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Questions for Evaluating Olmstead Compliance in Your State

1. Does your state have a formal Olmstead Plan, a state policy that implements the most integrated setting? Does it list by year the number of people who will be diverted from entering nursing homes (NH)? How many in NH who will be transitioned out each year? Have dollar estimates been made of what it will cost to transition or divert people out of NH each year?
2. Has your state cut or reduced home and community programs and services (e.g., waivers, PCO) while leaving nursing home programs status quo? What are the details of each program?
3. Has your state kept home and community programs at about the same reimbursement level but increased nursing home reimbursements?
4. Has your state used proportionally less drastic cuts on nursing homes than on home and community programs and services?
5. What is the pattern of funding NH and community services over the last 10 years?
6. Are there inequities in state budget policies that mandate increases for NH but not for community services?
7. Does your state do “global budgeting” (placing institution and community funds together in one budget)?
8. What are other inequities between NH and community policies and funding?
9. Do any of your HCBS programs that would divert people from NH have waiting lists? How many people are on them? How long do they wait for services? What obstacles in each program are keeping people from being placed in the community?
10. Does your state have a uniform assessment policy or form that focuses on diverting people from entering NH, such as a community integration screen? Does your state have a policy to divert people from NH? What is the state policy?
11. Does your state have a proactive process to inform people entering NH of all the programs available in the community? Could you explain what the state does before a person enters a NH? Does it use the “most integrated setting” as a criterion?
12. Has your state developed, submitted and signed a data use agreement (DUA) with CMS so it can obtain and release Q1 data (which can identify by name nursing home residents who want out)?
13. Does your state have a proactive process to inform the Q1 people of community services and programs that are available to help them move from NH to the community? Does it make referrals to community organizations such as AAAs and CILs or give assistance in relocating or transitioning? Does it have community integration coordinators? How does your state identify who wants out of a NH?
14. Does your state have a federal or state MFP project or policy? How many people have transitioned out of NH?
15. Does your state use a "too risky" criterion or require "informal care" as a reason to deny community services? Does your state make determinations that there are people in NH who are too significantly disabled to live in the community, such as “too physically ill” or “service needs too great”?
16. Does your state have a policy or program linking nursing home-eligible people to available behavioral health services that may not be available in traditional aged and disabled community programs?
17. Are there inequities in wages for the waiver or PCO work force versus the nursing home work force or inequitable wage increases for people doing similar work? Can you describe the inequities in each program?
18. Does your state have a formal policy or procedure to assist people either in NH or at risk of going into NH in obtaining affordable, accessible, integrated housing? Are there any housing coordinators or community integration coordinators available?
19. Does the Medicaid office have a relationship with the state housing office or with public housing authorities that helps people attempting to obtain housing avoid going into or getting out of NH?
20. Does your state have a policy or funding to acquire needed durable medical equipment or assistive technology that would allow people to remain or transition into the community?
21. Does your state have a nurse delegation or assignment policy or legislation to allow for qualified non-licensed people to perform health maintenance tasks?

-- Compiled by ADAPT/Institute for Disability Access