Single Point of Entry

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Single Point of Entry

• A System For The Future

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Help! I need Help!

• For whatever reason, people may face a need for
  care beyond what they can provide for themselves.
• How do they find out what options they have, and
  can they afford them?

3
Problems

• For seniors, or anyone with disabilities needing
  long term care, or their family members seeking
  to assist them, it is a maze with no seemingly
  right route.
• Under the current system addressing an array of
  needs
• personal care, self-directed care, in-home
  health care home adaptations delivered meals
  assisted living adult foster care
• the list of choices without informed advice, is
  disjointed, fragmented, not coordinated, and
  totally confusing, particularly for someone
  facing these choices for the first time.

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Goals for a Long Term Care Infrastructure

• An infrastructure needs to be put into place to
  deliver a cost-effective system of long term
  care
• a system which would support personal care-giving
  choices for consumers family supports.
• a system that would utilize agents of the state
  at a local and/or regional level
• provide a platform to provide timely access to
  services alternatives to institutional care,
  based on consumer choice and level of care
  required.

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A Single Point of Entry Agency will

• provide information and assistance to consumers
  as they consider their long term care options
• provide information on all services and supports
  that individuals need for long term health care
• provide consumer choice referral/assistance
• serve as a resource on long term care options for
  the community at large and caregivers.

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Role of A Single Point of Entry Agency

• Financial Eligibility Assessment/Assistance
• provide assistance to consumers in working
  through the process
• should be able to expedite the application
  process and identify any barriers
• also work with other agencies to resolve
  barriers found in the system.

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A Single Point of Entry Agency will

• facilitate movement between supports, services
  and settings
• assist consumers in determining if they are
  eligible for publicly funded programs, but DHS
  retains the responsibility for authorizing that
  determination

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A Single Point of Entry Agency will

• assist consumers in developing their long-term
  care plans through a person-centered process, and
  be available for follow up to update or
  re-evaluate needs.

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Case Coordination/Supports Coordination/Care
Planning

• Case and supports coordination will be a key role
  for the SPE agencies
• Consumers will have the ability to change Care
  (Supports) Coordinators when they feel it is
  necessary to do so
• Individuals will be able to develop their care or
  support plans through the Person-Centered
  Planning process.

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Transition Coordination and Facilitation

• Nursing Home transition will be a function of the
  SPE agencies
• offers choice for Nursing Home residents
• involves consumers in making decisions about
  their own lives
• facilitates a smooth transition into community
  living.

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SPE access to services

• mandatory for individuals eligible for Medicaid
  funded programs
• individuals who are private pay will be able to
  access all the SPE agency services
• information and referral/assistance will be
  available to everyone at no cost

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SPE access to services

• there may be a fee for private pay consumers who
  wish to access other SPE agency services (these
  services may be covered by long term care or
  other insurance).
• long term care providers will be required to
  inform consumers about the availability of the
  SPE agency.

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SPE IndependentNeutral Consultant

• Separation of Service Authorization Provision
• an SPE should do service authorization
• an SPE should NOT do direct service provision
• an advocate should not be a provider to avoid
  perceptions of bias.

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SPE Pilot Programs

• DCH has sought RFPs for pilot programs
• results of RFP process are expected by the end of
  April, 2006
• pilot programs are scheduled to start in June
  2006
• HB 5389 requires DCH to provide evidence based
  information regarding the effectiveness of Single
  Points of Entry pilot programs

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SPE Pilot Programs

• The legislature will review that evidence based
  data as part of the 2008-2009 budget process and
  recommend continuance of the program.
• Language and intent of RFP closely reflects Long
  Term Care Task Force recommendations.

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Why Legislation Now?

• This legislation will allow formal control over
  the services provided under Medicaid
• provides the mechanism so that the SPE acts as a
  triage point, to ensure that consumers have
  options for care relevant to their level of
  health care needs

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Why Legislation Now?

• This legislation conforms to the recommendations
  from the Michigan Medicaid Long Term Care Task
  Force set up under the Supreme Court agreement,
  in the Eager vs Engler (Granholm) class action
  suit filed on the basis of the Olmstead
  agreement.

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Why Legislation Now?

• This legislation will plug into the over-arching
  Long Term Care legislation bill sponsored by
  Representative Vander Veen ( HB 5762).
• The whole package will form the Long Term Care
  Code.

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HB 5389Objectives

• Identifying all the choices available in a
  cohesive manner is the challenge
• Past studies show that prior to the MI Choice
  Waiver program, in many cases once a person
  sought assistance for long term care, the nursing
  care facility was the only option offered,
  regardless of whether their level of care
  required this.
• People do not wish to leave their own homes if
  they can avoid it but often cannot find out about
  all the choices available to them, or what
  assistance they might be eligible for.

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HB 5389 - GOALS

• ability to purchase services cost effectively
  relevant to level of care needs
• promote personal responsibility by providing
  choices to consumers
• ensure provision of high quality services and
  supports, with positive outcomes for consumers
• balance provision and cost of Medicaid funded
  long term care.

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HB 5389 - GOALS

• HB 5389 will provide legislative authority for a
  Single Point of Entry System that will provide
  information about the full array of options open
  to consumers in need of long term care
  opportunities including person-centered planning,
  and consumer choice
• The consumer trumps all!

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Get on Board Now!

• Change is needed to deal with increased demand
• 32 states are currently operating/reviewing
  SPEs.
• the train is coming down the track this
  legislation gets Michigan on board
• Supplied by the office of State Representative
  Rick Shaffer 517-373-0832