Virginias Olmstead Initiative

1
Virginias Olmstead Initiative

• Community-Based Services, Inc.
• Board of Directors Meeting
• November 22, 2004
• Julie A. Stanley, J.D., Director
• Community Integration for People With Disabilities

2
Overview and Timelines

• 1999 The Olmstead v. L.C. decision
• 2002 Virginias Olmstead Task Force
• 2003 Olmstead Task Force Report
• Governor Warners Budget Proposals
• 2004 Adopted 2005-2006 Budget
• Executive Order 61 (2004)
• Implementation Team and Oversight Advisory
  Committee Role and Activities

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Olmstead v. L.C., 527 U.S. 581 (1999)

• Plaintiffs Two women with mental retardation
  and mental illness living in Georgia mental
  health facilities
• Issue Whether, under Title II of the ADA and
  its integration regulation, they had a right to
  live in the community
• Title II, 42 U.S.C. 12132 proscribes
  discrimination based on disability in the
  provision of public services
• Integration regulation requires a setting that
  enables individuals with disabilities to interact
  with non-disabled persons to the fullest extent
  possible. 28 C.F.R. Pt. 35 App. A. 35.130, at 469
  

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Olmstead v. L.C., 527 U.S. 581 (1999), contd

• Holding Unjustified isolation is properly
  regarded as discrimination based on disability.
• Post-Olmstead court decisions apply same
  reasoning to
• All qualified individuals with disabilities
  mental, cognitive, physical and sensory
• Individuals who are institutionalized and
  individuals who are at risk of institutionalizatio
  n

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Olmstead v. L.C., 527 U.S. 581 (1999), contd

• States must make reasonable modifications to
  programs to provide community-based treatment for
  qualified individuals when
• States treatment professionals determine that
  such placement is appropriate
• The affected persons do not oppose such
  placement and
• The placement can be reasonably accommodated,
  taking into account the resources available to
  the State and the needs of others with
  disabilities.

6
Olmstead v. L.C., 527 U.S. 581 (1999), contd

• States are not required to fundamentally alter
  services and programs.
• But if challenged, a state must be able to show
  that it has
• A comprehensive, effectively working plan for
  placing qualified persons with disabilities in
  less restrictive settings and
• A waiting list that moves at a reasonable pace
  not controlled by the states endeavors to keep
  its institutions fully populated.

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The Olmstead Task Force 2002-2003

• Item 329 M of 2002 Appropriation Act directed the
  Department of Mental Health, Mental Retardation
  and Substance Abuse Services to convene a task
  force to develop recommendations to implement the
  Olmstead decision in Virginia.
• Broad representation
• 70 members, including people with disabilities,
  family members, advocates, providers, local
  government, legislators, and 15 state agencies
• Approximately 55 others participated actively
• All disability populations were represented

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The Olmstead Task Force, contd

• Major activities
• Gathered populations and services data through
  agency reports survey of nursing homes, assisted
  living facilities and residential facilities and
  consumer and family feedback form
• Identified issues and made recommendations in 11
  topic areas, using 8 cross-disability teams
• Accountability Prevention and Transition
• Educating Qualified Providers
• Employment Transportation
• Housing Waivers

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Olmstead Task Force Report 2003

• Final Report submitted 9/15/03 to Governor
  Warner, Joint Commission on Health Care, and
  Chairs of the House Appropriations and Senate
  Finance Committees.
• Vision includes
• Individual choice of/access to services and
  supports
• Accountability to all
• Sufficient numbers of qualified providers
• Safe, available, accessible, affordable
  housing/transportation
• Opportunity to work
• Full continuum of care, from self care through
  institutionalization

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Olmstead Task Force Report, contd

• Goals Qualified individuals with disabilities
  in Virginia must, if they choose, have an
  opportunity to
• Move to a more integrated setting appropriate to
  their needs
• Stay in the community of their choice once they
  have moved
• Live successfully in the community in order to
  prevent unwanted institutionalization and
• Work collaboratively with all public and private
  partners to ensure implementation of the Olmstead
  decision.
• The Report identifies wide range of issues and
  proposes 201 recommendations, many with specific
  objectives and action steps.

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Olmstead Budget Items May 7, 2004

• 105 IFDDS waiver slots for people with
  developmental disabilities
• Minimum of 860 mental retardation waiver slots
• 160 for persons in the state mental retardation
  centers
• 700 for persons in the community
• Additional 180 slots for persons in the community
  if capacity is found to be sufficient to absorb
  the 180
• 300 slots for new day support waiver
• New Medicaid waiver for persons with Alzheimers
  Disease and related dementias

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Olmstead Budget Items May 7, 2004, contd

• Medicaid Buy-In Program
• 77 individualized discharge assistance plans
  (DAP)
• Community mental health services for children and
  adolescents
• 5 new Public Guardian and Conservator Programs
• 3 new Programs of Assertive Community Treatment
  (PACT)
• Expanded purchase of inpatient treatment in
  community hospitals

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Olmstead Budget Items May 7, 2004, contd

• Two DMHMRSAS licensing specialists
• Dementia-specific training for long-term care
  workers and Alzheimers training for public
  safety and health personnel
• Expanded DSS Caregivers Grant Program
• Expedited transitioning persons with disabilities
  from hospitals to rehabilitation centers (to
  include Medicaid disability determinations within
  seven business days)
• Core funding for Centers for Independent Living
• Restored funding for sheltered workshops

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Olmstead Budget Items May 7, 2004, contd

• Continuum of brain injury services to people in
  unserved or underserved regions of the
  Commonwealth
• Increased provider reimbursement
• MR waiver providers 3 as of July 1, 2005
• Nursing homes 3 per patient per day on July 1,
  2005
• Personal care providers 5 effective July 1,
  2005
• Inpatient hospitals from 72 to 75 of allowable
  costs on July 1, 2005
• Assisted living facilities Auxiliary grant
  increase of 3.2 as of July 1, 2005 and funding
  for 140 residents of ALFs who will become
  Medicaid-eligible due to that increase

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Executive Order 61 (2004)

• January 6, 2004 Governor Warner issued Executive
  Order 61 (2004), The Olmstead Initiative,
  establishing and specifying responsibilities of
• State Agency Community Integration Implementation
  Team
• Stakeholder Community Integration Oversight
  Advisory Committee and
• Director of Community Integration for People With
  Disabilities.

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Community Integration Implementation Team 2004

• Membership
• Four Secretaries voting ex officio members
• Commerce and Trade
• Education
• Health and Human Resources
• Transportation
• Designees from 18 state agencies
• Other agencies may be added by the Governor
• Chaired by Director of Community Integration for
  People With Disabilities Bill Fuller of VHDA
  elected Vice Chair

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Community Integration Implementation Team, contd

• Roles
• Categorize recommendations into
• Administrative
• Regulatory
• Legislative
• Budget
• Cost out and update recommendations in report
  prioritize and prepare legislative and budget
  proposals for Governors consideration
• Seek advice from and report annually to the
  Oversight Advisory Committee on the status of
  Olmstead implementation in the Commonwealth

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Community Integration Implementation Team, contd

• Activities to date
• Assigned a lead agency to each recommendation
  in the Task Force Report to cost out the
  recommendation and identified 9 additional state
  agencies to play major role identified
  assisting agencies and other stakeholders
• Divided recommendations into two phases for cost
  out and costed out 112 Phase 1 recommendations,
  identifying the type of action needed
• Submitted report to Oversight Advisory Committee
  July 15
• Held all day meeting to plan for the coming year
• Held joint meeting with agency ADA Coordinators
• Held joint meeting with Oversight Advisory
  Committee

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Community Integration Oversight Advisory
Committee 2004

• Membership
• Minimum of 15 members
• Minimum of five people with disabilities
• Minimum of three family members
• Up to seven advocates and providers
• Governor Warner appointed four additional members
• Joan Manley appointed Chair Vicky Fisher
  appointed Vice-Chair

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Community Integration Oversight Advisory
Committee, contd

• Roles
• Oversee Olmstead implementation in the
  Commonwealth
• Advise Implementation Team
• Receive annual reports from Implementation Team
• Report recommendations to Governor prior to
  October 21, 2004
• Director provides staff support to the Committee

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Community Integration Oversight Advisory
Committee, contd

• Activities to date
• Provided advice to Implementation Team, forming
  two subcommittees to address specific issues
• Reviewed Phase 1 cost outs with each lead
  agency
• Received public comment on Implementation Team
  Report
• Prioritized the recommendations to include in
  First Annual Report submitted to Governor Warner
  October 19
• Held joint meeting with the Implementation Team

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Committees First Annual ReportOctober 19, 2004

• Adopts vision, values and goals from Task Force
  Report
• Makes recommendations in three major areas
• Providing Virginians With Disabilities an
  Opportunity to Live in the Most Integrated
  Setting Appropriate if They Choose to Do So
• Providing Adequate Oversight and Monitoring to
  Assure that Virginians With Disabilities Are Able
  to Live in the Most Integrated Setting
  Appropriate When They Choose to Do So and
• Valuing, Encouraging, and Providing Opportunities
  for Interagency and Stakeholder Collaboration and
  Learning at All Times.
• Addresses Lessons Learned from Phase 1
• Recommends Next Steps

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Committees First Annual ReportOctober 19,
2004, contd

• Examples of Recommendations
• Plan for establishing/maintaining waiting list of
  residents, by disability, who are appropriate for
  discharge, who want to be discharged, from
  nursing facilities and assisted living facilities
• Housing Assistance Fund
• Medicaid-reimbursed transition benefits
• Brain Injury Waiver
• Continued elimination of Waiver and state mental
  health facility discharge waiting lists
• Continued increase of Medicaid reimbursement
  rates

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Committees First Annual ReportOctober 19,
2004, contd

• Examples of Recommendations, contd
• DSS companion program funding/expansion
• Continuum of crisis stabilization services
• Strengthened role for Director and Committee
• Systems complaint process
• Appointment of people with disabilities, family
  members, or surrogate decision makers to
  executive and legislative boards and commissions,
  beginning at the local level

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Committees First Annual ReportOctober 19,
2004, contd

• Recommended Next Steps
• Include funding for recommendations in next
  budget
• Introduce legislation to statutorily create the
  Team, a Commission similar to the Committee, and
  the Director
• Reissue Executive Order 61
• Collaborate with Implementation Team to develop a
  comprehensive action plan

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Additional Information

• Visit www.olmsteadva.com for
• The Olmstead decision and background information
• Copies of the Task Force, Implementation Team and
  Oversight Advisory Committee Reports
• Notes and Minutes from Team and Committee
  meetings
• Team and Committee meeting schedules
• Links to helpful websites
• Latest News