Tuesday, September 25, 2012

Draft revisions to Michigan's Dual Eligibles plan

Is it possible to make the Michigan plan for Dual Eligibles worse for people with developmental disabilities? Apparently, yes, but we all still have a say in how this comes out and so does the Michigan legislature.

This is an e-mail from Tom Bird from ddAdvocates of Western Michigan sent out on 9/5/12.  It provides links to documents and other sources of information on Michigan's new proposal for an Integrated Care Bridge between Medicare, Medicaid, and mental health services.

From the Michigan Department of Community Health (MDCH): 

The Michigan Department of Community Health submitted documents to the Centers for Medicare and Medicaid Services (CMS) in response to its request for additional detail regarding the Integrated Care Bridge.  The Care Bridge is Michigan’s model for care coordination that was first outlined in the integrated care proposal submitted to CMS in April 2012.

These documents are drafts of the proposed Care Bridge concepts, have been posted to the website, and will be updated as discussions with CMS and stakeholders continue.


See the current Care Bridge concepts here. Scroll down to "Care Bridge Documents - 8-30-2012" for the link to the documents. The direct link to the pdf file is here .

Tom Bird's comments on the proposal:

"This contains the letters to CMS as well as the power point presentation, and a 'narrative' on how the care bridge would work, in addition to the vignettes on how it is supposed to work. The PLC [Primary Lead Coordinator] is supposed to be an ICO [Integrated Care Organization] (multi-county Health Plan) employee, responsible for the initial screening and intake, and the LC [Lead Coordinator] is either an ICO employee or an ICO-certified and trained contractor of another organization which the ICO will ultimately have control over and oversight of. It could be an existing CMH supports coordinator, but they would have to be trained and supervised by the ICO, with their time billed to the ICO. Either way, it puts the ICO (Health Plan) in total control of the 'care Bridge' functions as well as all of the funding for both Medicare and Medicaid (which are co-mingled and can be redistributed as the ICO desires); it puts the ICO in a position to deny or restrict services desired by the consumer, all far removed from the current system of local delivery, which presently offers local input and oversight via control of CMH Board appointments. If you add the incentive for the ICO to restrict (expensive) services due to the proposed 'profit sharing' of any savings, you have a big red flag waving."

Legislative review of changes to the Dual Eligibles plan is required by law: 

The following is wording from the 2012 appropriations law concerning legislative review of plans submitted to the federal Centers for Medicare and Medicaid Services (CMS):

Sec. 264. 
(1) Upon submission of a Medicaid waiver, a Medicaid state plan amendment, or a similar proposal to the centers for Medicare and Medicaid services, the department shall notify the house and senate appropriations subcommittees on community health and the house and senate fiscal agencies of the submission.

(2) The department shall provide written or verbal biannual reports to the senate and house appropriations subcommittees on community health and the senate and house fiscal agencies summarizing the status of any new or ongoing discussions with the centers for Medicare and Medicaid services or the federal department of health and humanservices regarding potential or future Medicaid waiver applications.

(3) The department shall inform the senate and house appropriations subcommittees on community health and the senate and house fiscal agencies of any alterations or adjustments made to the published plan for integrated care for individuals who are dual Medicare/Medicaid eligibles when the final version of the plan has been submitted to the
federal centers for Medicare and Medicaid services or the federal department of health and human services.

(4) At least 30 days before implementation of the plan for integrated care for individuals who are dual Medicare/Medicaid eligibles, the department shall submit the plan to the legislature for review.
[emphasis added]


Here is a refresher course on the issues regarding dual eligibles and people with DD.

Monday, September 17, 2012

Vulnerable seniors at risk from paid home caregivers

The VOR Weekly News Update from 9/14/12 reports on a national study: Dangerous Caregivers - Agencies place unqualified, possibly criminal caregivers in homes of vulnerable seniors

According to the Northwestern University News Center, July 10, 2012, "A troubling new national study finds many agencies recruit random strangers off Craigslist and place them in the homes of vulnerable elderly people with dementia, don’t do national criminal background checks or drug testing, lie about testing the qualifications of caregivers and don’t require any experience or provide real training."

The study was published in the July 13 issue of the Journal of American Geriatrics Society.

VOR notes that VOR will encourage the study’s authors to consider a similar study of caregivers for people with intellectual and developmental disabilities.

Here is more from the Northwestern University News Center article by Maria Paul:

The author of the study Lee Lindquist, M.D., an associate professor of medicine at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital is quoted in the article:

“It’s a cauldron of potentially serious problems that could really hurt the senior,” Lindquist said. “These agencies are a largely unregulated industry that is growing rapidly with high need as our population ages. This is big business with potentially large profit margins and lots of people are jumping into it.”

Some of the findings from the study:
  • Only 55 percent of the agencies did a federal background check.
  • Only one-third of agencies interviewed said they did drug testing - "'Considering that seniors often take pain medications, including narcotics, this is risky,' Lindquist said. 'Some of the paid caregivers may be illicit drug users and could easily use or steal the seniors’ drugs to support their own habits.'"
  • Few agencies (only one-third) test for caregiver skill competency - "A common method of assessing skill competencies was 'client feedback,' which was explained as expecting the senior or family member to alert the agency that their caregiver was doing a skill incorrectly."
  • Inconsistent supervision of the caregiver.
“'The public should demand higher standards, but in the short term, seniors need to be aware what explicitly to look for when hiring a paid caregiver through an agency,' Lindquist said."

Dr. Lindquist's advice on hiring caregivers:

  1. How do you recruit caregivers, and what are your hiring requirements?
  2. What types of screenings are performed on caregivers before you hire them? Criminal background check—federal or state? Drug screening? Other?
  3. Are they certified in CPR or do they have any health-related training?
  4. Are the caregivers insured and bonded through your agency?
  5. What competencies are expected of the caregiver you send to the home? (These could include lifting and transfers, homemaking skills, personal care skills such as bathing, dressing, toileting, training in behavioral management and cognitive support.)
  6. How do you assess what the caregiver is capable of doing?
  7. What is your policy on providing a substitute caregiver if a regular caregiver cannot provide the contracted services?
  8. If there is dissatisfaction with a particular caregiver, will a substitute be provided?
  9. Does the agency provide a supervisor to evaluate the quality of home care on a regular basis? How frequently?
  10. Does supervision occur over the telephone, through progress reports or in-person at the home of the older adult?

Friday, September 7, 2012

Rights Workshop in Howell, Michigan: 10/4/12

A Web site for the Family-to-Family Health Information & Education Center, or F2FHIEC, has loads of information for families with special needs children. According to the Web site, "Our goal is to improve access to quality care and supports for children with special needs in their communities by empowering families." F2FHIEC is funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau under the Patient Protection and Affordable Care Act (ACA) of 2010. 

A workshop sponsored by Family-to-Family called "What Are My Rights and Responsibilities and Who Can Help Me Navigate the System?
 " should be helpful to families of adults with disabilities as well as families with special needs children.

This is from the Web site about the workshop in Howell that will be held on October 4, 2012, from 9 a.m. to 3 p.m. at the Livingston ESA, 1425 West Grand River Avenue, Howell, MI :

[The workshop] is for anyone who wants a better understanding of rights, responsibilities and complaint processes including timelines, complaint procedures and what someone could expect during the processes under:

  • Children’s Special Health Care Services
  • Community Mental Health Services/Hospital Mental Health
  • Medicaid
  • Special Education Services
Participants will receive resource information for groups and organizations available to assist in navigating systems and protecting a client’s rights. Basic information will be provided on how to gain access to and what makes someone eligible under each system.

Workshop Fee: $10 (Includes Meal)

SBCEUs or SWCEs: $15 [This is for people who need the workshop to count toward certification or accreditation.]

Scholarships: A limited number of scholarships are available for families. Please contact Lisa Cook-Gordon at (800) 359-3722.

Click here to register for the workshop in Howell.

Other Training Dates/Times/Locations outside of Southeastern Michigan:
  • October 9, 2012 from 9:00 am – 3:00 pm at Eastern Upper Peninsula ISD, 315 Armory Place, Sault Ste. Marie, MI 49783
  • October 11, 2012 from 9:00 am – 3:00 pm at Menominee ISD, 1201 41st Avenue, Menominee, MI 49858
  • October 29, 2012 from 9:00 am – 3:00 pm at Otsego District Public Library, 219 South Farmer Street, Otsego, MI 49078
  • November 12, 2012 from 9:00 am – 3:00 pm at Macomb ISD, Room 104, 44001 Garfield Road, Clinton Township, MI 48038 (586) 228-3321