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CALIFORNIA DEPARTMENT OF AGINGDEPARTMENT OF HEALTH CARE

SERVICES MSSP SITE ASSOCIATION (MSA)

MULTIPURPOSE SENIOR SERVICES PROGRAM(MSSP)

MODULE ONE

PROGRAM OVERVIEW

OBJECTIVES

• Program Overview

• Program History/Purpose

• Waiver Requirements

• Staffing Requirements

• Oversight Roles

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HISTORY OF MSSP

• MSSP started as a demonstration project in 1977.

• Converted to a Home and Community-Based Services Waiver in 1983.

• The MSSP Waiver is designed to provide services to seniors at home or in the community at a cost lower than a nursing home placement.

• MSSP serves approximately 12,000 participants annually.

• The Coordinated Care Initiative (CCI) is enacted in 2013, which involves eight counties, including 15 MSSP sites and 5,393 funded client slots.

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MEDICAID HOME & COMMUNITY BASED CARE 1915 (C) WAIVER ASSURANCES

The six assurances are:

• Level of Care• Care Plans• Qualified Providers• Health and Welfare• Fiscal Accountability• Administrative Authority

The State is responsible for monitoring to ensure compliance with waiver assurances and will continue to do so in CCI counties. 4

LEVEL OF CARE ASSURANCE

Waiver Participants enrolled in MSSP must be certified at a nursing facility level of care.

The Level of Care (LOC) determination is made by the MSSP Nurse Care Manager (NCM) on the MSSP approved form. The clinical determination must be consistent with the need for institutionalization per the California Code of Regulations, Title 22, Sections 51334 and 51335.

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LEVEL OF CARE ASSURANCE - CONTINUED

The initial LOC determination must be completed within 30 days of the MSSP application. The LOC may be concurrent with the application and is a requirement for enrollment.

Waiver Participants are re-assessed within 365 days for level of care; or sooner if they have a change in condition.

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CARE PLAN ASSURANCE

Each Waiver Participant must have a written care plan that addresses their needs, goals and health and safety risks

The Care Plan (CP) is developed and written through the interdisciplinary collaboration of the Social Worker Care Manager (SWCM), the Nurse Care Manager (NCM) and Supervising Care Manager (SCM)

The CP is approved by the SCM which activates the ability to purchase waiver services

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CARE PLAN (CP) ASSURANCE - CONTINUED

• The CP identifies the MSSP Waiver Participant's needs and preferences which are assessed and reflected in the person-centered care plan.

• The Waiver Participant is involved in the development of the CP and indicates their acceptance of the CP with their signature (or that of their legal representative).

• The CP is considered a “living” document that is modified as the Waiver Participant’s needs change.

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Components of the care plan include:

• Problem Statement

• Goal

• Interventions

• Service Type

• Outcome/Resolution

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CARE PLAN ASSURANCE - CONTINUED

The Care Plan must:

• Be client-centered.

• Include information gathered in the health and psychosocial assessment or reassessment.

• Reflect all appropriate client needs.

• Encompass both formal and informal services.

• Be written within two weeks of the completed initial assessment(s) or reassessment.

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CARE PLAN ASSURANCE - CONTINUED

CARE PLAN SERVICESo Informal Supports

• Family, friends, church, etc.o Referred Formal Services

• In-Home Supportive Services (IHSS), Meals on Wheels, Friendly Visitor, etc.

o Purchased Waiver Services • Supplemental Personal Care, Supplemental Chore, Respite,

Transportation, Emergency Response Service, Minor Home Repair, etc.

o MSSP Care Management• Assessment and Reassessment.• Arranging and coordinating referred and purchased waiver

services.• Monthly monitoring.• Quarterly Home Visit/ Alternate Discipline Visit.

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QUALIFIED PROVIDERS ASSURANCE

o MSSP Care Management Staff and MSSP Vendors must be qualified to provide services

• MSSP Care Management StaffSite DirectorSupervising Care ManagerNurse Care ManagerSocial Worker Care ManagerCare Manager Aide (optional)

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QUALIFIED PROVIDERS ASSURANCE-CONTINUED

o MSSP Vendors

For example:• Supplemental Chore• Supplemental Personal Care • Minor Home Repair• Respite Care

Vendors must meet licensure and insurance requirements as appropriate.

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QUALIFIED PROVIDERS ASSURANCE

o MSSP Care Management Staffo Site Director

• Bachelor’s degree in administration, a health or human services specialty or related field and four years of responsible managerial or administrative experience in health or human services. Demonstrated expertise and ability to perform all responsibilities associated with program operations

o Supervising Care Manager (SCM)• Master’s degree in social work, nursing, psychology,

counseling, gerontology, sociology or rehabilitation and two years experience working directly with the elderly. Demonstrated expertise and ability as a care manager, as evidenced by experience successfully carrying out these job duties and ability to supervise and train staff

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QUALIFIED PROVIDERS ASSURANCE

o MSSP Care Management Staff

o Social Work Care Manager (SWCM)• Bachelor’s degree in social work, psychology, counseling,

rehabilitation, gerontology, sociology, or related field, plus two years of experience working with the elderly.

o Nurse Care Manager (NCM)• California Department of Consumer Affairs Board of

Registered Nursing license that is current and in good standing, plus one year experience.

o Care Manager Aide (CMA) (Optional staffing)• Two years of experience working with the elderly or a

Bachelor’s degree in a human services discipline.15

SAMPLE STAFFING MODEL- 480 SLOTS

NOTE: MSSP site staffing varies depending upon the number of funded client slots

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Site Director1.0 FTE

Supervising Care Manager (SCM)

2.0 FTE

Nurse Care Manager (NCM)

2.5 FTE

Social Worker Care Manager (SWCM)

8.5 FTE

Care Management Aide (CMA)

1 FTE

HEALTH AND WELFARE ASSURANCE

o MSSP Care Managers are mandated reporters of elder and dependent adult abuse and must report all instances of suspected abuse, neglect, and exploitation.

o All incidents of suspected abuse are reported to county Adult Protective Services Agencies.

o The role of the MSSP Care Manager is one of observation, documentation and coordination with the APS on intervention as needed.

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HEALTH AND WELFARE ASSURANCE-CONTINUED

All Waiver Participants enrolled in the MSSP have the right to:

o Withdraw from the MSSP at any time.

o Not answer any question not relevant to the determination of services to be received or receiving.

o Participate in all aspects of care, including the determination of services needed (self-determination and choice to the fullest extent possible).

o Confidentiality of personal information, including case records.

o Request a fair hearing when the application for participation in the MSSP is denied, or if Waiver services are not satisfactory.

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FINANCIAL ACCOUNTABILITY ASSURANCE

o MSSP pays only for services that are approved and delivered.

o Annual Waiver Participant Medi-Cal costs for Waiver Participant cannot exceed those of providing care in a nursing facility.

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ADMINISTRATIVE AUTHORITY ASSURANCE

The California State Medicaid Agency, Department of Health Care Services (DHCS), retains authority over the MSSP Waiver

Long-Term Care Division Audits and Investigations

Through an interagency agreement, the California Department of Aging (CDA) is responsible for the administration and operation of the MSSP Waiver

MSSP Branch Audit Branch

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OVERSIGHT

o DHCS

• Long-Term Care Division, Waiver Operations Unit - Ensures that CDA performs waiver operational and administrative functions through independent MSSP site reviews.

• Audits & Investigation - Performs random Medi-Cal audits and investigations.

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CDA’s oversight role will continue throughout the CCI demonstration

CDA - MSSP Branch

•Performs biennial Utilization Reviews (UR) of 39 MSSP Sites.

•Verifies during UR that: Waiver Participant is MSSP eligible; services are authorized and delivered in accordance with Care Plan; and, no duplication exists between Waiver Services and other sources.

•Conducts follow-up visits and provides technical assistance to ensure that any problems identified in the URs are remediated.

•Provides ongoing technical assistance, guidance and training.

Oversight-continued

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Oversight-continued

• Audit Branch completes financial audits of all 39 MSSP Sites to ensure that payments made to the sites are in accordance with federal and state requirements.

CDA - Audit Branch

CDA UTILIZATION REVIEW

o On-site Utilization Review (UR) visit of every MSSP site every two years.

o On-Site Baseline Review first year of operation.

o Review sample of client records and other documents to determine MSSP Providers level of compliance.

o Remediation of findings through submission of Corrective Action Plans, Plan of Action, backup documentation, Technical Assistance and/or Follow-up visits.

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QUESTIONS

Thank you for your participation

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