Implementing the Olmstead Decision In Virginia

1
Implementing the Olmstead Decision In Virginia

• Insight Enterprises, Inc.
• Annual Conference on Disabilities
• Passion, Preparation and Persistence
  Empowerment
• Radisson Hotel Hampton
• October 18, 2004
• Julie A. Stanley, J.D., Director
• Community Integration for People With Disabilities

2
Implementing the Olmstead Decision in Virginia

• This presentation addresses the manner in which
  Virginia is going about implementing the Olmstead
  decision
• 2002 The Olmstead Task Force
• 2003 Olmstead Task Force Report
• Governors budget proposals
• 2004 Executive Order 61 (2004)
• Adopted 2005-2006 Budget
• Implementation Team and Oversight Advisory
  Committee Role and Activities

3
The Olmstead Task Force

• 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.
• 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

4
The Olmstead Task Force, contd

• Major activities
• Gathered populations and services data through
  agency reports survey of nursing homes, ALFs 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
• Held two live public comment sessions and two
  30-day public comment sessions on Interim and
  Final Draft reports

5
Olmstead Task Force Report

• Final Report was submitted September 15, 2003, to
  the Governor, the Joint Commission on Health
  Care, and the 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

6
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 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.

7
Olmstead Items in Budget Adopted May 7

• 1--105 IFDDS waiver slots for people with
  disabilities (for 2005, an increase of 1,478,089
  and for 2006, an increase of 2,159,675 GF)
• 2--Minimum of 860 MR Waiver slots
• 160 for persons currently in the state mental
  retardation centers (for 2005, an increase of
  2,666,667, and for 2006 an increase of
  4,000,000 (GF))
• 700 for persons currently in the community (for
  2005, an increase of 13,500,000, and for 2006 an
  increase of 18,200,000 (GF))
• Additional 180 slots for persons currently in the
  community if capacity is found to be sufficient
  to absorb the 180

8
Olmstead Items in Budget Adopted May 7, contd

• 3--300 slots for day support waiver (for 2006, an
  increase of 2,918,700)
• 4--Earmark Medicaid funds for a new Medicaid
  Waiver for Persons with Alzheimers Disease and
  Related Dementias-- 6.2 million (3.1 million
  GF)
• 5--Earmark Medicaid funds for the Medicaid Buy-In
  Program -- 1.4 million (0.7 million GF)
• 6--77 individualized discharge assistance plans
  (for 2005, an increase of 3,593,333 and for
  2006, an increase of 5,390,000 (GF))
• 7--Community mental health services for children
  and adolescents (for each year of the biennium an
  increase of 2,000,000 GF)

9
Olmstead Items in Budget Adopted May 7, contd

• 8--Five New Public Guardian and Conservator
• Programs -- 360,000 (GF)
• 9--Three New Programs of Assertive Community
  Treatment (PACT) -- 4.6 million (GF)
• 10--Expand the Purchase of Inpatient Treatment in
  Community Hospitals -- 2 million (GF)
• 11--Two DMHMRSAS licensing specialists to license
  new providers (200,000 GF for the biennium)
• 12Dementia-specific training of long-term care
  workers (70,000 earmarked in DSS budget) and
  Alzheimers training for public safety personnel
  (50,000 per year GF earmarked in DCJS budget)

10
Olmstead Items in Budget Adopted May 7, contd

• 13Expand Caregivers Grant Program (50,000 GF
  each year of the biennium)
• 14--Expedite process for transitioning persons
  with disabilities from hospitals to
  rehabilitation centers (to include Medicaid
  disability determinations within seven business
  days) (language only)
• 15--Core funding for CILs (160,000 (GF) in each
  year of the biennium)
• 16--Restore community rehabilitation funding for
  sheltered workshops (150,000 GF in each year of
  the biennium) and
• 17Provide continuum of brain injury services to
  people in unserved or underserved regions of the
  Commonwealth (for 2005, 750,000 and for 2006,
  1,000,000 (GF)

11
Olmstead Items in Budget Adopted May 7, contd

• 18--Increase Provider Reimbursement
• MR Waiver Providers 3 as of July 1, 2005 (for
  2005, 500,000 and for 2006, 4,700,000 (GF))
• Nursing Homes 3 per patient per day on July 1,
  2005 (for 2006, 9,740,987 GF)
• Personal Care Providers 5 effective July 1,
  2005 (for 2006, 3,000,000 GF)
• Inpatient hospitals from 72 to 75 of allowable
  costs on July 1, 2005 (9,125,000 GF)
• Assisted Living Facilities Auxiliary grant
  increase of 3.2 as of July 1, 2005 (2,190,720
  GF) and funding for 140 residents of ALFs who
  will become Medicaid-eligible due to that
  increase (991,219 GF)

12
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.

13
Community Integration ImplementationTeam

• Membership of Team
• Four Secretariats 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

14
Community Integration Implementation Team --
continued

• Role of Implementation Team
• 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
  Community Integration Oversight Advisory
  Committee on the status of Olmstead
  implementation in the Commonwealth

15
Community Integration Implementation Team --
continued

• Activities to date
• Assigned a lead agency to each recommendation
  in the Task Force Report to cost out the
  recommendation
• Identified 9 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
  identified the type of action needed
• Submitted report to Oversight Advisory Committee
  July 15
• Had all day meeting to discuss the coming year

16
Community Integration Oversight Advisory Committee

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

17
Community Integration Oversight Advisory
Committee -- continued

• Role of Oversight Advisory Committee
• Oversee Olmstead implementation in the
  Commonwealth
• Advise Community Integration Implementation Team
• Receive annual reports from Implementation Team
• Report recommendations to Governor prior to
  October 21, 2004
• Director of Community Integration for People With
  Disabilities provides staff support to the
  Committee

18
Community Integration Oversight Advisory
Committee -- continued

• Activities to date
• Provided advice to Implementation Team regarding
  several recommendations
• Formed two subcommittees to address specific
  issues
• Reviewed Phase 1 cost outs with each agency
  submitting them
• Received public comment on Implementation Team
  Report
• Decided to prioritize the recommendations
• Adopted First Annual Report to Governor, to be
  submitted by October 21

19
Future Activities

• Joint Meeting October 26 between Implementation
  Team and ADA Coordinators
• Joint Meeting November 9 between the Committee
  and the Team
• Presentations on the DMHMRSAS Discharge
  Assistance Program and the EDCD Waiver
• Planning for Phase 2

20

• For further information, visit the Olmstead
  Initiative website at
• www.olmsteadva.com