Personal Independence Commission

December 10, 2002

State Capitol Building
Jefferson City, MO
MINUTES

Members in attendance:

Kirsten Dunham
Robin Reed
Neva Thurston
Anne Jackson
Juan Samaniego
Anne Deaton
Greg Vadner
Senator Pat Dougherty
Linda Allen
Rick Horrell
John Solomon
Roger Garlich
Ron Vessell.

I.  Public Comment:

There was no public comment offered.

II.  Co-Chair's Report:

Derrick Dufresne will be speaking to the Olmstead Stakeholders Group meeting Monday, December 16^th.  He is working in the state of Ohio to do person- centered planning and individualized budgets.  Everyone is urged to attend the meeting.

The demonstration projects funded through the Real Choice Systems Change Grant were approved by the PIC during a conference call November 21^st.

The PIC work group reports are now on the Governor's Council on Disability web site.  The web address is www.dolir.mo.gov/gcd

III.  HB 11 Money Follows the Person Language:

The question that has come up is if a person who has a developmental disability is in a nursing home and wants to move out into the community can the money follow that person.  It has been working to follow people from the nursing home to the personal care options through Vocational Rehabilitation and Senior Services.  Could the money also follow a person from the nursing home to the Division of MR/DD community services and supports?  Part of the challenge is that some community options are in the Medicaid State Plan, which are entitlement services, and others are Medicaid waivers.  Another challenge is that the overall increased demand for all long term support options means that even if money follows the person, increased appropriations will have to be requested by one or more of the state agencies.  The effect, however, is that certain people with disabilities have access to personal assistance services while other individuals and families are placed on long waiting lists for necessary community supports.  If this is dependent on the type of disability a person has, then that is discrimination.  Discussion followed.  Mr. Solomon requested the item be put on the agenda again for the January PIC meeting.

IV.  Letter to DFS Staff and Medicaid Recipients:

Janel Luck from Division of Family Services explained the steps DFS has taken to inform workers and clients about the changes in spenddown.  It was requested at a previous PIC meeting that Division of Family Services send a letter to Medicaid recipients affected by spenddown telling them about the Medical Assistance for Workers with Disabilities (MA-WD) Program.

DFS did:

• Send a notification to spenddown recipients about the changes in spenddown
• Sent policy memos to field staff
• Did conference calls with managers and mid-level managers
• Sent memo to and did trainings for front line DFS workers
• Information is in the Medicaid Provider Bulletin available on line
• Provided spenddown education presentations to several consumer groups

The Correspondence and Information Section of DFS is answering an additional 700 phone calls a month since the changes in spenddown were implemented.  As of the end of November there were 6900 persons in the MA-WD Program.  This would suggest that people are taking advantage of the program.  They believe that three-fourths of these people came from spenddown population.  Approximately 25,000 Medicaid recipients were notified about the changes in spenddown.  Another change was the income limit for single individuals was raised to 80 % of the Federal Poverty Level.  There were about 4,000 who moved off spenddown into regular Medicaid based on this.   In addition some people age 63 and over have moved to Medicaid coverage under the Home and Community Based Waiver.

Senator Daugherty requested another letter be sent to DFS front line workers telling them about MA-WD and 1619 a and b.  These are long standing programs that help people move from SSDI and SSI into employment without loosing their health care coverage.

Greg Vadner mentioned that any Medicaid program that is over estimates would be closely scrutinized during the next legislative session. Also any optional group or program will be closely scrutinized.  MA-WD will be one of these programs.

Discussion concerning the cost of and effectiveness of additional mailings followed.  It was decided to keep Senator Daugherty's recommendation and to work to train groups who work closely with those with acute medical conditions, such as kidney transplant recipients, so they know what their options are. 

Ms. Luck requested DFS get this recommendation in writing as well as suggestions as to what the letter should contain.

V.  Work Group Reports:

Eligibility and Access Work Group:  First job is to create a standard application form for all departments.  They are looking at existing forms from other agencies to see what common information is requested.  Will need to cover all agencies the PIC works with.

Legislative Work Group:  Legislation addressing the six-month waiting period for children with certain disabilities to receive coverage on the CHIPS Program has been pre-filed.  Legislation concerning changing Medicaid rules to allow for an income disregard on housing has been postponed because of the financial status of the state.  Changing the definition of home bound under the Medicaid program will be addressed. Research will be done to determine if the change can be made through rule change.  If it will require legislation Sen. Dougherty will draft a bill.  Other possible legislative actions relate to nursing home funding and long tern care reform.  Another idea was requiring those on Medicaid to be re-evaluated every so often.

Service Capacity and Continuum Work Group: Looking at a seamless system.  A huge database of all services that are provided by the state needs to be developed.  This information would need to be housed within a central agency, possibly the Governor's Council on Disability. 

Follow Along and Outcomes Work Group:  In the process of gathering information.  Going to set timelines and responsible persons at their meeting Monday, December 16^th.

Informed Choice Work Group:  Informed Choice Brochure, part of the Real Choice Systems Change Grant activities, will provide a collective synopsis of Home and Community Based Services available in Missouri.  It is in the final process of being reviewed by each agency.  Following these reviews the booklet will then be brought back to the PIC for review, probably by February.  Cost of the initial printing of the booklet will be covered in the grant.  The cost of printing additional copies of the booklet would be shared by all agencies involved.  Agencies will need to figure this cost into their budgets.  Sherl Taylor will find out the cost.  A data collection source is set up and ready to start collecting data on why people are entering nursing homes.  The Division of Senior Services staff have met with Missouri Hospital Association and the Social Work Association of the Missouri Hospital Association who are willing to help train social workers on nursing home diversion.  They also will include the information in admissions documents of hospitals and rehab centers.  Admitting physicians and attending physicians also need to be educated about other options besides nursing home placement.  The work group came up with a list of categories of people who come in contact with people who have long term care choice issues.  The group is going to find ways to dissimilate information about Informed Choice to these people.  It was suggested the Informed Choice advocates could probably attend in-service trainings for doctors and tell them about the Informed Choice curriculum.  Information from other states conducting nursing home transition programs show the obstacles include:

1. Housing
2. Transportation
3. Opposition from un-cooperative guardians

A meeting was held December 5^th with representatives from nursing homes, habilitation centers, Centers for Independent Living, long term care ombudsman and state agencies.  The group discussed the PIC's plans for nursing home diversion and transition.  Guardianship issues affect habilitation center side of picture.  Linda Allen and Anne Deaton are working on procedures for presentation and wrap-around policy in place before trainings take place.  These meetings will take place before the January PIC meeting.

The meeting was adjourned at 3:00.