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State announces selection of four Single Point of Entry sites

MPLP Summer 2006 Elder Law Section Newsletter Article

Issue 31, Summer 2006

 

State announces selection of four Single Point of Entry sites in the state; Single Point of Entry legislation faces significant opposition and delays in the House of Representatives.

In June, MDCH selected four Long Term Care Single Point of Entry (SPE) demonstration sites which are to begin operation no later than October 1, 2006. SPEs, which will be located in Detroit, Western Michigan, Southwestern Michigan, and the Upper Peninsula, are designed to be a single regional agency to which consumers can go to obtain information about long term care options, be assessed for all available programs, and receive assistance developing a person centered plan. SPEs were a key recommendation of the Governor's Medicaid Long Term Care Task Force when it issued its final report last summer and many consider the SPE effort a crucial aspect of long term care reform in the state. The Task Force envisioned that all regions of the state would be served by SPEs within three years.

The state anticipated the 27 month demonstration projects will require $34.83 million. According to MDCH, the four demonstration sites encompass an estimated 47.5 percent of the state's current Long Term Care Medicaid population and incorporate 36 of the state's 83 counties. The successful bidders were selected after undergoing a three part broad-based review process that included representatives from community groups and agencies, health facilities, advocacy groups, and state agencies. In addition to these initial SPE awards, regional areas that made unsuccessful SPE bids will receive SPE planning grants to prepare them for the next round of SPE requests for proposals.

Advocates favor SPEs because they are designed to give consumers more information, choice and control. MDCH Director Janet Olszewski has also stated repeatedly that Michigan's initial investment in single points of entry will help ensure cost effectiveness by controlling the growth of high cost services, and by coordinating the delivery of high quality services that people want to use. Moreover, SPEs already operating in many other states appear to be both cost-effective and consumer friendly.

Hospitals and other Medicaid providers in the regions in which the demonstration projects exist will be required by MDCH to make mandatory referrals of potential long term care clients to the SPEs. However, at least until SPEs are available statewide, both Medicaid consumers and consumers with other sources of payment will be able to choose whether or not to use them. The fact that SPEs will be voluntary means that MDCH is unlikely to obtain as much useful data as was previously hoped about the number of potential long term care consumers and the choices they make.

One of the major advantages of the SPE was intended to be that consumers would have real choice in the services and supports they received. While it is likely that many eligible consumers who use the SPE are likely to choose MIChoice Home and Community Based Services over nursing home placement, it is unlikely that all consumers who select MiChoice will be able to obtain those services immediately. The availability of MiChoice services will depend on a number of factors including budget negotiations in the state legislature, internal decisions made by MDCH and state budget officials, and priority criteria MDCH is likely to develop to ration scarce MiChoice services. Because of lingering concerns about the "woodwork effect" -- large numbers of consumrers who are eligible for MiChoice and who would eagerly accept those services if they were available. MDCH is likely to develop policy that gives consumers in the community who are at imminent risk of nursing home placement priority in obtaining MiChoice slots. MDCH will also continue to encourage nursing home residents to transition into the community and those individuals may also utilize the SPE to assist them in that process.

At the same time that MDCH is going ahead with the demonstration sites, legislation concerning SPEs is stalled in the legislature. HB 5389, which was introduced by Rep. Rick Shaffer with a remarkable 41 co-sponsors, would require the Department to establish and maintain SPEs across the state. An amended version of the bill passed the House Senior Health Security and Retirement Committee unanimously. However, the bill is being opposed by the nursing home industry and the hospital association. As a result, House leadership has so far refused to schedule the bill for a vote on the floor of the House. A wide array of aging and disability rights groups have worked hard to move the legislation forward and the Long Term Care Supports and Services Advisory Commission recently voted in support of the bill.

For more information about Michigan's continued long term care improvement efforts, please visit www.michigan.gov/ltc. The site also includes information regarding the state's Office of Long Term Care Support and Services, the LTC Supports and Services Advisory Commission, and the Michigan Medicaid Long Term Care Task Force.


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