Olmstead CHFS Table of Responses to Stakeholder ... - Kentuckychfs.ky.gov/NR/rdonlyres/A9E5B6F0-34CD-4ED0-ADA8-… · Web view(4) Is the new living arrangement category in the State

Comment Submitting Party Pages(s) in Draft Accept/Reject Rationale(1) How, specifically, does Kentucky plan to use the Balancing Incentive Program (BIP) to rebalance long term care services? How many people will now be able to stay out of, or transition from, institutions?

Kentucky Equal Justice Center (KJC)

p. 15, Strategy 1.4

N/A Response: The detail of expenditures for BIP is found on p. 15. Due to the fluctuations in individual budgets, proportion of individuals aging, and individual expenditure fluctuations, the number of projected people to stay out of, or transition from institutions is not available. Retrospective and current time data continues to be tracked. As stated, all of the enhanced match rate will be spent toward increasing waiver costs.

(2) The plan should include more detail about the types of services that will now be available through the HCB waiver.


p.15, Strategy 1.5

Rejected See detail in paragraph under Strategy 1.5, p.15.

(3) Has the Section 811 project rental assistance been presented to HUD. Was it approved? How many individuals will be able to get assistance through this plan? Also the Plan states Kentucky Housing Corporation was to open a “funding round for rental housing” by April 2014. What does this mean? Is this related to the Section 811 assistance or something else? Is this now in place? How many individuals will be assisted through this program?


p.18, Goal 5 Accepted with revisions & Response

The Section 811 application was approved by HUD in March, 2015. It will support 150 individuals.

Response: In regards to the funding round for rental applications, this strategy has changed to be directed as rental assistance for individuals with Severe Mental Illness leaving Personal Care Homes or State Hospitals. This change should provide an additional 90-100 rental vouchers. The money will stay in the Olmstead Housing Initiative at KHC related to the CHFS and P&A Settlement Agreement (Strategy 6.4)

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Comment Submitting Party Pages(s) in Draft Accept/Reject Rationale(4) Is the new living arrangement category in the State Supplementation Program (Strategy 6.1)…the same as the housing assistance to be provided in 6.4? If not, how is it different? What are the yearly goals for this new living category in the State Supplementation Program?

Kentucky Concerned Family Network (KCFN) & VOR

p.18,Strategy 6.1p. 19, Strategy 6.4

N/A Response: No, the State Supplementation Program is specific to those who are aged, blind, or disabled, and it provides financial support to qualified individuals who have insufficient income to meet their needs in a qualified living arrangement category.

(5) It is not clear if the employment programs described will include sheltered workshops. The Fair Labor Standards Act allows operators of sheltered workshops to pay less than minimum wage. The Plan should require individuals be paid at least minimum wage in these shelters.


p.19, Goal 7 N/A Response: The supports received in a sheltered work environment do not meet the definition of Supported Employment within waivers because they do not occur one-on-one in the community.

(6) The Plan does not mention any assurance that agencies are complying with civil rights laws…needs to specify that Civil Rights notices and forms for filing complaints must be provided…available for persons with limited English proficiency…systems in place to ensure that agencies assist individuals as they go through the process...complying with ADA and Section 504 of the Rehabilitation Act.


N/A Rejected As a whole, Olmstead represents the Civil Rights of Individuals

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(7) Those who are at risk of institutionalization need to be aware of community services that are available, and how to access these services…ongoing outreach and media campaign.


N/A N/A Response: This is a very broad category for a wide range of individuals that would be difficult to address through a media campaign; however, it is being accomplished via various avenues by multiple agencies across the state and in most cases, it is required within contracts.

(8)…the plan could be improved by adding a short statement of principle and commitment from the Secretary.


N/A Support has been demonstrated for the principles of Olmstead by the Cabinet’s Interim Settlement Agreement with P&A and the ongoing development of the Plan. As Administration and staff changes, the plan will become “outdated” with specific names of individuals.

(9) Strategy 1.3: State Plan was approved January 2014, but additional strategies and either target dates or outcome measurements need to be added to the state plan to ensure that the array of behavioral health services is increased.

Children’s Alliance

p.3,Strategy 1.3

Rejected This type of detail is not appropriate for the State Plan that is approved by CMS; however, benchmarks are established through various contracts. Enrollment continues within the behavioral health network, and workforce development continues to be a primary focus of the technical assistance provided by the National Governor’s Association.

(10) CMS Final rule isn’t mentioned – unclear [Olmstead Compliance Plan] OCP will add to the complexity of that effort, or even if it will be possible to do both.


N/A N/A Response: Just as the Olmstead Compliance Plan is required, a 5 year plan is required by CMS that will demonstrate Kentucky’s readiness to comply with the “Final Rule” regarding home and community

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based waivers. Kentucky submitted a comprehensive “Final Rule” plan in December, 2014.

(11) KCFS and VOR expressly request full inclusion in any future planning, drafting and implementing effort.

KJC N/A N/A Response: There has been and will be ongoing opportunities for robust stakeholder input.

(12) Inappropriate process – arbitrary comment period without public meetings, nor is it available on OHP website.

KJC N/A Accepted Given the ease of email communication, this was the first period of dialogue with stakeholders prior to offering a draft for formal public comment; however, this may not have been clear. There has been and will be ongoing opportunities for robust stakeholder input.OHP will place revision on website.

(13) Strategy 6.3 calls for the transition of 175 clients from institutional settings…calling for the closure of facility settings…..

KJC & VOR p.18 (Strategy 6.3)

N/A Response: CHFS fully recognizes the importance and appropriateness of a continuum of care that includes institutions and is not targeting closure of facilities. CHFS seeks to provide appropriate choice to individuals and their families and will not impose community placement on individuals and families who do not desire to transition; furthermore, MFP does not require closure of facilities.

(14) The OCP never indicates that a person with an intellectual disability can choose to remain in a facility, institution, or a congregate residential setting.

VOR N/A N/A Response: Choice to live in the community does not negate the choice or desire to reside in a facility, institution, or a congregate residential setting. The spirit of Olmstead is concerning choice.

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(Additionally, See 13 above).(15) Strategy 6.6 related to Regional Olmstead Committees should include ICF family representatives and providers

VOR p.19, Strategy 6.6

Rejected The Committees (and funding), are specific to individuals with Severe Mental Illness.

(16) Add at the end of Goal 1, “according to individual need, with required input from their families and legal guardians”.

VOR p.3, Goal 1P.9, Goal 1p.14, Goal 1

Accepted, with revision.

…according to individual need, with input from their families and legal guardians, as appropriate.

(17) Strategy 1.2, correct October 1, “2103” to “2013”.

VOR p.3, Strategy 1.2p.14, Strategy 1.2

Accepted Corrected

(18) Specific to Strategy 3, increase availability of an array of behavioral health services: EPSDT mandates provide the state must provide specialized services to children and youth regardless of the inclusion of those service in the Medicaid State Plan. Yet historically, many have been unable to obtain necessary services even under EPSDT’s mandates. The lack of services can be attributed in large part, to a lack of providers available to provide these vital services. This lack of providers, in turn, can be attributed to various underlying causes, such as the complexity of the application process to obtain a Medicaid and EPSDT provider number; discrepancies in billing codes among MCOs; delays in

P&A p.15, Strategy 1.3

N/A Response: DMS has simplified the enrollment process and with State Plan services expanded, have more adequate number of providers. If there is a particular service need DMS and/or MCO’s will seek out a provider for the service.

After 6/30/2014, DMS is eliminating the EPSDT Special Services provider type. This means that qualified children’s diagnostic and treatment services providers will no longer be required to take the additional step of completing a secondary EPSDT Special Services DMS provider type application and waiting for approval of enrollment. Participating Medicaid providers will still submit requests for prior approval of children’s diagnostic and treatment services, i.e., services not covered by

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payment authorizations from MCOs. Expanding the State Plan does not address the state’s failure to ensure children and youth are receiving services under EPSDT’s mandates. What additional steps does the state intend to take to ensure that there are adequate providers available to fully effectuate EPSDT’s mandates for children and youth?

other Medicaid programs or exceeding the benefit limits for the services in the State Plan, but will no longer have the burden of applying a secondary set of billing rules for the EPSDT provider type. Additionally, providers have the opportunity to participate in new Medicaid provider types for Physical Therapists, Occupational Therapists, Speech Language Therapists, Private Duty Nursing and behavioral health services individual, group and organization providers, most of which are effective 1/1/2014. Since 1/1/2015, DMS began enrolling individual and group Professional Art Therapists and Applied Behavior Analysts. DMS reorganization established the Division of Program Quality and Outcomes including the following: a Quality Improvement Branch, working with MCO EQROs, to coordinate and promote DMS quality improvement activities including EPSDT implementation, a MCO Branch to monitor MCO contract performance and compliance including EPSDT Special Services contract compliance, and a Disease and Case Management Branch including DMS EPSDT case management, care coordination and monitoring activities.

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(19) Assessments: it is unclear who or what CHFS department will perform the reviews, revision and adoption of a new assessment tools. A letter was sent to then Commissioner of BHDID about family involvement with SIS. Prevent the denial, reduction or termination of Medicaid services to qualified individuals with intellectual and other developmental disabilities due to an inappropriate assessment tool or procedure.


N/A Response: The assessment tool, MAP 351, has traditionally been used (except for the recent adoption of the Supports Intensity Scale) to assess needs across all waivers, regardless of disability and has not been tested for validity, reliability, and is not regarded as a standardized instrument. The departments responsible for the administration of each waiver will be taking lead on exploring a more appropriate assessment and presenting a proposal to DMS for implementation. The assessment will inform the Plan of Care, and not replace it and family members will remain crucial to the development of the Plan of Care as defined within the Person Centered Planning Principles outlined within the “Final Rule” of CMS for HCB waivers as well as, informing assessments. CHFS is also continuing to explore the appropriate assessor entity for each waiver as assessments are adopted and experience/education levels for each assessment are learned.

(20) Assessments are mentioned – there may be different ones per waiver, family should have input. Add…”subject to public input and inspection during examination and

KJC p. 15, Strategy 1.4

Rejected See above. Additionally, they will be vetted by stakeholders through the waiver revision and subsequent regulation revision process.

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finalization” within the last sentence.(21) No cost estimate for collection of goals and strategies either for one, five or ten years. No estimate of, or time table for, identifying, securing and training the necessary staff and support personnel to make this a safe and secure operation.

VOR N/A Rejected CHFS does not expect goals and strategies expanding over ten years. CHFS is considering participating in SAMHSA’s Olmstead Community Integration Community of Practice initiative to better align with other states who opt to participate. CHFS staff have participated in conference calls to date and have been assigned a regional contact.

(22) Some strategies may be implemented while others after further review may be found unnecessary. There are three absolutes:

1) Number of persons transferred

2) Completion dates for transfers (less than 30 days away from 100)

3) Face it there is little or no individual or departmental accountability as the perfect storm materializes (p.10).

VOR p.18, Goal 6p.20, Goal 9

N/A Response: Stakeholder input ranged from no target goals to specified goals for individuals who expect to be transitioned under various initiatives. At this point in time, CHFS is under a legal Settlement agreement with P&A to target the specified numbers of individuals to be transitioned, if they are appropriate and interested in living in the a less restrictive setting.

(23) We call on Secretary Audrey Haynes to suspend all further development and implementation of the [Olmstead Compliance Plan] OCP until a plan is in place to meet the concerns identified in the letter (from KCFN & VOR)

VOR N/A Rejected The development of an Olmstead Plan is not optional for a state.The dialogue on the Olmstead Compliance Plan is ongoing, and will continue to be ongoing throughout the formal public comment period.

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(24) Should include more detail about types of services that will now be available through the HCB waiver, and outline goals to increase participant in the waiver each year.


N/A – see p.15 Response: The Department for Aging and Independent Living (DAIL) in collaboration with the Department for Medicaid Services (DMS) has drafted a renewal waiver to become effective with a target date of July 1, 2015. DAIL will also revise the HCB regulations to correspond with the HCB waiver amendments to enhance services to include home delivered meals, flexibility with personal services definitions (blending homemaker with personal care thereby allowing for multi-tasking, adding personal emergency response systems and increasing home modification limits. DAIL will also apply the rules of conflict-free case management to the waiver to ensure the participant’s objectives are the main focus and not the needs of the agency. DAIL has created an aging and disability infrastructure plan that outlines the goals (also stated below).

(25) Kentucky cannot meet Goal #1 without making a broad array of service and supports available to individuals housed in nursing facilities. MFP will not accept a nursing home resident with physical disabilities into the program if he or she needs more

P&A p.15,Strategy 1.5

N/A Response: Kentucky is making a concerted effort to modernize and rebalance its long-term care services system by reducing institutionalization and increasing opportunities for people to experience meaningful lives in the community. The Department for

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assistance than what is currently available in the HCB program. Thus, there remain Olmstead violations galore amongst the nursing home population in KY.HCB for physical disabilities make up just 14.4% of what is spent on total long-term services and support while we spend 72.5% for those with developmental disabilities. To be blunt, that is embarrassing. What is Kentucky’s plan to move us past competing for dead last? Kentucky cannot have an effectively working Olmstead plan that does not address the imbalance of nursing home institutional spending versus community based spending. MDS figures show that more than 4,500 Kentuckians in nursing homes want to return to the community.

Aging and Independent Living (DAIL) in collaboration with the University of Kentucky, University of Louisville, Western Kentucky University and numerous advocacy and provider agencies made five (5) recommendations to reform Kentucky’s long term care system to promote the independence, safety and well-being of seniors and peopled with physical disabilities. Recommendations: 1) Ensure that Kentuckians who are elderly or physically disabled and their families and caregivers can easily obtain information about long term care services; 2) Create a coordinated and streamlined single point of entry into long term care services for adults who are elderly and physically disabled, regardless of funding source; 3) Create a coordinated care management process that encompasses a holistic approach to preventive, transitional and on-going care; 4) Expand community based alternatives to create a full, versatile and seamless array of long term care services; 5) Maximize funding by standardizing funding options and financial eligibility requirements.The recommendations will create a new long term care system that is responsive, accessible, coordinated

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and consumer centered giving consumers and their families timely information about options and costs. Reforms should provide numerous choices for long term care options both within the community and facility based.

Since the plan was written, Kentucky applied and received approval for participating in the Balancing Incentive Program (Strategy 1.4) in which there is a projected availability of $25.6M enhanced match rate through September, 2015 that will be spent 100% toward increased costs and slots in waivers.

(26) Add “Revise” the HCB waiver and increase “allowed” hours of OT, etc. Correct December 1, 201 to “2015”Also, which agency is responsible for this strategy


p.3, Strategy 1.5 Accepted with Updated Changes

Response: Occupational services are required to be accessed through the Medicaid State Plan based on Medical Necessity and therefore will not be allowed to be provided within waivers as they are renewed (See #23 above).

(27) Strategy 1.5 states HCB waiver and regulations will be revised by December 1, 2015. My understanding is that the current Kentucky budget funded 153 additional ABI slots and that these would not be rolled out until the HCB waiver had been revised. Is this fact? I was also under the

NeuroRestorative p.3, Strategy 1.5 N/A Response: The ABI slots are not related to the revisions of the HCB waiver. The slots (dollars) were approved in the biennial budget which is 2014-2016.

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impression that if the slots are not allocated by the end of the fiscal year, June 30, 205 that the slots (dollars) would be lost. Is this fact?(28) Strategy 1.6 indicates collaboration with community partners in implementing the Building Bridges initiatives. Who are these partners?

NeuroRestorative p. 3, Strategy 1.6 Rejected This strategy is no longer relevant and should be deleted. (Unfunded)

(29) For home based care there is an issue with personal care attendants and the OCP should specify goals to ensure decent wages for home care workers, including compliance with new federal standards.

VOR N/A N/A Answer: CHFS does not have the authority to determine what a private provider pays employees.

(30) Spell out “Department of Behavioral Health, Development and Intellectual Disabilities”

VOR p.3, Strategy 1.6 N/A This strategy is no longer relevant and should be deleted. (Unfunded)

(31) Suggest addition of Strategy 1.8: All assessment tools, not individual assessments, are considered public documents available for public inspection.

VOR p.3, New Strategy 1.8p.15 New Strategy 1.8

Rejected Assessment tools will continue to be vetted by stakeholders through any waiver revisions (renewals) and subsequent regulation revision process.

(32) Add Strategy 1.8: Kentucky will designate an entity or entities to sign a Medicaid Data Use Agreement to obtain information about nursing home residents who express a desire to return to community pursuant to Section Q of the Minimum Data Set.See the Dear State Medicaid Director letter from CMS regarding

P&A N/A – New Strategy Suggestion (p.16)

Rejected Kentucky could post the contact information for each of Kentucky’s 15 Aging and Disability Resource Centers. Currently, Ombudsman contact information is posted.Additionally, all Medicaid eligible members in a nursing facility are directly referred to KY Transitions Office.

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implementation of the MDS Version 3.(33) Add Strategy New 1.9: Kentucky will make available to all KY nursing home residents and any designated representative the name and contact information for the local referral agency that assists individuals with in transitioning to the community. This information will be prominently displayed in the nursing home’s admissions information and in the lobby or common area adjacent to the nursing home Ombudsman poster.

P&A p.16 Rejected Currently, Ombudsman contact information is posted.Additionally, all Medicaid eligible members in a nursing facility are directly referred to KY Transitions Office. Additionally, all nursing homes were provided with resource guides from the Area Agencies on Aging and Independent Living when the “Section Q” of the Resident Assessment Instrument was revised to emphasis community options. Collectively, this communication remains fluid and constant.

(34) Add Strategy 1.9: “To ensure that eligible individuals have opportunity to make fully informed choice about available services in setting of their choice, the DBHDID will prepare with opportunity for public input, a document providing information on all service options within the Commonwealth, including but not limited to family supports, HCB waiver services, private and public Intermediate Care Facilities for Persons with Intellectual and Developmental Disabilities, and psychiatric supports by January 1, 2015. This document will be made available at all Aging and Disability Resource

VOR p.3, New Strategy 1.9P.16, New Strategy 1.9

N/A DBHDID maintains a Provider Directory on its website that is accessible to the public. Resources are available at multiple touch points (Money Follows the Person. ADRC, etc.)

Regardless, DBHDID will need to assess capacity to add this strategy.

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Centers, designated as the No Wrong Door/Single Point of Entry, and to anyone inquiring about DBHDID services.”(35) New Strategy 1.10: Kentucky will amend its SCL waiver to include a nursing specific service.

Rejected Nursing services are available through the State Plan according to medical necessity and thereby not allowed to be included in a waiver.

(36) Goal 2: Education/Outreach “to” prevent facility placement


p.3,Goal 2p.9,Goal 2

Accepted Clarification

(37) Add to end of Goal 2:...”when the facility option is not desired by the individual with a disability, with required input from his/her family and legal guardian”.

VOR p.3, Goal 2p. 9, Goal 2

Accepted with revisions

Activities to prevent facility placement is based on the individual’s preference and does not negate the option of a facility placement (did not revise with “when the facility option is not desired by the individual with a disability”), added, “…with input from his/her family and legal guardian, as appropriate”.

(38) Strategy 2.1: Kynect will include a portal to “provide”…


p.3,Strategy 2.1


(39) Add to end of Strategy 2.1 “…, ensuring eligible beneficiaries are fully informed about service options, as required by Medicaid”.

VOR p.3, Strategy 2.1p.16, Strategy 2.1

Accepted with additional revisions

Kynect will include a portal to seamless Qualified Health Plans and Medicaid eligibility (by January 2014), and waiver eligibility (provider phase completed by April 1, 2015 and consumer phase completed by January 1, 2016), ensuring eligible beneficiaries are fully informed about service options, as required by Medicaid.

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(40) Why 6 districts? What will happen after implementation in 6 districts? What is the plan for statewide implementation?


p.4,Strategy 2.3

N/A The six sites served as demonstration districts. Additional districts will be added during an expansion phase during Spring 2015. Any remaining school districts will be invited to participate in Fall 2015.

(41) Strategy 2.3: The provision of mental health screening, while arguably will assist in identifying children and youth with mental health concerns, will not have any preventable effect if those identified children do not have access to effective treatment

P&A p.16Strategy 2.3

N/A Agreed and noted.

(42) Goal 3: Expand “the” role of ADRC at the state level. Why is this just being done at the state level? What is the plan for the local implementation


p.4,Strategy 2.5

N/A Answer: State-wide local level Aging and Disability Resource Centers (ADRCs) have been supported for numerous years.

(43) Revise Goal 3: Assure that persons with disabilities are not incarcerated for minor offenses that are a result of their disability. Assure persons with disabilities who leave correctional “institutions or other institutions” are able to access needed community-based services

P&A p.16,Goal 3

Accepted Corrected

(44) Goal 3, delete “community based”, and add to end “according to individual choice and need, with required family and legal guardian input”.

VOR p.4, Goal 3p.9, Goal 3p.16, Goal 3

Accepted with revision

…with family and legal guardian input, as appropriate.

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(45) Goal 3: There are only two strategies aimed at prevention. Recommend more prevention or “front end” strategies. There are 3 strategies aimed at the “back end”.


p.4,Goal 3

N/A The Cabinet will strive to include a greater number of preventative measures at next revision.

(46) Strategy 3.1: Does “high need” correlate to a disability? The connection between the assessment and Olmstead or Goal 3 need to be made. Who will measure this and how will it be measured?


p.4,Strategy 3.1

N/A DJJ’s Family Accountability Intervention Response Team will be responsible and the measure is from the use of an assessment tool that renders a score.Revise:…services for children with or without a disability,…..

(47) Regarding Strategy 3.1, P&A has ongoing concern regarding availability of effective, evidence-based services. What additional opportunities will be available to youth referred through the court system?

P&A p.16,Strategy 3.1

N/A Continued collaboration with DJJ, AOC and the Cabinet.

(48) Regarding Strategy 3.3 – KDBHDID and DOC collaboration: CMS encourages states to suspend rather than terminate Medicaid benefits.

P&A pp.16-17Strategies 3.3 & 3.5

Accepted Scheduled to be implemented summer of 2015. (Also see #50 & #51)

(49) Strategy 3.5 indicates that release from prison is still considered as a “qualifying” event. Is this for all waivers?

NeuroRestorative p.4, Strategy 3.5 N/A Answer: This relates to a “Qualifying Event” to apply/obtain health insurance; it is not related to waivers, as that will remain a separate process (determination of level of care).

(50) Add New Strategy 3.7: “Kentucky will indefinitely suspend Medicaid when an individual is institutionalized. Kentucky

P&A N/A New Strategy on p.17

Accepted Suspension is planned to be implemented summer of 2015.

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currently terminates Medicaid upon institutionalization. Switching from terminating to suspending Medicaid will allow individuals that are reintegrating into the community to have much faster access to community-based services”(51) Add New Strategy 3.8: “Kentucky will screen all jail and prison inmates for Medicaid eligibility. Pursuant to strategy 3.7, all inmates found eligible under Strategy 3.8 will have their Medicaid eligibility indefinitely suspended while incarcerated.

P&A N/A New Strategy added to p.17

Accepted with revisions

Suspension is planned to be implemented summer of 2015.

Currently there is a Share Point site for correctional staff to explore Medicaid eligibility and service provision. Suspension is planned to be implemented summer of 2015. As such, DMS will continue to explore manpower and other associated costs.

(52) Goal 4, add…developmentally and “functionally” appropriate, “according to individual choice and need, with required family and guardian input”.


Accepted with Revision

…according to individual choice and need with family and guardian input, as appropriate.

(53) Strategy 4.2: Which agency is responsible for the TAYLRD program? How will effectiveness of this training be measured? How do the community partners know of the availability of this training?


p.5Strategy 4.3

Accepted DBHDID is responsible for TAYLRD, which is a specialized training for child and adult case managers on developmental issues and best practices for transition age youth. DBHDID utilizes the training evaluation to rate effectiveness of the training. Follow-up meetings are also scheduled, as needed, to discuss enhancements to programming

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based on the needs of transition age youth. Information about the training opportunity is shared at various interagency meetings and is provided on an as needed basis.

(54) Strategy 4.3: How many are targeted to be trained (as Specialists)? Who will track the number of training and number of youth trained?


p.5,Strategy 4.3

N/A Answer: As of March 2015, there are 9 Youth Peer Support Specialists. The number of trainings and number of youth trained will be maintained by DBHDID.

(55) Strategy 4.4: How many are targeted to be trained as young adult mentors?


p.5,Strategy 4.4

N/A There is no set number, nor limit (targeting as many who would like to participate).

(56) Strategy 4.4…”consenting” youth. Of those referred, “the goal is to pair” 90%, delete “will be…paired” and add final sentences: “Participation is voluntary based on informed consent from individuals, or where appointed, their legal guardians. The decision-making authority of a legal guardian, provided by a court of law, is not supplanted or circumvented by the appointment of a mentor. Mentors are required to provide individuals and families and legal guardians with information about all service options within the Commonwealth, including but not limited to family supports, HCB waiver services, private and public Intermediate Care Facilities for Persons with

VOR p.5, Strategy 4.4pp.17-18Strategy 4.4

Accepted with revisions.

The associated State Implementation grant ends Summer of 2015. The Commission continues to evaluate sustainability.Accepted changes through “legal guardians”.

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Intellectual and Developmental Disabilities, and psychiatric supports.”(57) Strategy 4.5: Foster Care FACTS sheet only tracks children in foster care. Suggest adding another way to measure the number of children/families receiving in-home and community based services where the children do not subsequently enter foster care. Also, is this measure specific to serving children with disabilities or parent with disabilities? What evidence based programs or practices will be used (how does this tie back to the goal)?


p.5,Strategy 4.5

N/A Answer: At the time of Olmstead Plan revision, DCBS was in the process of applying for a waiver under Title IV-E (of the Social Security Act). This waiver is currently in the initial implementation planning and design stage. It is expected there will be evaluative measures that should complement, if not address, the suggested strategy revision during the next plan revision. The Title IV-E waiver includes evidence based or evidence informed practices that will be supported through the waiver, though I know of nothing specific about parents with disabilities. Parents with substance abuse/addiction are targeted, but not broader and more traditionally categorized disabilities.Additional Foster Care FACTS information may be found on the DCBS website.

(58) End of Goal 5 add “…to accommodate individual choice according to need, with required input from families and legal guardians”.


Reject Keep global goal applicable to all populations, ages, and individuals who determine their own needs independently or who desire input from family and/or legal guardian.

(59) Please explain the HUD Section 811 Project Rental

NeuroRestorative p.5, Strategy 5.1 N/A Explanation: It is “Section 8” housing; however, the vouchers will

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Assistance. Is this different than “section 8” housing?

be project based. The vouchers will be attached to designated units. In that respect they are not “portable” as are other Section 8 vouchers (i.e., Housing Choice Section 8 Vouchers”. As long as the individual lives in that unit and meets the tenant eligibility requirements they can receive Section 8 rental assistance. If they decide to move they would need to find another source of rental assistance for their new housing.

(60) Strategy 5.2: Add the target number of individuals to be served by the target date.


p.5,Strategy 5.2

Reject This strategy is no longer valid – it has been revised significantly.DELETE Strategy.

(61) End of Goal 6 add “…, when transition is not opposed by the individual, or his/her family and legal guardian, as required”.


Reject Keep global goal applicable to all populations, ages, and individuals who determine their own needs independently or who desire input from family and/or legal guardian.

(62) Strategy 6.2: Transition of whom? Who is the target population? Add the target number of people to be served.


p.6,Strategy 6.2

N/A Answer: The Transition Age Youth Consultation Process is designed for youth 14-25. There will be coordination between DCBS staff and DBHDID for children in custody of the Cabinet. There is no target number of people to be served as it is open-ended.

(63) Strategy 6.3: Which agency is responsible?


p.6,Strategy 6.3

Accepted Clarify: MFP is administered by the Department for Medicaid Services

(64) Strategy 6.3 Delete the number “175” individuals will be transitioned through MFP (KCFN and VOR object strongly to quotas

VOR p.6,Strategy 6.3p.18, Strategy 6.3

1st item rejected, 2nd item accepted with revisions

Centers for Medicare & Medicaid Services required benchmarks for the demonstration.“…according to individual choice

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as arbitrary numeric goals trump person-centered planning and choice, risking the health and welfare of those impacted.At the end of existing strategy add…, “according to individual choice, with required input from families and guardians”.

with input from families and guardians, as appropriate.”

(65) Settlement agreement requirements to transition 600 clients, again we object to quotas.

VOR p.6,Strategy 6.4p.19,Strategy 6.4

Rejected These benchmarks are currently in a Settlement Agreement between CHFS and Protection and Advocacy. As a legal document, we do not currently have authority to change.

(66) Strategy 6.5: How will the data be used? Suggest measuring stability of these individuals in their community based settings.


p.6,Strategy 6.5

N/A Answer: Data will continue to be examined to determine relevant trends and service utilization as individuals transition from hospitals or other institutional settings.

(67) Strategy 6.6: Suggest this population be measured to see if the number decreases


p.6,Strategy 6.6

N/A Answer: Committees review data during the quarterly meetings.

(68) Strategy 6.6 add to the end, “By January 1, 2015, Regional Olmstead Committees will be expanded to include ICF providers and ICF family representatives.


Reject The Committees (and funding), are specific to individuals with Severe Mental Illness.

(69) Strategy 6.7: Include the purpose of collecting and analyzing the data:


p.6,Strategy 6.7

Accept The data is used to explore impact of voluntary outpatient commitment and inpatient length of stays, as well as the impact on hospitalization.

(70) Strategy 6.8: Where are the clinics referenced in this section located?

NeuroRestorative P.6,Strategy 6.8

N/A Answer: On the campuses of the ICF facilities.

(71) New Strategy 6.9?: Add the P&A p.19 Rejected DMS will explore the options of

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following to Strategy CHFS, to include DMS, DCCBS, and DBHDID, will collaborate with the SSA and Protection and Advocacy in an effort to create a pre-release process for SSA beneficiaries prior to their discharge from an institution or facility”.

collaboration with SSA based upon available funding; historically, it has not been feasible as SSA usually will only talk to the member or legal guardian, not a third party. Note: This is governed by federal regulation (20CFR, Part 416)

(72) New Strategy 6.10?: “Kentucky will indefinitely suspend Medicaid when an individual is institutionalized. Kentucky currently terminates Medicaid upon institutionalization. Switching from terminating to suspending Medicaid will allow individuals that are reintegrating into the community to have much faster access to community-based services”

P&A N/A New Strategy suggested p.19

Accepted Suspension is planned to be implemented June/July, 2015. As such, DMS will continue to explore manpower and other associated costs.

(73) New Strategy 6.11?: “All state owned and/or managed care facilities or institutions will notify SSA when an individual is eligible for temporary institutionalization (TI) benefits.”

P&A N/A New Strategy suggested. P. 19

Rejected DMS will explore the options of collaboration with SSA based upon available funding; historically, it has not been feasible as SSA usually will only talk to the member or legal guardian, not a third party. NOTE: This is governed by federal regulation (20CFR, Part 416).

(74) New Strategy 6.12?: “CHFS will inform all facilities and/or institutions in Kentucky about the availability of TI benefits”

P&A N/A New Strategy suggested. P.19

Accepted Information may be linked on website, as well as via notification letters.

(75) Strategy 6.8: revise…ensuring those “persons” transitioning….


p.6,Strategy 6.8

Rejected DBHDID currently does not have a measure in place to capture “upmost

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How will this be measured (the upmost quality of care). Add measure the utilization of the clinics.

quality of care”; however, utilization of services will be measured, and evidenced base practices encouraged.

(76) Strategy 6.8 correct “ut” to “up”


Accept Correction

(77) Create new “Strategy 6.9: DBHDID will every six months collect, analyze and report data on the outcomes of individuals transitioning from ICFs to community settings, including but not limited to mortality, hospitalizations,, abuse, neglect, interactions with the Department of Corrections, and additional transitions following the initial transition to the community”.

VOR p.6,New Strategy 6.9p.19,New Strategy 6.9

All State owned/operated Intermediate Care Facilities for individuals with intellectual disabilities monitor and track people 365 days post transition to the community.

(78) Create new “Strategy 6.10: An autopsy will be performed in each case in which an individual is, or has been, under the care of CHFS within three months of his/her passing”.

VOR p.6, New Strategy 6.10p.19,New Strategy 6.10

Reject The Department for Aging and Independent Living (DAIL) has 20 or more wards of the state who pass away each month; many of these are elderly who passed of natural causes. DAIL does not have jurisdiction after the ward has passed away as there is no legal authority; nor doesDMS have legal authority to require autopsies without legal cause.

(79) Goal 7 Delete “competitive” “and sustainable” add at end of sentence “according to individual


Rejected deletionAccepted addition with Revision

Keep “competitive” and “sustainable” as they are core tenants of the initiative.

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choice and need”.(80) Strategy 7.2: Include which agency is responsible for the strategy to “increase awareness”.


p.7,Strategy 7.2

Accepted Clarify: DBHDID will increase awareness….

(81) Strategy 7.4 add….DMS and DBHDID will continue to “support individual choice by offering” Delete “offer”



(82) Strategy 8.1: Include which agency is responsible for this strategy. Add which agency is responsible for the assessment. Suggest measuring the number of individuals accessing these services.


p.7,Strategy 8.1

Accepted with Revision

“DBHDID will continue to monitor provider agencies to ensure the new service provision within the Supports for Community Living waiver to include transportation reimbursement is fully implemented”.

Transportation, as well as all service utilization patterns are routinely monitored through ad-hoc and quarterly reports.

(83) Strategy 8.2: Add how number partnerships and meetings will be measured.


p.7,Strategy 8.2

Rejected This is an ongoing initiative, unable to quantify at this time.

(84) No specific plan stated for oversight and evaluation. There should be specific ways of measuring progress, by keeping track of numbers of people who have been discharged from institutions, numbers of people institutionalized in various settings, and tracking how successful individuals are after being transitioned in the community, at

KJC p.20, Goal 9 (marginally)

? OHP will put the revised plan on website. It is envisioned that upon further collaboration with SAMSHA, comparable data across states will be tracked as “dashboard indicators”.

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least quarterly. Include specific time tables, measurement tools and mechanism to ensure that this oversight and measurement of progress actually happens. Data should be available to the public on an inter-agency Olmstead Compliance website.(85) Goal 9: …In order to do “so”, the Commonwealth….delete “on a minimum of a biennial basis to “at least two times a year”. (since it has two meanings – is it ever 2 years or twice a year).Also, who comprises this Committee?


p.7,Goal 9

MEET EVERY SIX MONTHS

(86) Strategy 9.2 “The” Olmstead Team…..


p.7,Strategy 9.2

Accepted Correction

(87) Delete “segregated settings” and change to “institutions”

VOR p.8, 4th line of Introduction

Rejected This language is from the State of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C. as it is broader than institutions.

(88) Add at the end of 4th paragraph (beginning with “The Olmstead Decision”) “The Olmstead court urged that services be provided in the “most integrated setting possible for that person – recognizing on a case-by-case [individual basis], that setting may be an institution” (Olmstead, 527 U.S. at 605), and for others

VOR p.8 Accepted Citation was verified.

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community placement will be required (Id. At 587).(89) Introduction, 5th paragraph States should have “an objective”…process

VOR p.8 ? Correction

(90) Introduction, 5th paragraph: Does Kentucky have this information “assess the capacity of services and those who desire and would benefit from, community? This seems key.


p.8, 5th paragraph

N/A Answer: Yes, through various activities such as Section Q of the Minimum Data Set/Resident Assessment Instrument, presence and education of Ombudsman staff, Money Follows the Person activities, Olmstead Committees, and in-reach within Personal Care Homes to meet the Settlement Agreement between the Cabinet and P&A.

(91) Delete first two bullets at the bottom of p.8 and add “Provide community service to individuals who are eligible and request community service to prevent unjustified institutionalization, and”

VOR p.8 Rejected N/A

(92) Prior to “on June 18, 2001 on p.8 insert new paragraph “In addition, Kentucky will Review the annual Individual Habilitation Plans (IHPs) of those already in institutions to determine how many, according to IHPs, wish to be served in a home based setting” (He may have meant this as a bullet)

KCFN & VOR p.8/9 Rejected Service needs and home based setting options is a dynamic and ongoing process and not limited to a one-time review or discussion.

(93) Third paragraph beginning “Shortly after arriving” add the

VOR p.9 Rejected While KY will certainly continue exploring lessons learned from other

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following at the end: “According to some experts, some States have downsized and closed institutions but have not adequately invested in their community infrastructures, including adequate staffing, to ensure that the promise of community living, including individual protections, access to services, and true integration, is realized by those who choose to receive community services. Kentucky pledges to ensure adequate access to housing, services, health care and qualified staff before community transition for any individual.

states, we do not want to focus on the negative outcomes of other states.As stated, Kentucky will explore participating in SAMSHA’s new initiative, “Olmstead Communities of Practice”.

(94) Table 1 – Use more relevant data, such as those provided in Residential Services for Person with Developmental Disabilities; status and Trends Through 2015.

KCFS & VOR p.10 Rejected currently/Accepted for next revision

Next revision, under SAMSHA’s guidance, will include more recent and relevant data.

(95) Balancing the System of Community Based Services….third paragraph, first sentence. So should one of the goals be to increase the use of waiver or the number of individuals accessing waivers?


p.11,3rd paragraph

N/A Answer: Yes, please see p.15

(96) On page 11, ABI waiver description states it serves ages 21-65 (It should be 18-65)

NeuroRestorative p.11,4th paragraph

Accepted Correction: should be 18 or older

(97) Assessments (2nd paragraph): So should a goal be to expand the


p.132nd paragraph

Accepted See Strategy 1.7Clarification of sentence:…case

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use of assessments that will adequately facilitate the collection of information access [across] populations?Not sure what the last sentence means.

management processes are fairly consistent by each administrative agency.

(98) Second paragraph No Wrong Door/Single Entry Points/Information and Referral (I&R) Points

VOR p.13 Accepted More relevant/current information

(99) Third paragraph – about ¾ down, DMS has also announced readiness to directly contract with public and private providers “for behavioral health and substance abuse services”…


p.13 Accepted Corrected

(100) First paragraph, taxi, van, bus, or public transit and wheelchair services “are” provided…Does there need to be more outreach about these services [Medical Transportation]?


p.14,1st paragraph

Accepted Corrected grammar. These services are well advertised by various community agencies and $50M annual expenditures indicate high utilization.

(101) MFP: How many individuals are involved? How much money is being spent or saved due to this demonstration? Add something that shows that it works!


p.14,2nd paragraph

N/A Answer: Demonstration is currently scheduled to end March 31, 2016. To date (March 16, 2015), 614 members have been transitioned. Housing remains to be an obstacle, however, DMS has worked closely with KHC & HUD to continue to address the issue. MFP costs versus Nursing Facility costs have been compared since inception with a savings of $13,010,099.

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(102) How much longer with Money Follows the Person [demonstration] be available? How many people have transitioned so far? How are the obstacles to success through MFP being addressed?


p.18, Strategy 6.3

N/A Answer: Demonstration is currently scheduled to end March 31, 2016. To date (March 16, 2015), 614 members have been transitioned. Housing remains to be an obstacle, however, DMS has worked closely with KHC & HUD to continue to address the issue.

(103) Kynectors and “assisters”. Who are assisters? Are they applying for disabled people? How does this benefit the Olmstead population?


p. 14,3rd paragraph

N/A “Assisters” help the population as a whole apply for benefits which will also include those who need community based services

(104) 4th paragraph – last sentence…since the initial “Kentucky” Olmstead Plan “was developed/implemented.”


p.14,4th paragraph

Accept Corrected/Clarified

(105) Suggest that a word like “complete” or “met” be added after each strategy. The same if the goal was not met or not completed.


(Throughout) Accepted Additionally, dashboards will be considered as CHFS learns more about SAMSHA’s “Olmstead Communities of Practice”.

(106) Paragraph under Strategy 1.3, last sentence: Crisis Intervention services will be expanded to include multiple response modalities and substance abuse treatment will also be added to the state plan…When will these be added to the state plan?


p.15,Strategy 1.3/explanatory paragraph underneath, last sentence

N/A Answer: January, 2014

(107) Under strategy 1.4, last explanatory sentence regarding conflict free case management, examination of core standardized


p.15,Strategy 1.4/explanatory paragraph

Accept Clarification: Strategies to accomplish these deliverables include leveraging the Testing Experience and Functional Tools

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assessments, and strengthening NWD/Single Entry Points across waivers

underneath, last sentence

(TEFT) in Community-Based Long Term Services and Supports (CB-LTSS) grant, the No Wrong Door System of Access to LTSS for All Populations and All Payers grant, and the Waiver Case Management portal.

(108) Strategy 1.5 – Next, DAIL will revise the HCB regulations. What is the time frame?


p.15/explanatory paragraph underneath

N/A Answer: July 1, 2015

(109) Strategy 1.6 – “address the top three priorities by December 1, 2014”. What are the top 3 priorities?


p.15,Strategy 1.6

Rejected This strategy should be removed from the plan. (Funding was not secured.)

(110) There are over 200,000 Kentuckians with brain injuries. We applaud the almost doubling of the available BI waiver slots in the current biennium budget. New Strategy: Kentucky will, over the next three biennium budgets, increase the number of BI waiver slots to an amount equal to the number available in the SCL waiver.

P&A N/A New proposed strategy. P. 19

Rejected There are budgetary barriers for accomplishing this goal.

(111) With the establishment of Managed [Care] Medicaid, how do you see the waiver programs being managed in the future?

NeuroRestorative N/A N/A Answer: There are currently no anticipated management changes related to waivers related to MCOs.

(112) Who will be in charge of the Plan? Someone from the Cabinet? The plan should set out a structure of leadership, management, oversight, accountability and


N/A N/A Answer: OHP is responsible for coordinating along with representatives from each Department (Commissioner of each Department or their Designee).

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evaluation, including an organization chart of agencies and advisory bodies.

Membership is dynamic and with staff turnover and administration changes, using actual names will often make the plan outdated.

(113) The Olmstead Committee should include at least one representative from each department and cabinet, who should be responsible for evaluating and monitoring progress within its own department or cabinet and representatives from the disability community and other stakeholders. List the membership of the team and their responsibilities.

KJC N/A N/A Answer: OHP is responsible for coordinating along with representatives from each Department (Commissioner of each Department or their Designee). Membership is dynamic and with staff turnover and administration changes, using actual names will often make the plan outdated.

(114) For each type of service, there should be a description in the Plan of what supportive services will be provided. The Plan should outline who will follow up with persons who have transitioned into the community to make sure they are receiving the services they need to stay in the community successfully. Track the progress of individuals, and those who end up back in institutions so we can understand what works and what need to be changed in the Plan.

KJC Marginally, p.16 (Goal 3), p.17 (Goal 4), & p.18 (Goal 6)

N/A All State owned/operated Intermediate Care Facilities for individuals with intellectual disabilities monitor and track people 365 days post transition to the community. Olmstead Committees also review status.

Specific to the Settlement Agreement between CHFS and P&A, ACT Teams also follow-up with persons who have transitioned into the community.

(115) There is no mention of the major ongoing project by the SIAC to redesign the System of Care

KJC N/A N/A While initiatives are significant, they are not directly related to Olmstead Planning.

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(SOC) for children’s mental health services.(116) There are a number of programs [that are not familiar to the general public]…some of these include youth mental health first aid training, Coordinated Specialty Care, OnTrack, TAYLRD, EASA, Foster Care Facts, and Transition Age Youth Consultation Process. Are these programs in place now, and if so, are they working? Describe these plans, and include implementation and review dates and how these programs fit into a coordinated SOC.

KJC p. 17, Goal 4 as an example

N/A There are numerous mechanisms to review various programs (Block Grant review/application, State Plan Amendments and reporting to CMS, annual contract monitoring, service utilization, individual plan monitoring, provider monitoring, etc.)

NOTE: Kentucky will continue exploring the use of the “Community Integration Self-Assessment Tool” as a Pilot State, prepared by Substance Abuse and Mental Health Services Administration to align the plan, to the extent possible, with other states while maintaining unique features specific to Kentucky. More information can be found at: http://www.nri-inc.org/#!olmstead/cd9n

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http://www.nri-inc.org/#!olmstead/cd9n

Documents

Olmstead CHFS Table of Responses to Stakeholder ... - Kentuckychfs.ky.gov/NR/rdonlyres/A9E5B6F0-34CD-4ED0-ADA8-… · Web view(4) Is the new living arrangement category in the State