Single Points of Entry Robert Mollica March 2006

Overview Balancing long term supports systems Single points of entry Considerations

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

Medicaid spending balance (billions) FY 2004 All groups = Elderly, adults with disabilities, MR/DD

Percent by population group

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

Balance in the neighborhood Elders and adults with disabilities

Improving the balance in Michigan: How long will it take?

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

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)

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

Washington: NF caseload trends Figures for July each year

Washington: HCBS trends Figures for July each year

Washington LTC Spending trends (millions) Based on data from the Washington Aging and Disability Services Administration

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?

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

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

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

Impact of a comprehensive system Reduces Medicaid growth trend line NF reliance Broad array Time $$

Information + access + array of services = choice, better balance

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

CEP functions Information & referral Assistance Web based I&A Initial screening NF screening or options counseling Assessment Financial eligibility Functional eligibility Develop care plan Authorize service Monitor services Reassessment Protective services

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

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

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)

Populations served NASHP 2003

Funding sources NASHP 2003

Organizations NASHP 2003

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

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

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?