Personal Independence Commission

May 10 , 2004

Governor Office Building
MINUTES

Kirsten Dunham called the meeting to order.  Roll call was taken.  PIC members present were: Jeanne Loyd, Diane Poole (for Rick Horrell), Kay Green (for Anne Deaton), Sandra Levels, Nancie McAnaugh, Anne Jackson, Neva Thurston, Wendy Hayes, Roger Garlich, John Solomon, Martha Hicks and Bobette Figler.

Approval of Minutes:

The minutes from the March 15^th PIC meeting were not available.  They will be approved at the July meeting.

Co-Chair Reports:

Kyle Clower reported for Lt. Governor Maxwell.  Wants to hear about the status of the departments, the grant, and focus on what needs to be accomplished over the summer.

Ms. Dunham talked about the legislative session and the state budget and thanked all the advocates who worked hard on legislative issues.

Special Projects Update:

Nanci McAnaugh, Department of Health and Senior Services – Have established an Office of Community Integration to oversee transitioning people out of nursing homes and back into the community.  Will be setting protocol for entering nursing homes.  Will look at Informed Choice Training and will be taking this over for Division of Medical Services when the grant ends.  The office will also serve as a referral office.  Missouri has applied for the Cash and Counseling Grant and are very hopeful we will be one of the grant recipients.  Ms. McAnaugh will get copy of grant proposal to Donna Borgmeyer to send out to the PIC and the group.  Also have promulgated rules on resident rights in nursing homes saying that when people enter a nursing home they have the right to know of community-based services available to them.

Jeanne Loyd, Vocational Rehabilitation – Working with Office of Administration on universal application form.  RFP is out on this and are in the process of reviewing bids.  VR has put together a draft of the policy for sharing a universal application form.  The draft needs to be approved by Health and Senior Services.  They hope to have something in place by the July PIC meeting. 

Kay Green, Department of Mental Health  - The Division of MR/DD had prepared an amendment to their comprehensive waiver adding transition services.  The amendment was sent to Division of Medical Services and then on to CMS on April 8^th.  The Lt. Governor had requested to be notified when this happened.  He had also requested information regarding the decision by Vocational Rehabilitation and Division of Senior Services to not request an amendment to their waiver transition services.  VR had applied for a transition grant in 2002 to help people transition out of nursing homes back into the community.  VR did not receive grant because CIL’s were already providing the service.  VR had determined that it would cost about $1,500 per person or $4.2 million to transition 100 individuals back into the community.  The Division of Senior Services used that same cost estimate of $1,500 per person for a total cost of $2.8 million to transition 100 individuals out of nursing homes.  The Office of Community Independence will be charged with identifying individuals who potentially could transition from an institution to the community.  They will also look at barriers to transition opportunities and transitional service needs. 

The question was raised as to if Targeted Case Management could be used to help transition a person out of an institution.  There has been a change in CMS policy allowing Medicaid to be billed for six months or 180 days for Targeted Case Management if an individual is transitioning out of an institution.

Real Choices Systems Change Grant:

Sherl Taylor, Division of Medical Services – Gave update on grant activities over past six months.

• Objective 1 - Assure that the infrastructure and process reflects consumer choice and consumer input.  A presentation on Olmstead was done for attorneys, administrators and judges in St. Joseph.  Also Informed Choice trainings have been provided to community-based organizations, with only a couple of trainings left.  (This also falls under Objective 4).  Another item under Objective 1 is Best Practices Models.  A team has been identifying service delivery models on local communities.  These models will be listed in regional booklets.  These booklets will be set up according to the seven regions of the Division of Family Support. 
• Objective 2 - Streamline the system to assure easy and quick access to needed services and supports.  “The Missouri Guide to Home and Community Based Services” is available regular print, large print, Spanish, Braille, CD and cassette.  These have been distributed to libraries.
• Objective 3 – Conduct interagency coordination and collaboration to address Olmstead Stakeholders and Commission recommendations.  Cash and Counseling falls under this.  A group has been formed and have begun meeting.  A representative from CMS came and helped the group understand what Cash and Counseling is. 
• Objective 4 – Ensure informed choices at all stages of care so consumers can make good decisions.  The information from the Informed Choice Work Group will be transferred over to DHSS for the Office of Community Integration.
• Objective 5 – Enhance linkages at critical points to assure successful transition to community living.  Had started developing criteria for waiting lists but have had to put this on hold for the time being.
• Objective 6 – Conduct research on small demonstration projects to identify best practices and progress that should be replicated.  This falls under the Demonstration to Maintain Independence pilots.  There were six demonstration projects but two; Comtrea and Coalition for Independence have pulled out of the project.  The remaining four, Paraquad, Willows Way, Crider and People First implemented their projects.  The projects are now gathering their final evaluation information.
• Objective 7 – Establish a quality assurance mechanism that relies on consumer input and is data driven.  Community forums are being held around the state to get that information.

A request was made that the report on the grant be posted on the PIC web site.  A request was also made to put information about the number of people trained on Informed Choice on the PIC web site.

John Solomon made a motion that the PIC draft a letter to Anne Deaton commending her on her Five Year Plan for Habilitation Centers.  Roger Garlich seconded the motion.  Motion passed.  John Solomon will draft the letter.

Karia Basta, Department of Mental Health, gave a report on housing.  There is not enough affordable housing in the country or in the state.  Until this becomes an issue and a priority it will continue to be a problem.  The PIC Housing Work Group is working on a housing booklet.  This will give people a resource to go to for affordable housing.  There are waiting lists for most housing.

Public Comment:

Wayne Lee – Transportation is a major issue for him and others.  Needs to be looked at and dealt with.

Ms. Dunham suggested having someone from the transportation area do a presentation for the PIC similar to what the MO Housing Commission did.  Will try to get someone from MO Department of Transportation.

Meeting adjourned.