Virginias Olmstead Initiative

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Virginias Olmstead Initiative

• Presentation to the
• KOVAR Summer Institute
• Southside Virginia Training Center
• July 2, 2004
• Julie A. Stanley, J.D., Director,
• Community Integration for People With Disabilities

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Olmstead Timelines

• 1999 The Olmstead v. L.C. decision
• 2002 Virginias Olmstead Task Force
• 2003 Olmstead Task Force Report
• Governors Budget Proposals
• 2004 Executive Order 61 (2004)
• FY 2005-2006 Funding

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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 Americans
  with Disabilities Act (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 the 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
• The 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.

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

• States are not required to fundamentally alter
  their services and programs.
• 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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Olmstead v. L.C., 527 U.S. 581 (1999), contd

• Focus Mental Retardation
• Plaintiffs were individuals with mental
  retardation
• Setting involved was a state-operated
  institution
• Institution? Or degree of integration?
• Institutions as community for some people?
• Everyone has a role
• Individuals or their surrogate decision-makers
  (e.g., family members, guardians)
• Treatment professionals
• The State

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Virginias Olmstead Task Force

• Created by General Assembly, with Governors
  support, to develop recommendations to implement
  the Olmstead decision in Virginia (Item 329 M of
  the 2002 Appropriation Act)
• 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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Virginias Olmstead Task Force, contd

• Gathered populations and services data
• Surveyed nursing homes, ALFs and residential
  facilities
• Provided consumer and family feedback form
• Developed feedback form for parents/guardians of
  residents of state mental retardation facilities
• 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
• 4 public comment sessions

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Virginias Olmstead Task Force, contd

• Focus Mental Retardation
• Members included family members of people with
  mental retardation, providers of mental
  retardation services, PAIR and the Arc of
  Virginia
• Populations and services data collected on mental
  retardation description of mental retardation,
  prevalence rates, existing services, gaps in
  services
• Mental retardation representation on Issues Teams
• Survey of parents and guardians of individuals
  residing in the state mental retardation
  facilities

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Olmstead Task Force Report

• Submitted 9/15/03 to Governor, Joint Commission
  on Health Care, and Chairs of 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
  and 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
  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 into a setting that is appropriate for
  their needs
• Live successfully in the community of their
  choice while receiving appropriate services in
  order to prevent unwanted institutionalization
  and
• Work collaboratively with all public and private
  partners to ensure implementation of the Olmstead
  decision.
• Report describes issues and proposes 201
  recommendations to address them.

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Olmstead Task Force Report, contd

• Focus Mental Retardation
• Vision Statement Full continuum of care, from
  self care through institutionalization
• Examples of Issues and Recommendations
• Expertise within the continuum of care system for
  people with mental retardation exists, but is
  under-utilized.
• Expand Regional Community Support Center concept,
  now in place at the Northern Virginia Training
  Center, to other facilities.
• Virginia maintains a waiting list of over 3,000
  individuals who need Waiver services to live in
  an integrated setting (2003 data).
• Eliminate waiting lists for Waivers and other
  supportive services.
• There were 173 residents with mental retardation
  waiting for discharge from facilities to the
  community as of April 2003.
• Support DMHMRSAS current Regional Restructuring
  Partnership process as a means to encourage
  facilities and communities to function in a more
  integrated manner.

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Olmstead Task Force Report, contd

• Focus Mental Retardation
• Examples of Issues and Recommendations, contd
• Approximately 175 residents in State mental
  health and mental retardation facilities
  currently need a surrogate decision-maker.
• Recruit, train and support a pool of individuals
  who are willing to serve as surrogate
  decision-makers for individuals with
  disabilities.
• There is a significant lack of providers of
  employment services for individuals with mental
  retardation at the community level due to
  inadequate financial incentives and extremely low
  reimbursement rates.
• Develop joint initiatives to clearly identify and
  articulate the employment-related services and
  supports that could be provided to
  Medicaid-eligible individuals through each State
  agencys respective funding streams.

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Governors Olmstead Initiative--Executive Order
61 (2004)

• On 1/6/04, Governor Warner issued Executive Order
  61 (2004), The Olmstead Initiative,
  establishing and specifying responsibilities of
• Community Integration Implementation Team
  comprised of 18 state agencies in four
  Secretariats
• Community Integration Oversight Advisory
  Committee comprised of individuals with
  disabilities, family members, advocates, and
  providers
• Director of Community Integration for People With
  Disabilities

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Community Integration Implementation Team

• Membership Designees from 18 state agencies and
  4 Secretariats
• Commerce and Trade
• Education
• Health and Human Resources
• Transportation
• Governor may add other agencies
• Chaired by Director

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Community Integration Implementation Team, contd

• Role
• Decide type of action needed to implement
  recommendations
• Administrative
• Regulatory
• Legislative
• Budget
• Cost out/update report recommendations
  prioritize and prepare legislative/budget
  proposals for Governors consideration
• Seek advice from/report annually to Community
  Integration Oversight Advisory Committee on the
  status of Olmstead implementation in Virginia

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Community Integration Implementation Team, contd

• Activities to date
• Assigned lead agency to each recommendation in
  the Report to cost out the recommendation
• Identified 8 additional state agencies to play
  major role
• Identified assisting agencies and other
  stakeholders
• Divided recommendations into two phases for cost
  out
• Costed out 112 Phase 1 recommendations
• Adopted Report to Committee June 22 to be
  submitted by July 15

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Community Integration Oversight Advisory Committee

• Membership at least 15 members
• Minimum of 5 people with disabilities
• Minimum of 3 family members
• Up to 7 advocates and providers
• Governor appointed 4 additional members
• One rotating slot dedicated to person residing in
  a DMHMRSAS mental health facility

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Community Integration Oversight Advisory
Committee, contd

• Role
• Oversee Olmstead implementation in Virginia
• Advise Community Integration Implementation Team
• Receive annual reports from Implementation Team
• Report recommendations to Governor prior to
  October 21, 2004
• Director provides staff support to Committee

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Community Integration Oversight Advisory
Committee, contd

• Activities to date
• Advised Implementation Team re 4 recommendations
• Formed 2 subcommittees to address specific issues
• Reviewed 112 Phase 1 recommendation cost out
  reports
• Will seek public comment August 1 to September 1
  on portions of Implementation Team Report
• Currently discussing format and content of report
  to Governor by October 21

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Governors Olmstead Initiative--Executive Order
61 (2004)

• Focus Mental Retardation
• Secretary of Health and Human Resources,
  DMHMRSAS, DMAS, and VBPD are represented on the
  Implementation Team
• DMHMRSAS and DMAS costed out over 50
  recommendations made in the report
• DMHMRSAS received VBPD community inclusion grant
  to use regional partnerships to expand to people
  with developmental disabilities
• Family members, PAIR and the Arc are represented
  on the Oversight Advisory Committee

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Budget Initiatives FY 2005 - 2006

• Focus Mental Retardation
• 105 Waiver slots for people with developmental
  disabilities (for 2005, an increase of 1.5
  million and for 2006, an increase of 2.2 million
  GF).
• Minimum of 860 MR Waiver slots
• 160 for persons currently in the state MR centers
  (for 2005, an increase of 2.7 million and for
  2006, an increase of 4.0 million GF)
• 700 for persons currently in the community (for
  2005, an increase of 13.5 million and for 2006,
  an increase of 18.2 million GF)
• Additional 180 slots for persons currently in the
  community if capacity is found to be sufficient
  to absorb the 180

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Budget Initiatives FY 2005 2006, contd

• Focus Mental Retardation
• 300 slots for day support waiver (for 2006, an
  increase of 2.9 million)
• 2 DMHMRSAS licensing specialists to license new
  providers 0.2 million GF)
• Restore community rehabilitation funding for
  sheltered workshops (150,000 GF)
• Increase MR Waiver Provider Reimbursement 3 as
  of July 1, 2005 (for 2005, 0.5 million and for
  2006, 4.7 million GF)
• 5 Public Guardian Conservator Programs (0.4
  million GF)

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Budget Initiatives FY 2005 2006, contd

• Other Budget Initiatives
• Waiver for Persons with Alzheimers Disease and
  Related Dementias (3.1 million GF) dementia
  training for long-term care workers (70,000 GF)
  and Alzheimers training for public safety
  personnel (50,000 GF)
• Medicaid Buy-In Program (0.7 million GF)
• 77 individualized discharge assistance plans (for
  2005, an increase of 3.6 million for 2006, 5.4
  million GF)
• Community MH services for children adolescents
  (increase of 2.0 million GF per year)
• 3 new Programs of Assertive Community Treatment
  (PACT) (4.6 million GF)

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Budget Initiatives FY 2005 2006, contd

• Other Budget Initiatives, contd
• Expand Purchase of Inpatient Treatment in
  Community Hospitals (2 million GF)
• Expand Caregivers Grant Program (50,000 GF)
• Expedite transitioning persons with disabilities
  from hospitals to rehab centers (to include
  Medicaid disability determinations within 7
  business days) (language only)
• Core funding for CILs (160,000 GF)
• Continuum of brain injury services to people in
  unserved or underserved regions of Virginia (for
  2005, 0.8 million and for 2006, 1.0 million GF)
  

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Budget Initiatives FY 2005 2006, contd

• Other Provider Increases
• Nursing Homes 3 per patient per day on July 1,
  2005 (for 2006, 9.7 million GF)
• Personal Care Providers 5 effective July 1,
  2005 (for 2006, 3.0 million GF)
• Inpatient hospitals from 72 to 75 of allowable
  costs on July 1, 2005 (9.1 million GF)
• Assisted Living Facilities Auxiliary grant
  increase of 3.2 as of July 1, 2005 (2.2 million
  GF) and funding for 140 residents of ALFs who
  will become Medicaid-eligible due to that
  increase (1.0 million GF)

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For more information, visit

• www.olmsteadva.com