Thursday, April 7, 2016

Illinois : Proposed bill creates new system for "Continuum of Care" centers

"Molly Bourke's Journey" is about one of the 600 people with developmental disabilities who receives services from Misericordia in Chicago, Illinois.

An article in the Illinois Herald News by Lauren Leone-Cross, 4/2/16, reports on a bill before the Illinois House of Representatives that would create a new licensing system for "Continuum of Care" centers for people with developmental disabilities:

"The bill [HB 6304] would allow the state to apply for a federal waiver under Section 1115 of the Social Security Act, allowing for 'an alternative model' of licensing, reimbursement and quality assurance. Such a waiver allows states to test out experimental and pilot programs that do not necessarily meet federal Medicaid and Children's Health Insurance Program rules." 

The legislation is being pushed with strong support from the Chicago nonprofit Misericordia, "a 31-acre continuum of care campus that services more than 600 people with a staff of 1,000." Advocates, such as the Centers for Independent Living, who oppose everything but "full community inclusion" are rallying opposition to the bill.

"Sister Rosemary Connelly, [Misericordia's] longtime director, said this alternative care method provides a choice for families of those with severe developmental disabilities.

"'Community-integrated living arrangements are not for everyone, yet it's perceived as the 'right and only way,'" Connelly said.

“'[Opponents] are really denying families the right to choice,' she added."

Federally-funded advocates who oppose the bill, claim that it violates the U.S. Supreme Court's 1999 Olmstead decision that they say mandates full community integration. This is a misinterpretation of Olmstead that is so prevalent among advocacy organizations that promote full inclusion and many government agencies that it can only be described as a purposeful misstatement of the Supreme Court decision.  

Olmstead affirms the Americans with Disabilities Act (ADA) regulation that says that "a public entity must administer services, programs, and activities in the most integrated, least restrictive setting appropriate to the needs of qualified individuals with disabilities."
[28 C.F.R. § 35.130(d)] [emphasis added]

Neither the ADA nor Olmstead support only community care or only institutional care: 

"[O]ne conclusion seems plain: some disabled individuals can benefit from community placement, and some may not. While all disabled are covered by the ADA, different remedies are recognized by the statute for different degrees of disability." [Brief at VOR et al., as Amici Curiae, in Olmstead v. L.C., at 6 (February 3, 1999)]

Under the Illinois Continuum of Care system proposed by the bill, I wonder if it would be  possible for Intermediate Care Facilities and other institutional and group settings for people with intellectual disabilities to become vital resources for their surrounding communities. This could be done by waiving part of the Home and Community-Based settings rule from CMS that makes it nearly impossible to open these facilities to non-residents living in the community. 

The current policy is to close facilities and release their residents into communities that are often unprepared for them and lack needed specialized services. More often than not, "the community" fails to live up to a utopian vision of community inclusion. 

According to the news article, "under the bill, continuum of care facilities would be required to provide community-integrated living arrangements near their campuses, employment opportunities, training programs and skilled-nursing residential care."  

This blended system with Continuum of Care centers acknowledges the need for a "Continuum of Care" to meet the "Continuum of Needs", especially for people with the most severe developmental and behavioral disabilities.

More on Misericordia...

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