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pdfMFP Semi-Annual Report Crosswalk
2018 (old version)
Section A - General Information
Organization Information
1. Full Name of Grantee Organization
2. Program's Public Name
3. Program's Website
Project Director
4. Project Director Name
5. Project Director Title
6. Project Director Phone
7. Project Director Fax
8. Project Director Email
9. Project Director Status (may check multiple)
Full Time Acting Vacant New Since Last Report
10. Project Director Status Date: Change date if status is
different from last report. (MM/DD/YYYY)
Grantee Signatory
11. Grantee Signatory Name
12. Grantee Signatory Title
13. Grantee Signatory Phone
14. Grantee Signatory Fax
15. Grantee Signatory Email
16. Has the Grantee Signatory changed since last
report?
Other State Contact
17. Other State Contact Name
18. Other State Contact Title
19. Other State Contact Phone
20. Other State Contact Fax
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
25. Independent State Evaluator Fax
26. Independent State Evaluator Email
Report Preparer
27. Report Preparer Name
2021 (new version)
Section A - General Information
Organization Information
1. Full Name of Grantee Organization
2. Program's Public Name
3. Program's Website
Project Director
4. Project Director Name
5. Project Director Email
Grantee Signatory / Authorizing Official
Representative (AOR)
6. Grantee Signatory Name
7. Grantee Signatory Email
8. Has the Grantee Signatory changed since last
report?
CMS Project Officer
9. CMS Project Officer Name
Type of Change
Reduced level of detail for
the general information
section overall, such as title,
phone, fax, status, etc.
Clarified Grantee Signatory
as Authorizing Official
Representative (AOR)
Removed Other State
Contact, Independent State
Evaluator and Report
Preparer.
Reason for
Change
Details
provided in
the previous
version were
determined to
be redundant
or no longer
necessary to
be provided in
this report.
Burden
Change
Reduced
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28. Report Preparer Title
29. Report Preparer Phone
30. Report Preparer Fax
31. Report Preparer Email
CMS Project Officer
32. CMS Project Officer Name
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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MFP Semi-Annual Report Crosswalk
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2021 (new version)
Type of Change
Section B - Transitions
1. Please specify your MFP program’s “Other” target
population(s) here if applicable
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.
- Please indicate what constitutes an assessment for
MFP versus any other transition program.
4. Number of institutional residents who transitioned
during this reporting period and enrolled in MFP.
5. Cumulative number of MFP transitions to date.
6. Total number of current MFP participants.
7. Number of MFP participants re-institutionalized.
- Please indicate any factors that contributed to reinstitutionalization (open text)
8. Number of MFP participants re-institutionalized for
longer than 30 days, who were re- enrolled in the MFP
program during the reporting period.
9. Number of MFP participants -who ever transitioned who completed the 365-day transition period during
the reporting period.
- Please indicate any factors that contributed to
participants not completing the 365-day transition
period
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.
- Please describe your difficulties for each target
population
11. Does your state have other nursing home transition
programs that currently operate alongside the MFP
program?
(If Yes) Please approximate the number of individuals
who transitioned through other transition programs
during this reporting period.
Section B - Transitions
1. Please specify your MFP program’s “Other” target
population(s) here if applicable.
2. Number of people assessed for MFP enrollment.
3. Number of institutional residents who
transitioned during this reporting period and
enrolled in MFP.
4. Cumulative number of MFP transitions to date.
5. Total number of current MFP participants.
6. Number of MFP participants re-institutionalized.
- Please indicate any factors that contributed to reinstitutionalization. (check boxes)
7. Number of MFP participants re-institutionalized
for longer than 30 days, who were re- enrolled in
the MFP program during the reporting period.
8. Number of MFP participants -who ever
transitioned -who completed the 365-day transition
period during the reporting period.
- Please indicate any factors that contributed to
participants not completing the 365-day transition
period
9. Please specify the total number of participant
deaths that occurred during the reporting period.
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.
- Please describe your difficulties for each target
population
11. Do you intend to seek CMS approval to amend
your annual or total Demonstration period
transition benchmarks in your approved
Operational Protocol?
(If Yes) Please explain the proposed changes to your
transition benchmarks.
Removed the following
questions from the 2018
form:
2. Please note the
characteristics and/or
diagnoses of your MFP
program’s “Other” target
population(s).
- Please indicate what
constitutes an assessment
for MFP versus any other
transition program.
11. Does your state have
other nursing home
transition programs that
currently operate alongside
the MFP program?
(If Yes) Please approximate
the number of individuals
who transitioned through
other transition programs
during this reporting period.
(If Yes) Please explain how
these other transition
programs differ from MFP,
e.g. eligibility criteria.
12. Does your state have an
ICF-IDD transition program
that currently operates
alongside the MFP program?
(If Yes) Please approximate
the number of individuals
who transitioned through
other transition programs
during this reporting period.
(If Yes) Please explain how
these other transition
Reason for
Change
Details
provided in
the previous
version were
either
determined to
be redundant,
no longer
necessary to
be provided in
this report or
that moving
them to
another
section would
streamline the
reporting
process.
Burden
Change
Reduced
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(If Yes) Please explain how these other transition
programs differ from MFP, e.g. eligibility criteria.
12. Does your state have an ICF-IDD transition program
that currently operates alongside the MFP program?
(If Yes) Please approximate the number of individuals
who transitioned through other transition programs
during this reporting period.
(If Yes) Please explain how these other transition
programs differ from MFP e.g. eligibility criteria.
13. Do you intend to seek CMS approval to amend your
annual or total Demonstration period transition
benchmarks in your approved Operational Protocol?
(If Yes) Please explain the proposed changes to your
transition benchmarks.
14. Tribal Initiative Only - Report the number of people
enrolled, 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.
- Did the Tribal Initiative have any difficulty transitioning
the projected number of individuals it proposed in the
Operational Protocol during the reporting period?
- Use this box to explain missing, incomplete, or other
qualifications to the data reported in this section (B).
2021 (new version)
Type of Change
programs differ from MFP
e.g. eligibility criteria.
Reason for
Change
Burden
Change
Moved the question #9 on
participant deaths from
Section E.8 (2018 form) to
this section (2021 form)
Moved the Tribal Initiative
Only question #14 (2018
form) to Section M (2021
form)
Changed open text field in
question #7 (2018 form) to
check boxes in question #6
(2021 form)
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2021 (new version)
Section C - Qualified HCBS Expenditures
Completed during the second reporting period (JulyDecember) only.
1. Do you require modifying the Actual Level of
Spending for last period? Yes/No
(If Yes) Please describe why the changes were necessary
and update in the table below.
Please enter data for the relevant reporting period and
year.
2. Do you intend to seek CMS approval to amend your
annual benchmarks for Qualified HCBS Expenditures in
your approved Operational Protocol?
(If Yes) Please explain the proposed changes to your
Qualified HCBS Expenditures benchmark.
3. Please specify (CY or SFY) and the dates of your SFY
here.
4. Use this box to explain missing, incomplete, or other
qualifications to the data reported in this section (C).
Section C - Total Expenditures for Home &
Community-Based Services
Completed during the second reporting period (JulyDecember) and for close-out.
1. Do you require modifying the Actual Level of
Spending for last period? Yes/No
(If Yes) Please describe why the changes were
necessary and update in the table below.
2. Please enter data for the relevant reporting
period and year.
3. Please specify (CY or SFY) and the dates of your
SFY here.
4. Use this box to explain missing, incomplete, or
other qualifications to the data reported in this
section (C).
Type of Change
The question about
amending annual
benchmarks for Qualified
HCBS Expenditures was
removed.
Reason for
Change
This question
was
redundant, as
the
information is
included in the
Maintenance
of Effort
(MOE) form.
Burden
Change
Reduced
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MFP Semi-Annual Report Crosswalk
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2021 (new version)
Section D.1 - Additional Benchmarks
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 your 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 text box below to explain the barriers or
challenges that have hindered progress, and plans to
address them.
Benchmarks for grantees participating in the Tribal
Initiative can be added here.
Please enter data for the relevant reporting period and
year. Green outlined cells indicate the PDF will autocalculate the field.
Benchmark #1: [Please describe as specified in
Operational Protocol
Measure #1 - Please explain your Year End rate of
progress: (Open Text)
Measure #2 - Please explain your Year End rate of
progress: (Open Text)
Measure #3 - Please explain your Year End rate of
progress: (Open Text)
Do you intend to seek CMS approval to amend your
additional benchmarks in your approved Operational
Protocol? Yes/No
Benchmark #2: [Please describe as specified in
Operational Protocol
Measure #1 - Please explain your Year End rate of
progress: (Open Text)
Measure #2 - Please explain your Year End rate of
progress: (Open Text)
Measure #3 - Please explain your Year End rate of
progress: (Open Text)
Section D - Additional Benchmarks
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 longterm care system. The information below reflects
your 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 text box below
to explain the barriers or challenges that have
hindered progress, and plans to address them.
Benchmarks for grantees participating in the Tribal
Initiative can be added here.
Please enter data for the relevant reporting period
and year. Green outlined cells indicate the PDF will
auto-calculate the field.
Benchmark #1: [Please describe as specified in
Operational Protocol
Measure #1 - Please explain your Year End rate of
progress: (Open Text)
Measure #2 - Please explain your Year End rate of
progress: (Open Text)
Measure #3 - Please explain your Year End rate of
progress: (Open Text)
Benchmark #2: [Please describe as specified in
Operational Protocol
Measure #1 - Please explain your Year End rate of
progress: (Open Text)
Measure #2 - Please explain your Year End rate of
progress: (Open Text)
Measure #3 - Please explain your Year End rate of
progress: (Open Text)
Benchmark #3: [Please describe as specified in
Operational Protocol
Type of Change
The section identifier was
changed from D1 (2018
form) to D (2021 form) for
easier navigation and
section identification.
The question about
amending additional
benchmarks was moved to
the end of the section.
Reason for
Change
Significantly
streamline
reporting,
remove
redundancies
and irrelevant
information to
reduce
reporting
burden.
Burden
Change
None
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Benchmark #3: [Please describe as specified in
Operational Protocol
Measure #1 - Please explain your Year End rate of
progress: (Open Text)
Measure #2 - Please explain your Year End rate of
progress: (Open Text)
Measure #3 - Please explain your Year End rate of
progress: (Open Text)
2021 (new version)
Measure #1 - Please explain your Year End rate of
progress: (Open Text)
Measure #2 - Please explain your Year End rate of
progress: (Open Text)
Measure #3 - Please explain your Year End rate of
progress: (Open Text)
Do you intend to seek CMS approval to amend your
additional benchmarks in your approved
Operational Protocol? Yes/No
Type of Change
Reason for
Change
Burden
Change
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2021 (new version)
Section D.2 - Rebalancing Efforts
Completed only during the first period (January – June)
of each year
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.
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.
Rebalancing Initiative Name
Section E - Rebalancing Efforts
Completed only during the first period (January –
June) of each year and for close-out.
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 current, new, or
expanded rebalancing initiative resulting from state
savings from MFP program participation. If there
are more than 6 rebalancing initiatives, please
combine related programs and initiatives so that
there are no more than 6.
If you have not implemented rebalancing initiatives
to date, enter "$0.00" in the Total Actual
Expenditures box, and in the text box, describe your
state's planned rebalancing initiatives and projected
expenditures for each.
Brief Description of Initiative
Rebalancing Initiative Name
Total Actual Expenditures for this initiative (cumulative
spending from start of MFP grant program through end
of last calendar year).
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.
Explain any missing or incomplete data.
Type of Change
The section identifier was
changed from D2 (2018
form) to E (2021 form) for
easier navigation and
section identification.
The table was reformatted
into two sections.
Reason for
Change
This needed
change is to
allow for
grantees to
combine like
initiatives and
for additional
space to
report
descriptive
information.
Burden
Change
None
Brief Description of Initiative
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2021 (new version)
Section E.1 - Recruitment & Enrollment
1. Did anything change during the reporting period that
made recruitment easier? Choose from the list below
and describe by target population for each checked box.
Check "None" if nothing has changed.
• Type or quality of data available for identification
• 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? Choose from the
list below and describe by target population for each
checked box. Significant challenges are those that affect
the program’s ability to transition as many people as
planned.
• Type or quality of data available for identification
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Obtaining provider/agency referrals or cooperation
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Obtaining self referrals
• Please describe by target population.
• What are you doing to address the challenges?
Section F - Recruitment & Enrollment
1. Number and percent 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
Please indicate the average length of time required
from assessment to actual transition.
2. 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
3. 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.
Type of Change
The section identifier was
changed from E1 (2018
form) to F (2021 form) for
easier navigation and
section identification.
Questions 1-7 and 11-13
(2018 form) were deleted
(2021 form).
The Tribal Initiative Only
questions (2018 form) were
simplified and moved to
Section M (2021 form)
Reason for
Change
Significantly
streamline
reporting,
remove
redundancies
and irrelevant
information to
reduce
reporting
burden.
Burden
Change
Reduced
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What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Obtaining family referrals
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Assessing needs
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Lack of interest among people targeted or the
families
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Unwilling to consent to program requirements
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Other, specify below
• Please describe by target population.
• What are you doing to address the challenges?
•
•
•
•
•
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• 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. Choose from
the list below and describe by target population for
each checked box.
• Determination of initial eligibility
Please describe by target population.
• Redetermination of eligibility after a suspension
due to re-institutionalization
Please describe by target population.
• Other, specify below
Please describe by target population.
• 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. Choose from the
list below and describe by target population for each
checked box.
• Determining initial eligibility
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Reestablishing eligibility after a suspension due to
re-institutionalization
• Please describe by target population.
• What are you doing to address the challenges?
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Other, specify below
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• 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.
6. Total number of MFP eligible individuals assessed in
this period for whom transition planning began but
were unable to transition through MFP.
7. How many individuals could not be enrolled in the
MFP program for each of the following reasons:
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
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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• Other, Please specify below
If necessary, please explain further why individuals
could not be transitioned or enrolled in the MFP
program.
8. Number and percent 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
Please indicate the average length of time required
from assessment to actual transition.
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.
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.
11. What types of activities were supported by
ADRC/MFP Supplemental Funding Opportunity C grant
funds during this reporting period, awarded to MFP
grantee states to support activities that help to expand
the capacity of ADRCs as part of a no wrong 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
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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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 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
13. Please describe any barriers or challenges in
implementing the identified activities and the steps you
are taking to resolve them.
Tribal Initiative Only – Changes that made recruitment
and/or enrollment easier. Identify challenges that the
program had recruiting and/or enrolling individuals
during this reporting period.
• 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)
• 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)
• 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.
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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Identify any barriers or challenges in implementing
the activities proposed in your grant application
and steps you are taking to resolve them.
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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MFP Semi-Annual Report Crosswalk
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Section E.2 - Informed Consent & Guardianship
1. What changed during the reporting period that made
obtaining informed consent easier? Choose from the list
below and describe by target population for each
checked box.
• Revised inform consent documents and/or forms
Please describe by target population.
• Provided more or enhanced training for transition
coordinators
Please describe by target population.
• Improved how guardian consent is obtained
Please describe by target population.
• Other, specify below
Please describe by target population.
• Nothing
2. What changed during the reporting period that
improved or enhanced the role of guardians? Choose
from the list below and describe by target population
for each checked box.
• The nature by which guardians are involved in
transition planning
Please describe by target population.
• Communication or frequency of communication
with guardians
Please describe by target population.
• The nature by which guardians are involved in
ongoing care planning
Please describe by target population.
• The nature by which guardians are trained and
mentored
Please describe by target population.
• Other, specify below
Please describe by target population.
• Nothing
3. What significant challenges did your program
experience in obtaining informed consent? Choose from
2021 (new version)
N/A
Type of Change
Section E.2 (2018 form) was
removed in the revised 2021
form.
Reason for
Change
It was
determined
that, although
these
questions are
important to
address in
establishing a
new program,
this detailed
information
was not
necessary for
ongoing
reporting.
Burden
Change
Reduced
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the list below and describe by target population for
each checked box.
• Ensuring informed consent
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Involving guardians in transition planning
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Communication or frequency of communication
with guardians
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Involving guardians in ongoing care planning
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Training and mentoring of guardians
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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(If Resolved or Abandoned) Explain status
choice
Other, specify below
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
None
•
•
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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Section E.3 - Outreach, Marketing & Education
1.
What notable achievements in outreach,
marketing or education did your program accomplish
during the reporting period? Choose from the list below
and describe by target population for each checked box.
• Development of print materials
• Please describe by target population.
• Implementation of localized/targeted media
campaign
• Please describe by target population.
• Implementation of statewide media campaign
• Please describe by target population.
• Involvement of stakeholder state agencies in
outreach and marketing
• Please describe by target population.
• Involvement of discharge staff at facilities
• Please describe by target population.
• Involvement of ombudsman
• Please describe by target population.
• Training of frontline workers on program
requirements
• Please describe by target population.
• Other, specify below
• Please describe by target population.
• None
2. What significant challenges did your program
experience in conducting outreach, marketing, and
education activities during the reporting period?
Choose from the list below and describe by target
population for each checked box.
• Development of print materials
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
2021 (new version)
N/A
Type of Change
Section E.3 (2018 form) was
removed in the revised 2021
form.
Reason for
Change
It was
determined
that, although
these
questions are
important to
address in
establishing a
new program,
this detailed
information
was not
necessary for
ongoing
reporting.
Burden
Change
Reduced
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(If Resolved or Abandoned) Explain status
choice
Implementation of a localized / targeted media
campaign
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Implementation of a statewide media campaign
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Involvement of stakeholder state agencies in
outreach and marketing
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Involvement of discharge staff at facilities
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Involvement of ombudsman
• Please describe by target population.
• What are you doing to address the challenges?
•
•
•
•
•
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Training of frontline workers on program
requirements
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Other, specify below
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• None
Tribal Initiative Only – Describe any outreach,
marketing and education activities and challenges
during this reporting period specific to the Tribal
Initiative.
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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Section 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 all that apply.
• Consumers
• Families
• Advocacy Organizations
• HCBS Providers
• Institutional Providers
• Labor/Worker Association(s)
• Public Housing Agency(ies)
• Other State Agencies (except Housing)
• Non-profit Housing Assn.
• Other
2021 (new version)
N/A
Type of Change
Section E.4 (2018 form) was
removed in the revised 2021
form.
Reason for
Change
It was
determined
that, although
these
questions are
important to
address in
establishing a
new program,
this detailed
information
was not
necessary for
ongoing
reporting.
Burden
Change
Reduced
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 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
2. On average, how many consumers, families, and
consumer advocates attended each meeting of the MFP
program's advisory group (the group that advises the
MFP program) during the reporting period?
• 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?
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Choose from the list below and describe by target
population for each checked box.
• Identifying willing consumers
What are you doing to address the challenges?
• Identifying willing families
What are you doing to address the challenges?
• Involving them in a meaningful way
What are you doing to address the challenges?
• Keeping them involved for extended periods of
time What are you doing to address the
challenges?
• Communicating with consumers
What are you doing to address the challenges?
• Communicating with families
What are you doing to address the challenges?
• Other, specify below
What are you doing to address the challenges?
• 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? If yes, please describe.
• State agency that sets housing policies Please
describe
• State housing finance agency Please describe
• Public housing agency(ies) Please describe
• Non-profit agencies involved in housing issues
Please describe
• Other housing organizations (such as landlords,
realtors, lenders and mortgage brokers) Please
describe
• 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 / No (If Yes) Please Describe
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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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.
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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Section E.5 - Benefits & Services
1. What progress was made during the reporting period
regarding Medicaid programmatic and policy issues that
increased the availability of home and communitybased services DURING the one-year transition period?
Choose from the list below and describe by target
population for each checked box.
• Increased capacity of HCBS waiver programs to
serve MFP participants
• Please describe by target population.
• Added a self-direction option
• Please describe by target population.
• Developed State Plan Amendment to add or modify
benefits needed to serve MFP participants in HCBS
settings
• Please describe by target population.
• Developed or expanded managed LTC programs to
serve MFP participants
• Please describe by target population.
• Obtained authority to transfer Medicaid funds from
institutional to HCBS line items to serve MFP
participants
• Please describe by target population.
• Legislative or executive authority for more funds or
slots or both
• Please describe by target population.
• Improved state funding for pre-transition services
(such as targeted case management)
• Please describe by target population.
• Other, specify below
• Please describe by target population.
• None
2. What significant challenges or barriers did your
program experience in guaranteeing that MFP
participants can be served in Medicaid HCBS DURING
the one-year transition period? Choose from the list
2021 (new version)
N/A
Type of Change
Section E.5 (2018 form) was
removed in the revised 2021
form.
Reason for
Change
It was
determined
that, although
these
questions are
important to
address in
establishing a
new program,
this detailed
information
was not
necessary for
ongoing
reporting.
Burden
Change
Reduced
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below and describe by target population for each
checked box.
• Efforts to increase capacity of HCBS waiver
programs to serve more individuals are delayed or
disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Efforts to add a self-direction option are delayed or
disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• State Plan Amendment to add or modify benefits
needed to serve people in HCBS settings are
delayed or disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Plans to develop or expand managed LTC programs
to serve or include people needing HCBS are
delayed or disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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(If Resolved or Abandoned) Explain status
choice
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
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Legislative or executive authority for more funds or
slots are delayed or disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
State funding for pre-transition services (such as
targeted case management) have been delayed or
disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Other, specify below
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
•
•
•
•
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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• None
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 one-year transition period? Choose from the
list below and describe by target population for each
checked box.
• Increased capacity of HCBS waiver programs to
serve more Medicaid enrollees
Please describe by target population.
• Added a self-direction option
Please describe by target population.
• Developed State Plan Amendment to add or modify
benefits needed to serve MFP participants in HCBS
settings
Please describe by target population.
• Developed or expanded managed LTC programs to
serve more Medicaid enrollees
Please describe by target population.
• Obtained authority to transfer Medicaid funds from
institutional to HCBS line items to serve more
Medicaid enrollees
Please describe by target population.
• Legislative or executive authority for more funds or
slots or both
Please describe by target population.
• Improved state funding for pre-transition services,
such as targeted case management
Please describe by target population.
• Other, specify below
Please describe by target population.
• None
4. What significant challenges or barriers did your
program experience in guaranteeing continuity of care
for MFP participants in Medicaid HCBS AFTER the oneyear transition period? Choose from the list below and
describe by target population for each checked box.
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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•
•
•
•
Efforts to increase capacity of HCBS waiver
programs to serve more individuals are delayed or
disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Efforts to add a self-direction option are delayed or
disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
State Plan Amendment to add or modify benefits
needed to serve people in HCBS settings is delayed
or disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Plans to develop or expand managed LTC programs
to serve or include people needing HCBS are
delayed or disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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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
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Legislative or executive authority for more funds or
slots are delayed or disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• State funding for pre-transition services have been
delayed or disapproved
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Other, specify below
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• None
5. Tribal Initiative Only - What progress was made
during the period toward addressing any programmatic
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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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 oneyear transition period. Please describe the efforts by
populations affected.
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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SectionE.6 - Participant Access to Services
1. What steps did your program or state take during the
reporting period to improve or enhance the ability of
MFP participants to access home and community based
services? Choose from the list below and describe by
target population for each checked box.
Increased the number of transition coordinators
Please describe by target population.
• Increased the number of home and communitybased service providers contracting with Medicaid
Please describe by target population.
• Increased access requirements for managed care
LTC providers
Please describe by target population.
• Increased payment rates to HCBS providers
Please describe by target population.
• Increased the supply of direct service workers
Please describe by target population.
• Improve or increased transportation options
Please describe by target population.
• Added or expanded managed LTC programs or
options
Please describe by target population.
• Other, specify below
Please describe by target population.
• 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. Choose from the list
below and describe by target population for each
checked box.
• Insufficient supply of HCBS providers
• Please describe by target population.
•
2021 (new version)
N/A
Type of Change
Section E.6 (2018 form) was
removed in the revised 2021
form.
Reason for
Change
It was
determined
that, although
these
questions are
important to
address in
establishing a
new program,
this detailed
information
was not
necessary for
ongoing
reporting.
Burden
Change
Reduced
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What are you doing to address the challenges?
What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Insufficient supply of direct service workers
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Preauthorization requirements
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Limits on amount, scope, or duration of HCBS
allowed under Medicaid state plan or waiver
program
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Lack of appropriate transportation options or
unreliable transportation options
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
•
•
•
•
•
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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Insufficient availability of home and communitybased services (provider capacity does not meet
demand)
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Other, specify below
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• 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)
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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2021 (new version)
Section E.7 - Self-Direction
Did your state have any self-direction programs in effect
during this reporting period? Yes / No
1. If YES, how many MFP participants were in a selfdirection program as of the last day of the reporting
period? (describe by target population)
2. Of those MFP participants in a self-direction program
how many:
• Hired or supervised their own personal assistants
• Managed their allowance or budget
3. How many MFP participants in a self-direction
program during the reporting period reported abuse or
experienced an accident?
• 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
4. How many MFP participants in a self-direction
program disenrolled from the self-direction program
during the reporting period?
5. Of the MFP participants who were disenrolled from a
self-direction program, how many were disenrolled for
each reason below?
• Opted-out
• Inappropriate spending
• Unable to self-direct
• Abused their worker
• Other, Please specify
6. Tribal Initiative Only - As a subset of the numbers
reported in questions 1-5, 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.
• Directed their own service
• Reported abuse or experienced an accident
• Dis-enrolled in self-directed services
Section G - Self-Direction
Did your state have any self-direction programs in
effect during this reporting period? Yes / No
1. If YES, how many MFP participants were in a selfdirection program as of the last day of
the reporting period? (describe by target
population)
2. Of those MFP participants in a self-direction
program how many:
• Hired or supervised their own personal
assistants
• Managed their allowance or budget
Type of Change
The section identifier was
changed from E7 (2018
form) to G (2021 form) for
easier navigation and
section identification.
Questions 3-5 (2018 form)
were deleted (2021 form).
Reason for
Change
Significantly
streamline
reporting,
remove
redundancies
and irrelevant
information to
reduce
reporting
burden.
Burden
Change
Reduced
Use this box to explain missing, incomplete, or
other qualifications to the data reported in this
section (G).
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Please describe your efforts within the tribal initiative to
offer self-directed services.
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
Use this box to explain missing, incomplete, or other
qualifications to the data reported in this section (E.7).
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Section E. 8 - Quality Management & Improvement
✔ Do you want the information on critical incidents in
questions #6 through #10 on this page to appear in
print version of the report? If not, please uncheck box.
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.
• Improved intra/inter departmental coordination
Please describe by target population.
• Implemented/Enhanced data collection
instruments
Please describe by target population.
• Implemented/Enhanced information technology
applications
Please describe by target population.
• Implemented/Enhanced consumer complaint
processes
Please describe by target population.
• 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)
Please describe by target population.
• 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.
Please describe by target population.
• Enhanced a risk management process
Please describe by target population.
• Other, specify below
Please describe by target population.
2021 (new version)
Section H - MFP Quality Requirements
For every service and program that serves MFP
individuals, the state must have a quality
management strategy consistent with the section
1915(c) waiver requirements including the use of
performance measures, remediation strategies,
trending and analysis, and the implementation of
quality improvement initiatives. In addition, the
state must also have the following three quality
requirements in place in order to assure the health
and welfare of MFP participants upon discharge to a
community setting:
1. A critical incident reporting and management
system and a process to ensure that the system
is working as planned;
2. A risk assessment and mitigation protocol and a
process to ensure that the protocol is working
as planned; and
3. A backup strategy in place that includes access
to a 24 hour back up service to address a lapse
in the provision of essential health and support
services or other circumstances that could have
a negative effect on participant health or
welfare, and a process to ensure that the
strategy is working as planned.
Section H. will ask about the work that your state is
doing related to each of these requirements.
Type of Change
This section was
restructured to better
address program
requirements for critical
incident reporting and
management systems, risk
mitigation protocol and a
24-hour backup strategy to
ensure service provision.
Detailed questions on
specific critical incidents
were removed. Moved
question #6 (2018 form) to
section B #9 (2021 form)
Reason for
Change
Significantly
streamline
reporting,
remove
redundancies
and irrelevant
information to
reduce
reporting
burden.
Burden
Change
Reduced
Section H.1 - Critical incident reporting
1. MFP programs are required to have a critical
incident (CI) and management system and a process
to ensure that the system is working as planned. A
critical incident (e.g., abuse, neglect and
exploitation) is an event that could bring harm, or
create potential harm, to a participant. Please
complete the table below to report on each type of
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• 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.) (Please describe by target population)
• Transportation to get to medical appointments
• Life-support equipment repair/replacement
• Critical health services
• Direct service/support workers not showing up
• Other, Please Specify
3. For what number of the calls received were you able
to provide the assistance that was needed when it was
needed? (Please describe by target population)
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 / No (If Yes) Please Describe
5. Did your program experience any challenges in:
• Developing adequate and appropriate service plans
for participants, i.e., developing service plans that
address the participant’s assessed needs and
personal goals
Populations Affected
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Assessing participants’ risk
Populations Affected
• Please describe by target population.
• What are you doing to address the challenges?
2021 (new version)
critical incident related to the MFP program and
MFP participants.
Critical Incident Area
• Abuse
• Neglect
• Exploitation
• Involvement with Criminal Justice System
• Medication Administration Errors
• Deaths reported to state CI system
Type of Change
Reason for
Change
Burden
Change
Please specify the number of times this type
of critical incident occurred
Did the state make any changes, either for the
consumer(s) or its system, as a result of the analysis
of critical incidents?
What is the current status of the issue?
If resolved or abandoned, please explain
2. Please summarize any additional information on
progress, challenges, or solutions related to your
critical incident reporting and management system
Section H.2 - Risk assessment and mitigation
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.
• Improved intra/inter departmental
coordination
• Implemented/Enhanced data collection
instruments
• Implemented/Enhanced information
technology applications
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What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Developing, implementing, or adjusting risk mitigation
strategies
Populations Affected
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Addressing emergent risks in a timely fashion
Populations Affected
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Delivering all the services and supports specified in the
service plan
Populations Affected
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Modifying the service plan to accommodate
participants’ changing needs or circumstances i.e.,
increasing units of a service, adding a different type of
service, changing time of day when services are
delivered, etc.
Populations Affected
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
•
2021 (new version)
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
• Enhanced a risk management process
• None
• Other, specify below - Please describe the
improvement.
2. Please summarize any additional information on
progress, challenges, or solutions related to your
risk assessment and mitigation protocol.
•
Type of Change
Reason for
Change
Burden
Change
Section H.3 - 24 hour back up services
1. 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.)
Describe by population group
• Transportation to get to medical appointments
• Life-support equipment repair/replacement
• Critical health services
• Direct service/support workers not showing up
• Other, Please Specify
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2021 (new version)
• (If Resolved or Abandoned) Explain status choice
Identifying threats to participants’ health or welfare
Populations Affected
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Addressing threats to participants’ health or welfare
Populations Affected
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Other, specify below
Populations Affected
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
None
6. Please specify the total number of participant deaths
that occurred during the reporting period:
Describe by target population
7. Please provide information on the circumstances
surrounding the reported deaths:
8. How many critical incidents occurred during the
reporting period?
9. Please provide information on the circumstances
surrounding the reported critical incidents:
10. Please describe the nature of each critical incident
that occurred. Choose from the list below.
Abuse
• Please specify the number of times this type of
critical incident occurred.
2. For what number of the calls received were you
able to provide the assistance that was needed
when it was needed?
Describe by population group
3. 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 / No
(If Yes) Please Describe
4. Did your program experience any challenges in:
• 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
• 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, changing time of day
when services are delivered, etc.
• Identifying threats to participants' health or
welfare Addressing threats to participants'
health or welfare None
• Other, describe below.
5. Please summarize any additional information on
progress, challenges, or solutions related to your 24
hour back up services and systems.
Type of Change
Reason for
Change
Burden
Change
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Did the state make changes, either for the
consumer(s) or its system, as a result of the analysis
of critical incidents?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Neglect
• Please specify the number of times this type of
critical incident occurred.
• Did the state make changes, either for the
consumer(s) or its system, as a result of the analysis
of critical incidents?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Exploitation
• Please specify the number of times this type of
critical incident occurred.
• Did the state make changes, either for the
consumer(s) or its system, as a result of the analysis
of critical incidents?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Hospitalizations
• Please specify the number of times this type of
critical incident occurred.
• Of these hospitalizations, approximately how many
occurred within 30 days of discharge from a
hospital or other institutional setting?
Emergency Room visits
• Please specify the number of times this type of
critical incident occurred
• Of these emergency room visits, approximately
how many occurred within 30 days of discharge
from a hospital or other institutional setting?
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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Deaths determined to be due to abuse, neglect, or
exploitation - During the current reporting period, how
many deaths occurring either in the current or previous
reporting periods were determined to be due to abuse,
neglect or exploitation?
• Please specify the number of times this type of
critical incident occurred.
• For each of these deaths, please describe the
findings of the investigation and any actions taken
by the state:
Deaths in which a breakdown in the 24-hour back-up
system was a contributing factor - During the current
reporting period, for how many deaths occurring either
in the current or previous reporting periods did an
investigation determine that a breakdown in the 24hour back-up system was a contributing factor?
• Please specify the number of times this type of
critical incident occurred.
• For each of these deaths, please describe the
findings of the investigation and any actions taken
by the state:
Involvement with the criminal justice system
• Please specify the number of times this type of
critical incident occurred.
• Did the state make changes, either for the
consumer(s) or its system, as a result of the analysis
of critical incidents?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Medication administration errors
• Please specify the number of times this type of
critical incident occurred.
• Did the state make changes, either for the
consumer(s) or its system, as a result of the analysis
of critical incidents?
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Other, specify below
• Please specify the number of times this type of
critical incident occurred.
• Did the state make changes, either for the
consumer(s) or its system, as a result of the analysis
of critical incidents?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
None
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.
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.
Use this box to explain missing, incomplete, or other
qualifications to the data reported in this section (E.8).
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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Section E.9 - Housing for Participants
1. What notable achievements in improving housing
options for MFP participants did your program
accomplish during the reporting period? Choose from
the list below and describe by target population for
each checked box.
• Developed inventory of affordable and accessible
housing
Please describe the achievements
• Developed local or state coalitions of housing and
human service organizations to identify needs
and/or create housing-related initiatives
Please describe the achievements
• Developed statewide housing registry
Please describe the achievements
• Implemented new home ownership initiatives
Please describe the achievements
• Improved funding or resources for developing
assistive technology related to housing
Please describe the achievements
• Improved information systems about affordable
and accessible housing
Please describe the achievements
• Increased number of rental vouchers
Please describe the achievements
• Increased supply of affordable and accessible
housing
Please describe the achievements
• Increased supply of residences that provide or
arrange for long term services and/or supports
Please describe the achievements
• Increased supply of small group homes
Please describe the achievements
• Increased/Improved funding for home
modifications
Please describe the achievements
• Other, specify below
2021 (new version)
Type of Change
Section I - Housing for Participants
1. What notable achievements in improving housing
options for MFP participants did your program
accomplish during the reporting period? Choose
from the list below and describe by target
population for each checked box.
• 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
• Improved funding or resources for developing
assistive technology related to housing
• Improved information systems about
affordable and accessible housing
• Partnered with local public housing authority or
state housing agency to create preferences for
MFP participants and/or increase rental
assistance opportunities
• Increased affordable/accessible housing
opportunities for MFP participants
• Increased opportunities for apartments in MFP
qualified assisted living settings
• Increased group home opportunities qualifying
for MFP
• Increased/Improved funding for home
modifications
• Other, specify below
• None
Populations Affected
Please describe the achievements
2. 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
This section was modified to
restructure the format and
remove questions and
detailed data points that are
no longer relevant.
Question #2 and #4 (2018
form) were removed.
Question #5 (2018 form)
was moved to section M
question #6 (2021 form).
Reason for
Change
Significantly
streamline
reporting,
remove
redundancies
and irrelevant
information to
reduce
reporting
burden.
Burden
Change
Reduced
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2021 (new version)
Please describe the achievements
• 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. Choose from the list below and describe by
target population for each checked box.
• Lack of information about affordable and accessible
housing
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Insufficient supply of affordable and accessible
housing
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Lack of affordable and accessible housing that is
safe
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Insufficient supply of rental vouchers
• Please describe by target population.
• What are you doing to address the challenges?
individuals who transitioned to the community this
period, reported in Question B.3. (Transitions).
• 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
3. Describe specific housing efforts associated with
this initiative and housing challenges during this
reporting period.
Type of Change
Reason for
Change
Burden
Change
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What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Lack of new home ownership programs
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Lack of small group homes
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Lack of residences that provide or arrange for long
term services and/or supports
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Insufficient funding for home modifications
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
Unsuccessful efforts in developing local or state
coalitions of housing and human services
•
•
•
•
•
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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MFP Semi-Annual Report Crosswalk
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organizations to identify needs and/or create
housing related initiatives
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Unsuccessful efforts in developing sufficient
funding or resources to develop assistive
technology related to housing
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• Other, specify below
• Please describe by target population.
• What are you doing to address the challenges?
• What is the current status of the issue?
Resolved / In Progress / Abandoned
• (If Resolved or Abandoned) Explain status
choice
• 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). Describe by target
population.
• 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
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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• 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.
• 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
• 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. Check all
target populations that apply.
• 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
6. Describe specific housing efforts associated with this
initiative and housing challenges during this reporting
period.
Use this box to explain missing, incomplete, or other
qualifications to the data reported in this section (E.9).
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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Section E.10 - Employment Supports and Services
1. What types of ongoing employment supports are
provided through your MFP program to help
participants find or maintain employment?
• Job coaching or ongoing support planning
Please describe by target population.
How is this service or support funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
• Job training or re-training
Please describe by target population.
How is this service or support funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
• Peer to peer consultation and support
Please describe by target population.
How is this service or support funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
• Employment monitoring or mediation with
employer/employees to resolve barriers to work
Please describe by target population.
How is this service or support funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
2021 (new version)
N/A
Type of Change
Section E.10 (2018 form)
was removed in the revised
2021 form.
Reason for
Change
It was
determined
that, although
these
questions are
important to
address in
establishing a
new program,
this detailed
information
was not
necessary for
ongoing
reporting.
Burden
Change
Reduced
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•
•
•
•
•
Mediation with family/friends to secure their
support for individuals’ work-related needs
Please describe by target population.
How is this service or support funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
Assistance with transportation to and from work
Please describe by target population.
How is this service or support funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
Assistance with budgeting
Please describe by target population.
How is this service or support funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
Assistance developing interpersonal or
employment skills
Please describe by target population.
How is this service or support funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
Other, specify below
Please describe by target population.
How is this service or support funded?
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
• None
2. What activities or progress was made this period to
utilize MFP resources to support the goals of MFP
participants?
• Hired employment specialists to help MFP
participants achieve employment goals
How is this activity funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
• Produced training resources or delivered
employment training to MFP staff, transition
coordinators, or waiver staff
How is this activity funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
• Incorporated information about disability- and
employment-related agencies and services into
outreach materials
How is this activity funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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2018 (old version)
Financed services or supports (such as adaptive
equipment, transportation, personal assistance
services) to help address barriers to employment
How is this activity funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
• Leveraged Medicaid Infrastructure Grant program
resources or funds (via supplemental grants or nocost extension of previous grants) to support
employment of participants with disabilities
How is this activity funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
• Other, please specify
How is this activity funded?
o MFP Demonstration Services
o MFP Supplemental Services
o MFP 100% Administrative Funding
o Qualified HCBS
o Other
• 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
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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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
• None
4. Were there any other developments or progress this
period toward increasing the availability of employment
services and supports for MFP participants?
5. Tribal Initiative Only - Describe specific employment
efforts associated with this initiative and employment
challenges during this reporting period.
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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Section F - Organization & Administration
1. Were there any changes in the organization or
administration of the MFP program during this
reporting period? For example, did your Medicaid
agency undergo a reorganization that altered the
reporting relationship of the MFP Project Director?
Yes / No (If Yes) Please describe the changes.
2. What interagency issues were addressed during this
reporting period?
• Common screening/assessment tools or criteria
Which agencies were involved?
• Common system to track MFP enrollment across
agencies
Which agencies were involved?
• Timely collection and reporting of MFP service or
financial data
Which agencies were involved?
• Common service definitions
Which agencies were involved?
• Common provider qualification requirements
Which agencies were involved?
• Financial management issues
Which agencies were involved?
• Quality assurance
Which agencies were involved?
• Other, specify below
Which agencies were involved?
• None
3. Did your program have any notable achievements in
interagency communication and coordination during
the reporting period? Yes / No (If Yes) What were the
achievements in?
4. What significant challenges did your program
experience in interagency communication and
coordination during the reporting period?
2021 (new version)
Type of Change
Section J - Organization & Administration
1. Were there any changes in the organization or
administration of the MFP program during this
reporting period? For example, did your Medicaid
agency undergo a reorganization that altered the
reporting relationship of the MFP Project Director?
Yes / No (If Yes) Please describe the changes below.
This section was modified to
restructure the format and
remove questions and
detailed data points.
Questions 2-5 (2018 form)
were removed.
Reason for
Change
Significantly
streamline
reporting,
remove
redundancies
and irrelevant
information to
reduce
reporting
burden.
Burden
Change
Reduced
Interagency relations
Page | 54
MFP Semi-Annual Report Crosswalk
2018 (old version)
Please describe the challenges.
What agencies were involved?
What are you doing to address the challenges?
What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Privacy requirements that prevent the sharing of data
• Please describe the challenges.
• What agencies were involved?
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Technology issues that prevent the sharing of data
• Please describe the challenges.
• What agencies were involved?
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Transitions in key Medicaid staff
• Please describe the challenges.
• What agencies were involved?
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Transitions in key staff in other agency
• Please describe the challenges.
• What agencies were involved?
• What are you doing to address the challenges?
• What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
Other, specify below
• Please describe the challenges.
•
•
•
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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What agencies were involved?
What are you doing to address the challenges?
What is the current status of the issue? Resolved /
In Progress / Abandoned
• (If Resolved or Abandoned) Explain status choice
None
5. Tribal Initiative Only - Describe specific changes in
organization or administration associated with this
initiative and any interagency challenges during this
period.
•
•
•
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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2021 (new version)
Type of Change
Section G - Challenges & Developments
1. What types of overall challenges have affected
almost all aspects of the program? Please describe
• 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? Please
Describe
• 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
Section K - Challenges & Developments
Please use this section to describe any challenges,
achievements, or major changes to your MFP
program during the reporting period. Updates may
focus on, but are not limited to the following:
recruitment and enrollment, informed consent and
guardianship, outreach, marketing, and education,
stakeholder involvement, benefits and services,
participant access to services, self-direction,
housing for participants, employment supports and
services, organization and administration, and
independent evaluation.
1. What types of overall challenges have affected
almost all aspects of the program?
2. Did your program report any notable
achievements during the reporting period?
3. Were there any major changes to your program
during the reporting period?
The questions in this section
were reformatted to allow
for a narrative response.
This section of the 2021
form incorporates
information previously
collected through detailed
questions from multiple
sections in the 2018 form.
The sections removed from
the 2018 form include:
informed consent and
guardianship, outreach,
marketing, and education,
stakeholder involvement,
benefits and services,
participant access to
services, employment
supports and services and
independent evaluation.
Reason for
Change
Significantly
streamline
reporting,
remove
redundancies
and irrelevant
information to
reduce
reporting
burden.
Burden
Change
Reduced
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Section H - Independent Evaluation
1. Is your state conducting an independent evaluation
of the MFP program, separate from the national
evaluation by Mathematica Policy Research?
Yes / No (If Yes) Please explain.
2. Were there any outputs/products produced from the
independent state evaluation (if applicable) during this
period?
Yes / No (If Yes) Please explain.
2021 (new version)
N/A
Type of Change
This section of the 2018
form was removed from the
2021 form.
Reason for
Change
Significantly
streamline
reporting,
remove
redundancies
and irrelevant
information to
reduce
reporting
burden.
Burden
Change
Reduced
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Section I - 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. Do not use this section
to report on all-grantee meetings or events. Describe
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.
TA Event #1:
• Date
• Type
• Delivery Method
• Describe the focus of the TA you received
• Usefulness
• If useful, describe what changed as a result. – if
not useful, explain why.
TA Event #2:
• Date
• Type
• Delivery Method
• Describe the focus of the TA you received
• Usefulness
• If useful, describe what changed as a result. – if
not useful, explain why.
TA Event #3:
• Date
• Type
• Delivery Method
• Describe the focus of the TA you received
• Usefulness
• If useful, describe what changed as a result. – if
not useful, explain why.
2021 (new version)
N/A
Type of Change
This section of the 2018
form was removed from the
2021 form.
Reason for
Change
Significantly
streamline
reporting,
remove
redundancies
and irrelevant
information to
reduce
reporting
burden.
Burden
Change
Reduced
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TA Event #4:
• Date
• Type
• Delivery Method
• Describe the focus of the TA you received
• Usefulness
• If useful, describe what changed as a result. – if
not useful, explain why.
TA Event #5:
• Date
• Type
• Delivery Method
• Describe the focus of the TA you received
• Usefulness
• If useful, describe what changed as a result. – if
not useful, explain why.
Additional TA Events
2021 (new version)
Type of Change
Reason for
Change
Burden
Change
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Section J - Overall Lessons & MFP-related LTC System
Change
1. Are there any other comments you would like to
make regarding this report or your program during this
reporting period? (open text)
2021 (new version)
N/A
Type of Change
This section of the 2018
form was removed from the
2021 form.
Reason for
Change
This section of
the 2018 form
was
determined to
be redundant
in the 2021
form.
Burden
Change
Reduced
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N/A
2021 (new version)
Section L - Sustainability
Completed during the second reporting period (JulyDecember) only and at close-out.
1. Please indicate any MFP staff positions that will
be sustained at the end of the demonstration.
Check all that apply.
• Administrative staff Data analyst Housing
coordinator Outreach staff
• Quality and monitoring staff Social workers
• Transition coordinator
• Other. Please describe below:
2. Please indicate any MFP demonstration or
supplemental services that will be sustained at the
end of the demonstration, the target population,
and under what Medicaid authority the service will
be sustained.
• MFP Service
• Target Population (check all that apply)
• Medicaid authority (for example Section
1915(c)
3. Please describe any additional detail on MFP
services that will be sustained in the text box below.
4. Please indicate what demonstration or
supplemental services will not be sustained, and
why.
• MFP services that will not be sustained
• Reason (select all that apply)
5. Please enter any additional description below
related to what demonstration services will not be
sustained.
6. Indicate how your program assesses participants'
experience of care:
• MFP participants are included in a survey
through our HCBS waiver program.
• MFP participants complete a unique MFP
experience of care survey or standard survey.
Type of Change
This section was added to
the 2021 form.
Reason for
Change
To address
how grantees
intend to
sustain their
program
operations,
relative home
and
communitybased service
initiatives and
system
coordination
efforts after
the
demonstration
period ends.
Burden
Change
Increased
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MFP participants are not surveyed about their
experience of care at this time.
• Our MFP participants continue to complete the
MFP Quality of Life Survey.
7. What are the major barriers to sustaining
activities and initiatives implemented through your
current MFP program?
• Lack of, or insufficient funding
• Restrictions on the benefits that can be
provided under existing Medicaid authorities
Staff turnover or lack of staff resource
• Difficulties with referrals or lack of participation
• Housing challenges
• State legislative authority
• Other. Please describe below.
8. What efforts have you made during the reporting
period to advance sustainability of program
activities and initiatives? [Note: Programs that plan
to discontinue, do not need to complete this
question.]
9. What activities do you have planned for the next
six months to advance your sustainability of
program activities and initiatives? [Note: Programs
that plan to discontinue, do not need to complete
this question.]
•
Type of Change
Reason for
Change
Burden
Change
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N/A
2021 (new version)
Section M - Tribal Initiative
This section is to be completed by Tribal Initiative
grantees only.
1. Report the number of people enrolled,
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
2, 3, and 6 in Section B.
a. Enrolled
b. Transitioned
c. Re-institutionalized for more than 30 days
Type of Change
Moved MFP Tribal Initiative
questions from multiple
sections in the 2018 form to
one unified section in the
2021 form.
Reason for
Change
Incorporating
these related
questions into
one section
will provide a
streamlined
approach for
completion
and review of
information.
Burden
Change
Reduced
Did the Tribal Initiative have any difficulty
transitioning the projected number of individuals it
proposed in the Operational Protocol during the
reporting period?
Use this box to explain missing, incomplete, or
other qualifications to the data reported above.
2. Identify challenges that the program had
recruiting and/or enrolling individuals during this
reporting period.
3. 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.
4. Describe any improvement(s) or challenge(s)
related to the quality management within the Tribal
Initiative this reporting period. Include reported
critical incidents as a subset of those identified in
question H.1. Describe the challenges related to the
development of adequate service plans, assessing
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risk implementing or assessing risk mitigation
strategies, addressing emergent risks in a timely
fashion and delivering services as specified in the
plans.
5. Describe as a subset of the totals reported in
question B.9 and H.1, total number of participant
deaths (Question B.9), and critical incidents that
occurred (Question H.1).
6. As a subset of the totals in Question I.2 report by
population where tribal members transitioned to as
a results of the program.
• 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
7. If not previously discussed, describe specific
developments that you want to highlight for this
program including any challenges.
Type of Change
Reason for
Change
Burden
Change
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| File Type | application/pdf |
| Author | TODD WILSON |
| File Modified | 2021-07-21 |
| File Created | 2021-07-21 |