Olmstead Plan One Year Update

Presented at ACLAIMHNovember 6, 2014

Olmstead Cabinet

3

Olmstead Report• Executive Order No. 84 created Olmstead Plan

Development and Implementation Cabinet • Olmstead Cabinet issued final report in

October 2013• Ongoing oversight of Olmstead

implementation through Most Integrated Setting Coordinating Council

4

The Olmstead Plan• Community transition• Assessment and outcomes measurement• Reforms to support community integration• Accountability

Community Transition

6

Individuals with Intellectual and Developmental Disabilities

• Enhancing system capacity through partnerships

• System education on broader array of living environments

• Reduce reliance on institutional supports– Developmental center closure and reduction plans

– Community ICF transition plan

7

1970 1975 1980 1985 1990 1995 2000 2005 2010 20150

5,000

10,000

15,000

20,000

25,000

20,062

634

Developmental Center Census: 1975-2014

8

9

2013 2014 2015 2016 2017 20180

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,0007,322

6,426

5,334

4,382

2,649

606

ICF Transition Goals: 2013-2018

Year

Num

ber

10

OPWDD Activities to Increase Employment Outcomes

• New service initiated in July 2014—Pathway to Employment—to provide greater assessment and skill building to facilitate improved job matches

• Changing supported employment model and reimbursement to incentivize job retention; January 2015 implementation

Total Growth of People who Self Direct

11

12

Individuals with Mental Illness• Transform network of psychiatric center inpatient

and community services to enable individuals in care to live in the most integrated setting possible

• Focus state psychiatric center system on high quality, intensive treatment with shorter lengths of stay and enhanced treatment and support in the community

• Hospital adult inpatient census declined from 2,962 on April 1, 2012 to 2,577 on September 1, 2014

14

Community Pre-Investment

• $44 million annualized “pre-investment” for: – 628 Units of Supported Housing ($7.1 million)– 168 Waiver Slots ($4.5 million)– State Operated Community Services ($14.9 million)– Other Community/Aid to Localities ($15.9 million)– Suicide Prevention and Forensic funding ($1.5 million)

• Specific services and programs developed with State Operations and Aid to Localities subject to ongoing regional consultation and planning

15

Reducing Long-Term Stay Census• Number of long stay individuals in OMH PCs in

April 2013 was 1,060.• Olmstead Report set goal of 10 percent

reduction in long stay population over two years.

• We are currently at 936, already exceeding our goal.

16

Persons in Nursing Homes

• The Olmstead report provided the framework for New York to serve people with disabilities in the most integrated setting appropriate to their needs

• The Olmstead goal is to reduce long stay patients in nursing homes by 10 percent over five years

Assessment and Outcomes Measurement

18

Developing Common Assessment Instruments

• DOH– Uniform Assessment System (UAS)

• OPWDD– Coordinated Assessment System (CAS)

• OMH– In development (core set comprised of UAS and CAS)

• OASAS– In development (UAS and CAS)

• SOFA– Comprehensive Assessment for Aging Network Community

Based Long Term Care Services (COMPASS)

19

Key Olmstead Domains• Most Integrated Living Setting• Employment• Meaningful Day Activities • Access to Transportation• Access to and Use of Self-Directed Models• Choice in Services and Supports

20

Next Steps

• Challenges in consistent data collection bring need to build common data elements into systems

• Integrated approach envisioned with transition to managed care will help build common outcome measures upon full implementation

• Workgroup to identify measures that are lacking and recommend future data sources

Supporting Community Integration

22

Home and Community-Based Setting Requirements

• Ensures an individual’s rights of privacy, dignity, respect, and freedom from coercion and restraint;

• Optimizes individual initiative, autonomy, and independence in making life choices; and

• Facilitates individual choice regarding services and supports, and who provides them.

23

Home and Community-Based Setting Requirements

• Allowable Home and Community-Based Settings: – Are integrated in and support access to the greater community; – Provide opportunities to seek employment and work in competitive

integrated settings, engage in community life, and control personal resources; and

– Ensure the individual receives services in the community to the same degree of access as individuals not receiving Medicaid home and community-based services.

– Selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residential setting. • Person-centered service plans document the options based on the individual’s

needs, preferences; and for residential settings, the individual’s resources.

24

Home and Community-Based Setting Requirements for Provider-Owned or Controlled Residential Settings• Specific unit/dwelling is owned, rented, or occupied under

legally enforceable agreement; • Same responsibilities/protections from eviction as all tenants

under landlord tenant law of state, county, city or other designated entity; or

• If tenant laws do not apply, state ensures lease, residency agreement or other written agreement is in place providing protections to address eviction processes and appeals comparable to those provided under the jurisdiction’s landlord tenant law.

25

Requirements for Provider-Owned or Controlled Residential Settings

• The following are setting requirements for provider-owned or controlled residential settings:– Each individual has privacy in their sleeping or living unit; – Units have lockable entrance doors, with the individual and

appropriate staff having keys to doors as needed; – Individuals sharing units have a choice of roommates; – Individuals have the freedom to furnish and decorate their sleeping or

living units within the lease or other agreement; – Individuals have freedom and support to control their schedules and

activities and have access to food any time; – Individuals may have visitors at any time; and – Setting is physically accessible to the individual.

26

New York’s HCBS Implementation

• Draft plan available:https://www.health.ny.gov/health_care/medicaid/redesign/home_community_based_settings.htm• OPWDD plan available:http://www.opwdd.ny.gov/opwdd_services_supports/HCBS/home

27

Supportive Housing• New Yorkers with disabilities need affordable, accessible

housing to lead integrated lives

• Over the past three years, the state has made an investment of more than $388 million in supportive housing programs targeted at New York’s Medicaid recipients with a high level of need

28

Olmstead Review Process• In 2013, HCR implemented an Olmstead-specific review

process for all projects requesting funding under the competitive Unified Funding application process

• Unified Funding Olmstead review is conducted in collaboration with state, federal, and/or local funding partners

• Prior to award of funding, the review assesses whether persons with disabilities will be served in the most integrated setting appropriate to their needs

29

2014 Olmstead Review Enhancements• In 2014, HCR implemented a new pre-application

conference requirement for any applicant targeting 50% or more of a project’s bedrooms to persons with disabilities

• Conferences must include HCR and the state, federal or local agency that is providing the funding for appropriate services

• Purpose of this conference is to explore whether the contemplated project is consistent with the Olmstead decision

30

Employment First Executive Order• Issued in October 2014• Builds on Olmstead Cabinet’s work to enhance

employment for persons with disabilities• Employment First Commission report contains

additional recommendations to enhance employment outcomes

31

Transportation• Mobility management practices increase the

availability of transportation for people with disabilities

• Developing a pilot program to expand upon the existing Medicaid transportation management initiative to implement mobility management

32

Legal Reform• Seek to expand authority of non-licensed

personnel to provide health-related task assistance to persons residing in the community

• Seek reform of the law governing guardianship over people with intellectual and developmental disabilities to assure least restrictive option