Single Point of EntrySingle Point of Entry

A System For The A System For The FutureFuture

Help! I need Help!Help! I need Help!

For whatever reason, For whatever reason, people may face a people may face a need for care beyond need for care beyond what they can what they can provide for provide for themselves.themselves.

How do they find out How do they find out what options they what options they have, and can they have, and can they afford them?afford them?

ProblemsProblems

For seniors, or anyone with disabilities needing long For seniors, or anyone with disabilities needing long term care, or their family members seeking to assist term care, or their family members seeking to assist them, it is a maze with no seemingly right route.them, it is a maze with no seemingly right route.

Under the current system addressing an array of Under the current system addressing an array of needs: needs:

personal care, self-directed care, in-home personal care, self-directed care, in-home health health care; home adaptations; delivered care; home adaptations; delivered meals; assisted meals; assisted living; adult foster careliving; adult foster care; ;

the list of choices without informed advice, is the list of choices without informed advice, is disjointed, fragmented, not coordinated, and totally disjointed, fragmented, not coordinated, and totally confusing, particularly for someone facing these confusing, particularly for someone facing these choices for the first time.choices for the first time.

Goals for a Goals for a Long Term Care InfrastructureLong Term Care Infrastructure

An infrastructure needs to be put into place to An infrastructure needs to be put into place to deliver a cost-effective system of long term care:deliver a cost-effective system of long term care:

a system which would support personal care-a system which would support personal care-giving choices for consumers & family supports.giving choices for consumers & family supports.

a system that would utilize agents of the state at a system that would utilize agents of the state at a local and/or regional level;a local and/or regional level;

provide a platform to provide timely access to provide a platform to provide timely access to services; alternatives to institutional care, based services; alternatives to institutional care, based on consumer choice and level of care required.on consumer choice and level of care required.

A Single Point of Entry A Single Point of Entry Agency willAgency will::

provide information and assistance to provide information and assistance to consumers as they consider their long term consumers as they consider their long term care options;care options;

provide information on all services and provide information on all services and supports that individuals need for long term supports that individuals need for long term health care;health care;

provide consumer choice referral/assistance;provide consumer choice referral/assistance; serve as a resource on long term care options serve as a resource on long term care options

for the community at large and caregivers.for the community at large and caregivers.

Role of A Role of A Single Point of Entry Single Point of Entry

Agency:Agency: Financial Eligibility Financial Eligibility

Assessment/AssistanceAssessment/Assistance

provide assistance to consumers in provide assistance to consumers in working working through the process;through the process;

should be able to expedite the application should be able to expedite the application process and identify any barriers;process and identify any barriers;

also work with other agencies to resolve also work with other agencies to resolve barriers found in the system.barriers found in the system.

A Single Point of Entry A Single Point of Entry Agency willAgency will::

facilitate movement between supports, facilitate movement between supports, services and settings;services and settings;

assist consumers in determining if they assist consumers in determining if they are eligible for publicly funded programs, are eligible for publicly funded programs, but DHS retains the responsibility for but DHS retains the responsibility for authorizing that determination;authorizing that determination;

A Single Point of Entry A Single Point of Entry Agency willAgency will::

assist consumers in developing their assist consumers in developing their long-term care plans through a long-term care plans through a person-centered process, and be person-centered process, and be available for follow up to update or available for follow up to update or re-evaluate needs.re-evaluate needs.

Case Coordination/Supports Case Coordination/Supports Coordination/Care PlanningCoordination/Care Planning

Case and Case and supportssupports coordination will be a coordination will be a key role for the SPE agencies;key role for the SPE agencies;

Consumers will have the ability to Consumers will have the ability to change Care (Supports) Coordinators change Care (Supports) Coordinators when they feel it is necessary to do so;when they feel it is necessary to do so;

Individuals will be able to develop their Individuals will be able to develop their care or support plans through the care or support plans through the Person-Centered Planning process.Person-Centered Planning process.

Transition Coordination Transition Coordination and Facilitationand Facilitation::

Nursing Home transition will be a Nursing Home transition will be a function of the SPE agencies;function of the SPE agencies;

offers choice for Nursing Home residents;offers choice for Nursing Home residents; involves consumers in making decisions involves consumers in making decisions

about their own lives;about their own lives; facilitates a smooth transition into facilitates a smooth transition into

community living.community living.

SPE access to services:SPE access to services:

mandatory for individuals eligible for mandatory for individuals eligible for Medicaid funded programs:Medicaid funded programs:

individuals who are private pay will be able individuals who are private pay will be able to access all the SPE agency services;to access all the SPE agency services;

information and referral/assistance will be information and referral/assistance will be available to everyone at no cost;available to everyone at no cost;

SPE access to services:SPE access to services:

there may be a fee for private pay there may be a fee for private pay consumers who wish to access other SPE consumers who wish to access other SPE agency services (these services may be agency services (these services may be covered by long term care or other covered by long term care or other insurance).insurance).

long term care providers will be required to long term care providers will be required to inform consumers about the availability of inform consumers about the availability of the SPE agency.the SPE agency.

SPE: IndependentSPE: Independent“Neutral” Consultant“Neutral” Consultant

Separation of Service Authorization & ProvisionSeparation of Service Authorization & Provision

an SPE should do service authorization;an SPE should do service authorization;

an SPE should NOT do direct service provision;an SPE should NOT do direct service provision;

an advocate should not be a provider to avoid an advocate should not be a provider to avoid perceptions of bias.perceptions of bias.

SPE “Pilot” ProgramsSPE “Pilot” Programs

DCH has sought RFP’s for pilot programs;DCH has sought RFP’s for pilot programs;

results of RFP process are expected by the end results of RFP process are expected by the end of April, 2006;of April, 2006;

pilot programs are scheduled to start in June pilot programs are scheduled to start in June 2006;2006;

HB 5389 requires DCH to provide evidence HB 5389 requires DCH to provide evidence based information regarding the effectiveness based information regarding the effectiveness of Single Points of Entry pilot programs;of Single Points of Entry pilot programs;

SPE “Pilot” ProgramsSPE “Pilot” Programs

The legislature will review that evidence The legislature will review that evidence based data as part of the 2008-2009 based data as part of the 2008-2009 budget process; and recommend budget process; and recommend continuance of the program.continuance of the program.

Language and intent of RFP closely reflects Language and intent of RFP closely reflects Long Term Care Task Force Long Term Care Task Force recommendations.recommendations.

Why Legislation Now?Why Legislation Now?

This legislation will allow formal control This legislation will allow formal control over the services provided under over the services provided under Medicaid;Medicaid;

provides the mechanism so that the SPE provides the mechanism so that the SPE acts as a ‘triage’ point, to ensure that acts as a ‘triage’ point, to ensure that consumers have options for care relevant consumers have options for care relevant to their level of health care needs;to their level of health care needs;

Why Legislation Now?Why Legislation Now?

This legislation conforms to the This legislation conforms to the recommendations from the Michigan recommendations from the Michigan Medicaid Long Term Care Task Force Medicaid Long Term Care Task Force set up under the Supreme Court set up under the Supreme Court agreement, in the “Eager vs Engler agreement, in the “Eager vs Engler (Granholm) class action suit filed on (Granholm) class action suit filed on the basis of the “Olmstead” the basis of the “Olmstead” agreement.agreement.

Why Legislation Now?Why Legislation Now?

This legislation will plug into the This legislation will plug into the over-arching Long Term Care over-arching Long Term Care legislation bill sponsored by legislation bill sponsored by Representative Vander Veen ( HB Representative Vander Veen ( HB 5762).5762).

The whole package will form the The whole package will form the Long Term Care Code.Long Term Care Code.

HB 5389HB 5389Objectives:Objectives:

Identifying all the choices available in a cohesive Identifying all the choices available in a cohesive manner is the challenge;manner is the challenge;

Past studies show that prior to the MI Choice Past studies show that prior to the MI Choice Waiver program, in many cases once a person Waiver program, in many cases once a person sought assistance for long term care, the nursing sought assistance for long term care, the nursing care facility was the only option offered, care facility was the only option offered, regardless of whether their level of care required regardless of whether their level of care required this.this.

People do not wish to leave their own homes if People do not wish to leave their own homes if they can avoid it but often cannot find out about they can avoid it but often cannot find out about all the choices available to them, or what all the choices available to them, or what assistance they might be eligible for.assistance they might be eligible for.

HB 5389 - GOALSHB 5389 - GOALS

ability to purchase services cost effectively ability to purchase services cost effectively relevant to level of care needs;relevant to level of care needs;

promote personal responsibility by promote personal responsibility by providing choices to consumers;providing choices to consumers;

ensure provision of high quality services ensure provision of high quality services and supports, with positive outcomes for and supports, with positive outcomes for consumers;consumers;

balance provision and cost of Medicaid balance provision and cost of Medicaid funded long term care.funded long term care.

HB 5389 - GOALSHB 5389 - GOALS

HB 5389 will provide legislative authority for a HB 5389 will provide legislative authority for a Single Point of Entry System that will provide Single Point of Entry System that will provide information about the full array of options open to information about the full array of options open to consumers in need of long term care consumers in need of long term care opportunities including person-centered planning, opportunities including person-centered planning,

and consumer choiceand consumer choice;; The consumer trumps allThe consumer trumps all!!

Get on Board Now!Get on Board Now!

Change is needed to deal Change is needed to deal with increased demand;with increased demand;

32 states are currently 32 states are currently operating/reviewing SPE’s.operating/reviewing SPE’s.

the train is coming down the the train is coming down the track – this legislation gets track – this legislation gets Michigan on board:Michigan on board:

Supplied by the office of State Representative Rick Shaffer – 517-Supplied by the office of State Representative Rick Shaffer – 517-373-0832373-0832