2. Supreme Court Decision Olmstead v. L.C. 1999
Envisioned that States would provide long-term
services and supports ( LTSS ) to individuals with
disabilities through home and community-based
services ( HCBS ) and end forced segregation in
institutions .
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3. Decision covers people with intellectual and
developmental disabilities , physical disabilities ,
and older adults with chronic conditions such as
Dementia .
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4. CMS Proposed Rule Making April , 2011
Persons with Disabilities would have more
opportunities to Live inTheir communities Under
CMS Proposed Regulations
The proposed rule also clarifies what constitutes
a true HCBS setting and sets out new
requirements for “ person- centered “ care
plans .
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5. Proposed Rules would aide States in their
Compliance with Olmstead Decision
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6. Home and Community based settings cannot be
located on the campus of a facility that provides
institutional treatment or custodial care , including
nursing homes .
Prohibits housing complexes designed expressly
for persons with disabilities to qualify as “ home
and community based settings “
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7. United States Senate Health , Education ,Labor
and Pensions Committee Report
Separate and Unequal : States Fail to Fulfill the
Community Living Promise of the Americans with
Disabilities Act
July 18 , 2013
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8. FINDINGS
States must approach decisions about Medicaid
Delivery options from an Olmstead civil rights
perspective .
States must create an Olmstead Plan with
enforceable benchmark targets .
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9. To ensure that individuals can live in community
-based settings where they can fully participate
and be granted the power of individual decision
making and choice .
Providing services for people with disabilities
outside of an institutional setting is more cost
effective than providing institutional care .
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10. Most States increased the number of individuals
served in community settings from 2008 to 2012 .
States reported transitioning individuals with
disabilities from institutions into other congregate
settings ,group homes , assisted living and other
shared living arrangements .
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11. Widespread inequities in access to HCBS still exist
across States .
Hundreds of thousands of people with disabilities
remain on waiting lists for HCBS services .
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12. Many States have focused more on enrolling
people that currently live in community
settings into HCBS programs than
transitioning individuals living in institutional
settings back into the community .
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13. States have also continued to backfill institutional
beds rather than closing them and reallocating
institutional dollars to support individuals in their
own homes and communities .
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14. When individuals are transitioned , it remains
unclear whether they are transitioned to the most
integrated setting possible or merely to a “less”
institutional setting .
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15. CMS issued a proposed rule that clearly defined
whether a setting is home or community -based .
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16. Affordable Care Act : Allows States to submit HCBS
State Plan Option under 1915 (i) to allow HCBS to
be provided to individuals “ without linking the
benefit to either a current or future need for
institutional care “ .
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18. Congress should amend the ADA to clarify and
strengthen the law’s integration mandate and
to clarify that every individual who is eligible
for LTSS under Medicaid has a federally
protected right to a real choice in how they
receive services and supports
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19. State and federal efforts should focus on helping
people live in their own homes .
Virtually all people with disabilities can live in
their own apartment or house with adequate
supports .
Accordingly , for virtually all people with
disabilities , the most appropriate integrated
setting is their own home .
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20. DOJ should expand its Olmstead
enforcement efforts .
CMS should require Medicaid State spending goals
for 2015 , 2020, & 2025 to ensure that the
proportion of spending on HCBS continues to
increase .
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21. The Administration on Community Living at
HHS and HUD should collaborate to develop
and implement a national action plan to expand
access to affordable , integrated , accessible , and
“scattered site “ housing for people with
significant disabilities , consistent with the
OLMSTEAD Decision .
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