Blog Archives

Olmstead, Politics & Our Olmstead Planning Bill -- Broadly

8/9/2017

One of the supposed benefits of any law is that its application is going to take it outside the realm of politics.
   Well, as a lot of people who have pinned their hopes on civil rights laws are aware -- such laws are only as good as their enforcement.
   AND often, they are not very well enforced.
The Americans with Disabilities Act and the 1999 US Supreme Court Olmstead Decision represent pretty piecemeal enforcement.
Especially when we talk about Olmstead Planning this is not well institutionalized in many States, including Colorado.
   AND it is very political unfortunately sometimes in a way designed to circumvent the rule of law. That is not in the interests of the disability or senior communities.
Our Olmstead Planning Bill is NOT going to get Olmstead completely out of politics but if we could have a more neutral process based on law that would certainly more likely benefit people with disabilities and seniors.
AND would actually help the politicians and the State comply with the Law-- and take a big point/s of contention off the Table.

What Would Be the Cost of Our Proposed Olmstead Plan Bill?

8/8/2017

Well, that's an interesting question?

Initially, the question is what are the administrative costs of the Olmstead Planning itself and how are they covered?

   The bigger questions of additional costs for housing and services are part of the subject matter of the Olmstead planning itself.

   See below the process we set out in the draft bill.

   We would like to work with the State and the Disability and Senior Communities in getting some of these basic concepts that have been legally recognized in the Minnesota Court Ordered Olmstead Plan and others and the 2010 Dept of Justice Delaware Findings Letter institutionalized in Colorado [read so we don't have to litigate it]:

Specific Reasonable Meaurable Goals in an Olmstead Plan

Reasonable Plans to Bring Housing & Services To Scale To Meet the Need

[We would also note that "bringing to scale to meet the need" is a basic public health concept used by US Health agencies as well as the World Health Organization (WHO)].


Below from Our Draft Olmstead Bill:

5. Measurable Goals & Reasonable Plans to Bring to Scale to Meet the Need

A. Baseline: Each measurable goal for increased integration or improvement of quality of life begins with an analysis of what the State has currently achieved in the provision of housing or services, etc. for people with disabilities.

B. Unmet Need: Then the State in consultation with the Stakeholders must reasonably measure the unmet need for the housing or service, etc. in question.

C. Effectiveness & Efficiency Program Evaluations: Next the State must conduct high-quality evaluations of programs and practices" to ensure the most effective and efficient use of resources and to ensure that needs cannot be meet within existing resources more wisely utilized.

D. Reasonable Plan To Bring To Scale to Meet the Need: Then the State in consultation with Stakeholders must establish a reasonable plan to meet the unmet need with specific measurable goals and a reasonable plan to bring housing and services to scale to meet the need.

E. Specific and reasonable time frames: Each measurable goal has specific and reasonable time frames.

F. Funding: Each measurable goal will address the extent to which there is funding to support the goal including potential reallocation of funds, use of Social Impact Bonds, future legislation, Etc.

In its Fiscal Note, Nebraska seemed to find there would be no additional public expenditures for its Olmstead Plan Legislation, unless a Consultant was hired.

Our CO Olmstead Planning Draft Bill & Nebraska's Olmstead Planning Legislation

8/6/2017

Nebraska's Olmstead Planning Statute includes a list of organization that are to be included in Nebraska's Olmstead Planning Process.

The bill is below to the right. It was written as emergency legislation, we need to double check and see if it passed as emergency legislation. It mandates the following Olmstead Plannning participants:

Other State Agencies
The Area Agencies on Aging
Persons from each of the six divisions of the department
other state agencies that administer programs serving persons with disabilities;
Representative from the State Advisory Committee on Mental Health Services,
The Advisory Committee on Developmental Disabilities,
The Nebraska Statewide Independent Living Council,
the Nebraska Planning Council on Developmental Disabilities,
the Division of Rehabilitation Services in the State Department of Education,
a housing authority in a city of the first or second class and
a housing authority in a city of the primary or metropolitan class,
the Assistive Technology Partnership,
the protection and advocacy system for Nebraska,
an assisted-living organization,
the behavioral health regions,
mental health practitioners,
developmental disability service providers,
an organization that advocates for persons with developmental disabilities,
an organization that advocates for persons with mental illness,
an organization that advocates fo rpersons with brain injuries,
and an area agency on aging,
and including two persons with disabilities representing self-advocacy organizations, and,
at the department’s discretion, other persons with expertise in programs serving persons with disabilities;
determine the need for a consultant to assist with the development of the strategic plan;

.
In the Colorado Olmstead Planning Draft Bill above that we prepared we have included a lot of organizations. It looks like from the Nebraska legislation and law we should include more.
As things progress, some may feel this needs to be more generalized with respect to some of the organizations -- we'll see.
We want to get the State on the path to specific measurable goals and a reasonable plan to bring housing and services to scale to meet the needs of people with disabilities to avoid unnecessary institutionalization and great risk institutionalization inherent in homelessness.
Of course, at the same time we want to be good stewards of our resources.

Olmstead Change/Olmstead Bill -- Trying To Get To the Messy Middle

8/5/2017

  When it comes to complying with Olmstead, it feels like the beginning in some ways -- not in others.
Olmstead took a long time due to the need to flesh out the meaning of the decision itself with subequent caselaw, DOJ {Dept. of Justice] Findings Letters, DOJ Guidance, etc.
   To really progress on these Olmstead matters one does have to have at the very least open conversation if not debate about them.
    We don't have an objection to trying to build in concerns for efficient and wise use of resources, etc.
We are working on an Olmstead draft bill. We know there is interest in this in Colorado and there is some interest in it nationally.

Draft Olmstead Plan Bill & Authorization for Behavioral Health/Criminal Justice Plan --- We Need to Take the Next Step & Comply w/ Olmstead

8/4/2017

On July 5, 2017, Gov. Hickenlooper authorized work on a Behavioral Health Criminal Justice Plan which is not a mini MI-Criminal Justice Olmstead Plan, but it does a lot of good things (see document to the right).

One of the things that it does it sets up reasonable and measurable "performance outcome metrics."

Well, that sounds an awfully lot like specific meausurable goals in the Minnesota Court-Ordered Olmstead Plan.
https://orchidadvocacy.org/minnesotas-revised-aug-2015-olmstead-plan-approved-by-a-federal-court.html

So I think this is something Colorado is very capable of doing.

Now I "think" in Criminal Justice, the thought is getting people onto existing Medicaid programs where possible so there is the admonition -- that this is all going to be done "within existing resources."

We are looking to an Olmstead Statute, similar although very likely not identical to one passed in Nebraska.
https://orchidadvocacy.org/nebraska-olmstead-plan-statute.html

Further, we are trying to get as much buy-in from everyone (including the State) for this as possible and we are thinking of building into this language such as:

"Conducting high-quality evaluations of programs and practices" to ensure the most effective and efficient use of resources and to ensure that needs cannot be meet within existing resources more wisely utilized, establish a reasonable plan to meet the unmet need with specific measurable goals and plans to bring to scale to meet the need.

The above language bolded in black is essentially language from Gov. Hickenlooper's July 5 letter authorizing work on the Behavioral Health/Criminal Justice Plan.

We think there is common ground with the State.

Sometime next week I'll get a draft bill out and post it on the website.

The Olmstead decision was in 1999.

The Disability Communities in Colorado & Nationally Need the Burden on the States to Comply with Olmstead Either Administratively or Through Statute

8/3/2017

We have in the past talked about administrative enforcement of Olmstead through CMS and HUD, which the US Dept. of Justice (DOJ) was in the beginning stages of exploring under the Obama administration.
https://orchidadvocacy.org/arguments-in-favor-of-administrative-enforcement-of-olmstead.html
   We are definitely not Pollyannish when it comes to Olmstead enforcement -- it can definitely be done ---- but it is not easy, it is not cheap -- and States fight it -- Colorado does. So that means the costs go up.
That is just not feasible for the Disability Community and their advocates -- especially since we all know the State is not providing sufficient housing and services to meet the needs of thousands of people with disabilities who are institutionalized or at great risk of institutionalization.
   The burden needs to be on the State that it is complying with Olmstead, and if not that it has a Comprehensive, Effective Working Olmstead Plan with Measurable Goals to bring Housing & Services to Scale.
   Of course, that plan should be "reasonable."
   Olmstead really helped the Disability Community a lot. But cases that are brought and DOJ Findings Letters and Guidance are meant to help people with Disabilities around the Country --- States like Colorado routinely ignore them -- so the only way those cases, or DOJ Findings Letters, Guidance, etc is help is if one is forced to file a case of one's own.
   AND then the CO Attorney General's Office ignores them or dismisses them as inapplicable because it was from another State, even though we're talking about Federal Law.
   The States, certainly Colorado, do a lot of Happy Talk about Olmstead and the ADA, but they don't comply with it and we think that is because they operate in a very complicated political reality and they really don't see how that would happen politically.
   So that's why Olmstead Compliance in most States is by Court Order.
   Is the Trump Administration going to enforce Omstead through CMS & HUD? Hmmm . . . .
   Nebraska has passed an Olmstead Statute and other legal commentators have really been pushing for this kind of legislation.
       In Colorado and nationally we are going to be dealing with these Olmstead issues for some time and we need to build in the processes based on the Olmstead case and subsequent caselaw, DOJ Findings Letters, & Guidance to deal with these issues on an on-going basis.
   We think that means consideration of a Colorado Olmstead Statute.

We Have Made Some Real Progress But the Current Lack Of Compliance With Olmstead Is Not Only An Outrage, It is a Very Practical Impediment to Real Measurable Goals, Accountability, & Inclusion

Trying to Meet a Very Large Need: ACT & Housing

8/2/2017

When considering ACT [Assertive Community Treatment] and Housing, the State and Stakeholders need to consider separate legislative fixes.
For Adult and Youth ACT: authorization to seek Medicaid funding of ACT as a Rehabilitative Service for those where reasonably medically necessary as is done in Minnesota.
   We need a statute directing the State to develop a Housing/Supportive Housing Plan for People with Disabilities who are institutionalized (including incarceration) or at great risk of institutionalization in Colorado with Measurable Goals that would bring Housing & Supportive Housing to Scale to Meet the Need in a 5 to 10 year Time Frame.
   The State should be empowered to use Housing Trusts, Social Impact Bonds, Etc. to accomplish that Goal.
   If we start dealing with the BIG ROCKS of an Olmstead Plan with Measurable Goals and far greater access to Intensive Mental Health Services than what we've got now -- the Comprehensive Plan will be much easier.

2009: National Disability Rights Network -- A Decade of Little Progress Implement Olmstead

These conversations with the State re: Olmstead get so conflated into: "We're Doing Good Things."

AND the truth is the State is doing good things, very good things, but they are not complying with Olmstead.

"But if we're doin' good things, what does it matter?" Well, it is the law.

   But beyond that the problem of sufficient housing and community services for people with disabilities who are institutionalized or at great risk of institutionalization is incredibly difficult and complicated.both practically and politically.

     We NEED that Comprehensive, Effectively Working Olmstead Plan with Measurable Goals.

   The Olmstead decision was in 1999. In no state have housing and community services been brought to scale to meet the needs of substantially all people with disabilities in a State who are institutionalized or at great risk of institutionalization.

   In fact, the numbers are quite stunning with thousands of people with mental illness in Colorado incarcerated, in nursing homes, and homeless.

     It is right and proper to celebrate our successes. BUT it is also right and proper to be HONEST. AND to do that we need the most up to date data, construct measurable goals based on that data, and a plan to bring HOUSING & COMMUNITY SERVICES to SCALE to meet a very large need.

Forward>>

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