Home Repair Grants for Massachusetts by tlv21093

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									The Olmstead Decision:
State Responses and its
Implications for Public
Health and Law

Kim McWhorter
ORISE Fellow – CDC Public Health Law Program
MPH Candidate Emory University
Overview

   Olmstead v. L.C.
   Public health-mental health connection
   General Olmstead Responses
   Unique Olmstead Responses
   Legal Implications
   Future implications
Olmstead v. L.C.

   July 1999
   Interpreted Title II, ADA
    – “in the most integrated setting appropriate to
      the needs of qualified individuals with
      disabilities”
   Holdings limited to individuals with mental
    disabilities
   Executive order included all Americans with
    disabilities (Executive Order #13217)
     Summary of Olmstead
        Implications
   Provide services in the most integrated,
    appropriate setting
   Community treatment is preferable to
    treatment in an institution
   Must be reasonably possible (fiscally and
    programmatically) for the state to provide
    community placement
   States are required to provide community-
    based treatment if appropriate and not
    opposed by the person with a disability
New Freedom Initiative

   Initiated in 2001
   Increasing access to assistive and
    universally designed technologies
   Expanding educational and
    employment opportunities
   Promoting increased access into daily
    community life
Why are mental health
issues important to CDC?
   Link between mental health and
    physical health
   Risk factor
   Vulnerable populations
   Large public health issue that affects
    the broader community
    General State Olmstead
         Responses
   Services in home and community-based
    settings
   Broad-based education and dissemination
    of information
   Well-coordinated programs
   Simplified access to services
   Self-direction
   Funding
       Services in HCB Settings

   Moving nursing facility residents into
    the community
   Integrate self-determination concepts
    into the LTC system
   Increase capacity of community-based
    programs
Education and Dissemination of
         Information
   Education of family members/caregivers
    about community-based services
    – Family directed care
   Emphasize consumer choice
    – Informed choice
    – Increasing outreach
      Improvements in the LTC
            Workforce

   Increased training for service
    professionals
   Create incentives for people to become
    community-living support and personnel
   Innovative ways to find, hire and retain
    caregivers for LTC services
   Caregiver compensation
    Well Coordinated Programs

   Continuum of community integrated
    services
   Housing
   Employment
   Transportation
    Simplified Access to Services

   Aggregate information systems
   Electronic databases of available services
   System for ensuring timely and appropriate
    community placement
   Identifying and assessing waiting lists and
    developing guidelines for the movement in
    each program area
   Ongoing monitoring and reporting
    mechanism
                  Funding

   Establish new revenue sources
   Community-waiver programs
   Additional Medicaid waiver slots
   RCSC Grants
   Nursing Facility Transition Grants
    Unique State Olmstead
         Responses
   Education
   Self-determination
   Staffing
   Transportation
   Housing
   Accessibility
   Funding
Education

   Public education campaign (Hawaii)
Self-determination
   Peer support network (Connecticut)
   Train consumers on how to coordinate,
    negotiate, purchase, direct, hire and fire
    attendants (Missouri)
   Increase adult protective services and
    ombudsman networks (Montana)
   Crisis intervention and support system
    (South Carolina)
   Complaint system (South Carolina)
Staffing
   Interim pay to PCAs (Arizona)
   Professional liability insurance for
    community-living support personnel
    (Hawaii)
   Olmstead training for state agency and
    provider staff (Missouri)
   Personal care assistant registry (New
    Jersey)
   Career ladders (Ohio)
Transportation

   Partnerships to provide fixed route and
    flexible scheduling opportunities
    (Mississippi)
   Labor and mileage reimbursement to
    friends and family (South Carolina)
Housing

   Educate about accessibility (Connecticut)
   Coverage of home modifications, home
    repair, special medical equipment and
    supplies and assistive technology by waivers
    (Mississippi)
   Sufficient reserve bed capacity (South
    Carolina)
   One-time home modification grants (Texas)
Accessibility
   State contracts with “gate-openers” (Hawaii)
   Multiple attempts at community reintegration
    (Illinois)
   Olmstead coordinators at state-operated
    psychiatric hospitals and intermediate care
    facilities (Kentucky)
   “Choice letter” for LTC residents (Maine)
   Pre-screen for possibility of CB care
    (Massachusetts)
   LTC insurance promotion (Tennessee)
Funding

   Transition funds (Maryland)
   Ohio Success Pilot Program
   Income disregards (Massachusetts)
        Examples of State
           Legislation
   Colorado (2002: HB 1039)
   Colorado (2002: HB 1067)
   New Hampshire (2001: HB 350)
   Maine (2002: HB 1574)
   Maryland (2002: HB 752)
Legal Implications

   Professional liability insurance (place
    cap on liability)
   Medicaid
   Housing Policies
   Increase in Olmstead-type lawsuits
Examples of Lawsuits

   The Arc of Delaware v. Meconi
   Bradley Tinder v. Illinois Department
    of Public Aid
   Ball v. Beidess (AZ)
   Fisher v. Oklahoma Health Care
    Authority
Future Implications

   Continued legislation & lawsuits
   Decreased hospital/institution-based
    services
   Increased Medicaid burden

								
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