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I. Welcome Commissioner Maul began the meeting by stating that while he was out sick, he thought about how the MISCC can move faster. He questioned, "What does the law call for?" Commissioner Maul advised that there are four areas of the law: data, assessment, community services and quality assurance. Maul suggested that they develop four subcommittees, one for each area of the law. The subcommittees will then report back at a future meeting. Harvey advised that he read Kim Hill's letter and that he has the same concerns as Kim. The process must have public input. Harvey noted that the MISCC has had a slow start. They talked about transportation at the last meeting and Harvey hasn't heard anything since then. Harvey noted that he has gotten emails from people and that people are discouraged about the MISCC. Commissioner Maul named the chairperson of each committee. Sharon Carpinello (OMH) was appointed as chairperson of the Data Committee. Lisa from Commissioner Maul's staff at OMRDD will chair the Assessment Committee. Kathy Kuhmerker (DOH) will chair the Community Services Committee. Neal Lane (NYSOFA) will chair the Quality Assurance Committee. Kathy Kuhmerker (DOH) asked about timeframes. Commissioner Maul advised that the MISCC members should volunteer for the committees via email and have a first meeting. Then they can agree on time frames. Commissioner Maul noted that outreach to the public is permissible, but the final recommendations have to come from the committee. Maul said, "The best way to meet the needs of people is to talk to the people." II. Minutes of December 17, 2003 Meeting No one had any comments on the minutes. III. Long Term Care Reform Proposal Kathy Kuhmerker (DOH) and Neal Lane (NYSOFA) gave a presentation on the Governor's Health Care Reform Working Group Interim Report. Kathy advised that she and Neal have been working on the long-term care reform proposals and that the restructuring proposals are part of the Governor's report. Kathy advised that the Working Group look at long-term care primarily because the elderly and disabled populations are growing and because of the Olmstead decision. Kathy advised that the current system is fragmented and biased. Where you touch the system is what you get. The Working Group met with many groups to get input on how to restructure the system. The six major recommendations are: · A point of entry into the system that is available to everyone regardless of payer. · A new waiver program for all of long term care. · Closing eligibility loopholes. · Making long term care insurance accessible and affordable. · Expanding managed care. · A new nursing home model. Neal discussed that point of entry. He noted that the current long-term service array is really a maze. A report released in the summer of 2003 by Rutgers University talks about what other states are doing. Most commonly, other states are establishing a point of entry to provide unbiased information. The New Freedom Initiative is encouraging states to do this. Point of entry concepts: · Sense of being impartial · People have informed choice · Designed to support family or other caregivers in addition to the individual · An assessment that is strength-based an interdisciplinary (both medical and social) · Available to everyone Function of a point of entry: · Screening · Assessment · Information and assistance · Direct assistance in negotiating the system when needed. Service and care coordination are available · Screening and assessment for nursing home care (PRI and screen) A Request for Information (RFI) will be going out the members of the MISCC and other stakeholders to determine what is critical in a point of entry. Questions will be coming, such as "Should NY Answers services be organized around counties or regions?", "What is the best way to organize staff?", "What are people's (consumer, advocate, etc.) roles?" Neal encouraged people to be active in this debate. The RFI will come out in 1 or 2 weeks. There will then be a 30-45 day period for comments. Neal advised that the provider community knows the system is broken and needs to be fixed. The timing is right to do this. Commissioner Maul noted that people currently identify with funding streams, instead of identifying with services. Funding streams should be transparent. Kathy Kuhmerker then talked about the waiver proposal. She said that currently, we provide state plan and waiver services. We are setting up a dichotomy with the way that we provide services by having state plan services on one side and waiver services on the other. The Working Group recommended that over time, we create a single waiver and even expand services. There has been discussion about adding services such as informal caregiver support, mobility training and community transition services. Kathy explained that currently, you have to be nursing home eligible in order to be eligible for waiver services. We're looking at how to create a waiver for people that aren't nursing home eligible. Kathy noted that this is a major change and that they'll be meeting with stakeholders, such as providers, consumers and advocacy groups. She says that they are available to meet with anyone who wants to meet with them. Kathy also advised that statutory changes need to be done, as current state law doesn't allow the creation of this waiver. She states that they are working on the work plan right now so there is no timetable yet. Kathy then discussed closing eligibility loopholes. Elder law attorneys are very active. The Executive Budget contains recommendations to close loopholes that don't exist in other states. The Governor is calling for the elimination of spousal refusal because currently people with millions of dollars can get care under Medicaid. In one month, 71 out of 74 married individuals in New York City used spousal refusal to get home care (per HRA). Kathy advised that if you need home care, you can currently transfer a million dollars and get home care. This is not the same as going into a nursing home. The Working Group recommends applying the transfer of asset penalty period to home care. They also recommend increasing the look back period to 5 years and starting the penalty period the day you need services. The Working Group wants to, over time, make all of this equal across the board to level the playing field so it is not easier to go into a nursing home. Kathy discussed a little about long-term care insurance. She says that they are looking to make the NYS Partnership Program more affordable. The Working Group also recommends expanding managed care programs to include more long-term care services. Finally, the Working Group recommends creating a new nursing home model which will include a new Certificate of Need (CON) process and rightsizing nursing homes. Commissioner Maul commented that creating alternatives to institutionalized care and making them accessible changes the world enormously. He thinks what Kathy is doing is excellent. IV. Council Member Data Responses Susan Peerless advised that the Council Member Data responses are in the Council Member packets. Section 703A of the law deals with data. V. President's "Interagency Transportation Coordinating Council on Access and Mobility". President Bush issued an Executive Order dealing with Transportation. The kick off event/workshop was held in Washington DC. Representatives from DOH and SOFA were there. This is why the transportation subcommittee of the MISCC was on hold, but the subcommittee will meet soon. "United We Ride" is the name of the Government's effort to coordinate transportation for "disadvantaged persons". The state of North Carolina was presented as a best practice example. Harvey states that people in New York State who have success stories with transportation have contacted him. He asked if he could bring people to the transportation subcommittee meetings. The person from DOT advised that Harvey can bring non-council members to the subcommittee meetings. Information about the federal transportation initiative was distributed. VI. Assessment Procedures An Assessment committee was established. Commissioner Maul looks forward to receiving the recommendations of the Committee. VII. Consumer Satisfaction Surveys Lisa from OMRDD discussed NYS Cares. NYS Cares recently did an in-depth consumer satisfaction survey. NYS Cares created an oversight committee that includes self-advocates and family members. They designed a customer satisfaction form and tested it. Maul commented, "I cannot overstate consumer satisfaction!". Neal Lane advised that SOFA participated in the Performance Outcome Measurement Project (POMP) at the invitation of the Administration on Aging. SOFA can bring their experience with the POMP to the MISCC Council and in reform of long term care efforts. SOFA gained expertise with POMP and can apply to the point of entry and reform in general. POMP was designed to evaluate the value and effectiveness of services that older people are receiving. This year SOFA is taking the lead in developing a case management services survey. Neal found that the practice of an agency becomes more customer focused due to consumer satisfaction surveys. Sharon Carpinello from OMH advised that OMH developed a consumer satisfaction survey. Harvey noted that their survey is a good combination of multiple choice and open-ended questions. Sharon noted that OMR developed the survey with consumers. Sharon also suggested that the 4 chairs of the committees get together because there might be some overlap. VIII. Council Member Goal Responses This was sent out via email to members of the MISCC. IX. Miscellaneous Commissioner Maul encouraged members of the MISCC to quickly sign up for the committees. He said they should have a conference call within 2 weeks. Gary O'brien from CQC applauded the fact that the MISCC is moving forward. Harvey questioned how the committees should proceed. Maul stated that the committees should meet between the larger meetings and provide a status report. Commissioner Maul thanked Kim Hill for her letter. Harvey questioned how there would be public input. Commissioner Maul advised that those are the types of things that the MISCC is going to discuss, but public input is essential to the process. Commissioner Maul advised that they will have a series of meetings. There will be an agenda of meetings and also one for the committees. Lori Pizzola advised that DHCR will be partnering with the NYS Association of Affordable Housing to have a special needs housing panel at the housing conference on May 13th in NYC at the Grand Hyatt. Commentary Although we are very pleased that the MISCC is actually addressing issues, we have serious concerns about the direction that the administration is going and the proposals being made to the MISCC. The MISCC needs to seriously review the proposals being made. Advocates have been requesting a 1915c waiver as an alternative to nursing facility placement. Such a waiver leaves the long term care system intact and ADDS additional services which reduce costs and promote community living. Instead, New York State is working on developing an 1115 waiver. Such a waiver would actually REPLACE the existing long term care system. We have concerns about the 1115 Medicaid Waiver approach. Although they have portrayed this waiver positively, there are a number of reasons to be cautious: · Such a waiver will eliminate the due process and eligibility protections that people have when receiving "state plan" long term care services. · Such a waiver will essentially cap long term care services and could create new limits on individual services, restrict the availability of LTC services and create waiting lists. · New limits on service would force individuals with higher care costs into unwanted and unnecessary institutional placement. We are also very concerned about some of the administration's rhetoric which suggests that people are not taking "personal responsibility" and are overusing services. Quality institutional placement will be available for the people with higher care needs. We are concerned that this implies cuts in services and institutionalization of people who have lived successfully in the community with significant assistance. During a recent lobby day, advocates spoke with officials within the Administration and were told that they were not committed to an 1115 waiver. It appears that they are actually working on such a waiver. This lack of forthrightness concerns us even more. We will be looking to the community members of the MISCC to ask the hard questions and stand up to the potentially devastating changes disguised as reforms. |