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March 29, 2012

Meeting Materials

Olmstead Planning Committee

Vision & Principles Statement - DRAFT

I. Vision Statement

The Minnesota Olmstead Plan should empower and support people with disabilities of all abilities regardless of age to live with dignity and independence in the most integrated setting in their home and community, as appropriate, consistent with their own dreams and aspirations by expanding, strengthening, and integrating high quality and effective systems of community-based services and supports that are person-centered, as consumer controlled as possible, and adequately funded, with such funds being in the control of the consumer to purchase only those services and supports the consumer needs.

II. Principles

The primary principles that inform the development and implementation of the

Minnesota Olmstead Plan are the following:

• People with disabilities of all ages and abilities must have access to community living opportunities including employment opportunities, accessible and affordable housing, transportation and health care with necessary services and supports to make these opportunities possible;

• The principle of “community first” should shape state disability policy development and funding decisions;

• A full range of community-based and non-community –based services , supports, and long-term care are needed to address the broad range of persons with disabilities of all ages, abilities, limitations, and health conditions including persons with stable as well as degenerative chronic medical conditions;

Informed Choice, accessibility, quality, person-centered planning and wherever possible, consumer controlled decision-making should be the goals when developing services and supports;

• Systems of community-based care, services and supports must be strengthened, expanded and integrated to ensure access, effectiveness, efficiency and quality;

• Public and private mechanisms of financing long-term care and support must be expanded;

• Community-based services and supports as well as long-term care developed or maintained under this plan must be free of discrimination and must address the diversity of individuals with disabilities in terms of race, ethnicity, national origin, language and ability to communicate, sexual orientation, and geography.

• The Plan should be developed and implemented with specific and achievable goals and timetables and in a manner which provides for transparency and accountability.

The Minnesota Olmstead Plan is a work in progress. Ongoing community engagement will be critical to implementation, evaluation, and revision as the Plan evolves to meet changing needs and resources.

Olmstead Planning Committee

March 29, 2012

Proposed Draft Subcommittee Structure

I. Introduction

The Olmstead Planning Committee (OPC) agreed at its initial March 7 meeting that the primary work to create an Olmstead plan would need to be conducted by subcommittees if we are to be able to meet the Court’s October 1, 2012 deadline. A project lead will be hired by DHS to help coordinate the work of the committee, subcommittees, partners, and stakeholders. In addition, the department will contract with the Institute on Community Integration/Research and Training Center on Community Living. Following are sub- committees which the co-chairs are proposing for discussion at the March 29 meeting. We anticipate that each OPC member would be involved in one to two subcommittees and that each subcommittee would have a chairperson. We also anticipate that the subcommittees would need to meet at least once between each full OPC meeting. Please come ready to discuss the formation of subcommittees and give some thought as to which issues you would be interested in working on. By the end of this Thursday’s meeting, we would like the subcommittee structure established and have tentatively designated conveners who will set a meeting (in person, by teleconference, etc.) for each subcommittee prior to the April full

OPC meeting.

II. Proposed Subcommittees and Their Scope of Work

1. Subcommittee: Scope and Focus of Olmstead Plan – Services and Supports within Jurisdiction of Department of Human Services Whether Operated Directly by DHS or Indirectly Through Counties

A. Facilities:

1. Minnesota Security Hospital (MSH) – including people with mental illness committed as mentally ill and dangerous, people with developmental disabilities, and people with multiple diagnoses. Consider legislative changes needed to effectuate Olmstead in the forensic area, such as changes to or elimination of the mentally ill and dangerous indeterminate commitment.

2. ICF-MR’s, particularly the larger programs

residential facilities (some now grandfathered in and funded by CADI waivers)

4. Minnesota Sex Offender Program (MSOP) residents with disabilities at Moose

Lake and St. Peter.

5. Nursing facilities—people with disabilities under age 65 who are there for more than short-term rehab and persons over age 65 desiring community placement with needed services and supports.

6. Prisons and jails—inmates with disabilities, particularly with developmental disabilities and mental health disabilities.

7. Four and six bed group homes for people with mental illness and developmental disabilities.

8. All institutional settings/situations (e.g., foster care).

9. Day programs.

10. Anoka and other state operated services, including IRTs and CBH.

B. DHS (directly or indirectly through counties) MA Programs not tied to specific facilities:

1. MA State Plan and Proposed State Plan Amendments including access to and restrictions on use of PCAs, 20% relative wage cut, etc.

2. Waivers: State/DHS identifies, at beginning of committee process, waiting lists for services and presents information regarding the size of the waiting lists and the speed with which people on the list(s) receive services.

3. Connection and intersection with crisis capacity and prevention.

4. Consumer Directed Community Supports

5. HMOs: policies and practices, if any, which may inhibit transition to the most integrated community settings with needed services and supports. Investigate whether HMOs over “medicalize” their assessment of the appropriateness of community placement or when considering authorization of community-based services and supports.

6. Transportation

7. Obtain data regarding the availability of community-based services and supports as well as services such as public transportation in out state areas. What steps can the state and DHS take to increase the availability, effectiveness and quality of needed services to promote the ability of persons with disabilities to live in the most integrated setting with needed services and supports? See the MSCOD Options Too Report.

8. Others.

C. DHS Non-MA programs:

1. State Operated Services including guardianship.

2. Health

3. Employment – In the area of employment integration, consider data regarding individuals in segregated employment and data regarding integrated employment

employment.

4. Transportation services.

5. Review Medicaid Management Information System (MMIS) and other DHS data systems and issues/problems identified regarding people with disabilities, their guardianship status, residence/address/phone numbers, case managers, providers and any other information collected by the systems, and how monitoring will occur to ensure appropriate tracking is in place. Review People who have been abused and their reports filed with licensing, any death reports, etc.

2. Subcommittee: Services and Supports Within the Jurisdiction of Other State

Agencies

A. Health: HMOs, Health Care Homes, Accountable Care Organization and their impact, if any, on transition to the most integrated setting with needed services and supports.

B. Employment C. Transportation D. Housing

E. Education

F. Corrections/Forensics

G. Tribal Programs and Services

3. Subcommittee: What Does Access to Most Integrated Setting Mean

A. Current model supporting independent living is based on a medical model, what will replace it?

B. The individual with a disability is living and working in a typical setting - not a segregated setting. “Most integrated setting” is not equated with least restrictive environment.

C. Review research covering 150,000 personal interviews of people with developmental and other disabilities (Colleen Wieck can provide) to hear/learn from these citizens themselves.

D. Current providers, agencies will need to know where and how they fit in the new system.

4. Subcommittee: Safety/Risk/Liability Management

A. How to balance self-determination, safety and risk. What is an acceptable level of risk and who decides?

B. ADA restriction on using safety/risk as a basis to limit access to employment, governmental programs and activities and places of public accommodation: the “Direct Threat” Standard.

C. Confinement under state law for violent persons (including people with MI, sexual and other predators). Consider legislative changes needed to effectuate Olmstead in the forensic area, such as changes to or elimination of the mentally ill and dangerous indeterminate commitment.

D. Provider policies and practices based upon liability concerns. E. Who decides?

5. Subcommittee: Assessment Tools for Placement of Individuals with Disabilities

(including MN Choices)

A. Current model supporting independent living is based on a medical model, what will replace it?

B. Are these tools valid for all disabilities including persons with mental illness?

C. Does the assessment methodology look at abilities as well as functional limitations? D. Can assessments be done quickly upon request or when an individual’s disability

and/or circumstances change?

E. Can the system respond quickly to meet individual needs based upon an assessment?

6. Subcommittee: Financing to Achieve Integration

A. State/DHS identifies, at beginning of Committee process, current community based services and current levels of funding for services in both the community and institutions.

B. Specific funding issues - non-utilization of appropriated funds.

• Review annual waiver report submitted to the Legislature including information showing under spending of waiver funds (e.g., approx. $50 million in waiver funds for people with developmental disabilities were not spent and money reverted to the general fund).

C. Transferring funds from more segregated programs to more integrated programs. D. Additional sources of MA and Non-MA federal funds: Money Follows the Person

(MFP), Community First Choice Option (CFCO), demonstration grants, etc.

E. Other Non-CMS Federal grants, e.g. HUD housing grants. F. Public/private partnerships and funding

G. State legislative restrictions on funding which might/would violate Olmstead.

7. Subcommittee: Establishing Goals and Timetables

A. The subcommittee should review internal DHS concepts, proposals and enhancements as well as improvements described in Olmstead settlement agreements and consent decrees to create a list of tentative goals and timetables. You do not need to reinvent the wheel!

B. State/DHS identifies, at beginning of Committee process, waiting lists for services and presents information regarding the size of the waiting lists and the speed with which people on the list(s) receive services. A plan to reduce any waiting lists should be part of the Committee’s recommendation.

C. Review intake process for individuals entering institutional settings, and consider methods for diverting individuals from those settings, such as diversion waivers, to prevent institutionalization at the front end and direct resources to community settings.

D. Enhance Consumer Directed Community Supports program, budgeting and policies and include Self-directed Support Corporations and Microboards in addition to Financial Support Entities.

E. Establish specific goals and timetables for enhancement of Community Alternatives to institutionalization:

• Example: A specific number of additional waiver slots, broken down by state FY:

F. Specific waiver slot increases could be established for each facility and waiver.

• Example: Establish a process for informed consent taking into account fears and concerns by individuals with disabilities and/or their family members regarding moving from more restrictive settings into the community.

• Example (taken from the Virginia Olmstead settlement) develop a statewide crisis system for individuals with disabilities.

8. Subcommittee: How Will We Measure Success

A. University of Minnesota/Institute for Community Integration could be contracted to assist with development of methodology to define, capture and analyze data to measure whether Most Integrated Settings or other desirable Results are being achieved at the individual and system level.

B. Review trends in the movement/transfer of individuals from institutions to the community.

C. Measure of Quality assurance, working with the recently established Quality Council.

See also the Thompson Reuters draft on current elements of quality assurance and gaps within the current system.

9. Subcommittee: Stakeholder Engagement – Develop Plan for Public Inclusion in

Planning, Including Educating and Seeking Feedback

A. Ensure involvement of persons with disabilities and their families from other communities comprised of persons with varying races, creeds, ethnicity, national origins and languages. Ensure effective communication and outreach methods.

B. Use the website as a place to receive public comments. C. Develop materials for speakers to use.

D. Conduct town hall forums:

• Stream online/video teleconferencing, e.g., Town Hall Forums conducted by the

MN State Council on Disability.

E. Identify other key stakeholders across disability groups – example State Council on

Mental Health.

10. Subcommittee: Training for DHS, Other Agencies, County staff and Providers on

Olmstead

A. Obligations & Requirements:

Although critical, we envision this subcommittee cannot begin to work until the basic scope and requirements of the Olmstead Plan have been developped. Review and build capability and capacity for the workforce to support the Olmstead Plan (State staff, counties, providers, self-directed, contractors, volunteers, others). The

Olmstead plan will require changes in attitudes, skills, and knowledge. The Plan should specify the requisite training, how it will occur, and be measured to understand whether the training is successful. How will all of these groups be engaged to contribute to the success of the Olmstead plan?

III. Miscellaneous Issues Not Yet Addressed

1. Drafting the Olmstead Plan.

2. Sustainability and leadership of committee and plan when political control changes.

3. Review and address ethical issues and legal compliance issues.

Email from Shamus O’Meara to Greg Gray and Colleen Wieck dated January 10, 2012

• The Committee must take a broad approach to the Olmstead Plan to include all types of disabilities and should not be limited to the factual circumstances or category covered in the METO settlement.

• Committee, as a whole, should review the METO Settlement Agreement as it pertains to the Committee charge.

• Committee should develop a Vision and Values Statement for guidance in its role. (E.g., Empower and support people with disabilities of all abilities regardless of age to

live with dignity and independence in most integrated setting in their home and community consistent with their own dreams and aspirations by expanding,

strengthening, and integrating systems of community-based services and supports that are person-centered, consumer controlled, and adequately funded.)

• Committee as a whole reviews:

o Americans With Disabilities Act,

o Olmstead decision (with speakers from DOJ and others knowledgeable about the decision and its impact)

o Department of Justice guidance regarding Olmstead:



• Committee focus should be Results First – and deadlines should be developed to achieve

Results.

• Review and define “Most Integrated Setting” E.g., the Individual with a disability is living and working in a typical setting -- not a segregated setting. “Most integrated setting” is not equated with least restrictive environment.

• At the beginning of the Committee process, determine what the Olmstead Plan will look like, what does it contain, how it is implemented, etc. Utilize SWOT analysis to discuss Strengths, Weaknesses, Opportunities, and Threats to the planning process. Importantly, invite and welcome input from self-advocates and families about their needs, requirements, and preferences.

• Review research covering 150,000 personal interviews of people with developmental and other disabilities (Colleen Wieck can provide) to hear/learn from these citizens themselves for “most integrated setting” consideration.

• State/DHS identifies, at beginning of Committee process, current community based services and current levels of funding for services in both the community

and institutions. Review whether Most Integrated Settings or other desirable Results are being achieved at the individual and system level. Identify areas of focus. Identify impediments to achieving Most Integrated Setting (e.g., over 70% of people with disabilities in Minnesota are unemployed; lack of access to sufficient affordable and accessible housing; choice of community over institutional care is affected by the availability of community options and supports.)

• State/DHS identifies, at beginning of Committee process, waiting lists for services and presents information regarding the size of the waiting lists and the speed with which people on the list(s) receive services. A plan to reduce any waiting lists should be part of the Committee’s recommendation.

• Review current assessment procedures for individuals with disabilities and consider whether State/DHS should formally evaluate those procedures.

• State/DHS presents data on trends in the movement/transfer of individuals from institutions to the community.

• State/DHS presents data regarding trends in funding community services compared to funding institutional-based services.

• Review intake process for individuals entering institutional settings, and consider methods for diverting individuals from those settings, such as diversion waivers, to prevent institutionalization at the front end and direct resources to community settings.

• In the area of residential treatment, review how to move people from the following institutions into more integrated settings.

o Minnesota Security Hospital—including people with mental illness committed as mentally ill and dangerous, people with developmental disabilities, and people with multiple diagnoses. Consider legislative changes needed to effectuate Olmstead in the forensic area, such as changes to or elimination of the mentally ill and dangerous indeterminate commitment.

o ICF-MR’s, particularly the larger programs

o Board and care/board and lodge and other large “community based” mental health

residential facilities (some now grandfathered in and funded by CADI waivers)

o Moose Lake Sex Offender Program (MSOP) residents with disabilities

o Nursing facilities—people with disabilities who are there for more than short-term

rehab

o Prisons and jails—inmates with disabilities, particularly with developmental disabilities and mental health disabilities

o Four and six bed group homes for people with mental illness and developmental disabilities

o All institutional settings/situations (e.g., foster care;

o Day programs

o Anoka, Brainerd, Willmar, and other state operated services

o Waiting lists

o People who have been abused and their reports filed with licensing, any death

reports, etc.

• In the area of Employment Integration, consider data regarding individuals in segregated employment and data regarding integrated employment for recommendations to increase integrated employment and decrease segregated employment.

• Review Medicaid Management Information System (MMIS) and other DHS data systems and issues/problems identified regarding people with disabilities, their guardianship

status, residence/address/phone numbers, case managers, providers and any other information collected by the systems, and how monitoring will occur to ensure appropriate tracking is in place.

• Review annual waiver report submitted to the Legislature including information showing under spending of waiver funds. (e.g., approx. $50 million in waiver funds for people with developmental disabilities were not spent and money reverted to the general fund.)

• The Olmstead Plan must describe the vision, values, and mission of the Olmstead decision and the ADA and the Plan. The Plan should describe how DHS plans to deploy to all parts of the system including self-advocates, families, guardians, case managers, and providers information about vision, values and mission of the Olmstead plan (not a bulletin or website section). The Plan should incorporate a systematic and statewide communications approach to ensure everyone in Minnesota knows that the system is changing to align with the ideals and promise of the Americans with Disabilities

Act. Describe how DHS plans to function together to implement the Olmstead plan. Review and address ethical issues and legal compliance issues.

• The Plan should be SMART -- Strategic, Measurable, Attainable, Reasonable and

Responsible. Identify who will what particular tasks and specify all required

timelines. (Planning with the results in mind will allow Committee to set end dates and check point dates and manage the project). Utilize action plans to implement the Olmstead plan. What will happen during specific time periods. List resource allocations, workforce training requirements, specific performance measures – specify all of the details. The Plan should be written in accordance with the DOJ guidance. The plan should include timetables, goals and objectives for increasing community integration of people with disabilities in all aspects of life.

• Review and build capability and capacity for the workforce to support the Olmstead Plan (State staff, counties, providers, self-directed, contractors, volunteers, others). The Olmstead plan will require changes in attitudes, skills, and knowledge. The Plan should specify the requisite training, how it will occur, and be measured to understand whether the training is successful. How will all of these groups be engaged to contribute to the

success of the Olmstead plan. List measurable goal for how DHS plans to lead this effort, etc.

• Review statutes and rules impacting/impeding Olmstead -- civil commitment statute, statutes allowing ECT and sterilizations to be performed on people with developmental, competency of witnesses, etc.

I also attach a preliminary Olmstead Plan draft provided by Chris Bell, Co-Chair, MN Consortium of Citizens with Disabilities, which he derived from the Massachusetts Olmstead Plan (also enclosed). Chris conveyed that his draft is intended to stimulate discussion and perhaps help form a basis for a plan outline.

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3. Board and care/board and lodge and other large “community based” mental health

for recommendations to increase integrated employment and decrease segregated

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