Missouri

1
Missouri

• Comprehensive Entry Point for Long Term Services
  and Supports
• Presented by Barbara Edwards and Susan Tucker,
  Principals
• Health Management Associates
• July 22, 2008

2
Overview

• Remaining Work for CEP Committee
• Recommend Who, What, How
• Public testimony
• Review of recommendations
• Draft report
• Final report October 1

3
Senate Bill 577

• Comprehensive Entry Point (CEP)
• Delivery system easy to understand with access
  through multiple points
• Offer an array of LTC choices, info assistance
• Efficient - reduce duplication, streamline access
  to multiple funding sources and programs
• Strengthen QA and QI
• Timely access to, payment for cost effective
  care
• Study one-stop shopping for seniors

4
Lt. Governors Kinders Charge

• Statewide, universal information and assistance
  system for all ages, disabilities
• Integrated with MO HealthNet via web-based
  electronic patient health record
• Pre-admission screening mechanism and care plan
  assessment tool to help guide consumers, families
  and caregivers to appropriate services and
  providers
• Case management or care coordination system
  available as needed

5
Review Last Meeting

• The goal of CEP for LTC
• An integrated service delivery system that aims
  to streamline access to LTC services and supports
• One contact by consumer to receive information,
  assistance, access
• Models vary!

6
Review Last Meeting

• No Wrong Door (concept for the CEP)
• Multiple agencies serve as entry points to LTC,
  but regardless of where consumer seeks services,
  the same intake processing and information about
  the full range of available services is received

7
Review Last Meeting

• Federal Funding
• ADRC grants require a Single Entry Point, use
  standardized processes and tools to offer a
  comprehensive set of information and assistance
  to all who seek or provide LTC services and
  supports

8
Questions from last meeting

• Handouts
• Impact evaluations performed in other states
• Screening and assessment tools
• Information systems

9
Todays Assignment

• Who recommendations of serving all populations?
  
• What the recommended functions
• and activities of Missouris CEP?
• How the recommendations of this committee for a
  successful roll out?

10
Who Population Implications

• SB 577 requirement serve all
• Elderly
• Persons with physical disabilities (including
  TBI)
• Persons with mental retardation/developmental
  disabilities
• Persons with serious mental illness
• Publicly or privately paid

11
Considerations/Discussion

• Compatibility with requirements contained in
• grant opportunities
• Ease/complexity of implementation
• Applicability/transferability of single model to
  all LTC populations
• Relationship to How whether to phase in
  groups or implement all at once
• Identify gaps, strategies to address (which
  populations are well or under-served today?)

12
What Functions of CEP

• In state ADRC pilots (for example)
• Information and referral All
• Outreach and Marketing 98
• Benefits counseling 90
• Initial screening 81
• Assessment (LOC) 63
• NH pre-admission screening 37

13
Functions of CEP

• Minimal service set
• Outreach and marketing
• Information and referral
• More robust
• Benefits counseling
• Initial screening

14
Functions of CEP

• Even more robust
• Assisting to complete and/or submit financial
  eligibility applications
• Conducting level of care assessments
• Pre-screening for nursing home admission
• Financial eligibility determinations

15
Considerations/discussion

• Ease/complexity of implementation
• Start-up timeframe
• Target population needs
• Funding/resources
• IT capacity
• Compatibility with ADRC grant opportunity
• Relationship to How

16
How Strategies for Roll-Out

• Most states have phased in strategies, starting
  with regional pilots
• A function of complexity, learning curve
• A function of ADRC grant approach used in many
  states

17
Strategies for Roll-Out

• Option Phased in approach
• Issues resolution on manageable scale
• Adjust model before going statewide
• Phase locations, population, and/or services?
• Whoever is ready first, goes first vs. strategic
  site selection (geographic, etc.)
• Firm schedule to go statewide?

18
Strategies for Roll-Out

• Option statewide start-up
• Timeline to begin start-up may be longer
• May work better with phase-in of populations
  and/or functions
• Not all regions of state may be equally ready
  or able, depending on reliance on local
  agencies
• Requires significant training, outreach
  commitment

19
Considerations/discussion

• How quickly must start-up happen?
• Resource availability and funding
• Local system readiness and gaps
• Oversight and guidance
• Which agencies have which responsibilities?
• Use of IT
• Who else should be involved?

20
Recap CEP for Missouri

• Who Population Implications
• What Desired Functions of CEP
• How Roll Out Strategy

21
Getting there from here

• Outline of next steps
• Draft approach to CEP
• Public testimony
• Review elements of draft approach
• Draft subcommittee report
• Final subcommittee report