Blog Archives

"EFFICIENCY" AND A MENTAL HEALTH DEBACLE

1/12/2020

So our Society is RIFE with a "Big, Little Lie."

That "Big, Little Lie" is --- just call for help and you'll get fixed up.

In many cases, maybe that is TRUE -- but in a SIGNIFICANT PERCENTAGE it is NOT.

AND in a SIGNIFICANT PERCENTAGE of those cases, it is because the standard treatments are INADEQUATE.

What does it mean that the Standard Treatments are INADEQUATE for someone with:

Mental Illness
Brain Injury
Substance Issues, and/or
Developmental Disability

That person MAY need a lot of SUPERVISION and there need to be clear, rational criteria for Institutional versus Community Levels of Supervision.

In many cases our Society has just BLOWN THIS OFF and let Criminal Justice & the Streets step in-- because it doesn't look very "Efficient" -- and it costs a lot of money.

So we do "SOMETHING" far below the SCALE NEEDED -- and we are shocked that our DEBACLE has not resolved itself.

We're really picking on Gov. Polis and his comments on "Efficiency" and may be that is the language to use with the Legislature -- but Colorado has a HORRIBLE HABIT of not complying with the LAW.

AND quite frankly, we have a lot of concerns about how much the "Behavioral Health Task Force" is actually going to do. That may be horribly unfair -- we hope it is.

DISCRIMINATION: MEDICAID'S IMD EXCLUSION RULE & MEDICAID'S FAILURE TO FULLY FUND SUPPORTIVE HOUSING

1/12/2020

Underneath the Medicaid Institutes of Mental Disease Exclusion Rule and Failure to Fund Supportive Housing -- is a Failure to Appreciate the Need for Long Term Care among people with Cognitive Disabilities.

When you've got jails, prisons and the streets to take care of these invisible people -- who needs adequate healthcare -- well currently thousands of Coloradans who aren't getting it.

GOT HEALTH EQUITY? Hell, no.

Further, it often just doesn't make sense to talk about Mental Illness in isolation, when it is often a co-occurring condition.

We don't have Healthcare Systems that are good at dealing with co-occurring Cognitive Issues.

That has to be a priority.

With respect to DISCRIMINATION and the IMD Rule -- I often think of the Mental Health Parity and Addiction Equity Act of 2008. If we fund hospitalizations for people with physical ailments, we need to fund hospitals beds for people with cognitive ailments.

With respect to Supportive Housing, Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act prohibit discrimination in government programs and require REASONABLE MODIFICATIONS in Policies, Practices & Procedures.

Supportive Housing isn't just an issue for people with Cognitive Disabilities, but it can make it HARDER due to:

Fair Housing Non-Compliance among Medicaid Assisted Living & Nursing Homes -- the obvious alternatives to Supportive Housing
A high level of tolerance and comfort in incarcerating and relegating people with cognitive disabilities to the streets.
An absence of legally required alternatives

BUT we must have VIABLE ALTERNATIVES TO INCARCERATION AND THE STREETS -- and not just the one off innovative program -- thousands of people need a COMPREHENSIVE CONTINUUM of Care that includes Hospitalization and Supportive Housing.

TAC: End IMD Exclusion

KFF: State Options for Medicaid Coverage of Inpatient Behavioral Health Services

COGNITIVE DISABILITY, MEDICAID & "DISCRIMIN-ATION"

1/12/2020

  A big part of our challenge is understanding what "DISCRIMINATION" looks like when it is directed towards people with Cognitive Disabilities.

   If someone has significant problems with "emotional regulation" and/or "organization": What kinds of Reasonable Accommodations/Modifications in Policy, Practice & Procedure must be made?

Well, this presents A LOT OF HEAVY LIFTING for the BUREAUCRACY -- and if the BUREAUCRACY is trying to do this HEAVY LIFTING within EXISTING RESOURCES -- the HEAVY LIFTING generally doesn't get done.

  What does this HEAVY LIFTING look like:

Administrative Assistance
Legal Compliance Assistance -- Ensuring Medicaid Providers are complying with Fair Housing Law
Paying for Ad Hoc Placements when the Medicaid Network is Inadequate

We would argue that failure to do that is DISCRIMINATION and it is a problem at Colorado's Department of Health Care Policy and Financing.

We want state funding of a Medicaid Re-Design Team that will address:

Supportive Housing
Cognitive Disability among Justice Involved Individuals, and
Cognitive Disability among Homeless Individuals, and
Spearhead Comprehensive Olmstead Planning with:
- Measurable Goals
- Reasonable Time Frames, and
- Funding to Support the Plan

Discrimination on the Basis of Disability

As they apply to entities under the jurisdiction of the Office for Civil Rights (OCR), OCR enforces:

Section 504 of the Rehabilitation Act of 1973, including programs and activities that are conducted by HHS or receiving Federal financial assistance from HHS
Section 508 of the Rehabilitation Act of 1973, covering access to electronic and information technology provided by HHS
Title II of the Americans with Disabilities Act (ADA) of 1990, covering all health care and social services programs and activities of public entities
Section 1557 of the Patient Protection and Affordable Care Act (ACA), ensuring that an individual is not excluded from participating in, denied benefits because of, or subjected to discrimination as prohibited under Section 504 of the Rehabilitation Act of 1973 (disability), under any health program or activity, any part of which is receiving federal financial assistance, or under any program or activity that is administered by an Executive Agency or any entity established under Title I of the Affordable Care Act or its amendments.
Rights and Responsibilities under Section 504 and the ADA, Section 504 and the ADA protect qualified individuals with disabilities from discrimination on the basis of disability in the provision of benefits and services.

See the Facts Sheet - PDF and the Regulations for an explanation of who is a qualified individual with a disability and more detailed information about rights and responsibilities.

Covered entities must not, on the basis of disability:

Exclude a person with a disability from a program or activity;
Deny a person with a disability the benefits of a program or activity;
Afford a person with a disability an opportunity to participate in or benefit from a benefit or service that is not equal to what is afforded others;
Provide a benefit or service to a person with a disability that is not as effective as what is provided others;
Provide different or separate benefits or services to a person with a disability unless necessary to provide benefits or services that are as effective as what is provided others;
Apply eligibility criteria that tend to screen out persons with disabilities unless necessary for the provision of the service, program or activity.
Covered entities must:
Provide services and programs in the most integrated setting appropriate to the needs of the qualified individual with a disability
Ensure that programs, services, activities, and facilities are accessible
Make reasonable modifications in their policies, practices, and procedures to avoid discrimination on the basis of disability, unless it would result in a fundamental alteration of the program
Provide auxiliary aids to persons with disabilities, at no additional cost, where necessary to afford an equal opportunity to participate in or benefit from a program or activity
Designate a responsible employee to coordinate their efforts to comply with Section 504 and the ADA
Adopt grievance procedures to handle complaints of disability discrimination in their programs and activities
Provide notice that indicates:
That the covered entity does not discriminate on the basis of disability
How to contact the employee who coordinates the covered entity’s efforts to comply with the law
Information about the grievance procedures

"JOKER"-- A WORK OF ART THAT WANTS TO HAVE A BIG IMPACT ON OUR SOCIETY (& A Look @ Colorado)

1/8/2020

Two big takeaways from the "Joker":

Politicians claiming they are the SAVIORS --- when in fact they are actually doing very little
A Society that doesn't care about people with serious mental health needs and the Systems & Providers they rely upon.

Does that ring true in Colorado: You Bet It Does -- in one of the top economies in the nation.

Denver Post launches a project investigating Youth Suicide Rates (2019)

Channel 7 News: Dying for Help-- A Mental Health Crisis in Clear View (2019)

Channel 7: Too little money, too few beds: Colorado's Mental Health Crisis (2018)

Colorado Chamber of Commerce: Colorado Ranked #1 Economy in the U.S. Second Year in a Row (May 2019)

AP: Colorado State Budget Cuts to Mental Health (2011)

Denver Post: Breakdown -- Mental Health in Colorado (2015)

Colorado Springs Gazette: Mental Health Crisis in Colorado (2019)

Chieftain uncovers a mess at the state hospital in Pueblo (2017)

The reason why colorado's mental health Crisis has not been resolved is we have failed to address the large scale of the problem and make a reasonable plan to address it.

MEDICAID: ACCESS & BENEFITS UNDER SECTION 504 OF THE REHABILITATION ACT FOR PEOPLE WITH COGNITIVE DISABILITIES

1/8/2020

ACCESS

So many of the Disability Civil Rights Laws are Restatements of each other because of Federal & State Non-Compliance.

The US Department of Human Services sought to resolve the DREDF 504 Complaint involving people with hearing, vision and speech disabilities with a Long Term Action Plan.

A Section 504 Long Term Action Plan -- Olmstead Plan -- Tomatoe, Tomato -- nobody really cares -- but the Feds and States like Colorado blow off not just the FORM but the SUBSTANCE of disability rights law on a political whim.

The consequences are pretty severe -- NOT for the Politicians and Executive Agency Officials -- but for people with serious cognitive disabilities and the trajectory of their lives as well as the Safety of the Community.

We need a Long Term Action Plan for access to Medicaid (with a Comprehensive Continuum of Care) for people with Cognitive Disabilities who are Homeless and/or Incarcerated.

BENEFITS

Supportive Housing, Section 504 of the Rehabilitation Act, and arguing by analogy from the Americans with Disabilities Act (ADA), Subsequent Caselaw and Guidance.

So the current status of Caselaw under the ADA says that STATES have an obligation to provide housing for people with disabilities who are:

institutionalized
at great risk of institutionalization
homeless, and/or
at great risk of homelessness

Further US Department of Justice Guidance goes to great lengths to distinguish Medicaid and STATE RESPONSIBILITIES. The idea is that just because Medicaid doesn't cover currently it (e.g. HOUSING), doesn't mean the STATES aren't legally obligated to provide it under Olmstead.

Now the ADA doesn't cover the Executive Branch of the Federal Government -- BUT we have Section 504 of the Rehabilitation Act -- we're already covered.

This gets to DISCRIMINATION under Medicaid and Supportive Housing and people who need LONG TERM CARE.

How is it NOT DISCRIMINATION to:

pay for Nursing Home Care, and
pay for Assisted Living Care,
fail to enforce FAIR HOUSING requirements of nursing home and assisted living providers
fail to provide Supportive Housing

28 CFR § 42.503 - Discrimination prohibited.
(regulations relating to Section 504 of the Rehabilitation Act)

§ 42.503 Discrimination prohibited.(a) General. No qualified handicapped person shall, solely on the basis of handicap, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any program or activity receiving Federal financial assistance.

(b) Discriminatory actions prohibited.

(1) A recipient may not discriminate on the basis of handicap in the following ways directly or through contractual, licensing, or other arrangements under any program or activity receiving Federal financial assistance:

(i) Deny a qualified handicapped person the opportunity accorded others to participate in the program or activity receiving Federal financial assistance;

(ii) Deny a qualified handicapped person an equal opportunity to achieve the same benefits that others achieve in the program or activity receiving Federal financial assistance;

(iii) Provide different or separate assistance to handicapped persons or classes of handicapped persons than is provided to others unless such action is necessary to provide qualified handicapped persons or classes of handicapped persons with assistance as effective as that provided to others;

(iv) Deny a qualified handicapped person an equal opportunity to participate in the program or activity by providing services to the program;

(v) Deny a qualified handicapped person an opportunity to participate as a member of a planning or advisory body;

(vi) Permit the participation in the program or activity of agencies, organizations or persons which discriminate against the handicapped beneficiaries in the recipient's program;

(vii) Intimidate or retaliate against any individual, whether handicapped or not, for the purpose of interfering with any right secured by section 504 or this subpart.

(2) A recipient may not deny a qualified handicapped person the opportunity to participate in any program or activity receiving Federal financial assistance on the ground that other specialized aid, benefits, or services for handicapped persons are available.

(3) A recipient may not, directly or through contractual, licensing, or other arrangements, utilize criteria or methods of administration that either purposely or in effect discriminate on the basis of handicap, defeat or substantially impair accomplishment of the objectives of the recipient's program or activity with respect to handicapped persons, or perpetuate the discrimination of another recipient if both recipients are subject to common administrative control or are agencies of the same State.

(4) A recipient may not, in determining the location or design of a facility, make selections that either purposely or in effect discriminate on the basis of handicap or defeat or substantially impair the accomplishment of the objectives of the program or activity with respect to handicapped persons.

(5) A recipient is prohibited from discriminating on the basis of handicap in aid, benefits, or services operating without Federal financial assistance where such action would discriminate against the handicapped beneficiaries or participants in any program or activity of the recipient receiving Federal financial assistance.

(6) Any entity not otherwise receiving Federal financial assistance but using a facility provided with the aid of Federal financial assistance after the effective date of this subpart is prohibited from discriminating on the basis of handicap.

(c) The exclusion of nonhandicapped persons or specified classes of handicapped persons from aid, benefits, or services limited by Federal statute or executive order to handicapped persons or a different class of handicapped persons is not prohibited by this subpart.

(d) Recipients shall administer programs or activities in the most integrated setting appropriate to the needs of qualified handicapped persons.

(e) Recipients shall insure that communications with their applicants, employees and beneficiaries are effectively conveyed to those having impaired vision and hearing.

(f) A recipient that employs fifteen or more persons shall provide appropriate auxiliary aids to qualified handicapped persons with impaired sensory, manual, or speaking skills where a refusal to make such provision would discriminatorily impair or exclude the participation of such persons in a program or activity receiving Federal financial assistance.

Such auxiliary aids may include brailled and taped material, qualified interpreters, readers, and telephonic devices. Attendants, individually prescribed devices, readers for personal use or study, or other devices or services of a personal nature are not required under this section.

Departmental officials may require recipients employing fewer than fifteen persons to provide auxiliary aids when this would not significantly impair the ability of the recipient to provide its benefits or services.

(g) The enumeration of specific forms of prohibited discrimination in this subpart is not exhaustive but only illustrative.

DREDF: Medicaid Healthcare Accessibility for People with Disabilities

HHS COMMITMENT TO ACTION TO RESOLVE DREDF SECTION 504 COMPLAINTS

4. Development of Long-Term Action PlanWithin 30 calendar days of completing the Section 504 Self-Assessment of all of its programs and activities, CMS shall convene a cross-component agency workgroup that includes OCR to develop a Long-Term Action Plan for ensuring effective communication with individuals who have hearing, vision, or speech disabilities.

CMS shall complete the Long-Term Action Plan within 120 calendar days of convening the work group.

The Long-Term Action Plan will address the following issues (a through j, below) as needed and appropriate for each program conducted by CMS. CMS and OCR recognize that each program administered by CMS may need to implement some but not necessarily all of these provisions in order to ensure Section 504 compliance.
Modification of policies and procedures, as necessary, to ensure the timely and appropriate provision of auxiliary aids and services, including alternate formats, to individuals with disabilities;
Assessment of and consultation with the individual with a disability to determine an appropriate auxiliary aid and service;
Redesign and modification of systems and technology, as necessary, to facilitate the timely provision of appropriate auxiliary aids and services, including alternate formats, to individuals with disabilities;
Dissemination of notice about the policies and procedures to CMS staff and contractors;
Informing contractors of their legal responsibilities under Section 504 to ensure effective communication with individuals with disabilities in their administration of the CMS program;
Training CMS staff and staff of contractors on the legal obligation to ensure effective communication with individuals with disabilities in the administration of the CMS program and on the policies and procedures for providing appropriate auxiliary aids and services to individuals with disabilities;
Revision of contracts with contractors, as necessary, to ensure effective communication with individuals with disabilities;
Modification of the CMS websites, as necessary, to ensure compliance with Section 508 of the Rehabilitation Act;
Monitoring of implementation of the revised policies and procedures;
Other actions, as necessary, to ensure compliance with Section 504.

I WILL COMPLAIN: RELIGION, MENTAL ILLNESS & REFORM

1/4/2020

So I was watching the PBS NewsHour regarding the most recent Texas Church Shooting, and a Religious Leader in Texas -- a very nice Older white man who appeared to be channeling Santa Claus -- mentioned the problem of mental illness and these shootings.

Well, we get off the rails pretty quickly in discussing mental illness and gun violence, because:

we don't have a coherent definition of "mental illness"
and we're just starting to understand the broader BIOLOGY of violence, which can encompass a lot of things outside of Schizophrenia, Bi-Polar Disorder, and Post Traumatic Stress Disorder.
Of course, most people with serious mental illness are NOT violent. It is just that people with mental illness and other cognitive disabilities make up an overwhelming percentage of incarcerated populations.
It does include brain injury, substance use, developmental disability, and the multiplying effects of aggression on our bodies.

I do think there is a SPIRITUAL aspect to COMPLAINING and NOT PRETENDING things are perfect -- as desperately as the SOCIETY may want you to PRETEND.

This has taken on a new sophisticated level of CONTROL with the TYRANNY of POSITIVITY -- and anybody who doesn't agree labelled a TOXIC PERSON.

Now maybe there is an ARISTOTELIAN MEAN to BALANCE the need to correct plenty of horror and injustice in our society with the NEED to take care of ourselves and others in INTEGRATED, HOLISTIC ways.

When we think about:

Spirituality
Reason/Logic
Empiricism

Basic principles may be TIMELESS, but enormous amounts of NEW INFORMATION are constantly TESTING those principles and forcing us to redefine what is FUNDAMENTAL.

The foundation for re-defining "criminal intent" in 2020 in not with MENS REA -- it is in providing the:

Housing
Services, and
Placements

that are already legally required. We think our Religious Folks are ahead of the game on this.

Many Religions Have Long Histories of Championing the Marginalized

Those Religious People are doing it again in Modern Times with Cognitive Disability while Insisting on Safety & Seeking to Benefit Everyone

Are we further along in reforming "criminal intent" than we think?

Some older conservative religious folks are already attributing bad acts to mental health problems.

Of course the reality is that -- mental illness is just a part of a broad spectrum of problems that can negatively impact behavior and executive functioning.

This is a HUGE STEP -- Scientifically, Legally and Religiously & Spiritually.

It may very well be those Religious Folks who support the necessary funding for housing, services and placements -- that are already required by law.

IN THE GREAT STREAM OF HISTORY --BIG DATA IS A HUMAN RIGHTS ISSUE & NECESSARY TO COMPLY WITH US FEDERAL DISABILITY CIVIL RIGHTS LAWS

1/1/2020

Well, it's hard to imagine a debate in the US like the one between Boris Johnson and Mary Beard -- and maybe that's a good thing: Who was better -- the Ancient Greeks or the Ancient Romans?

The UK isn't religious like the US is -- but it has in some senses substituted Classicism & History for Traditional Religion. Religion is about making connections, so is history.

There are the stories that get re-told and re-told and re-interpreted to address the needs of Modern Times.

The US is certainly an inheritor of the Greeks, the Romans, the British, the Indigenous, the African, the German, the Spanish, the French, the South Asian, the Arab, the Chinese, etc. -- we claim it all.

The Greeks understood that all of that IDEALISM was at rock bottom a form of PRACTICALITY.

And the Romans understood that PRACTICALITY could be a form of IDEALISM.

So HYPOCRISY is not somehow new to the Human Experience -- BUT in the 21st Century -- we are engaging in MASSIVE HYPOCRISY in Federal & State Government. The CONSEQUENCES:

Thousands of People with Cognitive Disability Homeless,
Thousands of People with Cognitive Disability Incarcerated
Federal Disability Civil Rights Laws -- we routinely BLOW OFF.

Well, what are some solutions in our 21st Century World: Federal & State Funding of Independent Data Collection is a big part of the SOLUTION.

BIG DATA isn't all good, but it's not all bad either -- and it has the very real possibility of providing factual foundations for Civil Rights Reform and Compliance with Existing Laws.

Clash of the Titans: Boris Johnson, Dame Mary Beard debate who was greater -- The Greeks or the Romans. Moderated by BBC Journalist Andrew Marr -- all three Classicists in their own rights.

5th Century B.C.E. Athenian Leader Pericles

Forward>>

Val's Blog

"EFFICIENCY" AND A MENTAL HEALTH DEBACLE

DISCRIMINATION: MEDICAID'S IMD EXCLUSION RULE & MEDICAID'S FAILURE TO FULLY FUND SUPPORTIVE HOUSING

COGNITIVE DISABILITY, MEDICAID & "DISCRIMIN-ATION"

"JOKER"-- A WORK OF ART THAT WANTS TO HAVE A BIG IMPACT ON OUR SOCIETY (& A Look @ Colorado)

The reason why colorado's mental health Crisis has not been resolved is we have failed to address the large scale of the problem and make a reasonable plan to address it.

MEDICAID: ACCESS & BENEFITS UNDER SECTION 504 OF THE REHABILITATION ACT FOR PEOPLE WITH COGNITIVE DISABILITIES

I WILL COMPLAIN: RELIGION, MENTAL ILLNESS & REFORM

IN THE GREAT STREAM OF HISTORY --BIG DATA IS A HUMAN RIGHTS ISSUE & NECESSARY TO COMPLY WITH US FEDERAL DISABILITY CIVIL RIGHTS LAWS

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