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Kentucky

Task Force

In April 2000, the Olmstead Executive Commission was established within the Cabinet for Health Services. At the same time, the Cabinet partnered with the University of Kentucky for a Robert Wood Johnson planning grant. As a result, a draft plan was submitted to the Cabinet with recommendations in September 2001.

In May 2002, the secretary of the Cabinet for Health Services created the Kentucky Olmstead State Consumer Advisory Council through an Administrative Order. This council is to help implement a compliance and systems change plan to meet the broad mandate of the Olmstead decision. The council contains many of the same members of the original Olmstead planning group, in addition to 35 individuals who represent categories of disabilities, geographic regions and cultural diversity. The Cabinet for Health Services released its Olmstead Compliance Plan to the Consumer Advisory Council to the Long-Term Care Task Force and two legislatively created committees within the months of September and October, and it issued its final draft on December 11, 2002. "The Cabinet for Health Services Olmstead Compliance Plan for Fiscal Year 2002 Through Fiscal Year 2012" is located at http://chs.state.ky.us/olmstead

The Plan

A broad-based stakeholders group, the Kentucky Olmstead Plan Committee, began working on a plan in November 2000 with funding from the Robert Wood Johnson Foundation. Among the group's activities were a series of public forums throughout the state in which housing, access to services, and transportation were identified as key issues. The group included four issue teams: employment, housing, person-centered funding, and transportation. The group's recommendations were sent to the cabinet in fall 2001.

Issued in December 2002, the Cabinet's Compliance Plan outlines state programs that currently support community-based efforts, makes recommendations, sets goals and strategies for each initiative and lists challenges with Olmstead compliance. The plan is to be modified as needed and updated periodically. Here is the list of its following 13 goals and some of the strategies:

1. The Cabinet will continue to provide an ongoing mechanism for consumer involvement and input for compliance with the Olmstead decision. A strategy for ensuring this goal is to continue the Cabinet's Olmstead Advisory Council.
2. System capacity to support initial and ongoing self-determination initiatives should be assessed.
3. Consumers and families should have meaningful information about choices that they can understand.
4. Consumers and families should have a formal means to appeal administrative decisions.
5. The process for determining an individual's eligibility and need for services will be based on objective criteria focusing on functional ability and recommendations by the treatment team. As a result, current assessment tools will be evaluated, and new tools will be developed.
6. Plans will be developed to transition appropriate individuals from institutions into the community.
7. Systematic ways to prevent unnecessary institutionalization should be developed. A strategy for ensuring this goal is to review the current process for referral to long-term care institutions.
8. Quality community supports will be available for individuals with disabilities. Performance measures will be developed and modified.
9. Individuals who provide direct services in the community will be properly trained. A strategy for ensuring this goal is to create uniform training curricula for staff.
10. Appropriate housing options should be available. Strategies included maximizing the use of federal housing programs and promoting the use of universal designs in new construction.
11. The current transportation delivery system for medical and non-medical service, employment and recreational activities should be enhanced by developing grant opportunities.
12. The employment rate for people with disabilities should be increased through the creation of a seamless system of employment supports.
13. Performance measures will be systematically and regularly reassessed for program effectiveness and Olmstead compliance. A strategy is to develop outcomes measures for assessing Olmstead compliance.

Implementation

There is no current or pending legislation related to the Olmstead decision.

The state conducted much of its initial Olmstead planning with funding from a Robert Wood Johnson Foundation grant (eight states, including Kentucky, received approximately $100,000 each for a one-year period for Olmstead-related activities). The state grantee, the Kentucky Department of Mental Health and Mental Retardation Services, contracted with the Interdisciplinary Human Development Institute (IHID) at the University of Kentucky to spearhead development of the plan.

Earlier in 2002, the governor approved a spending plan, which included the following:

• Funding for the allocation of 250 supports for community living (SCL) waiver slots for FY 2003, based on a projected allocation of 500 slots for the biennium;
• $1 million allocated for FY 2003 for wrap-around services to facilitate community placement for individuals with severe or chronic mental illness who have been living in state psychiatric hospitals for twelve (12) months or more;
• $2 million allocated for FY 2003 to provide crisis stabilization units for children and adults through the Community Mental Health Centers; and
• $1.6 million allocated for FY 2003 to expand the home care program for frail and vulnerable people age 60 or older who are at risk of institutionalization.

Some of the challenges include:

• Building consensus regarding "wait list" criteria; and
• Increasing the provider base to meet the expanding need for community services.

In February 2002, a lawsuit was filed alleging that the state failed to provide services in the most integrated settings, that its waiting list failed to move at a reasonable pace, and that the state failed to provide informed choice to the developmentally disabled population of Kentucky. For an update on lawsuits in Kentucky 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

The state of Kentucky received a $2 million Real Choice Systems Change Grant. This money will allow the Olmstead State Plan Committee to continue its planning and implementation activities. The grant has three main areas of focus: consumer oversight by quality and consumer satisfaction, informed choice and access to housing options, and workforce development.

Throughout the state, Olmstead coordinators are in place at the state-operated psychiatric hospitals and intermediate care facilities for the mentally retarded (ICF/MR). The coordinators are responsible for community placement activities at each facility and work collaboratively with the facility, the client, potential supports for community living (SCL) providers, family members, guardianship, and representatives of protection and advocacy.

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