Louisiana hits first-year mark with MFP program
Louisiana hits first-year mark with MFP program
Louisiana's Money Follows the Person (MFP) Rebalancing Demonstration focuses on three important areas for measuring results and benefits of the program. These are long-term stay in community living, quality of life measures, and fiscal measures.
"At this point, it is really too early to show any results in the state's three population groups individuals with developmental disabilities, elders, and adults with physical disabilities," says Julia Kenny, assistant secretary of the Office for Citizens with Developmental Disabilities. "We are only now reaching that full-year mark with our first participant."
Louisiana's first MFP demonstration transitionee completed the 365-day demonstration period in August 2010, at which point she completed the first post-move quality of life survey. "This provided the first comparison of before and after," says Ms. Kenny. "We are eager to review the survey data, as we have observed positive outcomes that have developed in the young person's life during this past year."
The program is still analyzing the fiscal outcomes. "Generally, we know that we have been able to keep costs in line using the same "resources allocation" method we use for waiver participants," says Ms. Kenny. "This model is based on the acuity needs of individuals and is a more effective and fair way of allocating resources."
More costly than expected
In 2009, the developmental disabilities population expanded to include hospitalized children at risk for nursing home placement. "This altered some of the original program assumptions," Ms. Kenny says. "We are finding that these children's initial plans are more costly than assumed in our operational potocol, but our state's developmental disabilities service data in the Children's Choice waiver suggests we should see stabilization over time."
The state is using its current data systems to support program evaluation. Demonstration participants are flagged in the services/billing databases, so that reports can be produced specific to the demonstration.
The Medicaid office initiates a regular evaluation of Home and Community Based Services (HCBS) program utilization, including examination of participants in the demonstration as a sub-group.
"The state has requested and was awarded funding through the supplemental administrative award process to acquire contracted assistance to also develop demonstration-specific reports in the quality management data systems," adds Ms. Kenny.
The developmental disabilities population is using some new program elements that weren't previously included in the state's HCBS package. These elements are evaluated for cost-effectiveness and long-term success in community placement.
They are inclusion of children birth through 3 years of age participating in waiver services, creation of waiver opportunities for these children in the Residential Options and Children's Choice waivers, and conversion of Intermediate Care Facility for the Developmentally Disabled beds to Residential Options.
As of July 2010, 55 people with developmental disabilities met eligibility criteria and were presented with the opportunity to participate in the MFP demonstration. Of those, 38 signed informed consent. Of that group, 22 people have moved home with family or to live independently in a community-living setting, 13 are still in the planning stage, and three revoked their informed consent for a number of reasons not related to their interest in the MFP Demonstration.
For elders and adults with physical disabilities, 182 people meeting eligibility in nursing facilities have signed informed consent. "Of that group, 45 people have moved home with family or to live independently in a community living setting, and 137 are still in the planning stage," reports Ms. Kenny.
Wait time is cut
Louisiana has never before prioritized waiver access to persons with developmental disabilities in nursing homes. Additionally, waiver services to children under 3 years of age have not been offered, leaving families to rely primarily on Early Steps services.
In addition, Louisiana has never before offered waiver services to children outside of the Request for Services Registry process, which allows families to register their child at 3 years of age.
The current wait time is eight years. "Thus, the five children who were in nursing homes or hospitals currently participating in the state's demonstration would not have an opportunity to access services otherwise, if not for the demonstration," says Ms. Kenny. "To put this into perspective, our youngest participant is just over three months old and would otherwise face a wait for services until his 11th birthday."
To date, two of the five children have moved home with their families. Due to the needs identified in this unique population segment, the state has requested significant funding in the supplemental request to support the success of these transitions.
"Demonstration transition coordinators going into hospitals and nursing homes have met with hugs, tears, and thank-yous throughout the state," says Ms. Kenny.
Louisiana's MFP program is frequently finding that the longer the participant is in an institution, the harder it is to move the participant out in an expeditious manner and with a strong support structure. "For example, family members of some elders have moved out of the area and are not available for care, or the participant's former community residence is occupied or no longer available," says Ms. Kenny.
In the case of children with developmental disabilities, the families of children institutionalized for a longer term have become accustomed to a routine that does not include the intensive caretaking required.
"With other siblings involved and space concerns in the home for wheelchairs, hospital beds, and equipment, demonstration families are often required to move to accommodate the child coming home," says Ms. Kenny. "This disrupts siblings in school and the daily routine. We have had at least two families who have simply stated that these changes were too drastic and overwhelming."
One family decided not to sign informed consent, and one revoked consent after participating in months of transition planning. The state has had more success in nursing home transitions working with adult participants and families of children who have been institutionalized for a shorter period of months rather than years.
"We are excited about the reduction in length of stay to three months," says Ms. Kenny. "This will greatly assist in recruitment of participants who may have some community-based resources to return to."
The state anticipates meeting, and even exceeding, the originally proposed transition benchmarks for the three target populations in the existing operational protocol. However, expansion of the demonstration beyond the original benchmarks is contingent upon availability of funding for expansion of HCBS.
"HCBS expansion is required in Louisiana, since institutional bed closures are not occurring with every single transition," notes Ms. Kenny.
The state originally projected moving 20 children with developmental disabilities from nursing home placement, but this was amended to include hospitals as qualified institutions for this target group. In addition, the demonstration statute was revised, reducing the length of stay from 180 days to 90 days.
"Finally, the state Medicaid office has shown a willingness to support waiver entry for children under the age of three," says Ms. Kenny. "The original projection of 20 participants should increase over the life of the demonstration."
The state is now examining HCBS options for the behavioral health population. "CMS has counseled the state's demonstration team to consider incorporation of behavioral health transitions from nursing homes to qualified HCBS using the demonstration," says Ms. Kenny. "That is under review."
Contact Ms. Kenny at (225) 342-0095 or [email protected].Louisiana's Money Follows the Person (MFP) Rebalancing Demonstration focuses on three important areas for measuring results and benefits of the program. These are long-term stay in community living, quality of life measures, and fiscal measures.
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