Colorado Unveils New Olmstead Plan
August 28, 2014 10:46 AM
Colorado recently released its new Olmstead plan entitled Colorado’s Community Living Plan: Colorado’s Response to the Olmstead Decision. In it, Colorado highlights the accomplishments that the state has made to date, and future plans for strengthening community living and health care. The plan sets out key goals and strategies for at least the next three years. The National Council on Medicaid Home Care – a NAHC affiliate - discusses key aspects of the Plan below.
Olmstead vs. L.C., a landmark Supreme Court case decided in 1999, suggested that a state could comply with Title II of the Americans with Disabilities Act if, among other things, it “were to demonstrate that it had a comprehensive, effectively working plan for placing qualified persons with mental disabilities in less restrictive settings.” In the wake of the Olmstead decision, many states developed such “Olmstead plans.” As of May 2013, twenty-seven states had Olmstead plans, with an additional eighteen states having alternative strategies.
Colorado wrote but delayed implementation of an Olmstead plan in both 2002 and 2010. However, reports did emerge from these efforts, which provided some guidance on reform. The 2010 report, Olmstead: Recommendations and Policy Options for Colorado, resulted in key HCBS/Olmstead accomplishments by the state’s Departments of Health Care Policy and Financing, Human Services, and Local Affairs, discussed below.
To see a previous Council brief providing a synopsis of the Olmstead v. L.C. case, and its ongoing legacy, click here.
Accomplishments of the Department of Health Care Policy and Financing
Colorado Choice Transitions. Colorado implemented the Money Follows the Person Rebalancing Demonstration with a $22 million grant to last five years awarded in 2011. Called Colorado Choice Transitions, this grant will transition 490 Medicaid enrollees from institutional settings to home and community-based settings.
The Council supports Money Follows the Person as a cost-effective program to rebalance LTSS spending towards HCBS. For a recent Council brief on Money Follows the Person utilization nationally, click here.
Community Transition Services. Funds are available to Medicaid enrollees in nursing homes to transition into the community, including support of a transition coordinator.
Home and Community-Based Services (HCBS). Colorado was one of the first states to start an HCBS waiver program and much work as been done to rebalance towards home and community-based services and away from institutional based services. However, Ellen Caruso, lobbyist of Ellen Caruso Public Affairs, and who works with the Home Care Association of Colorado, stated that “about 1/3 of the Medicaid beneficiaries in Colorado are in nursing homes, which expend 2/3 of the state’s LTSS money. This leaves 2/3 of the clients in the home and community with 1/3 of the money.”
According to a recent report by the Centers for Medicare & Medicaid Services (CMS), in FFY 2012, Colorado spent 58.1% of its LTSS dollars on HCBS (i.e. on 2/3 of the Medicaid LTSS clients, according to Ms. Caruso), putting it in 10th place of all states. Of the nine states ahead of Colorado in this metric, four states (Vermont, Arizona, Washington, and California) haveOlmstead plans, three states (Oregon, Minnesota, and Alaska) have alternative strategies, and one state (Wisconsin) has both anOlmstead plan and an alternative strategy. For details, click here.
Accomplishments of the Division for Developmental Disabilities
Family Caregiver Support. The Division added 24/7 family caregiver support to those with developmental disabilities.
The Council supports such family caregiver support, so long as such support doesn’t evolve into an increased burden on the family caregivers, as was the found to be the case in the GAPP Program in Georgia.
Specialized Day Services and Case Management. These services are now available for residents of nursing facilities with intellectual disabilities, and help these residents transition into the home or community setting.
Accomplishments of the Department of Local Affairs-Division of Housing
The Division of Housing has secured multiple housing accomplishments, including: a housing voucher program for those with disabilities, rental assistance, tax credits, and more. For a full list, see pages 10-12, here.
Accomplishments of the Department of Human Services
Behavioral health reform to improve community capacity. Colorado will implement several reforms to improve community capacity for those with behavioral health transitioning from institutions to the community, including:
Money Follows the Individual program for an average of 36 high needs individuals, which includes person-centered planning for community transitions;
Assertive Community Treatment (ACT), which will increase the ACT program by 429 enrollees. ACT provides clinical, emergency, rehabilitation, and support services;
Rent subsidies for 109 enrollees;
Wrap around services (individualized mentoring, personal needs, and transportation); and
Intensive case management and navigation.
Behavioral health reform for crisis support services. These services will include a 24-hour help line, walk-in services, mobile crisis units, and others. For a full list of the behavioral health reforms, see pages 12-16, here.
These behavioral health reforms are similar to those recently established in New Hampshire as a result of a settlement agreement. Such reforms include: ACT, a 24-hour help line, and mobile crisis units. While it is too early to tell whether these reforms have been successful in New Hampshire, the Council is encouraged that such reforms will enable enrollees with behavioral health issues to move into and stay in the home and the community.
Key Aspects of Colorado’s Olmstead Plan
The Plan has nine goals. For each goal, the Plan lists several strategies to achieve these goals:
Goal 1: Identify individuals in institutional care who want to move into the community, and ensure their successful transitions.
Strategies: Develop processes to assess individuals who can transition to the community, implement a Person Centered Planning (PCP) protocol for these transitions, and build a training program for the workforce to implement this protocol.
Goal 2: Prevent unnecessary institutionalization.
Strategies: Inform people of community-based options when they are about to be discharged from a crisis center or hospital, or when they are in the community and are considering moving to an institution, and make access of these options easier.
Goal 3: Increase integrated housing options.
Strategies: See pages 23-26, here, for details.
Goal 4: Increase availability of HCBS that support successful transitions and prevent reinstitutionalization.
Strategies: Increase HCBS by examining financial means to expand HCBS, develop a user-friendly online system for consumers to see available HCBS, and annually report to the Governor on HCBS availability and barriers, and the status of waitlists. For the full list of strategies, see pages 26-29, here.
Ms. Caruso stated that this goal is very important and positive for the agency model of home care. Specifically, she hopes that the increased availability of HCBS will lead to higher rates, which in turn will lead to higher quality of care and staff.
Goal 5: Develop the long-term services and supports (LTSS) and behavioral health workforce’s skills and expertise.
Strategies: Develop a training program for this workforce, explore recruitment and retention strategies, implement a person-centered case management model, and implement a method to determine beneficiary satisfaction and effectiveness of HCBS.
Goal 6: Improve communication among LTSS agencies.
Strategies: Develop a core competency workforce training program, Olmstead-related literature and online clearinghouse for stakeholders, and market the online clearinghouse.
Goal 7: Eliminate redundancies, increase efficiencies, and improve plan incomes.
Strategies: Develop existing efforts to Olmstead plan implementation, align existing efforts to improve efficiencies, increase collaboration among state agencies regarding transitions to HCBS.
Goal 8: Implement an evaluation plan.
Strategies: Determine how the Olmstead plan will be evaluated objectively and transparently and reflects appropriate benchmarks, develop an annual evaluation plan, critically review policies and procedures as related to Title II of the ADA, and conduct an annual status report.
New HCBS Transition Plan
In addition to the Olmstead plan, Colorado is preparing an HCBS Transition Plan in response to the new HCBS rule from CMS that became effective in March. Colorado will be revising its existing HCBS waivers, including: Brain Injury (BI), Children with Life Limiting Illness (CLLI), Children’s Home and Community Based Services (CHCBS), Community Mental Health Supports (CMHS), Elderly, Blind, and Disabled (EBD), and Spinal Cord Injury (SCI) waivers. Public comment on the Transition Plan extends through September 10, and Colorado will submit the Transition Plan to CMS for review on September 30. For more details, click here, here, and here.
Ms. Caruso stated that she sees positive things about the Plan, and that it should include support of the agency model. The Council supports the goals of Colorado’s Olmstead Plan not only to provide greater opportunity for those seeking to move from the institution to a home and community based setting to do so, but to also ensure that they will safely remain in those settings. The Council will continue to monitor developments in the state’s new HCBS transition plan, and will continue to provide information as it is made available.
The Council encourages providers to continue to advocate for greater support of HCBS through their state associations, as well as through state and federal governments. Home care providers are encouraged to keep abreast of HCBS developments in their states, and nationally, and to contact the Council with any questions or concerns.