Recommendation 1: Technical Assistance to Assist States in Reaching the Goal of "Most Integrated Setting" |

Recommendation 2: Public Consultation to Facilitate Planning and Implementation of Programs Within States to Achieve the Goal of "Most Integrated Setting" |

Recommendation 1: Technical Assistance to Assist States in Reaching the Goal of "Most Integrated Setting"

The  Department of Health and Human Services, in conjunction with ASPE, HCFA, and other federal agencies, as appropriate, should conduct a nationwide program of technical assistance designed to assist states in reaching the goal of "most integrated setting" and community-based placement for people with disabilities who require routine, on-going assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

The recommended technical assistance program should be designed and conducted with substantial input from people with disabilities and organizations representing people with disabilities. Such individuals and groups should be employed by the program as advisors, consultants, program designers, and trainers. Preference should be given to individuals with disabilities and organizations of individuals with disabilities, including centers for independent living, in the process of awarding grants and contracts which may be associated with this initiative.

The recommended technical assistance program should include multiple components, including on-site training of regional Health and Human Services staff and state Medicaid personnel; on-going meetings with consumer groups; on-site consultation; remote consultation via telephone and Internet; one or more regional and or national training programs; and support materials and information necessary to carry out the program effectively.

The technical assistance program should assist states with program design, including the development of service delivery options. It should assist states in maximizing their use of the existing flexibility in Medicaid to improve access to high quality long term services in most integrated settings as required by the ADA. It should also assist states in developing successful methods for involving consumers in program design, delivery and continuous improvement.

The technical assistance program should assist states in addressing liability issues, particularly with respect to health-related personal assistance service activities. Additionally, it should assist states with issues pertaining to personnel development, personal assistant recruitment programming, and personal assistant training.

In general, the technical assistance program should address all issues pertinent to the development and operation of a state-wide infrastructure designed to support the provision of personal assistance services and other related services necessary to reach the goal of "most integrated setting". In each state, this program should be guided by a technical assistance advisory committee which includes consumers, consumer representatives, state agency personnel, and representatives of public and private service providers.

The technical assistance program should make demonstration grants available to states for the following purposes:

• Demonstration funds will be available to assist states with minimal experience to develop necessary skills and infrastructure to achieve the goal of "most integrated setting," and
• Demonstration funds will be available to facilitate the transfer of "best practices" in relation to the goal of "most integrated setting," from state to state.

The goal of this technical assistance program should be to insure that every state develop policies and programs that achieve the goal of "most integrated setting" for each eligible program participant in that state.

Return to Top of Page

Recommendation 2: Public Consultation to Facilitate Planning and Implementation of Programs Within States to Achieve the Goal of "Most Integrated Setting"

The Department of Health and Human Services, in conjunction with ASPE, HCFA, and other federal agencies as appropriate, should conduct a series of public discussions on the subject of "most integrated setting".  At least one such discussion should be held in each federal region. These meetings should be designed to:

• Promote understanding of the concept of "most integrated setting";
• Receive recommendations related to the elimination of institutional bias in HCFA-sponsored and other public programs, as appropriate;
• Receive reports and recommendations about progress toward reaching the goal of "most integrated setting"; and
• Facilitate the process of planning to achieve the goal of "most integrated setting" within states by providing an appropriate forum for consumers and advocates, including representatives from the aging community, the developmental disabilities community, independent living centers, and other interested parties to work together with state Medicaid officials and others, as appropriate, to develop implementation plans for their respective states.

The format for these public discussions should include:

• Plenary style presentations by federal and regional officials, and by consumers and their representatives relative to the public goal of "most integrated setting";
• Small group working sessions to include representatives of consumers and state agency personnel from each state within the region designed to facilitate planning and implementation of activities within states aimed at the goal of achieving "most integrated setting" placement for all eligible program participants; and
• An open forum for public discussion, particularly including invited input from representatives of the aging community, the developmental disabilities community, and centers for independent living.

The National Blue Ribbon Panel on Personal Assistance Services is staffed by ILRU (Independent Living Research Utilization program at TIRR).  Project support is provided, in part, by a grant from the Robert Wood Johnson Foundation. Recommendations and other products of the Blue Ribbon Panel do not necessarily reflect the views or opinions of the Robert Wood Johnson Foundation, ILRU, or any of the groups or organizations whose representatives or members serve on the Panel.  For further information, please contact Lex Frieden at (713) 520-0232 ext. 124.