Frequently Asked Questions and Answers
These frequently asked questions were derived from the MFP training sessions and were prepared in collaboration with staff from the Department of Mental Health, Mental Retardation/Intellectual Disabilities and Substance Abuse Services. Additional questions may be submitted to mfp@dmas.virginia.gov and there will be a monthly posting of the questions and answers.
Common Terminology
Money Follows the Person Project
This four year project, funded by federal and state sources provides participants of all ages and all disabilities who live in institutions (nursing facilities, Intermediate Care Facilities for Participants with Intellectual Disabilities/Mental Retardation and long-stay hospitals) in the Commonwealth of Virginia options to transition to a home-and-community based setting.
Transition Coordinator Provider Agency
This is a Department of Medical Assistance Services (DMAS) provider who is responsible for supporting the participant and family/caregiver, as appropriate, with the activities associated with transitioning from an institution to the community via the Elderly or Disabled with Consumer Direction Waiver (EDCD). Service descriptions, criteria, service units and limitations and provider requirements for the service are found in 12 VAC30-120-2000.
Transition Coordination Services
Transition Coordination is the management and coordination of the transition of a participant from the institution to the community. Transition Coordination is a covered service for participants exclusively for the EDCD waiver. Transition Coordination is limited to 15 months from date of prior authorization.
Transition Service/funding
Transition Service/funding is authorized for nine months, which may include up to two months while the participant is in an institution and seven months following discharge. It includes the set-up expenses for participants who are transitioning from an institution or licensed or certified provider-operated living arrangement to a living arrangement in a private residence where the person is directly responsible for his or her own living expenses. The service description, criteria, service units and limitation and provider requirements for this services are found in 12VAC 30-120-2010.
Frequently Asked Questions and Answers
General | Transition Coordination | Transition Services/Funding | Community Living | HCBS Waivers
If an eligibility worker from the local department of social services knows of someone who has expressed an interest in leaving a facility to whom should they be referred?
Answer: The adult services worker should provide the participant with a list of Transition Coordination organizations and refer them (or their responsible party) to the DMAS web site. With permission from the participant, the eligibility worker should discuss this with the facility and the discharge planner.
Who will make the final decision related to enrolling in MFP?
Answer: This program is person-centered, meaning that the participant or responsible representative will be the decision maker related to care and service type. All home-and –community-based waiver services require that services be provided to support the health and safety of the participant. Ultimately, it will be the Transition Coordinator or the Case Manager in consultation with the person transitioning that will determine that the program is a good match, and by enrolling the person into the appropriate waiver, assures that all requirements of the home-and-community-based waiver will be provided to the person.
May someone be discharged from an extended stay at a hospital to MFP?
Answer: No, the discharge must be from a nursing facility, a long-stay hospital or an Intermediate Care Facility for persons with Intellectual Disability/Mental Retardation.
What about consumer-directed supported employment?
Answer: Due to unresolved concerns over Worker’s Compensation issues, this is not a part of the initial MFP roll out. However, the service is still actively under study and if issues can be satisfactorily resolved it will be added at a later date.
In the MFP project, where is the money coming from? Is the money the money that which would be spent in a facility, and does that money “follow” the person into the community?
Answer: This is the concept of the program. In many states, the system of community- based care is less developed than in Virginia. Virginia has been working for many years to shift services from institutional settings to home-and-community-based settings to better serve recipients and meet their preferences. MFP will essentially strengthen the system of home-and-community-based services that are already in place through Medicaid waivers. We hope that MFP will make it a little easier for people to move to home and community settings.
The funding for MFP is still a state and federal match and does not constitute a “grant” to Virginia. Instead of receiving a 50/50 match for waiver services provided to participants after their first year of transition in the MFP Project, the federal match will be 75% of all expenditures (with the state paying the rest). This match, in addition to the anticipated cost savings for serving participants in the community instead of institutional settings, will enable Virginia to develop and pay for enhanced waiver services to strengthen the current long-term support system.
Will private providers receive referrals through MFP?
Answer: Participants may choose private providers that are Medicaid enrolled service providers, as allowed by the waiver regulation. There would be no change in the way waiver services are chosen, authorized, provided or administered.
Do we have access to a risk assessment tool and if so who is expected to complete this?
Answer: This will be incorporated in the development of a person-centered service plan by the Transition Coordinator or the Case Manager.
Can you give examples of “long-stay hospitals?”
Answer: There are two Medicaid long-stay hospitals in the Commonwealth and six in total that serve children with many critical medical needs. Long-stay hospitals serve people who would receive skilled care and may be ventilator dependent. The Tech waiver enables these participants to be at home, close to family while services continue.
What agencies can become Transition Coordination agencies?
Answer: Transition Coordination agencies (agencies that employ a transition coordinator) shall be employed by one of the following: a local government agency, or a private, nonprofit organization qualified under §26 USC 501 (c ) (3).
Can Area Agencies on Aging or local departments of social services be Transition Coordination agencies?
Answer: Yes, if they are a local government agency or a private nonprofit organization qualified under §26 USC 501 (c ) (3) and enrolled as a Medicaid provider of Transition Coordination.
Who can enroll as a Transition Coordination agency? (Agency or staff who works for an authorized agency) or both?
Answer: Only an agency which meets the requirements in regulations and the Medicaid provider agreement can enroll.
If an agency can enroll, then how do they communicate who the transition coordinator is?
Answer: Any employee of the agency that meets regulatory requirements can be a transition coordinator and this will be reviewed during quality management reviews of the provider agency.
How does DMAS validate the skills necessary for staff of the agency to perform this service?
Answer: DMAS will review this during quality management reviews of the provider agency to assure that staff providing transition coordination meet the skills outlined in regulations and policy.
Who signs the Medicaid application to become a transition coordinator (the agency's authorized representative or participant that is enrolling)?
Answer: The agency authorized representative signs the application
Are there any limits to the number of enrolled Transition Coordination agencies under MFP?
Answer: No
If a participant is enrolled in the Elderly or Disabled with Consumer-Direction (EDCD) waiver may a Community Services Board case manager serve as the Transition Coordinator?
Answer: Yes as long as the CSB has enrolled with Medicaid as Transition Coordinator and meets all applicable requirements.
CSBs do not have to enroll as a Transition Coordinator to provide support to participants on their case load who are enrolled in the EDCD Waiver. They can bill for case management through Targeted State Plan Case Management services. CSBs may not bill for Transition Coordination and Targeted State Plan Case Management services for the same time frame and for the same participant as this is a duplication of services.
If an agency is already a Case Management Medicaid provider do they have to apply to be a Transition Coordination Agency?
Answer: Yes. If the Case Management agency would like to provide services to new participants in the EDCD Waiver, then they need to enroll as a Medicaid provider of Transition Coordinator.
If a Community Services Board enrolls as a provider for Transition Coordination in order to be able to serve a new population, does each staff person need to enroll or only the agency?
Answer: Only the agency needs to enroll as a Medicaid provider of transition coordination and the staff is covered under that provider agreement for as long as they are employed.
How will Transition Coordination agencies come into contact with residents of qualifying institutions?
Answer: A multifaceted approach to generate public awareness has been developed for MFP. Transition Coordination agencies will be encouraged to advise facilities, families, etc. of the agency’s enrollment as a Medicaid provider agency for Transition Service/funding. Transition Coordinators/Case Managers may visit the local nursing facilities, intermediate care facilities and long-stay hospitals to work with the administration in identifying persons eligible for successful enrollment in the MFP program. Each identified participant will have the right to choose if they want to transition to the community.
What is the difference between services provided through MFP and the current waivers as it relates to case management?
Answer: Regarding case management or Transition Coordination, there is no difference. For EDCD waiver, Transition Coordinator will perform the basic functions of the case manager for up to 12 months, after reentry to community. This service is new, and we are currently recruiting agencies to enroll to provide Transition Coordination for EDCD participants. For the MR/ID, HIV/AIDS, Developmental Disabilities (DD) and the Technology Assisted (Tech) Waivers, each will use the current system for case management/oversight.
Is Transition Coordination billed as a monthly rate?
Answer: Yes.
What is the reimbursement rate for Transition Coordination?
Answer: $326.50 a month.
Can an agency contract with a private provider to provide Transition Coordination?
How will EDCD Transition Coordination interface with service facilitation?
Answer: There is no change. Interfacing with the Service Facilitator is no different than with any other provider. If the person elects to receive consumer directed services under a waiver, the Transition Coordinator or case manager will include that in the service plan, and provide the participant or his/her representative a list of Service Facilitators.
If an agency wants to be a Transition Coordination agency, what does the agency need to do?
Answer: Visit the DMAS website at www.dmas.virginia.gov for a provider enrollment form. Complete the form and submit it to First Health. The application process takes approximately 15 days, provided all of the required documentation is submitted by the applicant.
How will DD waiver be handled? Will a Transition Coordinator provide this service?
Answer: The DD waiver will be handled as it is now, with a case manager and DMAS oversight.
Who will be available for participants utilizing the EDCD and Technology Assisted waivers when Transition Coordination ends?
Answer: For the EDCD and Tech Waivers, the participant supported by community agencies and waiver providers, along with family, will be responsible for coordinating services.
When a person is hospitalized is the Transition Coordinator responsible for helping with ongoing bill paying/maintain household?
Answer: No. This responsibility would belong to the participant possibly with the help of their support group of family, friends, guardian or community
There is a 12-month limit to Transition Coordination case management. What will happen to those individuals in the community once the 12-month limit has been reached?
Answer: The 12 month limit is for the EDCD Waiver Transition Coordination. All other waivers continue with routine case management. In the EDCD waiver there will be an array of community services that the participant will be able to access by the time that Transition Coordination concludes, including several levels of back-up systems for emergencies to assist when there is a breakdown in service delivery. Each participant enrolled in MFP will be enrolled in and receiving waiver services and have a designated primary back-up system within the service plan as a requirement of community re-entry. All of the waivers’ assurances for health and safety will apply to any participant enrolled into a HCBS waiver upon discharge. Through the 2-1-1 (toll free) statewide call center, there will be person available 24 hours per day, seven days per week to assist with information, referral and available to answer questions when needed. Waiver services require that the participant be able to reside safely in the community as a prerequisite of authorization by the Case Manager/Transition Coordinator and KePRO.
If a participant participating in the MFP Project chooses to leave a nursing facility and relocate to live with family, may the Transition Services/funding be used in the family member’s home?
Answer: Please refer to the definition of Transition Services/funding. Those services may be used in relocating a participant to a qualified home-and-community-based setting, including the home of a family member
Can Transition Services/funding be utilized to maintain housing during a hospitalization or a readmittance back to a facility setting?
Answer: No. Transition Services/funding is to be used only for the set up of housing and active transition to a home-and-community-based setting.
If a participant leaves a facility, enters the community, then enters a hospital and then returns to the community, for how long may they use their Transition Services/funding?
Answer: Transition Services/funding is authorized for only nine months. Once the nine months have expired the participant no longer has access to this funding.
At what point during an individual’s transition planning process can Transition Services/funding be used to pay for set-up costs? For example, utility deposits and/or security deposits on a rental property.
Answer: Transition Services/funding is a new waiver service created as a result of the MFP demonstration. The service is authorized for a total of nine months. For individuals that are participating in the MFP Demonstration and have enrolled as an MFP Participant, these individuals may access the service up to two months prior to discharge from a facility. Therefore, appropriate essential goods and services may be purchased prior to discharge with prior authorization. Again, the ability to access this service prior to discharge is only available to MFP Participants. However, the Case Manager/Transition Coordinator will be key in assessing the appropriateness of enrolling the participant into the waiver upon discharge, and the Case Manager/Transition Coordinator who will be working with the participant must concur and authorize these transition purchases. Utility and rental security deposits are an appropriate expense for these funds.
As a current DMHMRSAS provider, what would we need to do to provide Transition Services/funding?
Answer: As a current provider of MR/ID services, there is nothing more that you would need to do in order to serve participants using the MR waiver through MPF. However, your agency would be required to provide “up-front” funds for Transition Services/funding and request reimbursement through Public Partnership, LLC (PPL) for those funds. You will be required to complete a provider enrollment package with PPL which may be obtained by contacting PPL at 866-529-7550.
How does the participant access the $5,000 Transition Services/funding?
Answer: The Transition Coordinator / Case Manager will work through the Transition Coordination agencies to upfront the costs of the Transition Services/funding (as items are needed/expenses are to be paid) and then submits for reimbursement to PPL, the DMAS fiscal agent.
Please clarify the billing/reimbursement process for Transition Services/funding. How long will it take?
Answer: Reimbursement for goods and services procured through Transition Services/funding will be issued within 14 business days of submission to PPL if appropriate expenditures and are provided.
I represent a private non-profit. How is an agency like mine able to provide the up-front money for Transition Service/funding?
Answer: During the planning process, a focus group was used to provide feedback from agencies who will be involved in administering MFP throughout the Commonwealth. At this point, we are working with a reimbursement model. However, over the long-term, we are looking to arrange a process, through PPL, to allow for on-line purchasing or a debit card method, which would make it easier for smaller agencies to procure items and services.
Does the $5,000 Transitional Services/funding apply to residential services settings?
Answer: Generally no. However, under MFP, an adult foster home or a sponsored residential home may be a qualifying residence in which participants may receive Transitional Service/funding through MFP. For an participant in this setting to be eligible for Transition Service/funding, the adult foster home or sponsored residential home could not be a waiver provider for the participant, and the participant must have control of his/her finances. This will be decided on a case by case basis.
Can Transition Services/funding be used to make repairs to a group home of four or less persons?
Answer: No, the transition services/funding may not be used for this purpose
Cab Transition Services/funding is used to make purchases for a participant moving into a group home of four or less?
Answer: No. However, for participants in the MR/ID waiver DMHMRSAS has “Community Capacity Funds” available for the personal needs of the participant, home furnishings to benefit the participant.. These are General Funds and may be used before the participant moves. They may be accessed by completing the "Request to Access FY09 Community Capacity Funds" form available on the Intellectual Disability Services website: http://www.dmhmrsas.virginia.gov/OMR-forms.htm.
Can Transition Services/funding be used for participants transitioning to sponsored residential homes in which there are two or fewer persons?
Answer: If participant is contributing towards their own housing costs then it may be used and it is not providing furnishings or supplies already provided by the sponsored home.
Who will make the request for Environmental Modifications (EM) and Assistive Technology (AT) under the EDCD waiver after 12 months when the Transition Coordinator is no longer working with the participant?
Answer: The providers of EM and AT may make the request directly to KePRO on behalf of the participant or the Services Facilitator under consumer-direction may assist.
Who is going to supervise the individual when they are in the community?
Answer: MFP is similar to the current Medicaid HCBS waivers. The participant must be able to reside safely in the community setting, with appropriate services and supports including informal systems such as family and friends. We envision that services will be provided collaboratively, across many agencies, to fully support the participant’s needs in the community. Health and safety are prerequisites to receipt of a waiver and all MFP recipients will receive information on health and safety.
Will MFP participants be able to live in group homes?
Answer: A group home is an allowable community residence if the home has 4 or fewer residents.
How will PACE be used?
Answer: The Program of All Inclusive Care for the Elderly (PACE) is a program which includes all acute and long-term care services. If someone transitions from an institutional setting to a qualified community residence in which there is a PACE program and they are meet eligibility requirements, then PACE might be a service option choice for them. Transition Services/funding are excluded from PACE, for purposes of MFP.
Our jurisdiction has long waiting lists for housing and other services. How will MFP address the issue of affordable housing?
Answer: We are aware of the affordable housing issues throughout the Commonwealth. This is something that we will all continue to work on across many agencies. MFP affords participants another option with funding for Transition Service/funding ($5,000 per lifetime per participant funding) which can include security deposits, first month’s rent, set-up costs, etc. Monthly rental or mortgage expenses or ongoing costs such as food or utilities are not allowable costs under Transition Service/funding. However, bridge rent provided by the Department of Housing and Community Development will be available to participants in the MFP Project who need assistance with covering rent until they transition into the community. Environmental modifications (up to $5,000 per year through a Medicaid waiver and $45,000 per participant through the Department of Housing and Community Development) will also be available to assist participants with locating accessible housing. More housing support information is available in the MFP Operational Protocol Guide.
Should CSB Case Manager’s start the screening process now?
Answer: Since MFP has not provided final approval it would be best that a case manager does not begin providing services before then. Final federal approval to implement MFP is expected by the proposed launch date of July 1, 2008.
How many participants are expected to transition from an institution into the EDCD during the four years of the MFP demonstration project?
Answer: Estimates are 47 persons in year one and 170 persons for each of the following three years.
Are there limited slots for EDCD waiver recipients in MFP?
Answer: The MFP slots have been approved by the Centers for Medicare and Medicaid Services for MFP participants in the EDCD waiver. This waiver does not have a waiting list.
Are slots in the waiver limited by geographic considerations?
Answer: No, the slots have been approved statewide to ensure that everyone desiring to transition has similar opportunities.
What about food stamps and other services. May these be obtained prior to discharge or otherwise expedited?
Answer: We will work with the Department of Social Services in every way possible to accommodate making this a smooth and expedited process.
People entering MFP through the EDCD, Tech or HIV/AIDS waiver must meet nursing facility level of care. People entering MFP through the MR/ID waiver must meet ICF/MR level of function. These people may be incapacitated. Who makes the decisions?
Answer: There is no difference with MFP than for any other waiver. If there is a responsible person or guardian who serves as a substitute decision maker, that decision maker would continue to act on behalf of the participant.
May a participant under MFP leave a facility, be enrolled in the EDCD Waiver and receive Environmental Modifications and Assistive Technology?
Answer: Yes. Both services have been added to the EDCD waiver and will be available, effective July 1, 2008.
Once a person transitions from a facility to the MR/ID waiver, is the slot handled like any other MR/ID waiver slot?
Answer: Yes, the slot has the same status as other “facility slots.” The participant would need to retain the slot for at least twelve months in order for that slot to become an official slot of the CSB providing case management to the participant. Should the participant return to the facility prior to the twelfth month, the slot is to be assigned to another participant residing in a facility.
If a CSB knows of participants who have expressed a desire to leave an institution, what is the next step of the process?
Answer: The MFP protocol provides the steps to take for the entire transition process. Training is scheduled in June and July to explain these steps in detail. All Case Managers and Transition Coordinators should attend.
How will EDCD Transition Coordination interface with service facilitation?
Answer: There is no change. Interfacing with the Service Facilitator is no different than with any other provider. If the person elects to receive consumer directed services under a waiver, the Transition Coordinator or case manager will include that in the service plan, and provide the participant or his/her representative a list of Service Facilitators.
How will DD waiver be handled? Will a Transition Coordinator provide this service?
Answer: The DD waiver will be handled as it is now, with a case manager and DMAS oversight.
Who will be available for participants utilizing the EDCD and Technology Assisted waivers when Transition Coordination ends?
Answer: For the EDCD and Tech Waivers, the participant supported by community agencies and waiver providers, along with family, will be responsible for coordinating services.
