Personal Independence Commission |
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June 11, 2007 MINUTES - DRAFT Kirsten Dunham called the meeting to order. PIC members present were: Kirsten Dunham, Eric Feltner, Neva Thurston, Roger Garlich, Bernie Simons, Wendy Hays, Kelly Flaugher (for Jeanne Loyd), Sandra Levels Co-Chair Reports/Legislative Update: Ms. Dunham gave a legislative update. The Medicaid Buy-In for Workers with Disabilities legislation was amended onto SB 577 and did pass. People with disabilities will be able to go back to work and can earn up to 300% of the poverty level or $30,000 a year for one person. There will be a sliding scale fee premium. Also in SB 577 people with disabilities will not be forced into managed care but there are no details at this time as to what kind of plans will be offered. Durable medical equipment was restored with a prior-authorization system. SB 577 also addresses spend down. If a person incurs current expenses that have already met their spend down that month they can apply that cost to the next month's spend down. Also the Non Medicaid Eligible Program sunset date was extended until 2019. Mr. Feltner also reported on SB 577. The bill creates a 22 member, governor appointed subcommittee to study and make recommendations to the Governor and the legislature about a Single Entry Point for seniors and disability services. The subcommittee will be appointed in January of 2008 and will have until October of 2008 to make recommendations. Money Follows the Person Presentation: Julie Ousley, Department of Social Services – Missouri was awarded the Money Follows the Person grant in January 2007. The operational protocol has been submitted to CMS to approve this. Missouri received two and-a-half million dollars in the grant. This is not all-new money as Missouri has already been providing services but the grant allows 20% extra fee on these services. Normally the federal/state match is 60/40 but this grant will allow a 80/20 match. The purpose of the grant is to transition 250 individuals back into the community. This will be 100 new people who are elderly or disabled and 150 individuals with developmental disabilities. Ms. Ousley stressed that this does not mean only 250 individuals will be served. If there are more they will be served, but the state will not get the enhanced federal match. Grant objectives:
Will need the collaboration and participation of multiple stakeholders to help design and implement the changes that will need to be implemented in this project. Some of the stakeholders that have been involved include the MO Planning Council, MO Statewide Independent Living Council, long term care and ombudsman, Centers for Independent Living, state agency staff, People First and other state advisory councils. Operational protocol covers five different areas: succession; basic policy and procedures of meeting other protocols; organization administration evaluation fee and the budget. Must find ways to educate people about what money follows the person is. Have developed brochures and would like stakeholder input on them. After CMS approves them they will be distributed to the regional centers, nursing facilities, day habilitation centers, Centers for Independent Living, Area Agencies an Aging, senior centers, local public health agencies, county and family support offices and other groups. Plan to get the word out through grass root efforts. Habilitation centers conduct an annual review of each resident and the Money Follows the Person information will be made available to them at this time. There is a transition policy called Lets Get Moving. This is a example of transitioning an individual out of a habilitation center. There are similar policy examples for nursing home transition. Components include:
Demonstration participants can receive wavered services including Independent Living for Aged and Disabled, MR-DD Waiver, some State Plan Services and Personal Care and Case Management among others. The Transition Coordinators will work with public housing authorities to identify types of housing an individual must move to. The MO Planning Council will assist in addressing housing issues. These objectives include:
Individuals will be required to move onto a community setting, either in a home they or a family member own or rent, a leased apartment or a residential setting with no more than four people living there. Habilitation Center transition process: Person will participate in the person centered planning. Friends, family, guardians, whoever the person wants will be a part of this process. They can choose to self-direct or have a provider provide their care. These meetings will address what the person needs to live in the community and any fears the person may have. They will get to meet their providers and roommates before they transition. They will go shopping for furniture and groceries. They will meet with their service coordinator within 30 days after they transition and on a monthly basis for the first six months. The service plan can be changed or modified at any time there is a need. Nursing facility transition process: Division of Senior and Disability Services will handle these. Participant and their friends, family or guardian will be a part of the planning process. Housing needs will be addressed. Person can choose to self-direct their care or have provider provide it for them. The Centers for Independent Living will be included in these transition meetings and will help assist transitioning individuals into the community. All participants will be surveyed to see what worked and what could have been done better. Continuity of care: Had to assure CMS that the participants would continue to receive their services once the grant period was over. DHSS and DMH are going to assure that they are available to continue services for these individuals. Benchmarks:
Have contracted with University of Missouri Institute for Human Development. They will be looking at some other measures. These include:
Ms. Ousley handed out brochures for the program for stakeholder input. She also asked for suggestions for a name for the project. PIC member's questions and concerns:
Public comment on Money Follows the Person: Wayne Lee, Epilepsy Federation. Had concerns as to if people with mental illness were included in the grant. Robin Rust responded that the institution has to be Medicaid certified and the state psychiatric facilities are not Medicaid matchable. Vicky Davidson, MO Planning Council for Developmental Disabilities. Had concerns as to if the brochures would be available in alternate formats. Response: Was told that would be addressed. Unidentified individual. Had questions as to the number of wavered hours that would be available under the grant. Are currently capped at five and one quarter hours. Response: Current programs that are in place now will not change. CMS has 90 days from the time the operational protocol is submitted to approve it. Once it is approved Missouri will start receiving the grant money. One Missouri: Mike Hanrahan, President of The ARC of the US, Missouri State Chapter. One Missouri, is a coalition for community inclusion has been formed to ensure that Missourians with disabilities have the opportunity to live, work, play, worship and fully participate in their community. Current members of One Missouri include The ARC of the US, MO State Chapter; American Association of Intellectual Developmental Disabilities, MO Chapter; TASH, MO Chapter; People First of MO; Missouri Planning Council; Paraquad and MO Protection and Advocacy. One Missouri is greatly concerned about the recent announcement by the Governor and the Department of Mental Health that they intend to build a new state-of-the-are facility on the grounds of Bellefontaine Habilitation Center in St. Louis. He sited the recent Department of Justice investigation of this facility. Ten states have closed all of their state institutions and thirteen other states are down to one remaining institution. The President's New Freedom Initiative and the CMS Money Follows the Person demonstration grant focus efforts on including individuals with disabilities in their community and providing funding to move them from institutions into the community. National, legislative, judicial and other administrative made four basic commitments:
One Missouri asks that the PIC recommend to the Governor and the Department of Mental Health that they rescind the proposal to build a state of the art facility on the grounds of Bellefontaine Hab Center. Instead they should focus on the person centered planning for individuals who deserve and desire to live in the community. Most young families will not choose to place their child with a disability in an institution. The money that will be spent on Bellefontaine could be better used. Ms. Hays made a motion that the PIC write a letter in opposition of continued support of Bellefontaine. Discussion followed as to if there was a quorum present to vote on a motion. Mr. Feltner stated that during the Mental Health Task Force meetings held last year there were a number of parents with adult children in the hab centers who were very opposed to closing the hab centers. Ms. Thurston seconded Ms. Hay's motion. The motion died due to lack of a quorum. Public Comment: Verlene Crumwhite, Talked about her son who had spent his early years at home then was institutionalized for several years. After that he moved back into the community in his own home. He later was diagnosed with cancer and passed away. He touched many people's lives in the community, which was evident at his memorial service. He could not have done this if he had been in an institution. Kent Kolaga, Jefferson City. Building a new state of the art facility will not take care of the problems of staffing levels, staff training, case management and failure of the administration to see these problems were taken care of. Need to show the hab center parents that community based services are just as safe if not safer than the hab centers. Gary Stevens, Rolla. Spoke against building a new facility at Bellefontaine. Linda Steinshouer, Springfield. Is the parent of a son with a disability. He is very involved in the community and church. Said she could understand the fears of parents but that they needed to be shown what was available in the community. Vicky Davidson, representing the American Association of Intellectual Disabilities. Expressed the organizations deep concerns over the Governor's and the Department of Mental Health reversal of their decision to close Bellefontaine. If the plan to build a new 120 bed facility moves forward it would set the work of the Personal Independence Commission back by decades and fly in the face of the efforts of the PIC to get people out of institutional settings. It is also a violation of individual's civil rights. AAID and The ARC have published a position statement stating that institutions are unnecessary and inappropriate for their constituents, regardless of type or severity of disability. It would be a wiser use of taxpayer dollars to focus efforts on developing community capacity rather than buildings and programs that have proven unsuccessful. Dolores Hampton, MO Planning Council for Developmental Disabilities. The MO Planning Council is working on a series of success stories of families who have transitioned loved ones from Bellefontaine into the community. These parents were very afraid at first but now say they wish they had done this years ago. They can be a great resource in helping other parents. Wayne Lee, Epilepsy Federation. Also spoke against habilitation centers. Has past experience as an employee of an institution. Parent of a younger child with a disability. Her daughter has always been included in her school and community. Studies show that students with disabilities perform better when in a regular classroom. The quality of life is improved when there is friendship and social integration. This is true for all age levels, not just children. Written testimony from a parent described the process they went through to transition her son from a habilitation center back into the community. It was decided that since the PIC was unable to vote on the motion, they would send a copy of the minutes reflect the discussion on the Money Follows the Person and the testimony on One Missouri to the Governor's Office. The next meeting of the Personal Independence Commission is Monday, September 10th. The meeting adjourned. |
