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Opportunities to Improve Care for Persons with Disabilities: The

Community Living Initiative

IMPLEMENTING NATIONAL HEALTH REFORM IN A DIFFICULT ECONOMIC CLIMATE

Annual Legislative and Policy ConferenceNational Association of County Behavioral Health and

Developmental Disability DirectorsMarch 3, 2011

Shawn TerrellHHS Office on Disability

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Community Living Initiative• Established in 2009 as part of President

Obama’s “Year of Community Living.”• HHS interagency initiative focused on

implementing solutions that address barriers to community living for individuals with disabilities and older Americans, including:– Promoting policy regarding home and community

based services across the Federal Government– Improving access to affordable housing– Advancing civil rights enforcement of the ADA and the

Olmstead decision

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Community Living Initiative Structure

• Led by the Office on Disability in partnership with the Administration on Aging and other agencies, including: – Administration on Developmental Disabilities at the

Administration for Children and Families (ACF)– Centers for Medicare and Medicaid Services (CMS)– Health Resources and Services Administration

(HRSA)– Substance Abuse and Mental Health Services

Administration (SAMHSA)– Office of the Assistant Secretary for Planning and

Evaluation (ASPE)– Office of Civil Rights (OCR)

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Community Living Initiative Structure

• Organized around a number of workgroups including: – Housing– Workforce – Services and Supports– Data/Quality– Communication

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Example: HUD/HHS PartnershipCapacity Building to Improve Services and

Access to Affordable Housing• Contract awarded June 2010

– Increase collaboration at federal level.– Explore, create and replicate state and local partnerships to

better integrate housing and services.– Conduct on-site team building activities between Medicaid,

service agencies and housing at specific sites.– Disseminate lessons learned from early adopters.– Create Housing and Services Resource Coordinators in state

Medicaid agencies to broker collaboration.– Enhance the partnership between Medicaid agencies and

Public Housing Authorities (PHAs)

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Example: HUD/HHS Partnership (cont’d)

Housing Choice Vouchers• HUD funding 5,300 Housing Choice Vouchers

which will enable non-elderly persons with disabilities live independently.– 4,300 for non-elderly people with disabilities.– 1,000 to help individuals transition out of institutional

settings (e.g., nursing homes) into the community.– PHAs applying for vouchers must show partnership

with Medicaid or other community organization(s).

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Example: Workforce Group• Developing and coordinating core competencies,

curricula, & training across HHS and other agencies.

• Caregiving Summit:– We worked collaboratively w/CMS to develop the Leadership

Summit on “Building Capacity & Coordinating Support for Family Caregivers & the LTSS Direct Service Workforce”.

– The DSW RC will prepare a White Paper based on the issues & solutions described by this broad cross-section of stakeholders.

• Collaboration w/DoL. – Developing a resource mapping document which should further

refine our strategies in training & caregiving.

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Example: Services Workgroup

• No Wrong Door: Developing a partnership with AoA, CMS, and the Department of Education to improve coordinated access to needed services and supports

• Improving mental health services through self-direction and medication optimization strategies.

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Example: Quality Workgroup

• Section 4302 of the Patient Protection and Affordable Health Care Act. Understanding health disparities: data collection and analysis– Focusing on including disability related

measures in surveys• Developing consensus on Home and

Community Based Services definitions

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Example: Communications Workgroup

• Focusing on ensuring that information regarding disability related topics is disseminated to a wide audience of stakeholders– Outreach information calls on public process, dual eligible, and

HUD/HHS partnership.

• Coordinates information sharing across all the Federal agencies (e.g. portal).

• We regularly send out disability policy related information through our list serve which we encourage you to join by going onto the OD website and clicking the List Serve button on the bottom right of the screen.

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Section 2402(a) of the ACA

Oversight and Assessment of the Administration of HCBS

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Section 2402(a)

• The Secretary of Health and Human Services shall promulgate regulations to ensure that HCBS service systems are designed to:– Allocate resources in a manner that is responsive to

changing beneficiary needs and choices;– Provide strategies to maximize independence;– Provide support to design individualized, self-

directed, community-supported life; and– HCBS will be designed with more uniformity across

HHS programs.

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Implementation Approach• OD is convening an HHS working group

which includes:– Centers for Medicare & Medicaid Services– Substance Abuse and Mental Health

Administration– Office for Civil Rights– Administration for Children and Families– Health Resources and Services

Administration– Administration on Aging– Assistant Secretary for Planning and

Evaluation

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Process for Promulgation

• Generate consensus within HHS:– Critical elements for inclusion in the regulations;– Basic principles for service delivery; and– Minimum expectations of participants, payers and

providers.

• Engage External Partners:– Participant and Consumer Organizations; – Other Federal Agencies including VA, DOL, DOE, HUD;– Provider Organizations; and– State Agencies and Associations.

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Key Policy Areas for Discussion

– Overview and Characteristics of HCBS;– Person Centered Planning;– Participant Direction;– Quality and Systems Improvement;– Participant Rights and Safeguards; and– Provider Qualifications.

• The discussions are centered around how these concepts and practices can be integrated into HCBS programs with a shared understanding of definitions and best practices.

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Resources

• HHS Office on Disability: http://www.hhs.gov/od

• Community Living Initiative: http://www.hhs.gov/od/topics/community/olmstead.html