Recommendations of the

Nevada Task Force on Disability

To the

Legislative Commission’s Subcommittee

To Study the State Programs

Providing Services to People with Disabilities

 

 

Establish, by legislative resolution, renewed by every succeeding session of the legislature,

that general legislative initiatives impacting children and adults with disabilities include consideration of the potential effects such legislation may have on their lives and access to services.

 

Develop a rider to Medicaid budgets based on the Texas model “money follows the person” for children and adults assessed to be in unnecessarily restrictive residential environments encouraged by HHS Director Tommy Thompson.

 

Assure all eligible at-risk children and adults quickly receive the assessments and Medicaid services they need through a single eligibility application for SSI and Medicaid.

Requires legislative appropriation, refer to 1) Single Eligibility, pg. 1

 

Implement a statewide system of outsourced mobile units for outreach, assessment and referral of children and adults with disabilities who are homeless and in crisis.

Requires legislative appropriation, refer to 2) Mobile Outreach, pg. 2

 

Require examination and reporting of the impacts and cost savings of assessments provided during the biennium to each session of the legislature.

 

Ensure waiting lists for services critical to community integration and avoidance of segregated service environments move at a reasonable pace, not to exceed 90 days.  Those

services are identified as medication clinics and treatment for mental illness, Home and Community Based Services (HCBS) waivers, personal assistance.

Requires legislative appropriation, refer to 3) Critical Services Waiting List, pg. 2

 

Provide a continuous allotment, through the 10% disability designation of Tobacco Settlement Funds, to: ensure families providing primary care to a severely disabled family member receive respite within 90 days of application; provide permanent funding for the state’s Positive Behavioral Supports Network at a level that, at a minimum, will support adequate training and service delivery to 1,500 families with children with autism and brain injury, and others in need of such interventions and provide home and environmental modifications to allow community access and/or return from institutional care.

Requires legislative appropriation, refer to 4) Tobacco Settlement, pg. 4

 

 

 

 

Require monitoring and reporting to each session of the legislature, the status of county paid nursing facility residents to ensure that people eligible for Medicaid services by virtue of being institutionalized and having their care paid with 50% county match monies, will be assured equal opportunity for services paid with 100% state funds should they choose to live in the community.

 

Fully implement the provisions of Senate Bill 174, the Nevada Personal Assistance Services Act, for efficacy in avoiding unnecessary entry into, and transfer from, skilled nursing facilities.

Requires legislative appropriation, refer to 5) SB 174 PAS pg. 5

 

Draft and support legislation allowing state funds allocated to the personal assistance programs administered by Aging Services and the Office of Community Based Services to be carried over into the next fiscal year so funding is not lost due to unanticipated hospitalization.

 

Provide training within personal assistance programs to ensure people with autism, other pervasive developmental disabilities and brain injury (who have a high need for a consistent and predictable environment) will obtain caregivers who understand and are trained in their individual particular characteristics and needs.

Requires legislative appropriation, refer to 6) Personal Assistant Training, pg. 6

 

Develop a Medicaid HCBS Cognitive Impairment Waiver to assure delivery of the complex and costly array of behavioral services needed by people with brain injury, autism, and other pervasive developmental disabilities and mental illness for their unique behavioral and independent living needs.

Requires legislative appropriation, refer to 7) HCBS Cognitive Impairment Waiver, pg. 6

 

Continually expand Nevada’s Medicaid Buy-In Program to equitably provide, by 2008, medical insurance coverage or wraparound to all people with disabilities who, by virtue of becoming employed, have established an income above poverty level, but cannot obtain the health care coverage and services required to terminate reliance on public benefits.

 

Expand funding to the on the Homeless Mentally Ill Outreach initiative (H.O.P.E. –

Homeless Outreach Pilot Education) program to implement ongoing programs providing intensive outreach and case management services including immediate access to necessary medications and housing.

Requires legislative appropriation, refer to 8) Project HOPE, pg. 7

 

Establish, by legislative resolution that, effective July 2003, critical health, mental health, nutrition and personal assistance services to children and adults with disabilities, poor children and frail seniors are exempted from budget cutting during economic downturns.

 

Ensure appropriate provider rates for personal assistance are established, adopted by the Nevada Legislature and implemented for all state programs.

Requires legislative appropriation, refer to 9) Provider Rates, pg. 7

 

Require annual monitoring and reporting, to the Legislative Committee on Children and Families, of progress on Project IMPRV, Self Improvement Plans, IDEA Parts B and C.

 

In collaboration with Nevada counties and United Way organizations, establish and fund a

2-1-1 universal access line with a supplementary No Wrong Door website and community level call centers providing information, referral and resolution assistance for people with disabilities and their families.

Requires legislative appropriation, refer to 10) No Wrong Door, pg. 8

 

Establish a state Office of Disability Services within the Department of Human Resources at the director’s level based on the New Jersey model.

Requires legislative bill draft. 

 

Develop regulatory change and implement course work leading to an AA degree in Independent Living at the community college and/or university level which will allow people with mental retardation, pervasive developmental and cognitive disabilities to earn such degrees while benefiting from campus learning experiences which will better prepare them for a life of integration and inclusion.

 

a.  Provide through Legislative Resolution that:

·        budget planning, decision-making and rate setting for one or more disability populations or services does not occur in isolation of the others, e.g., supported living arrangements for people with mental retardation vs. those with brain injury/autism, personal assistance for those with physical disabilities vs. those with mental illness, autism, mental retardation; and,

·        legislative budget requests and forecasting recognize and include the needs of people with severe disabilities and their families with incomes above Medicaid limits, but unable to afford the critical personal assistance, respite, health care, environmental modifications and medications needed to avoid family disruption, impoverishment, exacerbation of disability and institutionalization.

 

b.      Develop legislative bill draft requests to:

 

·        Implement a legislative interim study to comprehensively review, evaluate and recommend improvements in state and be sure to take out data systems for efficacy in providing consistent cross-agency information and meaningful client specific service outcomes needed for decision-making, planning, budgeting, tracking and monitoring costs and outcomes of disability services provided.

Requires legislative appropriation, refer to 11) Data System Review, pg. 8

 

·        Conduct an independent study examining the restructuring of state agency service provision to outsource, through a community grants and voucher systems, all direct service, care and case coordination to non-profit and private entities to strengthen and add independence to planning, coordination and quality assurance functions at the state level.

Requires legislative appropriation, refer to 12) Agency Outsourcing, pg. 8

 

Add responsibility for assessing the quality, effectiveness and/or need for policy/systems change in long-term care and service delivery to adults and seniors with disabilities to the “Powers” of the Legislative Committee on Families and Youth. (NRS 439B.200)

Add responsibility for assessing the quality, effectiveness and/or need for policy/systems change in long-term care and services to children with disabilities and their families to the "Duties" of the Legislative Committee on Children, Youth and Families.

 

Utilize the State Disability Consortium to develop and implement uniform statewide quality assurance measures in all state programs serving people with disabilities to evaluate and report impact, outcome, and consumer satisfaction; consistently solicit consumer perspectives for program improvements; and, assure service provision in the most integrated setting appropriate to individual in need.  Report biennium outcomes to legislative Committees on Health Care and Children and Families.

 

Establish a cabinet level position to coordinate planning across systems, agencies and disability populations, monitor implementation of strategic planning goals; ensure compliance with provisions of Olmstead and the ADA, oversee the development of a comprehensive, cross agency, data system and assure coordination of state and county resources.

Requires legislative appropriation, refer to 13) Chief Deputy for Disability Issues, pg. 9

 

Establish an independent, community-based, Disability Ombudsman within one or more legal services entities qualified to receive legal filing fees under NRS 19.031 with statewide responsibility for mediating “integrated settings issues,” related to provisions of the Olmstead Decision, the Americans with Disabilities Act, the Individuals with Disabilities Education Act (IDEA), which remain unresolved after exhaustion of available remedies.

Requires legislative appropriation, refer to 14) Disability Ombudsman, pg. 14

 

Support passage of legislation to include ADA accessibility guidelines within the State Building Code.

Requires legislative bill draft. 

 

Identify and transfer people in institutional care who can be served in the community, and who do not oppose such transfer, assuring appropriate discharge planning, transitional supports and targeted services coordination in the process.

May require legislative appropriation, if not, possible to fund with Title XX refer to 15) Institutional Transfer, pg. 9

 

Ensure waiting lists for medically necessary services to children with disabilities move at a reasonable pace.

Requires legislative appropriation, refer to Children’s Services, pg. 10

 

Increase state unit funding to school districts to reduce the proportion of local district funds needed for special education.

Requires legislative appropriation, level of funding unknown.