Maryland

Task Force

The Community Access Steering Committee under the Maryland Department of Health and Mental Hygiene, created by an executive order, conveyed its recommendations to the governor on July 13, 2001. The committee consisted of the secretary of Health and Mental Hygiene, the director of the Governor's Office for Individuals with Disabilities, the secretary of Budget and Management, a representative from the governor's office and up to six additional members appointed by the governor. The steering committee broke into four work groups: 1) the Mental Health Community Access Task Force, 2) the Medicaid Community Access Task Force, 3) the Developmental Disabilities Community Access Task Force, and 4) the Systems Integration Task Force.

The Plan

The recommendations focus on three major goals: 1) building community capacity, 2) helping people who currently are in institutions move to the community, and 3) helping people stay in the community.

• Building Community Capacity
• Recommendation A: Improve compensation for community-based direct care workers by increasing and restructuring reimbursement rates in the Medicaid Personal Care Program, making an automatic annual inflationary adjustment in public mental health system rates for community mental health services, and increasing compensation for direct care staff who support people with developmental disabilities in the community.
• Recommendation B: Enhance efforts to coordinate and develop affordable, accessible housing for people with disabilities by convening a workgroup to implement strategies to increase the availability of housing resources; creating a housing liaison function between the Department of Health and Mental Hygiene and the Department of Housing and Community Development to coordinate problem-solving and resource development; and initiating efforts to more effectively work with local public housing authorities to ensure they are aware of the needs of individuals with disabilities and are able to address them in ways such as setting aside a portion of their vouchers for people who want to leave institutions.
• Recommendation C: Enhance the availability of accessible transportation for people with disabilities by exploring opportunities to develop pooled funding on a regional basis so limited transportation funds could be expanded and by expanding the responsibilities of the State Coordinating Committee for Human Services to more comprehensively address transportation needs.
• Recommendation D: Create an Inter-Agency Workgroup, including state agencies, to coordinate programs for people with disabilities.
• Helping People Move from Institutions to the Community
• Recommendation E: Fund and support department plans to help individuals make the move from state-operated facilities to the community by continuing to help individuals with mental illness make the transition from state psychiatric hospitals to the community and people with developmental disabilities from state residential centers to the community and by conducting peer outreach and other education efforts in institutional settings.
• Recommendation F: Fund and support efforts to help individuals make the transition from private facilities that serve individuals who are receiving government assistance by conducting outreach and education in nursing homes and chronic hospitals, providing assessment services to individuals who self-identify or are referred with the individual's consent, expanding the Medicaid waiver for adults with physical disabilities and the waiver for older adults, establishing a transition fund to assist individuals who move from private facilities to the community, and making changes to the financial and medical eligibility criteria for Medicaid.
• Helping People Stay in the Community
• Recommendation G: Promote education and counseling on community options by pursuing measures to inform the public about community integration, enhancing awareness and understanding of state programs that support people with disabilities, and expanding anti-stigma programs in the community.
• Recommendation H: Ensure appropriate access and coordination between various public programs and private insurance by pursuing private insurance coverage of evidence-based best practice community support services, changing Medicare and Medicaid to make allowable reimbursements comparable, developing and implementing a plan for acute and private hospitals to ensure no disincentives exist to admit and treat patients, and exploring opportunities to remove barriers to employment for people with disabilities.
• Recommendation I: Expand crisis response and respite care programs for people who live in the community.

Implementation

On April 3, 2002, the governor signed into law House Bill 752. This law requires that social workers provide to nursing facility residents a one-page information sheet that explains the availability of services under the home and community-based waiver programs, explains that the resident's care is partially or fully reimbursed by the program, and provides information regarding the referrals to residents that may provide additional information. It directs the Department of Health and Mental Hygiene, in consultation with other state agencies, to prepare, distribute and update the one-page information sheet, which must be given to residents upon admission, discharge and at least annually upon request.

In 2001, the Maryland General Assembly passed legislation to increase the number of people to be served through the existing Community Attendant Services and Support Program Waiver. Budgeted at $10 million in FY 2002, the program permits individuals to select, manage and control their services and to choose their personal assistants, including hiring family members (except spouses).

The state received $100,000 from The Center for Health Care Strategies, funded by the Robert Wood Johnson Foundation, for planning to improve long-term care services cross-disability.

For an update on Williams vs. Wasserman in Maryland and lawsuits in other states, see Status Report: Litigation Concerning Medicaid Services for Persons with Developmental and Other Disabilities by Gary A. Smith at http://www.hsri.org/index.asp?id=news

The state received a $1.025 million Real Choice Systems Change Grant. The money will be used to:

• Develop a pilot project to provide outreach to people in hospitals to inform them of community-based long-term care options to prevent unnecessary institutional placement. The project will include working with a hospital discharge planner to inform individuals of community-based services and programs at the point of discharge from the hospital. This initiative also includes funding to develop educational materials to inform individuals about community-based programs in Maryland.
• Target efforts to increase the community long-term care workforce. This includes hosting provider job fairs across the state targeted to direct care workers where technical assistance with completion of the provider applications and specific qualifications can be provided.
• Develop a capitated demonstration program to better serve children with serious emotional disturbances (SED).
• Develop performance measures for community-based, long-term care programs. This includes development and implementation of consumer satisfaction surveys for Maryland's community-based programs.