Persons with brain injury living in rehabilitation facilities and nursing homes in Massachusetts with no community supports and services sparked a lawsuit with the state, which led to a settlement in 2010. Recently, a new agreement between plaintiffs of the original settlement and EOHHS was made in which individuals with brain injury will have opportunities to move out of nursing homes and rehabilitation facilities into the community and to receive other community-based supports and services.

EOHHS Assistant Secretary, Office of Disability Policy and Programs Rosalie Edes presented the outcome of the Hutchinson settlement to ADDP's Brain Injury Committee

Highlighting the conditions of the settlement and how EOHHS plans to implement those terms, she noted several key points about EOHHS' responsibility regarding the new settlement model, which spans fiscal years 2014 - 2019:

• EOHHS will create between 905 to 1,174 new waiver opportunities for individuals with Acquired Brain Injury (ABI), which will be provided through existing waivers: the Money Follows the Person (MFP) waivers, an expansion of the ABI waivers, the DDS waivers, and the Frail Elder waiver.
• There will now be continuous enrollment for the ABI and MFP community living and residential waivers.
• Starting in year two, transitions into the community must occur within 12 months of waiver enrollment.
• EOHHS will utilize an interagency approach to waiver administration:
• MRC will become the lead agency for the ABI and MFP non-residential waivers   
• DDS will become the lead agency for the ABI and MFP residential waivers.
• Currently, participants in the ABI waivers are receiving transition coordination and case management from University of Massachusetts Commonwealth Medicine (UMMS) staff and this service will transition to state staff during FY14:  
• DDS will takeover case management for the ABI and MFP residential waivers   
• MRC will take over case management for the non-residential ABI and MFP waivers.
• ILCs and ASAPs with experience in supporting individuals transitioning from nursing facilities and chronic rehabilitation hospitals will provide outreach to potential waiver participants to ensure that they are aware of their service options. They will also provide transition coordination services for all individuals in the MFP Demonstration Project.
• UMMS will continue to perform waiver eligibility determination & provider credentialing.
• Through a coordinated interagency approach, DDS will provide the infrastructure support of its total quality management system for all four waivers and support MRC in its administration and oversight functions, including incident and complaint management, licensing, certification and medication administration certification.
• EOHHS will access the existing DDS residential provider system in order to expand capacity and address individual choice of settings and locations.
• Expanded benefits will be offered, such as shared home supports (up to 16 hours) in ABI and MFP Community Living Waiver Services, shared living 24 hour supports and assisted living services in both the ABI and MFP residential waivers and self-direction for certain services.
• EOHHS will ensure that written rules, regulations and policies concerning client rights, investigation, incident management, mortality review, provider oversight and the provider network for the MFP and ABI waivers will be substantially similar to those of DDS.
• This new administrative responsibility does not change DDS's eligibility requirements; the authority to provide services to the ABI and MFP waiver populations is permitted through an amendment to their existing statute and limited to participants in this service population.

Assistant Secretary Edes, MRC Assistant Commissioner Debra Kamen, & DDS Deputy Commissioner Larry Tummino fielded questions from & responded to concerns raised by providers & advocates regarding the agreement & implementation schedule.  

Questions were raised around eligibility, quality management, and provider capacity (buildings & staffing) to serve individuals with brain injury. The latter included funding needed to renovate buildings to make them ADA accessible and to train staff to adequately provide clinical services to individuals with brain injury and their families. The response given was that the reconfiguration of rates that will occur through Chapter 257 would be the "ultimate" fix regarding these costs.

Overall, this meeting provided an opportunity for needed dialogue between the state and providers, as well as continued collaboration. ADDP appreciates the effort of Assistant Secretary Edes, Assistant Commissioner Kamen, and Deputy Commissioner Tummino in meeting with the provider community regarding the settlement.