Virginias Olmstead Initiative

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Virginias Olmstead Initiative

• Presentation to
• Virginia Association of Centers for Independent
  Living
• Statewide Training
• Virginia Housing Development Authority
• Richmond, Virginia
• June 9, 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)

• Plaintiffs two women with mental retardation and
  mental illness living in Georgia state 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 have applied
  similar reasoning to
• Qualified individuals with other types of
  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

• The reasonable accommodation standard is met
  when the state 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.
• No requirement to fundamentally alter services
  and programs
• No requirement to close institutions

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Virginias Olmstead Task Force

• Item 329 M of the 2002 Appropriation Act directed
  DMHMRSAS to convene a task force to develop
  recommendations to implement the Olmstead
  decision in Virginia.
• Broad representation, not limited to MHMRSA
  stakeholders
• 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
• Representatives from several CILS participated

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Virginias Olmstead Task Force, contd

• Major activities
• Gathered populations and services data through
  agency reports surveyed nursing homes, ALFs and
  residential facilities obtained consumer and
  family feedback
• Identified issues and made 201 recommendations in
  11 topic areas, using 8 cross-disability Issues
  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.
• VACIL submitted extensive comments

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Virginias Olmstead Task Force Report

• Report submitted September 15, 2003, 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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Virginias 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.

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Virginias Olmstead Task Force Report, contd

• Report did not include
• Data in support of some recommendations
• Assumptions for implementing some recommendations
• The cost of implementing the recommendations
• An indication of the relative importance (or
  priority) of implementing each recommendation.

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Executive Order 61 (2004)

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

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Executive Order 61 (2004), contd

• Roles of Implementation Team
• Categorize recommendations into type of action
  needed to implement administrative, regulatory,
  legislative, and/or budget
• Cost out and update recommendations prioritize
  and prepare legislative and budget proposals for
  the 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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Executive Order 61 (2004), contd

• Oversight Advisory Committee a gubernatorial
  commission composed of at least 15 members
• Minimum of five people with disabilities
• Minimum of three family members
• Up to seven advocates and providers
• Governor appointed 19 members in 2004 and 21
  members in 2005 several members are associated
  with CILs
• Governor appoints Chair and Vice-Chair

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Executive Order 61 (2004), contd

• Roles 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

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Executive Order 84 (2005)

• Executive Order 84 (January 14, 2005) continues
  The Olmstead Initiative and
• Maintains the same roles for the Oversight
  Advisory Committee, Implementation Team and
  Director as in EO 61
• Directs the Team and Committee to collaborate and
  use a strategic planning process to update and
  prioritize Task Force Report recommendations and
  
• Directs that the Teams Report to the Committee
  and the Committees report to the Governor
  include six specific recommendations.

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Six Specific Recommendations Requested

• Appointments of people with disabilities to local
  and state groups
• Nursing and assisted living facility discharge
  wait lists
• Community provider incident reporting
• Statewide rights notification system
• Monitoring of quality/coordination of services,
  including complaint process
• Cross-agency reporting system to measure
  performance

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Updating and Prioritizing Recommendations

• February Team sorted 225 recommendations into 3
  groups
• No additional action needed
• Already implemented
• Outdated
• Duplicative
• Defer to 2006 those not directly related to
  people moving to or staying in more integrated
  settings
• Focus in 2005 those needed for people to move
  to or stay in more integrated settings
• Team categorized each recommendation and
  considered whether to suggest merger,
  subdivision, and/or updates.
• March 2005 Team presented, and Committee
  adopted, general strategic framework

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Updating and Prioritizing Recommendations, contd

• April 19 Committee reviewed Teams suggestions,
  developed its own definitions for the three
  groups, and disagreed with 27 of the Teams
  suggestions
• May 24 Joint meeting resolved 17 of the 27
  differences remainder resolved by Director
• June 16 Committee to discuss/decide method of
  prioritizing Focus in 2005 recommendations
• July 26 Committee and Team meet jointly to
  adopt priorities
• August Public comment on priorities?

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How Are We Doing So Far?

• Many Task Force Report recommendations already
  fully implemented, including
• 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
• Increased oversight of community services
• Targeting of grants to fund Olmstead solutions

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How Are We Doing So Far?, contd

• Substantial progress on many other
  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, nursing facilities and
  hospitals

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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