COMPONENTS OF A COMPREHENSIVE PLAN
OLMSTEAD DECISION
Presented by: Tony Records
TRA, Inc

Components of a Comprehensive Plan
? Plan Accountability
? Involvement of Stakeholders
? Baseline Information
? Assessment Process
? Transition Supports
? Review of Community Capacity
? Budget and Infrastructure
? Quality Assurance

Plan Accountability
? Mission Statement with clear understanding of Olmstead
? List of Issues and Challenges in Compliance with Olmstead
? List of MEASUREABLE Objectives and Activities

Plan Accountability
? Identification of Specific Individuals (by name or title) Responsible for Implementation of each Objective
? Identification of Resources or Specific Strategy to Obtain Resources

Plan Accountability
? Identifies Lead Agency Responsible for Plan                Coordination
? Process for Approval/Finalization of Plan(s)
? Process for Plan Modification
? Process for Plan Evaluation

Involvement of Stakeholders	
? APPROPRIATE STATE AGENCIES
– Human Services
– Health Services
– Mental Health
– Substance Abuse
– Aging Services
– Transportation
– Education and Special Education
– Medicaid
– Housing
– Employment
– Corrections & Juvenile Justice
? People with ALL Different Disabilities
? People and/or Families of ALL Ages
? Advocates and Advocacy Agencies
? Community Providers
? Local and State Politicians

Baseline Information
? SPECIFIC LISTINGS OF RESIDENTIAL FACILITIES           AND CENSUS
? Serving Children and Youth
– Residential Schools
– State Schools for Deaf and Blind
– Out-of-State Residential Schools
– Youth Correction Facilities
– Facilities for Youth with HIV/AIDS
? Nursing Homes
– State and County Nursing Homes
– Privately Operated/Publicly Funded
– Rehabilitation Facilities
– Veteran Homes
– Rest Homes
? Serving People with Developmental Disabilities
– Public ICFs/MR
– Private ICFs/MR
– DD Units in Nursing Homes
– DD Units in Psychiatric Hospitals
? Serving People with Mental Illness
– Public Psychiatric Hospitals
– Private Psychiatric Hospitals
– Homeless Shelters
– Forensic Halfway Houses
– Publicly Funded Board & Care Homes
– Crisis Care Units

Assessment Process
? Describes Process for Assessing People in Segregated Settings
? Includes Assessment for Eligibility, Need and Transition to Most Integrated Setting
? Provides Information to Individuals Regarding Community Services
? Assessments are Written in Setting-Neutral Terms
? Identifies Risks Relevant to the Person's Safety and Health and How They may be Accommodated
? Ensures that the Assessors are Qualified
? Informs Individuals of their Right
? Allows Individuals to Reject Presented Options and Select Alternatives
? Provides for Transition which includes:
– Health Services
– Housing
– Social Support
– Transportation
– Advocacy

Review of Community Capacity
? Reviews Current and Projected Capacity of HCBS Waivers, Home Health Services and other Sources of Funding for Community Services
? Identifies the Costs of Exiting and New Community Supports
? Provides a Strategy for the Expansion and/or Restructuring of Community Services Consistent with Statement of Need
? Includes Waiting List(s) Data as a Primary Basis for Planning

Quality Assurance
? Includes a System of measurement and Quality Improvement Activities for all Populations in Community
? Describes the Availability of Advocates, Ombudsman or other Individual Representatives in the Community

Quality Assurance
? Identifies Established Principles, Expectations and Standards for all types of Community Services
? Includes an Independent System of Monitoring and Evaluating Community Services

State of the States:  Variation
? 42* states and D.C. have task forces
? 17 planning documents online
? 31 states developing/ developed set of compliance documents
? 12 states working on "plan to plan"
? 14 states gone through assessments
? 15 Olmstead-related bills considered in 8 states in 2001-with 4 enacted
? 8 states not developing plans.
? Illinois plan includes dissenting view and is being submitted to state.
? Michigan calls for closure of DD State facilities
? Texas plan has over 50 recommendations to Governor with budget estimates.
? Missouri addressing the infrastructure.
? Pennsylvania addressing the waiting list.
? New Mexico has 12 plans
? Arkansas has involved more than 1200 stakeholders

So, What Are the Feds Doing?
? OCR T.A. Consultation
? CMS (HCFA) 5 Letters to Medicaid Directors
? President Bush's New Freedom Initiative (Feb)
? New HHS Secretary Thompson awarded start-up grants in Spring, 2001
? President's Executive Order (July)
? President's Report (12/01) 
? $64 million in new grants to 37 states September 01.

So, What Are the Challenges?
? Shortage of community direct support workers
? Transportation
? Housing
? Medicaid statute & built-in institutional bias
? Two-tier systems with 3/4 of Medicaid funding spent on institutions
? Competing waiting lists and needs of unserved/underserved

Multiple, Simultaneous Changes
? Difficulties Balancing Safety and Security
? Growing Demand with Baby Boomers
? Modifying Funding Streams, Contracting Methods, & Payment Rules
? Designing Outcome Measures, Quality/Improvement Strategies
? Embracing Person-Centered, Consumer-controlled Principles
? Altering Organizational Cultures
? Initiating Manpower Development Strategies

The "X" Factor:
? Fiscal reality of economic recession and state deficits
? September 11th and the costs of national security and fight against terrorism