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.
CDPHE Survey Process for the Colorado Department of Health Care Policy and Financing
Mission Analytics worked with the Colorado Department of Health Care Policy and Financing’s (HCPF) to assist them in revamping the Colorado Department of Public Health and Environment (CDPHE) survey and certification process for providers of Home and Community Based Services (HCBS) provided in waivers.
Home and Community Based Services (HCBS), Appendix G for the Colorado Department of Health Care Policy and Financing
Mission Analytics worked with the Colorado Department of Health Care Policy and Financing’s (HCPF) to Mission Analytics worked with the Colorado Department of Health Care Policy and Financing’s (HCPF) to conduct a statewide review of the Home and Community Based Services (HCBS) for Persons with Developmental Disabilities (HCBS-DD) waiver, Appendix G.
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.
Home and Community Based (HCB) Settings Contract
Under subcontract to New Editions Consulting, Mission Analytics works with the Centers for Medicaid & Medicaid Services (CMS) to assist CMS in the national implementation of new regulations promulgated under Section 1915(c) and 1915(i) of the Act to ensure that beneficiaries receive services as described. In particular, individuals receiving HCBS must live and work in settings that are home and community-based and that are integrated into the community.
We will develop and implement necessary tools, protocols and guidance materials to assist CMS and the states in the consistent and accurate implementation of these new requirements, including, but not limited to, home and community-based settings’ characteristics, person-centered planning, restrictive interventions, to ensure states are in compliance with the new regulations. We will provide both on-site and remote education and training to Central and Regional office staff and state agencies, to assist them in implementing these new rules. We will collect, compile, review and analyze information to support CMS’ review of waiver submissions to ensure that the waiver settings, the state’s environmental scans and transition plans all conform to CMS requirements, identify areas of concern with the states proposals and make recommendations to CMS on how to resolve problems identified. We will conduct on-site reviews of state home and community-based settings to ensure compliance with the new regulations and make recommendations to CMS. We will analyze and track the status of states’ progress in implementing the new regulations and shall compile and submit data reports to CMS verifying state statuses, best practices and lessons learned to assist CMS in the development of future policy decisions.
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.
Waiver Modernization Manager for the Colorado Department of Health Care Policy and Financing
Mission Analytics worked with Colorado Department of Health Care Policy and Financing’s (HCPF) to simplify the state’s Medicaid funded system of community-based long-term services and supports while improving access and controlling costs. For this project, Mission Analytics had reviewed research on other states’ efforts to consolidate waivers. Using input from wide array of stakeholders, Mission Analytics drafted a "concept paper" for the Centers for Medicare and Medicaid Services (CMS) that proposes specific changes to the state’s waiver system. Once CMS has reviewed the concept paper, Mission Analytics developed a plan to guide implementation of the proposed changes. Mission also led a feasibility analysis for implementation of the Community First Choice (CFC) State Plan Option as a means to expand access to consumer-directed personal assistance services for Medicaid consumers who meet institutional level of care. As part of this work, Mission Analytics constructed a cost model that allows the state to specify which services will be included in the CFC program and how expensive those services are likely to be (based on uptake and level of need). Completion all deliverables relies heavily on a close working relationship with existing state committees, DHCPF staff, and various other stakeholder groups.