Introduction
Executive Order 13217 on Community-Based Alternatives
HHS Self-Assessment Methodology and Barrier Identification
Blueprint for Delivering on the Promise
1. Developing a Coherent, Cost-Effective System of Administration and Finance
   Eliminating Institutional Bias in HHS Programs
   Services for Persons with Mental Illness
   Improving Availability and Capability of Direct Care Workers
2. Assistance to Families and Informal Caregivers
3. Improving Coordination and Reducing Fragmentation
4. Ensuring Accountability and Fulfillment of Legal Obligations
Conclusion

Introduction
HHS: One Department Working to Promote Community Integration
Overview of HHS Programs
The Need for Community-Based Alternatives
Services and Supports Needed by Individuals with Disabilities
Who Pays: The Financing of Services and Supports for People with Disabilities
HHS Expenditures Regarding Individuals with Disabilities
Medicaid Funding of Home and Community-Based Services
HHS' Leadership in Promoting Community Integration
Personal Care and Home Health Services
Home and Community-Based Waivers
Real Choice System Change
Barriers Identified Through the HHS Component Self Evaluation and Public Input
1. Imbalance in System Structure and Financing
2. Lack of Responsiveness of Services to Meet Individual Needs
3. Need for Greater Assistance to Families and Informal Caregivers
4. Fragmentation and Lack of Coordination
5. Need for Increased Accountability and Legal Compliance
A Year of New Freedom     [17K]
HHS Community Integration Activities in 2001

1. Coherent, Cost-Effective Structure, Administration and Financing
   1. Medicaid: Eliminate Institutional Bias
      1. Immediate HCBS Reform Action
      2. Medicaid Community Services Reform Task Force
      3. Services for Persons with Mental Illness
      4. Administrative Efficiencies
      5. National Technical Assistance Strategy
      6. HCBS State Plan Option
      7. Removing Eligibility Uncertainty and Delays to Transition Qualified Persons from Institutions
      8. Services for Children in Residential Treatment
   2. Medicare: Eliminate or Reduce Institutional Bias
      1. Discharge Planning
      2. Durable Medical Equipment in Medicare
   3. Improving the Workforce Availability and Capability
      1. Direct Service Worker National Demonstration
      2. Collaboration for Direct Service Workers
   4. Productive Employment
      1. Medicaid Buy-In Improvements
2. Promoting Independence, Responsibility, and Consumer-Driven Services
   1. Person-Centered Planning
   2. Self-Directed Services Waiver
   3. Health and Disability Education and Mentoring
3. Assistance to Families and Informal Caregivers
   1. Model Waiver and Demonstration for Family and Caregiver Support
   2. 1. Medicaid Respite Service for Adults
      2. Demonstration: Respite Service for Caregivers of Children Who Have a Substantial Disability
   3. Action Plan for Children and Youth with Special Health Care Needs and Their Families
4. Coordination and Reduction of Fragmentation
   1. Coordination within HHS
      1. Establish an HHS Office on Disability and Community Integration
      2. HHS Disability Advisory Committee
   2. Coordination Among Federal Agencies
      1. Formalize Permanent Interagency Council on Community Living
5. Accountability and Fulfillment of Legal Obligations
   1. Complaint Resolution and Voluntary Compliance
      1. Alternative Dispute Resolution
      2. Regulatory Revisions To Facilitate Access To Records
   2. Specialized Technical Assistance and Related Activities
      1. Broad Dissemination of Information About Voluntary Compliance
      2. Clarification of Medicaid Policies Affecting Individuals with Psychiatric and Co-Occurring Disorders
      3. Increased Regional Efforts to Provide Technical Assistance to States and Promote Olmstead Compliance
      4. Technical Assistance on Services for Older Persons
   3. Effective Quality Assurance and Quality Improvement
      1. Develop a Multi-Pronged Strategy to Address Quality of Care Issues in HCBS
      2. Quality Improvement
      3. Action Reinvestment for Quality
   4. Specialized Technical Assistance and Related Activities
      1. Applied Knowledge
      2. Adequate Management Infrastructure
   5. Other Actions That Promote Accountability and Capability
      1. Systems Change Grants
      2. Disability Policy Fellows Program

Appendices

1. Barriers to Community Living     [92K]
   Introduction
   HHS Component Self-Assessment
   Structure and Financing of Programs Administered or Funded by HHS
   1. Medicaid
      1. Institutional Bias
      2. Eligibility Restrictions
   2. Medicare
      1. Medicare Home Health Restrictions
      2. Medicare Durable Medical Equipment (DME) Restrictions
   3. Array of Services
      1. Persons with Mental Illnesses
      2. Racial and Ethnic Minorities
      3. Rural Populations
      4. Children and Adolescents
      5. Transition Services
      6. Workforce Shortages
      7. Limited Access to Assistive Technology
   Responsiveness of Services to Meet Individual Needs
   Supports for Families and Informal Caregivers
   Fragmentation and Lack of Coordination
   Accountability and Legal Compliance
   Conclusion

2. Acronyms     [15K]

3. The Department of Health and Human Services: Component Descriptions   [68K]
   Administration for Children and Families (ACF)
   Administration on Aging (AoA)
   Agency for Healthcare Research andQuality (AHRQ)
   Office of the Assistant Secretaryfor Budget, Technology and Finance (ASBTF)
   Office of the Assistant Secretary for Public Affairs (ASPA)
   Office of the Assistant Secretary for Planning and Evaluation (ASPE)
   Centers for Disease Control and Prevention (CDC)
   Centers for Medicare & Medicaid Services (CMS)
   Food and Drug Administration (FDA)
   Health Resources and Services Administration (HRSA)
   Indian Health Service (IHS)
   Intergovernmental Affairs (IGA)
   National Institutes of Health (NIH)
   Office for Civil Rights (OCR)
   Office of Inspector General (OIG)
   Office of Public Health and Science (OPHS)
   Program Support Center (PSC)
   Substance Abuse and Mental Health Services Administration (SAMHSA)

Last revised: April 15, 2002