Personal Independence Commission

November 12, 2002

Meeting Minutes

Members in Attendance:

Lt. Governor Joe Maxwell
Kirsten Dunham
Ron Vessell
Richard Horrell
Anne Deaton
Robin Rust
Senator Pat Dougherty
Rep. Lana Ladd Baker
Ann Jackson
Mary O'Brien
Wendy Hayes
Roger Garlich
Linda Allen
Greg Vadner
Neva Thurston

Lt. Governor Maxwell called the meeting to order.

Department Updates on Action Plan

Ron Vessell, Division of Vocational Rehabilitation, gave an update on the Action Plan relating to his division. 

• No. 8 Training consumers on how to coordinate, negotiate, purchase, direct, hire and fire attendants:  There are a number of curriculums out there.  Although there is not one set curriculum, the division views this item as being completed.
• No. 9 Developing a universal application:  They have visited about this and have identified a few things that would need to be changed in rules.  They do have attorneys who are working on the coordination. 
• A waiting list was turned in at the October meeting.  There has been no change.
• Ticket to Work:  The "Tickets" are arriving.  They have not seen any numbers as to how many people are using the Medicaid Buy-In feature of the program. 
• Informed Choice Training: Rob Honan has agreed to facilitate a group to start to move to developing a process as to what will happen after individuals are trained. 

A state team that includes stakeholders has been identified, they do have a concern with setting protocols to follow the law since guardianship is involved.  (The state team is representatives from the departments that are involved in the informed choice workgroup.  Also included within that are those individuals who are involved in giving us access to nursing homes. 

The informed choice group plans on meeting in late November or early December to work out details and discuss concerns and comments.  Lt. Governor Maxwell requested a timeline on when the protocols would be done.  He suggested meeting the first part of December and taking a draft protocol so that they have something to respond to.  After the first meeting it was suggested to give them 30 days to review the protocols to allow time for their attorneys, etc. to review them and then have another meeting. 

Mr. Garlich suggested the group link to special education in order to talk with families about choice and access.

Linda Allen provided a brief update on the Missouri Care Options.  They are working on capturing unmet need information.  They are developing new materials that the Missouri Hospital Association has agreed to put in their admission packets.  They are also revising nursing home admission documents and revising pre-long-term care screening documents so there are specific questions about why people are going into or thinking about going into a nursing home.  This information will not only be useful when going to the legislature, but also for the informed choice group.  As people are being admitted that could have a chance of coming out we would refer that information to the group.  The R# will not be given out until the questionnaire is complete and turned in.

Social Services provided a written update on spenddown recipients by income level. Department of Mental Health provided a written update on action plan items.

Senator Dougherty asked if the letter discussed in an earlier meeting had gone out to front line workers.  Lt. Governor Maxwell said an e-mail has gone out to case workers, but to his knowledge it had not gone out to the other staff.  The Senator would like to see an answer as to why it has not gone out to all workers by the next meeting.

Workgroup Assignments

The Commission members agreed to focus on three main areas:

• Implementing PIC priorities outlined in the Action Plan
• Implementing Real Choice Systems Change Activities
• Implementing a systems that informs all individuals facing choices about long term care and supports about all the options by using strategies such as education; outreach; training providers, advocates, etc.; diversion and transition activities; and other methods of providing access to information

The Commission reviewed the communication process.  workgroup members who have questions for state agencies will go through the co-chairs or Rob Honan in order to coordinate multiple requests for information and to make sure the information is received.  Summaries of workgroup activities will  be disseminated through various means, including posting it on the website. 

Kirsten explained the updated budget, which includes funding for the workgroup structure.  Mr. Garlich made a motion to approve the budget as presented.  Ms. O'Brien seconded the motion.  Motion passed.

The Workgroups met and worked for two hours.

Real Choice Demonstration Projects

Robin Rust gave a quick briefing on the Real Choice Grant Demonstration project.  She requested the Commission to look over the materials and let them know whether it has been a fair process and whether they should move on.

Senator Dougherty made a motion to adopt the recommendation.  Ms. Hays seconded the motion.  Ms. O'Brien asked for additional time to review all of the requests.  Rob Honan will set up a teleconference call on Friday, November 15 for a vote to be conducted.  Senator Dougherty withdrew his motion.

Workgroup Plans

The Informed Choice workgroup's focus is to provide institutional diversion and community transition.  The group accepted each department or entity should develop a single document outlining available services, which is currently at the print shop.  They are excited about the idea of a database and will work with the individuals developing it to make certain it is collecting the information needed.  Everyone who will have contact with individuals need to be identified and trained.

The Eligibility and Access workgroup set as a priority developing a truly universal application.  They would like to be able to input the information into a computer and it give them a list of what services that individual might be eligible for.  They also outlined their action steps to implement the grant objective to establish an automated referral system. 

Legislative Subgroup made recommendations for three legislative concepts. The Children's Health Insurance program requirse that a child be uninsured for six months before they are eligible for coverage.  The committee recommended creating an exemption for children with disabilities.   Ms. Jackson made a motion to support the recommendation and Mr. Horrell seconded the motion.  The motion passed.

The second recommendation was to allow an income disregard for housing when determining Medicaid income eligibility.  Senator Dougherty made a motion to support the recommendation and  Ms. Jackson seconded the motion.  Motion passed.

The third recommendation was to support changing the "home-bound" requirement for Medicaid home health services.  Mr. Garlich made a motion to support the recommendation and Ms. O'Brien seconded the motion.  Motion passed.

The Service Capacity Continuum workgroup recommends that the commission enlist the assistance of GCD and Karen to contact SILC, MOCIL, state agencies, Senate Bill 40 Boards, etc. to request information regarding existing and needed community capacity.  (Community capacity is defined as people with disabilities being able to have equal access to community supports, physical infrastructure supports, paid and natural supports, provider, housing, transportation, employment and other community supports.) 

The Outcomes/Follow Along workgroup issues and topics include quality assurance measures, self-determination, contract service, coordination, various recommendations, evaluation progress on the home and community-based plan and best evaluation practices.  Their plan includes activities such as a toll free number to access information and evaluation of services and case managers.

Workgroup chairs were asked to email their plans to the Governor's Council on Disability. 

The Commission will begin meeting every other month on the second Monday at 10:30 a.m. beginning January 13, 2003.   Workgroups will meet in the month between Commission meetings.