PIC Eligibility and Access Committee Meeting
February 27, 2003
Finalized report number 1 dealing with selected topics issued to PIC on 3-10-03
Eligibility and Access Committee Charge
Issues/Topics include:
Point of entry and disability determination
Assessment/screening instruments
Services offered by agencies
Barriers and Recommendations
Chair: John Solomon
Members:
Wendy Hays
Kirsten Dunham
Julia Kaufmann
Sue Orton
Rick Horrell
Jo Moncrief
Stephanie O'Brien
Note: The state agency representatives serving on this committee provided technical assistance only. The comments and recommendations of the committee do not necessarily represent the opinions of the agencies they represent.
Issues and recommendations
Access
Standardized application form
We understand some state agencies are working on a standardized application form. We applaud these efforts. It is however important to acknowledge that some individuals may only need minimal services so let's be sure not to mandate a more complicated process for these individuals. "Let's don't make them go through the entire barnyard when all they need is an egg".
There is no formalized cross agency referral system. Persons often present for services to a single agency that may or may not be familiar with other agency services.
Agency automated systems have evolved over many years and in most cases are isolated to a specific agency. Agencies systems communicate between agencies.
Many families have complex and multiple service needs that cross agency responsibilities.
Often substantial federal funding is lost by not determining client eligibility for appropriate federal funding sources in a timely fashion.
Recommendation:
The state needs to develop an Automated Initial Assessment and Referral System to be used by all human service agencies during the initial assessment process. The system needs to be simple and run as a desktop application (CD ROM) or perhaps web based.
It would be a series of screens with links to other agency programs. For example, during the application process for Medicaid eligibility determination, the question may be asked, "do you have a child with DD. If yes the system would automatically bring up a reference to the Div. MR-DD. The potential for possible other links are almost endless.
There could even be questions related to abuse and neglect that may flag children at high risk.
Funding for the development of such a program may be appropriate through the Systems Change Grant.
Process for funding to follow individuals (N.H. funds flexibility)
While for the last several years H.B. 1111 (Dept. of Social Services Appropriations Section 11.455) allows funds to follow clients to prevent Nursing Home placement and to allow clients to move from Nursing Homes with their funds following no process or administrative procedure has been implemented to allow this to happen.
In addition, few persons are aware that this is an option. This may be an issue for the PIC informed choice committee. However information often is the prerequisite to access so the issue is also being addresses by this committee.
Recommendation:
There needs to be a formalized process for accessing the flexible funding authorized in H.B. 1111 Section 11.455. This could be accomplished through intergovernmental transfers of funds among agencies.
In addition, a mechanism to ensure that persons are aware of this option needs to be developed. Some process should be included by amendment to the current Nursing Home reform bill. Perhaps a requirement for N.H.'s to explain to potential and existing clients that other care options exist.
Develop base line data for measuring movement of agency waiting lists
We know that some agencies have waiting lists for services. The Olmstead Ruling does not prohibit waiting lists and acknowledges that the states "obligation is not boundless".
The ruling also mandates that waiting lists must move at a "reasonable pace". While the ruling does not define reasonable pace some lawsuits have been settled with courts defining reasonable pace as 30 days (Pennsylvania).
Recommendation:
Agencies with waiting list should develop a standard database, which can determine the average wait time by client. S.B. 266 sponsored by Senator Shields would mandate that the Division of MR-DD develop a plan to address the waiting list.
We recommend that the PIC support this bill and ask that it be expanded to all agencies with waiting lists.
Eligibility
Access to existing programs by disability group
Programs like the V.R. personal care program by law and state regulation limit or exclude persons with DD based on their inability to self direct services. In many cases persons with DD have legal guardians that serve as advocates and provide supports for their clients. These persons could well assist some individuals with DD to carry out the activities of self direction. To deny services to persons based on the severity of their disability we believe may violates the provision of the Americans with Disabilities Act, possibly the Olmstead Supreme Ruling and certainly individual civil rights.
One could argue that the same issue exists within the Division of MR-DD regarding the onset of the disability and the definition of DD. The definition of DD is in federal statue. However, our state has defined DD in state statue in a much more liberal fashion requiring functional deficits in only two life skill areas instead of the federal definition requiring deficits in the three areas. Public policy should give priority to persons with the greatest need. We believe it may be possible for an individual to be determined eligible for services under the state definition of DD but not have a disability serious enough to be covered by the Home and Community Based Waiver that uses the federal definition for eligibility determination.
Recommendation:
For the Personal assistance program, request a legal opinion as to whether or not limiting this program by disability and or functioning level is a violation of client rights. Revise current laws and regulations to allow a guardian/designee to assist persons with DD to self direct their services.
For the Division of MR-DD, the state definition of DD should be revised to be consistent with the federal definition. Persons determined eligible under the current definition would be "grandfather" in with their current services.
Since this recommendation involves legislative action we are referring these issues to the Legislative Committee of the PIC for further review and recommendations.
Related Issue
During our Feb. meeting information was distributed regarding the "New Freedom Initiative" introduced by President Bush. We believe this initiative is consistent with the goals of the PIC and that every effort should be made by our state to become involved in this "Money Follows the Individual" approach.
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