OFFICE OF LONG-TERM CARE SUPPORTS & SERVICES

1. OFFICE OF LONG-TERM CARE SUPPORTS & SERVICES Overview Elder Law Day September 22, 2006

2. Require and Implement Person-Centered Planning Practices. Improve Access by Adopting “Money Follows the Person” Principles. Establish Single Point of Entry Agencies for Consumers. Strengthen the Array of Services and Supports. Support, implement, and sustain prevention activities through (1) community health principles, (2) caregiver support and injury control, and (3) chronic care management and palliative care programs. Promote Meaningful Consumer Participation and Education by Creating a Long-Term Care Commission and Informing the Public about the Available Array of Long-Term Care Options. Establish a New Quality Management System Michigan should build and sustain culturally competent, highly valued, competitively compensated and knowledgeable long term care workforce teams. Adapt Financing Structures that Maximize Resources, Promote Consumer Incentives, and Decrease Fraud. LTC TASK FORCE RECOMMENDATIONS JUNE 2004

3. Basis for the LTC Office • Governor’s LTC Task Force: • Lack of a central point for quality management of the LTC system within the executive branch is a critical issue for consumers and policymakers alike. • Strategy: “Invest quality management functions in a new Long-Term Care administration.” • Outcome: “The administration would improve quality by consolidating fragmented pieces of LTC, and defining and establishing broader accountability across the LTC array of services and supports.”

4. Governor’s Executive Order2005-14 • The Office of Long-Term Care Supports and Services is created within the Department of Community Health. The authority, powers, duties, and functions of the Office, including, but not limited to, budgeting, procurement, and related management functions, shall be performed under the direction and supervision of the Director of the Department. • Staff shall be designated by the Director of the Department as deemed appropriate and sufficient to perform the duties and fulfill the responsibilities of the Office under this Order. • The Office shall be headed by the Director of the Office of Long-Term Care Supports and Services who shall be a member of the state classified service and report to the Director of the Department

5. Duties of the LTC Office • The Office shall do all of the following: • Administer activities to implement the recommendations of the Task Force. • Coordinate state planning for long-term care supports and services. • Review and approve long-term care supports and services policy formulated by state departments and agencies for adoption or implementation.

6. Duties of the LTC Office • Conduct efficiency, effectiveness, and quality assurance reviews of publicly-funded long-term care programs. • Identify and make recommendations to the Director of the Department regarding opportunities to increase consumer supports and services, organizational efficiency, and cost-effectiveness within Michigan’s long-term care system.

7. Duties of the LTC Office • Prepare an annual report for the Director of the Department and the Governor on the progress of implementing the recommendations of the Medicaid Long-Term Care Task Force Report. • Oversee the implementation of the single point-of-entry demonstration programs required under Section VI.

8. 20.0 FTEs: 8.0 grant-funded;12.0 funded through transferred positions

9. The Michigan LTC Supports & Services Advisory Commission • Also established by Executive Order 2005-14 • 17 members: • Nine representing primary and secondary consumers • Three representing direct care workers • Three representing providers of MA-funded programs • Two representing the general public • Ex Officio: Directors of DCH, DHS, DLEG, OSA and LTC Ombudsman • Advisory body within MDCH • Forum for issues relating to Michigan’s LTC supports and services • Meets 4th Monday’s of the month, 1 PM – 4 PM

10. Federal Medicaid LTC Policy • CMS Real Choice Systems Change Initiative • Part of President’s “New Freedom Initiative” – response to Olmstead Supreme Court decision • Remove barriers to community living for people with disabilities and long-term illnesses • Counter “institutional Bias” in the Medicaid program • Promote consumer choice and direction over home and community services

11. Real Choice Systems Change Grants • Purpose: Build infrastructure resulting in effective & enduring improvements in community long-term support systems • Focus on supporting beneficiary participation, choice and control to live a real life in the community • Consumer & advocate involvement must be a driving factor • Four grants since 2001: • PASS (Personal Assistance Services/Supports) ‘01 • Real Choice Systems Change ’01 • Money Follows the Person Rebalancing Initiative ‘03 • Independence Plus Initiative ’03 • Consumer Task Force – meets monthly

12. Other Grants • Cash & Counseling – RWJ Foundation • “Self-Determination in Long-Term Care” • Connected w/ CMS-funded Independence Plus Initiative • Home & Community-based Services Waiver changes • HCBS Quality Improvement methods – RCSC ’01 grant • Initiate activities in four MI Choice sites in Oct, ’06 • LTC System Transformation Project • Five Years, $2.4 M • Strategic planning begins October, ‘06

13. Aging & Disability Resource Centers • Funding shared by AoA & CMS • Aimed at “no wrong door” approach to LTC planning & access • Three years (in first year); dovetails with Single Points of Entry demonstrations • Grant resources support: technical assistance; data system development; training, project coordinator; project evaluation

14. Michigan Vision The Single Point of Entry will be a highly-visible and trusted source of information and assistance about long-term care, aiding Michigan residents with planning and access to needed services and supports, in accordance with their preferences.

15. WHAT DOES AN SPE DO? • Provide comprehensive information and referral • Provide long term support options counseling • Conduct functional eligibility determination • Coordinate financial eligibility determination • Provide benefits counseling • Provide LTC crisis intervention/stabilization • Facilitate person centered planning

16. WHERE ARE THE SPE DEMONSTRATIONS? • $34.83 million for four demonstrations • Detroit, $13.1 million • Southwest Michigan, $7.18 million • Western Michigan, $9.15 million • Upper Peninsula, $5.4 million • Demonstrations cover 47% of state • Official Name: MICHIGAN’S LONG-TERM CARE CONNECTIONS

17. Map Upper Peninsula West Michigan Detroit Southwest Michigan

18. SPE DEVELOPMENT • Implementation groundwork • 27 month contracts (7/1/06 – 9/30/08) • 1st quarter start-up activities: Governance, staffing , local planning, collaboration, outreach • Target date for initiation of I&A is 10/1/06 • Monthly Stakeholder Information Forums • Mornings of LTC Commission meeting days – 10 AM – noon) • Evaluation: • External evaluation initiates in January, 2007 • Final report due in December, ’08 • Subject of Legislative budget planning, Spring ’08 • HB 5389 • Provides parameters for demonstrations & eventual statewide system • Passed House 106-0 • Senate should address after the election

19. CURRENT AGENDA • DRA Money Follows the Person • Due November 1, ’06 • Increased federal Medicaid matching funds (78% FMAP) for one year for certain individuals transitioning from a nursing facility • Stakeholders, including nursing home providers, are to be a part of the development process • Nursing facility transition informational forum in mid-October • DRA Long-Term Care Insurance Partnership • Asset protection: HB 6478 • Insurance industry interested

20. ALSO • Enhance and expand communication with LTC constituencies • Planning for MI Choice Waiver renewal (due 6/30/07) • MFP Rebalancing grant: 1915 (b)/(c) LTC prepaid health plan pilot • Facilitate LTC Commission involvement overseeing implementation of Governor’s TF recommendations • Support LTC Commission advisory role in SPE evaluation • Annual LTC Plan & Budget • Quality improvement enhancement in nursing facilities