1. OFFICE OF LONG-TERM CARE SUPPORTS & SERVICES Overview Elder Law Day September 22, 2006

2. LTC TASK FORCE RECOMMENDATIONS JUNE 2004 Require and Implement Person-Centered Planning Practices. Require and Implement Person-Centered Planning Practices. Improve Access by Adopting Money Follows the Person Principles. Improve Access by Adopting Money Follows the Person Principles. Establish Single Point of Entry Agencies for Consumers. Establish Single Point of Entry Agencies for Consumers. Strengthen the Array of Services and Supports. Strengthen the Array of Services and Supports. Support, implement, and sustain prevention activities through (1) community health principles, (2) caregiver support and injury control, and (3) chronic care management and palliative care programs. Support, implement, and sustain prevention activities through (1) community health principles, (2) caregiver support and injury control, and (3) chronic care management and palliative care programs. Promote Meaningful Consumer Participation and Education by Creating a Long-Term Care Commission and Informing the Public about the Available Array of Long-Term Care Options. Promote Meaningful Consumer Participation and Education by Creating a Long-Term Care Commission and Informing the Public about the Available Array of Long-Term Care Options. Establish a New Quality Management System Establish a New Quality Management System Michigan should build and sustain culturally competent, highly valued, competitively compensated and knowledgeable long term care workforce teams. Michigan should build and sustain culturally competent, highly valued, competitively compensated and knowledgeable long term care workforce teams. Adapt Financing Structures that Maximize Resources, Promote Consumer Incentives, and Decrease Fraud. Adapt Financing Structures that Maximize Resources, Promote Consumer Incentives, and Decrease Fraud.

3. Basis for the LTC Office Governors LTC Task Force: Governors LTC Task Force: Lack of a central point for quality management of the LTC system within the executive branch is a critical issue for consumers and policymakers alike. Lack of a central point for quality management of the LTC system within the executive branch is a critical issue for consumers and policymakers alike. Strategy: Invest quality management functions in a new Long-Term Care administration. Strategy: Invest quality management functions in a new Long-Term Care administration. Outcome: The administration would improve quality by consolidating fragmented pieces of LTC, and defining and establishing broader accountability across the LTC array of services and supports. Outcome: The administration would improve quality by consolidating fragmented pieces of LTC, and defining and establishing broader accountability across the LTC array of services and supports.

4. Governors Executive Order 2005-14 The Office of Long-Term Care Supports and Services is created within the Department of Community Health. The authority, powers, duties, and functions of the Office, including, but not limited to, budgeting, procurement, and related management functions, shall be performed under the direction and supervision of the Director of the Department. The Office of Long-Term Care Supports and Services is created within the Department of Community Health. The authority, powers, duties, and functions of the Office, including, but not limited to, budgeting, procurement, and related management functions, shall be performed under the direction and supervision of the Director of the Department. Staff shall be designated by the Director of the Department as deemed appropriate and sufficient to perform the duties and fulfill the responsibilities of the Office under this Order. Staff shall be designated by the Director of the Department as deemed appropriate and sufficient to perform the duties and fulfill the responsibilities of the Office under this Order. The Office shall be headed by the Director of the Office of Long-Term Care Supports and Services who shall be a member of the state classified service and report to the Director of the Department The Office shall be headed by the Director of the Office of Long-Term Care Supports and Services who shall be a member of the state classified service and report to the Director of the Department

5. Duties of the LTC Office The Office shall do all of the following: The Office shall do all of the following: Administer activities to implement the recommendations of the Task Force. Administer activities to implement the recommendations of the Task Force. Coordinate state planning for long-term care supports and services. Coordinate state planning for long-term care supports and services. Review and approve long-term care supports and services policy formulated by state departments and agencies for adoption or implementation. Review and approve long-term care supports and services policy formulated by state departments and agencies for adoption or implementation.

6. Duties of the LTC Office Conduct efficiency, effectiveness, and quality assurance reviews of publicly-funded long- term care programs. Conduct efficiency, effectiveness, and quality assurance reviews of publicly-funded long- term care programs. Identify and make recommendations to the Director of the Department regarding opportunities to increase consumer supports and services, organizational efficiency, and cost-effectiveness within Michigans long-term care system. Identify and make recommendations to the Director of the Department regarding opportunities to increase consumer supports and services, organizational efficiency, and cost-effectiveness within Michigans long-term care system.

7. Duties of the LTC Office Prepare an annual report for the Director of the Department and the Governor on the progress of implementing the recommendations of the Medicaid Long- Term Care Task Force Report. Prepare an annual report for the Director of the Department and the Governor on the progress of implementing the recommendations of the Medicaid Long- Term Care Task Force Report. Oversee the implementation of the single point-of-entry demonstration programs required under Section VI. Oversee the implementation of the single point-of-entry demonstration programs required under Section VI.

8. 20.0 FTEs: 8.0 grant-funded;12.0 funded through transferred positions

9. The Michigan LTC Supports & Services Advisory Commission Also established by Executive Order 2005-14 Also established by Executive Order 2005-14 17 members: 17 members: Nine representing primary and secondary consumers Nine representing primary and secondary consumers Three representing direct care workers Three representing direct care workers Three representing providers of MA-funded programs Three representing providers of MA-funded programs Two representing the general public Two representing the general public Ex Officio: Directors of DCH, DHS, DLEG, OSA and LTC Ombudsman Ex Officio: Directors of DCH, DHS, DLEG, OSA and LTC Ombudsman Advisory body within MDCH Advisory body within MDCH Forum for issues relating to Michigans LTC supports and services Forum for issues relating to Michigans LTC supports and services Meets 4 th Mondays of the month, 1 PM – 4 PM Meets 4 th Mondays of the month, 1 PM – 4 PM

10. Federal Medicaid LTC Policy CMS Real Choice Systems Change Initiative CMS Real Choice Systems Change Initiative Part of Presidents New Freedom Initiative – response to Olmstead Supreme Court decision Part of Presidents New Freedom Initiative – response to Olmstead Supreme Court decision Remove barriers to community living for people with disabilities and long-term illnesses Remove barriers to community living for people with disabilities and long-term illnesses Counter institutional Bias in the Medicaid program Counter institutional Bias in the Medicaid program Promote consumer choice and direction over home and community services Promote consumer choice and direction over home and community services

11. Real Choice Systems Change Grants Purpose: Build infrastructure resulting in effective & enduring improvements in community long-term support systems Purpose: Build infrastructure resulting in effective & enduring improvements in community long-term support systems Focus on supporting beneficiary participation, choice and control to live a real life in the community Focus on supporting beneficiary participation, choice and control to live a real life in the community Consumer & advocate involvement must be a driving factor Consumer & advocate involvement must be a driving factor Four grants since 2001: Four grants since 2001: PASS (Personal Assistance Services/Supports) 01 PASS (Personal Assistance Services/Supports) 01 Real Choice Systems Change 01 Real Choice Systems Change 01 Money Follows the Person Rebalancing Initiative 03 Money Follows the Person Rebalancing Initiative 03 Independence Plus Initiative 03 Independence Plus Initiative 03 Consumer Task Force – meets monthly Consumer Task Force – meets monthly

12. Other Grants Cash & Counseling – RWJ Foundation Cash & Counseling – RWJ Foundation Self-Determination in Long-Term Care Self-Determination in Long-Term Care Connected w/ CMS-funded Independence Plus Initiative Connected w/ CMS-funded Independence Plus Initiative Home & Community-based Services Waiver changes Home & Community-based Services Waiver changes HCBS Quality Improvement methods – RCSC 01 grant HCBS Quality Improvement methods – RCSC 01 grant Initiate activities in four MI Choice sites in Oct, 06 Initiate activities in four MI Choice sites in Oct, 06 LTC System Transformation Project LTC System Transformation Project Five Years, $2.4 M Five Years, $2.4 M Strategic planning begins October, 06 Strategic planning begins October, 06

13. Aging & Disability Resource Centers Funding shared by AoA & CMS Funding shared by AoA & CMS Aimed at no wrong door approach to LTC planning & access Aimed at no wrong door approach to LTC planning & access Three years (in first year); dovetails with Single Points of Entry demonstrations Three years (in first year); dovetails with Single Points of Entry demonstrations Grant resources support: technical assistance; data system development; training, project coordinator; project evaluation Grant resources support: technical assistance; data system development; training, project coordinator; project evaluation

14. Michigan Vision The Single Point of Entry will be a highly-visible and trusted source of information and assistance about long- term care, aiding Michigan residents with planning and access to needed services and supports, in accordance with their preferences.

15. WHAT DOES AN SPE DO? Provide comprehensive information and referral Provide comprehensive information and referral Provide long term support options counseling Provide long term support options counseling Conduct functional eligibility determination Conduct functional eligibility determination Coordinate financial eligibility determination Coordinate financial eligibility determination Provide benefits counseling Provide benefits counseling Provide LTC crisis intervention/stabilization Provide LTC crisis intervention/stabilization Facilitate person centered planning Facilitate person centered planning

16. WHERE ARE THE SPE DEMONSTRATIONS? $34.83 million for four demonstrations $34.83 million for four demonstrations Detroit, $13.1 million Detroit, $13.1 million Southwest Michigan, $7.18 million Southwest Michigan, $7.18 million Western Michigan, $9.15 million Western Michigan, $9.15 million Upper Peninsula, $5.4 million Upper Peninsula, $5.4 million Demonstrations cover 47% of state Demonstrations cover 47% of state Official Name: Official Name: MICHIGANS LONG-TERM CARE CONNECTIONS

17. Map Detroit Upper Peninsula West Michigan Southwest Michigan

18. SPE DEVELOPMENT Implementation groundwork Implementation groundwork 27 month contracts (7/1/06 – 9/30/08) 27 month contracts (7/1/06 – 9/30/08) 1 st quarter start-up activities: Governance, staffing, local planning, collaboration, outreach 1 st quarter start-up activities: Governance, staffing, local planning, collaboration, outreach Target date for initiation of I&A is 10/1/06 Target date for initiation of I&A is 10/1/06 Monthly Stakeholder Information Forums Monthly Stakeholder Information Forums Mornings of LTC Commission meeting days – 10 AM – noon) Mornings of LTC Commission meeting days – 10 AM – noon) Evaluation: Evaluation: External evaluation initiates in January, 2007 External evaluation initiates in January, 2007 Final report due in December, 08 Final report due in December, 08 Subject of Legislative budget planning, Spring 08 Subject of Legislative budget planning, Spring 08 HB 5389 HB 5389 Provides parameters for demonstrations & eventual statewide system Provides parameters for demonstrations & eventual statewide system Passed House 106-0 Passed House 106-0 Senate should address after the election Senate should address after the election

19. CURRENT AGENDA DRA Money Follows the Person DRA Money Follows the Person Due November 1, 06 Due November 1, 06 Increased federal Medicaid matching funds (78% FMAP) for one year for certain individuals transitioning from a nursing facility Increased federal Medicaid matching funds (78% FMAP) for one year for certain individuals transitioning from a nursing facility Stakeholders, including nursing home providers, are to be a part of the development process Stakeholders, including nursing home providers, are to be a part of the development process Nursing facility transition informational forum in mid-October Nursing facility transition informational forum in mid-October DRA Long-Term Care Insurance Partnership DRA Long-Term Care Insurance Partnership Asset protection: HB 6478 Asset protection: HB 6478 Insurance industry interested Insurance industry interested

20. ALSO Enhance and expand communication with LTC constituencies Enhance and expand communication with LTC constituencies Planning for MI Choice Waiver renewal (due 6/30/07) Planning for MI Choice Waiver renewal (due 6/30/07) MFP Rebalancing grant: 1915 (b)/(c) LTC prepaid health plan pilot MFP Rebalancing grant: 1915 (b)/(c) LTC prepaid health plan pilot Facilitate LTC Commission involvement overseeing implementation of Governors TF recommendations Facilitate LTC Commission involvement overseeing implementation of Governors TF recommendations Support LTC Commission advisory role in SPE evaluation Support LTC Commission advisory role in SPE evaluation Annual LTC Plan & Budget Annual LTC Plan & Budget Quality improvement enhancement in nursing facilities Quality improvement enhancement in nursing facilities