The State is designing the Olmstead Plan, which we expect to be released this May.   The following is a quick reference of the components we believe should be incorporated into the Plan in order to effectively address the needs of people with disabilities who want to live in the community.

Above all, we believe the Plan must result in the movement of people and dollars out of institutional settings and into the community.

There is no order of priority, but the following list is laid out in terms of general data items, integration measures, community-based services, and then auxiliary areas like managed care, housing, transportation, etc.

• Report data on the number of people in institutional settings and on waiting lists for services who would prefer community living in order to establish baselines for the Plan;
• Establish specific long-range and annual targets for reducing the institutional population and institutional spending (for all institutional settings and specific populations), while increasing the number of individuals receiving community-based services and the associated funding;
• Establish a process for tracking whether waiting lists are moving at a reasonable pace and individuals are not waiting more than 90 days to get home and community-based services authorized;
• Address the existing loopholes in the authorization of state plan home and community-based services that result in the institutionalization of people with disabilities seeking personal care or certified home health care services and who are never offered the opportunity to go on a waiting list for such services;
• Consolidate State agencies to address disability needs across silos, modeled in part off of the US Administration on Community Living;
• Establishes a clear funding plan to implement the Olmstead Plan;
• Establish a “no wrong door” system for accessing long term services and supports that is truly cross-disability and cross-generational by leveraging the state’s extensive network of independent living centers;
• Establish a public process involving people with disabilities and our disability-led organizations in identifying barriers to community living and recommending annual updates to the Plan that include removing such barriers;
• Utilize the state’s extensive network of independent living centers who have demonstrated cost-effective best practices on community living;
• Establish a “Community First” default mechanism so that every person with a disability is provided services in the MOST integrated setting first and, only when necessary, moved into institutional placement (Until such a mechanism can be put in place, establish formal procedures that assure people with disabilities are offered community-based alternatives before any institutional admission and establish a tracking system that identifies potential barriers to community living for individuals who select institutionalization);
• Ensure the Uniform Assessment System determines Community First Choice (CFC) eligibility by assessing whether the individual meets any of the applicable institutional level of care standards, regardless of how they access the system;
• Establish an expedited community-based enrollment process so discharge planning teams in hospitals and nursing facilities can quickly connect individuals with disabilities to community-based services;
• Establish and fund a process to identify individuals who want to transition into the community and connect them to the resources they need to make the transition – including educating individuals in institutions about their right to live in the community and providing support to these individuals as they consider their options;
• Establish nursing facility transition services as a mandatory and billable service within managed care contracts billing rates that adequately support this function;
• Establish a priority for the Protection & Advocacy designated agency to monitor and enforce Olmstead, including assuring individuals in nursing facilities and other institutions are notified of their rights to receive services in the most integrated setting;
• Expand the jurisdiction of the Justice Center to include nursing facilities and home care, which it currently does not;
• Issue specific guidance to counties and managed care plans about their obligations in assuring state compliance with the Olmstead decision, including specific examples and model policies;
• Require that contracts in managed care, through rates and incentives, promote people with disabilities – including those with significant disabilities – living in the community;
• Require aid continuing and due process provisions in managed care, regardless of the expiration of the prior authorization;
• Require that quality measures in managed care capture integration and consumer control measures;
• Establish a statewide, independent advocacy program for seniors and people with disabilities in managed care and care coordination systems (ombuds);
• Establish a requirement that people with disabilities are first offered the opportunity to receive consumer directed services LTSS when entering the system and every time services are reauthorized;
• Address the needs of people with disabilities who require assistance with health related tasks and do not receive the services and supports they need because they do not qualify for, or want to, utilize Consumer Directed Personal Assistance services;
• Require that managed care pay for assistive technology and durable medical equipment to support individuals with disabilities living independently and fully participating in community life;
• Assure that the provision of home and community-based services is voluntary by eliminating forced treatment for people with psychiatric disabilities;
• Develop, in conjunction with disability-led organizations, a State definition of “home and community” that is truly independent and integrated;
• Create and adequately fund a housing subsidy for people with disabilities who are institutionalized or at risk of institutionalization due to the need for affordable, accessible, integrated housing (Note: this would be similar to the mechanism used in NHTD/TBI waivers, but would not be tied to waiver enrollment);
• Establish a preference for and set-asides of federal housing vouchers (e.g. Section 8) for people in institutions, at risk of entering an institution, or in state-run housing programs;
• Expand the availability of accessibility modification by requiring that they be funded in managed care for individuals receiving Medicaid LTSS and adequately funding Access to Home for those individuals who are not currently receiving Medicaid LTSS;
• Fund the development of integrated and accessible housing units that are affordable to people with disabilities living at extremely low incomes, well below 30% of area median income – determining appropriate target with the disability rights community;
• Fund the discovery phase in integrated employment;
• Phase out the use of sheltered workshops and payment at sub-minimum wage to people with disabilities;
• Establish a state policy/philosophy that ALL people can work in integrated employment (not just those who are considered or classified as “high functioning”);
• Address the need for transportation to allow people with disabilities to live independently in the community – this would include addressing the need for non-medical, accessible, and affordable transportation alternatives for attendants;  and
• Meet the unique, and unaddressed, needs of Deaf-Blind individuals who require services and supports to live independently and fully participate in community life.

Make your voice heard! Tell the State what you think should be included in the Olmstead Plan by visiting http://www.governor.ny.gov/olmsteadplan.