Long-Term and Community-Based Care

Analysis of State Efforts to Comply with the Expansion of Fair Labor Standards Act Protection to Home Care Workers Providing Services to Medicaid or Other Public Program Participants

Mission Analytics serves as the contractor to the Office of the Assistant Secretary for Planning and Evaluation (ASPE). In 2013, the Department of Labor (DOL) released a rule requiring that most home care workers be paid overtime and travel time. This rule substantially narrowed the so-called "companionship exemption" that had been in place since the 1970s. Individuals who self-direct their services are responsible to pay these costs out of their personal budgets; likewise for agencies that serves as "joint employers" (also called "the employer of record") with individuals. In some cases, state agencies are joint employers, making the state directly liable for any additional costs. The purpose of this study is to conduct a preliminary analysis of the steps states have taken to comply with the DOL rule, whether to set aside additional funds in their program budgets; to cap hours so that homecare workers do not accrue overtime; or to pursue other strategies. The project includes interviews with key informants at organizations with national footprints (e.g., the National Employment Law Project) and case studies of states that have taken different approaches to achieve compliance.

Balancing Incentive Payments Program - No Wrong Door Initiative Technical Assistance

Under subcontract to New Editions Consulting, Mission Analytics serves as the technical assistance contractor for the Centers for Medicaid & Medicaid Services' (CMS) Balancing Incentive Program, an Affordable Care Act initiative that provides incentives to states to rebalance Medicaid their long-term services and supports (LTSS) systems toward community-based care. To be eligible for enhanced federal funding, State Medicaid Agencies in participating states must oversee the implementation of three structural changes: a No Wrong Door/Single Entry Point (NWD/SEP) System for enrollment into community LTSS; a Core Standardized Assessment (CSA) for determining eligibility for community-based LTSS; and a system to eliminate conflict between eligibility determination and case management, and between case management and the provision of services. See the technical assistance website here.

Home and Community-Based Services (HCBS): Technical Assistance to States

Under subcontract to New Editions Consulting, Mission Analytics works with the Centers for Medicaid & Medicaid Services (CMS) to provide states with individualized technical assistance to improve the Medicaid waivers and State Plan amendments they use to provide community-based services to individuals who need them. To determine the level and means of assistance needed, Mission Analytics reviews the regulatory environment in which HCBS programs operate, much of which has changed since the passage of the Affordable Care Act in 2010 and the adoption of Medicaid managed care programs in many states. Technical assistance is provided through a website, peer education, individually tailored reports and presentations, webinars, and direct consultations between expert consultants and state staff.

PASRR Technical Assistance for States (Long-Term Care)

Under subcontract to Truven Health Analytics, Mission Analytics works with the Centers for Medicaid & Medicaid Services (CMS) to help states improve their Preadmission Screening and Resident Review (PASRR) programs. PASRR has three main objectives: to see that individuals who apply to a Medicaid-certified nursing facility (NF) are evaluated for mental illness and/or intellectual disability and related conditions; to see that they are placed appropriately, whether in nursing homes or in the community; and to ensure that they receive the services they need, wherever they are placed. To help states improve their programs, the project team established the PASRR Technical Assistance Center (PTAC), which includes a group of expert consultants. Mission Analytics facilitates discussions and meetings between PTAC consultants, CMS staff, and state staff; facilitates CMS Regional PASRR calls and trainings; maintains a website (www.pasrrassist.org); conducts a series of monthly webinars; and develops technical assistance materials both for states and for CMS.