receive from MFP participants for emergency back-up
assistance during the reporting period by type of assistance needed? Emergency refers to
situations that could endanger the health or well-being of a participant and may lead to a
critical incident if not addressed. (Please note this question only captures calls that were
considered to be emergencies and not those that are informational or complaints.) Provide
the number of calls for emergency backup assistance for each target population made during the
reporting period in the appropriate box. If a tiered approach is used by the state (an example of a
tiered or multi-level approach may include the Provider being contacted first [Tier 1], use of predetermined informal supports as the second contact [Tier 2], and then finally, an On-Call Case
Management Agency being contacted [Tier 3]), report only the number of calls that were made to
the final tier of the backup strategy during the reporting period. Also, report in the text box at the
bottom of the page (i.e., “Use this box to explain missing, incomplete, or other qualifications to the
data reported in this section.”) that your MFP state utilizes a tiered approach to its emergency
back-up strategy.
■
Transportation: to get to medical appointments.
■
Life-support equipment repair/replacement.
■
Critical health services that are essential to the individual whereby without such services,
the individual’s health, safety and/or welfare are placed in jeopardy.
■
Direct service/support workers not showing up.
■
Other, please specify. [this option may be modified with a brief explanation – if
necessary]
■
Total –for each target population.
3. For what percentage of the calls received were you able to provide the assistance that was
needed when it was needed? Please provide the number of calls for emergency backup
assistance for each target population made during the reporting period where backup assistance
was appropriately provided. In the appropriate box, provide the number of instances where
emergency back-up was provided appropriately and in a timely fashion in response to a request
for emergency back-up (as defined in Question #2 above).
4. Did your program have to change back-up services or quality management systems due to
an identified problem or challenge in the operation of your back-up systems?
■
Yes
□
■
Please describe the changes you have made, as well as the effectiveness of these
changes.
No
5. Did your program experience any challenges in: For all selected challenges below: i) Please
indicate target population(s) by checking appropriate box; ii) Please describe challenges by target
population; iii) Please describe what you are doing to address the challenges; and iv) For the
selected status, [“resolved,” “in progress” (still working on it), or “abandoned” (not resolved and no
longer pursuing it)], please describe the current status of the challenge: (1) If resolved, please
describe how was it resolved, e.g. received CMS approval to change approach, revised
strategy/developed a work around; or (2) If not resolved and no longer pursuing it, please
describe why are you no longer pursuing it.
■
Developing adequate and appropriate service plans for participants, i.e., developing
service plans that address the participant’s assessed needs and personal goals
■
Assessing participants’ risk
■
Developing, implementing or adjusting risk mitigation strategies
■
Addressing emergent risks in a timely fashion
26
■
Delivering all the services and supports specified in the service plan
■
Modifying the service plan to accommodate participants’ changing needs or
circumstances, i.e., increasing units of a service, adding a different type of service, or
changing time of day when services are delivered, etc.
■
Addressing threats to participants’ health or welfare
■
Other, please specify. [this option may be modified with a brief explanation – if
necessary]
■
None
6. Please specify the total number of participant deaths that occurred during the reporting
period: [please provide a number for each target population in the appropriate box]. Report the
total number of all deaths of MFP participants who died during the reporting period, regardless of
cause.
7. Please provide information on the circumstances surrounding the reported deaths: Briefly
summarize the nature and circumstances around the reported deaths by category, to the extent
possible. Categories of reported deaths may include, but are not limited to natural,
unexpected/untimely, murders, suicides, and accidental and due to injury.
8. How many critical incidents occurred during the reporting period? [please provide a number
in the provided number box]
9. Please describe (in the text box below). Further detail regarding the nature of each critical
incident may be provided with Question #10 (below, in this section). Summarize any
circumstances around the reported critical incidents that will not be covered in Question #10
below. [please use the provided text box to explain further]
10. Please describe the nature of each critical incident that occurred. [CMS defines a critical
incident or event as an alleged, suspected, or actual occurrence of: (a) abuse (including physical,
sexual, verbal and psychological abuse); (b) mistreatment or neglect; (c) exploitation; (d) serious
injury; (e) death other than by natural causes; (f) other events that cause harm to an individual;
and, (g) events that serve as indicators of risk to participant health and welfare such as
hospitalizations, medication errors, use of restraints or behavioral interventions.]
Choose from the list below.
■
Abuse
■
Neglect
■
Exploitation
■
Hospitalizations
■
Emergency Room visits
■
Deaths determined to be due to abuse, neglect, or exploitation
■
Deaths in which a breakdown in the 24-hour back-up system was a contributing factor
■
Involvement with the criminal justice system
■
Medication administration errors
■
Other, specify below
■
None
For these selected critical incidents of Abuse, Neglect, Exploitation, Involvement with the criminal
justice system, Medication administration errors, and Other):
■
Please specify the number of times this type of critical incident occurred [please provide a
number in the provided number box];
■
Please explain if the state made changes, either for the consumer(s) or its system, as a
result of the analysis of critical incidents; and
27
■
Please specify the status of the critical incident: [“resolved,” “in progress” (still working on
it), or “abandoned” (not resolved and no longer pursuing it)].
For these selected critical incidents of Hospitalizations:
■
Please specify the number of times this type of critical incident occurred [please provide a
number in the provided number box]
■
Of these hospitalizations, approximately how many occurred within 30 days after an
individual transitioned to the community for the first time, or after an individual re-enrolled
in the MFP program and re-transitioned to the community after a lengthy institutional stay
lasting longer than 30 days?
For these selected critical incidents of Emergency Room visits:
■
Please specify the number of times this type of critical incident occurred; and
■
Please specify approximately how many occurred within 30 days of discharge from a
hospital or other institutional setting.
For the selected critical incident of Deaths determined to be due to abuse, neglect or exploitation:
■
Please specify the number of deaths occurring either in the current or previous reporting
periods where an investigation determined that the death was due to abuse, neglect or
exploitation [please provide a number in the provided number box]; and
■
For each of these deaths, please describe the findings of the investigation and any
actions taken by the state [please provide a text response in the text box].
For the selected critical incident of Deaths in which a breakdown in the 24-hour back-up system
was a contributing factor:
■
Please specify the number of deaths occurring either in the current or previous reporting
periods where an investigation determined that a breakdown in the 24-hour back-up
system was a contributing factor. [please provide a number in the provided number box]
■
For each of these deaths, please describe the findings of the investigation and any
actions taken by the state. [please provide a text response in the text box]
11. Tribal Initiative Only – Describe any improvement(s) or challenge(s) related to the quality
management within the Tribal Initiative during this reporting period. Include reported
critical incidents as a subset of those identified in question 8. Describe the challenges
related to the development of adequate service plans, assessing risk implementing or
assessing risk mitigation strategies, addressing emergent risks in a timely fashion and
delivering services as specified in the plans. (1) Describe any improvements or challenges
related to quality management activities impacting individuals under the Tribal Initiative. (2)
Specifically include a count of critical incidents for these individuals. And, (3) provide a description
of challenges related to other quality management systems listed in the question. [text box
provided]
12. Tribal Initiative Only – Describe as a subset of the totals reported in questions 6, 7, 8, 9
and 10, the total number of participant deaths, circumstances surrounding the deaths,
critical incidents that occurred and nature of the incidents. For individuals enrolled under the
Tribal Initiative, provide (1) the number of participant deaths that occurred during the reporting
period as a subset of Section E.8 question 6 and the circumstances around those deaths, and
(2) the number of critical incidents that occurred as a subset of Section E.8 question 8 and the
circumstances regarding the nature of those incidents.
Use this box to explain missing, incomplete, or other qualifications to the data reported in this
section. [text box provided]
28
E.9.
Housing for Participants
Note: For the following questions, please update the previous period’s report as applicable.
Questions #3 and #4 MUST be updated each period.
1. What notable achievements in improving housing options for MFP participants did your
program accomplish during the reporting period? For all selected improvements: i) Please
indicate target population(s) by checking appropriate box; and ii) Please describe the
achievement.
■
Developed inventory of affordable and accessible housing.
■
Developed local or state coalitions of housing and human service organizations to identify
needs and/or create housing-related initiatives.
■
Developed statewide housing registry.
■
Implemented new home ownership initiatives.
■
Improved funding or resources for developing assistive technology related to housing.
■
Improved information systems about affordable and accessible housing.
■
Increased number of rental vouchers.
■
Increased supply of affordable and accessible housing.
■
Increased supply of residences that provide or arrange for long term services and/or
supports.
■
Increased supply of small group homes.
■
Increased/Improved funding for home modifications.
■
Other, specify below.
■
None.
2. What significant challenges did your program experience in securing appropriate housing
options for MFP participants? Significant challenges are those that affect the program's
ability to transition as many people as planned or to keep MFP participants in the
community. For all selected challenges: i) Please indicate target population(s) by checking
appropriate box; ii) Please describe challenges by target population; iii) Please describe what you
are doing to address the challenges; and iv) For the selected status, [“resolved,” “in progress”
(still working on it), or “abandoned” (not resolved and no longer pursuing it)], please describe the
current status of the challenge: (1) If resolved, please describe how was it resolved, e.g. received
CMS approval to change approach, revised strategy/developed a work around; or (2) If not
resolved and no longer pursuing it, please describe why are you no longer pursuing it.
■
Lack of information about affordable and accessible housing.
■
Insufficient supply of affordable and accessible housing.
■
Lack of affordable and accessible housing that is safe.
■
Insufficient supply of rental vouchers.
■
Lack of new home ownership programs.
■
Lack of small group homes.
■
Lack of residences that provide or arrange for long term services and/or supports.
■
Insufficient funding for home modifications.
■
Unsuccessful efforts in developing local or state coalitions of housing and human
services organizations to identify needs and/or create housing related initiatives.
■
Unsuccessful efforts in developing sufficient funding or resources to develop assistive
technology related to housing.
29
■
Other, specify below.
■
None.
3. How many MFP participants who transitioned to the community during the reporting
period moved to each type of qualified residence? The sum total reported below should
equal the number of individuals who transitioned to the community this period, reported in
Question #4 (Transitions). [This question is required.] Please provide a number for each target
population (if applicable for this reporting period) in the appropriate box.
■
Home (owned or leased by individual or family).
■
Apartment (individual lease, lockable access, etc.).
■
Group home or other residence in which 4 or fewer unrelated individuals live.
■
Apartment in qualified assisted living.
4. Have any MFP participants received a housing supplement during the reporting period?
Choose from the list of sources below and check all target populations that apply. Included
in this count should be housing supplements that were awarded during the reporting period, but
not yet dispensed. For all selected sources of housing supplement, please indicate target
population(s) by checking appropriate box.
■
202 funds.
■
CDBG funds.
■
Funds for assistive technology as it relates to housing.
■
Funds for home modifications.
■
HOME dollars.
■
Housing choice vouchers (such as tenant based, project based, mainstream, or
homeownership vouchers).
■
Housing trust funds.
■
Low income housing tax credits.
■
Section 811.
■
USDA rural housing funds.
■
Veterans Affairs housing funds.
■
Other, please specify. [this option may be modified with a brief explanation – if
necessary]
■
None.
5. Tribal Initiative Only – As a subset of the totals in question 3, report by population where
tribal members transitioned to as a result of the program. Of the count provided above in
Section E.9 questions 3, please provide the subset of these counts that are the number of
individuals considered part of your state’s Tribal Initiative.
■
For the first row, provide the number of individuals that transitioned into a home that was
owned or leased by the individual or family. [please provide a number for each target
population (if applicable for this reporting period) in the appropriate box]
■
For the second row, provide the number of individuals that transitioned into an apartment
during the reporting period. [please provide a number for each target population (if
applicable for this reporting period) in the appropriate box]
■
For the third row, provide the number of individuals that transitioned into a group home or
other residence in which 4 or fewer individuals live. [please provide a number for each
target population (if applicable for this reporting period) in the appropriate box]
30
■
For the fourth row, provide the number of individuals that transitioned into an apartment
in a qualified assisted living. [please provide a number for each target population (if
applicable for this reporting period) in the appropriate box]
■
Total For This Reporting Period.
6. Describe specific housing efforts associated with this initiative and housing challenges
during this reporting period. [please use the provided text box]
Use this box to explain missing, incomplete, or other qualifications to the data reported in this
section. [text box provided]
E.10. Employment Supports and Services
Note: For the following questions, please update the previous period’s report as applicable.
1. What types of ongoing employment supports are provided through your MFP program to
help participants find or maintain employment? For all selected ongoing employment
supports: i) Please indicate target population(s) by checking appropriate box; ii) Please describe
by target population; and, iii) Please answer: How is this service or support funded? Choose from:
Qualified HCBS, MFP Demonstration Services, MFP Supplemental Services, MFP 100%
Administrative Funding, or Other.
■
Job coaching or ongoing support planning.
■
Job training or re-training.
■
Peer to peer consultation and support.
■
Employment monitoring or mediation with employer/employees to resolve barriers to
work.
■
Mediation with family/friends to secure their support for individuals’ work- related needs.
■
Assistance with transportation to and from work.
■
Assistance with budgeting.
■
Assistance developing interpersonal or employment skills.
■
Other, please specify. [this option may be modified with a brief explanation – if
necessary]
■
None.
2. What activities or progress was made this period to utilize MFP resources to support the
goals of MFP participants? For all selected activities or progress: i) Please answer: How is this
activity funded? Qualified HCBS, MFP Demonstration Services, MFP Supplemental Services,
MFP 100% Administrative Funding, or Other?
■
Hired employment specialists to help MFP participants achieve employment goals.
■
Produced training resources or delivered employment training to MFP staff, transition
coordinators, or waiver staff.
■
Incorporated information about disability- and employment-related agencies and services
into outreach materials.
■
Financed services or supports (such as adaptive equipment, transportation, personal
assistance services) to help address barriers to employment.
■
Leveraged Medicaid Infrastructure Grant program resources or funds (via supplemental
grants or no-cost extension of previous grants) to support employment of participants
with disabilities.
31
■
Other, please specify. [this option may be modified with a brief explanation – if
necessary]
■
None.
3. What progress was made during the reporting period to establish collaborative
relationships with your state employment agencies (i.e., state departments of labor,
vocational rehabilitation, workforce development, or commissions for the blind)?
■
Participated in cross-agency awareness training.
■
Participated in multi-agency working groups that address employment for individuals with
disabilities.
■
Participated in state or local Workforce Investment Boards.
■
Shared enrollment information to determine eligibility for services.
■
Shared the costs of direct services for shared clients.
■
Shared a database that allows the agencies to access one another’s intake and client
information.
■
Other, please specify. [this option may be modified with a brief explanation – if
necessary]
■
None.
4. Were there any other developments or progress this period toward increasing the
availability of employment services and supports for MFP participants? [please use the
provided text box]
5. Tribal Initiative Only – Describe specific employment efforts associated with this initiative
and employment challenges during this reporting period. [please use the provided text box]
F.
Organization and Administration
Note: For the following questions, please update the previous period’s report as applicable.
1. Were there any changes in the organization or administration of the MFP program during
this reporting period? For example, did Medicaid agency undergo a reorganization that
altered the reporting relationship of the MFP Project Director?
■
Yes
□
■
Please describe the changes.
No.
2. What interagency issues were addressed during this reporting period? For all selected
interagency issues: i) Please indicate which agencies were involved. [please use the provided
text box to explain further]
■
Common screening/assessment tools or criteria.
■
Common system to track MFP enrollment across agencies.
■
Timely collection and reporting of MFP service or financial data.
■
Common service definitions.
■
Common provider qualification requirements.
■
Financial management issues.
■
Quality assurance.
32
■
Other, specify below.
■
None.
3. Did your program have any notable achievements in interagency communication and
coordination during the reporting period?
■
Yes
□
■
What were the achievements in?
No.
4. What significant challenges in interagency communication and coordination did your
program experience during the reporting period? For all selected challenges: i) Please
describe challenges and (if applicable) what agencies were involved; ii) Please describe what you
are doing to address the challenges; and iii) For the selected status, [“resolved,” “in progress”
(still working on it), or “abandoned” (not resolved and no longer pursuing it)], (iv) please describe
the current status of the challenge: (1) If resolved, please describe how was it resolved, e.g.
received CMS approval to change approach, revised strategy/developed a work around; or (2) If
not resolved and no longer pursuing it, please describe why are you no longer pursuing it.
■
Interagency relations.
■
Privacy requirements that prevent the sharing of data.
■
Technology issues that prevent the sharing of data.
■
Transitions in key Medicaid staff.
■
Transitions in key staff in other agency.
■
Other, specify below.
■
None.
5. Tribal Initiative Only – Describe specific changes in organization or administration
associated with this initiative and any interagency challenges during this period. [please
use the provided text box]
G.
Challenges and Developments
Note: For the following questions, please update the previous period’s report as applicable.
1. What types of overall challenges have affected almost all aspects of the program? For all
selected challenges, please describe the effects of the challenge.
■
Downturn in the state economy.
■
Worsening state budget.
■
Transition of key position(s) in Medicaid agency.
■
Transition of key position(s) in other state agencies.
■
Executive shift in policy.
■
Other, specify below.
■
None.
2. What other new developments, policies, or programs (in your state’s long-term care
system) have occurred that are not MFP initiatives, but have affected the MFP
demonstration program’s transition efforts? For all selected new developments, policies, or
programs that have occurred: i) Please describe the efforts that are not MFP initiatives and their
effect on the MFP demonstration program.
33
■
Institutional closure/downsizing initiative.
■
New/revised CON policies for LTC institutions.
■
New or expanded nursing home diversion program.
■
Expanded single point-of-entry/ADRC system.
■
New or expanded HCBS waiver capacity.
■
New Medicaid State Plan options (DRA or other).
■
New managed LTC options (PACE, SNP, other), or mandatory enrollment in managed
LTC.
■
Other, specify below.
■
None.
3. Tribal Initiative Only – If not previously discussed, describe specific developments that
you want to highlight for this program including any challenges. [please use the provided
text box]
H.
Independent Evaluation
Note: For the following questions, please update the previous period’s report as applicable.
1. Is your state conducting an independent evaluation of the MFP program, separate from the
national evaluation by Mathematica Policy Research?
■
Yes –Please describe.
■
No –If this box is checked, please skip to Section I – Technical Assistance.
2. Were there any outputs/products produced from the independent state evaluation (if
applicable) during this period?
I.
■
Yes –Please describe.
■
No
State-specific Technical Assistance
What type of state-specific programmatic TA did you receive during the reporting period? This
could include TA provided to a group of states, such as all- state TA teleconference calls hosted by one of
the TA contractors. This could also include individual TA received by one of the TA contractors or
Mathematica Policy Research. Do not use this section to report on all-grantee meetings or events, or
individual contacts with your CMS project officer.
Add an event for each type of issue (quality, housing, self-direction, other programmatic issues,
evaluation, and data management/submission; any others) and indicate how the TA was delivered (group
by teleconference, group in person, individual by telephone, individual in person, or peer-to-peer).
You may add more than one event of the same type to indicate different delivery methods.
34
TA Event #1:
Date
[Text Response Requested]
Type
[Dropdown]
Delivery Method
[Dropdown]
Describe the focus of the TA you received
[Text Response Requested]
Usefulness
[Dropdown]
If useful, describe what changed as a result. – if not useful, explain why.
[Text Response Requested]
J.
Overall Lessons & MFP-related LTC System Change
1. Are there any other comments, observations or lessons learned from your experience to
date with MFP program design or implementation?
You can use this section to explain how MFP is contributing to long-term care system reform or
rebalancing that is not captured by any of the other questions in this report. [please use the
provided text box to explain further –if necessary]
35
| File Type | application/pdf |
| File Title | Money Follows the Person (MFP) Semi-Annual Progress Report User Guide and Help File |
| Subject | Money Follows the Person, semi-annual report, long-term care, Medicaid, home and community-based services, MFP |
| Author | Mathematica Policy Research |
| File Modified | 2018-08-21 |
| File Created | 2017-09-14 |