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Single Points of Entry. Robert Mollica March 2006 rmollica@nashp.org. 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:

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single points of entry

Single Points of Entry

Robert Mollica

March 2006

rmollica@nashp.org

overview
Overview
  • Balancing long term supports systems
  • Single points of entry
  • Considerations
the spe context
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
Medicaid spending balance (billions) FY 2004

All groups = Elderly, adults with disabilities, MR/DD

medicaid spending balance 2004 elders and adults with disabilities
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

measures of balance
Measures of balance
  • Percentage spending on HCBS, NF
  • Percentage of people served in community settings
  • Participants days or days of coverage
balancing strategies
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
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
Washington: NF caseload trends

Figures for July each year

washington hcbs trends
Washington: HCBS trends

Figures for July each year

washington ltc spending trends millions
Washington LTC Spending trends (millions)

Based on data from the Washington Aging and Disability Services Administration

key spe questions
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
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
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
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
comprehensive entry points
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

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

SPE examples
funding sources
Funding sources

NASHP 2003

organizations
Organizations

NASHP 2003

split system vermont
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
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
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?