Roadmap to Change: Updating Maine’s Response to the Olmstead Decision Project Overview

What is Olmstead? 1999 Supreme Court decision States must provide services to individuals in the most integrated settings appropriate to their needs Values of integration and inclusion

Why is Olmstead Important? The Supreme Court decision has directed the evolution of services for persons with disabilities throughout the U.S. since 1999 It has guided the Centers for Medicare & Medicaid Services (CMS) of the federal government in supplying funds to the states The federal Department of Justice has required many states to implement it.

Maine DHHS Vision and Mission Vision: Maine people living safe, healthy, and productive lives in the most independent way possible Mission: To promote safe, healthy, independent lives for all, while ensuring efficient and effective use of resources for Maine’s most vulnerable

Maine Is National LTSS Leader In top 10 LTSS expenditures per state resident nationally – #1 for mental health services – #2 for 1915(c) I/DD waivers – #7 for all 1915(c) waivers – #10 for all LTSS expenditures High proportion of LTSS expenditures on LTSS – #15 for % HCBS v institutional – #7 for growth in HCBS %

Maine’s Response to Olmstead In 2003 Maine DHHS released the Roadmap for Change: Maine’s Response to the Olmstead Decision. Product of 3 years of work by a broad stakeholder group. Provided vision and direction over the last decade for all people with disabilities.

2003 Roadmap Recommendation Areas 1.Voice and self-advocacy 2.Control over services and supports 3.Person-centered 4.No wrong door 5.Coherent IT systems 6.Responsive service coordination 7.Waiting list 8.Funding and planning 9.Direct care providers 10.Quality of services 11.Transportation 12.Housing 13.Jobs

Progress Report Built on 2014 I/DD Olmstead update Analyzed all populations receiving long term services and supports – Aging population – Adults and children with physical disabilities – Adults and children with intellectual/ developmental disabilities and autism spectrum disorder – Adults and children with mental/behavioral disorder – Individuals with substance use disorder

Progress Report Approach and Structure Review secondary source documentation Examine administrative data Conduct stakeholder interviews Conduct survey Progress and opportunities for each LTSS population within 2003 Roadmap recommendation area

Progress Report Findings

Updating Olmstead Roadmap Facilitate meetings with DHHS to define parameters of roadmap changes Facilitate series of external stakeholder meetings Synthesize information collected through meetings and research into report Public comment

Updated Olmstead Roadmap 1.Support individual choice so individuals can effectively make decisions about issues that are important to them – Further develop the system of choice to meet individual needs – Expand person-first, individual-driven treatment/care plans

Updated Olmstead Roadmap 2.Improve systems coordination to improve delivery and management of long term services and supports – Improve statewide access to information and resources – Support seamless transitions – Continue to expand conflict resolution – Improve and integrate information technology systems

Updated Olmstead Roadmap 3.Improve community integration so individuals are able to meaningfully participate in community life – Develop and enhance natural supports – Increase community-based housing options – Increase vocational and employment opportunities – Improve statewide transportation services

Updated Olmstead Roadmap 4.Create efficient and effective policies and regulations to manage the implementation of long term services and support and achieve intended outcomes – Support access to and capacity of innovative services and supports – Support value-based services – Address unique needs of people in remote areas

Updated Olmstead Roadmap 5.Promote continuous quality improvement to ensure high quality long term services and supports and the prudent use of public funds – Increase preventative and evidence- based/informed community services – Invest in workforce development – Increase and improve regulatory and quality review

Where Olmstead Fits in DHHS

Evaluating Implementation What does success look like to you? – Outputs – products or deliverables the organization intends to provide; measured by count or other data – Outcomes: Results or consequences of an action or intervention; represented as short-term (1-3 years) or long term (4-7 years) – Indicators: A measurement of the outcome; outcomes stated in measurable and observable terms to help stakeholders assess achievement toward intended outcome