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Single Point of Entry

Single Point of Entry. A System For The Future. 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?. Problems.

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Single Point of Entry

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  1. Single Point of Entry A System For The Future

  2. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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;

  8. 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.

  9. 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.

  10. 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.

  11. 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;

  12. 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.

  13. SPE: Independent“Neutral” 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.

  14. SPE “Pilot” Programs • DCH has sought RFP’s 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;

  15. 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.

  16. 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;

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  21. 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!

  22. Get on Board Now! • Change is needed to deal with increased demand; • 32 states are currently operating/reviewing SPE’s. • 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

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