Bill Promoting Olmstead Plan Passes RI Senate

By Gina Macris

The Rhode Island Senate on May 21 passed a bill that would lead to an Olmstead plan for funding an array of community-based health and human services to prevent the unnecessary segregation of children and adults with disabilities.

The bill is moving through the General Assembly at a critical time, just a week after U.S. Attorney Zachary A. Cunha alleged the state has failed “miserably and repeatedly” to meet its legal obligations to provide appropriate services to children with mental health and developmental disabilities in their communities.

Instead, children and adolescents have been “warehoused” at the state’s only children’s psychiatric hospital, Bradley Hospital in East Providence, Cunha said, calling the state’s reliance on a single option an “appalling failure.”

The state must respond by tomorrow, May 23, to alleged violations of the Integration Mandate of the Americans with Disabilities Act (ADA), according to a spokesman for Cunha.

The Senate’s proposed Olmstead plan takes its name from a 1999 U.S. Supreme Court decision which reinforced the Integration Mandate of the ADA. The decision said the ADA requires public services for people with disabilities to be offered in the least restrictive environment that is therapeutically appropriate, and that environment is presumed to be the community.

Rhode Island is the only state in New England and one of seven in the nation that does not have an Olmstead plan, said Sen. Louis DiPalma, D-Middletown, in describing the bill on the floor of the Senate.

Last week’s allegations of civil rights violations serve as a prime example of the reason the state needs such a plan, said DiPalma, the chief sponsor of the legislation.

The bill, which has been sent to the House, would establish a 25-member commission to make annual recommendations for “integration for all” to the governor and the General Assembly, beginning on Jan. 15, 2025. The bill also requires the commission to do a comprehensive assessment of needs and accomplishments every five years.

More immediately, a spokeswoman for Governor Dan McKee has said the state will cooperate with the DOJ to resolve the brand new Olmstead civil rights allegations.

The findings, the result of a joint investigation of the U.S. Attorney’s Office and the Department of Health and Human Services, make two broad recommendations:

· The state must ensure that existing community-based services are available in sufficient quantity to prevent long and repeated hospitalizations at Bradley. These services include intensive in-home and community services, crisis services, and therapeutic foster care.

· The state Department of Children, Youth, and Families must make improvements in discharge planning to smooth the way for a prompt transition to the most integrated setting that is appropriate.

Rhode Island has a new law that could go a long way toward adequately funding community-based children’s services and satisfying the demands of the Olmstead complaint.

In 2022, the General Assembly enacted a requirement that all federal-state Medicaid reimbursement rates for struggling community-based social and human services undergo a review every two years by the Office of the Health Insurance Commissioner (OHIC).

The first OHIC rate review recommended hefty hikes which would have cost an estimated $90 million in state revenue in a single year, according to a spokeswoman for Governor McKee.

That does not include more than $50 million for health care providers outside the OHIC review and $29.1 million for Certified Community Behavioral Health Clinics, she said.

The governor has recommended implementing the recommended OHIC rates over three years, including $22.1 million that would represent the state’s share of the federal-state Medicaid match in the next fiscal year. He would also slow the pace of future rate reviews in each of four categories of services to once every four years.

But companion bills sponsored by DiPalma and Rep. Tina Spears, (D-Charlestown, South Kingstown, New Shoreham, and Westerly,) in the House would require the governor to use figures from OHIC rate recommendations in his budget. It would also require the twice-yearly caseload estimating conference to adopt the latest OHIC rate recommendations in advising the governor and the General Assembly on Medicaid costs for the next budget year.

In an email to supporters, Spears says those two bills “gained traction” after 100 advocates went to the State House May 14.

Grass roots advocacy for those relying on a broad array of community-based health and human services has been a hard slog for nearly 15 years.

In 2014, the state entered into an Olmstead consent decree with the DOJ to end the segregation of adults with developmental disabilities. It was not until 2021, when it faced the threat of heavy fines for alleged non-compliance, that the state began overhauling Medicaid rates to community service providers and changing its approach to services for adults with developmental disabilities.

Those changes are still underway, and federal oversight continues in the developmental disabilities case.

RI Senators Urge "Urgent Action" On Children's Mental Health And Behavioral Needs

Joshua Miller Sandra Cano Alana DiMario Louis DiPalma Valarie Lawson

Five RI State Senators respond to May 13 findings of the Department of Justice that the state has violated the civil rights of children and adolescents “warehoused” in a psychiatric hospital because it failed to appropriate therapeutic treatment in the community.

By Senators Sandra Cano, Alana DiMario, Louis DiPalma, Valarie Lawson and Joshua Miller

“We are not meeting our shared obligation to some of Rhode Island’s most vulnerable children,” we wrote in 2021, in an opinion piece intended to highlight the urgent need to improve our treatment programs for youth with behavioral health issues, and particularly girls. “This is an emergency. It is also an equity issue that needs to be addressed as soon as possible.”

It is extremely troubling that those same words are just as applicable today as they were when we first wrote them.

On May 13, US Attorney Zachary A. Cunha described an “appalling failure” of our state to appropriately meet the needs of children with behavioral health issues, particularly girls. He outlined a situation in which hundreds of Rhode Island children were hospitalized, usually at Bradley Hospital, for unnecessarily lengthy periods of time.

We are failing these children, and, frankly, it is unjustifiable.

So again today, we are calling for urgent action to address this situation. We need to work together – all of us, the Legislature, Governor McKee, the Department of Children Youth & Families (DCYF), the Department of Education (RIDE) – to address the systemic failures that have led to this situation.

Firstly, it is important to say how much we value and respect the work taking place at the DCYF and RIDE. We appreciate the difficulty of the jobs they do and their dedication to the children and families in our state.

Let us all work together, with increased urgency, to provide sustained investments in supportive services throughout the continuum of care, including at home and at school – and in those services between counseling and hospitalization – to ensure our children receive the supports they need in the most appropriate settings.

These issues have been – and continue to be – priorities for us in the Senate. We have advanced legislation and conducted several oversight hearings with DCYF and RIDE in our efforts to improve treatment and to ensure that children are receiving quality education regardless of their placement. To that end, it is absolutely imperative that RIDE ensure all children, including those placed at Bradley, have an educational plan in place.

In the Senate, we have prioritized – and in 2022 the General Assembly provided $57 million to fund – two residential treatment facilities, one for psychiatric treatment and one for behavioral health treatment. While it is important that these facilities are brought online as expeditiously as possible, this will not be enough to solve the problems we are facing, as Mr. Cunha noted.

The General Assembly also appropriated $22.9 million in wage stabilization funds to help DCYF recruit and retain qualified staff. However, these funds were temporary by nature. Another critical step is for the department to enter into new contracts that increase reimbursement rates to providers. These contracts are long overdue, and we hope and expect that they will be awarded soon.

Additionally, we expect that the Senate will again pass legislation (S-2705) requiring DCYF to conduct periodic comprehensive needs assessments to determine whether the department’s programs and services meet the needs of children and families in their care, assess client accessibility, and collect data to develop goals and measurable objectives for new and existing programs and services. This data is an important step as we work to strategically improve our systems of care.

Finally, we need an Olmstead Plan.

The Supreme Court ruled in Olmstead v. L.C. that states must make services available to individuals with disabilities in the most integrated setting possible. That decision was in 1999. While this administration – and prior administrations – have worked towards compliance, we remain the only state in New England, and one of just a few in the nation, that lacks a plan.

Therefore, the Senate is scheduled to consider legislation (S-2618) that would create, by statute, an Olmstead Planning Commission to develop this long-needed plan to better serve people vulnerable to unnecessary institutionalization.

Too often, we have made decisions based on short-term budgetary pressures, and that has led us to the insufficient services in place today. However once in place, better care, in more appropriate settings, will not just benefit the individuals being served; it is also more cost effective.

The extremely troubling findings by the US Attorney are a reminder that we can and we must prioritize sustained investments throughout our continuum of care to better serve Rhode Island’s most vulnerable children and families.

Senators Sandra Cano (D-Dist. 8, Pawtucket), Alana DiMario (D-Dist. 36, Narragansett, North Kingstown, New Shoreham), Louis DiPalma (D-Dist. 12, Middletown, Newport, Little Compton, Tiverton) and Joshua Miller (D-Dist. 28, Cranston, Providence) are all committee chairpersons in the Rhode Island Senate. Sen. Valarie Lawson (D-Dist.14, East Providence) is Senate Majority Whip.