Presented By:
Maryland Department of Health and Mental Hygiene: Lorraine Nawara, Devon Snider, Eric Saber
Maryland Department on Aging:
Stephanie Hull
HCBS Strategies: Steve Lutzky, Kristy Michael
State of Maryland 1
Impacting Federal Initiatives
Money Follows the Person
Aging and Disability Resource Center Program
Community Living Program/Veteran Directed
HCBS Program
Options Counseling Development
Balancing Incentive Program
Community First Choice Option
Care Transitions Programs
State of Maryland 2
The ADRC: Did we have any idea
where we would end up?
State of Maryland 3
Quick ADRC History
2003 first grants: Maryland was one of
twelve states with two local sites
Maryland now statewide with 20 sites and
part of national program
No Wrong Door/Partnership Development
New pilot programs
Self-direction
Care Transitions
Ready for the Affordable Care Act
State of Maryland 4
Implementation of Statewide Aging and
Disability Resource Center Program
State of Maryland 5
MAP (ADRC)
Care Transitions
CLP/ Veteran Directed HCBS
Program
Money Follows the
Person
Balancing Incentive Program Options
Counseling Development
Community First Choice
Option
HCBS Waivers/ Personal
Care
Implementation of Statewide Aging and
Disability Resource Center Program
Overview of Maryland Access Point
Partnerships
Statewide web-based searchable
database www.marylandaccesspoint.info
State of Maryland 6
Options Counseling Development
Target population:
Older adults and all adults with a disability with the exclusion of individuals with developmental disabilities who would be referred to DD agency.
Development of Options Counseling standards/ partners Setting of OC delivery strategy, Staffing, Documentation and tracking
Partnerships with Local agencies, CIL partners
Development of protocols: Intake
Support Plan
Participant Survey
6 Month Follow up Tool (includes POSM)
Implementation timeframe: Pilot: January-August 2012, evaluation beginning September. Roll-out
July 2013
Challenges expected with implementation: Implementation across 20 counties/MAP sites
Integration with Level I Screen and Level II Assessment
State of Maryland 7
Untangling the OC Complexities
8 State of Maryland
Proposed Options Counseling Process Flow
State of Maryland 9
State of Maryland 10
Rebalancing Themes
Pursue Community First Choice and the
Balancing Incentive Program
Improve quality
Improve/expand HCBS
Increase funding
Expanded/simplified eligibility
Enhancing Person Centered Planning and
Participant Direction
Improve administration
Implement the In-home Supports Assurance System
Money Follows the Person (MFP)
Federal demonstration offered through the Centers for Medicare and Medicaid Services (CMS) and designed to:
Assist states in rebalancing long-term care systems.
Increase the use of Home- and Community-Based Services (HCBS).
Remove barriers to receiving services in the community.
Affordable Care Act added funding, extended the demonstration, and offered grants to additional states.
Maryland has transitioned over 1300 individuals to home and community based services through MFP since March 2008.
State of Maryland 11
Money Follows the Person (MFP)
State of Maryland 12
Increase outreach to institutional residents
Peer Supports and Options Counseling
Enhance existing community-based services
Peer Mentoring and Pilot programs
Improve Systems
Statewide ADRC sites (Single Entry Point/No Wrong Door)
Integrated web-based tracking system
Balancing Incentive Program
Offers an enhanced federal medical assistance
percentage (FMAP) for all HCBS covered during the
“balancing incentive period” through September 30,
2015. Maryland awarded a projected $106 million
All enhanced federal payments must be used to fund new
and expanded Medicaid community-based LTSS.
States must initiate the following “structural changes” to
their LTSS systems:
No Wrong Door / Single Entry Point system for LTSS.
Implement a Core Standardized Assessment Instrument.
Ensure Conflict-Free Case Management.
By the end of the BIP period states must:
Increase HCBS to 50% of total Medicaid LTSS spending.
Implement required structural changes.
State of Maryland 13
14
Single Entry Point
Services
Quality
Community
First Choice
BIPP
Core Standardized Assessment
Level I Screen
Conflict-free Case
Management
Provider Registry
Emergency Back-up
System
Consumer Surveys
In-home Supports
Assurance
Self-Direction
Provider Training
MAP Sites The Exchange
MFP
Challenges in Merging ADRC and
MFP, BIP and CFC
State of Maryland 15
There’s no such thing as a LITTLE mistake but
EVERYTHING can be fixed!
Collaboration and Coordination
Partnerships/trust
Marriage of Medicaid, Aging, and
Disabilities Departments and
infrastructures
Clear vision
Horizontal and vertical integration
Maintaining bigger picture while
muddling through the details
State of Maryland 16
The Communication Challenge
State of Maryland 17
Information/Feedback and Buy-in
Communication and coordination
Multiple overlapping projects
Multiple funding streams
Multiple state level departments
24 local jurisdictions
Local governmental and non-profit organizations
Collaboration between aging and disability networks
Everything is new and emerging
Constant change
State of Maryland 18
Maintaining Your Sanity
State of Maryland 19
Lessons Learned
Communication is key to partnerships Sitting at the same table
Regular stakeholder feedback and input
Shared decision making
Reorganization is not always needed
Pooling of resources
Tolerance for conflict
Commitment at all levels
Perseverance
Shared vision and coordination of plans
Good consultants and advisors
State of Maryland 20
This Cannot Be Done Alone
State of Maryland 21
Thank You
Speakers:
Maryland Department of Health and Mental Hygiene:
Lorraine Nawara, Devon Snider, Eric Saber
Maryland Department on Aging: Stephanie Hull
HCBS Strategies: Steve Lutzky
For a copy of this presentation please contact:
Kristy Michael: [email protected]
State of Maryland 22
