Declaration of Independence Highlights from the National Advisory - - PowerPoint PPT Presentation

Declaration of Independence

Highlights from the National Advisory Board Recommendations for Medicaid Managed Care

Six Principles Necessary to Modernize Our Health Care Infrastructure

• Enhance S

elf-Care through Improved Coordination

• Encourage Community Integration and Involvement
• Expand Accessibility of S

ervices and S upports

• Uphold Personal Preference
• Empower People to Participate in the Economic

Mainstream

• Invest in Improved Technology

Enhance Self-Care through Improved Coordination

• Transform America’s health

care system from one that focuses on episodic illnesses to one that assists individuals in self-managing their whole health, with the support of providers and communities.

• Encourage the fundamental

and financial investment in physicians to serve as the medical home for patients.

Encourage Community Integration and Involvement

• Coordinate support services,

housing, and transportation so people are able to participate in the social, economic, educational, and recreational activities available through community living.

• Promote data integration,

continuity, and coordination

• f services through the use
• f health information

exchange.

Expand Accessibility of S ervices and S upports

• Retool programs and

regulations which allow people to access the services they need to live independently without creating financial hardship for the family.

Uphold Personal Preference

• Leverage the success of

long-term services and supports models that promote personal strengths and preferences and preserve dignity of participants.

Empower People to Participate in the Economic Mainstream

• Encourage the employment
• f older adults and

individuals with disabilities by removing disincentives for people to work and redefine antiquated descriptions of disability.

Invest in Improved Technology

• Invest resources in the

continued development of technology that improves individuals’ ability to self- monitor chronic health conditions and live independently.

Olmstead

• In Olmstead v. L.C., 527 U.S. 581 (1999), two women

who resided in a psychiatric unit of a Georgia hospital brought claims through the Americans with Disabilities Act (ADA), challenging their confinement in a segregated environment.

• The plaintiffs were dually diagnosed with mental illness

and mental retardation. Their treatment professionals concluded that each of the women could be cared for appropriately in a community-based program. However, the state asserted that it was already using all available funds to provide services to other persons with disabilities.

Olmstead

• The United States Supreme Court held that “unjustified

isolation” is discrimination covered by the ADA and the states are required to provide community-based services when”:

▫ Community placement is appropriate ▫ The individual does not opposed to living in the community ▫ Placement can be reasonably accommodated taking into account the resources to the State.

Olmstead

• “Institutional placement of persons who can handle and

benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life.”

• “Confinement in an institution severely diminishes the

everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.”

Olmstead v. L.C. interprets Title II of the ADA and its implementing regulations:

• The ADA requires states to administer their services, programs, and

activities in the most integrated setting appropriate to the needs of individuals with disabilities. (Sue & Sue, 2003).

• It challenges states to develop more opportunities for individuals

with disabilities through more accessible systems of cost-effective community-based services.

• A public entity shall make reasonable modifications in policies,

practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity. 28 CFR 35.130(b)(7) (1998).

Olmstead v. L.C. interprets Title II of the ADA and its implementing regulations:

• Comprehensive, effectively working plan for

placing qualified persons with disabilities in less restrictive settings; and

• A waiting list that moves at a reasonable pace

not controlled by the state's endeavors to keep its institutions fully populated.

Olmstead v. L.C.

• A state can show that it has satisfied the reasonable-

modifications regulations by demonstrating that it has a: ▫ Comprehensive, effectively working plan for placing qualified persons with disabilities in less restrictive settings; and ▫ A waiting list that moves at a reasonable pace not controlled by the state's endeavors to keep its institutions fully populated.

Oklahoma’s 2006 Olmstead Plan - Healthcare

• Oklahomans with disabilities have inadequate health
• care. Contributing factors include:

▫ Poverty ▫ Physical accessibility ▫ Communication accessibility ▫ Health care providers who are unprepared to manage the communication, cognitive, behavioral and other needs of people with disabilities ▫ Health care intervention that is focused on acute-care, rather than prevention and wellness.

Healthcare Recommendations

• Involve people with disabilities in identifying

needed policy and developing policies and procedures.

• Make sure all policies support the rights of

people with disabilities to live, work and play in the communities of their choice.

Healthcare Recommendations

• Provide additional programs and services for

persons who are currently not served, including but not limited to, people with autism, brain and spinal cord injury, developmental disability with no diagnosis of mental retardation, and mental illness.

• Reduce health care costs by providing wellness

and prevention programs.

Healthcare Recommendations

• Increase funding flexibility so individuals and their

families can use money more effectively.

• Improve higher education programs to better prepare

physicians, nurses, therapists and teachers to serve people with disabilities and their families.

• Provide incentives to increase disability awareness and

sensitivity training for health care professionals.

Opportunities – Disability Integration Act

• The Disability Integration Act creates a

comprehensive solution, assuring the full integration of disabled people in the community by:

▫ Clarifying that every individual who is eligible for LTSS has a federally protected right to a real choice in how they receive services and supports; ▫ Assuring that states and other LTSS insurance providers deliver services in a manner that allows disabled individuals to live in the most integrated setting, have maximum control over their services and supports, and lead an independent life;

Opportunities – Disability Integration Act

• Articulates the right to live in the community without

creating unnecessary or wasteful Government programs; States have broad latitude to determine how they will secure that right;

• Establishing a comprehensive planning requirement

that includes enforceable benchmarks;

• Requiring public entities to address the need for

affordable, accessible, integrated housing that is independent of service delivery; and establishing stronger, targeted enforcement mechanisms.

Opportunities – Disability Integration Act

• It secures the Constitutional right to liberty for millions
• f disabled people and seniors who are in institutions

and want to live in the community.

• It helps seniors stay in their own homes as they age.
• It saves millions of Federal and State dollars compared

with institutionalization.

• It keeps families together

Opportunities – Community First Choice S tate Plan Option

• Provides a six percentage point match in FMAP
• As a “State Plan” benefit, the option is available to states

without the need for special waiver authority

• States that take up this option are required to use a

person-centered plan of services and supports that is based on an assessment of functional need and that is agreed to in writing by the individual or, as appropriate, the individual’s representative

Community First Choice Option

• Attendant services—also called personal care and

attendant care services—are one form of home and community-based services (HCBS) intended to enable people with disabilities and chronic conditions to remain in their homes and communities by providing them human assistance in performing tasks they could do independently were it not for their disabilities.

Community First Choice Option

• Tasks Include:

▫ Activities of daily living, such as eating, toileting, grooming, dressing, and bathing; instrumental activities of daily living, such as meal planning and preparation, managing finances, light housework, and transportation; and health-related tasks, such as tube feedings, catheterization, range of motion exercises and medication administration.

Community First Choice Option

• States electing the CFC option must make hands-on

assistance (actually performing a task for a person) or supervision and cueing available to eligible Medicaid beneficiaries so that they accomplish such everyday tasks for themselves. In addition to attendant services, CFC funds are used to support:

▫ Back-up systems or mechanisms to ensure continuity of services and supports (such as the use of beepers or other electronic devices); ▫ Voluntary training on selecting, managing, and dismissing

• attendants. States also have the flexibility to cover the

following under CFC:

Community First Choice Option

• Transition costs associated with moving from an

institution to home or a community-based setting, such as security deposits for an apartment or utilities, basic kitchen supplies, bedding and other necessities required for transition;

• Expenditures related to a need identified in an

individual’s person-centered service plan that increases independence or substitutes for human assistance.

Community First Choice Option

• Individuals to be served through CFC are persons of all

ages who choose to receive CFC services and supports, receive Medicaid eligibility through State Plan eligibility rules, and meet institutional level-of-care criteria.

• Individuals must be in an eligibility group that is entitled

to receive nursing facility services, or if in an eligibility group that is not entitled to nursing facility services, have an income that does not exceed 150 percent of the federal poverty level.

Resources

• DIA - http:/ / www.disabilityintegrationact.org/ fact-

sheet/

• 1915(i) waiver

https:/ / www.medicaid.gov/ medicaid/ hcbs/ authorities/ 1 915-i/ index.html

• Community First Choice Option

https:/ / www.medicaid.gov/ medicaid/ hcbs/ authorities/ 1 915-k/ index.html

Jeff Hughes, Executive Director Progressive Independence 121 N. Porter Norman, OK 73071 405-321-3203 www.progind.org