Long-Term and Community-Based Care

Current Projects

PASRR Technical Assistance for States

Formerly under subcontract to IBM (Truven) and now under subcontract to New Editions Consulting, Mission Analytics Group works with the Centers for Medicare & 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 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.

Home and Community Based (HCB) Settings Contract

Under subcontract to New Editions Consulting, Mission works with the 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 home and community-based services (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.

Technical Assistance to the Administration for Community Living

Mission is working with the Administration for Community Living (ACL) to provide expert technical assistance and guidance to ACL and their partners, and other Aging & Disability Services Network organizations at the state, sub-state, and community levels to enhance the capacity of states and Community Based Organizations (CBOs) to secure contracts and other business arrangements with health care providers and various payers.

Community Care Hub Evaluation

Mission is working with ACL to design and conduct an evaluation that will assess the impact of the Community Care Hub (CCH) Program on several outcomes: health in general, health care costs, and the use of health services. Mission will evaluate the roughly ten CCHs who participate as sub-grantees of the CCH Center of Excellence. Our team will start by developing an evaluation design report to guide this project, and then will collect primary and secondary data to support the evaluation.

Complementary and Integrative Health Services (CIHS) Evaluation Design

Mission is working with the Colorado Department of Health Care Policy and Financing (HCPF) to review past evaluations of Colorado’s Complementary and Integrative Health Services (CIHS) by the National Research Center, Inc. from 2012 to 2019 and to prepare and present to HCPF a study design to meet the department’s evaluation goals.

Data Sharing with State Unit on Aging (SUA)

Mission is working with Colorado HCPF to increase information sharing between the State Unit on Aging (SUA) and Case Management Agencies (CMAs). Through this project, Mission and HCPF hope to improve individuals’ access to Medicaid services and the care they need. To help HCPF bridge the gap between services provided through the SUA and those provided by HCBS waivers, Mission will work with various stakeholders to understand data capacity, data availability, and any barriers to sharing data. Mission will conduct an environmental scan and other research on data sharing, culminating in a Best Practices Research Report, a Systems Analysis Report, and Interagency Referral Process Report.

Self-Directed Services Review

Mission is working with Colorado HCPF to review self-directed services in Colorado. Mission will document and analyze the current processes for various services, plan stakeholder engagement activities on self-directed services, and facilitate at least 10 stakeholder engagement activities. These tasks will culminate in the creation of a concept paper for the Centers for Medicare and Medicaid Services (CMS) about how stakeholders wish to enable self-direction for Complementary and Integrative Health Services and other services.

National Center on Advancing Person-Centered Practices and Systems (NCAPPS)

Mission, as a subcontractor of Human Services Research Institute (HSRI), serves ACL by providing actionable technical assistance to state programs, in order to help transform state Long Term Services and Supports (LTSS) systems to implement Health and Human Services policy on person-centered thinking, planning, and practice.

Completed Projects

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 served 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 was 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 included 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.

Assessing Whether Colorado Centers for Independent Living Can Claim a Share of Their Activities for Medicaid Claiming

Mission was contracted by the Colorado Department of Health Care Policy and Financing to assist them in determining whether Colorado Centers for Independent Living (CILs) can claim a share of their activities for Medicaid claiming.

Balancing Incentive Payments Program - No Wrong Door Initiative Technical Assistance

Under subcontract to New Editions Consulting, Mission served as the technical assistance contractor for the 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 worked with Colorado HCPF to assist them in revamping the Colorado Department of Public Health and Environment (CDPHE) survey and certification process for providers of HCBS provided in waivers.

HCBS Appendix G for the Colorado Department of Health Care Policy and Financing

Mission worked with Colorado HCPF to conduct a statewide review of the Home and Community Based Services for Persons with Developmental Disabilities (HCBS-DD) waiver, Appendix G.

Models of Care

Mission worked with the Colorado HCPF to conduct a models of care analysis of funding mechanisms and feasibility regarding how to improve transitions of care for people transitioning from nursing facilities and other institutional settings to potential new models of care for investment and innovation.

Planning for Provider Scorecards

Mission supported Colorado HCPF in the implementing scorecards for HCBS providers in Colorado. Mission helped define requirements to implement scorecards for an initial set of services.

Review Process for Eligibility Determinations

Mission worked with Colorado HCPF to develop a comprehensive review process for eligibility determinations and to assist with promptly addressing error findings and vulnerabilities in eligibility determinations for long term care.

Waiver Modernization Manager for the Colorado Department of Health Care Policy and Financing

Mission worked with Colorado 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 had reviewed research on other states’ efforts to consolidate waivers. Using input from wide array of stakeholders, Mission drafted a "concept paper" for the CMS that proposes specific changes to the state’s waiver system. Once CMS has reviewed the concept paper, Mission 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 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, HCPF staff, and various other stakeholder groups.