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Personal Independence Commission

Special Team Report

Personal Care (Lead Agency: DESE)

Result Area:  Common Application/Assessment  Information & Common Release of Medical Information

Draft of a general information form to be used by all agencies is in progress.  It will be designed for automation after pilot testing. The process begins when a consumer requests assistance and concludes with being connected with the appropriate (community or state) services.   To minimize repetition of information, consumer information in the redesigned system will be collected as needed and utilized and shared by multiple agencies per consumer authorization:

  1. General information necessary to understand the request for assistance and refer the consumer to the best provider;
  2. Information needed to determine program eligibility:  financial information, medical information, and functional/clinical/psychiatric assessment; and
  3. Authorization for agencies and providers to share consumer/client information.  Voc. Rehab, DHSS, DSS, and DMH have agreed upon common general information data elements.   All of these agencies will be using the same Authorization for Release of Medical Information. 
Action
(What needs to be done to accomplish the result - key actions) 		Deliverables
(How will we know if the action is complete) 		Responsible Agency & Person
(Only one name per action) 		Due Date Resources Existing and/or Needed Measures or Indicators, if appropriate
Design a common general information form for all partner agencies to use and share (common application for services) - involve front-line staff in the development.  Include consumer input Common general information form piloted by multi-agencies Jeanne Loyd, Voc. Rehab.
DHSS
MRDD
DSS
 November 2003 Staff time to develop and implement 95% complete, The common  general information form is complete, and research into the best electronic method is ongoing.
Consensus on a universal assessment tool and process using DA-2 Universal assessment tool and process Jeanne Loyd, Voc. Rehab.
DHSS,  and DSS		 2003-2004 Existing staff 100% Completed
Request rule change to allow DVR to accept DHSS Rule Change for DHSS placed on State Board Meeting Agenda - July 2003 Jeanne Loyd, Voc. Rehab.
DHSS		 2003-2004 Existing staff 50% with expected completion by march of 04 in the areas where this will work.

Transition from Institutions (Lead Agency:  DMH)

Result:  Process for Transitioning Individuals with disabilities who are institutionalized and who are eligible for community-based treatment.

Develop approaches to assist with funding the transition from institutions to community services and supports.

Action
(What needs to be done to accomplish the result - key actions)		 Deliverables
(How will we know if the action is complete)		 Responsible Agency & Person
(Only one name per action)		 Due Date Resources Existing and/or Needed Measures or Indicators, if appropriate
Submit an amendment to the CMS for MRDD Comprehensive waiver to add Transition Services Amendment approved by CMS DMH/DMRDD
Kay Green		 Submit March 2004 Existing funding As of  2/10/04 amendment is drafted but has not been submitted)
Further discussion with Voc. Rehab and DHSS to consider similar amendments Amendments submitted to CMS Kay Green will coordinate the discussion Immediate Discussion Additional funding may be required VR and DHSS will not request amendments due to funding limitations
Spatial Analysis of State Operated ICF/MR Facilities Appraisal; Report from Design & Construction DMH/DMRDD Anne Deaton/Design & Construction Randy Allen January 2004;
September 2004		 DMS Real Choices Grant funding Appraisal Completed (20%)
DMRDD Consolidation of Management Functions at Hab Centers Management Functions Consolidated at Bellefontaine & DDTC & Higginsville & Marshall DMH/DMRDD Anne Deaton July1 2004 Existing Resources Action Plan Under Development
DMRDD 5 Year Habilitation Center Plan Online tracking for the entire 5 year plan is being developed
Relocate approximately 225 persons from 3 State Operated ICFs/MR to Community Living Arrangements Reduced census at Marshall by 51; Bellefontaine by 110; Nevada HC by 64 DMH/DMRDD Anne Deaton July 2006 Parent/Guardian Choice; Community provider capacity; money transfers from ICF/MR to Community Action Plan Under Development

Transition from Institutions (Lead Agency:  DMH)

Result Area:  Recommend any potential means of expanding home and community-based services or community-directed programs.

Identify and alleviate barriers to community placement for "high risk" individuals. 

Action
(What needs to be done to accomplish the result - key actions)		 Deliverables
(How will we know if the action is complete)		 Responsible Agency & Person
(Only one name per action)		 Due Date Resources Existing and/or Needed Measures or Indicators, if appropriate
Explore Housing Options
  • US Housing and Urban Development (HUD) / Community Development
  • MO Housing Development Commission (MHDC)
  • US Department of Agriculture/Rural Development
  • Karia Bastia, DMH Housing Coordinator
 Invite contact person from each of the  Housing Agencies to meet with subcommittee to provide information on options Edwin Cooper
DMH Housing Team Member		 90 Days   Presentations were given at the January 12 PIC meeting from each of the 3 Housing Agencies
Housing Conference in Iowa Housing Professional Attends Conference Karia Bastia, DMH Housing Coordinator 45 Days DMS Real Choices Grant funding to defray any conference costs above $2500 allocated by Community Living Exchange and the Center for State Health policy at Rutgers University State Agency Staff participated and prepared a report for PIC members
Independence Plus Grant
  • Establish Task Force;Plan Pilots;
  • Implement Pilot;
  • Plan QA;
  • Evaluation;
  • Apply for Independence Plus Waiver
DMH, MRDD/MO Planning Council/UMKC Center for ExcellenceKay Green/Dolores Hampton/Tec ChapmanGrant Taskforce Dec. 2003;
Oct. 2004;
Mar. 2005;
June 2006;
October 2005		 Grant funds & waiver funds Action Plan Under Development
Pilot Community Employment Supports Individuals will obtain and/or keep jobs with support of a personal assistant DMH, MRDD, Terry Jackson Begin services in Barry/
Lawrence County Feb. 2004;
End Sept. 2004		 DMS Real Choices Grant funding Action Plan Under Development
Training & Evaluation of Pilot Community Employment Supports Training completed; evaluation tool completed UMKC September 2004 Existing Funding Action Plan Under Development
Explore Cash & Counseling options Focus groups and speakers from other states; planning document DMS Aug 2004 DMS Real Choices Grant funding Action Plan Under Development
Secure Independent facilitator to lead focus groups Agreement to facilitate DHSS   CMS technical assistance staff 100%
Finalize participants list Participants list DHSS March 2004    
Send in Letter of Intent to apply for RWJ Cash & Counseling Grant Submit letter DHSS February 13, 2004 Letter was submitted Action Plan Under Development
Cash & Counseling Grant Work with UMKC to prepare Cash & Counseling Grant DHSS March 31, 2004 Grant is being written  Action Plan Under Development
Development Office Policy and Protocols Policy Manual Completed DHSS June 2004-August 2004 Existing resources Action Plan Under Development

Consumer Options Based on Needs, Choices, and Capacity
(including diversion strategies)

(Lead Agency: DHSS)

Result Area:  Amend DHSS Rule 19 CSR 30-88.010 (Nursing Home Resident's Rights)

DHSS is currently crafting a change to the above rule that would clarify that clients have the right to receive treatment in the least restrictive environment, as appropriate, and to be informed of their choices concerning community placement.  Information regarding resident rights and facility rules are required to be posted in a conspicuous location in the facility and copies provided to anyone requesting them.

Action
(What needs to be done to accomplish the result - key actions)		 Deliverables
(How will we know if the action is complete)		 Responsible Agency & Person
(Only one name per action)		 Due Date Resources Existing and/or Needed Measures or Indicators, if appropriate
Write the rule amendment and mail out the revision to Board of Health members Amended rule with language concerning least restrictive environment Nancie McAnaugh 11/6/03 Current Staff Rule revision was filed  with the Secretary of State's office

Consumer Options Based on Needs, Choices, and Capacity
(including diversion strategies

(Lead Agency: DHSS)

Result Area:  Work with MU-School of Nursing to Add Data Elements to the MDS Screening Form

Currently in Missouri the MDS only collects federal data elements.  DHSS will work with MU to add state specific questions to the MDS screening form.  For example, we do not know with any certainty why people choose to enter skilled nursing facilities.  Is it because they could not find services in their local communities?  Is it because they no longer had family members to help care for them? Were they informed of other options?  Or, is it because it is the most appropriate placement for them at the time.  By collecting data on why people enter nursing facilities it may be possible to identify gaps that may exist in our current service delivery system, and to develop programs to fill those gaps.

Action
(What needs to be done to accomplish the result - key actions)		 Deliverables
(How will we know if the action is complete)		 Responsible Agency & Person
(Only one name per action)		Due Date Resources Existing and/or Needed Measures or Indicators, if appropriate
Meet with MU-School of Nursing concerning proposed changes to MDS Modified MDS to include state-specific questions Nancie McAnaugh December 2003 Current Staff Currently in Negotiations, Next meeting scheduled for April 1, 2004

Consumer Options Based on Needs, Choices, and Capacity
(including diversion strategies)

(Lead Agency: DHSS)

Result Area:  Transitional placement in habilitation centers

New admissions to state operated habilitation centers shall be considered time limited, unless the person is offered community services and chooses the habilitation center, the person has been admitted by the Court or has forensic status.  Admission to the state operated habilitation center will be based on most critical need first.   All new admissions to state operated habilitation centers shall be reviewed at thirty (30) days to determine if the person has a continued need for habilitation center services.

Action
(What needs to be done to accomplish the result - key actions)		 Deliverables
(How will we know if the action is complete)		 Responsible Agency & Person
(Only one name per action)		 Due Date Resources Existing and/or Needed Measures or Indicators, if appropriate
Implement policy that approaches all placements in habilitation centers transitional placements. Statewide Implementation of Policy Anne Deaton, MRDD 2004 Existing Staff Complete: Implemented 7/1/03
Develop Evaluate tool for implementation & success of the habilitation center transitional placement policy Recommendations to Anne Deaton from Management Advisory Team Terry Jackson, MRDD April 2004 Existing Staff On time

Real Choices (Lead Agency:  DSS)

Result Area:  Streamline the system to assure easy and quick access to needed services and supports

Action
(What needs to be done to accomplish the result - key actions)		 Deliverables
(How will we know if the action is complete)		 Responsible Agency & Person
(Only one name per action)		 Due Date Resources Existing and/or Needed Measures or Indicators, if appropriate
Review the DHSS TBI project and Voc. Rehab Project Success collectively, agree on modifications and give final approval to the development of data standards for electronic data dictionary Document identifying the data elements/standards  for the electronic data dictionary Sandra Levels, DMS
DHSS
DMH
DSS
DOLIR
DED
OA-Office of Information Technology		 October 1, 2003 To be discussed 100% Complete
Participate with partner agencies in initial planning of the development of Project Assessment Quotation for the development of data standards necessary for common electronic data dictionary Project Assessment Quotation to secure development costs of developing a multi-agency data dictionary that links with national XML standards Faye Zumwalt, DHSS and Jan Grecian, OA
DMH
DSS
DOLIR
DED		 October 31, 2003 MOU's for shared resources to fully develop the standards and a small pilot implementation project 95% Complete:
Develop a plan to sustain ongoing training on Informed Choice Plan for sustaining Informed Choice training Sandra Levels, DMS
Real Choices Grant		 December 2003 Shared resources to be identified 95% Complete: Scheduled training should be complete by April 04; Next Informed Choice team meeting scheduled for March 31 to discuss who will be responsible for ongoing sustainability.
Schedule training for Office of Community Placement Plan to train   July 2004   Action Plan Under Development

* Action Plan Under Development:  Many of the Actions encompass several steps that are not currently listed on the plan.  The team is currently