SB2416_S_Amend

Adopted

AMENDMENT NO 1 PROPOSED TO

Senate Bill No. 2416

BY: Senator(s) Burton

AMEND by inserting the following sections after line 398 and renumbering subsequent section(s) accordingly:

SECTION *. (1) The Legislature finds and declares that:

(a) The current population of adults sixty (60) years of age and older in Mississippi is expected to double in size over the next twenty-five (25) years;

(b) A primary objective of public policy governing access to long-term care in this state shall be to promote the independence, dignity and lifestyle choice of older adults and persons with physical disabilities or Alzheimer's disease and related disorders;

(c) Many states are actively seeking to "rebalance" their long-term care programs and budgets in order to support consumer choice and offer more choices for older adults and persons with disabilities to live in their homes and communities;

(d) The federal "New Freedom Initiative" was launched in 2001 for the purpose of promoting the goal of independent living for persons with disabilities; and Executive Order No. 13217, issued by the President of the United States on June 18, 2001, called upon the federal government to assist states and localities to swiftly implement the 1999 United States Supreme Court decision in Olmstead v. L.C. and directed federal agencies to evaluate their policies, programs, statutes and regulations to determine whether any should be revised or modified to improve the availability of home- and community-based services for qualified persons with disabilities;

(e) The federal "Older Americans Act Amendments of 2006" (Public Law 109-365) and the Deficit Reduction Act (DRA) provided states with much flexibility to make significant reforms to pursue innovative ideas in health care, Medicaid services for the aging and disabled, consumer directed health care and rebalancing long-term care. These amendments defined the functions of Aging and Disability Resource Centers to provide comprehensive information on long-term care program options and directed states to create a state system of long-term care to enable older individuals to receive long-term care in home- and community-based settings and to provide counseling services relating to such long-term care; and

(f) Older adults and those with physical disabilities or Alzheimer's disease and related disorders that require a nursing facility level of care should not be forced to choose between going into a nursing home or giving up the medical assistance that pays for their needed services, and thereby be denied the right to choose where they receive those services; their eligibility for home- and community-based long-term care services under Medicaid should be based upon the same income and asset standards as those used to determine eligibility for long-term care in an institutional setting.

(2) As used in this act:

(a) The term "Aging and Disability Resource Center" means a program established by a state as part of the state system of long-term care, to provide a coordinated system for providing:

(i) Comprehensive information on the full range of available public and private long-term care programs, options, service providers and resources within a community, including information on the availability of integrated long-term care;

(ii) Personal counseling to assist individuals in assessing their existing or anticipated long-term care needs, and developing and implementing a plan for long-term care designed to meet their specific needs and circumstances; and

(iii) Consumers' access to the range of publicly supported long-term care programs for which consumers may be eligible, by serving as a convenient point of entry for such programs.

(b) The term "at risk for institutional placement" means, with respect to an older individual, that such individual is unable to perform at least two (2) activities of daily living without substantial assistance (including verbal reminding, physical cuing or supervision) and is determined by the state involved to be in need of placement in a long-term care facility.

(i) Intended to assist individuals in coping with, and to the extent practicable compensate for, a functional impairment in carrying out activities of daily living;

(ii) Furnished at home, in a community care setting (including a small community care setting as defined in subsection (g)(1), and a large community care setting as defined in subsection (h)(1) of Section 1929 of the Social Security Act (42 USC 1396t), or in a long-term care facility; and

(iii) Not furnished to prevent, diagnose, treat or cure a medical disease or condition.

The term "state system of long-term care" means the federal, state and local programs and activities administered by a state that provide, support or facilitate access to long-term care to individuals in such state.

(d) "Home- and community-based services" means Medicaid home- and community-based long-term care options available in this state, including, but not limited to, the Community Care Program for the Elderly and Disabled, Assisted Living, Adult Family Care, Caregiver Assistance Program, Adult Day Health Services, Traumatic Brain Injury, AIDS Community Care Alternatives Program, Community Resources for People with Disabilities, and Community Resources for People with Disabilities Private Duty Nursing.

(3) (a) There is hereby established the Long-Term Care Advisory Council within the Mississippi Department of Human Services. The advisory council shall be entitled to receive such information from the Department of Human Services, the Division of Medicaid, the State Department of Rehabilitation Services and other agencies relating to services for the aged and disabled, as the advisory council deems necessary to carry out its responsibilities under this act.

(b) The advisory council shall be provided a copy of the Division of Medicaid's study titled Comprehensive Review of Long-Term Services Money Follows the Person Program in response to RFP #2006505-01 and shall assess and develop a recommendation no later than December 1, 2007, to the Governor, the Lieutenant Governor and Speaker of the House of Representatives on the impact this study and of federal amendments to the "Older Americans Act" and the Deficit Reduction Act of 2005 on Mississippi's public and private system of programs and care for the aged and disabled.

(i) The Executive Director of the Department of Human Services, the Executive Director of the Division of Medicaid-Office of the Governor, the Executive Directors of the State Department of Rehabilitation Services and the State Department of Mental Health, or their designees, as ex officio members;

(ii) The Public Health Policy Advisor to the Governor; and

(iii) Ten (10) public members to be appointed by the Governor as follows: one (1) person appointed upon the recommendation of AARP; one (1) person upon the recommendation of the Mississippi Association of Area Agencies on Aging; one (1) person upon the recommendation of the Mississippi Association for the Rights of Citizens with Disabilities (The ARC); one (1) person upon the recommendation of the Mississippi Health Care Association; one (1) person upon the recommendation of the Mississippi Hospital Association; one (1) person that represents the independent nursing home industry; one (1) person who is a representative of the home care industry; one (1) person upon the recommendation of the Coalition for Citizens with Disabilities; one (1) person upon the recommendation of the Living Independently for Everyone (L.I.F.E.) organization; and one (1) person appointed upon the recommendation of the Mississippi Department of Transportation.

(d) The advisory council shall organize as soon as possible after the appointment of its members upon call of the Governor and shall select from its membership a chairman and a secretary.

(e) The Department of Human Services and the Division of Medicaid shall provide such staff and administrative support to the advisory council as it requires to carry out its responsibilities.

(f) The advisory council shall identify home- and community-based long-term care service models that are determined by the division to be efficient and cost-effective alternatives to nursing home care, and develop clear and concise performance standards for those services for which standards are not already available in a home- and community-based services waiver.

(4) Upon presentation of its recommendation to the Governor, the Lieutenant Governor and the Speaker of the House of Representatives, the Long-Term Care Advisory Council shall be dissolved.

SECTION *. Section 43-7-7, Mississippi Code of 1972, is amended as follows:

43-7-7. (1) The Department of Human Services shall be responsible for the collection of data and statistics and for making a continuing study of conditions affecting the general welfare of the aging population; for providing for an inter-agency and inter-departmental exchange of ideas; for encouraging and assisting in the development of programs for the aging in municipalities and counties of the state; for cooperation with public and private agencies and departments in coordinating programs for the aging; for encouraging and promoting biological, physiological and sociological research; for making recommendations for residential housing and needed nursing and custodial care facilities.

(2) Beginning with the 2009 fiscal year, the Department of Human Services may, consistent with federal law and regulations, promote the development and implementation of a state system of long-term care that is a comprehensive, coordinated system that enables older individuals to receive long-term care in home-and community-based settings, in a manner responsive to the needs and preferences of older individuals and their family caregivers by:

(a) Collaborating, coordinating and consulting with other agencies in such state responsible for formulating, implementing and administering programs, benefits and services related to providing long-term care;

(b) Conducting analyses and making recommendations with respect to strategies for modifying the state system of long-term care to:

(i) Respond to the needs and preference of older individuals and family caregivers;

(ii) Facilitate the provision, by service providers, of long-term care in home- and community-based settings; and

(iii) Target services to individuals at risk for institutional placement, to permit such individuals to remain in home- and community-based settings where appropriate and available;

(c) Implementing (through area agencies on aging, service providers and such other entities as the state determines to be appropriate) evidence-based programs to assist older individuals and their family caregivers in learning about and making behavioral changes intended to reduce the risk of injury, disease and disability among older individuals;

(d) Providing for the availability and distribution (through public education campaigns, Aging and Disability Resource Centers, area agencies on aging and other appropriate means) of information relating to:

(i) The need to plan in advance for long-term care; and

(ii) The full range of available public and private long-term care (including integrated long-term care) programs, options, services providers and resources; and

(e) Nothing in this section shall conflict with the authority of another state agency.

FURTHER, AMEND by striking lines 720 through 724 and substituting in lieu thereof the following:

(15) Home- and community-based services for the elderly and disabled, as provided under Title XIX of the federal Social Security Act, as amended, under waivers, subject to the availability of funds specifically appropriated for that purpose by the Legislature. Beginning in fiscal year 2009, and in each succeeding fiscal year through fiscal year 2013, the division may implement a process that promotes a rebalancing of the overall allocation of Medicaid funding for long-term care services through the expansion of home- and community-based services for persons eligible for long-term care as defined by regulation of the division, consistent with federal law and regulation. The expansion of home- and community-based services may occur by the voluntary migration of persons in need of long-term care from nursing home placements to home- and community-based services where appropriate and available to these persons. The Division of Medicaid may apply to the federal Centers for Medicare and Medicaid Services for any waiver of federal requirements, or for any state plan amendments or home- and community-based services waiver amendments, which may be necessary to obtain federal financial participation for state Medicaid expenditures in order to effectuate the purposes of this act. Provided, however, that any programs proposed or implemented by the Division of Medicaid under this paragraph (15) shall be in compliance and shall not interfere with any federal court order regarding the rights of disabled citizens.

FURTHER, AMEND the title by inserting the following after the semicolon on line 12:

TO ESTABLISH A LONG-TERM CARE ADVISORY COUNCIL TO STUDY AND DEVELOP RECOMMENDATIONS TO THE GOVERNOR AND THE 2008 REGULAR SESSION OF THE LEGISLATURE RELATING TO THE SERVICES PROVIDED TO THE AGED AND DISABLED UNDER RECENT AMENDMENTS TO FEDERAL LAW; TO PROVIDE DEFINITIONS; TO SPECIFICALLY PROVIDE THAT THE ADVISORY COUNCIL SHALL MAKE RECOMMENDATIONS RELATING TO COORDINATION OF HOME- AND COMMUNITY-BASED SERVICES FOR THE AGED AND DISABLED AND THE ESTABLISHMENT OF A COORDINATING UNIT OF GOVERNMENT; TO DIRECT THE DEPARTMENT OF HUMAN SERVICES TO PROVIDE SUPPORT FOR THE WORK OF THE ADVISORY COUNCIL; TO AMEND SECTION 43-7-7, MISSISSIPPI CODE OF 1972, TO PRESCRIBE THE RESPONSIBILITIES OF THE DEPARTMENT OF HUMAN SERVICES AS LEAD AGENCY FOR FEDERAL OLD AGE ASSISTANCE PROGRAMS IN FISCAL YEAR 2009; TO AMEND SECTION 43-13-117, MISSISSIPPI CODE OF 1972, TO PROVIDE FOR AN EXPANSION OF HOME- AND COMMUNITY-BASED SERVICES BY THE DIVISION OF MEDICAID, OFFICE OF THE GOVERNOR, IN FISCAL YEAR 2009;