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Present: Greg Montague (DOT), Henry Sloma, Susan Peerless, Lisa Kagan, Donna Mackey (OMRDD Counsel), John Allen (OMH), Pat Fratangelo, Nancy Martinez (OCFS), Gary O'Brien (CQC), Constance Laymon, Kathy Kuhmerker (DOH), Doug Bailey (SED), Commissioner Maul (OMRDD), Carol Raphael, Tim Williams (OASAS), Karen Oates, Lorrie Pizzola (DHCR), Kim Hill, Greg Jones (Office of the Advocate), Kathy Bunnell, Harvey Rosenthal, Michael Parker. I. Introduction of New Council Members The MISCC has two new members. Carol Raphael is from Visiting Nurse Service of New York. Henry Sloma is the Administrator of a skilled nursing facility and is a Commissioner of the Niagara Frontier Transportation Authority. Carol and Henry introduced themselves to the MISCC members. II. Council Web Information The website for the MISCC is now available. It is housed on the DOH website at www.health.state.ny.us. On the right hand side is the MISCC icon. The website will contain information about future MISCC meetings and public hearings. The MISCC website can also be accessed through the website's of other state agencies. III. Committee Process All meetings (both meetings of the full MISCC and committee meetings) are open to the public. Audience comments will be requested at the end of each meeting. IV. Committee Reports Data Committee: John Allen (OMH) reported for the Data Committee. The Data Committee has had several meetings and has met with technical experts to identify formatting and definitional issues. The Data Committee is hoping to have data to report by the next full MISCC meeting. They are currently looking at best practices in terms of data collecting and reporting (state agencies). They have had two full subcommittee meetings and other meetings with technical experts. Community Services: Kathy Kuhmerker (DOH) reported for the Community Services Committee. They have met two times (4/22 and 5/24). Their next meeting is scheduled for 6/14. They are in the process of developing an inventory of services and then they will develop recommendations for improving services. Over time, they will be including publicly and privately funded services. They are starting with publicly funded services which are regulated or licensed by the state agencies that are represented on the MISCC. The Committee has information from many of the state agencies. At the meeting on 5/24, the Committee went over the format of the information that has been received and decided that it would be best to receive information in a tabular format. Once the Committee gets all of the information, they will begin working on recommendations. Kathy noted that there was a big discussion on how to let people know that services are available. Kathy pointed out that this is consistent with the Point of Entry proposal. The Committee is hoping that the public forums can be used to get information on how to best get information to people about available services. Commissioner Maul asked Kathy who is on the Committee. He said that the reason he is asked is because the private sector gets information out differently than state agencies. Kathy advised that the Committee got useful advice from the audience. One of the questions that the audience posed is "How do you make community services as easy to access as institutional services?" Kathy also noted that DOH and SOFA have a discharge planning workgroup to discuss issues related to discharge planning and long- term care. Kathy noted that the MISCC must develop a plan on how to fix things, but things won't be fixed right away. Some questions to be asked are: What services, medical or non- medical, help people to remain in the community? Are there best practices? Where do people in your community go to find out what they need? Henry Sloma asked if the Community Services Committee is also capturing available funding sources for the services that they are inventorying. Kathy advised that they are obtaining this information and then reviewed the items that the Committee is asking each of the state agencies for. Henry noted that funding is a barrier to services. He questioned if the Committee was going to determine service gaps in a community. Kathy advised that they will not be looking on a county basis for gaps, but they are hoping that from the data that is collected they'll be able to determine where the gaps are. Commissioner Maul noted that it is fine to talk about gaps and choices, but the main issue is that people don't know what their choices are. Harvey advised that the Committee is hoping that they'd get some of this from the public forums. Commissioner Maul commented that the question about funding source creates and interesting dilemma. A consumer should be able to say that he/she needs a service and the funding should follow. Kathy advised that DOH, CQC, SOFA, DHCR, OASAS and OMRDD have already responded to the Committee's request for information. Susan Peerless advised that additional data came in yesterday. They will also be sending out an email to specify the requested format. Kathy noted that the Point of Entry Concept is a best practices idea. Transportation Committee: Greg Montague (DOT) reported for the Transportation Committee. He advised that the Committee met on 4/22 and 5/24. The 4/22 meeting was an organizational meeting. The Committee has asked the MISCC agencies about their transportation programs and best practices. DOT, OMRDD, SOFA, OASAS and DOH got their responses in. Greg noted that transportation is a complex issue. The Committee is inviting program representatives from transportation programs in Jefferson, Monroe, Schoharie and Orleans Counties to speak at the next Committee meeting. During the public input period, the Committee received questions that they could ask at the public forums. Commissioner Maul asked how public transportation is represented in the Committee's discussion. He noted that agencies giving a list of their transportation programs is not the most integrated setting. Harvey advised that the state agencies are being asked first and then public transportation will be asked. The Committee will also look at transportation beyond services. Harvey noted that the Committee should scan for utilization of the half fare program. Assessment Committee: Lisa Kagan (OMRDD) reported for the Assessment Committee. She advised that no one joined her Committee. She advised that she is gathering all of the assessment tools used by the various programs. She will bring what she finds and match it up with the various community services that the Community Services Committee is inventorying. There was a lengthy discussion about the Assessment Tool and the requirements of the MIS Law. Lisa advised that the Committee is looking at how eligibility is determined. Kathy Kuhmerker advised that assessment is really, "Should you be getting home care services?" Carol Raphael commented that having one assessment tool might be futile. John Allen suggested that we could assess need without assessing eligibility in a single tool. This would satisfy the statutory requirements without getting into clinical assessments. It is about asking what the individual wants and needs in their life. No matter what system the person enters into, the person would prompted for what they want. Commissioner Maul commented that there is a problem if someone is being discharged from a hospital, the person might go to a nursing home because that's all they know about. John advised that need is different than program. You might get a referral based on what a person knows, but need is different. Karen Oates discussed the use of flexible service dollars. Commissioner Maul expressed concern that choice is absent. Harvey commented that if you had assessments based on needs, you'd have more choices. Donna Mackey (OMRDD Counsel) advised that the MIS Law says that each agency has to look at their assessment tool and how each agency identifies how someone can live in the most integrated setting. Each state agency should submit this information. Constance and Nancy Martinez volunteered to be on the assessment committee. Henry Sloma advised that he has been a provider for 37 years. He's seen sing point of control systems as disqualifiers. Commissioner Maul commented that it is equally important to make people feel at home when asking them the assessment questions. Pat Fratangelo commented that the MISCC must keep in mind that its basic human rights. Carol Raphael commented that we need to find a way to listen to what people need. We've created programs that aren't what people need. There has to be a structure that goes across agencies/funding streams. We need to think about what it is that will help us. We need to move towards looking at needs rather than constructing a uniform assessment tool. QA/QI Committee: Neal Lane (SOFA) reported for the QA/QI Committee. There are multiple challenges that the Committee faces. The first is to conduct an environmental scan of what tools are out there. Neal identified 40 tools and his staff made the initial cut and sent 12 of the tools to the Committee. Another challenge is that we have various populations, and we have not mastered Quality Assurance/ Consumer Satisfaction with some populations. A final challenge has to do with process. The service evaluation must be conducted in a manner where you can get an honest response. Neal gave a report of the 5/24 meeting. At the 5/24 meeting, Neal asked the Committee about desired outcomes of services evaluation tools and the quality and characteristics of a good QA tool. The committee decided that they are going towards a quality of life tool versus a tool to evaluate the system. The Committee needs to identify gaps, aspects of tools that are positive and identify unique data elements. The Committee will look at the 12 tools and do this. During the public input period of the Committee meeting, the audience advised that an issue is how to reconcile the differences between the provider perspective and the consumer perspective. The audience also commented on the importance of timing and ways to engage the consumer is dialogue. The administration of a QA tool has to be done in a manner that will elicit honest disclosure from the consumer. Commissioner Maul commented that it should not matter if the provider thinks I have a quality of life; it matters if I think I have a quality of life. V. Upcoming Meetings All 5 Committees are meeting on 6/14/04. Kathy Kuhmerker suggested that the Committees have another meeting on 7/1/04. VI. Public Forums A schedule has been set up for the public forums. 7/15: NYC, 7/22: Albany, 8/10: Syracuse, 8/11: Buffalo. Commissioner Maul requested that the entire MSICC be available for the public forums. VII. Next Meetings July 12th: Full MISCC Meeting, 1-3:30 pm, ESP #1 September 20th: Full MISCC Meeting, 1-3:30pm, ESP #1 VIII. Public Comment Period Chris Hilderbrant suggested that the MISCC develop a Housing Committee and that advocates be allowed to join the Committee. Commissioner Maul said he would think about it and give a formal reaction. He agrees that housing is important, but doesn't want to make up the rules as they go along. Commissioner Maul advised that they will incorporate housing into the work of the MISCC, but he will get back to us on the process of incorporating housing. Bruce Darling commented on the discussion of an Assessment Tool. He advised that the purpose of the Assessment Tool is to identify people with disabilities who could live in the Most Integrated Setting. He gave several descriptions of how this could be done. He said that this could be accomplished by linking the MDS question about preferring to live in the community with an automatic referral for discharge planning. He also pointed out that some states are funding Independent Living Centers to go into the skilled nursing facilities to identify people and assist with nursing facility transition. Bruce also referred to the legislative intent of the MIS Law to support the assertion that the Assessment Tool should not be used for eligibility determination. Commissioner Maul also noted that he would be thinking of other ways to induce public participation. Pat Fratangelo suggested that the MISCC work with 4 or 5 people who are stuck in nursing homes. The MISCC could walk through the process to get the experience of facing barriers when trying to obtain services. Commissioner Maul advised that he would give Pat's suggestion further thought. Commissioner Maul advised that he would develop a general notice about the public forums. Each agency will distribute to their constituencies. Commentary The MISCC Meetings (the full Council meetings and Committee meetings) seemed more productive now that an exchange is being allowed between audience members and the MISCC. Whereas at previous meetings the audience was not allowed to provide comments or expertise, the most recent meetings have allowed for a public comment period. Given that state agency representatives have steered the discussions, the public comment period is even more important in order for the members of the MISCC to hear concerns and advice from the consumer perspective. The discussion about an Assessment Tool is an example of how important the audience's comments are to the process. Certain members of the MISCC stood out in the 5/26 meeting. Commissioner Maul should be applauded for trying to get the other MISCC members to discuss integrated programs versus segregated services. Additionally, he discussed the importance of money following the person and the use of peers. Pat Fratangelo provided the MISCC with the excellent idea of meeting with 4 or 5 people who want to live in the most integrated setting in order to get a sense of the barriers that they have encountered when trying to obtain needed community based services. Karen Oates and John Allen tried to steer the discussion of an Assessment Tool away from eligibility determinations and offer a model that has been used for consumers of mental health services. Harvey Rosenthal should also be applauded for his dedication as exemplified through his participation in all of the Committee meetings. New MISCC member, Henry Sloma, made some excellent points during the meeting. He questioned if the MISCC was going to focus on the gaps in the system. He also commented that he has seen a point of entry system turn into a point of disqualification. Given that he is an Administrator of a skilled nursing facility, NYS ADAPT has serious concerns about his appointment, however, he did raise very good questions. Although the MISCC is moving towards more of a participatory process, NYS ADAPT remains concerned that the Administration is framing the MISCC instead of the MISCC framing the reform of the long-term care system to address the inherent institutional bias. We have serious concerns that the Community Services Committee is being guided by the Governor's Health Care Reform Working Group's Interim Report on Long-Term Care, which was more concerned with cost containment than addressing the institutional bias in our state. Often, it seemed that the Community Services Committee is actually a commercial for the Working Group's Point of Entry proposal. Kathy Kuhmerker noted that the Point of Entry was a best practices idea. How could this possibly be a best practices idea when it has not been implemented in New York State, and therefore, cannot be evaluated? We are concerned that because the Administration is so entrenched in this concept that it is being viewed as "the Answer" even before the MISCC has a chance to evaluate the existing long-term care system. In addition, while the Community Services committee has asked the state agencies to provide information on what community-based services they provide, they have not asked the state agencies which institutional services they provide. The inventorying of institutional services is equally important as the next logical question would be, can a state agency provide both institutional and community-based services and not be biased? NYS ADAPT will continue to monitor the MISCC and pressure them to create a plan so that living in the community becomes the norm. People with disabilities and seniors have waited long enough for the recognition of their right to live in the most integrated setting, and must have real choices. It is the duty of the MISCC to create a plan to make this happen. It is our duty to make sure that it does happen. |