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September 19, 2006
Hearing Room 3, Capitol Building
Jefferson City, Missouri
MINUTES - DRAFT
Kirsten Dunham called the meeting to order. PIC members present were: Sandra Levels, Kay Green, Wendy Hays, Kelly Flaugher (for Jeanne Loyd), Eric Feltner, (for the Lt. Governor). There was not a quorum so the PIC met as a sub-committee.
Co-Chair Reports/Legislative Update:
There was no co-chair report.
Single Entry Point Presentation:
Area Agencies on Aging – Ray Diekmeier and Dave Sykora did a presentation on single entry point. A single entry point is an integrated, coordinated system to help access to long-term care. It embodies concepts like one-stop shop, uniformed assessment process, and statewide information and technology system. Why is a single entry point important for Missouri? First a single entry point improves access to long-term care services for both the consumers and caregivers and second is cost of long-term care services to consumers and taxpayers. Missouri spends more on nursing home care than on Home and Community Based Services. A balance between spending on these two services needs to be set. Long-term care services in the least restrictive environment are the most cost effective option. A single entry point enables individuals to learn about eligibility for services, to receive assistance to get access to those services and coordinate the delivery of those services. The single entry point would also provide information and referral and a statewide database covering all medias.
Mr. Sykora talked about some of the initiatives the Area Agencies on Aging have been doing. In a single entry point there are two key components; one is the development and implementation of the Aging Information Network (MAIN). This can be accessed at www.moaging.com This is the information and assistance program operated and maintained by the ten Area Agencies on Aging. The program can be searched by key word, category or list of services. The program has four modules:
- A client registration package that includes service tracking, billing, reporting, etc.
- Information and assistance module that allows I & A tracking and recording, service referral and client registration
- Intake and assessment
- Care plan manager is automated case management
The second thing was the development and implementation of a NAPIS Pack, the statewide information and management system. This is a shared database and is terminal server based program. The program meets HIPAA requirements for security and is hosted in a data center in St. Louis and one in Illinois. If for some reason the database cannot be accessed in Missouri it can be accessed in the other location.
Centers for Independent Living – Amy DeLine, Paraquad, did a presentation about the concerns of people with disabilities with the current system and how a single entry point could benefit them. The research was done through focus groups and surveys. She also looked at what other states are doing. These were the major concerns raised:
- Communication service delivery – Feel there are differences between information from state and local providers. Do not know what services are available or how to access them. A single entry point could address this in several different ways:
- In Arkansas they created a website that consumers can log onto and get a list of the different referral services available in their area. Also providers can log onto the database and update their information
- In Minnesota kiosks were set up in public places where people go to access health information
- Indiana has a stakeholders board composed of representatives from CIL’s, Alzheimer’s Association and other groups to have input on how people receive services, how they access services and how those services are communicated to the public.
- Marketing – People were afraid if we switched to a single entry point they would not know where it was or if they could be served at that single entry point.
- New Jersey used the telephone line as one of the major single entry points. After using this a year they surveyed people and people did not realize they were using a single entry point.
- Massachusetts used the no wrong door model. The aging population still accessed services through AAA’s and people with disabilities still used CIL’s. The two agencies increased their coordination of services to become a single point of entry.
- Wait lists and wait periods – if they will be decreased by a single point of entry and create a bottleneck with everyone wanting to get services. Service providers were concerned about when people would be assessed for services and how long it would take for them to start receiving services
- Wisconsin has a no wait list policy. People enter through their single entry point and cannot be put on a wait list.
- The Federal Government has authorized presumptive eligibility for their Resource Centers.
- The Area Agencies on Aging have further integrated their single entry point to cut down on wait lists
- The capacity of a local agency to serve the disability community – The AAA’s were concerned that they might not have experience working with people with disabilities and those under age 60. Funding streams might create turf wars. In other states with single entry points the AAA’s have successfully served both populations.
- In Colorado agencies put in bids or proposal and are selected based on the care and services they can provide
- In Illinois or Oregon the AAA’s are given first bid. If they decide they do not have the capacity to serve everyone it is opened up to other agencies
- Having stakeholders and advisory boards to make sure all populations are represented
- In Pennsylvania the AAA’s have space for liaisons from all of the local agencies come in and handle referral calls for their agency
- Concerns about training and being sure case managers and those working at the single entry point understand the needs of people with disabilities and the philosophy of Home and Community Based Services and Independent Living.
- In Illinois each staff member has to go through periodic assessments to see where their deficiencies are, where their skills are and what trainings they have had or could use
- In Massachusetts, as stated earlier, consumers keep going to agencies they have always used
- Grants for funding single point of entry have funds available for training staff
- Concerns about transition from one agency to another and what might be lost in the transition process
- Some states working on single point of entry have had pilot projects and some states have taken up to seven or eight years before their single entry point was up and running
- The Federal Government is also reissuing center grants to states for another two years so they can expand their programs
- Another concern was having a statewide assessment tool and having the statewide access via databases to client information. Will the assessment tool be reliable? Will there be flexibility? How long will it take? If someone wants only one service do they need to take the full assessment? Information from other states in this area is inconclusive. In some states it takes four hours to complete the assessment while in other states it may only take half an hour. In some states you have to take the whole assessment while in other states you do not. The cost also varies greatly from state to state.
Other interesting information about single entry points:
- Funding for single entry point systems. Some states funded their single entry point through Resource Center Grants, Real Choice Systems Change Grants or supplemental grants. There are also grants for technology systems. Some states use general funds and Medicaid funds to establish it.
- Ways states established their single entry point
- In Oregon it went through legislation
- In Wisconsin an advocacy group took a report to the governor and said the system needed to change
- In Florida and Colorado it was done through budgetary measures
- Other states have done it through administrative reorganization
- All states with single entry points have the need for on-going evaluation of these so they know how well they are doing.
Mr. Feltner – One of the Lt. Governor’s priorities is to put together a panel to look at single entry point. The PIC and CIL’s can serve as a connection between the state and the disability community to solicit input and get advice on what is proposed.
There was some discussion about what Missouri has already done to promote Home and Community Based Services and the need bring the different agencies together to work on a single entry point.
Money Follows the Person Grant Update:
Ms. Green reported that the Division of MR/DD is interested. The Medicaid agency has to be the applicant for this particular funding. DMH will be working with other agencies on this.
Public Comment:
There was no public comment offered.
The next PIC meeting is Monday, December 11th.
The meeting adjourned. |
