We need to:
- Build out :
- CO's Long Term Care Ombudsman Program,
- Single Entry Point Program &
- Independent Living Centers to address the needs of people with brain injury, mental illness, substance use issues & developmental disabilities in the Criminal Justice System.
- Fund an independent study to determine the level of need & what services, housing & placements are needed for people with brain injury, mental illness, substance use issues & developmental disabilities in the Criminal Justice System.
- Develop specific criteria for each level of service, placement & level of supervision.
CO Office of Behavioral Health's Excellent Newsletter
[it would be great to have such regular Newsletters from each state dept. that has olmstead &/or other responsibilities to Coloradans with disabilities --- for example, HCPF, Dept. of Local Affairs -- Div. of Housing, Education, Transportation, CDOC, CDPHE, etc AND maybe giving a little bit of a status report including accomplishments & barriers.]
Enhancing Medication Consistency in Criminal and Juvenile Justice Settings
In January, OBH will release "A Resource Guide to Medication Consistency: Medication Formulary, Cooperative Purchasing and Health Information Exchange."
This toolkit will assist behavioral health and criminal justice partners as they work to ensure incarcerated individuals transitioning between settings and service providers have access to a broad spectrum of effective medications. OBH will introduce the toolkit in January via webinar.
There are two opportunities to participate: Jan. 7, 10-11 a.m. or Jan. 16, 2-3 p.m. Visit the Medication Consistency web page to register to participate and access the toolkit once it is released.
Updated Children and Youth Mental Health Treatment Act Rules
On Dec. 7, 2018, the State Board of Human Services adopted updates to the rules implementing the Children and Youth Mental Health Treatment Act. The updated rules go into effect on Feb. 1, 2019. Read the OBH blog to access the rules as well as learn more about the Act.
As a reminder, the following four adopted rules go into effect on Jan. 1, 2019:
Our "Holiday Tables" are going into the Polis Administration before the end of the year. Is it a lot -- yes, it is. But we are in a world of hurt and we do think these are things the New Administration should take on--- some of them are legally required -- all are required for the safe and fair treatment of Coloradans with invisible cognitive disabilities):
- Develop Plan to bring housing to scale for Coloradans with Disabilities with Measurable Goals, Reasonable Time Frames, Funding to Support the Plan [which can include innovative funding strategies such as Social Impact Bonds] --- further Olmstead Planning below.
- Medicaid Community Mental Health Supports Waiver re-vamp;
- Bring Assertive Community Treatment [ACT] to scale & available to all Medicaid recipients where reasonably medically necessary;
- Consider additional Tier within Mental Health Continuum of Care that is built on an Assisted Living Model with additional security to address concerns of Prosecutors & the Court System in releasing inmates with disabilities to the "Community."
- Improved Communication/Reasonable Accommodation
- Dept. of Health Care Policy & Financing posting of data tracking obligations under:
- The 2008 Mental Health Parity & Equity Addiction Act
- Federal Medicaid Network Adequacy Requirements
- Federal ADA/Olmstead Obligations to bring Medicaid placements and services, including intensive mental health services, to scale.
- Monthly updated e-mail newsletters on State Dept. accomplishment & barriers re: Compliance with Federal legal duties to Coloradans with Disabilities -- FOR SURE including Parity, Medicaid Network Adequacy, and Olmstead Compliance for many State Departments.
- Routine Screening & a Database of people in Jails & Prisons with:
- Brain Injury
- Mental Illness
- Substance Use Issues
- Developmental Disability [All cognitive developmental disabilities, including those with HIGH IQ Autism, ADHD, etc.]
- INCLUSIVE OLMSTEAD PLANNING AS REQUIRED BY FEDERAL LAW WITH:
- Measurable Goals
- Reasonable Time Frames
- Funding to Support the Plan
- 24/7 Support to Law Enforcement, Mental Health Professionals & the Public re: Application of CO's Civil Commitment Statutes [Possibly grafted on to Colorado Crisis Services]
- Institute LEGAL REQUIREMENTS ON CO HOSPITALS to provide psychiatric hospital beds on a proportional basis to address Colorado's Psychiatric Bed Crisis. Pair this with an increase in Medicaid reimbursement. CO Medicaid already pays for psychiatric hospitalization for 45 days. [IS THE FAILURE OF CMS TO REIMBURSE FOR MORE THAN 45 DAYS A VIOLATION OF PARITY?]
- Dept. of Health Care Policy & Financing posting of data tracking obligations under:
HOUSING, SERVICES, SECURE PLACEMENTS
[tO AVOID INCARCERATION]
|
Priorities
*Complying with Disability Civil Rights Laws *Medicaid Mental Health Service Reform *Statistics & Data Collection *Inclusive Stakeholder Group to consider creation of secure placements To address problem of incarceration of people with disabilities & Court & Prosecutor unwillingness to consider currently available community options in some cases and a State bed shortage crisis. One possibility is an Assisted Living Model with additional Security. |
[We will be sharing our 2019 Reform Table with the Polis Administration. Much of this involves the CO Dept. of Health Care Policy & Financing] [Our 2019 Reform Table. What we are looking for is Inclusive Engagement on the issues to the right.
We've foregone seeking Federal Administrative relief until we find out if the Polis Administration is open to dealing with these issues in a substantive and timely manner.] |
Next Steps
- We will be circulating a Draft Letter to HCPF [CO Dept. of Health Care Policy & Financing] among stakeholders going to what we would like to see on the HCPF website regarding Medicaid Managed Care Network Adequacy & Parity.
- The Letter will include requests going to:
- Code of Federal Regulation Requirements
- CMS [Centers for Medicare & Medicaid Services] Guidance, &
- Reasonable Accommodations
- The Letter will probably be available on or before Tues. Nov. 6, 2018. If you would like to comment, e-mail Val @ vcorzine@orchidadvocacy.org
- We are creating a website page on concerns regarding CO Medicaid Network Adequacy Standards.
- We anticipate getting our Letter to the CO Dept. of Health Care Policy & Financing & the AG's Office on or before Wed. Nov. 15 and giving the State until Wed. Dec. 5, 2018 to reply.
- If the reply is insufficient, we will see what the New Administration says before we go to CMS. Some might ask: "Why not just wait for the new administration?" There actually are a lot of reasons why we're not waiting:
- We've seen a draft of the Governor's Community Living Report [see above]. It certainly has some good points, BUT it just can't seem to come to terms with the legal requirements of Olmstead which is pretty par for the course for the Hickenlooper Administration. The Hickenlooper Administration is in pretty much a CATCH 22 because if they recommend that the next Administration comply with Measurable Goals, Reasonable Time Frames & Funding to Support the Plan ---- they look like Hypocrites -- BUT if they don't they look like the Lawless State Officials who cavalierly disregard disability civil rights laws when it suits them and hope that good deeds falling far short of compliance are enough--- the Hickenlooper Administration we've come to know if not love. The Disability Community REALLY needs to take this seriously -- If Hickenlooper won't scrupulously comply with the LAW around Olmstead -- WHO IS GOING TO COMPLY? WE NEED TO HAVE FRANK DISCUSSIONS WITH THE NEXT ADMINISTRATION SO THESE COMPLIANCE PROBLEMS CAN BE RESOLVED ADDRESSING CONCERNS OF ALL SIDES. That is going to take A LOT of creativity and innovation.
- As upset as we are about perceived past failures, injustices, whatever -----by others & by ourselves---- there is nothing that is going to change the past.
- We have tried to communicate this before & want to reiterate it: OLMSTEAD, MEDICAID NETWORK ADEQUACY, PARITY ARE ALL HARD.
Draft Letter to CMS Re: Concerns of CO Medicaid's Mental Health Program
III. Colorado’s contract with CMS includes an agreement to comply with Federal Law. Colorado has failed to Comply with Olmstead, namely Colorado has failed to develop an Olmstead plan with measurable goals, reasonable time frames and funding to support the plan to prevent the unnecessary institutionalization or great risk of institutionalization inherent in homelessness for people with disabilities.
[We think Colorado is discriminating when it comes to its designation of essential Residential Services, Assertive Community Treatment, & Intensive Case Management as Alternative Services. If Colorado would work with stakeholders to develop a “mini-Olmstead Plan” to address these 3 services to bring them to Scale and available to all Medicaid recipients where “reasonably medically necessary” -- we would be satisfied with respect to these services.