MASSACHUSETTS

The executive offices of Health and Human Services, Administration, and Finance and Elder Affairs, in consultation with an Olmstead advisory group, issued Enhancing Community Based Services: Phase One of Massachusetts Plan on July 31, 2002. It is located at http://mass.gov/resources/ecbs_plan.pdf. Phase One includes 62 activities that were to be implemented in FY 2003. Most of these activities center around community placement of individuals with disabilities and helping people make the transition from nursing homes when appropriate and desired. Believing that this plan did not go far enough, the state independent living council issued the Peoples' Plan in January 2003.

The Olmstead advisory group is no longer active. Instead, the Real Choice Collaborative Team, which is made up of state officials and consumers, is making decisions about the Systems Change grant activity regarding a pilot project that allows money to follow the person.

Also, as part of its phase two report, the executive offices of Health and Human Services, Administration and Finance, and Elder Affairs is working on a new report, Transforming Long-Term Supports in Massachusetts. The draft was released for comment at the end of September 2003; this report contains no any recommendations. Unlike the previous report, the purpose of this report is to spark a dialog and to frame the issues for future recommendations. Like the previous report, the report encompasses all long-term care populations.

A change in administration and the state's fiscal crisis put on hold many of the activities listed in the phase one report. However, some activities-such as the pilot project described above-were implemented through the systems change grant and existing agency budgets.

Legislation that was enacted in 2003 shifted some Medicaid funds into the Department of Elder Affairs. The Legislature also appropriated fund rate adjustments to eligible nursing homes that meet utilization standards aimed at reducing unnecessary nursing home admissions and facilitating the return of nursing home residents to non-institutional settings (House Bill 4004). The law creates a home care program to assist elders in maintaining their residences in the community consistent with their clinical and psychosocial needs in the most cost-effective manner possible. The coordinated system of care will be administered by agencies under contract with the department that will be known as aging services access points (ASAPs). The ASAPs will coordinate services on behalf of Medicaid eligible elders. The state is directed to make administrative payments to ASAPs for Medicaid-funded functions, including screenings, assessments and case management.

Although there were more budget cuts than expansions, the Systems Change grants have kept alive the long-term care reform efforts of the state.

The state recently received a new Independence Plus grant that will support the state's development of a waiver to allow for more self-directed care. In addition to the pilot project, the Real Choice Collaborative Team will be working on this waiver application.