Slide 1

Olmstead PlanOne Year Update

Presented at ACLAIMH

November 6, 2014

Olmstead Cabinet

Olmstead Report

•Executive Order No. 84 created Olmstead PlanDevelopment and Implementation Cabinet

•Olmstead Cabinet issued final report inOctober 2013

•Ongoing oversight of Olmsteadimplementation through Most IntegratedSetting Coordinating Council

The Olmstead Plan

•Community transition

•Assessment and outcomes measurement

•Reforms to support community integration

•Accountability

Community Transition

Individuals with Intellectual andDevelopmental Disabilities

•Enhancing system capacity throughpartnerships

•System education on broader array of livingenvironments

•Reduce reliance on institutional supports

–Developmental center closure and reduction plans

–Community ICF transition plan

OPWDD Activities to IncreaseEmployment Outcomes

•New service initiated in July 2014—Pathwayto Employment—to provide greaterassessment and skill building to facilitateimproved job matches

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

Total Growth of People who Self Direct

Individuals with Mental Illness

•Transform network of psychiatric center inpatientand community services to enable individuals in careto live in the most integrated setting possible

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

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

Community Pre-Investment

•$44 million annualized “pre-investment” for:

–628 Units of Supported Housing ($7.1 million)

–168 Waiver Slots ($4.5 million)

–State Operated Community Services ($14.9 million)

–Other Community/Aid to Localities ($15.9 million)

–Suicide Prevention and Forensic funding ($1.5 million)

•Specific services and programs developed withState Operations and Aid to Localities subject toongoing regional consultation and planning

Reducing Long-Term Stay Census

•Number of long stay individuals in OMH PCs inApril 2013 was 1,060.

•Olmstead Report set goal of 10 percentreduction in long stay population over twoyears.

•We are currently at 936, already exceedingour goal.

Persons in Nursing Homes

•The Olmstead report provided the frameworkfor New York to serve people with disabilitiesin the most integrated setting appropriate totheir needs

•The Olmstead goal is to reduce long staypatients in nursing homes by 10 percent overfive years

Assessment andOutcomes Measurement

Developing CommonAssessment Instruments

•DOH

–Uniform Assessment System (UAS)

•OPWDD

–Coordinated Assessment System (CAS)

•OMH

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

•OASAS

–In development (UAS and CAS)

•SOFA

–Comprehensive Assessment for Aging Network CommunityBased Long Term Care Services (COMPASS)

Key Olmstead Domains

•Most Integrated Living Setting

•Employment

•Meaningful Day Activities

•Access to Transportation

•Access to and Use of Self-Directed Models

•Choice in Services and Supports

Next Steps

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

•Integrated approach envisioned with transition tomanaged care will help build common outcomemeasures upon full implementation

•Workgroup to identify measures that are lacking andrecommend future data sources

SupportingCommunity Integration

Home and Community-BasedSetting Requirements

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

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

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

Home and Community-BasedSetting Requirements

•Allowable Home and Community-Based Settings:

–Are integrated in and support access to the greater community;

–Provide opportunities to seek employment and work in competitiveintegrated settings, engage in community life, and control personalresources; and

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

–Selected by the individual from among setting options, including non-disability specific settings and an option for a private unit in a residentialsetting.

•Person-centered service plans document the options based on the individual’sneeds, preferences; and for residential settings, the individual’s resources.

Home and Community-Based Setting Requirementsfor Provider-Owned or Controlled Residential Settings

•Specific unit/dwelling is owned, rented, or occupied underlegally enforceable agreement;

•Same responsibilities/protections from eviction as all tenantsunder landlord tenant law of state, county, city or otherdesignated entity; or

•If tenant laws do not apply, state ensures lease, residencyagreement or other written agreement is in place providingprotections to address eviction processes and appealscomparable to those provided under the jurisdiction’slandlord tenant law.

Requirements for Provider-Owned orControlled Residential Settings

•The following are setting requirements for provider-owned orcontrolled residential settings:

–Each individual has privacy in their sleeping or living unit;

–Units have lockable entrance doors, with the individual andappropriate staff having keys to doors as needed;

–Individuals sharing units have a choice of roommates;

–Individuals have the freedom to furnish and decorate their sleeping orliving units within the lease or other agreement;

–Individuals have freedom and support to control their schedules andactivities and have access to food any time;

–Individuals may have visitors at any time; and

–Setting is physically accessible to the individual.

New York’s HCBS Implementation

•Draft plan available:

https://www.health.ny.gov/health_care/medicaid/rede sign/home_community_based_settings.htm

•OPWDD plan available:

http://www.opwdd.ny.gov/opwdd_services_supports/HCBS/home

Supportive Housing

•New Yorkers with disabilities need affordable, accessiblehousing to lead integrated lives

•Over the past three years, the state has made an investmentof more than $388 million in supportive housing programstargeted at New York’s Medicaid recipients with a high level ofneed

Olmstead Review Process

•In 2013, HCR implemented an Olmstead-specific reviewprocess for all projects requesting funding under thecompetitive Unified Funding application process

•Unified Funding Olmstead review is conducted incollaboration with state, federal, and/or local fundingpartners

•Prior to award of funding, the review assesses whetherpersons with disabilities will be served in the mostintegrated setting appropriate to their needs

2014 Olmstead Review Enhancements

•In 2014, HCR implemented a new pre-applicationconference requirement for any applicant targeting 50%or more of a project’s bedrooms to persons withdisabilities

•Conferences must include HCR and the state, federal orlocal agency that is providing the funding for appropriateservices

•Purpose of this conference is to explore whether thecontemplated project is consistent with the Olmsteaddecision

Employment First Executive Order

•Issued in October 2014

•Builds on Olmstead Cabinet’s work to enhanceemployment for persons with disabilities

•Employment First Commission report containsadditional recommendations to enhanceemployment outcomes

Transportation

•Mobility management practices increase theavailability of transportation for people withdisabilities

•Developing a pilot program to expand uponthe existing Medicaid transportationmanagement initiative to implement mobilitymanagement

Legal Reform

•Seek to expand authority of non-licensedpersonnel to provide health-related taskassistance to persons residing in thecommunity

•Seek reform of the law governing guardianshipover people with intellectual anddevelopmental disabilities to assure leastrestrictive option