April 17, 2006
Hearing Room 3, Capitol Building
Jefferson City, Missouri
MINUTES - DRAFT
Kirsten Dunham called the meeting to order. Roll call was taken. PIC members present were; Kirsten Dunham, Kelly Flaugher (for Jeanne Loyd), Mary Wehrle (for Brenda Campbell), Kay Green (for Kent Stadler), Sandra Levels, Anne Jackson, Neva Thurston, Martha Hicks. A quorum was not established so the PIC met as a sub-committee.
Co-Chair Reports/Legislative Update:
Were combined with legislative update.
Legislative Update:
- Medicaid by in for Workers With Disabilities – HB 1742 sponsored by Representative Charles Portwood. Has passed through the House and been voted on by the Senate Committee it was assigned to. The proposed legislation will serve around 1,800 individuals. Some of the issues legislators had with the MAWD program have been removed. People will have to earn a certain amount of income in order to qualify. Also, sheltered workshop income will not be considered during Medicaid eligibility determination. These employees will have the option of entering the by in program or staying as they are. Individuals can save up to $5,000 in an Independent Living Account to cover anything needed to stay in the home and community. Individuals can also save up to $5,000 in a medical savings account without it counting as an asset.
- Durable Medical Equipment – There is money in the budget for wheelchair batteries and accessories and eyeglasses. No other durable medical equipment was included. Physical therapy, occupational therapy and rehabilitation services were also not included.
- Non-Medicaid Eligible Program – Provides services for people whose income is too high for them to qualify for Medicaid but who do not have income to pay for services out of their pocket. The Non-Medicaid Eligible Consumer Directed Program provides services to these individuals. Legislation was passed last year to sunset this program July 1st of this year. There is legislation to remove the sunset provision. HB 1873 passed the House unanimously. The House put the money to fund this in the budget but the Senate removed it so it will go to a conference committee. The program serves about 100 individuals.
Discussion followed concerning the status of Olmstead and Olmstead Commissions in other states. There was also discussion about the PIC and the status of new appointments.
- Deficit Reduction Act – Passed last year. Has components aimed toward serving people better in the community. Under this act, states now have the option of making some Home and Community-Based Services state plan services.
- Family Opportunity Act – Allows states to have a specialized eligibility category in their state to help families who have children with special needs pay to access Medicaid services. The family income must be below 300% of the Federal Poverty Level to qualify.
- S 2409 – The Home and Community Services Co-payment Equity Act of 2006. When the Medicaid Part D Prescription Drug Benefit Act was passed there were differences in treatment of co-payments for residents of nursing homes versus people living in the community. This legislation would equalize co-payments of nursing home residents and in-home service recipients.
- S 1955 – Health Insurance Marketplace Modernization and affordability Act. Would allow insurance companies to override state laws and regulations related to what types of services are required to be covered through insurance companies, what kinds of access to specialists and limits on premiums and cost sharing. This could affect the disability community with higher premiums and lack of access to some treatments, causing more people to go on Medicaid.
Roadmap for Medicaid Reform from CMS:
The Federal Budget passed in January or February included money for Money Follows the Person Rebalancing Demonstration Grants. States could apply for these grants and use the funds to transition people out of nursing homes and ICF/MR institutions. The federal government will pay an enhanced federal match for all those transitioned out of nursing homes into the community. If Missouri applies for and receives the grant there could be an 80% federal match for the first year. The grant can last up to five years. The request for proposals will not be out until later this year, but this might be a roll for the PIC to look into these grants and see what systems change Missouri has already done and could do that would support nursing home transition. Department of Mental Health is considering applying for this grant. DMH would work with DHSS on the application. Other groups such as the CIL’s, MO Planning Council and the AAA’s are also looking at submitting applications. There was a consensus among the PIC members present that Missouri should apply for this grant, but since a quorum was not present, an official vote could not be taken.
Data and Information Sharing:
- State of the States on Developmental Disabilities – In Missouri about 10% of those with developmental disabilities are in nursing homes compared to 6% nationally. 54% of persons with DD in Missouri are in settings with less than six people, compared to 68% nationally. 71% of individuals are in supported living in Missouri compared to 40% nationally. This is information to look at when transitioning people out of Habilitation Centers.
- CMS Nursing Home Data Compendium – Collects data from nursing homes on both private pay and public ally paid nursing home placements. 33% of persons in nursing facilities had no Activity of Daily Living impairment. Missouri is one of the states listed with a large percentage of persons with no ADL impairments living in nursing facilities. This may be a population to target for transition back into the community. Discussion followed as to if this data accurately reflects trends in Missouri.
Informed Choice Report:
This was in response to a request from a PIC member. The first series of Informed Choice trainings were held in Nevada, Columbia, Kirksville, St. Joseph, St. Louis, Kansas City, Springfield, Sikeston, Cape Girardeau and Hannibal. These were held last year. Two additional trainings were done in Springfield and Hannibal. Rob Honan of the Governor’s Council on Disability did follow-up calls to some of the people who had attended both of these trainings. Four people in Springfield indicated that they had shared the information from the training with other people, co-workers, staff, interns and consumers. Two had done presentations about Informed Choice. There was no information about the Hannibal training. Generally people felt that it was not presented as a train the trainer type of training, which is what it was supposed to be.
This information did not address all the specific questions Ms. Thurston had asked to have answered. These included a list of groups and individuals who have received the training, what is the current result of the training, how many visits have occurred with residents in institutional settings, what outcomes have been reported to CMS and what is the plan for the curriculum now, how much of the grant money was spent on the curriculum. Discussion followed. Ms. Hicks pointed out that the Guide to Home and Community Based Services was developed by the Informed Choice Work Group and has proven to be a very valuable tool. Ms. Dunham said that some of this information would be difficult to obtain, such as how many people who had taken the training actually went out and met with someone in an institution. She suggested a sub-committee might be formed to look at the trainings and make recommendations as to how to keep the trainings going. Ms. Levels indicated that DSS could provide answers to the questions about the Informed Choice Trainings.
Public Comment:
There was no public comment.
The next PIC meeting is scheduled for July 10th. The meeting adjourned. |
