Olmstead Plan Chronology

Department of Administration Governor's Council on Developmental Disabilities
July 1, 2019

2014

January 2014

The OIO was operational, but appointments were minimal, interim-based, and time-limited. January 16, 2014

The Centers for Medicare and Medicaid Services (CMS) published a rule outlining new requirements for states' Medicaid home- and community-based services (HCBS). The intent of the rule was to ensure that individuals receiving long-term services and supports through HCBS programs had full access to benefits of community living and the opportunity to receive services in the most integrated setting appropriate to meet the needs of the individual. The rule was designed to enhance the quality of HCBS and provide protections for people who use those services. The rule defined, described and aligned requirements across the HCBS programs. It defined person-centered planning requirements for persons in home- and community-based settings. The regulations went into effect on March 17, 2014, and any new 1915(c) waivers or 1915(i) state plans had to meet the new requirements to be approved. For 1915(c) waivers and 1915(i) state plan programs that were already approved, states were afforded a maximum of a one year period to submit a transition plan for compliance.

In Minnesota, this impacted the Brain Injury (BI), Community Alternative Care (CAC), Community Alternatives for Individuals with Disabilities (CADI; currently the Community Access for Disability Inclusion Waiver), Developmental Disabilities (DD), and Elderly Waiver (EW) programs. New programs under 1915(i), 1915(k) and any new 1915(c) were required to be in full compliance from the date of implementation. In Minnesota, the new Community First Services and Supports (CFSS) program needed to meet this requirement. The new federal HCBS rules required that individuals be afforded a real choice between settings in which they receive services. Minnesota's implementation of these rules furthered the state's progress in implementing its Olmstead goals. Later, on May 9, 2017, Health and Human Services (HHS) Secretary Tom Price and CMS Administrator Seema Verma announced a three-year extension (to March 17, 2022) for state Medicaid programs to demonstrate compliance with the final rule.

January 22, 2014

The Court provisionally approved the Olmstead Plan with revisions required: The Court has now received not only the Olmstead Plan, dated November 1, 2013, but also the court monitor's report to the Court: Minnesota's 2013 Olmstead Plan ("Report"). Based upon the presentations of all parties and the current procedural status of the case, and the Court having reviewed the contents of the file in this matter and being otherwise duly advised in the premises, the Court hereby enters the following:

The Court provisionally accepts and approves the Olmstead Plan, subject to the Court's review after the state of Minnesota revises the Olmstead Plan based upon the report by the court monitor and after the Court has reviewed any submissions by plaintiffs' class counsel and the executive director of the Minnesota Governor's Council on Developmental Disabilities and the Ombudsman for Mental Health and Developmental Disabilities.
Within 30 days of the date of this order, plaintiffs' class counsel may file any comments or objections to the Olmstead Plan as currently submitted.
Within 30 days of the date of this order, the executive director of the Minnesota Governor's Council on Developmental Disabilities and the Ombudsman for Mental Health and Developmental Disabilities may file any comments or objections to the Olmstead Plan as currently submitted.
The state of Minnesota shall file its first update, including any amendment to the Olmstead Plan and a factual progress report that shall not exceed 20 pages, within 90 days of the date of this order. The Court expects the parties to address the progress toward moving individuals from segregated to integrated settings; the number of people who have moved from waiting lists; and the results of any and all quality of life assessments. The Court needs to be in a better position to evaluate whether the settlement agreement is indeed improving the lives of individuals with disabilities, as promised and contemplated by the settlement agreement itself. As the Court ordered on August 28, 2013, updates to the Olmstead implementation plan shall include activities undertaken pursuant to the plan, documentation of such activities, and any requests for modification of the Plan's deadlines or other elements.
The state of Minnesota shall file a revised Olmstead Plan on or before July 15, 2014, after first providing a draft to the court monitor on or before July 5, 2014.
This Court respectfully directs that the Olmstead Subcabinet use all of its combined resources and talents to implement the Olmstead Plan. Further, the Court respectfully directs that the Olmstead Subcabinet cooperate, communicate, and work with the court monitor. The Court expects the Olmstead Subcabinet to discuss ongoing implementation with the court monitor, as well as the executive director of the Governor's Council on Developmental Disabilities and the Ombudsman for Mental Health and Developmental Disabilities, on a 60-day report system, with feedback and communication between all parties, so that true progress can be realized in the lives of the individuals with disabilities intended to benefit from the settlement agreement and so their lives can truly be significantly improved.

February 11, 2014

The court monitor letter to lieutenant governor outlined the deadline (April 22, 2014) of the first update to the Plan after provisional approval of the Court on January 22, 2014. The court monitor offered to discuss the deadline and a drafted response to the court order.

February 20, 2014

The OIO joined the Olmstead Subcabinet meetings for the first time, offering support to both the Olmstead Subcabinet and the lieutenant governor's office in areas such as report review and plan revision.

February 22, 2014

The OIO report to the Subcabinet was reviewed. This report fulfilled the bi-monthly reporting schedule on the status of work being done within the Olmstead Plan to move toward greater integration for persons with disabilities. It also was used as a mechanism to recommend other actions (e.g., modification to the Plan) to the Olmstead Subcabinet and other parties, including the Court and other stakeholders. For the Olmstead Subcabinet's comments on the report, see page 4 of the February 20, 2014 meeting minutes.

The Quality of Life Assessment Subcabinet report was also released. The OIO recommended that an annual plan for $5,000 be developed with the Center for Outcome Analysis to create a Quality of Life assessment tool specific to the Minnesota Olmstead Plan recommendations. A placeholder budget of $500,000 for survey administration and analysis costs were included in the OIO budget.

March 17, 2014

First draft of modifications to Minnesota's 2013 Olmstead Plan were developed. To develop the revisions and additions in this draft, teams conferred with stakeholders and agencies (particularly mental health advocates and the Department of Corrections), and reviewed comments from the court monitor overseeing the Jensen settlement agreement.

Representatives from the OIO worked closely with the court monitor and the Subcabinet's ex officio members to identify necessary changes to the 2013 Olmstead Plan. Goals continued to focus on supports and services, housing, transportation, employment, community engagement, lifelong learning and education, and healthcare and healthy living and overarching strategic actions remained unchanged from the November draft. Some goals were updated to further address mental health/illness. Plan actions and timelines were outlined for each of these topic areas, though measurable goals were not yet identified.

April 21, 2014

The Quality of Life assessment tool was reviewed and approved by the Olmstead Subcabinet. Additionally, a contract with Management Analysis and Development was approved by the Subcabinet to conduct a pilot of the Quality of Life assessment. To review the assessment, see page 60 of the April 22 report to the Court.

May 5, 2014

Darlene Zangara was appointed the Director of the OIO, housed in the Department of Employment and Economic Development (DEED).

June 2014

The Quality of Life survey pilot was launched. June 9, 2014

The Olmstead Subcabinet reviewed Plan modifications that were submitted to the court monitor. It was noted that 46 modifications were requested, of which 32 were either granted outright or with small modifications. Areas where modifications were already approved included:

Adding assistive technology issues to the Plan and coming up with ways to address the topic in each area.
Adding goals for the Department of Corrections (DOC).
Incorporation of feedback from a mental health advocacy group.
Defining baselines for employment work.

It was noted that the day training section of the employment topic focused more on processes than outcomes and needed more work. Additionally, the six areas pending approval from the court monitor were reviewed by the Subcabinet. However, exact language from the Plan regarding modifications was requested before approval would be given. For additional details on the six areas pending approval, see page 2 of the June 9, 2014 meeting minutes.

The legislature also approved a budget of $500,000, although it was noted that additional analysis would be needed to determine the breakdown of the budget. Darlene Zangara suggested several areas to focus on, including implementation of the Plan in compliance with the Court, properly resourcing the OIO, outreach and communications, and accessibility and contract services. It was also noted that additional discussions would be needed to determine the most effective structure and governance for the office and that consideration needed to be given to what legislative proposals would be brought forward for the next session regarding Olmstead. Discussion included:

Resources for Darlene to consult.
Resource needs for the OIO.
Importance of everyone looking at policies and practices with an Olmstead lens.

Finally, the Olmstead Subcabinet noted that it was important to put together a plan to get to a place where there would no longer be Court oversight, although it was mentioned that implementation of the Plan was in its early stages and the Subcabinet may not be ready to be out from under the Court's jurisdiction yet.

June 19, 2014

The Olmstead Subcabinet approved the six proposed modifications to the Plan that were pending approval at the June 9, 2014 meeting. These modifications included:

Clarification regarding replacing the personal care assistance (PCA) programs with a more flexible personal support service, with CFSS.
A new action item to set annual goals to increase the number of counties and tribal nations providing individualized housing options.
New proposed language intended to broaden the person-centered concept to include all people with disabilities.
Edit to action item to extend the deadline from March 31, 2014 to August 31, 2014 to offer enhanced person-centered planning training components to assure employment planning strategies and employment first principles were understood and incorporated into the tools and planning process.
New language to update the section on public comments on the Olmstead Plan to include feedback received from November, 2013 to the present.
New language to provide background information on housing issues faced by individuals with disabilities when they were released from prison. New action items to track individuals with disabilities exiting and entering state correctional facilities and their ability to access appropriate services and supports. Identify trends and gaps and set measurable goals.

July 1, 2014

The state of Minnesota allocated $500,000 to the OIO for fiscal year 2015. DEED, DHS, and Minnesota Housing (Minnesota Housing Finance Agency, or MHFA) also committed to the provision of monetary and in-kind support for the OIO in fiscal year 2015. Funding ($875,000) for the OIO for in fiscal years 2016 and 2017 was also secured as base funding.

July 10, 2014

Second draft of modifications to Minnesota's 2013 Olmstead Plan were developed. To develop the proposed modifications in this document, teams conferred with stakeholders and agencies, considered comments from Subcabinet listening sessions held across the state, and reviewed comments from the court monitor overseeing the Jensen settlement agreement.

Goals continued to focus on supports and services, housing, transportation, employment, community engagement, lifelong learning and education, and healthcare and healthy living and overarching strategic actions remained unchanged from the November draft. Plan actions and timelines were outlined for each of these topic areas, though measurable goals were not yet identified. The Olmstead Subcabinet did, however, commit to identifying specific strategic actions and timelines to modify the Plan accordingly, once baselines were established.

Modifications regarding the elimination of prone restraint were made, as requested by the court monitor. Information on person-centered planning was added to the Plan for context. A full list of goal updates can be found in the summary of proposed modifications to the Olmstead Plan document.

August 11, 2014

Darlene Zangara reported that staffing of the OIO was increasing, including moving a part-time position into a full-time position and plans for future staffing.

August 18, 2014

Included in the August 18, 2014 report to the court monitor was a report on the alignment of the Minnesota Council on Transportation Access (MCOTA) with the Olmstead Plan. MCOTA was established by the Minnesota legislature in 2010 (Minn. Statute 2010 174.285) to study, evaluate, oversee, and make recommendations to improve the coordination, availability, accessibility, efficiency, cost-effectiveness, and safety of transportation services provided to the transit public.

Due to the cross-agency nature of providing transportation for the Olmstead population, the Minnesota Department of Transportation (MnDOT) looked to MCOTA as a potential partner to begin the cross-agency conversation that would be needed to identify needs and expand overall awareness of Olmstead obligations. The relationship was useful for primarily exchanging information, and the strategic actions focused on gathering baseline information benefited from already planned MCOTA research. However, the connection to a more concrete strategic direction to directly contribute to Olmstead's population based outcomes was not apparent.

While many strides were made in creating greater awareness on Olmstead needs among a broader group of transportation stakeholders, MnDOT, in conjunction with the MCOTA membership, determined that inclusion of MCOTA in the Olmstead Plan would be discontinued. The primary reason was that MCOTA's charge was advisory and the Olmstead Plan was seeking direct measurable impact to furthering Minnesota's Olmstead Plan, which was outside of MCOTA's purview. MnDOT did see value in maintaining a connection and MnDOT's Olmstead agency lead continued to provide updates on Olmstead progress to MCOTA and recommended Olmstead-based research for consideration in MCOTA's work plan. MnDOT was in the process of developing alternatives to replace MCOTA in the transportation section of Minnesota's Olmstead Plan.

Recommended replacements included:

Inclusive transit planning: Providing technical assistance to transit systems on best models for increasing the participation of people with disabilities in the design and implementation of responsive, coordinated transportation systems.
Enhancing communications: Providing technical assistance on improving access of persons with disabilities to transit through improved communication techniques. These techniques could include: travel training, driver sensitivity training, and improved signage.
Development of performance measures: Identification of key measures for determining increased access by persons with disabilities. These measures could include: overall disabled ridership, customer satisfaction responses, and level of investment.

For additional details on this report, see page 82 of the August 18, 2014 report to the court monitor.

Also included in this report to the court monitor was a report on processes to access crisis services in schools in response to the action item: By June 30, 2014, establish a process for school districts to ensure that students with complex disabilities can access crisis services. This report defined key terms (e.g., complex disabilities, crisis), identified barriers to service provision in schools, and set forth goals and processes for schools to access crisis services. For additional details on this report, see page 106 of the August 18, 2014 report to the court monitor.

September 18, 2014

The Court declined adoption of the Olmstead Plan and required revisions: On July 10, 2014, the state filed the proposed Olmstead Plan that is now before the Court. In response to the proposed Olmstead Plan, the plaintiff class submitted a letter to the Court on July 24, 2014, "reiterat[ing] the settlement class positions… in [its] prior letters to the Court and court monitor concerning the Olmstead Plan" and observing that "issues remain, including a necessary recommitment and focus needed to complete and implement an Olmstead Plan using measurable goals."

Specifically, the plaintiff class referenced a February 25, 2014 letter to the Court in which the plaintiff class expressed concerns that "the Olmstead Plan be strategic, measurable, and clearly state who is responsible, with a listing of specific timelines, and how the Plan will be implemented, and specific resources needed," and an October 22, 2013 letter to the court monitor in which the plaintiff class criticized DHS' "cavalier approach to the development of the Court ordered Olmstead Plan" and the resulting "rushed, incomplete and deficient Olmstead Plan."

On August 6, 2014, the court monitor filed the Olmstead Plan report with the Court, recommending final approval of the proposed Olmstead Plan. However, in the Olmstead Plan report, the court monitor observed that "[s]ome concerns remain." The court monitor recommended "refinement with regard to [the Olmstead Plan's] structure and specificity," including the need for measurable goals, new methods for presenting and reporting information, and better phrasing of commitments to enable compliance evaluation.

For the reasons discussed below, the Court declines to approve the proposed Olmstead Plan as it is currently written. The Court finds that the proposed Olmstead Plan contains significant shortfalls that require modification to comply with the comprehensive standards articulated in the settlement agreement and in subsequent Court orders and court monitor reports. The Court emphasizes two particularly deficient areas of concern:

The lack of measurable goals; and
The lack of accurate reporting.

Based on the entire record of this case, IT IS HEREBY ORDERED THAT:

The Court DECLINES TO ADOPT the state's proposed Olmstead Plan at this time.
The parties shall submit a revised Olmstead Plan to the court monitor by November 10, 2014.

September 29, 2014

As part of its planning process, the Olmstead Subcabinet adopted a Minnesota Employment First Policy, requiring all state agencies to integrate a vision, values and guiding principles in their work, and assigning three agencies (DHS, Minnesota Department of Education, and DEED) responsibility to define, operationalize and document a process to ensure a person- centered approach and informed choice were used. The three agencies needed to align programs, funding and policies, and develop uniform data collection and reporting procedures. The operational planning process was initiated. The policy was the culmination of an Employment First Coalition effort that began in 2007.

September 30, 2014

The Continuing Care Administration and the Children and Family Services Administration within DHS released a report on potentially segregated settings. This report was produced in conjunction with the Olmstead Plan actions to:

Identify people with disabilities who desire to move to more integrated housing, the barriers involved, and the resources needed to increase the use of effective best practices; and
Support people in moving from institutions to community living, in the most integrated setting.

This report included demographic and baseline data about people receiving services in potentially segregated settings and laid out targets and timelines for moving people to more integrated settings. Included in this report were data about types of potentially segregated settings and day and employment services. This report also included information on targets and timelines related to residential interventions and day services interventions. Finally, this report included summary tables of Massachusetts, Oregon, and Rhode Island state reform initiatives around competitive, community-supported employment and community-based day support services.

September 2014–September 2015

Advocating Change Together created an Olmstead Academy and continued offering the academy on an annual basis. The academy includes training sessions on disability rights, leadership skills, and the Olmstead decision and Minnesota's Olmstead Plan. Fieldwork consists of community projects that promote full community integration.

October 13, 2014

A presentation on the Environmental Quality Board's (EQB) framework was reviewed as a potential model for the Olmstead Subcabinet regarding structure. Concepts for consideration when designing the framework for the Olmstead structure included: the focus of the governing entity, definitions, the governing body, membership, and staff. The Olmstead Subcabinet approved moving forward with designing a permanent structure that built on the existing structure and the EQB model.

October 20, 2014

The crisis triage and hand-off process was submitted with the October 20, 2014 report to the court monitor. For additional details on this process, see page 40 of the March 27th Subcabinet status report to the Court, which includes the version of the process that was approved by the Olmstead Subcabinet.

November 3, 2014

In response to the September 18, 2014 Court order, which declined to adopt the proposed Olmstead Plan, emphasizing a concern with the lack of measurable goals, agency staff worked on each Plan action item requiring establishment of baselines and measurable goals. A worksheet was prepared for each measurable goal to provided context, background, and source information used to establish the goals. The measurable goals submitted were based on existing resources. The goals were to be reviewed and modified once the 2015 budget was approved. The Court was also concerned about the accuracy of reporting. It was discussed during the Olmstead Subcabinet meeting that the measurable goals being proposed would provide more accurate, complete, and verifiable reporting in the bimonthly reports.

Additionally, the report would continue to reflect the number of people who moved from segregated to integrated settings, the number of people who were no longer on the waiting list, and the Quality of Life measures.

December 22, 2014

In their report to the court monitor, the Olmstead Subcabinet included a report on the Olmstead HCBS waiver wait list from DHS. This report addressed the definition of urgency, how to track urgency and those waiting for waiver services, and how adopting the recommended practices would result in improving the waiting list process. DHS committed to taking the following administrative actions based on the recommendations of the Olmstead Wait List Workgroup members:

Within three months of this report's presentation, DHS will convene a group of county and disability stakeholders to discuss further action on maximizing the benefit of waiver funds. This was completed on September 5, 2014.

By December 31, 2014, DHS will:

Establish four levels of urgency (institutional exit, immediate need, serious need, and planned need) for individuals requesting waiver services. Lead agencies will prioritize individuals applying for waiver services on their assessed level of urgency.
Develop and distribute criteria based on statute and the prioritization for urgency of need for services (PUNS) system that will be used to determine urgency of need.
Establish and publish a training curriculum on using the temporary electronic record system. This system will collect data on urgency of need categorizations.
Offer support to lead agencies prior to implementation of the electronic record system.
Create a temporary electronic record system to track the urgency of need categories across the DD, CAC, CADI and BI waivers.

By February 1, 2015, DHS will develop and publish a protocol for implementing the provisions of M.S. 256B.092, subd. 12 and M.S. 256B.49, subd. 11a, granting the commissioner the power to transfer waiver funds between lead agencies to accommodate statewide priorities.

Beginning February 1, 2015, DHS will:

Require that individuals with the "institutional exit" categorization begin service planning within 90 days of an assessment. DHS will require that individuals with the "immediate" categorization receive services within 90 days to the extent that statewide resources are available to support them. This may be accomplished through DHS technical assistance or transferring waiver funds between lead agencies. Categorization of individuals will be completed on a rolling basis, as they are assessed and reassessed. Information about the number of days an individual has been on the waiting list will be available to DHS through the temporary electronic record system.
Provide technical assistance to lead agencies that do not comply with the reasonable pace requirement.
By July 1, 2015, DHS will provide technical assistance to lead agencies on their ability to access a second year to control excess spending as per M.S. 256B.0916, subdivision 11.
Beginning February 1, 2016, DHS will provide summary data about waiting list urgency categories to the public on an annual basis.
By February 2017, DHS will create a final electronic record system that may work with the state's electronic assessment system to track the urgency of need categories across the DD, CAC, CADI and BI waivers. Corresponding training and support will be offered to lead agencies before this date. This system will replace the temporary electronic record system.
DHS will participate in an upcoming discussion on waiver waiting lists, hosted by the National Association of State Directors of Developmental Disabilities Services.

For additional details on this report, see page 150 of the December 22, 2014 report to the court monitor.

December 31, 2014

The court monitor issued a report on Olmstead Plan deliverables: In this report, the court monitor notes that the current functioning of the Subcabinet and the OIO with regard to completing deliverables (reports, plans and analyses) is unacceptable. Of 26 deliverables due this past summer and fall, requirements in seven instances (27 percent) were completed and those in 19 (73 percent) have not been completed. Compliance is routinely very late. The Olmstead Implementation Office and its supervisory Subcabinet do not have a system which operates effectively to track and ensure timeliness, or to explain lateness, with regard to deliverables. This must be fixed immediately. The Subcabinet was required to issue a foundational report by August 31, 2014 on the staffing, funding and responsibilities of the Olmstead Implementation Office and on oversight and monitoring structure described above, including timelines for completion of any outstanding items. That report has not yet been issued. There is a failure to articulate a clear function for the OIO. Pursuant to the Court's order of September 3, 2014, the court monitor finds defendants in NON-COMPLIANCE with the

Olmstead Plan as described in this report and recommends that the Court act with regard to said non-compliance. In addition, the court monitor stands ready to oversee and supervise defendants' activities under the Olmstead Plan with the goal of ensuring their substantial compliance.