Utah 2003 | advancingstates.org

<H3>Utah</H3>   <H4>Task Force</H4> In September 1999, key state agencies created a long-term care (LTC) network task force to address issues raised by the Olmstead decision and to extend the state's work on community-based services. The task force submitted a draft plan in March 2002 and a final version in November 2002. The plan is available online at <A HREF=\"http://www.dhs.utah.gov/olmstead.htm\">http://www.dhs.utah.gov/olmstead.htm</A> The task force has established subcommittees to address certain sections of the plan, such as: housing, risk management, transitional services and transportation.   <H4>The Plan</H4> <UL> <LI><A NAME=\"_Toc531664730\">Goals</A></LI> <UL> <LI>The state will continue to make good faith efforts to enable qualified recipients in institutional settings to receive applicable services in a less restrictive environment within five years.</LI> <LI>Once a qualified individual elects to move to a less restrictive environment and state professional staff agree that such a move is appropriate, the move should occur as fast as reasonably possible given the individual's needs and available supports and funding.</LI> <LI>Continue the assessment of disabled individuals and their critical needs to determine whether publicly funded home and community-based services are appropriate.</LI> <LI>Taking into consideration the barriers, problem statements and goals identified earlier in this document, the state will continue its efforts to meet the increased needs of the diverse disabled population in the most integrated, least restrictive environment. </LI> <LI>To assist the state in accomplishing the identified goals, the action plan outlines the course of action to be taken in three categories: overarching home and community-based initiatives, cross-agency planning and individual department or division plans.<A NAME=\"_Toc531664731\"></LI></UL> <LI>Home and Community-Based Initiatives Action Plan</A></LI> <UL> <LI>Evaluate the outcomes of the Department of Health's Long-Term Care Managed Care Initiative (FlexCare) to determine whether to expand to other areas of the state. </LI> <LI>Outline the plan for continuing the DD/MR Open Enrollment Process (Portability) by reviewing:</LI> <LI>The progress and outcome data, obtaining additional input from the original design group, and making any necessary modifications to the program's outline.</LI> <LI>Design the plan for continuing the Nursing Facility Consumer Education and Assessment Process and determine the feasibility of implementing the processes over the long-term by evaluating;</LI> <LI>Assessment data from the current project to determine needs and availability of resources.</LI> <LI>Evaluate the effectiveness of the Dual Diagnosis Demonstration Project and determine the appropriate course of action for continuing, modifying or expanding the project. </LI> <LI>Design necessary modifications of existing 1915(c) HCBS waivers to assure compliance with the intent of the January 2000 letter from the HCFA State Medicaid Director. </LI> <LI>Evaluate existing agency policies and practices relating to the current 1915(c) HCBS waivers to address issues that may exist in terms of both:</LI> <LI>Equitable allocation of resources between the various target populations, and </LI> <LI>Equitable access to covered services between the various waivers.</LI> <LI>Evaluate existing waiting lists to address issues that may exist, and make any necessary modifications.<A NAME=\"_Toc531664732\"></LI></UL> <LI>Cross Agency Action Planning</A> </LI> <UL> <LI>The following apply:</LI> <UL> <LI>Design a model for continuity of care across the long-term care system that will include clearly delineated elements of institutional-based services, community congregate care-based services and home-based services. </LI> <LI>Design necessary modifications to existing agency policies and practices to assure an objective, reasonable and consistent methodology for defining and measuring institutional level of care as an element of long term care program eligibility. </LI> <LI>Design a model for integrating long-term care programs into the continuum of care for people who do not meet institutional level of care eligibility criteria. </LI> <LI>Integrate self-determination concepts into the long-term care system. </LI> <LI>Identify opportunities to expand access to effective services through the redesign and unbundling of existing service packages and definitions (attendant care, personal care, emergency response systems, assistive technology, and environmental adaptations are among the services to be considered). </LI> <LI>Identify effective approaches to expand access to community-based services by complex populations that cannot currently be appropriately served outside an institutional setting (intensive behavioral characteristics, advanced dementia, heavy assist needs, and intensive skilled; all who are non complaint with treatment regimes should be evaluated). </LI> <LI>Identify the problems, needs and potential partners for expanding the integration and transition of housing and health care for people with chronic illness and disabilities, as well as the specific desired outcomes. </LI> <LI>Identify the problems, needs and potential partners for expanding medical and non-medical transportation for people with chronic illnesses and disabilities, as well as the specific desired outcomes. </LI> <LI>Identify the problems, needs and potential partners to support meaningful, integrated employment for people with chronic illness and disabilities. </LI> <LI>Identify the problems, needs and potential partners to address workforce shortage issues in the long-term care system. </LI> <LI>Design and implement a system for the sharing of accurate, current and responsive information about the availability of services for people who are seeking assistance to prevent the untimely loss of independence for a disabled person, due to the lack of knowledge of the available options.<A NAME=\"_Toc531664733\"></LI></UL> </UL> <LI>Individual Department or Division Plans</A></LI> <UL> <LI>The state's plan is a compilation of concepts and principles taken from the various reports of each affected agency within the Department of Human Services, the Department of Health and the Department of Workforce Services. As additional action steps from various agencies or communities are developed, reviewed and approved they will be added to this plan. Individual division plans are available from the respective divisions within each department. Some of the goals and recommendations in the divisions' plans are found in the state's plan, but some are not. </LI> <LI>The comprehensive plan is Utah's statement of responsibility for providing identified services and programs. Individual division directors were asked to include specific Olmstead planning in their overall annual management plans in order to avoid fragmentation of services or separation of the Olmstead-specific population. These division plans and specific action steps are broader and address all populations served by the respective divisions. The following are division specific plans for serving the Olmstead population. </LI> <LI><A NAME=\"_Toc531664734\"><A NAME=\"_Toc525725952\">Division of Aging and Adult Service</A>s</A></LI> <LI>Identify barriers that prevent qualified senior citizens from moving back into the community from institutional settings, as well as potential partners and action steps to overcome these barriers. </LI> <LI>Identify barriers that prevent qualified senior citizens from remaining in their homes, as well as potential partners and action steps to remove these barriers. </LI> <LI>Develop and implement the family caregiver support program statewide. </LI> <LI>Develop an online-statewide resource directory. </LI> <LI>To ensure that programs to enable senior citizens obtain care in a community setting are having the desired effect, the division and the area agencies identified a series of outcomes for seven services that will be measured regularly. A random sample of recipients will be surveyed to assess how well their needs are being met. Information will be used to continuously monitor the effectiveness of the programs. </LI> <LI><A NAME=\"_Toc531664735\">Division of Child and Family Services (DCFS)</A></LI> <LI>To ensure that all children (including those with disabilities) are consistently placed in the least restrictive, most appropriate placement, a wide range of placement options must be maintained. A least restrictive placement, in most cases, is one that allows the child to remain close to family and community when out-of-home placement is required. </LI> <LI>Through increased skill training, child protective workers, with the assistance of kin locators in each region, will successfully engage the family at the time of removal to jointly find an appropriate resource for children who require out-of-home care.</LI> <LI>By strengthening their approach to recruitment and training, DCFS will make more foster families that practice the behavior replacement model of care available statewide.</LI> <LI>Caseworkers will be appropriately trained to know where and how to research appropriate resources, both formal and informal, for children in the custody of DCFS. </LI> <LI>DCFS will develop \"wraparound plans\" to provide individualized, community-based services and natural supports for the child and family.</LI> <LI><A NAME=\"_Toc531664736\"><A NAME=\"_Toc525725953\">Division of Mental Health</A></A> (DMH)</LI> <LI>Adopt standardized preferred practice guidelines in the assessment of adults. These standardized guidelines would ensure statewide consistency in the delivery of mental health services. The goal is to provide a comprehensive assessment to identify the least restrictive appropriate level of treatment for each consumer. </LI> <LI>Engage the Mental Health Planning Advisory Group in continued Olmstead planning in order to outline the problems, needs, potential partners and desired outcomes on mental health issues. </LI> <LI>Hire a consultant to work with the Olmstead planning committee and the division to develop the details of the plan and to coordinate it with the other Olmstead efforts within health and human services. </LI> <LI>A new utilization review process plan has been developed to coordinate the efforts of the Utah State Hospital (USH), the Division of Mental Health (DMH) and the Department of Health (DOH). This Plan brings together Health Care Financing (HCFA) standards and hospital processes. The plan is designed to monitor compliance with all federal requirements and to implement safeguards to ensure that the patient is receiving proper treatment and appropriate integration of USH services with community programs. </LI> <LI>DOH has retained two independent consultants to review USH programs, and the overall health system. They will provide recommendations for programs and alternate care options to provide services in the community whenever possible. </LI> <LI>DMH will continue to conduct internal reviews of its monitoring process for the community mental health centers. DMH will continue to review best practices and to apply them to individual cases and will include consumers and advocates in these reviews. </LI> <LI>Individual Case Review Process. </LI> <LI>Outline a process to assess a referral for community placement from any source. The process will include the following steps:</LI> <LI>The client is referred for a case review from any source, such as USH, the local mental health centers, advocates, families, courts, the Disability Law Center, professionals and others.</LI> <LI>A review team is convened and provides a clinical assessment. The review team includes mental health professionals, a consumer advocate, a representative from an advocacy group, and a representative of DHS for cases that involve DHS clients. </LI> <LI>Olmstead criteria are applied to the case and a system response is developed.<A NAME=\"_Toc531664737\"><A NAME=\"_Toc525725954\"></LI> <LI>Division of Services for People with Disabilities</A></A> (DSPD)</LI> <LI>The division and department are engaged in efforts to address the waiting list in concert with the Legislative Auditors Office. </LI> <LI>DSPD will provide individuals with disabilities who are receiving division services:</LI> <LI>The option of self-directed supports; </LI> <LI>The option of using a micro-board; </LI> <LI>Local access to an independent, statewide self-advocacy network;</LI> <LI>Direct voting representation on boards, advisory groups and committees that make or influence decisions that directly affect their lives; and </LI> <LI>Choice of providers and service locations, along with the ability to initiate a request for a change of providers or locations at any time.</LI> <LI>DSPD will also:</LI> <UL> <LI>Extend service brokering to everyone on the waiting list; </LI> <LI>Redirect administrative funds to program budgets; </LI> <LI>Develop and implement a plan to address the immediate needs of those who are found eligible for services at their entry point and thereby prevent them from enduring the wait for services that typically increases the need for more intrusive and costly services; </LI> <LI>Develop new approaches to the waiting list, after considering shared ideas; and </LI> <LI>Build capacity to ensure availability of community-based services.</LI></UL> <LI><A NAME=\"_Toc531664738\">Division of Youth Corrections</A> (DYC)</LI> <LI>Length of stay in secure facilities as it relates to disabled individuals served. </LI> <LI>DYC will identify problems, perceived needs, potential partners and desired actions to address the following issues and populations:</LI> <LI>Secure facilities</LI> <LI>Sex offenders/residential treatment</LI> <LI>Restrictive treatment centers, and</LI> <LI>Remote/isolated restrictive residential treatment.</LI> <LI><A NAME=\"_Toc531664739\"><A NAME=\"_Toc525725955\">Division of Health Care Financing (DHCF)-Long-Term Care Unit</A></A></LI> <LI>The Long Term Care Unit established workload priorities to achieve the following objectives:</LI> <LI>Support and assist in the timely completion of the Action Plan. </LI> <LI>Make \"good faith\" efforts to implement the strategies outlined in the \"HealthPrint for Long-Term Care\" and the \"Final Report of the Long-Term Care Technical Advisory Group\" as elements of the Medicaid long-term care program. </LI> <LI>Monitor major long-term care initiatives, identify issues emerging on a national scale, and evaluate their implications for Utah's long-term care system.</LI> <LI><A NAME=\"_Toc531664740\">Department of Workforce Services</A> (DWS)</LI> <LI>DWS will identify the employment needs of people with chronic illness and disabilities and will develop strategies to address these needs. </LI> <LI>DWS will address workforce development issues related to the long-term care system. </LI> <LI>DWS will provide eligibility services for people in community-based settings.</LI></UL> </UL>   <H4>Implementation</H4> Legislation There was no legislation in 2002 related to the Olmstead decision. Funding New funds allocated during the past several years are being used to extend home and community-based waiver services to those with chronic illnesses and disabilities. Successes The Utah Department of Health's Long-Term Care managed care demonstration project became operational in 2000 and as of October 2001 had helped 160 Medicaid clients make the transition from acute care hospitals, Medicare skilled nursing facility beds, and Medicaid nursing facility beds to home and community service arrangements. The project will continue through March 2003 with the potential to serve up to 500 enrollees at any given time. Under a state legislative initiative and a grant from Center for Health Care Strategies Inc., residents of nursing facilities and ICFs/MR received information about available home and community-based long-term care programs and were offered individualized assessment and support to determine transition opportunities. Education outreach activities will continue as an element of fostering informed consumers. Challenges Reduction of waiting lists remains a priority in the state. Lawsuits There are no lawsuits related to the Olmstead decision. Next Steps Utah received a $1.368 million Real Choice Systems Change Grant. The money is being used to study and establish a structure for an entity to direct individuals to both institutional and non-institutional services.