MHW: Advocates Call for Effective Implementation of Olmstead Mandate

Resources, supports and workforce necessary in NYS Olmstead plan
Mental Health Weekly

Vol. 23, # 40; Oct. 21, 2013

Amid  plans to reform state mental health  facilities, New York Gov. Andrew Cuomo released the state’s Olmstead mandate to support community integration efforts, with  the  intent, say officials, to create a “unified” mental health system, bolster recovery and resiliency efforts and will position state staff into community-based roles.

Advocates say they intend to ensure  that  sufficient  community   resources  and supports  are in place to provide   an  effective  transition   for consumers  with mental  illness from institutions into the community.

In November  2012, Cuomo  created    the   Olmstead    Development and   Implementation  Cabinet   that was charged  with developing a plan consistent   with  the   state’s  obligations   under   the   Supreme   Court’s Olmstead v. L.C. decision.  The Olmstead  Cabinet  received   input  from stakeholder groups  across  the state, including   mental   health   advocacy organizations.

The   subsequent  “Report   and Recommendations  of the  Olmstead Cabinet:  A Comprehensive Plan for Serving  People   with  Disabilities  in the  Most  Integrated   Setting”  notes that  the  state  will transition  people with disabilities into community  developmental    centers,     psychiatric centers,   adult   homes   and   nursing homes.  State officials also intend  to adopt  new  Olmstead  outcome  measures for people  with disabilities.

The   Olmstead   plan   highlights the  settlement   agreement the  state reached  in July 2013 with  plaintiffs in  longstanding  litigation  concerning 23 adult homes in New York City serving  people  with  serious  mental illness   (see   MHW,  July  29).  The agreement will allow  consumers  to make   an   informed   choice   about where  to live. As residents  move  to

supported housing,  they will participate  in a person-centered transition planning  process.

“In creating  its Olmstead  plan, New  York  conducted  broad  stakeholder   outreach   and   consulted  a wide variety of resources,  including the experience of other  states,” Ben Rosen,  spokesperson  for  the  New York  State  Office  of  Mental  Health (OMH), told  MHW. “The OMH has launched  a  regionally  based   planning process, wherein local communities, represented by Regional Centers  of  Excellence   (RCE) advisory teams, will help determine the needed   services   to   reduce   psychiatric hospitalizations and  create  community-based  support systems.”

“As part  of this plan,  OMH will reinvest  state  staff into  community-based  roles and expand  mobile  and residential services throughout New York,” Rosen  said. “OMH has  committed  to continuity  of employment for our workforce  and will redeploy  highly skilled staff into the community, where  they  can  have  an  even greater impact.”

The RCE plan  is phased  in over three   years,   allowing   community-based  services to be adequately developed  and  implemented  as  psychiatric  centers  are  reorganized, he said. “A key point of the RCE plan is to  create  a  unified  New  York  state mental  health  system,  breaking  the boundaries between  the  ‘state system’ and  other  providers  whom  we license  and     regulate, including county-operated and  voluntary  programs,” Rosen said.

Addressing BH needs

The  Olmstead   plan  states  that under   Medicaid  redesign   for  managed   behavioral    healthcare,  New York  will  create  special-needs Health and Recovery Plans (HARPs): distinctly  qualified,  specialized   and integrated  managed   care  programs  for  people   with  significant  behavioral   health   needs, said   officials. Mainstream    managed    care   plans may  qualify  as  HARPs only  if they meet  rigorous  standards or if they partner  with a behavioral  health  organization  to meet  those  standards,  they said.

HARPs  will   include   plans   of care  and  care  coordination that  are person-centered  and   will   be   accountable  for both  in-plan  benefits and  non-plan services.  HARPs will interface with social service systems and  local governmental units to address  homelessness, criminal justice and employment-related issues, and with  state psychiatric  centers  and health  homes  to coordinate care.

HARPs will include  specialized  administration  and management appropriate  to the  populations/services,  an   enhanced  benefit package  with specialized  medical  and  social necessity/utilization  review  approaches  for expanded  recovery- oriented   benefits,  integrated   health and  behavioral  health  services,  additional  quality  metrics  and  incentives, enhanced access and network  standards,  and  enhanced care coordination  expectations.

Advocacy input

The  New  York  State  Coalition for the Aging was one of several organizations  with  input  into  the  development  of  the  plan.  Ann  Marie Cook,   president  of  the  coalition, which includes individuals  with mental   illness   and   developmental disabilities,  said a major concern  at this   point   involves   resources - namely, whether there  are  enough  resources  in the community  to handle everyone  who  will be impacted  by the plan.

“Older  adults   want   to  live  in their  community   of  choice,”  Cook told  MHW.  “We  saw  in  the  early 1990s, when  state mental  health  institutions   closed   or  were   dramatically reduced, that support  services needed in  the  community  were  not there.” The plan  notes  that many  of the  state  institutions  for  consumers  with  developmental  disabilities  are downsizing,   she   said.   “We   don’t want  to muddy  the  waters,  but  we want  to make  sure  the  support  and services are there,” Cook said.

Cook  added,  “Our organization will continue  advocacy  and  education  about  the  need  for home-  and community-based services.  We  will join a consortium  of aging organizations looking  at the issue.”

New  York  state  could  possibly establish a national  standard  for disability policy  and  deinstitutionalization,  said  Harvey  Rosenthal,  executive   director    of   the    New   York Association of Psychiatric Rehabilitation Services (NYAPRS). “The governor  is building  a strong  recommendation    on   disability   policy   very much tied to Olmstead compliance,” Rosenthal  told MHW. He cited such long-awaited reform  efforts as Cuomo’s downsizing of state  hospitals, the Medicaid redesign  plan  and  the adult-home settlement.

Cuomo  had  announced on  August 6, 2012, that New York has submitted  an  application for  a  waiver from  the   federal   government  that will allow  the  state  to invest  up  to $10 billion  in savings  generated by the Medicaid Redesign  Team (MRT) reforms to implement  an action plan to  transform   the  state’s  healthcare  system.

Rosenthal,   a   member    of   the Most Integrated  Setting Coordinating Council, developed to provide  input to   the   state’s  Olmstead   planning  process,  said  that  the  state  should take  any  money  it expects  to  save from  Medicaid  redesign   and  other state  reform  efforts  and  reinvest  it into the community.

“This plan  will only work  if the state  front-loads   sufficient  community  resources   to  put  in  place  the housing and job supports  and transportation  reforms  necessary  to support  these  required  and  long-awaited   community   integration    plans,” Rosenthal said.

“We  have   to   watch   that   the money   is  fully  reinvested   and  we have  to  make  sure  community  capacity is in place in advance  of people coming  into the community,” he said. “The state has agreed  to a full investment of the savings.”

Rosenthal   said   he   and   other stakeholders are  trying  to  wrap  up recommendations  by  December   in advance  of the  release  of the  2014 state   budget.   “Next  year’s  budget  will be  the  first indication  of commitment the state is making with regard to Olmstead,  Medicaid savings from the downsizing of state hospitals and  funding  from  adult  homes to  move  consumers   into  the  community,”  he  said. “That’s where  the rubber  meets the road.”

Jennifer Mathis, deputy  legal director of programs  for the Judge David  L. Bazelon   Center   for  Mental Health  Law, said  the  Bazelon  Center  has  not  yet  reviewed   the  Olmstead  plan  in  its entirety.  “It is encouraging  that the state has set some concrete  goals for affording individuals with  psychiatric  and  other  disabilities the chance  to live and work in  integrated   settings,”  Mathis  told MHW. “The Olmstead  plan is an important  step toward promoting community   integration,   but   the   plan’s success  will  depend  on  how  it  is