November 1, 2005, Introduced by Reps. Shaffer, Amos, Vander Veen, Caul, Proos, LaJoy, Marleau, Nitz, Pearce, Zelenko, Byrnes, Alma Smith, Farrah, Pastor, Casperson, Kahn, Kooiman, Palsrok, Newell, Ball, Green, Stahl, Robertson, Wojno, Gillard, Clack, Bennett, Mortimer, Hansen, Sheen, Farhat, Sak, Emmons, Vagnozzi, Donigan, Hune, Garfield, Polidori, Spade, Byrum, Gosselin and Gleason and referred to the Committee on Senior Health, Security, and Retirement.
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
(MCL 400.1 to 400.119b) by adding section 109i.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 109i. (1) The director of the department of community
health shall designate and maintain locally and regionally based
single points of entry for long-term care that shall serve as
visible and effective access points for individuals seeking long-
term care and that shall promote consumer choice of long-term care
options.
(2) The department of community health shall monitor single
points of entry for long-term care for, at a minimum, all of the
following:
(a) To prevent bias in eligibility determination and to
prevent the promotion of specific services to the detriment of
consumer choice and control.
(b) To review all consumer assessments and care plans to
ensure consistency, quality, and adherence to the principles of
person-centered planning and other criteria established by the
department of community health.
(c) To assure the provision of quality assistance and
supports.
(d) To assure that quality assistance and supports are
provided to applicants and consumers in a manner consistent with
their cultural norms, language of preference, and means of
communication.
(e) To assure consumer access to an independent consumer
advocate.
(3) The department of community health shall establish and
publicize a toll-free telephone number for areas of the state in
which a single point of entry is operational as a means of access.
(4) The department of community health shall promulgate rules
establishing standards of reasonable promptness for delivery of
single point of entry services and for long-term care services and
supports.
(5) The department of community health shall require that
single points of entry for long-term care perform all of the
following duties and responsibilities:
(a) Provide consumers and any others with information on and
referral to all long-term care options, services, and supports.
(b) Facilitate movement between supports, services, and
settings in an adequate and timely manner that assures the safety
and well-being of the consumer.
(c) Assess a consumer's eligibility for all medicaid long-term
care programs utilizing a comprehensive level of care tool.
(d) Assist consumers to obtain a financial determination of
eligibility for publicly funded long-term care programs.
(e) Assist consumers to develop their long-term care support
plans through a person-centered planning process.
(f) Authorize and, if requested, arrange for needed transition
services for consumers living in nursing facilities.
(g) Work with consumers in acute and primary care settings as
well as community settings to assure that they are presented with
the full array of long-term care options.
(h) Reevaluate consumers' need and eligibility for long-term
care services on a regular basis.
(i) Perform the authorization of medicaid services identified
in the consumer's care supports plan.
(6) The department of community health shall, in consultation
with consumers, stakeholders, and members of the public, establish
criteria for designation of local or regional single points of
entry for long-term care. The criteria shall ensure that single
points of entry for long-term care meet all of the following
criteria:
(a) Are not a provider of direct medicaid services. For the
purposes of this section, care management and supports coordination
are not considered direct medicaid services.
(b) Are free from all legal and financial conflicts of
interest with providers of medicaid services.
(c) Are capable of serving as the focal point for all
individuals seeking information about long-term care in their
region, including individuals who will pay privately for services.
(d) Are capable of performing consumer data collection,
management, and reporting in compliance with state requirements.
(e) Have quality assurance standards and procedures that
measure consumer satisfaction, monitor consumer outcomes, and
trigger changes to the care and supports plan.
(f) Maintain an internal and external appeals process that
provides for a review of individual decisions.
(g) Complete an initial evaluation of applicants for long-term
care within 2 business days after contact by the individual or his
or her legal representative.
(h) In partnership with the consumer, develop a preliminary
person-centered plan within 7 days after the applicant is found to
be eligible for services.
(7) Single points of entry for long-term care that fail to
meet the criteria described in this section, and other fiscal and
performance standards as determined by the department of community
health, may be subject to termination as a designated single point
of entry by the department of community health.
(8) The department of community health shall promulgate rules
establishing timelines of within 2 business days or less for the
completion of initial evaluations of individuals in urgent or
emergent situations and rules establishing timelines for completion
of a final evaluation and assessment for all individuals. Timelines
established under this subsection shall not be longer than 2 weeks
from initial contact with the individual.
(9) The department of community health shall solicit proposals
from entities seeking designation as a single point of entry and
shall designate at least 3 agencies to serve as a single point of
entry in at least 3 separate areas of the state. There shall be no
more than 1 single point of entry in each designated region. An
agency designated by the department of community health under this
subsection shall serve as a single point of entry for an initial
period of 3 years, subject to the provisions of subsection (7).
(10) The department of community health shall evaluate the
performance of the agencies designated as single points of entry
under this section on an annual basis and shall make any report or
recommendation for improvement regarding the single point of entry
system available to the legislature and the public.
(11) Not later than October 1, 2008, the department of
community health shall designate an agency to serve as a single
point of entry in each region of the state. Nothing in this section
prohibits the department of community health from designating
single points of entry throughout the entire state before October
1, 2008.
(12) The department shall promulgate rules to implement the
provisions of this section not later than 180 days after the
effective date of the amendatory act that added this section.