Advocates for Community Services:

The MFP submittal date of November 1st is now history. We understand CMS got 37 submittals by the deadline.

Below is a link to a good article on Targeted Case Management (TCM) which is a Medicaid program that can be used for identification of and service coordination for folks transitioning out of institutions.

During your states development of the Demonstration Operational Protocol (DOP) there may be an opportunity to push for TCM.

There are three critical pieces in transitioning folks out of institutions:

• Identification
• Service Coordination
• Housing - Accessible, Affordable, Integrated

If your state DID NOT APPLY there is no reason they cannot move the money from the nursing home/institution to the community under the current rules and regulations (THEY FOOLISHLY JUST WON'T GET THE ENHANCED MATCH).

Identification of folks who want out of nursing homes and other institutions, in the non-responding states, will require the state to provide them community services or explain WHY THEY TURNED DOWN INCREASED FEDERAL FUNDS under MFP.

As former CMS Administrator said about MFP: "States have NO MORE EXCUSES".

Don't Mourn...ORGANIZE!!

The ADAPT Community

The Targeted Case Management article.

Demonstration Operational Protocol (DOP)
(Phase One: Pre-implementation – 3 months to 12 months)

The State, if they receive approval by CMS to receive MFP funding, MUST prepare a demonstration operational protocol (DOP) document that represents all policies, operating procedures and the evaluation plan applicable to the MFP demonstration.

During this Pre-implementation phase, CMS encourages States to “…formally engage all needed stakeholders as required by section 6071©(1) of the Deficit Reduction Act…”

This DOP must be submitted WITH the final budget (amended) to CMS for approval.

The project CANNOT be implemented (Phase Two) without the FINAL approval of the DOP.

Timelines: DOP must be submitted no later than 60 days prior to program implementation date;
No later than 13 months after Award Date;
CMS must respond in 45 days on issues/areas for clarification;
After approval of DOP service funding can be utilized

Sample Elements
for the
Demonstration Operational Protocol (DOP)

1. Organization and structural administration;
2. Reporting items;
3. Benefits and services description, including unit costs;
4. Outreach/Marketing/Education;
5. Eligibility/enrollment;
6. Service provision procedures;
7. Billing and reimbursement procedures;
8. Quality;
9. Participant Protections;
10. Informed Consent;
11. Revised Budget

Once the DOP has been approved by CMS, a state will be permitted to claim the enhanced match rate for Home and Community Based (HCB) services for demonstration participants transitioned from the institutional setting into the community for 12 months after they have transitioned from the institution.

ADAPT/Institute for Disability Access
October, 2006

Institute for Disability Access
Funding ideas for Identification/Service Coordination
Getting People out of Nursing Homes/Institutions

1. Grant/Federal/State funds
   1. CMS – Real Choice Grants (Nursing Home Transition, Money Follows the Person)
   2. Developmental Disabilities Councils
   3. State Independent Living Councils
   4. Foundations/Corporations
   5. Other Federal/State Agencies (ie. Veterans Administration)
      
      
2. Targeted Case Management - Medicaid State Plan Service Identify those in nursing homes answering yes on the MDS Q1a as the targeted population using Medicaid funding to pay for the transition services for those out who choose to leave.
   1. Can be used up to 180 days
   2. Can be administered by contract or billed hourly - State decision
      
      
3. Vocational Rehabilitation/Independent Living Services
   1. VR Agency can create a reimbursable pre-employment service called "Relocation Services" that can be used by non-profit agencies (like ILC's, AAA’s) to identify and service coordinate folks in nursing homes who want out. Funding would only be used to coordinate the transition services not directly pay for employment or home and community service needs.

Relocation Services - an array of services, the outcome is the development of services and supports that result in relocation of a VR or ILS client from an institutional setting such as a nursing home.

Using Title I VR dollars could be a potential funding source at the state level for those in nursing homes who have employment potential. There is currently a demonstration project using VR dollars for this purpose in Texas. This will become more important as a funding source, if Getting/Keeping folks out of nursing homes and other institutions becomes the 5th core service for Independent Living Centers.

Using both Vocational Rehabilitation Title I funds ALONG with Medicaid Targeted Case Management to fund identification/service coordination services is a good strategy.

Medicaid funding source should be pursued first because it is the largest possible funding source. Voc Rehab dollars used only for those with employment potential.

Institute for Disability Access
April 2005