Because persons with brain injuries often lack both legislative recognition and administrative accountability by a designated state agency, they often do not have access to a specialized system of community services that provides an alternative to institutionalization. Recently, the Center has focused its ADA integration efforts on the unnecessary segregation of persons with brain injuries in nursing facilities and publicly-operated or funded facilities.
Hutchinson v. Patrick: The Litigation and Settlement
Acquired Brain Injury (ABI) Program
Community First Demonstration Project
Money Follows the Person Demonstration
New Community Service System
Brain Injury Community Integration Project
February 2017: Hutchinson v. Patrick
Policy issued on the rights of ABI-RH and MFP-RS waiver participants
At the urging of Center attorneys, the Commonwealth has issued a formal policy clarifying the individual rights, safeguards, and procedural protections available to Hutchinson class members who enroll in the Acquired Brain Injury Residential Habilitation waiver (ABI-RH), as well as those utilizing the Money Follows the Person Residential Services waiver (MFP-RS).
Negotiated in 2016, this policy mirrors the rights and protections afforded to clients of the Massachusetts’ Department of Developmental Services (DDS). DDS provides service coordination to all ABI-RH and MFP-RS waiver participants. It also licenses and oversees the network of providers delivering residential services under these waivers.
The new ABI-RH and MFP-RS policy describes the process for individual service planning, as well as the responsibilities of service coordinators and waiver service providers. It enumerates participants’ individual rights including self-determination, freedom from mistreatment and restraint, and access to integrated community services. The policy explains participants’ rights to appeal service denials or proposed modifications to their service plan, while also creating an informal way to resolve disputes with the help of DDS staff. Finally, the policy directs that complaints of abuse, neglect or mistreatment be investigated pursuant to regulations governing the Disabled Persons Protection Commission (DPPC) and the DDS investigation process.
The ABI-RH and MFP-RS policy is posted below and available on the MassHealth website at http://www.mass.gov/eohhs/docs/masshealth/mfp-demowaivers/policy-for-abi-rh-and-mfp-rs.pdf. A similar policy governing the non-residential ABI and MFP waivers is in development. A Participant Handbook will be published in early 2017 as a companion to these policy documents.
In addition, MassHealth has issued a fact sheet for professionals seeking more information about the ABI and MFP waivers, including staff in long term rehabilitation and skilled nursing facilities. That fact sheet, and updated ABI and MFP waiver applications, are available below.
May 2014: CMS Approves Amendments to ABI and MFP Waivers
In early March, 2014 the Commonwealth submitted proposed waiver amendments to the Center for Medicaid and Medicare Services (CMS), seeking approval for ongoing administrative and operational changes to four home and community-based service programs: the Acquired Brain Injury Residential Habilitation Waiver (ABI-RH); the Acquired Brain Injury Non-Residential Waiver (ABI-N); the Money Follows the Person Community Living Waiver (MFP-CL); and the Money Follows the Person Residential Supports Waiver (MFP-RS).
Several substantive changes will affect how waiver services are delivered and monitored in the community. First, individual case management and service coordination for waiver participants will now be provided by the Massachusetts Rehabilitation Commission (MRC) (for those in non-residential waiver programs) and the Department of Developmental Services (DDS) (for those receiving residential waiver services). This change in responsible state agencies is expected to improve and enhance the delivery of case management services under the waivers. Waiver participants will receive needs assessments and individualized service planning consistent with person-centered planning principles, as well as assistance planning for their transitions from institutional care. For persons residing in the community, case managers will continue to coordinate and monitor the provision of waiver services while updating individuals’ plan of care as needed.
Waiver amendments also include changes in the Commonwealth quality assurance system, designed to ensure the provision of safe, effective, high quality services to waiver participants. Licensing and oversight of all residential services will be the responsibility of DDS. Using one integrated computer system, DDS and MRC will jointly monitor the safety of waiver participants and the quality of waiver services using DDS incident management and investigation procedures. The agencies also will jointly oversee the waiver’s clinical eligibility determination process, performed by the University of Massachusetts.
A third and significant change involves eligibility criteria for the ABI waivers. In the past, if waiver applicants’ service needs were expected to exceed individual waiver cost caps their applications would be denied. The proposed amendments eliminate the use of these individual cost caps, allowing persons with more significant needs greater access to waiver services.
The effective dates for these waiver amendments are April 1, 2014 for the MFP waiver programs and May 1, 2014 for the ABI waivers.
April 2014: Spring Enrollments Scheduled for ABI and MFP Residential Waivers
As part of the Commonwealth's implementation of the Amended Settlement Agreement in Hutchinson v. Patrick, MassHealth, in collaboration with the Massachusetts Rehabilitation Commission (MRC) and the Department of Developmental Disability Services (DDS) operates four home and community-based services waivers. These waivers can help Medicaid-eligible persons with Acquired Brain Injury (ABI) transition from nursing and long term rehabilitation facilities to integrated community settings with a variety of services and supports.
Starting April 1, 2014, MassHealth will begin accepting applications for the Money Follows the Person Residential Supports waiver (MFP-RS), with enrollment for the Acquired Brain Injury Residential Habilitation waiver (ABI-RH) scheduled to begin on May 1, 2014. MassHealth will continue to review applications for both waiver programs until all available slots for the 2015 waiver year are filled.
The MFP-RS and ABI-RH waivers provide a range of residential supports for persons who are unable to live in their own homes or the homes of family members, including 24/7 residential programs, assisted living and shared living arrangements. Both waivers also provide a range of community-based services including supported employment, day services, physical, occupational and speech therapies, and specialized medical equipment.
The Money Follows the Person Community Living Waiver (MFP-CL) is designed for persons who wish to live in their own home or apartment (or a family home) with supports, or who are interested in sharing a home with a caregiver/agency they select. Once determined eligible, waiver participants can receive support with housing search activities as part of their transition planning. The MFP-CL waiver has current openings and will continue to accept applications on a rolling basis until all available slots for the 2014 and 2015 waiver years are filled.
Individuals may apply directly to one or more of these waiver programs based on their clinical needs and preferences. Brochures describing the services available under each waiver, their respective eligibility criteria, and application forms can be found by visiting the following websites:
Money Follows the Person Waivers:
Acquired Brain Injury Waivers:
Interested applicants and family members can receive assistance in selecting from among these waiver options. Local Transition Entities are available to visit with interested applicants and their families, answer questions about the waiver programs, and help submit necessary application paperwork. The Transition Coordination Contact List provides contact information for these regional Transition Entities. A description of Transition Entities' role and responsibilities for assisting waiver applicants can be found in the Money Follows the Person Quarterly Stakeholder Meeting Power Point, dated October 23, 2013.
Interested applicants also can contact the Center for Public Representation at (617) 965-0776 or the Brain Injury Association of Massachusetts (BIAMA) at (508) 475-0032 for additional information and support in navigating the waiver process.
Court Grants Preliminary Approval of Amended Settlement Agreement in Hutchinson v. Patrick
Nearly 1200 institutionalized people with brain injuries will have the opportunity to move out of nursing facilities and into community residences over the next six years under an Amended Agreement jointly proposed by state officials and attorneys for the plaintiffs. The Joint Motion, filed on June 20, 2013, summarizes the key terms of the Amended Agreement, including the delivery of community-based services under the Commonwealth’s Money Follows the Person Demonstration and an enhanced education and outreach program to ensure class members are aware of opportunities to leave institutional settings and reside in the community. The Court has approved a Notice to the Class concerning the Amended Agreement, with responses due on July 8, 2013. The parties issued a joint press release on June 21, 2013 to aid in the notice process. A fairness hearing is scheduled for July 11, 2013.