MCIL Supports Governor Bredesen’s Comments
During his State of the State Address Governor Bredesen said it is time to “fundamentally restructure how long-term care is handled in our TennCare program…” He continued with, “We need to make it easier to stay at home with more Home and Community Based Services.”
MCIL supports these ideas and looks forward to evaluating the Governor’s proposed Long Term Care Community Choices Act of 2008.
The following, in no particular order, are some ideas, principles and rules changes that we hope Governor Bredesen and TennCare will have in their legislation.
It should be as easy to stay home as it is to be dumped in a nursing home.
Take proactive steps to divert individuals before they end up in a nursing facility. In other words give individuals real choices to community based services before they end up in a nursing facility. This would mean real changes in the way hospital discharge planners work. A discharge planner should be able to coordinate supports in an individual’s home as easily as dumping that individual in a nursing home.
- -We need presumptive and expedited eligibility for HCBS. The state’s goal should be to have services up and running within five working days from initial phone call.
- -Colorado has a Fast Track System a model that could be used here.
- -Community based services should be the first step and nursing facilities are the option, leaving individuals with Real Choices.
Saving the state money can be done without discrimination
Cost neutrality.
Waiver services cannot cost more then nursing facilities. We believe that costs must be averaged on the aggregate, not on an individual basis. If it’s done for each individual, we will end up with a system that discriminates based on disability.
Diverse communities, diverse service delivery
The system should be needs based. Services types and amounts should be based on each individual’s need, not on their diagnosis or label. There should be multiple models of service delivery, from the current agency type, to cash vouchers, fiscal intermediaries, agencies of choice and more. All of these should be coordinated with consumer direction as its core value
Emancipation for those who want out of nursing facilities.
The aging and disabled community must have assistance for funding the transition to community-based services from institutions.
There needs to be grants or other funding for Consumer Driven Community Based Organizations, like Centers for Independent Living, to do Transition Coordination, or what we call here at MCIL, our Emancipation Team.
Without exception the must be moneys made available to consumers for transitioning in order to pay for such items as deposits, household goods, equipment, basic furniture etc. hopefully around $2000 per person.
Two important points on the “transition funds”:
- 1.) Centers for Medicare and Medicaid Services, CMS, has already stated that they will reimburse states for these transition funds through the HCBS Waivers.
- 2.) Individuals moving out of nursing facilities typically have no money and cannot move out without deposits etc
Change the Nursing Homes Stranglehold on Funding
Change the way nursing facilities bill for services. Currently nursing homes have too much control. Plus, the way the current system works prevents a “Money Follows the Person” which would gradually move funds from institutions into HCBS.
Better Coordination Service Delivery
Better coordination of services.
A consumer who needs both waiver funded services and basic Medicaid services such as home health nurse should not be able to readily tell they come from different funding sources.
Direct Consumer Input
The state and the Commission on Aging—AND Disability, thank you very much—need to have a statewide Home and Community Based Services advisory group with at least 51% consumers that addresses service delivery issues, quality measures and funding reports
Nurse delegation, exemption or assignment
Many people with disabilities need help with breathing tubes, feeding tubes, bowel programs and other tasks that the state will only pay a nurse to perform. If, however, a person is able to pay for his/her own care, to direct that care and train a care-givers to perform these tasks, it is perfectly legal to do so. Why, then, should the state discriminate against persons who are not able to pay for their own care by requiring that only a nurse perform these tasks? We need rules that will allow non-nurses to perform these tasks.
RULES CHANGES:
-Abolish all rules that require that attendant and nursing services be provided only in the home. We want Home & COMMUNITY based services. We know several people stuck in their homes because their services are not allowed to follow them into the community
-Free our nurse’s, once we have nurse exemption create rules to support consumer controls.
MCIL Journal Index 2008
| Date | Name |
|---|---|
| 5/22/2008 | Long Term Care Community Choices Act of 2008. |
| 3/18/2008 | Bredesen's Proposal for Long Term Care |
| 2/10/2008 | MCIL Comments on the Tennessee Community Choices Act |
| 1/29/2008 | Gov. Bredesen Highlights the Tennessee Community Choices Act |
| 1/24/2008 | Tennessee Community Choices Act |
| 1/21/2008 | The ADAPT Community Poster |
| 1/3/2008 | Nursing Home Trasition Drawbacks |
