Money Follows the Person Rebalancing Initiative
MAINE
Target Population
Adults with mental retardation and autism; adults with brain injury; persons with any type of disability in all age groups.
Geographic Focus
Statewide for Individual Budgets and Performance Measures; possibly a regional pilot for the Brain Injury Transition Pilot.
Primary Focus
- Develop or improve the infrastructure necessary for shifting the balance of control and services to consumers. The grant will focus on the Money Follows the Person (MFP) principle of flexible finance and reimbursements systems by adopting a standardized assessment and budgeting tool to produce truly portable budgets based on individual need, and by analyzing and testing the feasibility of offering cost-effective community options that redirect funding for individuals with brain injury to more integrated settings.
- The grant will also focus on the MFP principle of accessible and available community services by developing strategies for stimulating new community service options to support individuals with brain injury in more integrated settings.
Planned Use of Medicaid Statistical Information System (MSIS): No.
Goals, Objectives, and Activities
Goal: Enhance individual choice and control by adopting a standardized assessment and budgeting process for mental retardation waiver services that result in consistent, fair, predictable, and truly portable budgets.
Objectives/Activities
- Develop a strategy for communicating rate-setting plans to stakeholders and invite participation.
- Review existing assessment tools and identify opportunities for streamlining eligibility and budget assessment tools.
- Define the desired policy outcomes for portability, fairness and equity, and community integration, and identify rate-setting policies that will have an impact on these outcomes as well as on flexibility of services.
- Gather cost data for waiver services from regional offices, design and construct a database, and enter the cost information for analysis. If necessary, survey providers for additional information.
- Evaluate cost data analysis in the context of the desired outcomes earlier identified, and identify strategies for adjusting rates to promote desired outcomes.
- Adapt the Individual Cost Guideline (ICG) tool, a strength-based assessment tool recently implemented in Florida, by incorporating the new rate structure.
- Develop a training curriculum and a users manual with a focus on supporting a shift in control from providers to consumers.
- Pilot the individual budget tool in a variety of regions for a variety of service plans, comparing existing budgets with new individual budgets calculated using the modified ICG tool. Data will be gathered for measuring impact on staffing requirements, information systems, budget neutrality, etc.
- Develop an implementation plan, based on the impact analysis, and a sustainability plan, to include a manual for maintaining the rate structure and individual budget tool over time with changing staff.
Goal: Create more community options for persons with brain injury by redirecting resources toward more person-centered, consumer-driven services offered in the most integrated and appropriate setting.
Objectives/Activities
- Review relevant reports and materials, including the needs assessment conducted by the Acquired Brain Injury Advisory Council, and synthesize a summary of "best practices" for transitions, consumer direction and supported decision making, housing, and community service options for persons with acquired brain injury.
- Review and identify regulatory barriers to portable funding and explore the applicability of a scattered-site residential funding strategy as one way of providing a high level of service in an integrated setting.
- Design a pilot for offering a more appropriate set of community options for persons with brain injury. The pilot may be designed to test the feasibility of revising eligibility criteria for existing services, modifying covered services, or developing new service options to meet the needs of persons with brain injury.
- Identify required resources and infrastructure, financial impact, regulatory or statutory changes, etc., required to implement service options and funding strategies.
- Develop an implementation plan for expanding the pilot systemwide, including, if appropriate, recommended regulatory and funding strategies, and evaluate sustainability of selected service options.
Goal: Develop and implement cross-system performance measures to enable the State to comprehensively and coherently assess its success at expanding community options for persons with all types of disabilities.
Objectives/Activities
- Identify key terms to be defined and measured, review existing definitions, and develop and adopt definitions for the key terms.
- Identify performance measures for measuring the State's success at rebalancing service options across service systems. To the degree possible, measures will build on existing data collection and reporting activities (e.g., the National Core Indicators).
- Develop an implementation plan for annually reporting on the performance measures and a sustainability plan for supporting the annual reports on performance.
Key Activities and Products
- Adapt a standardized individual assessment and budget tool to meet Maine's needs.
- Develop published rate structure, rebalanced to enhance community integration goals.
- Pilot an individual budget tool and assess its impact on consumer satisfaction, providers, budget neutrality, staffing requirements, and Medicaid management information systems.
- Analyze service needs, identify best practices, and analyze funding constraints and alternative funding strategies for persons with brain injury.
- Design and implement a pilot for testing community service options for persons with brain injury transitioning to more integrated settings.
- Identify and define key terms related to rebalancing and community integration and identify performance measures for measuring the State's success at rebalancing.
- Products will include feasibility studies, implementation plans, and sustainability plans.
Consumer Partners and their Involvement in Implementation Activities
- The Work Group for Community-Based Living is the State's Olmstead planning group, comprising consumers, advocates, and the steering committee members (see Public Partners below). The work group will continue in its role as the overarching consumer advisory body for Real Choices Grant activities and will also be responsible for developing cross-system performance measures for implementation by the State.
- The Individual Budget Resource Team, comprising consumers, family members, providers, a self-advocacy organization, Maine's single association of mental retardation providers, and regional resource coordinators, will be responsible for establishing the parameters of a fair and equitable rate structure and for identifying possible adjustments to rates to promote community inclusion.
- The Community Options Resource Team, comprising consumers, family members, the Brain Injury Association, the Disability Rights Center's advocate for persons with brain injury, Goold Health Systems (the assessing services agency for long term care services), and Elders Independence of Maine (the health care coordinating agency for long term care services), will assist the lead agency and the Department of Human Services (DHS) in identifying gaps in service options and funding constraints that act as barriers to community integration.
Public and Private Partners and their Involvement in Implementation Activities
Public Partners
- The Steering Committee for Community-Based Living, comprising membership from five departments (Behavioral and Developmental Services, Human Services, Corrections, Education, and Labor) will provide State leadership for work group activities and other coordinating functions resulting from grant activities.
- DHS Bureau of Elder and Adult Services (BEAS) will oversee the community options project for persons with brain injury and will liaise with DHS Bureau of Medical Services to ensure that project activities comply with Medicaid requirements.
- The Muskie School of Public Service will provide staff support to grant activities and serve as master contractor with the project's other paid partners.
Private Partners
- Roger Deshaies (consultant) will provide assistance in tailoring the individual budget tool to Maine; guide the historical cost analysis conducted by the lead agency and incorporate the rate structure into the tool; and design and conduct the impact analysis for implementation of the individual budget tool.
- The Brain Injury Association (BIA) will partner with BEAS to identify best practices for serving persons with brain injury in the community. BEAS will look to the needs assessment to be performed by BIA as a significant information source for this project.
- Speaking Up For Us, a self-advocacy organization, will partner with the lead agency to support the participation of self-advocates on the Individual Budget Resource Team.
Advisory Body, Committee, or Task Force
The Work Group for Community-Based Living already serves as the Consumer Task Force for the Quality Choices I Grant, and will continue as the overarching consumer advisory body for the second round Real Choices Grant activities. Work group membership includes consumers and advocates representing persons of all ages with any type of disability.
Formative/Process Evaluation Activities
- Data collected for analyzing the impact of the individual budget will include consumer satisfaction and other measures that will be used to modify the tool and budgeting process before implementation.
- Data collected during the pilot of community options for persons with brain injury will be used for mid-course corrections and will provide a source of information for modifying the design of the project before implementation. The design for the formative learning will be developed prior to implementation of the pilot.
- Project staff will be responsible for identifying opportunities for learning across the grant activities, identifying points of intersection and opportunities for enhanced coordination.
Summative/Outcome Evaluation Activities
The work group will be developing performance measures to measure the State's progress in achieving a successful rebalancing across settings and a successful shift toward consumer choice and control. The performance measures are intended to provide the State with an ongoing mechanism for measuring rebalancing achieved past the term of the grant.
Strategies to Ensure Sustainability
- In combination with the State's efforts to introduce consumer direction under an Independence Plus waiver, this project will result in a transformation of the services, supports, and attitudes that currently limit consumer choice and control, and provides the opportunity to gather better information and test ideas before investing in new service options.
- By building the individual budget tool for persons with mental retardation, the Department of Behavioral and Developmental Services (BDS) will be relieved of the task of individually negotiating provider contracts, freeing up staff for other responsibilities, including enhanced quality assurance.
- BDS staff will have hands-on responsibility for constructing the rate-setting infrastructure, building the knowledge base (and a maintenance manual in the event of staff turnover) that permits BDS to internally support the tool with existing resources.
- The budget tool is not expected to increase the cost of services, just more fairly and predictably allocate thembefore implementation, the tool will be tested for budget neutrality.
- The services developed for persons with brain injury will necessarily be funded by a reallocation of resources. The State plans to leverage alternative funding strategies already in use for other population groups, and to address other fiscal constraints to transitioning across service settings, with the goal of redirecting resources to more integrated settings.
- The State already collects a wealth of data that can be used to measure performance. Work group members will be asked to prioritize existing resources and identify gaps to be filled. Sustainability may also be enhanced by cross-system measurement proving more cost effective than individual reports.