Governors Olmstead Initiatives

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Governors Olmstead Initiatives

• Presentation to the Senate Finance
• Health and Human Resources Subcommittee
• January 19, 2004
• Julie A. Stanley, J.D., Director
• Community Integration
• for People With Disabilities

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Governors Olmstead Initiatives

• This presentation addresses the Olmstead Decision
  and the Governors Olmstead Initiatives.
• What is the Olmstead decision?
• What does Virginia need to do to implement the
  Olmstead decision?
• What are the Governors budget proposals that
  move Virginia toward Olmstead implementation?
• Following this presentation, Commissioner
  Reinhard will address the Governors DMHMRSAS
  Olmstead and Other Budget Initiatives.

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What Is The Olmstead Decision?

• Title II of the Americans with Disabilities Act
  (ADA), 42 U.S.C. 12132, proscribes
  discrimination in the provision of public
  services. No qualified individual with a
  disability shall, by reason of such disability,
  be excluded from participation in, or be denied
  the benefits of, a public entitys services,
  programs, or activities.
• Olmstead v. L.C., 527 U.S. 581 (1999), was a
  challenge under Title II by two women with mental
  disabilities who lived in mental health
  facilities operated by the state of Georgia, but
  who wished to live in the community.
• The U.S. Supreme Court held that unjustified
  isolation is properly regarded as discrimination
  based on disability under Title II.

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What Is The Olmstead Decision? - continued

• The Court held that a State is required under
  Title II to provide community-based treatment for
  persons with mental disabilities 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.
• States must make reasonable modifications to
  programs in order to provide community-based
  services to qualified individuals, unless doing
  so would fundamentally alter the services
  provided.

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What Is The Olmstead Decision? - continued

• This reasonable modification standard is met if
  the state can demonstrate that it has
• A comprehensive, effectively working plan for
  placing qualified persons with mental
  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.
• States are not required to fundamentally alter
  the states services and programs.

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What Is The Olmstead Decision? - continued

• In evaluating fundamental alternation, the
  courts consider, in view of the resources
  available to the state
• The cost of providing community-based care
• The states responsibility for maintaining a
  range of services for the care of persons with
  diverse disabilities and
• The states obligation to mete out the services
  equitably.
• A simple comparison of the cost of providing care
  for individuals in the community with the cost of
  institutional care is not sufficient.

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What Is The Olmstead Decision? - continued

• Although the Olmstead case involved individuals
  with mental disabilities, the decision is broader
  in its scope and applies to all qualified persons
  with disabilities as defined in the ADA.
• The decision applies to all qualified individuals
  with disabilities, be they mental, physical or
  sensory disabilities.
• The decision applies both to individuals who are
  institutionalized and to individuals who are at
  risk of institutionalization.

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What Does Virginia Need to Do?

• Virginia has already taken significant steps to
  address the Olmstead decision.
• Item 329 M of the 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.
• This broadly-representative Task Force completed
  its work in September 2003, with the submission
  of its Final Report to the Governor, the Joint
  Commission on Health Care, and the Chairs of the
  House Appropriations and Senate Finance
  Committees.

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Olmstead Task Force Vision

• The Task Force Report provides a vision for the
  Commonwealth that includes
• Individual choice of and access to services and
  supports
• Accountability to people with disabilities, their
  family members, decision-makers, and the public
• Sufficient numbers of qualified providers
• Safe, available, accessible, and affordable
  housing and transportation
• An opportunity to work
• A full continuum of care, from self care through
  institutionalization

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Olmstead Task Force 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 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.
• The Report describes a wide range of issues and
  proposes specific objectives and action steps to
  address them.

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Executive Order 61 (2004)

• After receiving the Task Force Report, Governor
  Warner issued Executive Order 61 (2004), The
  Olmstead Initiative. This Executive Order
  establishes and specifies the responsibilities
  of
• A Community Integration Implementation Team
  comprised of 18 state agencies in four
  Secretariats
• A Community Integration Oversight Advisory
  Committee comprised of individuals with
  disabilities, family members, advocates, and
  providers and
• A Director of Community Integration for People
  With Disabilities.

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Next Steps Olmstead Implementation Budget
Language

• The Governor also included budget language
  directing the Community Integration Oversight
  Advisory Committee to work with and receive
  periodic reports from the Governors Community
  Integration Implementation Team.
• The Community Integration Oversight Advisory
  Committee is charged with reporting any
  recommendations for legislative and budgetary
  action to the Governor and to the Chairmen of the
  Joint Commission on Health Care, the Senate
  Finance Committee, and the House Appropriations
  Committee prior to the 2005 General Assembly
  session.

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Next Steps Nine Governors Olmstead-Related
Budget Proposals

• 1--Fund 25 new Individual and Family DD Support
  Waiver slots -- 1.6 million (0.8 million GF)
• Some slots will be used to move individuals from
  institutions, including nursing facilities, to
  more desirable and cost-efficient community
  services. Emergency slots will increase from 5
  to 10 over time, and 50 of emergency slots will
  be designated for institutional discharges.
• 2--Fund 160 new MR Waiver slots -- 13.3 million
  (6.6 million GF)
• This will allow 107 training center residents to
  be discharged to appropriate care in more
  integrated settings and 53 individuals in the
  community to receive a full array of services in
  lieu of facility care.
• Urgent criteria for both waivers will be amended
  to
• include institutionalization.

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Next Steps Nine Governors Olmstead-Related
Budget Proposals - continued

• 3--Earmark Medicaid funds for a new Medicaid
  Waiver for Persons with Alzheimers Disease and
  Related Dementias-- 6.2 million (3.1 million
  GF)
• This requires the Department of Medical
  Assistance Services to develop a home and
  community-based waiver with an enrollment of no
  more than 200 individuals in the first year.
  Approval from the federal Centers for Medicare
  and Medicaid Services is required prior to
  implementation.
• 4--Earmark Medicaid funds for the Medicaid Buy-In
  Program -- 1.4 million (0.7 million GF)
• This would enable 200 persons with disabilities
  to return to work without losing Medicaid
  benefits.

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Next Steps Nine Governors Olmstead-Related
Budget Proposals - continued

• 5--Fund 5 New Public Guardian and Conservator
• Programs -- 360,000 (GF)
• These programs will serve approximately 125
  adults ages 18 and older who do not have the
  financial resources to pay for services of a
  guardian, and who have no family or friends to
  provide the service. They offer community
  reinvestment opportunities by allowing
  individuals in state facilities to move back to
  the community.

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Next Steps Nine Governors Olmstead-Related
Budget Proposals -- continued

• 6--Fund 77 Individualized MH Discharge Assistance
  Plans -- 9 million (GF)
• These 77 individuals are long-term extended
  rehabilitation patients in state mental health
  facilities who need highly specialized services
  and supports to leave the hospital.
• 7--Expand Community MH Services for Non-Mandated
  Children and Adolescents -- 4 million (GF)
• This will fund services for children and
  adolescents with serious emotional disturbances
  and mental disorders who qualify but who are not
  mandated for services under the Comprehensive
  Services Act, and who are at risk for
  institutional placement.

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Next Steps Nine Governors Olmstead-Related
Budget Proposals - continued

• 8--Fund 3 New Programs of Assertive Community
  Treatment (PACT) -- 4.6 million (GF)
• These programs avoid the need for hospitalization
  by meeting the individual and changing needs of
  adults with mental illness in the community.
• 9--Expand the Purchase of Inpatient Treatment in
  Community Hospitals -- 2 million (GF)
• This will reduce admissions and possible
  longer-term stays in state facilities and enhance
  opportunities for further restructuring of MH
  services by strengthening community-based
  inpatient options.

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Next Steps Tax Reform

• All funding appropriated for Olmstead
  implementation in the Governors Budget is
  contingent upon the passage of tax reform.

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Governors Olmstead Budget Proposals(in Millions)
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Governors Olmstead Budget Proposals (in
Millions) - continued