Money Follows the Person (MFP)

Medicaid Redesign in New York State

  • Presentation is also available in Portable Document Format (PDF, 325KB)

MFP Stakeholder Advisory Committee

Mark Kissinger, Director, Division of Long Term Care
Kerry A. Delaney, Acting Commissioner, OPWDD

February 10, 2014

Money Follows the Person Updates

  • Since the last meeting of the Money Follows the Person (MFP) Stakeholder Advisory committee, the following activities have taken place:
    • OPWDD outreach
    • Peer Outreach and Transition Centers RFA
    • Quality of Life Survey
    • MFP Operational Protocol
    • Balancing Incentive Program (BIP) update
    • MFP´s participation in the national core competency validation study

OPWDD Outreach

OPWDD Peer Based Outreach

  • In October 2013, OPWDD entered into a contract with Self Advocacy Association of NYS (SANYS) to promote self-advocacy and to assist individuals in understanding available choices.
  • SANYS utilizes regional coordinators and self-advocates to conduct peer based outreach across the state using a simple message that people now living in intuitional settings can move and be supported in the community.
  • SANYS uses personal presentations, flyers, posters and videos and sends self-advocates to visit individuals residing in developmental centers (DC) and intermediate care facilities (ICF) for individuals with intellectual disabilities.
  • In the final quarter of 2013, SANYS met with 717 individuals in DC and ICF settings.
  • This outreach exceeded OPWDD´s MFP benchmark goal which was to reach 300 residents of ICFs.
  • SANYS outreach resulted in 107 referrals of individuals who expressed interest in moving out of their current setting.
  • SANYS will continue to provide outreach to individuals in these OPWDD settings and in nursing homes in 2014.

OPWDD Peer Based Outreach Lessons Learned

To make the outreach meaningful:

  • Have family members/advocates present for outreach message, especially when the individual cannot communicate his/her own desires.
  • Keep the format flexible to adapt to the needs of the individuals present.
  • Be mindful that presenters are guests in people´s homes.
  • Work closely with facility staff to schedule the visit, invite individuals´ family members, and provide list of individuals who want to pursue a move.
  • Use peers who have experience in the OPWDD system and preferably experience in an institutional setting.
  • Understand that this outreach is just the start of a conversation. Staff may be concerned for the individual and resistant to the message. Be patient and respectful.

OPWDD Peer Based Outreach Next Steps

  • OPWDD is working to improve the outreach process, promote the opportunity for community supports, and ensure effective follow-up with individuals who express a desire to move.
  • OPWDD is developing a new outreach video that showcases success stories of individuals with higher levels of need living in community settings.

Housing Technical Assistance Workshops

  • CMS and OPWDD conducted two housing technical assistance workshops in the fall. One in Long Island and one in Batavia. The topic of the workshops was: "Accessing Housing Resources for People with Disabilities Transitioning from Institutions to the Community."
  • Objectives included educating participants to:
    • Identify at least four new sources of existing housing in their area.
    • Analyze a Public Housing Authority Plan (PHA).
    • Describe methods for collaborating with key housing agencies to promote/expand access to existing services and supports concepts.
    • Identify services and supports concepts.
    • Obtain action steps to continue their efforts.

Housing Technical Assistance Workshops Next Steps

  • CMS approved the continuation of housing technical assistance workshops from January 2014 through March 2014.

Housing Capacity Building Initiative Next Steps

  • CMS in conjunction with the State will host two webinars, the first of which will be February 19, 2014.
    • #1: Expand the inventory of housing alternatives for people with intellectual and developmental disabilities.
    • #2: Increase access to rental subsidies.
  • CMS will provide welcoming remarks for the Office of Home & Community Living Housing Forum on March 31, 2014: "Rebalancing Residential Resources: One Region´s Approach to Building a Sustainable Infrastructure that provides choice, promotes integration and is responsive to changing needs/demands."

Peer Outreach and Transition Centers RFA

Identification and Outreach Project Update

  • The Identification and Outreach Project began on January 1, 2010. Since then:
    • On March 3, 2013, NYS´ Balancing Incentive Program (BIP) proposal was approved. BIP and MFP share the long term care rebalancing goal and are designed to work together across populations.
    • In the Spring of 2013, OPWDD´s population was approved for MFP.
    • Managed Long Term Care (MLTC) plans are being phased in and will be the predominant service delivery mechanism for NYS´ long term care system. In the near future the MLTC population will be phased into MFP.
  • Outreach accomplishments to date:
    We have consistently exceeded the benchmark goal for contacts with nursing home residents.
    Calendar Year Number of Contacts
    2010 1,277
    2011 3,044
    2012 4,764
    2013 1,621 (January - September 2013)
    Total 10,706

Identification and Outreach Project Update

  • MFP transitions from facilities:
    • DOH - since January 1, 2009
      • 768 individuals through the NHTD Waiver
      • 356 individuals through the TBI waiver
    • OPWDD - since April 2013
      • 94 individuals

Results of MFP transition project efforts to date: 1,218 individuals were able to transition out of nursing homes or other institutional setting into the community.

  • Why the Identification and Outreach Project is being redesigned:
    • More emphasis on cross population collaboration.
    • Enhance supports to facilitate the transitioning of individuals out of institutions.
    • Strengthen training and support the current transition process.
  • MFP is taking a new approach to its Identification and Outreach project:
    • The Peer Outreach and Transition Centers RFA was posted last week.
    • Contracts will include serving populations from both (DOH and OPWDD) agencies.
    • The functions will be expanded to:
      • Include use of peers.
      • Enhance transition period services.
      • Enhance transition period coordination.

Quality of Life Survey

Quality of Life Survey Update

  • The Quality of Life Survey is a tool used to measure satisfaction at three different points in time (both pre- and post-transition): A baseline administered prior to transition, a follow up at 11 months after transition and a second follow up at 24 months after transition.
  • As noted at the last stakeholders meeting, a program evaluation was completed looking at satisfaction pre- (baseline) and post- (11 month) transition during the years of 2009-2011.
  • Overall, all areas evaluated had an increase in satisfaction post transition. These findings imply that the programs focused on alternatives to institutional care and support provided post transition are enhancing individuals´ quality of life.

Quality of Life Survey - Next Steps

  • MFP plans to examine the satisfaction rate pre- and post- transition at the 24 month mark using survey responses from the 2011-2013 timeframe.
  • A goal of this new study would be to see if satisfaction continues to increase after a year post-transition.
  • Another goal of the study would be to understand the reasons for satisfaction decreases and increases.

MFP Operational Protocol

MFP Operational Protocol

  • The Operation Protocol (OP) details the policies and procedures of the MFP Demonstration. Amendments may include but are not limited to addition of new populations (i.e., MLTC, OPWDD, OMH), revisions to rebalancing activity benchmarks, and incorporation of new guidance/forms.
  • The current version OP 1.8 included a revision to the MFP Informed Consent Form.
  • Version 1.9 is currently under development and will incorporate language related to the inclusion of Managed Long Term Care into the Demonstration.
  • Over the course of 2014 subsequent versions (2.0 and above) will see a reformatted design and incorporate frequent changes in the rapidly shifting long term care environment.

Balancing Incentive Program (BIP) Update

Balancing Incentive Program (BIP) Update

MFP and BIP shared goals:

    • Encourage successful transition of individuals from institutional LTC settings to the least restrictive community-based settings.
    • Provide enhanced funding for transitions to support people living in the community.
  • The BIP work plan, including the funding plan, has been approved by CMS.
  • A BIP Stakeholder webinar was held in January. Materials are available on the MRT web site.
  • The State will continue to work on the implementation of the BIP work plan.

MFP´s Participation in the National Core Competency Validation Study

National Direct Support Professional Core Competency Validation Study

  • In 2009 the Department of Health and Human Services set forth an initiative to develop and implement innovative strategies that would increase the opportunities for Americans with disabilities and older adults to enjoy meaningful lives in the community.
  • CMS funded a multi phased research project which is being implemented through the National Direct Service Workforce Resource Center called the Roadmap of Core Competencies for the Direct Service Workforce.
  • New York State will be participating in the Phase IIIB part of the project - the Validation Study.
  • The MFP Demonstration was designated the lead coordinator because the project is in line with NYS rebalancing goals and can be supported by MFP funds.

What is the Validation Study?

Focus groups and an online survey are tools that will be used to validate that the Direct Service Workers (DSW) Core Competency Set which can be used across sectors.

The DSW Core Competency Set were designed to inform direct support service delivery and promote best practices across 4 sectors

  • Aging
  • Behavioral Health (Mental Health & Substance Use)
  • Intellectual & Developmental Disabilities
  • Physical Disabilities

14 Core Competency Areas

The 14 core competency areas being addressed in this study include:

  • Communication
  • Facilitation of individualized services
  • Evaluation and Observation
  • Participant Crisis Prevention and Intervention
  • Safety
  • Professionalism and Ethics
  • Participant Empowerment
  • Advocacy
  • Supporting Health and Wellness
  • Community Living Skills and Supports
  • Interpersonal and Family Relations
  • Community and Service Networking
  • Cultural Competency
  • Education, Training and Self-Development

Core Competency Areas

  • These competencies will be relevant to new direct service workers and to tenured workers across sectors.
  • The competency set is not intended to impose requirements for community-based long term services and supports Direct Service Workers upon entry into the workforce, but instead to provide guidance for development of initial and ongoing training to promote continued competency development.

New York State´s Role

An interagency team comprised of representatives from NYS Department of Health, Office of Health Systems Management, Office of Mental Health, Office for the Aging, Office for People with Developmental Disabilities, and Office of Alcoholism and Substance Abuse Services have been tasked with the following:

  • Recruiting participants for focus groups throughout each of the 4 sectors:
    The focus groups will be comprised of 3 sub groups:
    1. Direct Service Workers
    2. Service Recipients (family caregivers and/or guardians)
    3. Service Providers (Administrators/Supervisors)
  • Identify organizations and agencies to participate in an online survey.
  • Disseminate the survey to prospective respondents via e-mail.
  • Conduct follow-up outreach to non-respondents and solicit additional as needed.

DSW Resource Center´s Role

  • Develop surveys.
  • Compile and analyze data collected through focus groups and surveys.
  • Use results to modify the draft core competency set to create a final validated DSW Core Competency Set.
  • Publish final report making it available to the public.
  • Create a web-based tool kit with competency-based resources and workforce development tools.
  • Develop webinars and presentations to establish the DSW Core Competency Set in the public domain.
  • Provide technical assistance to states that are looking to use the Core Competency Set.

Current Status of the Study

  • Dates and location for the focus groups have been secured for March 18th and 19th at the School of Public Health - University at Albany.
  • State agencies have started to work on identifying organizations/agencies to recruit participants for the focus groups and participate in the online survey.
  • Ongoing communication continues with the DSW Resource Center and NYS.
  • Stakeholders can be critical in assisting with the recruitment of focus group and survey participants.

Open Discussion

Contact Information

Send all questions and comments to the MFP BML =MFP@health.ny.gov

Or Contact

Mark L. Kissinger, Director, Division of Long Term Care
Mark.Kissinger@health.ny.gov

Dave Hoffman, Director, Bureau of Community Integration and Alzheimer´s Disease
David.Hoffman@health.ny.gov

Dixie Yonkers, MFP OPWDD Project Director
Community.Transitions@opwdd.ny.gov