big 3 priorities

1. Olmstead & the ADA [Americans with disabilities Act]
2. Parity, and
3.  Medicaid Network AdequACy 



A breakdown of 1-18 of DOJ's Q&As on Olmstead

States have Federal Contracts in which they agree to comply with Federal Law

Why isn't the burden on the States to show they are complying with Olmstead -- Measurable Goals, Reasonable Time Frames & Funding to Support the Plan

      The US Dept of Justice 2011 Guidance looks pretty good, and in a lot of ways it is.

       But if the test is actual enforcement across the Country -- it has fallen pretty short.

         It is largely based on the idea that "Plaintiffs" will do the "complicated" investigations involved in these cases -- for the most part the Department of Justice doesn't have the resources.

         DOJ is largely relying on the Federally mandated Protection and Advocacy Offices to spearhead the investigations -- and some of them have -- but many don't have the resources.

          Further, if DOJ doesn't have the resources, and the P&As don't have the resources, individuals with disabilities and their advocates often don't have the resources.

            Now there are some good cases out there and even the guidance to the right -- but when most States ignore what are designed to be models & templates for the States so every disability group across the country doesn't have to re-litigate these things -----it is no wonder you have most States that haven't complied with Olmstead after almost 20 years.        

         From our perspective, the process doesn't make sense and really needs to be handled administratively with presumptive benchmarks based on the:
  • Current service and housing provision
  • Unmet Need
  • Etc.

         We desperately need States to come to the Table ready to 
work on:
  • Measurable Goals
  • Reasonable Time Frames, &
  • Funding to Support the Plan

​


​CO IS NOT applying parity analysis correctly

CMS Parity Analysis

10.  Implement Any Changes Needed To:
  • The Medicaid State Plan
  • ABP State Plan
  • Child Health Plan
  • MCO/PIHP/PAHP Contract
          [Managed Care Organization, Prepaid Inpatient Health Plan,
           Prepaid Ambulatory Health Plan]
  • MCO/PIHP/PAHP Rates
  • State Policies & Procedures
  • MCO/PIHP/PAHP Policies and Procedures
 
 Implement any changes needed to the Medicaid state plan, ABP state plan, child health plan, MCO/PIHP/PAHP contract, MCO/PIHP/PAHP rates, state policies and procedures, MCO/PIHP/PAHP policies and procedures, and so forth, in order to meet parity requirements by the applicable compliance date.

[This is a really important point and one Colorado State Government seems very confused about – HCPF video -- https://youtu.be/x5AiubAV7BI

According to the State:

"What the Law Does NOT Require?"
  • ​A MCO or BHO to provide MH/SUD benefits outside the contractual Obligations.

​BUT the law is CLEAR the State has a legal duty to change the State Medicaid Plan, Contractual Obligations, Etc. to Comply with Parity

We first mentioned this in April 2018 – and that misleading video is still up & we had informed the State of the problem before that.

http://orchidadvocacy.org/vals-blog/hcpf-is-mis-stating-parity-law-on-youtube-we-have-a-big-problem-with-that-weve-got-an-even-bigger-problem-with-hcpfs-misapplication-of-parity-in-co-medicaid
 
 


It's really about democracy & whether our laws mean anything or Not

Process, Process & Process
  • States are pretty good @ declaring themselves in compliance with various disability civil rights laws
  • The reality is generally pretty messy.
  • We're going to be focusing a lot on the processes the State is using or isn't using to comply with:
    • ​Olmstead/ADA
      • ​Measurable Goals
      • Reasonable Time Frames
      • Funding to Support the Plan
    • Parity
    • Medicaid Network Adequacy
42 CFR 438.88(a) & (b)

​9 Minimum Federal Requirements for States' 
Development of Medicaid Network Adequacy Standards

42 CFR 438.68(c)

So What is the Plan?
  • Develop a number of "Checklists" regarding State compliance with:
    • ​Medicaid Network Adequacy
    • the Mental Health Parity and Addiction Equity Act of 2008 as it relates to Medicaid;
    • The Olmstead Decision and Requirements on States to develop
      • ​Meaurable Goals
      • Reasonable Time Frames &
      • Funding to Support the Plan
  • Use those as a basis of discussion with Advocates, the State, and possibly CMS [Centers for Medicare & Medicaid Services] 
  • Any discussion of Olmstead involving CMS would probably be limited to healthcare
  • We may try to work with the US Interagency Council on Homelessness to get HUD to require States to comply with Housing Olmstead requirements in order to receive HUD funds.