March 6, 2007, Introduced by Rep. Shaffer and referred to the Committee on Senior Health, Security, and Retirement.
A bill to amend 1939 PA 280, entitled
"The social welfare act,"
by amending section 109i (MCL 400.109i), as added by 2006 PA 634.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 109i. (1) The director of the department of community
health shall designate and maintain locally or regionally based
single point of entry agencies 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 and quality
in long-term care options.
(2) The department of community health shall monitor single
point of entry agencies for long-term care to assure, at a minimum,
all of the following:
(a) That bias in functional and financial eligibility
determination
or assistance and the promotion of specific services
to the detriment of consumer choice and control does not occur.
(b) That consumer assessments and support plans are completed
in a timely, consistent, and quality manner through a person-
centered planning process and adhere to other criteria established
by this section and the department of community health.
(c) The provision of quality assistance and supports.
(d) 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) Consumer access to an independent consumer advocate.
(f) That data and outcome measures are being collected and
reported as required under this act and by contract.
(g) That consumers are able to choose their supports
coordinator.
(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 agency is operational as a means of
access.
(4) The department of community health shall require that
single point of entry agencies for long-term care perform the
following duties and responsibilities:
(a) Provide consumers and any others with unbiased information
promoting consumer choice for all long-term care options, services,
and supports.
(b) Facilitate movement between supports, services, and
settings in a timely manner that assures consumers' informed
choice, health, and welfare.
(c) Assess consumers' eligibility for all medicaid long-term
care programs utilizing a comprehensive level of care assessment
approved by the department of community health.
(d) Assist consumers in obtaining a financial determination of
eligibility for publicly funded long-term care programs.
(e) Assist consumers in developing their long-term care
support plans through a person-centered planning process.
(f) Authorize access to medicaid programs for which the
consumer is eligible and that are identified in the consumer's
long-term care supports plan. The single point of entry agency for
long-term care shall not refuse to authorize access to medicaid
programs for which the consumer is eligible.
(g) Upon request of a consumer, his or her guardian, or his or
her authorized representative, facilitate needed transition
services for consumers living in long-term care settings if those
consumers are eligible for those services according to a policy
bulletin approved by the department of community health.
(h) Work with designated representatives of acute and primary
care settings, facility settings, and community settings to assure
that consumers in those settings are presented with information
regarding the full array of long-term care options.
(i) Reevaluate the consumer's eligibility and need for long-
term care services upon request of the consumer, his or her
guardian, or his or her authorized representative or according to
the consumer's long-term care support plan.
(j)
Except as otherwise provided in subdivisions (k) and (l),
provide the following services within the prescribed time frames:
(i) Perform an initial evaluation for long-term care within 2
business days after contact by the consumer, his or her guardian,
or his or her authorized representative.
(ii) Develop a preliminary long-term care support plan in
partnership with the consumer and, if applicable, his or her
guardian or authorized representative within 2 business days after
the consumer is found to be eligible for services.
(iii) Complete a final evaluation and assessment within 10
business days from initial contact with the consumer, his or her
guardian, or his or her authorized representative.
(k) For a consumer who is in an urgent or emergent situation,
within 24 hours after contact is made by the consumer, his or her
guardian, or his or her authorized representative, perform an
initial evaluation and develop a preliminary long-term care support
plan. The preliminary long-term care support plan shall be
developed in partnership with the consumer and, if applicable, his
or her guardian or authorized representative.
(l) Except as provided in subsection (20) (22),
for a consumer
who receives notice that within 72 hours he or she will be
discharged from a hospital, within 24 hours after contact is made
by the consumer, his or her guardian, his or her authorized
representative, or the hospital discharge planner, perform an
initial evaluation and develop a preliminary long-term care support
plan. The preliminary long-term care support plan shall be
developed in partnership with the consumer and, if applicable, his
or her guardian, his or her authorized representative, or the
hospital discharge planner.
(m) Initiate contact with and be a resource to hospitals
within the area serviced by the single point of entry agencies for
long-term care.
(n) Provide consumers with information on how to contact an
independent consumer advocate and a description of the advocate's
mission. This information shall be provided in a publication
prepared by the department of community health in consultation with
these entities. This information shall also be posted in the office
of a single point of entry agency.
(o) Collect and report data and outcome measures as required
by the department of community health, including, but not limited
to, the following data:
(i) The number of referrals by level of care setting.
(ii) The number of cases in which the care setting chosen by
the consumer resulted in costs exceeding the costs that would have
been incurred had the consumer chosen to receive care in a nursing
home.
(iii) The number of cases in which admission to a long-term care
facility was denied and the reasons for denial.
(iv) The number of cases in which a memorandum of understanding
was required.
(v) The rates and causes of hospitalization.
(vi) The rates of nursing home admissions.
(vii) The number of consumers transitioned out of nursing
homes.
(viii) The average time frame for case management review.
(ix) The total number of contacts and consumers served.
(x) The data necessary for the completion of the cost-benefit
analysis required under subsection (11).
(xi) The number and types of referrals made.
(xii) The number and types of referrals that were not able to
be made and the reasons why the referrals were not completed,
including, but not limited to, consumer choice, services not
available, consumer functional or financial ineligibility, and
financial prohibitions.
(p) Maintain consumer contact information and long-term care
support plans in a confidential and secure manner.
(q) Provide consumers with a copy of their preliminary and
final long-term care support plans and any updates to the long-term
care plans.
(5) The department of community health, in consultation with
the office of long-term care supports and services, the Michigan
long-term care supports and services advisory commission, the
department, and the office of services to the aging, shall
promulgate rules to establish criteria for designating local or
regional single point of entry agencies for long-term care that
meet all of the following criteria:
(a) The designated single point of entry agency for long-term
care does not provide direct or contracted medicaid services. For
the purposes of this section, the services required to be provided
under subsection (4) are not considered medicaid services.
(b) The designated single point of entry agency for long-term
care is free from all legal and financial conflicts of interest
with providers of medicaid services.
(c) The designated single point of entry agency for long-term
care is capable of serving as the focal point for all individuals,
regardless of age, seeking information about long-term care in
their region, including individuals who will pay privately for
services.
(d) The designated single point of entry agency for long-term
care is capable of performing required consumer data collection,
management, and reporting.
(e) The designated single point of entry agency for long-term
care has quality standards, improvement methods, and procedures in
place that measure consumer satisfaction and monitor consumer
outcomes.
(f) The designated single point of entry agency for long-term
care has knowledge of the federal and state statutes and
regulations governing long-term care settings.
(g) The designated single point of entry agency for long-term
care maintains an internal and external appeal process that
provides for a review of individual decisions.
(h) The designated single point of entry agency for long-term
care is capable of delivering single point of entry services in a
timely manner according to standards established by the department
of community health and as prescribed in subsection (4).
(6) A single point of entry agency for long-term care that
fails to meet the criteria described in this section or other
fiscal and performance standards prescribed by contract and
subsection (7) or that intentionally and knowingly presents biased
information that is intended to steer consumer choice to particular
long-term care supports and services is subject to disciplinary
action by the department of community health. Disciplinary action
may include, but is not limited to, increased monitoring by the
department of community health, additional reporting, termination
as a designated single point of entry agency by the department of
community health, or any other action as provided in the contract
for a single point of entry agency.
(7) Fiscal and performance standards for a single point of
entry agency include, but are not limited to, all of the following:
(a) Maintaining administrative costs that are reasonable, as
determined by the department of community health, in relation to
spending per client.
(b) Identifying savings in the annual state medicaid budget or
limits in the rate of growth of the annual state medicaid budget
attributable to providing services under subsection (4) to
consumers in need of long-term care services and supports, taking
into consideration medicaid caseload and appropriations.
(c) Consumer satisfaction with services provided under
subsection (4).
(d) Timeliness of delivery of services provided under
subsection (4).
(e) Quality, accessibility, and availability of services
provided under subsection (4).
(f) Completing and submitting required reporting and
paperwork.
(g) Number of consumers served.
(h) Number and type of long-term care services and supports
referrals made.
(i) Number and type of long-term care services and supports
referrals not completed, taking into consideration the reasons why
the referrals were not completed, including, but not limited to,
consumer choice, services not available, consumer functional or
financial ineligibility, and financial prohibitions.
(8) The department of community health shall develop standard
cost reporting methods as a basis for conducting cost analyses and
comparisons across all publicly funded long-term care systems and
shall require single point of entry agencies to utilize these and
other compatible data collection and reporting mechanisms.
(9) The department of community health shall solicit proposals
from entities seeking designation as a single point of entry agency
and, except as provided in subsection (16) and section 109j, shall
initially designate not more than 4 agencies to serve as a single
point of entry agency in at least 4 separate areas of the state.
There shall not be more than 1 single point of entry agency in each
designated area. An agency designated by the department of
community health under this subsection shall serve as a single
point of entry agency for an initial period of up to 3 years,
subject to the provisions of subsection (6). In accordance with
subsection (17), the department shall require that a consumer
residing in an area served by a single point of entry agency
designated under this subsection utilize that agency if the
consumer is seeking eligibility for medicaid long-term care
programs.
(10) The department of community health shall evaluate the
performance of single point of entry agencies under this section on
an annual basis.
(11) The department of community health shall engage a
qualified objective independent agency to conduct a cost-benefit
analysis of single point of entry, including, but not limited to,
the impact on medicaid long-term care costs. The cost-benefit
analysis required in this subsection shall include an analysis of
the cost to hospitals when there is a delay in a patient's
discharge from a hospital due to the hospital's compliance with the
provisions of this section.
(12) The department of community health shall make a summary
of the annual evaluation, any report or recommendation for
improvement regarding the single point of entry, and the cost-
benefit analysis available to the legislature and the public.
(13) Not earlier than 12 months after but not later than 24
months after the implementation of the single point of entry agency
designated under subsection (9), the department of community health
shall submit a written report to the senate and house of
representatives standing committees dealing with long-term care
issues, the chairs of the senate and house of representatives
appropriations committees, the chairs of the senate and house of
representatives appropriations subcommittees on community health,
and the senate and house fiscal agencies regarding the array of
services provided by the designated single point of entry agencies
and the cost, efficiencies, and effectiveness of single point of
entry. In the report required under this subsection, the department
of community health shall provide recommendations regarding the
continuation, changes, or cancellation of single point of entry
agencies based on data provided under subsections (4) and (10) to
(12).
(14) Beginning in the year the report is submitted and
annually after that, the department of community health shall make
a presentation on the status of single point of entry and on the
summary information and recommendations required under subsection
(12) to the senate and house of representatives appropriations
subcommittees on community health to ensure that legislative review
of single point of entry shall be part of the annual state budget
development process.
(15) The department of community health shall promulgate rules
to implement this section not later than 270 days after submitting
the report required in subsection (13).
(16) The department of community health shall not designate
more than the initial 4 agencies designated under subsection (9) to
serve as single point of entry agencies or agencies similar to
single point of entry agencies unless all of the following occur:
(a) The written report is submitted as provided under
subsection (13).
(b) Twelve months have passed since the submission of the
written report required under subsection (13).
(c) The legislature appropriates funds to support the
designation of additional single point of entry agencies.
(17) A single point of entry agency for long-term care shall
serve as the sole agency within the designated single point of
entry area to assess a consumer's eligibility for medicaid long-
term care programs utilizing a comprehensive level of care
assessment approved by the department of community health.
(18) Although a community mental health services program may
serve as a single point of entry agency to provide services to
individuals with mental illness or developmental disability,
community mental health services programs are not subject to the
provisions of this act.
(19) Medicaid reimbursement for health facilities or agencies
shall not be reduced below the level of rates and payments in
effect on October 1, 2006, as a direct result of the 4 pilot single
point of entry agencies designated under subsection (9).
(20) The provisions of this section and section 109j do not
apply after December 31, 2011.
(21) Funding for the MI Choice Waiver program shall not be
reduced below the level of rates and payments in effect on October
1, 2006, as a direct result of the 4 pilot single point of entry
agencies designated under subsection (9).
(22) A single point of entry agency for long-term care may
establish a memorandum of understanding with any hospital within
its designated area that allows the single point of entry agency
for long-term care to recognize and utilize an initial evaluation
and preliminary long-term care support plan developed by the
hospital discharge planner if those plans were developed with the
consumer, his or her guardian, or his or her authorized
representative.
(23) For the purposes of this section:
(a) "Administrative costs" means the costs that are used to
pay for employee salaries not directly related to care planning and
supports coordination and administrative expenses necessary to
operate each single point of entry agency.
(b) "Administrative expenses" means the costs associated with
the following general administrative functions:
(i) Financial management, including, but not limited to,
accounting, budgeting, and audit preparation and response.
(ii) Personnel management and payroll administration.
(iii) Purchase of goods and services required for administrative
activities of the single point of entry agency, including, but not
limited to, the following goods and services:
(A) Utilities.
(B) Office supplies and equipment.
(C) Information technology.
(D) Data reporting systems.
(E) Postage.
(F) Mortgage, rent, lease, and maintenance of building and
office space.
(G) Travel costs not directly related to consumer services.
(H) Routine legal costs related to the operation of the single
point of entry agency.
(c) "Authorized representative" means a person empowered by
the consumer by written authorization to act on the consumer's
behalf to work with the single point of entry, in accordance with
this act.
(d) "Guardian" means an individual who is appointed under
section 5306 of the estates and protected individuals code, 1998 PA
386, MCL 700.5306. Guardian includes an individual who is appointed
as the guardian of a minor under section 5202 or 5204 of the
estates and protected individuals code, 1998 PA 386, MCL 700.5202
and 700.5204, or who is appointed as a guardian under the mental
health code, 1974 PA 258, MCL 300.1001 to 300.2106.
(e) "Informed choice" means that the consumer is presented
with complete and unbiased information on his or her long-term care
options, including, but not limited to, the benefits, shortcomings,
and potential consequences of those options, upon which he or she
can base his or her decision.
(f) "Person-centered planning" means a process for planning
and supporting the consumer receiving services that builds on the
individual’s capacity to engage in activities that promote
community life and that honors the consumer’s preferences, choices,
and abilities. The person-centered planning process involves
families, friends, and professionals as the consumer desires or
requires.
(g) "Single point of entry" means a program from which a
current or potential long-term care consumer can obtain long-term
care information, screening, assessment of need, care planning,
supports coordination, and referral to appropriate long-term care
supports and services.
(h) "Single point of entry agency" means the organization
designated by the department of community health to provide case
management functions for consumers in need of long-term care
services within a designated single point of entry area.