Single Points of Entry

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Single Points of Entry

• Robert Mollica
• March 2006
• rmollica_at_nashp.org

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Overview

• Balancing long term supports systems
• Single points of entry
• Considerations

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The SPE context

• SPEs are one of several key components of long
  term support systems that affect choice balance
• Others
• Funding streams
• Budget mechanisms
• Eligibility process
• Nursing home supply strategies
• Full array of services

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Medicaid spending balance (billions) FY 2004
All groups Elderly, adults with disabilities,
MR/DD
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Percent by population group
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Medicaid Spending Balance 2004 Elders and adults
with disabilities
Includes HCBS waiver, state plan personal care
and home health. Does not include some state plan
services, state general revenue, OAA and other
programs
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Balance in the neighborhoodElders and adults
with disabilities
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Improving the balance in Michigan How long will
it take?
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Measures of balance

• Percentage spending on HCBS, NF
• Percentage of people served in community settings
• Participants days or days of coverage

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Balancing strategies

• Single long term care budget (OR, MD, WA)
• Access PA Community Choices
• Money Follows the Person (TX, MD, IN)
• Options counseling (NJ)
• Nursing home transition (NJ, WA, MA)

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PA Community Choices

• Access to assessment 24/7
• Services within 12 to 72 hours
• Reduce financial application (12 to 5 pages) and
  functional assessment (27 to 5 pages)
• Disregard 6,000 in assets
• Self-declaration of income and assets
• Presumptive eligibility

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Washington NF caseload trends
Figures for July each year
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Washington HCBS trends
Figures for July each year
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Washington LTC Spending trends (millions)
Based on data from the Washington Aging and
Disability Services Administration
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Key SPE questions

• What is SPE? One stop? No wrong door?
• A place, a web based process or both?
• For whom?
• For what?
• Who does it?
• How much does one organization offer?
• Aging and Disability Resource Centers
• Full or split functions?

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ADRC role

• Provide information and assistance to public and
  private-pay individuals
• Entry point to publicly administered long term
  supports
• Target individuals at imminent risk of admission
  to an institution by creating linkages with the
  pathways to long-term care

Greg Case, AoA, 3/3/04
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Key access features

• Planting the seed - awareness of resources
• Information readily available when the need
  arises
• Access vs referrals
• Streamlined assessment, clinical and financial
  eligibility
• Virtual gateway using the internet

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Comprehensive system selected features

• Philosophy, leadership
• Comprehensive entry points/one stop
• Financing that supports access and choice
• Full array of services
• Nursing home case management and relocation
  assistance
• Streamlined access

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Impact of a comprehensive system
Reduces Medicaid growth trend line
NF reliance

Broad array
Time
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Information access array of services
choice, better balance
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Comprehensive entry points

• What is entry?
• A system that enables consumers to access long
  term and supportive services through one agency
  or organization
• 42 CEPs in 32 states and DC

NASHP 2003
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CEP functions

• Information referral
• Assistance
• Web based IA
• Initial screening
• NF screening or options counseling
• Assessment

• Financial eligibility
• Functional eligibility
• Develop care plan
• Authorize service
• Monitor services
• Reassessment
• Protective services

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Michigan SPE functions

• Planning and collaboration
• Outreach, education and advocacy
• Information and assistance
• Person centered planning (care plan)
• Facilitator
• Options counseling

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Michigan SPE

• Program or service transitions
• Supports coordination (authorization)
• Function/medical eligibility determination
• Facilitate financial eligibility decision
• Ongoing coordination

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SPE examples

• Colorado
• Connecticut (CBOs)
• Illinois (CCUs)
• Indiana (AAAs)
• Kansas (AAAs)
• Maine (split)
• Massachusetts (ASAPs/AAAs)

• Minnesota (Counties)
• Oregon (County AAA, state field offices)
• Pennsylvania (AAAs)
• Vermont (split)
• Washington (split)
• Wisconsin (Counties)

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Populations served
NASHP 2003
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Funding sources
NASHP 2003
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Organizations
NASHP 2003
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Split system - Vermont

• DAIL (state agency) reviews referral information
  and determines clinical eligibility
• May make a home visit
• Decides level of need (highest, high, moderate)
• Reviews service options with the applicant
• Sends information to selected CMA (AAA or HHA)
• CMA completes assessment, develops care plan
• DAIL reviews the plan of care

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Split system - Washington

• Aging and Disability Services Administration
  staff complete all assessments
• Determine clinical and financial eligibility
• Review service options
• Develop initial care plan
• Provide CM for consumers in nursing homes and
  residential settings
• AAAs provide ongoing CM for in-home clients

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Discussion

• What does SPE mean to you?
• What functions should an SPE perform?
• What components of the current system should be
  kept in a SPE system?
• What linkages will be needed between community
  providers, physicians and SPEs?