6151 MFP Pre-Transition Workflow Management | ACCESS-TO-SERVICES-5200-MANUAL

Georgia Division of Aging Services
Access to Services Manual

Chapter:

6000 Community Transitions

Effective Date:

Section Title:

MFP Pre-Transition Workflow Management

Reviewed or Updated in:

MT 2016-02

Section Number:

6151

Previous Update:

Summary Statement

Money Follows the Person (MFP) Transition Coordinators (TCs) will identify MFP Participants for transition in a consistent manner in all areas.

Basic Considerations

To create a consistent experience across Area Agencies on Aging (AAAs), the procedures below are followed to determine a Participant’s Readiness to Transition. As MFP and the Aging Network partner with other regional and state-wide agencies in transitioning Participants, it is imperative these transitions occur in a recognizable pattern across all AAAs.

AAA Procedures

MFP Transition Coordinators will approach their pre-transition workflow in the following fashion:

Secure waiver services:

Waiver services are considered secured when a care plan (even if provisional) is shared with the Participant and Transition Coordinator.
Identify housing:
Housing is considered identified under any one of the following circumstances:
- Family has stated to the TC they will bring the MFP Participant into their home.
- A Personal Care Home has agreed to accept the Participant.
- The TC has confirmed the Participant’s own home is habitable (according to local code).
- The Participant has secured rental arrangements in coordination with their TC.

Once the above tasks are completed, the TC is to conduct an ITP to facilitate transition. After the ITP is conducted, Participant moves to ‘Ready’ status.

TCs will transition Ready Participants in order of the original MFP Screening date.

Under the guidelines described above, Transition Coordinators are expected to continue to assist those Participants who require assistance or do not independently show readiness to transition in a reasonable timeframe.

Confirming MFP Refusals

Some MFP Participants will refuse MFP services. They will do so at different stages of the process. Follow the procedure below to address their status in the MFP workflow.

Withdrawal

MFP Participant chooses to withdraw from the program prior to ITP.

Obtain signature on Page 7 of the MFP Screening Form, confirming refusal.
Send Denial/Termination letter, marked refused.

Refusal Based on Services

Some MFP Participants will wish to follow the MFP process through the transition plan. It is imperative the TC respect this wish.

Refusal Based on Services If/Then
IF	THEN
Participant refuses waiver services, is denied waiver services, or the TC believes the services available cannot support the Participant.	Conduct final ITP and discuss unmet needs, barriers, and risks the Participant will face.
Participant accepts risks as discussed at ITP.	Proceed with execution of ITP.
Participant would be at a significant risk upon Transition.	Submit completed ITP to DAS for further review (described below).
Participant does not accept risks as discussed at ITP.	Complete refusal page of MFP Screening and send Termination Letter & PSC. Mark as Denial, with reason as ‘Refused.’

Pre-Transition Status Management

DAS-level ITP Review

The Participant states they wish to transition, regardless of the risks outlined in the ITP.

TC submits ITP for review at the DAS level.
DAS staff reviews ITP and conferences with AAA staff.
DAS staff issue decision as to whether the AAA staff are to transition or send Denial/Termination letter.

Pre-Transition Status Management If/Then
IF	THEN
Contact is made by individual on approved list & documented.	No contact needed for another 90 days.
TC confirms Participant has transitioned without MFP.	A Denial/Termination letter may be sent, removing Participant from workflow.
TC confirms Participant has moved from their PSA outside of MFP process.	TC communicates with other PSA to make contact with Participant as to next steps.