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Personal Independence Commission

May 12, 2003

Governor Office Building, Room 450
MINUTES

Lt. Governor Joe Maxwell called the meeting to order.  PIC members in attendance were; Lt. Governor Maxwell, Kirsten Dunham, Linda Allen, Anne Deaton, Roger Garlich, Wendy Hayes, Rick Horrell, Anne Jackson, Mary O'Brien, Robin Reed, John Solomon, Neva Thurston, Greg Vadner and Ron Vessell.

Co-Chair Reports:

Lt. Governor Maxwell - He and Ms. Dunham met with staff from the Governor's Office and provided an update on the activities of the PIC.  Set eleven short-term goals for each of the state departments with representation on the PIC to work on.  The Governor plans to take the recommendations of the PIC, meet with department directors to see what deadlines have or have not been met, have the agencies go back over the recommendations and put an operational plan in place.  This operational plan will be presented to the PIC at the June meeting and the PIC will be asked to respond.  One of the problems is a lack of technical expertise for the work groups.  The Governor will also establish a lead agency prior to the June meeting.  The work groups will not be required to meet during the 30 to 40 day time period between the May and June meetings. 

The list of the eleven objectives or short-term goals was handed out.  Also a list of the perceived barriers to the work groups was also handed out.  These, along with the objectives of the Real Choice Systems Change Grant will be reviewed.

The work group chairs need to get any additional backup information regarding barriers to Ms. Dunham by May 23rd.

Website Status Report:

Donna Borgmeyer, Governor's Council on Disability - reported that there is now a self-determination link on the PIC website.  The work groups need to get their reports to Rob Honan in a timely manner. 

Status of Request for new Legislative Appointments:

The Lt. Governor reported that letters have been sent to both Senator Kinder and Representative Hannaway asking for appointments for the legislature.  They are hopeful these appointments will be made before the June PIC meeting.

Medicaid Managed Care for Aged, Blind and Disabled Proposal Overview:

Greg Vadner, Division of Medical Services - The Department of Social Services is looking at the possibility of a managed care program for aged, blind and disabled adults.  They are looking at this possibility due to the budget crisis and also because the MC= Program for kids has done some good things.  Mr. Vadner plans to talk to the Governor's Advisory Council on Aging, the Governor's Council on Disability and the directors of the Area Agencies on Aging to see how these groups feel about this proposal.  There is a Request of Information for Proposal out but they have not received any comments to date.  He said managed care would pay for some things that traditional Medicaid will not pay for.  There are concerns that managed care will push some people into long term care facilities.  Mr. Vadner assured people that this would not happen.  They are also considering Consumer Directed Choice in the program.  There are several groups that will not be put into a managed care program because they are too unique and difficult to deal with under managed care. These include Public Health, Transplant Services, Community Psychiatric Rehab, Substance Abuse and Treatment, Protease Inhibitors and MR-DD Waiver.

Public comment will be accepted concerning this issue until the end of July.  The final decision concerning Medicaid managed care will not be a PIC decision.  The PIC just needs to be informed of the process.  The program would not be implemented until fiscal year 2005 at the earliest.

There were several comments from Commissioners.  Mary O'Brien stated she wanted to go on record as being totally against a Medicaid managed care program.  Anne Deaton stated there are advantages and disadvantages to managed care.  She is afraid it would lead to more institutionalization of high end users.  Other states have tried managed care for the elderly but it has not worked well.  Would need to be a voluntary program.  John Solomon commended Mr. Vadner for his efforts.  Linda Allen felt that the current system is focused on improving life in the care level.  Managed care would look at the whole picture, not just level of care but how to make the person's life better.

Real Choice Systems Change Grant Update:

Sherl Taylor, Division of Medical Services.

  • Demonstration Projects.  There were six pilot projects approved.  These are The Coalition for Independence, Contrea Community Treatment Center, Crider Center for Mental Health, Paraquad, People First and Willows Way, Inc.  UMKC, who is functioning as a support contractor, had developed and mailed contracts to each pilot project. All six contracts were signed and returned to UMKC in March.  UMKC has created and mailed the evaluation plans to two of the organizations for their input.  Three of the demonstration projects are creating curriculums that are not fully developed.  One-on-one meetings will be held so UMKC can obtain a better understanding of the full scope of the projects.
  • Dissemination plan for brochure.  10,000 copies of the brochure "Missouri's Guide to Home and Community-Based Services have been printed.  They will be distributed to the two pilot projects first, then to state agencies.  The Departments of Elementary and Secondary Education, Mental Health, Social Services, Health and Senior Services and Labor and Industrial Relations will each receive 1,000 copies. Additional copies will be distributed to community organizations.  The brochure will also be available on the web, but not till a later date.  The Co-Chairs later requested Ms. Taylor have the brochure on the web site by May 30th.  The PIC will do a public announcement a couple of weeks after that to help inform the public about Olmstead.  There should also be links from the different departments to the brochure.

There was some discussion about the content of the brochure.  It was decided that changes could be made in future printings.  The Lt. Governor suggested that the agencies using the brochure survey the functionality of it as it is utilized in the field and give feedback before another printing is done.  Mr. Garlich suggested a sticker with the date of publication be put in the brochure so people will know if they have the most current copy.  Ms. O'Brien raised concerns that the brochure does not comply with what the grant said we would do. Lt. Governor Maxwell said he would check the grant and report back at the June meeting as to if the brochure does what we said it would do.  Mr. Vessell made a motion to approve the brochure for distribution.  Ms. Deaton second the motion.  The motion passed.  The Lt. Governor also mentioned that the PIC had talked about doing presentations to different organizations.  He asked the PIC members to compile a list of organizations and dates they were meeting and get the information to Maria before the June meeting. 

  • Recommendation of pilots versus focus group forums.  The purpose of the focus groups is to get consumer input on the current system and suggested changes or improvements to the system.  They are one and a half years into the grant. There is not sufficient time for additional pilot projects.  Forums, focus groups or interviews would be better.  Several suggestions were made by the PIC.  It was suggested that forums would be better than focus groups.  It was also suggested that they join forces with other agencies that are already doing forums for other grants.  It was decided to table the issue.  The Lt. Governor will meet with the Governor's Office to find out what other meetings are being held.  He and Kirsten will take care of this.
  • Survey tool.  UMKC will administer a survey to the six demonstration projects.
  • State Team status report.  A list of each of the agencies that have major impact on the grant activities and their designated point person was included in handouts to the PIC.  This list is attached.
  • Waiting list data collection.  A team has been meeting to discuss waiting list criteria. An individual may be placed on a waiting list only if the following exist:
    1. A specific service is an eligible service
    2. The individual consumer is immediately eligible to receive the specific service
    3. The service is not readily available

Discussion followed. SB 266, which was just passed by the legislature, requires the Department of Mental Health to develop a plan to address their waiting lists.  This plan has to be in place by October of this year.  It was decided that those working on the waiting list issues for the RCSC Grant should work in conjunction with the DMH group to work on the waiting list issue.

  • Traumatic Brain Injury Pilot.  Grant was funded for $100,000 to the Health Resources and Services Administration.  The intent of the grant was to improve access to and provide quality health care services for people with TBI.  Have an annual report that will be distributed to involved agencies.  Is a completed project for 2001 and 2002, but are continuing with new activities for 2003.  As of January 1, 2003 they have developed a common release form that is being used by all state agencies except Social Services.  A common assessment team is meeting in May to develop a common assessment form for TBI.  Another activity of the grant is to work with Missouri E-Government initiative through the Office of Administration to focus energies on doing things in electronic media as opposed to forms and paperwork.  Department of Elementary and Secondary Education has a common assessment form that is being used by other agencies.
  • Ms. Taylor presented information on procedures and requirements for travel reimbursement for PIC members and work group members.
  • Informed Choice Training.  Linda Allen, Senior Services, reported they have been working with Paraquad on this.  Have finalized protocols.  Have had a training.  Anne Deaton also reported there would be another Informed Choice training at Marshall Habilitation Center later in May.  Ms. Allen also said the training is very valuable and they plan to have volunteers conduct the Informed Choice training for physicians and rehab centers among others. Have a mechanism in place to get feedback from the nursing facilities about the training.

Public Comment:

Tish Thomas, Division of Comprehensive Psychiatric Services - CPS has a small Olmstead grant (about $20,000 a year) targeting people with mental illness.  Have applied through the grant for technical assistance on housing and coalition building.  Had two nationally known speakers come in and do presentations at Mental Health Awareness Day and the day before.  They presented on housing, accessing housing, fair housing and coalition building.  This grant is focused on the 2500 people with mental illness that still live in Residential Care Facilities.  Also, the DMH Housing newsletter that has just been available on the web due to budget cuts, has been revitalized thanks to the grant, and will be distributed in the next couple of weeks.  This issue will focus on Olmstead and fair, safe housing and community capacity.

Wayne Lee, Epilepsy Foundation of America- SB 695 was voted Do Pass out of committee.  He had several concerns about the bill, one being the high cost of prescription drugs.  Another concern is the bill could be in conflict with federal law.  The bill could also result in cuts to the Medical Assistance for Workers with Disabilities (MAWD) Program funding.  He raised the issue of should people with disabilities try to work and be productive part of society or should they just sit back and let the government take care of them.  Also said he is working to get people involved in the legislative process. 

Nancy Murphy, Delta Center for Independent Living - At a recent DMH stakeholders meeting she received a draft of a report of admissions at Bellefontaine and there is a move to cap the population at Bellefontaine.  She also has had reports from providers that case managers are favoring institutional placement over community placement because of the cost factor.  Ms. Deaton responded that they have put two case managers in habilitation centers and point people for them to report to try to keep that type of thing from happening.  She would like to be informed of these types of situations.  Ms. Deaton also said they are requesting cola and rate increases for providers in their budget.

There was some discussion about money following the person out of an institution and the cost of/and services provided in both settings.

The next meeting of the Personal Independence Commission will be June 16th from 10:30 a.m. to 12:30 p.m. with time for public comment at the end of the meeting. 

Mr. Garlich made a motion to adjourn the meeting.  Mr. Solomon seconded the motion.  The meeting was adjourned.