long-term care - Legislative Reference Bureau

SINGLE ENTRY POINT FOR LONG-TERM CARE SERVICES
chronic illnesses, there may be a combination of services that would be more helpful
than one or another service alone.
A Horizontally Integrated SEP Process: In any case, a horizontally integrated SEP
would attempt to either consolidate or coordinate access to diverse services across
authorizing agencies and providers. The difference between consolidation and coordination is
one of degree. It is important to remember that an SEP is only a first step to true system
integration. As an initial process, an SEP can coordinate, rather than totally consolidate, the
process of access to long-term care among agencies. This is particularly true under the
"cabinet" model of state administration. Under this model, existing cabinet level agencies
retain their long-term care responsibilities but function under an official interagency
coordinating committee, or the like. Such an interagency coordinating committee would be
the natural locus for development of any integrated long-term care state policy. There is no
need for departmental reorganization. It is generally acknowledged that this form of structure
lends itself least to true service integration and coordination, largely being dependent upon
personal effort and informal agency head consensus. Support of a state's governor is key
under this model. However, this structure requires the least amount of change; the umbrella
model requires much more, and the consolidation model entails wholesale governmental
reorganization. 9
Under the "umbrella" model of state administration, all long-term care services are
provided under one single agency, usually a department of health and social services.
Different long-term care programs and functions are dispersed among various divisions and
bureaus within the umbrella department. Internal responsibilities are shifted in order to
increase inter-divisional coordination. An intra-departmental coordinating structure is usually
developed to integrate planning, policy development, and resource allocation among the
different divisions. Integration of services is fostered by assigning responsibility for programs
to one division, using one local access and delivery system, and developing an intradepartmental
planning and coordinating committee. Thus, regardless of whether categorical
or functional criteria are used to define target populations, all services are channeled through
the various divisions of one umbrella agency. (See chapter 3 for discussion of functional vs.
categorical approaches.) Horizontal integration for system entry is achieved, then, across
various state divisions by channeling access through one supervising department.
For example, Governor Bayh of Indiana proposed a plan in 1990 to create a new
Department of Health and Family Services under the umbrella model. Three departments -­
Human Services, Mental Health, and Public Welfare, and the Board of Health were proposed
to be merged. While not specifically addressing long-term care, the plan would result in the
umbrella structure necessary to accommodate the coordinated umbrella model. A new
Division of Health would administer the Medicaid program, take over facility regulation
formerly carried out by the Board of Health, and operate Indiana's sole state-run nursing
home. A new Division of Family Services would operate most of Indiana's community-based
and social service programs and functions. 10
Obstacles to Service Integration: However, Indiana wisely acknowledges that under a
coordinated umbrella or consolidation model (see following section), integration of either the
single entry process or of the entire long-term care system does not occur automatically: 11
Simply having all long-term programs under one departmental structure or model
however, does not guarantee an integrated state long-term care system. The
Governor's plan would need to include the following specific actions to ensure that
this integration takes place:
7