Olmstead Plan Chronology

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

2016

January 4, 2016

A gap report on the Olmstead Subcabinet was approved by the Olmstead Subcabinet and released to provide updates on:

The number of people who had moved from segregated settings into more integrated settings (n = 700).
The number of people who were no longer on the waiting list (n = 412 for CADI and n = 129 for DD).
The results of any Quality of Life measures from March 1, 2015 to September 30, 2015.

Since goals for the number of individuals moved from ICFs/DD, from Nursing Facilities, and from Minnesota Security Hospitals (MSH) into integrated settings were met, these settings were earmarked for new goals in the August 10, 2015 Olmstead Plan update. Also included in the update were goals to eliminate certain waiting lists over specified time periods and goals related to reasonable pace standards.

January 25, 2016

The role of the OIO was established by the Olmstead Subcabinet and involved:

Quality assurance and accountability, including compliance evaluation, verification, and oversight.
Engagement with the community, especially people with disabilities, including on-going management of communications and the Quality of Life Survey.

Additionally, Olmstead Subcabinet procedures were revised. A full list of procedure revisions can be found in the Subcabinet meeting minutes, beginning on page 6.

February 11, 2016

DHS released the first bulletin in a three-part series on requirements for person-centered principles and practices for people who receive publicly funded services in Minnesota. The bulletin was developed to provide a comprehensive introduction to person-centered principles and practices, including reasons for using person-centered practices, what person-centered means, and an overview of requirements to implement person-centered planning from federal rules and requirements, state rules, state statutes, and court settlement agreements.

February 12, 2016

The Chair of the Olmstead Subcabinet, Mary Tingerthal, submitted a proposed compliance, evaluation, verification, and oversight of plan to the Court. The purpose of the letter was to set forth the procedures that the OIO, under the guidance of the Olmstead Subcabinet, intended to use in carrying out its role of quality assurance and accountability, including compliance evaluation, verification, and oversight.

February 22, 2016

A Court order was issued for reporting on the Olmstead Plan outlining the submission of quarterly and annual status reports regarding Olmstead Plan implementation by DHS. Orders included details of the content of the reports as well as a reporting schedule.

Additionally, the quarterly report was approved by the Olmstead Subcabinet, including data acquired through January 31, 2016. This report included progress toward goals related to:

Movement of people with disabilities from segregated into integrated settings (n = 532).
Movement of individuals from waiting lists.
Quality of Life measurement results (not available at the time of the report).
Increasing system capacity and options for integration.

The majority of Olmstead Plan measurable goals (18 of 24) were met, on track to be met, or in process. Notable findings and planned responses include:

The 2015 goal of increasing the number of people that moved from ICFs/DD to more integrated settings to 84 was not met. In response, the state planned to increase reporting to counties about persons in ICFs/DD, and persons who were not opposed to moving with community services. DHS also planned to monitor and provide technical assistance to counties regarding timely access to the funding and planning necessary to facilitate a transition to community services. New person-centered planning and transition protocols were also being introduced, and technical assistance through different venues was focused on those helping people leaving ICFs/DD. Additionally, work was done to increase education and technical assistance on housing subsidies, and ways to work with landlords, or services available to do so. Housing access services also expanded to be available across the different waivers by MA-enrolled providers in July 2016.
The goal to reduce the percentage of people at Anoka Metro Regional Treatment Center (AMRTC) who did not require hospital level care and were awaiting discharge to the most integrated setting to 35 percent or more by June 20, 2016 was also not on track to be met. Proposed actions to help achieve the goal included:
- Exploring the feasibility of community-based competency restoration services for individuals with a Treat to Competence/Rule 20.01 commitment who do not require acute inpatient care.
- Continuing monitoring of AMRTC's monitoring and reporting on the number, percent, and length of stay for AMRTC patients under Treat to Competence/Rule 20.01 commitment on a monthly basis as part of the Olmstead workplan process.
- Optimizing lengths of stay through care management strategies, initiatives, and transition protocols to promote timely patient flow and throughput.
The goal to increase the average monthly number of individuals leaving MSH to 14 individuals per month by 10 or more by December 31, 2015 was also not met. Efforts to increase this number included working with counties (particularly Hennepin and Ramsey) to increase the number of providers that were willing and able to serve individuals transitioning into the community from MSH.
As of May 30, 2015, the goal to eliminate the CADI waiting list by October 1, 2016 appeared to be on track.

March 4, 2016

DHS released the second bulletin in a three-part series on requirements for person-centered principles and practices for people who received publicly funded services in Minnesota. The bulletin was developed to provide information to professionals at lead agencies (Developmental Disabilities-Vulnerable Adult case managers, MnCHOICES certified assessors, Moving Home Minnesota case managers, relocation services coordinators, Rule 185 case managers, targeted case managers, and waiver case managers) about the Person- Centered, Informed Choice and Transition Protocol, including defined person-centered support plans, when the protocol should be used, the skills and knowledge a person should have in order to provide person-centered planning, and essential protocol elements. The bulletin also outlined expectations for lead agencies and training and technical assistance resources for lead agencies.

April 12, 2016

A Court order was issued to submit an updated August 2015 Olmstead Plan:

Defendants will have until May 13, 2016 to submit an updated Olmstead Plan that incorporates their proposed goals for the remaining topic areas (assistive technology and preventing abuse and neglect);
If the parties require further mediated discussions, they must contact Magistrate Judge Becky R. Thorson's Chambers before April 18, 2016 for scheduling.

May 23, 2016

The quarterly report was approved by the Olmstead Subcabinet, including data acquired through April 30, 2016. This report included progress toward goals related to:

Movement of people with disabilities from segregated into integrated settings (n = 241).
Movement of individuals from waiting lists.
Quality of Life measurement results (not available at the time of the report).
Increasing system capacity and options for integration.

The majority of Olmstead Plan measurable goals (12 of 18) were met, on track to be met, or in process. Notable findings and planned responses included:

None of the goals to move people from segregated settings into more integrated settings were on track to be met. Responses included strategies such as continual monitoring and technical assistance, continued partnerships with lead agencies to improve the supply of affordable housing and knowledge of housing subsidies, and a planned expansion of housing access services (July 2016) to broaden the array of providers.
National Core Indicator data from Minnesota from 2014 to 2015 suggested that people with intellectual and developmental disabilities were mobile, and that there was room for improvement in the choice of living situation and community engagement.

Also, two new baselines were reviewed and approved by the Olmstead Subcabinet:

Transportation 1.C: In 2012: DOT maintains 620 miles of sidewalks. Of the 620 miles, 285.2 miles (46 percent) met the 2010 ADA Standard and Public Right of Way (PROW) guidance.
Community Engagement 1.C: As of April 30, 2016, there are 16 individuals employed by Assertive Community Treatment teams or Intensive Residential Treatment Services (IRTS) throughout Minnesota.

For additional details on these baselines, see page 39 of the May 23, 2016 meeting materials.

Finally, amendments to new measurable goals regarding assistive technology and prevention of abuse and neglect were reviewed and approved by the Olmstead Subcabinet:

Assistive technology: A goal was added in the lifelong learning and education topic area that worked with a set of targeted school districts. The goal was to increase the number of Individualized Education Programs (IEPs) that met the required protocols for effective consideration of assistive technology.
Prevention of abuse and neglect: The four goals included:
- By September 30, 2016, the Olmstead Subcabinet will approve a comprehensive abuse and neglect prevention plan, designed to educate people with disabilities and their families and guardians, all mandated reporters, and the general public on how to identify, report and prevent abuse of people with disabilities.
- By January 31, 2020, the number of emergency room visits and hospitalizations of vulnerable individuals due to abuse and neglect will decrease by 50 percent compared to baseline.
- By December 31, 2021, the number of vulnerable adults who experience more than one episode of the same type of abuse or neglect within six months will be reduced by 20 percent compared to the baseline.
- By July 31, 2020, the number of identified schools that have had three or more investigations of alleged maltreatment of a student with a disability within the three preceding years will decrease by 50 percent compared to baseline. The number of students with a disability who are identified as alleged victims of maltreatment within those schools will also decrease by 50 percent by July 31, 2020.

For additional details on these goals, see page 10 of the May 23, 2016 meeting minutes. May 25, 2016

DHS released the last bulletin in a three-part series on state protocols for monitoring lead agency compliance with requirements outlined in the Person-Centered, Informed Choice and Transition Protocol, including the monitoring process (e.g., waivers and alternative care, elderly waiver administered through managed care organizations, mental health services), expectations for lead agencies, and training and technical assistance resources for lead agencies.

June 1, 2016

The 2016 Olmstead Plan was amended and incorporated proposed goals for two new topic areas: assistive technology and preventing abuse and neglect.

June 21, 2016

The Court approved the June 1, 2016 update to the Plan, which included new goals on assistive technology and prevention of abuse and neglect.

June 27, 2016

Two new baselines were reviewed and approved by the Olmstead Subcabinet:

Crisis Services 4:
- Proposed baseline A: In fiscal year 2015, 89.21 percent of people received follow-up services within 30 days after discharge from the hospital compared to 88.56 percent in fiscal year 2014.
  - Associated proposed goals:
    - By June 30, 2017, the percentage of people who receive appropriate community services within 30 days from a hospital discharge will increase by one percent compared to the previous fiscal year.
    - By June 30, 2018, the percentage of people who receive appropriate community services within 30 days from a hospital discharge will increase by one percent compared to the previous fiscal year.

Proposed baseline B: In fiscal year 2015, 81.89 percent of people discharged from the hospital due to a crisis were housed five months after the date of discharge compared to 80.94 percent in fiscal year 2014.
- Associated proposed goals:
  - By June 30, 2017, the percentage of people who are housed five months after discharge from the hospital will increase by one percent compared to the previous fiscal year.
  - By June 30, 2018, the percentage of people who are housed five months after discharge from the hospital will increase by one percent compared to the previous fiscal year.
  - Crisis Services 5: Between September 1, 2015 and January 31, 2016, the average length of a crisis episode was 81.3 days.

For additional details on these baselines, see page 19 of the June 27, 2016 meeting materials.

July 25, 2016

The Olmstead Subcabinet reviewed and approved the preventing abuse and neglect and assistive technology workplans. For additional details on the work plans, see pages 13 and 33 of the July 25, 2016 meeting materials. For additional details on changes sought by the Olmstead Subcabinet, see pages 3 and 10 of the July 25, 2016 meeting minutes.

August 22, 2016

The quarterly report was approved by the Olmstead Subcabinet, including data acquired through July 31, 2016. This report included progress toward goals related to:

Movement of people with disabilities from segregated to integrated settings (n = 301).
Movement of individuals from waiting lists.
Quality of Life measurement results (not available at the time of the report).
Increasing system capacity and options for integration.

The majority of Olmstead Plan measurable goals (15 of 19) were met, on track to be met, or in process. Notable findings and planned responses included:

The June 30, 2016 goal to increase the percentage of people at AMRTC awaiting discharge to 35 percent or more was not met. To address this, it was proposed that a third level of Competency Restoration Program care be developed to treat Minnesotans accused of a crime and in need of competency restoration (a large population within AMRTC; locked community residential setting), in addition to AMRTC and MSH.
The 2016 goal to increase the average monthly number of discharges of individuals leaving MSH to 11 or more was also not on track to be met. Recommendations included MSH and county collaboration to identify individuals who were able to be served in more integrated settings while working to expand community capacity, collaboration between MSH and DHS to implement newer practices in an effort to expand re- integration options for individuals served, a proposal to increase staffing levels at MSH (funding not provided by the legislature), a bonding proposal to finish renovations to the therapeutic environment (funding not passed during the regular session), recommendations for additional resources and statutory changes to better support the mission of MSH, and specialty services necessary for patients with developmental disabilities and autism spectrum disorder, so they may be diverted (as necessary from a secure treatment setting) and reintegrated to the community in a timely fashion.
Finally, the June 30, 2016 goals to reduce mechanical restraints to no more than 369 reports and 25 approved uses for emergency mechanical restraint were not on track to be met, though the goals were on track to realize reductions overall.

September 28, 2016

The abuse and neglect prevention plan was approved by the Olmstead Subcabinet. Additionally, the Specialty Committee was formed to oversee the implementation of the abuse and neglect prevention plan as approved by the Olmstead Subcabinet, including recommendations to the Subcabinet for baselines and annual measurable goals and the provision of cost projections for key elements of the Plan.

September 29, 2016

Work plans for the 2016 Olmstead Plan were developed. In addition to the preventing abuse and neglect and assistive technology workplans, Plan modifications were made to the person- centered planning, transition services, employment, and lifelong learning and education topic areas. Workplans covered a one- to two-year time span. They were intended to be flexible blueprints capable of modification when necessary to better accomplish strategies. By developing and then regularly reviewing the agency workplans, the Olmstead Subcabinet, the OIO, and the public would be able to see that work was being done to support the achievement of the measurable goals in the Olmstead Plan.

October 2016

The CADI waiver waiting list was eliminated.

October 6, 2016

The Improve Group was selected for the administration of the Quality of Life Survey.

October 24, 2016

The Specialty Committee's charter was approved by the Olmstead Subcabinet. The Specialty Committee was responsible for the following areas:

Establishing a comprehensive public awareness campaign targeted on the prevention of abuse and neglect to educate people with disabilities and their families, which included the bulleted items in the charter.
Beginning discussions with state agencies regarding establishing a multidisciplinary approach to address violence committed against people with disabilities.
Providing recommendations to the Subcabinet for baselines and annual measurable goals and cost projections for key elements of the Plan.

For additional details on the Specialty Committee's charter, see page 25 of the October 24, 2016 meeting materials. For additional details on changes sought by the Olmstead Subcabinet, see page 5 of the October 24, 2016 meeting minutes.

The Community Engagement Advisory Workgroup Charter was also reviewed and approved by the Olmstead Subcabinet. The workgroup strategically focused on:

Strengthening community engagement between members of disability communities and the OIO and state agencies on matters impacting the implementation of the Olmstead Plan.
Supporting the implementation of a communication plan for diverse communities with disabilities.
Supporting the public input processes for amending and extending the Olmstead Plan.

For additional details on the workgroup's charter, see page 29 of the October 24, 2016 meeting materials. For additional details on changes sought by the Olmstead Subcabinet, see page 6 of the October 24, 2016 meeting minutes.

November 21, 2016

The quarterly report was approved was by the Olmstead Subcabinet, including data acquired through October 31, 2016. This report included progress toward goals related to:

Movement of people with disabilities from segregated to integrated settings (n = 276).
Movement of individuals from waiting lists.
Quality of Life measurement results (not available at the time of the report).
Increasing system capacity and options for integration.

The majority of Olmstead Plan measurable goals (15 of 19) were met, on track to be met, or in process. Notable findings and planned responses included:

The 2016 goal to increase the average monthly number of discharges of individuals leaving MSH to 11 or more was not on track to be met. Recommendations included MSH and county collaboration to identify individuals who were able to be served in more integrated settings, collaboration between MSH and DHS to implement newer practices in an effort to expand re-integration options for individuals served, and convening a task force on mental health (planned for November 2016) as directed by executive order from the governor.
As expected, based on the prior quarterly report, the June 30, 2016 goal to reduce mechanical restraints to no more than 369 reports was not met.
The 2015 goal to increase the number of passenger trips to 13,129,593 was not met, though it was noted that the lack of success in this area may have been due to decreased gasoline prices. That is, low gas prices may have been a contributing factor to the decrease in ridership.
Finally, the June 30, 2016 goal to increase the percentage of adults who received adult mental health crisis services and remained in their community (e.g., home or other setting) after crisis to 84 percent was not met, though it was noted that the lack of success in this area may have been due to changes in reporting requirements.

Additionally, the Quality of Life Survey Workgroup Charter was reviewed and approved by the Olmstead Subcabinet. The workgroup was created to provide support and guidance to the Improve Group and OIO to sustain the survey administration plan's progress. The charter included deliverables and benchmarks to keep the process on track. For additional details on the workgroup's charter, see page 49 of the November 21, 2016 meeting materials.

December 19, 2016

The 2016 annual report on Olmstead Plan implementation was approved by the Olmstead Subcabinet, including data acquired through October 31, 2016. This report included progress toward goals related to:

Movement of people with disabilities from segregated to integrated settings.
Movement of individuals from waiting lists.
Quality of Life measurement results.
Increasing system capacity and options for integration.

This annual report covered the 48 measurable goals in the Olmstead Plan. Thirty-eight of the annual goals were either met or were in process. Ten annual goals were not met. Significant strides were made in the implementation of the Olmstead Plan. Two milestones that represented meaningful change in the lives of people with disabilities in the state of Minnesota included:

The CADI waiver waiting list was eliminated as of October 1, 2016. This represented a significant number of individuals with disabilities who gained access to housing and supports, providing the opportunity to successfully live in the community.
In addition, as of the November 2016 quarterly report, the number of individuals approved for use of mechanical restraint was reduced to 13, an all-time low. This was a noteworthy trend in the right direction.

The Olmstead Subcabinet took several steps in the last year to review and update the Plan and workplan activities. With the assistance of the Court, State agencies developed new Plan goals in the areas of assistive technology and preventing abuse and neglect. The June 1, 2016 Olmstead Plan update incorporated the adopted goals and related strategies. The Court approved the updated Plan on June 21, 2016. State agencies also took a number of steps to update workplan activities. The Olmstead Subcabinet adopted new workplan activities for the new assistive technology and preventing abuse and neglect goals and strategies in July 2016. Many other successes were realized within specific domains and can be found in the annual report highlights.

\Additionally, several amendments to Plan goals were reviewed and approved by the Olmstead Subcabinet. For additional details on updates to measurable goals, see page 73 of the December 19, 2016 meeting materials and page 4 of the meeting minutes.