Oklahoma Olmstead Strategic Planning Committee by salazarcannon

VIEWS: 15 PAGES: 73

									Interim Report of the Oklahoma Olmstead Strategic Planning Committee
July 15, 2004

“Making Olmstead a Reality in Oklahoma.”
―The mission of the Oklahoma Olmstead committee is to develop needed services for persons with disabilities to enable them to live a quality life style and to develop a plan for ensuring that all Oklahoma residents have access to and informed choice of services in the most integrated settings and that those services are a reality."
*The Interim Report is pending a vote by the Olmstead Strategic Planning Committee on August 6, 2004. Final Report will be submitted by August 15, 2004

Interim/July 15, 2004

1

Oklahoma Olmstead Strategic Planning Committee Interim Report July 15, 2004

Table of Contents

SECTION I

Introduction / Historical Perspective

3

SECTION II

Essential Components of a Successful Olmstead Plan

5

SECTION III

Current System Assessment Medicaid / Healthcare Housing Assistive Technology Transportation Employment Advocacy

7

SECTION IV

Summary

17

SECTION V A. B. C. D. E. F. G. H. I.

Appendices

18

Review of Olmstead Decision Life Empowerment System Quality Assurance Principles Interagency Strategic Plan – Olmstead Employment Section Members of OSPC Olmstead Strategic Planning Committee Minutes Olmstead Subcommittee Minutes Olmstead Strategic Planning Committee Update Glossary

Interim/July 15, 2004

2

SECTION I
Introduction The Second Annual Report of the Oklahoma Olmstead Strategic Planning Committee (OSPC) was prepared for the Governor and the Oklahoma Legislature as a progress report on the second year of activities. The information is arranged in broad categories that represent the major life areas for which planning must occur. Observations from the subcommittees are integrated into the overall document, but minutes from the OSPC and its subcommittees are contained in Appendix E. On June 22, 1999, The United States Supreme Court issued a decision in the case of Olmstead v L.C. (119 S. Ct. 212187), finding that the unjustified institutional isolation of people with disabilities is in violation of the Americans with Disabilities Act of 1990 (ADA). (See Appendix A) The ADA was enacted by Congress to establish a clear and comprehensive prohibition of discrimination on the basis of disability. Oklahoma Senate Bill (SB) 1512 was enacted on May 30, 2002, establishing the Strategic Planning Committee on the Olmstead Decision. SB 750 was enacted on April 10, 2003, amending SB 1512. 56 O.S. Supp.2003§. SB 750 clarified the voting membership of the Olmstead Strategic Planning Committee (OSPC). The voting membership is listed in Appendix D.

Historical Perspective on Oklahoma Services for Persons with Disabilities From 1909 until the early 1980s, Oklahoma‘s strategy for serving people with disabilities relied almost exclusively on institutional placement. This system was driven largely by economic factors and institutional care was considered the most cost effective means of providing care for persons with disabilities. In 1965, Medicaid was created as Title XIX of the Social Security Act, as a federal and state partnership that provides medical benefits to many low-income individuals without any means of accessing health care, including persons with disabilities. Medicaid is administered by the Centers for Medicare and Medicaid Services (CMS), which monitors certain funding, eligibility and quality requirements of the program. Medicaid is highly regulated and mandates certain services such as basic health care and institutional care. Medicaid is the primary funding source for services to

Interim/July 15, 2004

3

persons with disabilities who meet both income and medical requirements. These services are currently funded in both institutional and community settings. Medicaid is funded through a cost sharing arrangement between the federal government and state Medicaid programs. States are required to provide funds to pay for services, which are then matched by the federal government at a matching rate, which they determine for each state. Thus, the number of persons with disabilities which can be served through Oklahoma‘s Medicaid program, and the scope of services, is largely determined by the amount of funding which the legislature is willing to appropriate for these services. Currently, Medicaid is the largest source of federal financial assistance in Oklahoma. Medicaid accounted for nearly 40 percent of all federal funding flowing into Oklahoma in state fiscal year (SFY) 2003. Federal Medicaid dollars received for SFY 2003 totaled almost 1.7 billion dollars. During the first few decades of its existence, Medicaid funded services for persons with disabilities almost exclusively in institutional settings. By the mid 1980s, federal policy towards persons with disabilities began to shift and CMS offered state Medicaid programs some creative options for serving persons with disabilities outside of institutional settings. These opportunities came in the form of Home and Community Based Waiver Services programs (HCBS). The requirement that a person be in an institution before Medicaid will pay for the services is waived. The HCBS waiver program authorized under Section 1915(c) of the Social Security Act, recognizes that many individuals at risk of being placed in institutions can be cared for in their own homes and communities, thus preserving their independence and community ties, with a cost of care no higher that that of institutional care. Currently the Oklahoma Health Care Authority (OHCA), the single state Medicaid agency, has four HCBS waivers. Three waivers serve people with mental retardation and certain persons with ―related conditions‖. The fourth waiver serves the frail elderly and adult disabled population. The Department of Human Services (DHS) was the state‘s Medicaid agency prior to 1995 and the state dollar matching portion of all four waiver budgets as well as program control remain in DHS.

Interim/July 15, 2004

4

SECTION II Essential Components of a Successful Olmstead Plan
There are certain components or conditions essential to the successful implementation of the Oklahoma Olmstead Strategic Plan. Individuals with disabilities, their families, providers and advocates identified these critical success factors as part of their participation in subcommittee meetings of the OSPC. The factors also were identified through surveys conducted by advocacy groups over the past few years. The key factors are described below:

Person-Centered or Person-Driven Services A person-centered approach means that services are developed, implemented and evaluated with full participation from individuals with disabilities and/or their families. Nothing about me without me! is the slogan used by self-advocates to express what this approach really means. Informed Consumers Many people with disabilities are uninformed about how the service delivery systems work. Individuals with disabilities and their families need to be informed about the benefits, policies and funding for the services they receive, or may need. Offering information may not be enough. Information should be provided in the most accessible format for individual consumers, such as:  sign language, Braille  primary language, if non English  written in a way he/she will understand, or  explained in person Personal Choice Persons with disabilities, like all people, want to exercise as much personal choice as possible. Information will empower the person with disabilities to make the decisions necessary to live a meaningful and productive life. Flexible Funding Persons with disabilities and/or their families want flexibility to use funds in the most cost-effective manner and in ways that best meet their unique needs. The

Interim/July 15, 2004

5

current funding structure lacks flexibility. Persons with disabilities and families want:  Providers and professionals who are paid enough to insure consistency and reduce the rate of turnover;  Option to purchase needed supplies from local stores when it costs less than paying higher costs through contracted vendors;  Access to generic community services, such as: o recreation activities instead of hiring physical and occupational therapists to provide exercise programs; o purchase of transportation services through neighbors, friends or local transportation providers instead of having to depend upon extremely limited services; Additionally, funds from different sources and different systems should be coordinated to make the best use of resources and to accomplish the goals of the individual. Money Follows the Person Currently the funds that pay for the care of an individual in a residential facility are not transferred to pay for the services the individual will need at home. In order for the individual to leave the facility, new dollars must be appropriated for their services because funding is tied to beds instead of people. Having funding follow the person makes far more efficient use of limited service dollars and creates a market driven long-term care system. Money tied to the individual reduces the problem of over-capacity in some service areas and scarcity in others. Furthermore, funding is needed to help the individual with the expenses associated with transitioning from the nursing home or institution. These expenses include such things as housing deposits, assistive technology, architectural modifications, and a basic level of home furnishings Diversion Services are funded and delivered so that staying in a person‘s own home is as realistic and cost effective a choice as going to a nursing facility or intermediate care facility. Easy Access Access to information about available services and access to services must be available to all persons with disabilities, as well as information about how the services really work. Individuals with disabilities and their families need to know
Interim/July 15, 2004 6

as many options as possible including access to multiple state and local agencies, peer supports, access to a variety of social, educational, healthcare, religious, transportation, housing, and other services.

SECTION III CURRENT SYSTEM ASSESSMENT
During the past two years the OSPC identified certain needs and issues of importance to consumers, families and service providers. This information came from direct participation in Olmstead subcommittee meetings and through several surveys and studies conducted in the past few years.

Medicaid / Health Care
Over 600,000 of Oklahoma‘s 3.3 million residents have no health insurance. Despite the fact that most of this population qualify as the ―working poor,‖ many either have no employer sponsored private insurance plan or fail to qualify for public programs such as Medicaid which has strict financial eligibility requirements or Medicare which has age and health status requirements. Thus, it comes as no surprise that the lack of health care is one of the most pressing issues facing Oklahomans today. This issue is even more critical to Oklahomans with disabilities who rank insurance coverage for medical care as their most important need. (citation here) Many low-income adults, even if they are very poor, simply do not qualify for Medicaid. Medicaid eligibility for non-elderly adults is extended primarily to those who are pregnant, disabled, or low-income parents of a dependent child. The program simply does not have the state funding necessary to extend coverage to all adults or even to all adults with disabilities. Thus, even though the Medicaid program provides a vehicle to capture significant federal financial participation in the form of matching federal dollars, the monthly average Medicaid enrollment of 484,848 in SFY-2003 represented only about 14% of Oklahoma‘s overall population. (OHCA SFY-2003 Annual Report, page 12)

Interim/July 15, 2004

7

A new optional federal waiver program called the Health Insurance Flexibility Act (HIFA) allows matching federal dollars to be used as premium assistance for employer sponsored insurance and offers new opportunities to cover more low income working people. Funding for this health insurance expansion is dependent on the increased tobacco tax proposal, which is on the state ballot in November 2004. In 1994, House Bill 1573 created the Oklahoma Health Care Authority (OHCA) and designated it as the single state Medicaid agency effective January 1, 1995. OHCA was charged with purchasing Medicaid benefits, studying state-purchased and state-subsidized health care systems, recommending changes aimed at minimizing the financial burden on the state and providing the most comprehensive health care possible for eligible Medicaid recipients. To accomplish these mandates, OHCA oversees several health care programs. Most of these programs include services such as primary care, inpatient and outpatient hospital services, prescription drugs, family planning, pregnancy services, dental care, behavioral health services, transportation, and institutional care. Oklahomans eligible for Medicaid primarily include low-income women and children, the disabled and elderly. Some of these groups are considered ―mandatory‖ eligibility groups and must be covered by the state Medicaid program, while others are considered ―optional.‖ The same is true of the covered benefits. The decision by a state Medicaid program to cover an optional population or optional benefits has important implications for the State and health care providers that otherwise might be paying for or providing health care services without compensation. Federal matching payments through Medicaid often allow states to partially refinance the cost of services that states have traditionally provided at their expense or to pay for services that otherwise might have to be written off by providers as uncollectable debts or charity care. Unfortunately, the availability of federal matching funds for a particular service or a particular category of individuals does not necessarily mean that a state is able to cover these individuals since the state must first provide their share of the costs. Thus, in Oklahoma, though the Medicaid program does provide the federally required mandatory services for adults such as hospital care and institutional care, it does not pay for many necessary services such as physical therapy, dental services, or eyeglasses, and some services, like prescription drugs, are restricted by monthly or annual coverage limitations. Additionally, during periods of economic recession resulting in revenue shortfalls, state appropriations, including those to Medicaid, are reduced. Under these circumstances, OHCA is forced to eliminate both optional

Interim/July 15, 2004

8

benefits and optional coverage groups, discontinuing services to thousands of Oklahomans with critical health care needs, including persons with disabilities. By statute, eligibility for the Oklahoma Medicaid program is determined by the Department of Human Services (DHS). Income guidelines outlined by the federal government for mandatory coverage groups and by the state for optional coverage groups must be met in order to be eligible for Medicaid services. Depending upon availability of state funds, a state may choose to be very restrictive or very lenient with regard to coverage of optional groups. OHCA administers several health care programs which impact persons with disabilities. Among these are SoonerCare. SoonerCare is a managed care program, which primarily provides services to low-income children and pregnant women. Additionally SoonerCare covers people with disabilities who are not dually eligible for Medicare and Medicaid, and who do not meet the level of care criteria for institutional care. SoonerCare covers primary care, inpatient and outpatient hospital services, prescription drugs, behavioral health care, transportation, family planning and limited dental care. Long-term care services, primarily nursing home services (NF) and services in intermediate care facilities for the mentally retarded (ICFs/MR) are mandatory Medicaid benefits. Since Medicare does not cover these services, Medicaid is the only public program that provides substantial coverage for long-term care. Indeed Medicaid funded approximately 71% of the total actual long-term care bed days in the state for SFY 2003 with total long-term care expenditures accounting for 19% ($277,714,649 NF and $32,437,898 for ICF/MR) of the total OHCA Medicaid expenditures. These services include expanded benefits such as coverage of nonemergency transportation with attendant care, eyeglasses, dentures, and an expanded personal needs allowance, and expanded benefit for durable medical equipment and supplies services. Long term care services through Medicaid are available to individuals who meet the level of care requirements and who are at or below 300% of the federal benefit level ($1,692 income per month or about 220% of the federal poverty level). The Medicare Buy-In Program is a Medicaid program, which impacts people with disabilities who are eligible for both Medicare and Medicaid. Medicare is the primary payer of services and Medicaid is the secondary payer for these individuals. For hospital expenses, Medicaid pays the coinsurance and deductible including skilled nursing services. The deductible and coinsurance are also paid for supplementary medical insurance expenses that are primarily physician
Interim/July 15, 2004 9

services. Currently the eligibility for this program slightly exceeds the mandatory federal criteria. Another buy-in program, the Qualified Medicare Beneficiary program, assists low-income beneficiaries who are below 100% of the federal poverty level. Medicaid and Social Security have strict income and resource eligibility criteria, which must be met in order to qualify for benefits. These criteria are a disincentives to persons with disabilities who want to work to earn more income, but who cannot jeopardize their access to Medicaid which pays for their health care. Increased income may also jeopardize their access to other social services such as subsidized housing and food stamps. In many cases, an increase in income will not cover the cost of lost benefits. A resource (savings or equity) limit of $2,000 for an individual is a disincentive for beneficiaries with a disability to accumulate savings for things like a specially equipped van or a down payment on a home. Thus, the incentive for people with disabilities is to stay in the system and live on very limited income, rather than to move outside the system through meaningful employment

Housing
 71% of people without disabilities own homes, but fewer than 10% of those with disabilities do.  Nationally, approximately 750,000 people with developmental disabilities live with aging parents. (http://www.aucd.org, Legislative Brief on Housing)  For the first time ever, the national average rent was greater than the amount of income received by 3.7 million Americans with disabilities who rely on a monthly Supplemental Security Income (SSI) of $545 to pay for all their basic needs. (Priced Out in 2002)  In 2002, of the nation‘s 2,702 housing market areas, there was not one single area where modestly priced rental units were affordable to people with disabilities. (Priced Out in 2002)  The 1992,‖elderly only‖ designation law allowed owners of federally subsidized housing to restrict or exclude non-elderly people with disabilities from moving into HUD funded public and assisted housing.
(http://www.aucd.org/, Legislative Briefing on Housing)

 Nationally, over 400,000 units (out of 1 million) are designated exclusively for people over the age of 62. (http://www.aucd.org/, Legislative Brief on Housing)

Interim/July 15, 2004

10

People with disabilities are often very limited in the housing options available to them. Factors that contribute to these limited options are described below:  Many people with disabilities must rely on Social Security disability payments as their only source of funds. This payment is approximately $564 per month in 2004, which is not enough money to pay rent and other living expenses unless the person on Social Security chooses to live with other individuals who may share the rent and living expenses. If they exceed the income limits to qualify for Medicaid they will lose health care coverage.  Housing often is not accessible for people who use wheelchairs or other forms of mobility assistance. Frequently the bathrooms do not have grab bars and doorways are not wide enough to permit wheelchairs to get through. Additionally, most landlords are not willing to make modifications.  Some people with disabilities choose to live with members of their family and do not have any out-of-pocket expenses for rent or living expenses. Therefore, many Oklahomans with disabilities look to programs that provide housing assistance. The Housing and Urban Development (HUD) Section 8 program provides housing assistance payments through rental certificates, vouchers, or payments to participating property owners. However, there are drawbacks to this type of housing. The most crucial and common issues raised by persons with disabilities were the concerns about:  Physical accessibility;  Affordability - difficulty finding housing within their means;  Safety of HUD Section 8 housing - housing is often located in undesirable areas, causing concern for people‘s safety and ability to become fully participating members of their community;  Waiting lists make it difficult to time an individual‘s exit from a nursing home, or an individual may have to live in a nursing home waiting for housing vouchers; and  Funding sources for owning one‘s own home.

Assistive Technology
 U.S. Census Bureau statistics estimate that 20% of Oklahomans, over a half million people, have a disabling condition(s). Some disabilities will be life long; others may be temporary. Whether permanent or temporary, however, provision of necessary adaptive equipment is essential for increasing function, decreasing complications, and promoting the psychological well being of individuals with disabilities.
Interim/July 15, 2004 11

Technology makes things easier for people without disabilities, but for people with disabilities, assistive technology makes things possible. The purpose of assistive technology devices and services, regardless of the type of device or service, is to:       Improve or maintain functional abilities. Prevent the development of secondary impairments and disabilities. Increase independent living. Decrease or eliminate the need for caregivers. Facilitate entrance into or return to work, school, or living situation. Enable full access to, participation in, the opportunities afforded the nondisabled citizens of Oklahoma.  Empower persons with disabilities to compete with persons without disabilities within their capabilities. Technology – having it and being able to use it – has become a necessity of daily life. This reality applies to all and affects everyone‘s quality of life. Technology has become one of the primary engines for economic activity, education and innovation in this Nation, and throughout the world. Commitment to the development and utilization of technology is one of the main factors underlying the strength and vibrancy of the economy. As technology has come to play an increasingly important role in the lives of all, in the conduct of business, in the functioning of government, in the fostering of communication, in the conduct of commerce, and in the provision of education, its impact upon the lives of Oklahoma‘s 625,000 individuals with disabilities is comparable to its impact upon the remainder of Oklahoma‘s citizens. No development in mainstream technology can be imagined that would not have profound implications for Oklahomans with disabilities. Hence, the concept of assistive technology is not just a device or a service. It requires systems working together in a coordinated effort to keep the needs of individuals with disabilities for access to technology as a central component of decision making related to the development, use, and availability of technology in both the public and private sectors. The Technology-Related Assistance for Individuals with Disabilities Act (Tech Act) of 1998 was passed by Congress to increase access to, availability of, and funding for assistive technology through state efforts and national initiatives. With the passage of the Tech Act, children, youth and adults with disabilities and their families and advocates were given a clear and expanded set of expectations that assistive technology devices and services would be more available, accessible, and responsive to consumer needs.
Interim/July 15, 2004 12

To develop these comprehensive changes will require the involvement of individuals with disabilities, family members, providers, professionals, technology manufacturers and dealers, insurers, federal and state agencies, and members of the Oklahoma Legislature.

Transportation
 Funds from the Transportation Equity Act for the 21 Century, Section 5310
st

program, can only be used for capital expenses and cannot be used for operating expenses. (Legislative brief on Transportation http://www.aucd.org/)  A lack of adequate transportation bars people with disabilities from employment. (Legislative brief from http://www.aucd.org/) Under the home and community-based waivers and the in-home support waiver, 4,200 persons with disabilities may access Medicaid-funded transportation services to and from medical appointments, work or employment services, recreational activities, and other community activities within the number of miles authorized in their Plan of Care, and within the rules established by the Department of Human Services and the Oklahoma Health Care Authority. For thousands of Oklahomans, finding adequate transportation services is an ongoing struggle, but is an even greater barrier for people with disabilities. There are four urban transit providers— Metro Transit (Oklahoma City), LATS (Lawton), CART (Norman), and Tulsa Transit and there are twenty rural transit providers operating throughout the state. In a study conducted by the Oklahoma Department of Transportation, more than eighty percent (80%) of the residents surveyed thought it was important for the State of Oklahoma to foster public transportation improvements at the city and county level and almost half rated the availability of public transportation in their community as ―poor.‖ Similarly, ―stakeholders‖ who influence transportation decisions in the state were surveyed. Seventy-one percent (71%) of this group rated the availability of public transportation in their community as poor, and eighty-seven percent (87%) thought that funding for public transportation should be increased over the next five years. Voucher programs also exist (often through Medicaid funding) which are intended to service persons with disabilities and/or their families. Programs offer rides to hospital visits or reimburse those who use their own means of transportation for their driving expenses. Though these programs can and do provide transportation to people in need of it, they have restrictions which prevent them from being a
Interim/July 15, 2004 13

realistic option for many who need transportation services. For instance, services providing individual transportation to the hospital require that three days of advanced notice is given before the hospital visit must take place. Furthermore, these programs carry the restriction that only one passenger is allowed to accompany the person requiring the transportation. Parents with more than one child who cannot find alternate care for their other children are unable to take advantage of these services. The Department of Transportation has been concentrating its efforts on trying to create a viable transportation network. With more coordination of dollars and ideas, needed programs can be given a stronger footing and more statewide support. They are in agreement with the feelings expressed by many Oklahomans with disabilities who need reliable public transportation—strength in numbers is required to make lasting and noticeable change. Workgroups and consumer advisory boards could play a vital role in coordinating transportation services throughout the state and tailoring those services to consumer‘s needs. Before any of this can become a working reality, new and reliable funding sources must be established. Currently, the Oklahoma Department of Transportation administers funding from the government and from the ―Public Transit Revolving Fund‖—an allocated portion of the state‘s gasoline tax. The funds they receive now are inadequate to support the improvements that so many Oklahomans require. The Oklahoma Transit Association is lobbying for an increase in the fuel tax directed to more funding for public transportation services. (Information taken from:
Transportation and Oklahoma: Putting Residents with Disabilities on the Road to Success)

Employment
 In 1997, over 33% of adults with disabilities lived in a household with an annual income of less than $15,000, compared to only 12% of those without disabilities.  Unemployment rates for working-age adults with disabilities have hovered at the 70 percent level for the past 12 years.  72% of Americans with disabilities want to work, but because of the disincentives in Federal law, less than 1% of those receiving disability benefits fully enter the workforce. (www.aucd.org, Legislative Brief on Employment) In Oklahoma, Developmental Disabilities Services Division funding for sheltered
Interim/July 15, 2004 14

workshops in the fiscal year 2002 was $9.1 million compared to $10.8 million that was spent on integrated employment. The Department of Rehabilitation Services spends approximately $2 million on supported employment and $1 million on sheltered workshops. Economic hardship is a constant concern for many individuals with disabilities. This single factor keeps many individuals with disabilities and their families from realizing even their most basic needs. Oklahomans with disabilities who participated in a recent survey, The Needs of Individuals with Disabilities in Oklahoma, conducted by Esther I. Wilder, Department of Sociology and Social Work, Lehman College, City University of New York and sponsored by the Oklahoma Office of Handicapped Concerns, reported having a median annual income of just over $8,760 when living alone. Twenty-five percent of these respondents have annual incomes of less than $5,000. Moreover, the situation is no better in multi-person families; who have a median annual income of $18,133. In comparison, the median annual income of all Oklahoma households was $33,235 in 1999-2000. That same year, the median U.S. household income was $42,168 (United States Census Bureau 2001). For Oklahoma to increase the number of people with disabilities who enter, re-enter, and remain in the workforce, the State must develop and implement a strategic plan that focuses on the system as a whole. While state agencies might feel that progress toward integrated employment has been made, there are still large numbers of people with disabilities wanting jobs in the community. A statewide conference and strategic planning workshop held in October 2003 produced the Interagency Strategic Plan – Olmstead Employment Section. The plan stresses the importance of interagency collaboration and the need for more effective matching of an individual‘s interests and strengths with quality jobs providing equitable pay and benefits. The following actions steps are taken from this plan. See Appendix D.

Advocacy
Individual advocacy enables people to have a voice in the decision-making process, especially when those decisions affect their quality of life. Advocacy means helping someone by speaking or acting in his/her best interest. Whereas many individuals with disabilities are able to self-advocate there is also a need for advocates who work on behalf of individuals who cannot advocate for
Interim/July 15, 2004 15

themselves. They must take the individual‘s perspective in trying to resolve the problem. If the individual can represent themselves, the advocate may assume a mediator role to ensure that the individual‘s views are heard and that everyone participates in determining the resolution. When advocating for another, objectivity is required to determine the validity of the complaints. Sufficient information must be gathered to have an accurate understanding of the problem and to plan a resolution strategy ―Families and self-advocates have a body of information and experience that is needed by service providers, policy makers and people in education. Yet, their individual voices are often a whisper in the noise of systemic change.‖ (Center for Learning and Leadership Training Initiative Project, Non-competing Renewal Application) Advocates work in a variety of ways to improve quality of life for individuals with a disability as defined under Olmstead. People in the disability advocacy community must become more visible and cross the line to become ability advocates. A good example of an advocacy spectrum is the Oklahoma Long Term Care Ombudsman Advocacy Spectrum, which encompasses:  Empowering residents and community citizens;  Getting necessary system-wide changes;  Extending community resources to residents;  Making overall changes in the facility environment (community); and  Working to resolve resident‘s individual and group problems. Pockets of advocacy across the state of Oklahoma do not have the same impact as one unified voice speaking for all people with differing abilities and health care needs. Olmstead advocacy efforts must be addressed by persons with disabilities as a group, not just those who provide services to persons with disabilities.

Interim/July 15, 2004

16

SECTION IV
SUMMARY Based upon the OSPC‘s evaluation of the current system, the following statement is pertinent. ―It is clear that we need a new model. No longer should communitybased services be the exception to the institutional rule. Community services must become as easy to access as institutional services. To accomplish this, the tie between institution and funding must be cut.‖ (Bruce Darling, Director of the Center for Disability Rights, End the Institutional Bias: No More Stolen Lives, testimony to the Senate Finance Committee, March 2004) Disability advocates have long pushed for the enhancement of a system that would allow the seamless delivery system for individuals with disabilities. Fragmentation of services results in inefficiencies in serving both children and adults with disabilities. Cooperation of state agencies, consumers and providers is an essential element toward the elimination of gaps and the efficient maximization of dollars in providing disability services. These advocates have asked that: 1) People have the option to choose where they will live, work and play; 2) Supports in community are available to make those choices a reality; and 3) Systems move toward a service design that supports individual choice and uses funding to support individual choice. 4) Systems be designed to include unserved/underserved populations such as the Mental Health Community, Alzheimer Community, Traumatic Brain Injury Community and other people with disabilities. ―No one would have guessed that today this system would warehouse over 1.4 million Americans in nursing facilities and 110,572 in ICFs, or Intermediate Care Facilities for the Mentally Retarded.‖ (Lakin, K.C. and Prouty, R. (2003). Medicaid Home and Community-Based Services: The first 20 years. Policy Research Brief, http://ici.umn.edu/products/prb/143/)

Interim/July 15, 2004

17

APPENDICES:

Appendix A Appendix B Appendix C Appendix D

Olmstead v L.C. Life Empowerment System Quality Assurance Principles Interagency Strategic Plan – Olmstead Employment Section Members of the Oklahoma Olmstead Strategic Planning Committee Olmstead Strategic Planning Committee Minutes Subcommittee Minutes Olmstead Strategic Planning Committee Structure Glossary

19 21 33 36

Appendix E

39

Appendix F Appendix G Appendix H Appendix I

41 45 70 71

Interim/July 15, 2004

18

Appendix A: Olmstead v. L.C.
A Supreme Court case filed under the ADA dealt specifically with issues related to community placement. Olmstead v. L.C. involved two Georgia women residing in a State mental health facility. Both plaintiffs had dual diagnoses of mental illness and mental retardation. Though both parties were eligible for community-based services through an existing State program, which had open slots to serve them, the women were denied community placement because of inadequate funding. In June 1999, the Supreme Court determined that ―unjustified isolation is discrimination under the ADA and required that the women be served ―in the most integrated setting appropriate to (their) needs‖. Olmstead v. L.C. interprets Title II of the ADA and its implementing regulations.  It requires states to administer their services, programs, and activities in the most integrated setting appropriate to the needs of individuals with disabilities. It extended the federal mandate of nondiscrimination towards people with disabilities to state and local governments and the private sector. The ADA also gave people with disabilities increased opportunities by making it illegal to discriminate in many areas such as employment, public accommodations, and transportation. Congress defined disabilities as a ―physical or mental impairment that substantially limits one or more of the major life activities of such individual‖ (Sue & Sue, 2003).  It provides a legal framework for /State efforts to enable individuals to live in the most integrated setting appropriate to their needs.  It challenges states to develop more opportunities for individuals with disabilities through more accessible systems of cost-effective community-based services. What did the Supreme Court say about institutionalization?  Unjustified isolation is regarded as discrimination based on disability.  ―Institutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life.‖  ―Confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.‖ The Supreme Court wrote that States are required to ―make reasonable modifications in policies, practices, or procedures‖ when the changes are necessary to avoid discrimination on the basis of disability. The Supreme Court further stated that a State could show that it had met the ―reasonable accommodation‖ standard by demonstrating that it has a:  Comprehensive, effectively working plan for placing qualified persons with disabilities in the most integrated setting; and  Waiting list that moves at a reasonable pace not controlled by a State‘s objective of keeping its institutions fully populated. Interim/July 15, 2004 19

All individuals with disabilities protected from discrimination by Title II of the ADA are affected by this decision. Olmstead is not limited to:  Persons receiving Medicaid;  SSA/SSI definition of disability;  Persons with mental illness; or  Persons in an institution. States are required to provide community-based services for persons who would otherwise be entitled to institutional services when:  Professionals determine such placement is appropriate;  Affected persons do not oppose such treatment; and  Placement can be made taking into account resources available to the State and the needs of others. States are to:  Involve individuals with disabilities, or their representatives, in development and follow up;  Ensure the availability of community integrated services;  Afford individuals with disabilities and their families the opportunity to make informed choices; and  Take steps to ensure that quality assurance and improvement support implementation of the plan.

Interim/July 15, 2004

20

APPENDIX B: Life Empowerment System
Report from the Olmstead Diversion Subcommittee May 21, 2003 Background Olmstead addresses a large and varied universe of individuals with disabilities. Unfortunately services are available to only a fraction of this population and these services are often inconsistent, arbitrarily assigned, or nonexistent. Because of this, the Diversion Subcommittee has identified its goals and objectives as follows: Goal: The Diversion Sub-Committee will design a system that supports informed choices and service options for every Oklahoman with disabilities in the most integrated setting. Objectives: 1. To develop and refine the ―Life Empowerment System‖ which is a new service delivery system that addresses the needs of all individuals with disabilities and which gives them more control of the supports they need to live in the most integrated setting possible. 2. To research any laws, policies, or procedures and amend them if necessary to support the ―Life Empowerment System.‖ 3. To effectively inform people with disabilities, providers, and others about the ―Life Empowerment System.‖ 4. To coordinate the efforts of all agencies and providers; including blending funding and administrative activities, to develop a pilot project for the ―Life Empowerment System‖. 5. To take a ―first faith step and just do it‖—implementation of a ―Life Empowerment System‖ pilot project. Goals: 1. To develop and refine the “Life Empowerment System” which is a new service delivery model that addresses the needs of all individuals with disabilities and which gives them control of the supports they need to live in the most integrated setting possible. Objectives a. b. c. d. e. f. g. h. i.

Identify the Basic Infrastructure Available in Oklahoma Develop the Prototype for a Single Statewide Service Delivery Model Identify Additional Resources Available at the Regional Level, which will be Considered Local Enhancements but not Guaranteed Statewide Develop Methodology for Continuity – Consistency in Training (Currently Being Done Through a Grant to Progressive Independence) Incorporate Quality Assurance at the Regional Level Incorporate Monitoring at the Statewide Level Develop a Minimum Mandatory Safety Net Structure Blend Multi Agency Supports that Appear Seamless to the Consumer Transition from Medical Model to Social Model for Community Supported Choices

Interim/July 15, 2004

21

j.

Identify Ways to Maximize Services and Maximize Funding Sources (Coordinate with Dollar Follows and Finance Committee) Olmstead Diversion Subcommittee was responsible for initial development. Refinement and implementation will include Diversion Subcommittee members and representatives from OHCA, DHS, DRS, OSDH, DMHSA, CILs, ODOT, ONHA, OSF, Private Providers, Advocacy Groups, Consumers and Families and Legislators, ADD, Advocacy Groups, Consumers, and Families. Year 1 and ongoing

Responsible Parties:

Timelines: 2.

To research any laws, policies, or procedures and amend them if necessary to support the “Life Empowerment System.” Objectives a. Develop supporting letter/survey defining Olmstead Life Empowerment System and soliciting expertise to identify barriers in current laws, policies and procedures b. Contact Various State Agency legal divisions for input c. Work with responsible parties to affect necessary legislative and policy changes Responsible Parties: Diversion Subcommittee, Lynn Rambo Jones, OHCA, State Attorney General‘s Office, Various State Agency Legal Divisions Beginning Year 2, July 1, 2003

Timelines:

2.

To effectively inform people with disabilities, providers, and others about the “Life Empowerment System.” Objectives : Responsible Parties: Timelines: To be developed Coordinating efforts through Social Marketing Committee Beginning Year 2 and ongoing with emphasis on major methods and implementation during Year 3

4.

To coordinate the efforts of all agencies and providers; including blending funding and administrative activities, to develop a pilot project for the “Life Empowerment System.” Objectives: Responsible Parties: To be developed OHCA, DHS, DRS, OSDH, DMHSA, CILs, ODOT, ONHA, OSF, Private Providers, Advocacy Groups, Consumers and Families and Legislators, ADD, Advocacy Groups, Consumers, and Families Beginning Year 4 and ongoing

Timelines

Interim/July 15, 2004

22

6.

To take a “first faith step and just do it” – implementation of a “Life Empowerment System” pilot project. Objective: Implement with a manageable population and model which can easily be replicated statewide. OHCA, DHS, DRS, OSDH, DMHSA, CILs, ODOT, ONHA, OSF, Private Providers, Advocacy Groups, Consumers and Families and Legislators, ADD, Advocacy Groups, Consumers, and Families Beginning Year 5, or sooner if possible

Responsible Parties:

Timelines:

Areas Considered by the Diversion Subcommittee when Defining the Diversion Model entitled the “Life Empowerment System” One Statewide System with One Entry Point and Basic Services and Regional Optional Enhancements The Diversion Subcommittee discussed several options for developing a new model of service delivery for persons with disabilities to access the supports they need. The committee members agreed that anyone should be able to access a seamless service delivery system through a single entry point. The analogy used was a ―train station‖ where anyone can purchase a ticket to a destination of their choice which will allow them to pursue personal needs, recreational needs, business needs, or needs that have not yet been identified. Additionally, this ―train station‖ needs to be easily identifiable and accessible to all individuals with disabilities and their families, and should offer as many options as possible including access to multiple state and local agencies, peer supports, access to a variety of social, educational, healthcare, religious transportation, housing, and other supports and well as all sources of funding. This single statewide model should be easy to access. It should utilize the supports available on a statewide basis and, additionally, it should also utilize any regional ―enhancements‖ or services available on a limited regional basis. However, such regional ―enhancements‖ would not be considered mandatory services and would only be available when and were they are available. The State would not be required to duplicate such services statewide.

Negative Aspects Positive Aspects It is easier to administer one model statewide then One size does not fit all. multiple models. From a consumer perspective, one model is easier This model may meet only minimum needs. to understand than multiple models. Having a single model is cost effective. Having a single statewide model easily allows for regional comparison, research and quality assurance. Having a single model makes it easier to monitor. Having a single model makes it easier to coordinate services.

Interim/July 15, 2004

23

Presenting Choices to the Person with the Disability or their Representatives* Presented appropriately, information about personal choices will empower the person with disabilities to make the decisions necessary to live a meaningful and productive life. Thus, the model is a ―Life Empowerment‖ model. The ―offering‖ of information to the person with the disability or their representative is absolutely crucial to the process. Additionally, simply offering information is not enough. The information must be presented:  In a manner which is realistic and does not set the person up for misunderstanding or failure  In a manner which is non-biased  In a manner which is appropriate to for a ―non-professional‖ or ―consumer‖ level of understanding Negative Aspects Information must be presented carefully in order to prevent the person with the disability from forming for unrealistic expectations. This model maximizes personal empowerment. Individual, face-to-face communication is time consuming and labor intensive as well as costly. Information is individually customized for the Extensive and ongoing training of personnel to person with the disability. present information is required. This approach seems perfect for involvement with Individual customization of information is time the statewide Independent Living Centers. consuming and costly. Independent Living Centers may not have the resources to perform the activities required. Positive Aspects This approach maximizes consumer control. *It is important to note that the Diversion Subcommittee is concerned with diverting persons with disabilities from institutions, rather than transitioning them from institutions back into the community.

Making Living in the Community a Realistic Choice and a Medicaid Mandatory Service Fundamental to the concept of diverting individuals from institutions is the concept that living in the community is just as equally realistic choice as living in an institution. Several obstacles prevent this concept from being realized. They include:    The abundance of nursing homes and the need to keep them filled The scarcity of community resources such as personal care assistants, transportation, affordable housing, employment The ability and resources of hospital discharge planners

Most hospital discharge planners currently discharge newly disabled individuals to nursing homes since they offer an array of services and supports as a ―package.‖ This process is easier than trying to piece together multiple services and supports which might include such things as transportation, home health care, house keeping assistance, meals, etc., on a very tight time schedule. In order to implement the ―Life Empowerment System‖ it is necessary to change this so that staying at home is as realistic a choice as going to a nursing home. The Diversion subcommittee discussed changing the Medicaid program so that Home and Community Based Services would be unlimited and would be mandatory services, just as nursing home benefits are mandatory for State Medicaid programs. The Subcommittee also discussed

Interim/July 15, 2004

24

changing assessment criteria so that it is harder to go into a Nursing Home. The Subcommittee discussed capping the number of nursing home beds or not allowing nursing homes to refill beds, but making them provide ―at home supports‖ instead. The following questions are still under discussion:  Could a person go into a nursing home as a short-term stay for education and preparation about living in the community while the arrangements were being made for community supports? Could Medicaid pay for this? Could the Independent Living Center take on the educational role? Would this then be diversion or transition? Could Medicaid pay for holding a nursing home bed open while a person explores living in the community in case they want to return to the nursing home? Would this be duplicate payment? Since the money should follow the person, would you have individual budgets while persons were in an education and preparation phase in the nursing home are would there be a flat dollar amount? If someone is living in the community with appropriate supports and has a change in health status requiring that they go into a nursing home for a short term stay could Medicaid retain and pay for their community services during the period they are in the nursing home? If not, how would you maintain continuity?

  

Resources and Infrastructure Oklahoma has many resources currently available to persons with disabilities. However, not all resources are available at all locations. It was determined by the Subcommittee that the first step in designing any model would be looking at the resources available and identifying those components which are available statewide. Once identified, these components would form the basic infrastructure of the ―Life Empowerment System.‖ However, the ―Life Empowerment System‖ should also be customized enough to include other services available on a regional level only. As part self directed care, it was determined that it would be up to an individual to access services not available in their region (local enhancements) and that the State would not be expected to provide every service to every person in every area of the state. An example of this might be transportation. Public transportation for persons with disabilities might be more accessible in urban areas of Oklahoma than in urban areas, and might be more accessible in some urban areas than others. A list of the basic minimum infrastructure components would include:       Education Health Care Transportation Education Employment Social Opportunities

Potential ―players‖ would include entities with a statewide and preferably county-wide presence:       Schools Nursing homes Co-ops The Department of Human Services County Health Departments County Extension Office

Interim/July 15, 2004

25

  

Home Health Care Authority Independent Living Centers Other State Agencies

Negatives Positives The person with a disability would have a face-to- Some individuals might not be able to get to the face assessment. local resources. Partners could easily collaborate. Funding would be needed to set new resources in place. There would be effective outreach on the local Multiple partners may create difficulty in level. providing consistent information. A website could be developed and maintained. Everyone does not have web access.

Care Coordination In the ―Life Empowerment System‖ care coordination replaces medical case management. Medical case management is a function better done by a medical professional such as a primary care provider or nurse case manager. Case management is utilized primarily to coordinate medical care. However, care coordination implies coordination of medical and social services at a ―semi-professional‖ level. The care coordinator might be a non-medical professional or social worker. Care Coordinators will facilitate the implementation and coordination of services prescribed or recommended by Primary Care Providers and other medical professionals. They will also facilitate the services desired or needed by the consumer including: transportation, employment, medical care, behavioral health care, recreation, church/religious activities, peer contact and association, etc. The role of the care coordinator is to:  Monitor ―safety‖ of consumer through personal contact.  Promote independence of consumer – not be a babysitter  Provide information including regional information  Address, the individual, unique needs of each person with a disability  Serve as a ―frontline‖ level of contact  Work with the DHS case worker to assure continuous eligibility  Conduct outreach The care coordinator:  Does not develop a plan of medical care  Does not do everything for the person with a disability  Does not provide a 24 hour safety net

Positive Aspects Because ―Care Coordination‖ combines medical care and social support, it is a more holistic approach than traditional ―Case Management.‖ Because one person is providing ―Care Coordination‖ of both social and medical services, there is less duplication of administrative services.

Negative Aspects A Care Coordinator is a new concept and would require new policies. Care Management is very labor intensive.

Interim/July 15, 2004

26

Because ―Care Coordination‖ does not require that a nurse perform the services, it is less costly than traditional ―Case Management‖ performed by a nurse. Care Management allows the person with the disability to more directly manage their own care than traditional Case Management. The Care Coordinator could be a social worker or could work closely with the Department of Human Services to assure continual eligibility. Expanded Rolls for Nursing Homes and Other Institutions Currently, nursing homes and other institutions provide the bulk of services for Medicaid eligible persons with disabilities. Thus, nursing homes present an extensive amount of resources. Rather than trying to create an new service delivery system, the current resources offered by nursing homes and other institutions should be examined and modified to fit a community services delivery system rather than an institutional delivery system. Since more bricks and mortar are only needed to warehouse more people, instead of expanding their facilities, nursing homes would expand their services beyond facility walls and into the community. Though Nursing Home Services are a mandatory benefit for state Medicaid programs, home and community based services could be afforded the same status if resources and funding were available to support the change. A model as described would include ―crossing facility borders to create a system which is seamless to the consumer.‖ An example of this might be a person with a disability living in the community and receiving personal assistance services from an employee of a nursing home. In the event that the health status of the person changes and he or she has to be institutionalized temporarily, the same nursing home employee might provide personal care within the institution. Negative Aspects Positive Aspects This model expands personal control and options To be effective, this model requires continual refor the person with the disability. assessment of the person with the disability, which could be costly and burdensome for the provider and consumer. This change provides greater continuity of care. There could be a financial and administrative strain on provider (nursing home or other institution). This change allows the nursing home industry to This model presents some difficult payment remain viable while better meeting the needs of the issues, such as duplicate payments. individuals it serves. It will be difficult to get the nursing home industry to “buy-in” to this change. The discussion of this phase of the model was very intense. Several additional questions were generated by the subcommittee including: 1. How do we accommodate circumstances when a person in living in the community and experiences an acute condition which requires a more advanced level of care (i.e. nursing home), but has an outlook to return to the community? Can Medicaid or some other source provide assistance, which will help the person with the disability retain their home in the community and how long will this assistance be available?

2.

Interim/July 15, 2004

27

3. 4. 5. 6.

When a person leaves a nursing home or other institution, can some (financial) provision be made which would assure them a spot in the same institution should they need it? How does Medicaid avoid double payment? (NH & HCBS) How do you make this seamless to the person with the disability? How do you maintain what you have and avoid starting over?

Hospice and End of Life Options Hospice is a personal choice:  About personal dignity  That must be available in all environments Just as people with disabilities should be able to choose where they want to live, they should also be able to choose where they want to die. Currently, the Medicaid program does not have a well developed Hospice benefit. Hospice allows one to stay at home until end of life; whether home is a single person dwelling, group home, nursing home, or other living arrangement. For many people hospice might be a way to avoid returning to a nursing home, hospital, or other institution. Implementing a Medicaid Hospice benefit would require extensive education of nursing homes regarding patient choice, responsibilities of the nursing home, and boundaries. The conflict lies in the mission of the nursing home, which is to do everything possible to keep a person alive and the mission of Hospice which is to allow one to choose death at home without heroic measures. Negative Aspects Hospice would be a new Medicaid service and thus require new policies, procedures and rates. Hospice allows the person to remain at home with The cost is not known family and friends. Home environment There is a conflict between nursing home regulations and Hospice mission which might have to be addressed legislatively. The cost of implementing a Hospice benefit should be easily determined because the State is required to follow Medicare payment guidelines. Positive Aspects Hospice expands consumer choice. Marketing, Education and Outreach One of the biggest drawbacks to any program is the lack of consumer friendly outreach and education. Many consumers do not know what resources are available or how to find out about them. The Diversion Subcommittee discussed the need for social marketing. Such efforts should start at the discharge planning level, be consistent, measurable and person centered. The Subcommittee agreed that the Independent Living Centers should have a role in Social Marketing efforts. It was agreed that a Social Marketing Committee should be established to address this issue since it is only one component of diversion activities, but it is both crucial and extensive. Expanding the Role of the Independent Living Centers Oklahoma‘s Independent Living Centers are a consistent and untapped resource available to persons with disabilities. They can provide access to both highly trained personnel experience in both technical and practical issues. Additionally, the Independent Living Centers can link peers who can combine personal experiences to solve problems and address concerns of the disability community. The Diversion

Interim/July 15, 2004

28

Subcommittee agreed that Independent Living Centers are integral to the ―Life Empowerment System‖ and should provide training and education, advocacy outreach and coordination at the local level. Positive Aspects Independent Living Centers are specifically designed to facilitate a ―Life Empower Interaction Independent Living Centers can provide peer interaction. Independent Living Centers have access to resources at both the statewide and local level. Negative Aspects There is inconsistency between the Independent Living Centers. Independent Living Centers may not all have the same resources available to them. Most Independent Living Centers do not have the staff necessary to serve all persons with disabilities statewide. Most Independent Living Centers do not have the necessary funding to increase their staff and services.

Establishing a Safety Net The Diversion Subcommittee agreed that individuals have the right and should have the freedom to direct their own care. However, concerns were expressed about where the need for a ―safety net‖ and selfdirection intersect. Several ―Safety nets‖ were identified including: Independent Living Centers Friends Medical Providers Peers Family Ministers Care Coordinators and Case Managers Job Coaches

However, there is no guarantee that an individual could depend on any of these ―safety nets‖ on a 24-hour basis. While nothing is better than personal face-to-face human contact, it is unrealistic to believe that it will always be available. Thus, the Subcommittee agreed that a telephone should be a mandatory support for all persons with a disability. The Subcommittee discussed working with local telephone companies to arrange for this service and requiring individuals to pay only a minimum amount per month. It was suggested that the Independent Living Centers could assure that the equipment was appropriate for the user, and that the user received training on how to use the phone. Additionally, a toll free number 24 hour number, similar to ―911‖ should be established to assure access to some type of emergency response.

Negatives Positives A ―safety net‖ would be available for all persons Establishing a 24 hour support services for with disabilities. persons with disabilities may require legislation. There may be some cost to the individual. There may be increased cost to the State. This is a new service and would require an entity to administer it.

Interim/July 15, 2004

29

Complaints, Grievances and Appeals Essential to the ―Life Empowerment System‖ is a process for complaints, grievances and appeals. The resolution of complaints, grievances and appeals is essential for provider and consumer satisfaction as well as monitoring quality. Additionally, resolution should be timely and should involve either an Ombudsman and/or peers. Complaints, Grievances and Appeals are defined in the following manner:  A complaint is an informal concern and may be simply voiced over the telephone. A complaint could be resolved in several ways, such as mediation or by bringing the parties together for open communication about the situation. It usually does not require formal written notification to lodge a complaint. A grievance is a more formal complaint. A formal process is usually established to file a grievance and a formal process is usually outlined to respond to a grievance. Both processes usually include written documentation, which must be filed within a specific timeframe. An appeal is the opportunity for the person who filed the grievance to have the disposition of the grievance reevaluated. An appeal is the ultimate opportunity to resolve a grievance without going to court.

 

Positive Aspects There are already many complaint, grievance and appeal processes in place so new ones won‘t have to be invented. Complaint, grievance and appeal processes empower the person with disability.

Negative Aspects Once a formal process is implemented it must be adhered to.

The person with the disability has a great deal of personal responsibility for lodging a complaint, grievance, or appeal, and following up. There are already many complaint, grievance and The Independent Living Centers could offer appeal processes in place so there should not be services in role of peer support, complaint additional costs associated with developing new resolution, etc. However, the activities of the strategies. Independent Living Center would need to be monitored and evaluated by an outside entity to identify trends, assure statewide consistency, etc. An outside entity would need to be named for this purpose. The person with the disability has a great deal of personal responsibility for lodging a complaint, grievance, or appeal, and following up. A complaint, grievance and appeal system improves monitoring capabilities and quality improvement efforts. Partnerships and Blended Funding Made Seamless to the Consumer Since Medicaid pays for most nursing home care for persons with disabilities in Oklahoma and since Medicaid is mandated by State to operate within a balanced budget, there is an incentive to use State dollars in an effective and efficient manner. Additionally, it is unlikely that there will be new funds to expand community services. The Diversion Subcommittee agreed that you should protect the services and infrastructure that you have while combining multi-agency efforts and funding streams. This would

Interim/July 15, 2004

30

reduce duplication of effort and assure coordinated spending in an efficient manner. The Subcommittee agreed this is the best way to make Olmstead a reality rather than a dream. Additionally, services and funding should be seamless to the person utilizing the service. In reality most consumers of services want their needs met, and do not want to be burdened by having to identify the funding source for their services.

Positive Aspects Combining funding sources could maximize State purchasing power. The consumer of a service would not be responsible for dealing with multiple providers or funding sources. Time Lines and Implementation Strategies

Negative Aspects This could be an administrative nightmare for the State. This could increase the bureaucracy.

At this time there is no ―Life Empowerment System.‖ It is a concept of the Diversion Subcommittee, developed for this report. Since this model represents a new means of service delivery and an expanded role for many providers including the Independent Living Centers, Nursing Homes and other institutions, the Subcommittee recommends implementation of a one year pilot program which could be gradually phased in statewide. The goal of the pilot is the implementation of a successful statewide program making resources available to all persons with disabilities whether they have Medicaid or other means of access to care. An incremental or ―pilot‖ approach was chosen because it will allow:    Regional services areas to be defined using the same service area boundaries as the Independent Living Centers. An opportunity for learning, observation, measurement and modification of the model using a manageable number of participants. Minimal disruption of services to persons with disabilities.

A pilot project is the opportunity to achieve success. Thus, the site should be chosen carefully to minimize risk of discontinuing implementation efforts and should minimize negative publicity and provide multiple opportunities for improvement. The choice of pilot site should be made using the following criteria:       Experience, resources, ability, level of commitment of the Independent Living Center, relationships between agencies and service providers, etc. Availability of community resources Number of consumers (The pilot should contain a large enough population to provide realistic typical experiences yet a small enough population to allow for adequate controls, assurances of consumer safety, quality, etc. Administrative considerations for participating state agencies (Pilot area should be close enough to overseeing agency to allow for easy travel) Acceptance level of the community (Is the community accepting or resistant of change) Systems by definition focus on services not the needs of any one individual so a service package will have to have many services available, but not everything

Interim/July 15, 2004

31

The Subcommittee agreed that there is nothing worse than doing nothing. A pilot project is a step forward. It will allow the State to move forward – gain experience – be flexible – and continually reassess and modify the model. It will help define, refine and perfect the model by providing details which don‘t have to be determined before you implement the pilot. Positive Aspects A pilot allows experience. Negative Aspects Inexperience puts people in danger. Doing nothing is a bad way to address a problem.

LIFE EMPOWERMENT SYSTEM
SOCIAL MARKETING REACHES ALL OKLAHOMA COMMUNITIES HOSPITAL DISCHARGE STAFF

ENTER THE SYSTEM HERE 

*Locate—local Health Depts. * Well-trained staff w/ effective data base/ w/ all local resources * 800 number & 211 number





INFORMATION & REFERRAL ―ONE-STOP SHOP‖ OPERATORS

•

•

•

TRAINING BY OKLAHOMA’S INDEPENDENT LIVING CENTERS EFFECTIVE INFORMED CHOICE TRAINING TRAINING BY CENTER FOR LEARNING & LEADERSHIP

PEER CARE COORDINATORS WHO DO OUTREACH

ACCESS TO LOCALLY DRIVEN COMMUNITY RESOURCES EMPOWERING THE INDIVIDUAL

SOCIAL M ARKETING ON THIS PROGRAM

   

HOUSING TRANSPORTATION EMPLOYMENT PEER SUPPORT GROUPS

   

HOLISTIC HEALTH CARE SW BELL LOW RATE LINE SOCIAL SUPPORTS RECREATION

   

FAITH COMMUNITY SUPPORTS 24/7-ON CALL HELP ABLETECH/TECHNOLOGY EDUCATION

MONITORING ON A DAILY BASIS @ THE MICRO LEVEL, ANNUAL, & ON THE MACRO/SYSTEMS LEVEL W/ FEEDBACK LOOP

AN ADEQUATE QUALITY ASSURANCE SYSTEM—

Interim/July 15, 2004

32

Appendix C: Quality Assurance Principles
Quality Assurance should encourage the delivery and improvement of supports consistent with the preferences and needs of individuals receiving services by assessing, providing feedback, encouraging quality improvement and providing follow up.

QA Systems will:
Assure partnerships, which actively include individuals who are receiving services and/or their families.  Are recipients and/or families included in all aspects of planning, developing and implementing programs, policies, and quality assurance?  Do systems policies and funding support and train the person and/or families in understanding how to contribute to the process and inform policy makers of their ideas?

Honor the Expertise of Individuals and/or Families
        Is the person with a disability and/or families given the same respect as the service provider or health care provider? Are people with disabilities and/or their family members valued at the table? Are people with disabilities and/or their families involved in determining what information needs to be gathered? Do we inform them of why we are gathering information? How is this information used and distributed? Do people with disabilities and/or families feel the providers have really listened to them and acted upon their input? Is the expertise of people with disabilities and/or their families honored when evaluating the information? Are all team members trained on how the expertise of people with disabilities and/or their families should be valued, respected and considered? Are all team members trained on how people with disabilities and/or their families are to be informed and included in the evaluation of information?

Respect and Accept their Values
     Are cultural/ethnic differences and personal values respected and accepted? Are safeguards in place to protect against negative assumptions made based on culture, life style, economic status and religious beliefs? Are people with disabilities and/or families given a chance to articulate their values? Are people with disabilities and/or families treated with dignity? Is training provided to service providers regarding cultural values, issues, biases and preferences to be considered as determinations are being made?

Interim/July 15, 2004

33

Focus on Entire Family
    When a child is living with family, is the impact on the whole family assessed? When a recipient is living in his/her own home, is the impact on his/her natural support system assessed? How will an assessment evaluate preferences when the recipient and family may not agree on services or risks? Are we providing training to service providers, case management and monitors on family dynamics, which include cultural issues?

Promote Flexible Service and Funding
        Do people with disabilities and/or families have control over who, what, when, where and how supports are provided? Are people with disabilities and/or families given an opportunity to state their preferences, needs and how they want services delivered? Are services restricted due to lack of funding or lack of flexibility of funding? Do policies restrict a recipient‘s ability to direct how services are delivered and access to needed funding? How are services coordinated when multiple agencies are involved? Is it a seamless system or a nightmare? Are community/natural resources accessed to fill in gaps in services? How are community supports evaluated? Are people with disabilities and/or families given sufficient information to make informed and beneficial choices? Are they trusted to make decisions for themselves, including decisions that may include some risks?

Affirm Lifespan Planning
          Is the system flexible enough to respond to current needs and preferences and still plan for the future? Is the person with a disability and/or family involved in planning for the future? Is the system seamless so that services do not drastically change when a person hits a certain age or there is a change in needs? Is information shared between systems so that vital information and the history of the person is not lost during the transition period? Is training provided on lifespan issues from birth to aging issues? Will the services be beneficial across the lifespan?

Practice Open Communication
Are people with disabilities and/or their families given information in various ways and formats and given time to assess and understand the information? Was information provided in a way that people from all cultural, educational and ethnic backgrounds could understand? Are policies clear? Are policies available in different formats and languages?

Interim/July 15, 2004

34

   

Are interpreters provided when needed? Do service providers communicate and collaborate to assure all vital information is exchanged? Are service providers and agency personnel trained in communication skills, including ―I messages‖ and reflective listening techniques? Are persons with disabilities, families and service providers given the opportunity to be jointly trained in policies, resources and funding?

Recognize the Importance of Community
   Based on the person‘s preferences, is integration into the community a valued component of the support system? Is community integration supported by policies and practices, or do people with disabilities have to live where services are? Are service providers and public agency personnel trained regarding the value of living in the community and the policies that support community integration?

Measure things that make a positive difference in the lives of people with disabilities.
          Are individual outcomes measured? Is there a reason to gather the information? Are people with disabilities and/or families included in determining what information is needed and how the information is gathered? Are monitors trained to be respectful of the recipient and/or family? Are monitors sensitive to the needs of the recipient and schedule visits at the convenience of the recipient? What is the purpose of evaluating a program or system? What information is needed to effect system change? What do we do with the information gathered? How do we share the information? Are monitors trained in how to gather information, evaluate it and include the family in determining the results?

Interim/July 15, 2004

35

Appendix D: Interagency Strategic Plan – Olmstead Employment Section
Develop and implement cross-agency strategies that will link employment supports and services into the Olmstead planning process. Cross-agencies strategies will focus on employment services which support effective matching of an individual’s interests and strengths with quality jobs providing equitable pay and benefits.

Strategic Plan Elements Systems Collaboration 1. Practice interagency partnerships & collaborations leading to competitive outcomes of choice. Create a network of collaboration and cooperation among state agencies, private 1.1 agencies, organizations, advocacy groups, consumer groups and other stakeholders that result in effective, seamless service delivery. Assure effective use of resources through communication mechanisms, coordinated 1.2 case management, and joint educational and training efforts. 1.3 Create quality assurance standards in the area of collaboration. 1.4 Develop metrics to track/document client choice and respectful treatment. Establish collaborative effort to move systems‘ focus from ―one size fits all‖ to 1.5 customized individualized services. Study potential for agencies to share information and funding toward a system of 1.6 comprehensive management. Create a mechanism to hold state agencies accountable for their participation in 1.7 collaborative efforts with accountability to people with disabilities. Create a single point of entry for service delivery for people with disabilities. 1.8 Public Awareness 2. Marketing: Increase public awareness of the economic contribution of persons with disabilities wd in the workforce resulting in a changed mindset and culture of what “disability” is. Create a multi-faceted, coordinated marketing campaign to create public awareness 2.1 of disability related issues. 2.2 Educate the general public about failure of current system. Educate the general public about the positive contributions, skills and abilities of persons with disabilities; the important and valuable economic impact of their 2.3 contributions. Employment Medical, Transportation, Access, and Education - Skills and abilities of persons with disabilities are important/valuable economic impact. Coordinate advocacy efforts to eliminate barriers to full-inclusion of people with 2.4 disabilities in the workforce. 2.5 Create targeted marketing strategy for education legislative bodies. Create a targeted marketing campaign to support employers in hiring and 2.6 accommodation persons with disabilities in the workplace.

Interim/July 15, 2004

36

2.7 2.8 2.9 2.10

Develop and provide training and follow-up for employers in meeting the needs of their employees with disabilities. Create targeted training packages appropriate for consumers with disabilities and service providers. Infuse all marketing efforts with a philosophy of all citizens being viewed as valuable and contributing members of society. All stakeholders should have a voice in the development of marketing campaigns.

Ease of Access 3. Ease of Access to Services: ease of access to services with choices made by the consumers. Create an interactive system of access to services among participating agencies that 3.1 consumers evaluate as easy to access and consumer friendly. Establish a central point of entry for accessing services from multiple participating 3.2 agencies. Create a system of supports appropriate for persons with different disabilities by 3.3 efficiently coordinating resources among participating agencies. Establish a mechanism for accurate information and referral, services, mentoring, 3.4 and assistance to consumers, parents, and others in navigating service delivery systems. 3.5 Develop the capacity of one stop centers to provide informed, person centered opportunities for employment, training and job retention for all customers who enter the workforce system.

3.6

Establish mechanism to ensure that organizational practices and protocol create ease of access to services for consumers and ensure consumer –made choices.

Funding 4. Funding: A fiscally responsible & accountable system to provide sufficient, equitable funding for services that are consumer directed and driven and follow the individual. Create a funding structure that reflects efficiency, accountability, and consumer 4.1 choice. Seek sufficient funding for participating organizations to provide needed services 4.2 in an organized, coordinated, efficient, and timely manner. Ensure funding is flexible, follows the individual, and is directed toward services 4.3 selected by the consumer. Interim/July 15, 2004 37

4.4 4.5

Ensure adequate funding of Medicaid to encourage a stable pool of quality service providers. Establish and fund a Medicaid buy-in option to extend benefits to individuals with incomes higher than is currently allowed.

Universal Design 5. Universal Design: all employment and independent living venues will be accessible – ADA & assistive technology. Strive to establish a statewide system of accessible housing that is affordable and 5.1 widely available. 5.2 Strive to establish a comprehensive healthcare system for all. 5.3 Strive to establish a service delivery system that is accessible to all. 5.4 Strive to establish access to affordable assistive technology Strive to ensure that all employment venues are accessible. 5.5 School to Work Transition 6. Organize transition services in a manner that results in equal access to the workforce and community for individuals with disabilities; providing opportunities that are aligned with the individuals’ interests, needs, skills, and abilities. Create a school to work transition process that is transdisciplinary, person-centered and collaborative that will provide individuals with a meaningful functional 6.1 relationship with the community and workforce aligned with his/her individual needs, skills, and abilities. Create a public school system that provides a true inclusive free appropriate 6.2 education in a least restrictive environment with measurable outcomes, holding schools accountable for the outcomes. Explore multiple funding streams to implement appropriate services during the 6.3 transition process.

Transportation 7. Create a statewide transportation system in Oklahoma that is effective, affordable, reliable and accessible. 7.1 Ensure that transportation networks statewide meet the needs of all citizens.

Interim/July 15, 2004

38

Appendix E: Appointed Members of OSPC
Senator Bernest Cain, Co-Chair Senator Ben Robinson Representative Bill Nations, Co-Chair Gina McDonald, Kansas Centers for Independent Living, Consultant Rose Ann Percival, DHS Developmental Disabilities Services Division, Facilitator Patricia Bush, DHS Developmental Disabilities Services Division, Administrative Support Charlotte Bowen, Statewide Independent Living Council Kayla Bower, Oklahoma Disability Law Center Doug Bursey, Parent/Advocate Drew Edmondson / Mark Jones, Office of Attorney General Nancy English, Oklahoma Housing Finance Agency Norma Ferguson, Advocate Michael Fogarty / Trevlyn Terry, Oklahoma Health Care Authority Sandy Garrett / Kathy Riddle, Department of Education Mark Gillett, Oklahoma City Housing Authority Chuck Gressler, Ticket to Work, DRS Michael Harmon, Department of Health Lari Hauge, BIOS Jauna Head, Office of State Finance Howard Hendrick, Department of Human Services Janice Hendryx, Oklahoma Commission on Children and Youth Jeff Hughes, Progressive Independence, Centers for Independent Living Linda Jaco, ABLE Tech Kenneth LaRue, Department of Transportation Carla Lawson, Ability Resources Vyonda Martin, Center for Learning and Leadership, OUHSC Jan Moss, Parent/Advocate James Nicholson, DHS Developmental Disabilities Services Division Kathy Otis / Melody Riefer, Department of Mental Health Substance Abuse Services Linda Parker / Mary Howell, Department of Rehabilitation Services Laura Dempsey Polan, Advocate Kay Rote, Oklahoma Mental Health Consumer Council Lance Schneiter, Advocate Earl Snow, Advocate Steve Stokes, Office of Handicapped Concerns Michael Taylor, Department of Labor Ann Trudgeon, Developmental Disabilities Council Michael Upthegrove, Advocate Mike Ward, Oklahomans for Independent Living Nancy Ward, Oklahoma People First

Interim/July 15, 2004

39

Olmstead Interested Parties (non-voting members)
Dan Arthrell, Community Services Council, Tulsa Lisa Bradley, OU School of Social Work Practicum Student Casey Browning, DHS Developmental Disabilities Services Division Darren Crauthers, Long-Term Care Authority Gail Dunsky, Advocate Jerry Durbin, Specialized Foster Care Parent / Oklahoma Parent Center Sandi Eslick, OSU Wellness Center John Gajda, TARC William Ginn, Office of Handicapped Concerns Melissa Gofourth, ABLE Tech Genny Gordon, DHS Developmental Disabilities Services Division Roy Hancock, Tulsa Housing Authority Connie Johnson, Senate Staff Helen Kutz, Progressive Independence Mike Lester, Enid Long-Term Care Authority Rick Lewis, Progressive Independence Anastasia Pittman, House Staff Lula Potts, OU School of Social Work Practicum Student Debbie Pumphrey, DHS Developmental Disabilities Services Division Barabara Schneeberg Sally Selvidge, Parent / OASIS Family Outreach Coordinator Carla Tanner, Community Services Council Valerie Williams, Center for Learning and Leadership Jennifer Philp Winslow, National Multiple Sclerosis Society

Interim/July 15, 2004

40

Appendix F: Olmstead Strategic Planning Committee Minutes
September 11, 2003 Senator opened the meeting by asking for introductions around the room. Committee Reports: Finance Committee -- Laura Dempsey-Polan Jauna Head was asked to do overview on budget for November meeting. Subgroup – report of people in nursing homes, institutions, etc. Jauna suggested that folks from independent living centers come. Want developmental disabilities folks and families to have input. Social Marketing Committee -- Discussion regarding issues dealing with marketing. Learning marketing. Learning projects regarding Olmstead. Training on Olmstead court decision. Contact Jan Moss for training at (405) 271-4500, x 205 or email Jan-Moss@ouhsc.edu. Quality Assurance Committee -- Vyonda Martin – Principles to insure or to use for a guide for QA systems. Rose Ann Percival -- Overview on Olmstead. Tasks for next two years ---- 1) Legislative committee 2) Oversight committee meet two times a year. 3) Consumer task force committee. Suggested putting minutes on website. Looking at doing some public forums. Senator Cain suggested having committee meetings in communities throughout the state. Carla & Jeff Hughes- Independent Opportunities gave update on employment conference. It would be at the Renaissance in Oklahoma City from 10 – 3. Background checks if hiring through agency. Website: www.ability-resources Charlotte Bowen made a presentation on the Life Empowerment Model. March 11, 2004 Senator opened the meeting by asking for introductions around the room. Meeting dates for 2004 were decided as follows: Sub Committees --- April 1 a.m. Sub Committees and full Committee --- May 6 Sub Committees and full Committee --- June 3 Sub Committees and full Committee --- July 1

Interim/July 15, 2004

41

The chairs of the subcommittees met in December and worked on issues related to clarifying Strategic Planning Committee and subcommittee roles. Gina talked about some of the recommendations which included values and guidelines. (Attached) Committee Reports: Finance Committee -- Jauna Head – combining with Dollar Follows. The combination should track very well together. Jauna made a presentation on the various types of individuals of developmental disabilities. Social Marketing Committee -- Sandy Eslick asked Senator Cain to come to meetings for an overview. Jan Moss represented Kathy Otis for community supports. Center for Learning & Leadership develop one-stop model. Charlotte Bowen --- power point presentation on Life Empowerment Model – diverting people from going into institutions. Holistic, not limited to DOs and MDs. Single point of entry. Voted to accept concept on Life Empowerment Model Ann Trudgeon --- DD Council told members about the upcoming Governor‘s Conference to be held March 29 & 30, 2004. Disabilities Awareness Day will be March 17, 2004. Meeting adjourned to meet again May 6, 2004.

May 06, 2004 Gina McDonald chaired the meeting for Senator Cain. Corrections were made to the minutes of the March 11th meeting and approved. Gina asked Jim Nicholson to share with the committee about Linda Broerse who died on May 4, which he did. On April 7, the senate Finance Committee held a hearing on the President‘s proposed New Freedom Initiative Demonstrations, including small Medicaid respite demo for adults and one for children. Other proposed demos included Money Follows the Person, worker issues, children in psychiatric sessions. Jan Moss was asked to tell the committee about her appearance before the U.S. Senate Finance Committee. Sub Committees and full Committee --- July 1

Interim/July 15, 2004

42

The chairs of the subcommittees met in December and worked on issues related to clarifying Strategic Planning Committee and subcommittee roles. Gina talked about some of the recommendations which included values and guidelines. Committee Reports: Steering -- Nine members – Diversion and Community Supports need to become dormant since they will have completed their work. The Finance and Social Marketing Committees will continue working. Gina asked to visit with Senator Cain for an interim hearing. The hearing would ask the Heads of the state agencies to report their progress and barriers on implementation of Olmstead. It would give us all a better sense of where we are with Olmstead and what we have yet to accomplish. Finance will continue to work on finances for implementation. Social Marketing will continue and may become dormant at a later time. Finance Committee - Jauna Head – Gina talked about how pilot program works in Kansas. Rick Billings, long-term-care of Enid, talked about people transitioning out of institutions. Social Marketing Committee -- Helen Kutz -- Looked at concepts, at possible video out to give information to new members to bring them up to where we are. New folks may not know everything regarding what is going on. Put information in letter friendly way. Simplify for better understanding. Create information like brochures, etc., see what other states have. Nancy Ward said that having a mentor at committee meetings has been a very helpful to understand the committee meeting better. Gina: Interim study – we would invite agencies to share what they were doing. Goal to make sure that agencies understand the plan; what are different entities doing. Give us a report that you would like in the annual report. Develop task force to make report consumer friendly as soon as possible. Social Marketing will meet one more time in June then go dormant for a while. Then implement committee to identify how many objectives or goals get started in July. Folks from Social Marketing moving to implement committee. June 3 committees – Finance Committee and Social Marketing Jauna Head asked for Carla Lawson to do presentation on her employment seminar next month for committee.

Interim/July 15, 2004

43

For July and August presentation meeting with DHS & Mental Health and Aging and DDSD so that committee can know just what these folks do. Meeting adjourned to meet again June 3, 2004. June 3, 2004 Connie Johnson, Senate staff, presided for Senator Bernest Cain. She asked for introductions around the room. Minutes for the last meeting, May 6, 2004 were approved. Carla Lawson, along with Linda Jaco made a presentation on the employment conference work force coordination grants. Gina McDonald asked to have the Interagency Strategy Plan – Olmstead Employment section added to the report as an addendum. Laura Dempsey-Polan made the motion and Charlotte Bowen seconded. Mark Reynolds made a presentation on the Join Oklahoma Information Network (JOIN) now on the Internet to be used for resources. Eligibility wizard is up now. Community resource will be up in July. HB 2197 – web design accessibility. Rose Ann said that Finance committee will send out information of the committee to members. Social Marketing finalized five goals to put in report. Rose Ann reported the annual report was due in the Governor‘s office July 8th. Need all reports in by June 15 to review by July 1 meeting in order to get the annual report done by July 8th. Rose Ann handed out disks containing the FY04 compiled Olmstead minutes for September, 2003 to May, 2004. Interim study: Invite Senator Cain to join Steering Committee for report from agency heads about what is going on in the agencies that could be a part of the report. Connie asked for a list of what would be reported on. Steering Committee to meet on June 30 pm or July 1 am. No sub committees to meet next month. Gina told committee about other employment opportunities which will not allow her to continue with Olmstead because of new position. There is a conference in Minneapolis on training the trainer.

Interim/July 15, 2004

44

Appendix G: Subcommittee Minutes
Quality Assurance / Safeguards / Ombudsman Subcommittee Meeting
September 11, 2003 ATTENDING Lisa Bradley, Vyonda Martin, Casey Brownin, Rose Ann Percival, Caroline Clark, Margo Upthegrove, Sandi Eslick, Mike Upthegrove, John Gajda, Carla Lawson, Joyce Lewis QA Guiding Principles Oklahoma QA Principles were reviewed, discussed, and revised. A final version will be presented at the October meeting. Future Direction for QA Subcommittee Two Social Work students from the University of Oklahoma will be helping with research on the Quality Assurance components of other states' Olmstead plans. Sub-committee members were asked to consider what work we have left to do and whether we can stop meeting for a while and attend other committee meetings. We will discuss this issue at the October meeting.

October 9, 2003 Workforce Conference The transition conference was discussed. Carla mentioned 150 individuals attended. Bobby Silverstein presented and emphasized the importance of having shared guiding principles, which highlighted the importance of what our committee is trying to accomplish. Finalize Oklahoma QA Principles Questions about quality assurance principles were discussed. Concerns about clarity were raised and a consensus was met to make a few deletions and additions. (See attachment). Consensus was reached on changes made to the Quality Assurance Subcommittee piece in the annual report. (Rose Ann will make the official changes). Members of the Quality Assurance subcommittee decided to participate in other meetings and reconvene on an as-needed basis. Co-chairs will continue to work with students on research and keep members posted via e-mail.

Interim/July 15, 2004

45

Social Marketing Subcommittee
May 8, 2003
Present: Helen Kutz (chair), Linda Jaco, Deborah Austin, William Ginn, Rick Lewis, Charlotte ―Charlie‖ Bowen, Nancy Ward, Jimmie Harris, Barbara Schneeberg, Jan Moss, Norma Ferguson, Lew Blockcolski and Sandi Eslick Linda Jaco took a short time explaining their subcommittee report and why social marketing is so important to the planning and implementation of Olmstead. People just don‘t know about all that is happening around this issue. Charlie shared that this component is very curtail to the Diversion Subcommittee also. Time was spent strategizing on ways to market such as news releases, press conferences, and other media attention. Education sheets might also be helpful. It was decided that initially we should focus on a press conference in conjunction with the July 15 report and also post meeting notices (in accordance with open meetings act) in as many papers as possible to keep the public seeing ―Olmstead Planning Committee‖ and hopefully peak interest. Jan shared about a workshop she had attended and basically we have to answer the following questions to reach the general public or any targeted audience: What is in it for me: personally, financially? How will it change me? What is expected of me? Will I have to do anything? Will it cost me anything? How about my neighborhood? Basically we identified the following key strategies: 1. Identify key people to market to (target audience) 2. Find volunteer resources with social marketing expertise 3. Develop marketing strategy to get message to target audience 4. Social Marketing Committee will educate themselves regarding marketing 5. Craft marketing strategy about audience—not us 6. Craft marketing strategies around supports instead of disability 7. Target key op-ed media opportunities and also keep ―Olmstead‖ before the public by publishing all meetings 8. Possibly incorporate existing disability awareness tools as part of our marketing strategy, especially to state agencies 9. Gather realistic demographics for our state Committee Assignments: 1. Helen will bring two resources for our self-education 2. Linda will get newspaper announcements for meetings established 3. Entire committee will begin task of identifying our audience.

September 11, 2003 (Social Marketing)
Present: Helen Kutz, Chair, Cathy Ames, Charlotte ―Charlie‖ Bowen, William Ginn, Jeff Hughes, Linda Jaco, Jan Moss, Sally Selvidge, Nancy Ward and Kim Weir.

Interim/July 15, 2004

46

Chair Helen Kutz called meeting to order and introductions were made. Committee reviewed the first product of Olmstead Training Grant through Progressive Independence and The Parent Training Center. The PowerPoint Presentation can be a full 1½ hour presentation but Helen did a short review. It has already been presented to some 121 Tribal VR Programs, the OBPAP staff, at the OKAPSE Conference and the Oklahoma Parent‘s Conference. It is available for any forum. Nancy asked if CILs and OK People First could collaborate to go to their national conference in Anaheim in May of 2004 Charlie shared that the Library for the Blind and Physically Handicapped can Braille PowerPoint presentations Jim Nicholson applied for People First to train DD Services staff on ―My Voice, My Choice‖ and Nancy suggested that a collaborative effort be done to train on both this and Olmstead while the audience is there as it is mandated staff training. Nancy shared that they have 65 people trained to make the My Voice presentation in teams. They plan to start in October. Helen expressed delight in being a part of this collaborative effort Linda stated that this would be a good comprehensive medium to share with all state agencies to educate on Olmstead William suggested services organizations such as the Lions Club, etc. would benefit. Helen shared that she and William wrote press release concerning first year report and Helen has gotten meeting announcement into paper. Channel 25 did ADA piece with Helen and Ray Jones and she interjected about Olmstead—they asked to do a follow-up report. Jeff suggested that we work on a marketing plan and train the trainer to send folks out Committee Assignments: 1. Cathy will offer to market to DRS through Mike Hamrick and Linda Parker 2. Linda will get Milissa to suggest for Transportation Conference Agenda 3. Kim will work with private sector by giving booklets to consumers concerning Olmstead and possibly set up professional provider presentations 4. Charlie will check with OU for marketing expertise or student practicum 5. Linda will check with OSU for the same 6. Group will also work to identify a marketing person who has a disability and Nancy has a possible lead. 7. Nancy will call Sheree Powell with DDSD 8. Cathy will call Jody Harland 9. All will encourage newsletters to do Olmstead updates

10. Jan will look at the Olmstead group as a whole and begin to coordinate a speaker‘s bureau within the Olmstead group. She will 1) look at who is doing training on Olmstead and 2) house and make list and biographies to have central speaker‘s bureau 11. Jan & Charlie will write a proposal to the identified college programs that might consider our committee as a practicum marketing project

Interim/July 15, 2004

47

The Social Marketing Committee will have a guest speaker for marketing training at our next meeting to help us 1) define our audience and 2) develop our message. March 11, 2004 (Social Marketing) Out of the general meeting that began at 9 a.m., it became apparent that there are committee members that (1) don‘t understand what it means when we use the term, ―Olmstead‖ and (2) there are committee members that believe they are not the best representative from their agency. From that, we agreed: Basic Olmstead training needs to be available to any members of the Olmstead Strategic Planning committee, their representatives or interested parties. The basic training needs to be available on an on-going basis as new people become involved or if others would like a ―refresher‖. Charlie Bowen will develop a letter and distribute for committee comments before the next meeting. The letter will be to the Olmstead Strategic Planning Committee appointees (named in the legislation). Some of the items to be included or considered for the letter are:    Ask appointees to become involved in the meetings or make sure a designated representative is attending and reporting back to them. Ask appointees to revisit who they are sending to the meetings/are they the appropriate person. Offer the ―Olmstead Basic Training‖ before the large committee meetings. The training would be scheduled from 1-2 p.m. prior to the large committee meetings—same room in the Capitol and the Business Meeting will begin at 2:30

We felt a videotape of the training session should be made with ―our message‖ (below) at the beginning of the videotape. This videotape could be used before each meeting of the Strategic Planning Committee. Rick is to check with Heather Altone of Progressive Independence to check on her availability and the cost of making a videotape and report back to Charlie before the next meeting. It is possible that DDSD or other agencies might be able to help with this project. Gina suggested that we ask the large committee for help with these resources and ask for a vote when we know what our needs are. Questions to ask: What other components are there? What will it cost? Who can contribute resources/dollars? We then asked: (1) Who is our message for?  Olmstead committee and new members/representatives  Agencies/agency heads  General public

Interim/July 15, 2004

48

   

Consumers State employees Providers Lawmakers

(2) What is our message?

I didn’t plan…
I didn’t plan to have two hips replaced. I didn’t plan to have to get around my house in a wheelchair. I didn’t plan to need help after my surgery. I didn’t plan to need help after my stroke. I didn’t plan to be the caregiver of my parents. I didn’t plan to have a special needs child. I didn’t plan to have a mental illness. I didn’t plan to be institutionalized. I didn’t plan to be without health insurance. I didn’t plan on losing my ability to provide for my family. I didn’t plan to get old. I didn’t plan to have to leave my home. I didn’t plan to be in a nursing home. I didn’t plan to be unable to get into my work place. I didn’t plan to not have transportation to worship, shop, vote, play. I didn’t plan on losing the ability to make my own decisions.

And neither did my community…
Follow by asking audience:

What plans have you made…? (in your business, in your agency—
or whatever audience we are speaking to)

This is your opportunity to be a part of the plan.
Next steps: Bring in a social marketing person (Gina is checking on this.) Gina suggested reading the book ―The Tipping Point‖ on social marketing. Develop a marketing plan to get out ―our message‖.

Interim/July 15, 2004

49

Questions to consider:  Who is the message for?  What population?  What media?  How are we going to use it?  How are we going to know if it is effective? (Study was suggested – Lu is going to check with OU to see if there is a marketing class or graduate student that might like to do this; Sandi is going to check with Linda Jaco to see what contacts might be available through OSU) Charlie took down other agenda items for the April 1 meeting. Committee Assignments 1. Charlie Bowen will draft a letter (for Senator Cain‘s signature) and distribute to committee for comments prior to the next meeting. 2. Rick Lewis will check with Nancy to arrange for a presentation of the ―Olmstead Basic Training‖ at our next sub-committee meeting to be held on April 1. 3. Rick Lewis will ask Heather Altone (of PI) about making a video of the Olmstead Basic Training—with introduction of ―our message‖…ask about her availability and the cost and report back to Charlie before the next meeting. 4. Gina McDonald will contact the Social Marketing person in Wichita and see if she would meet with our committee, the cost and her availability in the near future. 5. Lula Potts will contact the OU Marketing Department to see if a class or graduate student might want to develop a study to see if our marketing plan (media message) is making a difference and let us know at the next meeting. 6. Sandi Eslick will contact the OSU Marketing Department (via Linda Jaco) to see if a class or graduate student might want to develop a study to see if our marketing plan (media message) is making a difference and let us know at the next meeting.

June 3, 2004 (Social Marketing) Present: Helen Kutz, Debie Fidler, Carla Lawson, Norma Ferguson, Sally Selvedge, Trevlyn Terry, Kera Tyson, Charlotte Bowen, Dan Arthrell, Laura Dempsey-Polan, Sandi Eslick, Linda Jaco, Gail Dunsky, Rick Lewis, Lew Blockcolski, William Ginn, Lori Hauge, Barbara Graham, Kimberly Crawford. Review of planning to date:       Identify key people to market to (target audience) Find volunteer resources with social marketing expertise Develop marketing strategy to get message to target audience Social Marketing Committee will educate themselves regarding marketing Craft marketing strategy about audience—not us Craft marketing strategies around supports instead of disability

Interim/July 15, 2004

50

  

Target key op-ed media opportunities and also keep ―Olmstead‖ before the public by publishing all meetings Possibly incorporate existing disability awareness tools as part of our marketing strategy, especially to state agencies Gather realistic demographics for our state

All has come down to production of a video and the cost would be around $30,000. Final suggested goals: 1. Mentoring process for new members to the Olmstead Committee and Sub-Committees. 2. Create a consumer friendly report of Oklahoma‘s Plan 3. Create public awareness (i.e., brochures, videos, public service announcements, website, etc.) 4. Gather Olmstead pertinent materials that have already been developed across the United States and customize as applicable. 5. Research potential funding sources for marketing materials. Suggestions were made that we could begin with brochures that are audience appropriate that could be made inexpensively on computer programs. Remember the KISS principle with possibly only 3 points with money being a key factor. Discussion next centered on website. Staffing is again a key problem. We think this might be important when we get to the implementation committee phase. Sally shared that we might be able to be a part of the JOIN project when it rolls out at the end of summer. Possible areas for hosting website:  JOIN Project  Oklahoma Health Care Authority  Oklahoma Parent‘s Center Reasons for website:  Post minutes and agendas to keep entire Olmstead Committee current  Education of consumers and general public who would like to learn about impact of Olmstead on Oklahomans with disability and progress of the planning process. Strategies for website:  Linking capabilities from multiple agency sites to reduce frustration  Implementation Committee will find ways to make this happen.

Mentoring will be done by development of a packet that includes the Olmstead book already developed by the Olmstead Training Project through PI that Helen heads.   We will work with People First on the consumer friendly language. Legislators will be a one-page sheet and one on one to educate. 51

Interim/July 15, 2004

   

Lu is still working on gathering other state materials. Strategies for funding sources: Approach the Ad Council for help We are officially dormant after the report is finished.

Social Marketing Subcommittee Summary for Second Annual Report Submitted June 25, 2004 The Social Marketing Sub-Committee was formed because the Community Support Sub Committee identified the need to share information regarding activities and recommendations of Olmstead Strategic Planning Committee. The Social Marketing Sub Committee met five times during the year. The February 2004 meeting was a joint meeting with the finance sub committee and the social marketing sub committee. There was a guest presenter who presented on marketing strategies and development of a marketing plan. Notes from all meetings except the joint meeting are attached to this report. During the first meeting the committee members discussed the potential activities for the year, which included:           Identify key people to market to (target audience) Find volunteer resources with social marketing expertise Develop marketing strategy to get message to target audience Social Marketing Committee will educate themselves regarding marketing Craft marketing strategy about audience—not us Craft marketing strategies around supports instead of disability Target key op-ed media opportunities and also keep ―Olmstead‖ before the public by publishing all meetings Possibly incorporate existing disability awareness tools as part of our marketing strategy, especially to state agencies Gather realistic demographics for our state The composition of the subcommittee varied throughout the year. Not all of the activities identified at the first meeting were addressed but most of them were discussed. A list of participants was collected at each meeting and is included in the meeting notes.

The Final suggested goals are as follows:      Develop a mentoring process for new members to the Olmstead Committee and SubCommittees. Create a consumer friendly report of Oklahoma‘s Plan Create public awareness (i.e., brochures, videos, public service announcements, website, etc.) Gather Olmstead pertinent materials that have already been developed across the United States and customize as applicable. Research potential funding sources for marketing materials.

Interim/July 15, 2004

52

There are two attachments to this report, a document entitled "I didn't plan…" (see above) and recommendations for creating a consumer friendly report. The full subcommittee created the first document. The consumer friendly language ideas were the results of efforts by Michael Upthegrove, Margot Upthegrove, Nancy Ward, Jimmie Harris and Helen Kutz.

Finance / Dollar Follows Subcommittee
Finance Sub-Committee 7/10/03 Attendees: Jauna Head (co-cjair), Laura Dempsey-Polan (co-chair), Sally Selvidge, Kathy Otis, Catina Baker, Trevlyn Terry, Linda Jaco, Deborah Austin Note Taker: Catina Baker    Introductions Laura suggested an overview of the financial data sheet. Jauna discussed the hand out and which funds the legislature has approved for the next fiscal year 2004. Jauna noted that in December of 2002 there were cut backs in making the governor‘s budget, once we get into the new year, we will collect one month and disburse the next. Jauna noted that July collections will go out to agencies in August. Jauna informed the group that appropriations are disbursed in 12-month increments, and during fiscal year 2003 funding fell below what agencies were targeted to get. In 2003 every dollar collected went toward appropriations and they won‘t hand out more than what was collected for that month. Jauna added when money is disbursed in June, we would not know in July if we achieved the goal and August will determine how much you get back. Jauna added that in the past, the legislature would adjust agency appropriations on current year standing. Jauna noted that by law OSF has to cut according to the same percentage and total agency dollars are cut, and the agency will have to adjust for the shortfall. Reductions in the amount of 7.85% took place across the agencies. Jauna noted that the hand out shows how they spent the appropriated amount of $501.4 billion. The Medicaid match was increased and OHCA will restore programs such as pharmacy, long hospital stays etc. Jauna added that the ―Rainy Day Fund‖ is a best estimate of next year and can appropriate 95% of funds, in years past, when collections are 100% everyone got there level and 5% went into the bank under ―Prior Years Cash on Hand.‖ The fund is set up to take care of any shortfalls. Jauna added the ―Rainy Day Fund‖ upon emergency can spend half of the funds.



 



Interim/July 15, 2004

53

                         

Jauna noted that cash flow is different from ―Rainy Day Fund‖. Cash flow reserve comes out of total. Laura added there was a one-year increase of money and the economist based there estimates on that one-year. Jauna suggested that we need longer term forecasting. Jauna was asked by the group to do presentation in November to review the report and make recommendation to budget. Jauna noted that if the funds are not available they won‘t borrow them. Laura noted 3 ways to make up for the shortfall: Tobacco, Racing and Native Americans. Jauna noted she is working with Jim and Peggy at DHS who are looking at the state budget for developmental disabilities. Jauna informed the group that refinancing bonds are a one time funding option and basic court costs have increased. Gina asked if the State has to spend all funds? Jauna - States can set funds aside to save. Jauna noted that Nursing Homes are going out of business in their districts. Legislature would like to spend $12 million to help Nursing Homes. Sally added that Nursing Homes would be the only option in rural Oklahoma. Gina suggested that this could create an opportunity for individualized care. Sally suggested a more flexible system could be developed like Self-Directed Care. Gina noted that Nursing Homes look at provider community services. Gina asked what would we need to change financially to make this happen? and are there incentives and disincentives? Kathy noted that a shift to community-based providers reduces the number of beds and an individual could be employed in the community. Jauna asked what would be the Home Health and Nursing Home gulf? Gina asked what would be the State incentive for entities to change? Nursing homes will be what ever they are funded for. Laura noted that PACT will allow you to retain Medicaid longer by living in the community. Kathy noted PACT is working with OHCA to expand services. Laura asked how often would you re-evaluate? Deborah - ―it varies by waiver.‖ Deborah added that 1619 revaluated every 6 months with a 30 day window. Sally noted she takes her son in yearly for evaluations and reports which are sent to Medicare and Medicaid once per year. Gina suggested that we look at what other states are doing. Deborah suggested that we look at the Medicaid Buy-In because it includes PAS and Transportation. Laura asked, ―are states looking at new money‖? Deborah added that we are looking at grant programs and adjusting our current waivers. Currently we have PAS in workplace but no way to provide services, Self Directed Care will give you the flexibility.

Interim/July 15, 2004

54

9/11/03 (Finance) Attendees: Gina McDonald (co-chair), Laura Dempsey-Polan facilitator), Sally Selvidge, Catina Baker, Eddie Miller, Rick Billings, Dan O‘Brien, Lew Blockcolski, Evelyn McKenny.     Introductions. Committee agreed to meet at 10:00 a.m. during this session of meetings. Laura discussed where we are during this fiscal year. Eddie noted that F-MAP increased to reinstate some programs but who guarantees the funds? (or where do the funds go?). F-MAP for ‗04 continues to be new monies found in the ‘03 session. Oklahoma‘s economy might improve and if revenues are impacted by events, e.g., a causing higher use of energy. Community action programs in Tulsa have a newsletter that says we are a ½ billion short, due to one-time fixes. Laura heard that--if we have a hard winter they could recoup funds from gas revenues. Gina noted that we have to create a crisis before we get a response. We should do the planning before a crisis starts. Eddie asked the group if DHS had a $60 million carry-over that was not spent. Laura answered, the carry-over funds were from TANF. Gina added that Kansas was challenged with new money of $11 million to get individuals off the waiting list, of that list 200 people qualified. Gina said they overspent so much that claims were pended and those pended claims had to be paid out of this year‘s funds. Eddie noted that natural gas is going up. How do we be fiscally responsible and what is a time budget forecast in this state? Laura suggested that we get more information about the budget so better research can be conducted. Eddie added there is a $1 billion bond out for road construction. Laura noted there is an upcoming meeting on the state of the State in Tulsa at the Community Service Council of Greater Tulsa with the Metropolitan Human Services Commission (9/20/03). Eddie suggested that we look at what we want instead of what we have. Eddied added the legislature should decide who gets funding. Laura agreed that we should look at what we can leverage and enrich and look at new dollars last. Laura added that, for instance, the ADvantage waiver demonstrates care and savings. Diversified services, including community-based services, Gina suggested creative thinking can pull together and redistribute funds. Our problems are with institutional focus; Sally added that we want to change the way Nursing Homes do business and create diversity within them. Eddie added that the issues are about an expensive system that is not good for the state. Laura noted we want to avoid dumping. Laura added Hissom released individuals once supports were in place. Laura suggested that we look at what other states are doing. Gina noted that more states that don‘t take action with Olmstead will find themselves with lawsuits. Mississippi hearings begin next month, because they never funded Olmstead.

              

Interim/July 15, 2004

55

                        

Laura added advocates are really moving in Oklahoma and there are court cases pending in Mental Health. Sally added that she thought the Supreme Court decision has no built in penalties. Eddie noted that we want to accomplish outcomes. Laura suggested that we look at a strategy as to how we could win. What is our strategy to win? Gina suggested that we take in theory how many are on waiting lists and look at overall cost per person. Gina asked where do the funds come from? Sally asked the group, can federal agency withhold funding from a State if Olmstead is ignored? Laura suggested that we can focus on the average waiting list for waiver programs and institutions. Dan added that we should look at national studies and compare. Rick with LTCA noted there is no waiting list for ADvantage program. Gina suggested that we look at states that did residence reviews and compare similar states. Gina asked who would be responsible for gathering the data and what would be the cost per population? Dan suggested that we look at the budget; it‘s a matter of time before lawsuits begin. Gina noted that we are in a better position now that we have Olmstead. Gina added that MICASA does not give up until they win. The reality for legislation is to solve the problem. Eddie suggested that we let them know the cost and that it will take collaborative efforts to get this done. Sally addressed the lack of family at the table. Laura encouraged the group to also learn more about ―Political Organizing‖, if it is to move forward on a goal like ―dollar follows.‖ Eddie also suggested that we put our meetings on Saturdays in order to have more consumer input. Dan added that there is a ―Systems of Care Project‖ meeting held on Saturday and there is lots of family representation. Laura suggested that we ask the DD council for scholarship money so consumers can attend meetings. She will follow up with Ann Trudgeon, the Executive Director of the Council. Gina suggested that we look at grassroots organizing outside of this group. Sally added that we need to get the families to support the committees. Laura again suggested adding training on grassroots organizing to this process to ensure follow-up. Eddie suggested that we make a proposal to DD council for funding to get consumers to the table and set-up a meeting a month. Gina added that we need to change our meeting date to accommodate the DD Council. Gina suggested that we create a consumer task force with a disabled individual or parent on every committee. Eddie added that we could use a standard agenda and report back to the main committee. Laura asked the group what is our message to present as well as coordinating with the Social Marketing committee.

Interim/July 15, 2004

56

 

Gina added that focus groups are more productive. Laura wrapped up by letting the group know that Jauna will do the budget presentation on finance in November. Gina reiterated the group will work on putting data together on financial issues with the help of consumers. The next Finance Committee will be working on how the data will be helpful in light of hearing Jauna‘s overview on how the finance process works in Oklahoma.

11/06/03 (Finance) Attendees: Jauna Head (co-chair), Laura Dempsey-Polan (co-chairs), Sally Selvidge, Catina Baker, Lew Blockcolski, Trevlyn Terry, Rose Ann Percival, Lula Potts, Lisa Bradley, Jim Nicholson (cochair), Dan Arthrell, Carla Tanner        Introductions. Laura discusses September notes. Jauna discusses the Oklahoma State Budget handout. Laura asked if gas revenues were up. Jauna advised the group that metro gas and sales taxes are up. Dan noted that most states only have control of their state dollars and there are other states that have control over their federal dollars. Jauna informed the group that gross production includes gas. The Tax Commission collects money one month and hands it out the next to satisfy the current year appropriations. The Board of Equalization meets in December and February to discuss the money that will be collected for next year and makes estimates for next year. Any changes to Tax laws will cause the Board of Equalization to meet at the end of legislative session. Jauna added that we can spend 95% of the estimate and the 5% becomes prior year‘s cash on had for the next fiscal year, which cannot be spent or appropriated. Revenue is marked by the year in which it was collected. 2004 general revenue will not be spent until 2006 and there is always a clean break in fiscal years. Before the start of a new fiscal year, June collections are not handed out in July. July funds come from the Cash Flow Reserve Fund. The Rainy Day Fund is on the ballot for 2004 to change the amount of spending that can occur within the fund. Laura gave a web site for CAPTC (www.captc.com) and asked is a line item limited or advantageous? Jauna explained the different types of line items. Laura suggests that we look at Dollar follows as a case study.

  

Interim/July 15, 2004

57

3/11/04 (Finance) Attendees: Jauna Head (co-chair)), Jim Nicholson (co-chair), Lori Hauge, Trevlyn Terry, Jerry Durbin, Helen Kutz, Laura Dempsey-Polan, Vyonda Martin, Rose Ann Percival, Carla Tanner, Michael Upthegrove, Cheneah Williams, Gina McDonald.    Introductions. Jim suggested that we create a matrix identified by agency. The matrix should include the following: what the agency does, how it fits into Olmstead, funding sources and any programs for disabilities. Helen added, that she did training on services provided and researched the legislation that goes with it and explained how it flows together. She has also researched the legal process available from the complaint, hearing, and appeal process. She has researched the different lawsuits going on and reviewed the state fund structure. Laura suggested that we could have interns develop the template for the matrix and Laura added that DDSD has a great flow chart. Vyonda noted that we should know what services are provided within the agency and which services are state and federally funded programs. Jim suggested identifying funding streams and their strengths associated with each agency. We would get more fundamental questions if the matrix is laid out in this format. Laura added that Olmstead impacts across all age spans. Helen said she is getting questions as to how Olmstead impacts Medicare. Jim noted that private ICF/MR‘s is in OHCA budget. DHS covers waivered services. Jauna added that blended and mixed funding will be an issue. Vyonda noted that we could pull all monies together. Laura said we should commit to pulling money together just as Iowa pulled their funds together. We have our Respite program which is a good model. Jauna added we need to identify the landscape so will have something to look at. Helen added that she has all the federal legislation. The group agreed to do matrix by agency first and then re-group by funding source. Jauna said she will start agency matrix. Helen suggested that we look at the money flow of HUD. Carla added we need to look at services provided and funding source. Jim added we need to look at funding limitations. Jauna said by the end of the month we will have a draft matrix out to the group. Jauna will present to the full group at a later date once the draft matrix is presented to the Olmstead Steering committee. Jauna discussed the Governor‘s budget hand out. New rules were signed by the governor. We will get final ruling on the rules this session. Jim added 86% of the people interviewed wanted in home supports. DHS is in the process of developing two new waivers. The waivers are intended to be consumer driven. Direct care staff was the biggest issue along with staff support, adaptive

                   

Interim/July 15, 2004

58

            

       

equipment, and architectural & modifications. Families will choose what type of supports they want. Rose Ann noted that the homemaker contracts are $6.18 per hour; agency pays $6.00$7.00. HTS rate is $12.80, which allows more hours of support for rural areas as opposed to 20 hours of direct services versus 30-35 of home maker services. Jim added we currently have 3,900 individuals on waiting list. Jauna noted the most expensive service is the private ICF/MR‘s. Jim noted that we have an occupancy of 210 in Pauls Valley, 51 in Greer, and 172 in NORCE. Jauna noted that mental health began to close patient beds. That is why we have an increase in occupancy. Jim noted that the new health department director is more aggressive in closing or decertifying facilities. Jauna noted that all agencies by law have to reduce budgets. Laura noted Howard Hendricks maximizes funds in DHS. Vyonda added children remain on Medicaid after adoption. Jim discussed a hand out on fiscal intermediaries and changes to IRS rules. How we might use this for an in-home support waiver and look at adding self-directed services component to existing waiver. Laura asked the group does it address the liability issue. Jim noted families are the employers of record and would carry liability insurance. A written agreement between OHCA and the family would be signed. Family would be the employer agent. Lori asked the group would new enrollees have access. Jim answered current recipients on the waiver would have access. Jauna suggests that Dollar Follows joins Finance sub-committee. Dollar Follows could make a presentation to Finance Committee about work they‘ve already accomplished. Is Dollar Follows literally when individual leaves nursing home, those dollars are carved out from nursing home budget or are waiver dollars following the individual? What do we mean by dollar follows? Can you do it with new money and how. It is less expensive to serve individuals in-home than in an institution. Jerry asked the group how we balance. Trevlyn noted that the money did not actually follow the individual, but this is what you are allowed to spend. Jauna added that State Department of Education looks at 3 years rollover of attendance to funnel money in school system. Where there is a decrease in students there is a decrease in money. When there is an increase in students there is an increase in money. Laura noted Missouri is concerned with loosing monies in regard to Olmstead. Jauna noted we have two models: 1) qualifies for services and Medicaid eligibility, service array, and 2) average numbers of people and funding. How do you merge the two when money is in different agencies? Jerry asked whatever funds they receive does the individual have control of them. Trevlyn noted members are entitled to Medicaid services not funds. Jauna asked what is the definition of entitlement? Money or services.

Interim/July 15, 2004

59

     

Jauna assigned the group to come up with a definition or statement of what ―dollar follows‖ means. If a program is the entitlement, what are you entitled to? Olmstead is in opposition to what Medicaid means. We need to rethink Medicaid‘s definition. Vyonda noted once we get the matrix completed would we be in a better position. Lori asked is the state obligated to serve in the institution. Trevlyn noted one is an entitlement and the other is a choice. Jim noted that group homes have dollar follows. Jauna added at the risk of loosing Medicaid funding we have to open a bed in the community and community services cost more. Laura noted the grass roots groups‘ works together with other groups to get things accomplished. Jauna asked what is the best way to spend the dollars. Gina noted LTC says we have funds actually coming from the facility. If MICASA passes it will push states to have entitlement to community services. MICASA has a huge price tag, services on both sides would have to be minimized and eligibility criteria changed.

Summary Report on the Activities of the Finance/Dollar Follows Subcommittee September 2003 through May, 2004 After the conclusion of the first year activities and annual report of the Task Force, the Finance and Dollar Follows Subcommittees joined together to continue their work. Jauna Head, Office of State Finance Budget Analyst for Health, designee on for State Director of Finance, Scott Meacham and Jim Nicholson, Developmental Disabilities Services Division Director, designee for Howard Hendrick, Director of Human Services, were selected as CoChairs of the Subcommittee. Meetings, presentations and discussions were devoted to these topics:  Review of the state revenue estimating, appropriating and budgeting process  Review of the expenditures for persons with developmental disabilities served through the Developmental Disabilities Services Division of the Department of Human Services  Information on how other states, especially Texas and Kansas have implemented their Dollar Follows the Consumer initiatives  The role of the Advantage Waiver for transitioning people out of nursing homes as well as diverting people from entry into nursing homes  The status of Medicaid Buy-In in Oklahoma  The relationship and interaction of various means tested programs and the implications for persons with disabilities as their income increases  Identification of all services and funding sources in Oklahoma, both state and federal, that provides services and supports to persons with disabilities. Initial design of a matrix for presentation of the information  Spanning the policy and fiscal gaps created by state Medicaid matching dollars and program/policy authority being split between two state agencies: o Medicaid matching funds for community based services is in Department of Human Services

Interim/July 15, 2004

60

o Medicaid matching funds for state run Intermediate Care Facilities for the Mentally Retarded (ICFs/MR) is in Department of Human Services o Medicaid matching funds for all privately run long term care facilities, including private ICFs/MR and nursing homes is in the Health Care Authority Finance Subcommittee Goals and Directions for Year Three of the Olmstead Strategic Plan Development Process: 1) Outline policy changes for the Advantage Waiver which encourage the transition of persons currently in long term care facilities into more integrated community based settings including: o Placement and tracking of these individuals on the Advantage Waiver waiting list o Identification of additional community supports which may be required for individuals who are currently institutionalized as they move to more integrated service settings o Develop a system which requires that funding currently dedicated to long term care facilities is available to pay for community based services when a person in transitioned from and institution to the community, i.e. truly make the dollars follow the people. 2) Study the costs of delivering services to persons with developmental disabilities in the two state operated ICFs/MR versus the costs of delivering services to persons in more integrated community based services. Make recommendations to the full Olmstead Strategic Planning Committee regarding the findings. 3) Study the costs involved to fund the Medicaid Buy-In Option allowing persons with disabilities who are currently covered by Medicaid to retain their coverage when their earnings go above the current allowable level. o Is their a ―cliff effect‖ which results in a person with disabilities being worse off financially when their income increases even if they are allowed to retain Medicaid coverage due the loss of other services such as housing assistance? o Obtain further information from the Health Care Authority about how Medicaid Buy-In works and what the state could buy with and investment of state dollars into the program. What are the various funding scenarios, how many people are affected and how? 4) Address the first year Olmstead Committee Goal of exploring the feasibility of changing Oklahoma‘s 209(b) status and using federal SSI eligibility as the financial standard. o What administrative savings are possible by not operating a separate eligibility system? o What is the projected number of additional Medicaid eligibles if the two income and resource standards were the same?

Interim/July 15, 2004

61

Diversion Subcommittee
4/1/2004 Attendees: Charlotte (Charlie) Bowen (co-chair), Lew Blockocolski, Laura Dempsey-Polan, Gail Dunsky, Lisa Toth-LaTracy, Earl Inon, Lori Hague, Debie Fidler, Helen Kutz, Vyonda Martin, Nancy Wardok, Michael Upthegrove, Rick Lewis, William Ginn, Cheneah Williams, Lula Potts, RoseAnn Percival, Lisa Bradley, Catina Baker, Dan Arthrell, Sandi Eslick, Jan Moss      Introductions. The Diversion Model has been accepted by the Full Committee and the group agreed to call it a Diversion System. Charlie discusses the Dollar Follows web-cast and goes over the goals of the Diversion group. Laura suggested that County Health Departments could be a single point of entry, where as one idea where a single point of information could co-locate. Helen added that the knowledge level of the staff in a single point (One Stops) of entry is very important; competency is needed in working with individuals. Nursing homes are not required to learn about the responsibility to the community, which leaves doctors no alternative but nursing homes. Laura added that we would like trained, competent individuals to staff the needs of the individual (Peer Coordinators). Peer Coordinators, in this suggested system, could be trained by independent living centers or like organizations. Charlie suggested the group brainstorm on the problem and we could spend 30 minutes discussing single point of entry. Laura explains the Diversion system to the group. Lori added that single point of entry is good and if we could get the Money Follows piece we could have a bigger buy-in into the model. Businesses like Cox Communications could provide space and community resources, this would be better accepted by the community. Laura added this would be great to build private/public relations. RoseAnn said that Quality Assurance started with the basic foundation for review. We have a cultural change and we need to know what to market. The full committee suggested that we call the diversion model a system, each system across the state should be made up of the same components. How do we include One Stops? JOIN is working on creating a database that staff can access and use. Our focus should be on creating a database of information. Helen added that a single place for information is good. Who would transport the individual from the nursing home, find them a place to live, and moves them. Earl asked the group if parents would be included as staff or consultants. Charlie responded that the system is based on consumer choice. Laura added that we should have a person that a consumer could discuss their needs with. Charlie liked the idea of single point of information. Rick additionally said you call one number to get information specific for that county and we need to get all the agencies involved.

   

 

     

Interim/July 15, 2004

62

   

 

          

Laura noted that Peer Coordinators could help individuals get to the resources they needed. RoseAnn added that the Health Department, Mental Health, DOT, HUD are involved with JOIN. Funding is coming from OCCY, DHS, and Disability Council. Vyonda added that we have layers of information that require human follow-up. The positions can‘t be entry level funded. Dan suggested that we look at what has been tried in the past and find out how to create it to work of us. He said that it seems as though there are two levels to deal with: 1. Individual -- How to assure that the individual can address their own needs; and 2. System -- How to provide the opportunity for the consumer to bring issues that need to be corrected in the system to make them more useable. As an example he referenced the Metropolitan Human Services Commission in Tulsa. This group represents local decision makers, including the superintendent of schools, mayor‘s office, county commissioner, United Way, health department director, DHS area director, metropolitan ministry, and chamber of commerce. Groups like this could be established in other areas and issues could be taken to them and addressed at the local level. Rick suggested that we work within the system to get it going. Dan suggested that instead of one-stop being one place, there needs to be access to services, information, etc. from many places, such as the library, health department, DHS, job centers, etc. From the individuals perspective there would be multiple places to meet one need. Helen added that Peer Coordinators should build a trust with their social workers and doctors, which is the intent of the proposed system. Laura added the Peer Coordinator would also reach out to the individual. Dan said he supported the idea of ―market forces‖ driving services. He also suggested that we have a master plan stating our goals, but implement only a portion of the plan at a time. Charlie suggests the group look at the narrative, policies, and procedures and identify what is in place and what needs to change. Laura added the Care Coordinator would do follow-up and identify assets and needs. Dan updated the group on SB 1405 (2-1-1 telephone access to services), which goes before the House of Representatives on the 7th of April. Laura added that 211 is a help-line similar to 911 in concept. RoseAnn added that agencies require 80% of the same information on applications for state services, how do we go about getting a common application for all services. Lori suggests that we engage the local community to find out what is available. Laura added - we need to use all available resources. Dan added that, according to the Oklahoma Constitution, the counties are responsible for care of the needy and poor.
Title XVII SECTION XVII-3 Provision for persons in need - The several counties of the State shall provide, as may be prescribed by law, for those inhabitants who, by reason of age, infirmity, or misfortune, may have claims upon the sympathy and aid of the county.

 

Gail asked the group how do we decentralize government issues and how will this impact the future of anything. Charlie answered it all depends on what happens in the nation. 63

Interim/July 15, 2004

   



     

     

   

Laura added that Olmstead has taken a back seat since 9/11. We could look at funds available for Olmstead and look at getting more grants in the state. Charlie noted that Jan Moss is in D.C supporting the Life Span Respite Act and Respite Service. This task force goes before senator Don Nickles. RoseAnn suggested that we look at getting more community grants. Charlie added that there is legislation that deals with special need trust funds. The trust will be administered through a bank. Presently this legislation is stalled. Senator Cain is working on the CD-Pass legislation. The legislation for CD-PASS targets the aging. The legislation came out of the Aging Services Division. Charlie added that the single point of entry system will include transition. We will have individuals work on the transition piece that will include: child, high school, and college. Transition would work into the system setting and design entry support an individual would need. Lori asked what the process of transition is. Is it transition from any institution or transition to where they are going? Laura added - we need to transition across the entire life span. Debi added the Community Supports group broke down supports within the community. Vyonda added you cannot divert unless you have community supports, maybe the group should go dormant for a while and bring issues to the steering committee. Where do we go from here since the system inter-relates with other sub-committee groups. Laura suggested that Diversion could meet again and take the transition piece to the steering committee. RoseAnn added that we should break down into goals, objectives, task and look at where the committee needs to go next. Look at task for next year and make recommendations for One Stop information services. The steering committee will need to meet the month before the Diversion Sub-committee meets. Charlie suggested we work on transitioning individuals from facility and transitioning children. Nancy added that Chuck is working on a student first transition program. Williams suggested that we divide parts to each sub-group. Dan added our goals should be outcome driven and the outcomes should be measurable. RoseAnn suggested that we get a good plan on paper with strong goals and basic objectives and focus on moving as a body. We should go to the steering committee and get goals and objectives. Charlie informed the group that Debie will chair the transition group and will meet between now and June. Nancy will talk to Chuck about the student first program and Laura will volunteer Carla Tanner for the transition group. Charlie also appointed Rick Lewis and Lew Blockcolski to this group. RoseAnn noted the full committee will meet every month through July. Rick suggested we get an overview from the marketing committee chair, so we can come up with pro‘s and con‘s to marketing. Helen added that we need to look at what social marketing is. Helen suggested that we view some videos already made in other states and Charlie suggested that we view the marketing video for the next meeting. Social marketing will need to work on what message we want to give the legislature about Olmstead, where

Interim/July 15, 2004

64

 

does the message start, which individuals do we target first and what states do we use as examples. Sandi added that SBC has grants available. Lisa T. added SBC on there web-site has a solicitation for a grant due in August, look at their web-site under foundations.

Steering Committee
December 4, 2003 The chairs of the subcommittees met in December and worked on issues related to clarifying Strategic Planning Committee and subcommittee roles. The following are recommendations from the Subcommittee Chairs for your review. I. Subcommittees Those subcommittees that are active will meet regularly and give updates at the full meeting. Any action or activity suggested by the subcommittees will be discussed at the full committee and when discussion is completed a vote will be taken. Subcommittees may be formed as a result of suggestions from the full committee and approved by vote of the full committee. Inactive subcommittees will not meet unless more work is recommended by the full committee. 1. Dollar Follows ( Inactive) - will merge with Finance Subcommittee Topics that will surface may include but are not be limited to:  Who is impacted? Ask agencies. Look at numbers affected in institutions.  Who is responsible?  Enabling legislation.  Talk about what other states are doing. 2. Diversion (Active) - Report to full committee on Life Empowerment Model today. 3. Community Supports (Active) - Develop priorities 4. Quality Assurance (Not active) - Report to the full committee on QA Principles today. 5. Finance (Active)  Data on info on disability/age.  How Many? What Services? How Much Money?  Where is $? What are the opportunities for rearranging or reallocating $ 's for integrated settings?  Any new $?  Time to look at alternatives for cost and options for funding approved recommendations.

Interim/July 15, 2004

65

6. Social Marketing (Active)  Input on plan.  Learn about marketing.  Who's the audience?  Determine the message.  Develop the message to go to legislators, family consumers, providers, general public.  Develop educational materials regarding informed consent that is consistent.  Knowledge to consumers and providers about what already exists and how to use them better. II. Olmstead Strategic Planning Committee  Minutes of the large committee should be available to members prior to the next scheduled large meeting. Minutes are voted on for acceptance.  Redefine who voting members of committee are and who are participants.  Set votes on committee reports.  Majority rules for votes.  Minority reports are allowable.  Packets from Committees would go out prior to votes.  Large committee recommends legislation, if necessary. III. Role of Chairs  Encourage participation.  Give legislative report.  Assures votes occur on all issues and subcommittee reports that will become a part of the Oklahoma Olmstead Report. IV. Role of Consultant  Facilitates the full committee meeting.  Assures a vote of the full committee occurs on all issues and subcommittee reports that will become part of the Oklahoma Olmstead report.  Works with subcommittees and chairs. V. Full Committee Agenda  Announcements.  Approval of minutes.  Presentations.  Reports from committees- with votes.  Public Input. VI. Sub Committee Structure  Work is done at sub committee level.  Anyone can participate at the sub committee level and we should encourage consumers, advocates and providers to participate.  Sub committee will come to consensus on recommendation.  Chair takes recommendations to full committee for input and vote.

Interim/July 15, 2004

66

VII. Steering Committee  Chairs of subcommittee will serve as members of steering committee.  Chairs of subcommittees appoint two at large members.  Give reports at this meeting for consensus.  Rose Ann Percival will serve as chair.  Charlie Bowen will take the minutes.  Steering committee may request data and/or develop position papers.

March 10, 2004 (Steering) Present: Dan Arthrell, Charlotte Bowen, Laura Dempsey-Polan, Sandi Eslick, Mary Howell, Jeff Hughes, Linda Jaco, Mark L. Jones, Helen Kutz, Vyonda Martin, Gina McDonald, Jim Nicholson, Rose Ann Percival, Anastasia Pittman, Trevlyn Terry, Michael Upthegrove Gina reviewed report of the December 3rd meeting and some revisions were made. Rose Ann will correct those and pass to entire group at the meeting tomorrow at the Capitol. Reports were as follows:  Dollar Follows (Jeff Hughes and Kathy Otis) subcommittee is inactive at this time and folded into the Finance Committee  Diversion Committee (Charlotte Bowen and Mike Fogarty/Trevlyn Terry) waiting on vote concerning their work tomorrow and will probably need to continue work either beginning again or tweaking the first years work  Community Supports (Linda Jaco) will meet tomorrow and develop priorities for their work  Quality Assurance (Carla Lawson and Vyonda Martin) will present principles to be adopted tomorrow and them will be inactive  Finance Committee (Jauna Head and Jim Nicholson)—Active and reviewing the ―New Freedom Initiatives‖ from CMS. There are some with no match requirement for dollar follows but may be some strings. Laura asked about them and Gina suggested watching the advocacy lists to get the latest. There have also been some IRS rulings on state agencies as fiscal intermediaries. Kansas had a good presentation from Susan Flannigan and the committee will try to get her here in May or June. Peter Thomas was also suggested as a speaker  Social Marketing (Helen Kutz and Linda Jaco)—Active and ready to look at ―What is the message‖ and how to adapt it to fit the audience it is presented to. From there materials will be research and developed as needed. We will also continue to use the marketing materials developed through the grant administer by Progressive Independence. Dan volunteered to consult with this committee because of past experience in marketing. Discussion was held concerning formal minutes versus notes and it was decided that we would continue to use note format with addition of voting sheets when formal voting begins. Attendance will be recorded with sign in sheets. Website is still in development and will be used

Interim/July 15, 2004

67

to post minutes when finished. CSC website will still be available in the interim per Dan and Laura. Rose Ann will be clarifying the voting membership and 2004 meeting dates tomorrow at the Capitol. May 5, 2004 (Steering) Present: Gina McDonald, Trevlyn Terry, Sandi Eslick, Jim Nicholson, Dan Arthrell, Linda Jaco, Laura Dempsey-Polan, Jauna Head, Charlotte Bowen   It was decided that the Diversion & Community Supports Sub-committees need to go dormant until further notice and everyone will work in Finance and Social Marketing Committees. Discussion was held about public input in the future. To get regional coverage there is a possibility that Enid, Tulsa, McAlester, Lawton, Oklahoma City and Guymon will be sites. Discussion was also held around focus groups versus town hall meetings and it was decided that the Social Marketing committee would address these issues when the timing was more imminent. A lengthy discussion was held around the issue of how to get Olmstead buy-in from state department heads and to get reports so that we can see what programs are already being administered that align philosophically with Olmstead. We would also want to discover gaps that need to be filled so that the committee can strategize on how to do that. Jim shared that part of the problem stemmed from the fact that there is no overarching agency that provides oversight to nursing facilities and ICFMRs. He also reiterated that each agency does their own strategic planning and each fulfills their own mission and agenda. It was decided that Gina would visit with Senator Cain concerning an Interim Hearing that would request state agency heads to report to the legislators and Governor. We will also visit with him asking him to develop his committee in such a way that state legislators who head committees that affect the agencies will be a part of the committee structure and membership. Summary of steps this committee must help in implementing in the near future: 1. Interim Hearing with Agency Heads and key legislators and report from that hearing be added to Olmstead Report 2. Begin looking at what it will take to implement plan 3. Summarize work the committees have done during the year and add to the report for FY2004 4. Finance Committee will continue working on financing for implementation 5. Social Marketing Committee needs to refocus and plan strategically for the Who, What, When, Where and How of getting the Olmstead Message out and getting Public Input to make this a truly valid state plan.





Interim/July 15, 2004

68

July 12, 2004 (Steering) Present: Mike Upthegrove, Margo Upthegrove, Helen Kutz, Rose Ann Percival, Treasa Lansdowne, Jeff Hughes, Janice Hendryx, Sandi Eslick, Mark Jones, Nicole Altobello Trevlyn Terry, Vyonda Martin Jim Nicholson, Connie Johnson, Chuck Gressler, Carla Tanner, Charlotte Bowen, Jauna Head Jim began meeting suggesting that we limit the size of report and build it around specific goals such as:  Build solidarity among state agencies and disability groups  Identify groups not under umbrella of a state agency and make them the core responsibility of that agency  Every agencies incorporate principles of self-determination into their policies Vyonda agreed with Jim as did Mike. The big report that has been built may be used as position papers and white papers to give to the legislators during the year to keep the ideas in front them. We are going to try to condense 80 pages into a 10-12 page executive summary. Extensive discussion was held about what should be included in report and what should not. This included but was not limited to Education and IDEA. Mark brought us back to the fact that Olmstead was about moving people from residential to integrated settings. However, he also thinks that a logical extension of the law would be when withholding services would force a person into an institutional setting. We began work of what to include into executive summary. 1. Introduction--Mention Olmstead and our legislation and refer to the appendix. 2. Keep 1st sentence of written introduction and first 2 sentences of 2nd paragraph for opening statement 3. Historical perspective—(page 6 & 7) begin with ―from 1909……‖ Also suggested paragraph 3 of page 5, par. 6, and par. 7 with inclusion of info from page 3 & 4. 4. Critical Success Factors—Essential Components of Oklahoma‘s Olmstead Plan was agreed on for title of this section. (Changes under informed consumers). 5. Current System Assessment—scratch Education, Transition, & Supports for now, change was made to other sections, 6. Decisions were made as to order of ‗current system assessment‘ and what would be in appendices. 7. Disclaimer—Interim Second Annual Reported * (*Pending full review and approval of members in August 2004)

Interim/July 15, 2004

69

APPENDIX H: Olmstead Strategic Planning Committee Update
The duties and responsibilities of the Olmstead Strategic Planning Committee are: a) Develop a comprehensive, strategic plan for Oklahomans with disabilities; b) Review Oklahoma‘s service delivery system and the way in which persons with disabilities currently access the system; c) Review existing statutes, policies, programs, services and funding sources that affect Oklahomans with disabilities; d) Identify and review funding and resource information available to persons with disabilities and their families in Oklahoma; e) Identify gaps and barriers in programs and services to individuals with disabilities and make recommendations to enhance programs and the delivery system; and f) Take all other actions necessary to develop the comprehensive strategic plan. SB 750 further states, ―the Department of Human Services and the Office of the Attorney General shall serve as lead agencies and as such shall provide primary staffing for the Committee. Appropriate personnel from the Oklahoma Health Care Authority and the Department of Mental Health and Substance Abuse Services shall also assist with the work of the Committee.‖ The OSPC approved the formation of a Steering Committee to assist in the assignment of tasks, review recommendations from the subcommittees for presentation to the OSPC, determine which subcommittees are active or inactive, develop position papers on issues relating to the Oklahoma mission, and set the agenda for the OSPC meetings. The Steering Committee is comprised of the chairs of the subcommittees and two at-large members. The Steering Committee recommended the following procedures, which were approved by the Olmstead Strategic Planning Committee: a) Provide OSPC minutes to the voting members for approval; b) Align voting membership of the OSPC for compliance with SB 750; c) Set votes on subcommittee reports; d) Accept majority votes to approve motions; e) Permit minority or dissenting votes; f) Send out subcommittee materials prior to votes; and g) Recommend legislation, if necessary. Subcommittees meet on the first Thursday of the month unless the first Thursday is a holiday. Six subcommittees have met or are continuing to meet since the OSPC began meeting. Each active subcommittee provides regular updates to the OSPC. Any action or activity suggested by a subcommittee is discussed and voted on by voting members of the OSPC. Actions taken by the OSPC:    Approved the First Annual Report Approved Quality Assurance Principles. (See Appendix B) Approved Life Empowerment System. (See Appendix C) 70

Interim/July 15, 2004

Appendix I: Glossary Of Helpful Terms and Acronyms
Advocate - Person who works in support of another person or cause. Americans with Disabilities Act (ADA) - An act established in 1990 which prohibits discrimination on the basis of disability. Developmental Disability - A severe, chronic disability which:  is attributed to a mental or physical impairment, or combination of mental impairments that is manifested before age 22;  is likely to continue indefinitely  results in substantial functional limitations in three or more of the following areas of major life activity – self-care, receptive and expressive language, learning, mobility, selfdirection, capacity for independent living, economic sufficiency and reflects the person‘s need for a combination and sequence of special, interdisciplinary, or generic care, treatment or other services which are lifelong or extended. IDEA - ―Individuals with Disabilities Education Act‖ IEP - Individualized Education Program Oklahoma Health Care Authority (OHCA) - The financial manager for Oklahoma‘s Medicaid program. Glossary Of Medicaid Definitions Activities Of Daily Living (ADL) - Activities you usually do during a normal day such as getting in and out of bed, dressing, bathing, eating, and using the bathroom.

Assisted Living A type of living arrangement in which personal care services such as meals, housekeeping, transportation, and assistance with activities of daily living are available as needed to people who still live on their own in a residential facility. In most cases, the "assisted living" residents pay a regular monthly rent. Then, they typically pay additional fees for the services they get. Community Mental Health Center - A facility that provides the following services:  Outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHC's mental health services area who have been discharged from inpatient treatment at a mental health facility;  24 hour a day emergency care services;  Day treatment or psychosocial rehabilitation services;  Screening for patients considered for admission to State mental health facilities; and  Consultation and education services.

Interim/July 15, 2004

71

Disability - For Social Security purposes, the inability to engage in substantial gainful activity by reason of any medically determinable physical or mental impairment that can be expected to result in death or to last for a continuous period of not less than 12 months. Special rules apply for workers aged 55 or older whose disability is based on blindness. The law generally requires that a person be disabled continuously for 5 months before he or she can qualify for a disabled worker cash benefit. An additional 24 months is necessary to qualify under Medicare. Eligibility - Refers to the process whereby an individual is determined to be eligible for health care coverage through the Medicaid program. Eligibility is determined by the State. Eligibility data are collected and managed by the State or by its Fiscal Agent. In some managed care waiver programs, eligibility records are updated by an Enrollment Broker, who assists the individual in choosing a managed care plan to enroll in. Hospice - Hospice is a special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling. Long-Term Care - A "variety" of services that help people with health or personal needs and activities of daily living over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including nursing homes and assisted living facilities. Long-Term Care Ombudsman - An independent advocate (supporter) for nursing home and assisted living facility residents who works to solve problems between residents and nursing homes or assisted living facilities. Managed Care - Includes Health Maintenance Organizations (HMO), Competitive Medical Plans (CMP), and other plans that provide health services on a prepayment basis, which is based either on cost or risk, depending on the type of contract they have with Medicare. Medicaid - A joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid. Medicare - The federal health insurance program for: people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD). Nursing Facility - A facility which primarily provides to residents skilled nursing care and relate services for the rehabilitation of injured, disabled, or sick persons, or on a regular basis, health related care services above the level of custodial care to other than mentally retarded individuals. Personal Care - Nonskilled, personal care, such as help with activities of daily living like bathing, dressing, eating, getting in and out of bed or chair, moving around, and using the bathroom. It may also include care that most people do themselves, like using eye drops. The Medicare home health benefit does pay for personal care services.

Interim/July 15, 2004

72

Vocational Rehabilitation - The process of facilitating an individual in the choice of or return to a suitable vocation. When necessary, assisting the person to obtain training for such a vocation. Vocational rehabilitation can also mean to preparing an individual regardless of age, status (whether U.S. citizen or immigrant) or physical condition (disability other than ESRD) to cope emotionally, psychologically, and physically with changing circumstances in life, including remaining at school or returning to school, work, or work equivalent (homemaker).

RESOURCES:
www.whitehouse.gov New Freedom Progress Report, May 2002 www.hhs.gov/newfreedom/ “Delivering on the Promise” www.aucd.org Legislative briefs on disability issues www.adapt.org www.ucp.org United Cerebral Palsy www.thearc.org Advocacy organization www.aamr.org American Association on Mental Retardation www.access-board.gov Technical assistance materials for web and software development www.section508.gov Technical assistance documents and 508 training www.usdoj.gov/crt/ada/adahome1.htm Technical assistance manuals on Titles II & III National Association of State Legislators www.archrespite.org National Respite Resource and National Respite Coalition

Interim/July 15, 2004

73


								
To top