Virginias Olmstead Initiative: 2005 In Review

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Virginias Olmstead Initiative 2005 In Review

• Presentation to
• Insight Enterprises, Inc.
• Annual Conference on Disabilities
• October 17, 2005
• Julie A. Stanley, J.D., Director
• Community Integration for People With
  Disabilities

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Timeline of Events

• 1999 U.S. Supreme Court decides Olmstead v. L.C.
• 2002 Virginias Olmstead Task Force convened
• 2003 Olmstead Task Force Report completed
• 2004 Executive Order 61 (2004) issued
• 2005 Executive Order 84 (2005) issued

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

• Title II of the Americans With Disabilities Act,
  42 U.S.C. 12132 Government may not
  discriminate based on disability in the provision
  of public services.
• U.S. Supreme Court Olmstead holding Unjustified
  isolation of people with disabilities is
  discrimination based on disability.

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

• Three-Prong Test
• Community placement is appropriate
• The person does not oppose it
• State can reasonably accommodate it

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Virginias Olmstead Task Force

• Charge Develop recommendations to implement
  Olmstead in Virginia
• Report issued September 18, 2003
• Consensus vision and goals
• Issues/Barriers
• 201 Recommendations
• Suggested agencies to implement recommendations
• Some time lines, strategies

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Executive Order 61 (January 6, 2004)

• Community Integration Implementation Team 18
  state agencies and four Secretariats
• Community Integration Oversight Advisory
  Committee individuals with disabilities, family
  members, advocates, and providers
• Director of Community Integration for People With
  Disabilities

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Executive Order 61 (contd)

• Team costs out, implements recommendations
• Committee oversees, advises Team
• Team reports implementation status to Committee
  annually
• Committee reports recommendations to Governor by
  October 21
• Director Chairs Team, provides staff support to
  Committee, reports annually to Governor

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Executive Order 84 (January 14, 2005)

• Continued Oversight Advisory Committee,
  Implementation Team and Director
• New directives
• Team/Committee to update and prioritize
  collaboratively
• Team and Committee reports to include six
  specific recommendations

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2005 Major Activities

• Narrowing the focus
• Prioritizing
• Implementing

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Narrowing the Focus

• Some recommendations merged
• Some recommendations updated
• All recommendations sorted into three groups
• No additional action needed
• Defer to 2006
• Focus in 2005

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No Additional Action Needed

• Measurable evidence supports that they
• Already have been implemented
• Are duplicative
• Are outdated

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Focus in 2005

• Recommendations believed to be needed in order
  for people with disabilities to live in the most
  integrated setting

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Defer to 2006

• Recommendations not fitting into the other two
  groups

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Prioritizing

• Six (6) top priorities
• Eight (8) additional priorities
• Several housing priorities

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Six Top Priorities

• 1 Increase Medicaid reimbursement rates.
• 2 Increase PMA to 300 of SSI payment limit in
  all Waivers.
• 3 Increase availability of Waiver slots.
  Require waiting list of people in nursing
  facilities and ICFs/MR who want to move. There
  should be no wait longer than 90 days for
  discharge for people living in any institution.
• 4 Eliminate State mental health facility
  discharge waiting lists.
• 5 Develop and fully fund incentives to attract
  and retain qualified candidates to disability
  fields of care.
• 6 Increase Medicaid financial eligibility to
  100 of FPL.

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Eight additional priorities

• Funding/other incentives for providing and
  establishing new services
• Employment as issue in discharge planning
  protocols
• Recovery-oriented services for adults with SMI
  mental health consumer mentoring group
• Revolving fund for people in institutions to use
  for upfront household expenses
• Nurse Practices Act amendment to exclude
  personal assistants, respite workers/companion
  aides under direction of a consumer or his/her
  surrogate from requirements
• Brain Injury Waiver
• Dementia Waiver
• Housing plans to identify people with
  disabilities as a high priority housing need
  population agencies to assign high priority to
  these needs

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Housing is Vital to Community Integration
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Housing Priorities

• Lead entity to coordinate housing for people with
  disabilities
• State housing supplement program
• Housing Choice Vouchers/other public benefits as
  income
• Advance notice of availability of fully
  accessible housing
• Housing plans that identify people with
  disabilities as high priority population.
  Agencies that assign high priority to housing
  needs. Dialogue with stakeholders on how to do
  this
• Training on best practices in affordable/accessibl
  e housing partnerships determining local
  capacity for delivering affordable/accessible
  housing meetings with stakeholders
• Alternatives to Auxiliary Grant program
• Education of decision makers re negative impacts
  of many local land use regulations/practices on
  creating affordable/accessible housing

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Six Specific EO 84 Recommendations

• Appointments/membership
• Nursing home/ALF discharge wait lists
• Incident reporting
• Rights notification system
• Quality monitoring, including complaint process
• Cross-agency reporting system

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Committees Recommended Next Steps

• Phase One of Olmstead Plan
• Legislation to establish the Committee, Team and
  Director
• New Executive Order in January
• Continuity through transition to new
  administration
• Educational campaign
• Future agenda to include populations not
  addressed in Report

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Implementing

• Recommendations already fully implemented
  include
• Creation of Governors Olmstead designee,
  stakeholder group and interagency team
• Housing Registry
• Home Accessibility Modifications Programs
• Education of architects, contractors and others
  in accessibility and universal design
• Newborn Screening
• Waiver Choices Brochure
• Targeting of grants to fund Olmstead solutions

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Implementing, contd

• Substantial progress on many recommendations,
  including
• PACT programs, discharge assistance plans, crisis
  stabilization units and community inpatient bed
  purchases for people with mental illness
• 860 additional Medicaid waiver slots and two
  Regional Community Support Centers for people
  with mental retardation
• 105 additional Medicaid Waiver slots for people
  with developmental disabilities
• New Waivers for day support services and people
  with Alzheimers and dementia
• Rate increases for mental retardation waiver and
  personal care providers

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Implementing, contd

• Latest Initiatives
• VBPD Nursing Home Transition grant awarded to
  VACIL
• VBPD Community Inclusion grant awarded to
  DMHMRSAS
• DMAS drafting fast track regulations to add
  transition benefits to Waivers

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For more information

• Visit our website at
• www.olmsteadva.com
• Contact Director at
• julie.stanley_at_governor.virginia.gov
• 804-371-0828