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ADAPT issues recommendations to HHS on Olmstead implementation

By mid-October, 2001, HHS Sec. Tommy Thomspon, as required by the Executive order issued by the White House in June, will issue recommendations for implementing the Supreme Court Olmstead decision. In mid June, 2001, ADAPT issued the following list of recommendations:

1. Recommendation(s): Executive Order

• ADAPT representatives be involved in the development of the recommendations developed by the various Federal agencies;
• ADAPT members be part of an implementation task force to assure that all recommendations are carried out in a timely manner after the 120 day period ends; this group should be composed of a majority of people effected by the Olmstead decision;
• HHS and other agencies should develop specific timetables for the next year which includes steps that need to be taken to ensure compliance with the Olmstead decision and the goals of the Executive Order;
• HHS as lead agency work with other agencies to ensure they request adequate funding to implement recommendations that will assure that folks receive long term services and supports in the "most integrated setting;
• HHS/OCR and HCFA/Policy be given the adequate resources and authority to implement the Olmstead decision so that folks receive long term services and supports "in the most integrated setting".

2. Recommendation(s): Real Choice System Change RFP's

• Secretary Thompson will meet with Secretary Martinez by July 15th to assure that there are Section 8 vouchers coordinated with the Nursing Home Transition RFP's that HHS will award in October 2001 as well as $10 million in the HUD 2002 budget for accessible, affordable, integrated housing vouchers specifically to implement the Olmstead decision; Secretary Martinez should assure that HUD will fund vouchers for the next 5 years specifically to implement the Olmstead decision;
• HHS support the continuation of the Real Choice System Change initiatives;
• HHS support $70 million for funding of the Real Choice System Change initiatives in the 2002 budget request;
• HHS support the infrastructure necessary to develop the policies and monitor the implementation of the Olmstead decision and reform of the institutionally biased long term service and support system.

3. Recommendation(s): Support for Federal Legislation reversing the institutional bias and creating a Community First! policy in the United States.

• Support a five-year enhanced Federal match for community attendant services and supports as a transition to a Community First! policy;
• Support federal legislation [MiCassa, S 1298] that will give people with disabilities a "Real Choice" when choosing long term services and supports

4. Recommendation(s): Home Health Medicare/Medicaid

• Develop and fund a Medicare home health demonstration project that will illustrate how Medicare Home Health funds can be more cost effectively used by delivering HH services using concepts used in Personal Attendant Services including eliminating the "homebound" requirement;
• Monitor the states and enforce the HCFA rule that using the homebound requirement in the Medicaid Home Health benefit is illegal;
• Review the Medicaid Home Health benefit and develop policy clarifications, rules/regulations through January 2002 that will allow the delivery of these HH services with less medical, less bureacratic and more consumer control concepts;

5. Recommendation(s): Development of structure within HHS that reflects all people with disabilities.

• Review the current structure within HHS that has an Administration On Aging (AOA), an Administration On Developmental Disabilities (ADD) but has no administrative way to address people under the age of 60 who are not labeled DD.
• Create an administrative structure by November 1, 2001 that reflects the fact that HHS provides services and supports to all people with disabilities old and young.
• Possible structure(s):

• 1) Administration on People with Significant Disabilities (Keep the functional criteria in the DD Act but do away the current age of onset language and use under 60 as the age of onset)
• 2) Create an office within HHS that specifically focuses on People with Significant Disabilities modeled after the Dept of Labor position

6. Recommendation(s): Medicaid/Medicare Policy Recommendations

• Develop a Medicaid service called "Transition Services" that would reimburse the things necessary to transition from a nursing home or other institution to a community setting. This could include but not limited to: 1st month rent, utility deposits, basic home furnishing, etc;
• Develop policy clarifications on the issue of "risk". Many states use health and safety as a reason to either deny service or place a person in a congregate setting; policy should clarify that providers are responsible for the services they provide but are not responsible for the rest of the person's life (as in an institution);
• Allow direct family members to be paid for services provided under the Medicaid State plan;
• Review and implement the recommendations from the UCSF study as reviewed by the PAS Blue Ribbon Advisory Committee;
• Allow states to submit a consolidated 1915(c) waiver if they choose. Waivers currently are categorical rather than functional in design;
• Create a demonstration project on people eligible for Medicare and Medicaid under 65
• Review Medicaid reimbursement requirements to enhance consumer control delivery options;
• Eliminate the Medicare Home Health "homebound" requirement.