Acquired Brain Injury
Community Services Coming Soon

 

The Brain Injury Association of Massachusetts (BIA-MA) has prepared answers to many frequently asked questions about the Hutchinson settlement and the status of the program implementation.

What is the Hutchinson Settlement Agreement? What changes will it make to the Massachusetts service system for persons with brain injury? 

Hutchinson v. Patrick was a class action lawsuit raising federal ADA and Medicaid claims on behalf of institutionalized persons with acquired brain injuries. In September 2008, a court-ordered Settlement Agreement established a plan to dramatically enhance community-based services in Massachusetts, allowing 1900 class members to transition to the community over the next eight years.  These individuals will be supported by services from two new Medicaid waiver* programs and the Community First demonstration project.  Over the next year, this Medicaid service system will be designed and implemented.  An education and outreach campaign will assist eligible individuals, their providers and families in applying for these resources.  To read more about the Hutchinson case and resulting Settlement, see www.centerforpublicrep.org

*What are Waivers? The Medicaid statute lays out the rules about what can be a covered service and who can be covered. A waiver program is one that allows a state to request a waiver, i.e., permission, to adhere to Medicaid waiver rules rather than traditional eligibility and coverage rules.

What types of community-based services and supports will be available under the Hutchinson settlement ?

The Commonwealth is working to expand its community-based service system for persons with brain injuries, creating opportunities for transition from nursing and rehabilitation facilities to integrated community living. Two new Medicaid home and community-based waivers have been submitted to the federal government.

These waivers will afford applicants access to a range of services including case management, residential habilitation, individual support and community habilitation, one-time transitional services, homemaker services, personal care, respite, supported employment, specialized medical equipment, adult companions, home accessibility adaptations, transportation and therapies.  See below (under “Education and Outreach Campaign”) for upcoming information session dates.

The Waivers
The Settlement Agreement enhances community-based services for Medicaid-eligible individuals with an acquired brain injury in a number of ways and over a period of years, by offering two new programs for brain-injured individuals who seek to transition from nursing facilities to the community and by monitoring the participation of brain-injured individuals in programs that provide those services. These waivers are in the process of receiving Federal approval.

  1. ABI Waiver -- Through the ABI Waiver, managed by Massachusetts Rehabilitation Commission (MRC), the state will offer community residential and nonresidential services for up to 300 persons with an acquired brain injury who are currently in nursing facilities and rehabilitation hospitals.  The ABI Waiver will begin accepting applications within nine months of federal approval, and will serve up to 300 persons with an acquired brain injury within three years following federal approval.
    Click here to read more about the ABI waiver.     

  2. Community First Demonstration Project - Following federal approval, this program will make available certain transitional services, designed to help persons transition to community settings, to MassHealth eligible residents of nursing facilities.  The state's application for federal approval of Community First proposes that up to 1000 persons in nursing facilities each year may receive transitional services as participants in the Community First "Transition Group."  Under the terms of the Settlement Agreement, the state will monitor applications to the Transition Group for at least five and up to eight years to ensure that 20% of the participants are persons with an acquired brain injury.  If this monitoring process discloses that less than 20% of the participants are persons with an acquired brain injury, the state will take various corrective actions.

How will treatment planning services be delivered under the Hutchinson settlement agreement?
Massachusetts will create a new individual treatment planning process for waiver participants that is based on the principles of person-centered care. Waiver services will be provided pursuant to an Individual Service Plan (ISP). The waiver participant’s strengths, personal goals and objectives are at the heart of this planning process.  A Team is formed which may include individuals from the person’s community, providers, friends, family members and other professionals of the person’s choosing.  Together the Team considers the individual’s transitional service needs and identifies community-based resources.  Team meetings and coordination from the assigned care manager help to ensure there is effective communication and that the individual is meaningfully involved in, and actively directing, every aspect of their care.

What is the status of the ABI waivers described under the Hutchinson Settlement Agreement and when will they be available to families?

Despite repeated and serious budget reductions across the Health and Human Services Secretariat, the Commonwealth has recently provided assurance both of its commitment to the Hutchinson Settlement Agreement and to implementation of the agreed upon ABI Home and Community-Based Services waivers.

Subject to approval from the Center for Medicaid and Medicare Services, the ABI waivers are anticipated to begin a two week, open enrollment period on or about May 1, 2010.

Prior to that time, the parties (the Commonwealth of Massachusetts, BIA-MA, and the Center for Public Representation) will develop and launch an education and outreach campaign (see dates below) intended to inform brain injury survivors, their families and providers about the ABI waivers and resulting options for transition from institutional/nursing home care to community living.  These outreach efforts will include written communications, regional meetings and public presentations designed to explain the range of new waiver services, relevant eligibility criteria and the application process itself.  Informational materials will also be available on the BIAMA website.

In the interim, the Commonwealth continues to engage in implementation activities, including development of waiver policies and procedures and preparations for the expansion of existing provider networks.  Most recently, the Commonwealth has announced its selection of the University of Massachusetts to serve both as third party network administrator and provider of case management services for ABI waiver participants.

Education and Outreach Campaign

An education and outreach campaign will assist eligible individuals, their providers and families in applying for these resources.  Representatives from Medicaid, MRC, UMass, EOHHS, and BIA-MA will be on hand to explain the application process and to answer your questions.  No registration required.

Meeting dates, times, and locations:

- From: “Hutchinson v. Patrick Class Action Settlement Frequently Asked Questions”, Brain Injury Association- Massachusetts, http://www.biama.org/whatdoes/casefaqs.html retrieved 2/8/10. and “ Hutchinson v. Patrick Class Action Settlement: Eligibility”, at http://www.biama.org/whatdoes/eligibility.html retrieved 2/8/10.

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