Arizona
Task Force
The governor directed officials in the Arizona Department of Human Services' Division of Behavioral Health Services (ADHS/DBHS), the Arizona Department of Economic Security's Division of Developmental Disabilities (ADES/DDD), and the Arizona Health Care Cost Containment System (AHCCCS, the Medicaid agency) to prepare plans to address the issues raised in Olmstead. These separate plans were consolidated and revised to create a final version. The final plan, released in September 2001, is located at http://www.ahcccs.state.az.us/publications/olmstead/default.asp
The agencies meet periodically to review and update the final plan and continue to seek consumer input as to the status of the recommendations. As of Dec. 5, 2002, there had been no changes in the plan and none are anticipated until 2003. These agencies are focusing the Olmstead plan on the programs that are covered by Medicaid funding.
The Plan
The plan addresses individuals with mental illness, the elderly, and the physically and developmentally disabled. The focus is on moving individuals from institutions into community settings and on preventing the loss of services for those who already are in the community. In developing the final plan, consumer input was sought in regional stakeholder meetings and statewide public forums.
The stated goals of the plan are to:
- Address the recommendations of the Centers for Medicare and Medicaid Services (CMS) and the Office of Civil Rights in meeting the principles embedded in the Olmstead decision.
- Demonstrate the progress Arizona has made in meeting these principles.
- Identify areas for improvement in the delivery of home and community-based setting and services.
- Ensure that consumers, advocates and other stakeholders are included in the planning process.
- Identify the data that must be collected to achieve the goals.
- Evaluate the progress the state is making toward meeting the goals and revising them, as needed.
- The outcomes from the plan are to:
- Strengthen informed decision-making and choice for consumers.
- Improve community service systems.
- Improve administrative processes to support community integration.
- Monitor the overall capacity of the service system to provide services and supports that improve access to community integration.
The common themes for all state agencies are as follows:
1. Labor Force
- AHCCCS/ALTCS/EPD and ADES/DDD are considering the following options:
- Use of Medicaid Arizona Long-Term Care System (ALTCS) funds to pay spouses and parents as personal care attendants
- Provision of interim pay to personal care attendants when the consumer is out of the home (e.g., hospitalization).
- Increase pay for home and community-based providers.
- Provide consumer-directed services.
- In addition, ADHS/DBHS is reevaluating its current service matrix, which includes the types of services and the recommended service reimbursement rates.
2. Education and Information to Consumers
- AHCCCS is considering developing and distributing informational materials to help make informed choices.
- Beginning Oct.1, 2001, AHCCCS requires all contractors to convene member/provider councils that represent the ALTCS/EPD consumers within a given geographical region. These councils will provide a forum for discussions and feedback on the Olmstead plan.
- ADHS/DBHS will provide training to consumers and providers on the philosophy of recovery. Training programs for peer mentors also will be expanded.
3. Consumer Centered Care Management
- Provide ongoing training to consumers on consumer centered care management.
- Encourage self-advocacy.
4. Provider Networks
- Agencies are conducting an ongoing analysis of the service networks in Arizona.
- Beginning October 1, 2001, all AHCCCS/ALTCS program contractors must have formal Network Development and Management Plans to identify the current status of the network and project future needs based on membership growth.
- ADHS/DBHS is implementing a new system for monitoring service networks.
Implementation
Legislation
There was no 2002 legislation related to the Olmstead decision.
Funding
State officials expect any program or service changes to be cost-neutral and do not expect increases beyond normal inflation.
Successes
Existing programs do not restrict the number of people that can be placed in home and community-based services settings, making it one of the major successes to date.
Challenges
Lack of both time and staff are major challenges for the state. Another barrier is the extreme shortage of providers.
Lawsuits
One current lawsuit, Ball vs. Beidess, which addresses the issue of the extreme shortage of providers and low reimbursement rates, is pending in federal district court. The plaintiffs, a group of disabled individuals, claim they have been or will be denied adequate attendant care services as prescribed in their care plans. For an update on lawsuits in Arizona and other states, see Status Report: Litigation Concerning Medicaid Services for Persons with Developmental and Other Disabilities by Gary A. Smith at http://www.hsri.org/index.asp?id=news
Next Steps
There are no specific timetables for plan implementation. Each agency involved in the planning is working on implementing what it can, when it can. In general, the workplan items are related to program improvement.
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