Money Follows the Person
Arkansas Money Follows the Person (MFP)
The Arkansas Money Follows the Person application has transitioned 773 individuals who have resided in institutions 90 consecutive days and one day on Medicaid into qualified home and community-based programs.
The following populations residing in nursing homes and ICF-ID's will be served: Individuals with developmental disabilities; individuals 21 to 64 with physical disabilities; and individuals age 65+.
Number of people targeted for transition through 2015: 773
Minimum Eligibility prior to transition:
A period of 90 days that includes hospitalization and current recipient of Medicaid benefits for in-patient services for at least 1 day.
Populations targeted for transition:
Elderly; adults (21 and over) with physical disabilities, individuals with developmental disabilities; and individuals with mental illness who have another qualifying condition.
Licensed nursing homes, Human Development Center and the Arkansas Health Center under the administration of the Division of Behavioral Health and ICF/IDs.
Qualified Residence in Community:
A home leased or owned by the individual or the individual's family member; and apartment with an individual lease; or an Assisted Living facility or a residence, in a community-based residential setting in which no more than 4 unrelated individuals reside.
The Operational Protocol, Phase One of the Money Follows the Person Initiative, will address key issues such as target population(s), participant selection mechanisms, a detailed service delivery plan, and a quality management system. This document will be submitted in December to the Centers for Medicare and Medicaid Services for review and revised as needed each January thereafter.
Purpose: To measure progress in transitioning individuals to the community and rebalancing its long-term care system.
1. Arkansas will assist individuals, from four target groups of eligible individuals, in transitioning from institutional settings to qualified community based settings, as shown below.
Year Aged ID Physically Disabled Adults with MI Total
FY 2007 0 0 0 0 0
FY 2008 1 13 7 0 21
FY 2009 13 11 16 0 40
FY 2010 10 39 19 0 68
FY 2011 8 88 21 0 117
FY 2012 17 55 29 0 101
FY 2113 31 75 49 0 135
FY 2014 27 65 47 0 139
FY 2015 38 57 37 0 132
FY 2016 32 69 45 0 146
FY 2017 30 63 42 0 135
FY 2018 23 50 33 0 106
FY 2019 0 0 0 0 0
FY 2020 0 0 0 0 0
Estmated transitions 230 585 345 0 1160
2. Arkansas will demonstrate an increase in qualified expenditures for HCBS during each year of the demonstration program.
AR HCBS Expenditures
* Note: Benchmark expenditures include the following services: Private Duty Nursing, Independent Choices, Home Health, ElderChoices Waiver, DD ACS Waiver, Targeted Case Management, Alternatives Waiver, Personal Care, and Transportation.
Participant Recruitment and Enrollment
The Operational Protocol requires a detailed description of the methods used to inform, recruit and enroll potential participants into the MFP project. It is anticipated that several methods will be incorporated into this project, including:
Direct Recruitment: The MDS (Minimum Data Set), a federally mandated Resident Assessment Instrument (RAI), collects vital information on nursing home residents and could be utilized to identify individuals living in institutions who want to return to a home and community residence. The data could also be used to identify those individuals who have similar characteristics to individuals who transitioned out of nursing homes under a previous demonstration grant called Passages. Once these individuals are identified, a personal letter can be sent outlining the project and allowing them the opportunity to request further information.
Indirect Recruitment: The Department of Human Services will conduct a social marketing campaign to inform the public as well as professionals working with the MFP targeted populations about the specifics of the MFP Initiative. Presentations will be conducted throughout the state to facility Family Councils, Arkansas Advocates for Nursing Home Residents, professional organization conferences and workshops, and various local agency venues.
Referral: An individual can self refer or be referred by a variety of sources. Once identified, the potential participant will be screened to determine general eligibility. If eligible, and if the potential participant wishes to continue the process, a more detailed assessment will be completed and a transitional coordinator will discuss their needs, desires and expectations regarding the transitioning process and service plan components of MFP. Each potential participant, and his/her guardian or responsible party, should fully understand all aspects of the project, their rights and responsibilities, and, risks and benefits in order to give informed consent to enroll and participate in the MFP project.
Informed Consent should be (1) clearly explained (2) completely understood (3) absolutely voluntary. Informed Consent is a process of information exchange that discloses the intent and elements about the MFP program, including the services and supports provided both during and after the demonstration year; aspects of the transition process; participants rights and responsibilities; criteria for who can provide consent as well as the requirements for someone to "represent" an individual in this manner; and question and answer opportunity.
The Consent Form serves as a written summary of the information that is presented to a potential participant and/or responsible party. The MFP Transition Coordinator is responsible for ensuring that the Informed Consent document is obtained from each participant or responsible party before any transition activities begin.
Rights and Responsibilities
Statement of Rights of MFP Participants
•To live as independently, actively and fully as desired.
•To have personal information treated confidentially.
•To be treated in a courteous and respectful manner and to be free from mental, physical, and financial abuse.
•To live safely in a healthy environment.
•To be dealt with in a manner that recognizes your individuality and that responds to your needs and preferences. This includes preferences based on ethnic, spiritual, linguistic, familial and cultural factors.
•To have information about community services provided to you and to choose the manner in which the services will be provided.
•To participate in the assessment of your requirements, development of your service plan, review of your requirements, evaluation and revision of your service plan.o participate in the assessment of your requirements, development of your service plan, review of your requirements, evaluation and revision of your service plan.
•To give or refuse consent to the provision of any community service.
•To raise concerns or recommend changes in connection with the community services provided to you and in connection with policies and decisions that affect your interests, to your service provider, government officials or any other person, without fear of interference, coercion, discrimination or reprisal.
•To know of any changes to the Money Follows the Person (MFP) Program in a timely manner.
•To appeal decisions, actions or conflicts to Division of Aging and Adult Services (DAAS) by calling Toll-Free 866-801-3435 or by formally writing to DAAS to appeal decisions received in writing from DAAS.
Statements of Responsibilities of MFP Participants
•To know about your rights, and to understand what each right means and how it applies to you.
•To make your needs and expectations known.
•To give your consent only when you understand fully what you are agreeing to.
•To be honest and respectful toward the people who provide your services.
•To participate in planning and reviewing your services.
•To let your service provider know if you are having problems with your service or if you feel that your rights are not being respected.
•To provide true and complete information to any person, associated with the Money Follows the Person (MFP) program, specific to the assessment process, transition planning and implementation and ongoing care, through an authorized plan of care.
•To ask questions or request the information in an alternative format to ensure full understanding of the process and information being presented.
•To follow the plan of care and rules governing the programs and services you are enrolled in.
•To notify your primary care medical provider of any health or medical changes or concerns, in a timely manner.
•To know and review your Back Up Plan, in the event of need, to ensure service is not interrupted, and to notify the appropriate personnel when the need to implement the Back Up Plan occurred.
Benefits and Services
The Operation Protocol must detail the services to be made available to the MFP participants; the delivery mechanism (fee-for service, self-directed care, agency directed services, managed care); and the Medicaid mechanism through which the services will be continued at the termination of the demonstration period (Medicaid Section 1915 waivers, Medicaid Demonstration, Section 1115, waivers, State Plan amendments, etc.).
Home and Community Based Services will be provided to each participant through the existing system of Medicaid Waivers and the State Plan services. Each participant will be enrolled into the specific waiver and/or plan service that best addresses their service needs and desires to self-direct their care. Following are charts depicting Medicaid waiver and state plan services available to the MFP participant.
Waiver Eligibility Self Direct Option Services
ElderChoices (EC) 1915 (C)
Income: 300% SSI Age: 65+ Medical: NF LOC
No, but can self-direct Adult Companion Services and State Plan Personal Care through the IndependentChoices program.
Adult Day Care; Adult Family (Foster) Home; Chore, Companion; Homemaker; Home Delivered Meals; Personal Emergency Reponse System; Respite. Amendment requested to add
1.Transitional costs such as utility and security deposits, household goods and other necessary services to establish community living;
Developmentally Disabled (ACS) 1915 (c)
Income: 300% SSI
Age: birth death (dz Prior to age 21)
Medical: ICF-MR LOC
Yes, will be available by end of '08
Adaptive Equipment; Case Management; Community Experiences; Consultative Services; Counseling Service; Crisis Center; Environmental Accessibility Adaptations/Modifications; Non-medical Transportation; Respite; Respite Care Child Support; Specialized Medical Equipment and Supplies; Supplemental Support; Supported Employment; Supportive Living
Independent Choices (IC)
Full Medicaid eligibility required
Companion Service; Consultative Service; Fiscal Support; Individual Directed Goods and Services; Personal Attendant
Physical Disabilities (APD) 1915 (c)
Income: 300% SSI;
Medical: NF LOC
Adaptive Equipment; Case management; Environmental Accessibility Adaptations/Modifications; Fiscal Support; Personal Attendant.
Amendment request to add:
1.Working Disabled (Medicaid Buy-In participants)
3.Case management and counseling support
5.Increasing age limit
6.Transitional costs such as utility and security deposits, household goods and other necessary services to establish community living
State Plan Services Available to MFP Participant
Service Eligibility Self Direction Option
Case Management no
Self-Directed Care vs. Agency Directed
Self-direction of Medicaid services means that the participant (or representative) has the decision making authority over some or all of his/her services and takes responsibility for taking the direct role in managing them with the assistance of needed supports. Self-direction is an alternative to provider management of services wherein a service provider has the responsibility for managing all aspects of service delivery in accordance with a person-centered planning process.
Self-direction promotes personal choice and control over the delivery of services, including who provides services and how they are delivered. While participant choice is a fundamental construct within Medicaid, participants may need assistance and support in order to effectively exercise this freedom. It is the responsibility of the Medicaid program to ensure the provision of the necessary supports (either paid or unpaid) to people who are eligible to self-direct within the state.
In addition to these programs and services, MFP will introduce several demonstration services that will be made available to the MFP participants during their demonstration period of 12 months. They include:
1.Telemedicine - "Telemedicine" means the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications. Telemedicine is not a consultation provided by telephone or facsimile machine.
2.Intense Transitional Coordination - Individuals transitioning from institutions often need more community support than is offered through traditional waiver services. Intense Transitional Management, similar to case management, includes activities such as information and assistance; assistance with linkage with appropriate resource(s), including contact and follow-up with provider(s); and more frequent follow-up with the client to ensure expectations are met regarding outcome of action(s) taken and any need for further services.
3.In-Home Monitoring Technology - 24/7 personal monitoring system that identifies developing health problems and alerts for potential emergencies by detecting changes in key behaviors. These changes are tracked through a patented technology. It detects prolonged inactivity, extreme temperatures, and other activity and captures this to a web-based program that is monitored by around the clock emergency response operators.
4.Therapeutic Interventions - An array of medical, health, and other therapeutic activities designed to assess potential risks and identify plans of care for risk mitigation, including:
Assessments: The application of assessment instruments to evaluate participants' status specific to Nutrition, Depression, Continence, Wound Care, and Medication Management.
5.Community Transition Services - Items, goods, or services necessary to allow an institutionalized individual to transfer into a community setting. May be provided 60 days prior to discharge from NF up to 60 after discharge and may include:
Environmental Modifications; Assistive Devices; Security Deposits; Rental and Utility Deposits; Essential furniture, appliances, and household items; other items, goods, or services approved by DAAS as necessary for the health and welfare of the participant
Transitioning to a community residence will be dependent on having a sufficient supply of qualified residences in the service area of the potential participant. Keeping in mind the projected number of participants for each year, the MFP project encompasses the entire state of Arkansas and will require a concerted effort between the State Department of Human Services, Arkansas Development Finance Authority, Public Housing Authorities (PHAs) and other related organizations.
Alfonzo Johnson, the Secretary of the U.S. Department of Housing and Urban Development, sent letters to all public housing authorities (PHAs) requesting their active support and participation in MFP. In addition, the State Director of Public Housing for Arkansas's HUD office sent a similar appeal for support. In essence, the request was made for each existing authority to set local preferences, to use Public Housing units, to set aside Housing Choice vouchers, and Mainstream Vouchers for participants in the MFP project.
An inventory of available units and other housing resources (such as the Choice vouchers), as specified by local PHAs and other related organizations, will be developed for use by the transitional coordinators and/or case managers.
Other housing initiatives include, but are not limited to:
1.The development of Adult Family Homes;
2.The development of affordable assisted living facilities for individuals with low incomes;
3.The Tenant Based Bridge Rental Assistance (TBRA), developed with HOME funds from the Arkansas Development Finance Authority (ADFA). The fund provides rental assistance for up to two years for an individual wishing to divert or transition from an institution. The funds are currently contracted to community service providers, who in turn assist individuals with the completion of the application and assist the client in working with the local Public Housing Authority to make application for a Section Eight voucher.
Arkansas is using a Systems Change grant to implement a new Comprehensive Quality Management System, which will be based on the CMS HCBS Quality Framework and Procedural Guidance. This revised system will add program staff to the Quality Management Unit and add capacity to the system to evaluate and disseminate reports about all waiver programs. The grant will also be used to write an Advanced Planning Document to enhance funding of MMIS to automate solutions.
We are to outline the Quality Management System (QMS) applicable to each existing waiver and any additional measures put into effect for MFP. The QMS must address the Level of Care determinations, Service Plan descriptions, identification of qualified home and community based service providers, health and welfare or participants, administrative authority, and financial accountability. In addition, MFP will be subject to two levels of program evaluation. Nationally, a review will be completed across the states participating in the program. Internal to Arkansas, a more detailed assessment will be conducted to determine cost effectiveness, cost benefit, quality of life, and other identified outcomes to determine the program success.
Each MFP participant will be enrolled into an existing HCBS waiver which best suits the participant's desires and needs. Agency directed providers of waiver HCBS services are required to maintain emergency access and back up plans specific to their service. Self Directed (SD) care options empower the participant as the direct care provider/employer with the associated responsibilities of that role, including the development of back-up plans.
Some of the consumer support that we have been asked to put into place for MFP participants will provide the participant consistent access to assistance and supportive services. Examples of these are:
1. Educational materials that will spell out what services are available to the participant.
2. A description of the 24-hour back up systems that the participants will have access to for things such as:
b. Direct services workersb. Direct services workers
c. Repair and replacement of durable medical equipment or other medical equipment
d. Access to medical cared. Access to medical care
3. A copy of the complaint and resolution process when the backup system fails.
Consumers, agencies, providers, non-profits, and others are invited to assume an active role in development of the Operational Protocol and the MFP program design through a variety of opportunities, including:
Stakeholder meetings such as GIST (Governor's Integrated Services Taskforce).
Personal presentations at area conferences and workshops for organizations that serve the various target populations. Examples of annual conferences and workshops targeted for presentation of MFP information are included below:
•DD Annual Conference
•Arkansas Nurses Association
•AR Health Care Association
•Arkansas Chapter of American Case Management Association (ACMA)
•Arkansas Gerontological Society
•AR Ombudsmen Annual Training
•Arkansas Waiver Assn
For more information or to request a presentation, please contact:
Office Address Phone/TDD Email
Latonya Robinson, Interim Program Coordinator; DAAS - Money Follows the Person PO Box 1437 Slot S530
Little Rock, AR 72203-1437 501-320-6577
Fax: 501-682-6658 Email
24 Hour Contact Informaton Form
DHS-4000 Authorization to Disclose Health Info-Release of Info Form
DHS-8504 DAAS Home and Community Based Waiver Programs - Start Services Form
DHS-8505 Informed Consent Form
DHS-8506 MFP Assessment and Personal History Form
DHS-8507 Checklist of Clients Rights
DHS-8508 Statement of Rights of MFP Participants
DHS-8509 Provider Freedom of Choice Referral Form
DHS-8510 Demonstration Services Freedom of Choice
DHS-8511 Transition Risk Form
DHS-8512 Risk Mitigation Monthly
DHS-8520 General Professional Recommendation
DHS-8521 Demonstration Services Plan of Care
DHS-8523 Housing Info Checklist
Goods N Services Form
MFP Emergency Dental Form
MFP Form (Consent to Discuss )
MFP ITM Checklist
Potential MFP Satisfaction Survey Questions