U.S. Department of Health & Human Services
Initiative ~ Executive Order ~ HHS Role ~ News & Additional Resources
Delivering on the Promise
Preliminary Report of Federal Agencies' Actions
to Eliminate Barriers and Promote Community Integration
Presented to the President of the United States
Table of Contents
December 21, 2001
[Complete Report: HTML = 153K, DOC = 535K; Cover: PDF = 203]
Transmittal Memorandum and Dedication [DOC= 28K]
- Federal Agency Actions to Eliminate Barriers and Promote Community Integration
Executive Order 13217 -- The Legal and Factual Backdrop
- Summary of Disability-Related Legislative Initiatives
- Entities that Provided Input Into Federal Agencies' Self-Evaluation Process
- July 27, 2001 Federal Register Notice Seeking Public Input Into Federal Agencies' Self-Evaluation Process
"By the authority vested in me as President by the Constitution and the laws of the United States of America, and in order to place qualified individuals with disabilities in community settings whenever appropriate, it is hereby ordered as follows: The Federal Government must assist States and localities to implement swiftly the Olmstead decision, so as to help ensure that all Americans have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment, and to participate in community life."
- Federal Agency Actions to Eliminate Barriers and Promote Community Integration
-- President George W. Bush, Executive Order 13217
On June 18, 2001, President George W. Bush signed Executive Order No. 13217, "Community-Based Alternatives for Individuals with Disabilities." The Order calls upon the federal government to assist states and localities to implement swiftly the decision of the United States Supreme Court in Olmstead v. L.C., stating: "The United States is committed to community-based alternatives for individuals with disabilities and recognizes that such services advance the best interests of the United States."
Executive Order 13217 directs six federal agencies, including the Departments of Justice, Health and Human Services, Education, Labor, Housing and Urban Development and the Social Security Administration to "evaluate the policies, programs, statutes, and regulations of their respective agencies to determine whether any should be revised or modified to improve the availability of community-based services for qualified individuals with disabilities."1
Executive Order 13217 represents a milestone in the implementation of the American with Disabilities Act's (ADA) integration mandate. The Order is unique in its recognition that the federal government has a critical role to play in promoting community living. Conceptually, too, the Order is remarkable; its emphasis on public input and a comprehensive federal-state partnership around achieving community living for people with disabilities is groundbreaking. Finally, the Order is notable for the broad sweep of its mandate for federal agency collaboration. The Order represents the first time that federal agencies have been directed to act together to ensure compliance with Title II of the ADA and achieve community living for people with disabilities. This cross-agency charge recognizes that in order for integration and full participation in community life to be realized, agencies must work together towards this goal. They must address barriers within their own programs and services, and collaborate to create an environment in which people with disabilities have the opportunity for participation and contribution in ways that promote self-determination and choice.
Preliminary Report Overview
Part I of this Preliminary Report sets forth the federal agencies' vision for a successful community service system consistent with the Order. In 13 major areas, the Report discusses the barriers to community integration articulated by the agencies and highlights key solutions. Detailed descriptions of all agency activities will be provided in the individual reports of each agency, which will be released shortly.
Part II of the Preliminary Report describes federal agency efforts to ensure public input in conducting self-evaluations of agency programs, policies, statutes and regulations, and provides the legal and factual context for the Order. Specifically, it describes the roots of the Executive Order, providing background on the Supreme Court decision in Olmstead v. L.C. and on the ADA.
Highlights of Federal Agency Actions to Promote Community Integration
As a result of the self-evaluation process required by Executive Order 13217, federal agencies devised literally hundreds of solutions to facilitate the community integration of individuals with disabilities. These solutions fall into the following categories:
Health Care Structure and Financing
"Institutional bias" stems largely from the way in which the Medicaid program was structured nearly 40 years ago, when few community-based alternatives were available. Today, despite the possibility of community alternatives, approximately 73 percent of Medicaid long-term care funding goes to pay for institutional care, while only 27 percent is directed toward home and community-based services. Federal agencies, and particularly HHS, identified a number of actions to address the barriers to community integration that result from the structure and financing of health care through Medicaid and Medicare.
Department of Health and Human Services
- HHS will establish a Medicaid Community Services Reform Task Force to advise the Department on actions that may be advisable to remove barriers and promote community living for people with disabilities. The Task Force would include representatives of all age and target groups within the disability community as well as representatives from key national, state and local organizations and government associations.
- HHS will propose a coordinated package of regulatory or potential legislative improvements that would quickly reduce some of the barriers to community living and reduce institutional biases in the Medicaid program, in consultation with states, tribes, and people who have a disability or long term illness. Among other things, this reform package may include proposals that: (a) make waiver renewal requirements less burdensome; (b) clarify the ability of Medicaid to cover individuals' one-time transition costs from institutional settings; (c) allow states that tighten eligibility for hospitals and Intermediate Care Facilities for the Mentally Retarded (ICF-MRs) to do so without simultaneously narrowing eligibility for Medicaid Home and Community Based Services (HCBS) waiver eligibility; and (d) let states disregard state-specified income or assets of HCBS waiver recipients specifically for those individuals who meet an institutional level of care and are served through home and community-based services waivers (rather than apply such disregards to an entire Medicaid eligibility group).
- HHS will examine the costs and benefits of a statutory change to establish a state option enabling presumptive Medicaid eligibility for people determined to need nursing facility or Intermediate Care Facility for the Mentally Retarded (ICF-MRs) level of care who are being discharged from hospitals or other institutions to the community, similar to the presumptive eligibility for pregnant women but retaining the asset test. Hospitals now represent the single most frequent source of nursing facility admissions. Presumptive eligibility in this circumstance may make it more feasible to discharge a hospitalized person to the community rather than to a nursing facility or similar institution, or ensure that the institutional placement is one of short duration.
- HHS will propose statutory improvements to create a ten-year Home and Community-Based Services demonstration as an alternative to Medicaid-funded psychiatric residential treatment centers. The demonstration would allow states to set up home and community-based alternatives for children who would typically be served in psychiatric residential treatment facilities.
- HHS will allow Durable Medical Equipment, prosthetics, orthotics, and supplies (DMEPOS) to be furnished in a skilled nursing facility prior to discharge.
- HHS will establish an Office on Disability and Community Integration. The Office on Disability and Community Integration will oversee the coordinated development and implementation of policies, programs and special initiatives within HHS that impact people with disabilities regardless of age or type of disability. The Office on Disability and Community Integration will serve as the focal point within the Department for disability issues, including the coordination of disability science, policy, programs and special initiatives within the Department and with other federal agencies. The Office on Disability and Community Integration will be led by a senior-level HHS official.
- HHS will develop a multi-pronged strategy to address quality of care issues in home and community-based services. This strategy will include: (a) establishing defined expectations for home and community-based services; (b) assisting states in using the results of HHS quality reviews of community placements; (c) providing technical assistance to states and HHS regional staff in effective systems design or quality improvement strategies; and (d) implementing new quality assurance and improvement systems uniquely suited for services in one's own home.
- HHS will review current Medicare and Medicaid discharge planning policies to ensure that institutions participating in Medicare and Medicaid provide more effective discharge planning for adequate and appropriate community-based care.
- HHS has already begun taking steps to help ensure that individuals with disabilities are able to live in their communities by awarding $70 million in "Systems Change Grants for Community Living" to more than 38 states and territories. HHS received over $240 million in proposals in response to the FY 2001 solicitation. These grants assist states as they improve or redesign their Medicaid and long-term care systems to enable individuals to reside and participate in their communities. The Administration believes these grants will help states implement the Olmstead decision.
- HHS' Health Resources and Services Administration (HRSA) will take the lead, in partnership with states, tribes, and other organizations, in developing and implementing a plan to achieve appropriate community-based service systems for children and youth with special health care needs and their families.
Department of Veterans Affairs
- VA will consider expanding its authority to pay for assisted living or board and care home services following evaluation of a pilot program for VA-paid assisted living. Many veterans who could reside in a less restrictive environment are placed in nursing homes because they do not have the income to pay for assisted living or board and care. The Veterans Health Administration currently has statutory authority only to pay for nursing home care. However, Public Law 106-117 provided for a pilot program for VA-paid assisted living. Evaluation of this pilot program will determine the feasibility of expansion.
- VA will increase the availability of mental health services at its community-based outpatient clinics. Currently, some of the clinics do not offer basic mental health services. The clinics will now be required to submit plans for the provision of mental health services to veterans receiving care in the clinics in fiscal year 2002.
- VA will evaluate its community-based programs (e.g., Contract Adult Day Care Program, providing services to veterans who would otherwise be placed in institutions, Homemaker and Health Aide Program, and HomeBased Primary Care Program) to determine whether any of these could be expanded or modified to further promote service to veterans with disabilities in community-based settings.
- VA will focus resources on reducing a backlog of over 661,000 claims for benefits and appeals. Adjudicating these claims -- starting with those pending longest, and from the oldest veterans -- will result in enhanced opportunities for veterans with disabilities.
The lack of accessible, affordable housing continues to present a major barrier to the participation of people with disabilities in their communities and in the economic life of the nation. There exists a full range of housing barriers, manifesting themselves differently depending on geographic location, available services, infrastructure arrangements, and whether the individual is currently living in a community or an institutional setting.
There currently is not enough appropriate or affordable housing for those people with disabilities who already live somewhere in the community. As more people with disabilities leave institutions to enter community life, this housing shortage will become even more acute. There are an insufficient number of accessible privately owned rental units in some housing markets in the nation, often resulting in families with general or targeted vouchers having an extremely difficult time locating an accessible unit that meets their needs.
In order to address these barriers, federal agencies will carry out the following activities.
Department of Housing and Urban Development
- HUD will provide technical assistance to local Public Housing Authorities (PHAs) to expand knowledge of need and utilization of vouchers for people with disabilities. HUD will strongly encourage local PHAs to consult with local disability organizations on how best to distribute that knowledge and maximize usage within their local areas.
- HUD will coordinate efforts with DOJ to devote substantial resources to investigations and enforcement actions against developers, architects, and site engineers who design and/or construct multi-family housing that does not comply with the accessibility provisions of the Fair Housing Act (FHA).
- HUD proposes to allow Section 811 (Cranston-Gonzales National Affordable Housing Act) tenant-based assistance to be used for homeownership, and will seek changes to the Section 811 statute to allow greater flexibility in terms of supportive services.
- HUD's Office of Community Planning and Development will issue a notice informing Community Development Block Grant Entitlement and State grantees of what the Olmstead decision means to grantees.
- HUD's Office of Public and Indian Housing will develop a notice to be transmitted to Public Housing Authorities and HUD Field Offices explaining the New Freedom Initiative, the Executive Order on "Community-Based Alternatives for Individuals with Disabilities," and what the Olmstead decision means to grantees.
Department of Labor
- DOL's Office of Disability Employment Policy (ODEP) will support collaboration with DOL's Employment and Training Administration, the Department of Housing and Urban Development, and the Department of Transportation, to develop strategies to encourage integration of housing and transportation services for people with disabilities within One-Stop Career Centers.
Department of Education
- ED's Rehabilitation Services Administration (RSA) will explore establishing an ad hoc workgroup comprised of appropriate federal agencies (Departments of Education, Health and Human Services, Housing and Urban Development, Justice, etc.) to address the housing issues associated with individuals with disabilities.
- RSA will identify resources for funding opportunities for modifications to living spaces and disseminate that information to consumers of independent living services.
Department of Justice
- DOJ will devote substantial resources to investigations and enforcement actions against developers, builders, architects, and site engineers who design and/or construct multi-family housing that does not comply with the requirements of the FHA and rental offices and other places of public accommodation within housing complexes that do not comply with the ADA.
- DOJ will encourage advocacy groups and private counsel representing persons with disabilities to alert DOJ to private lawsuits where amicus participation by DOJ would assist the court in interpreting and applying the provisions of the FHA and Section 504 of the Rehabilitation Act.
- DOJ will work with other agencies to improve the accessibility of public housing and to ensure that tax incentives do not go to those who discriminate on the basis of disability in housing.
- DOJ will develop guidelines to assist HUD in identifying section 504 accessibility cases that should be referred to DOJ for enforcement action.
- DOJ will meet with HUD on a quarterly basis to discuss section 504 accessibility cases that meet the guidelines for referral to DOJ for enforcement action.
Department of Health and Human Services
- HHS will work with HUD and with other federal agencies to devise and implement strategies on housing issues as part of the Interagency Council on Community Living.
Personal Assistance, Direct Care Services
As the President's Executive Order is implemented and more people with significant disabilities live in home and community-based settings and enter the workforce, the already critical need for personal care assistants and other direct care staff and community service workers will become even more pronounced. A chronic inability to attract and retain dedicated people in these fields can be traced to the fact that traditionally, across the country, these workers earn very low pay, work long hours, and often receive no benefits. There is an urgent need to address the areas of recruiting, training, retaining, promoting, and improving the earnings/benefits of personal assistants and other community service workers. The following activities are planned to address these barriers.
and Community Workers
Department of Labor
- DOL's Office of Disability Employment Policy (ODEP) will work to identify and propose options for increasing the availability of personal assistants for people with disabilities and providing some path of career progression for personal assistants and other direct care staff. ODEP expects to consult with DOL agencies and with other Federal agencies including the Department of Education, HHS' Assistant Secretary for Planning and Evaluation's Office for Disability, Aging and Long Term Care; and others. The overarching goal is to develop a cross-agency/cross-department plan to increase the availability and quality of personal assistants, and to identify options for the education, training, and career advancement for personal assistants and other direct care staff and community service workers.
- ODEP and ETA will explore increased access to personal assistance supports through the One-Stop Center system.
- ODEP will establish an online registry, similar to America's Job Bank, on DisAbilityDirect.gov where local or community-based organizations that help locate personal assistance can be identified.
- ODEP will work with ESA's Wage and Hour Division to assess the impact, if any, of the Fair Labor Standards Act's minimum wage and overtime exemptions for companionship services and live-in help services on the availability of personal assistance services.
Department of Education
- ED's Rehabilitation Services Administration (RSA) will seek collaboration and partnerships with appropriate federal agencies in order to explore how funds for attendant services can be more "consumer driven." RSA will also work with other Federal agencies to assess training opportunities for personal assistance service providers, consumers, family members, and consumer representatives in skill areas such as recruiting, hiring and supervision of personal assistance service providers.
Department of Health and Human Services
- HHS will, together with a limited number of volunteer states, initiate a national demonstration designed to address workforce shortages of community service direct care workers. The demonstration will test the extent to which workforce shortages and instabilities might be addressed through (a) better coordination with the Temporary Assistance for Needy Families (TANF) program; and (b) the availability of vouchers for worker health insurance or for tuition or day care credits. Participating states would be expected to develop options for workers to purchase affordable group health coverage through the state health insurance system or similar organized insurance group.
- HHS components will collaborate on a joint initiative to: (a) mobilize and make available to states a coherent body of information about methods to address worker shortage issues; (b) research significant issues; and (c) partner with foundations, other private sector organizations, the Department of Labor, and other agencies to formulate a comprehensive approach to the worker issue.
- HHS will work with other federal agencies to devise and implement additional strategies on workforce issues as part of the activities of the Interagency Council on Community Living.
Caregiver and Family Support
There is little debate about the critical role that families and other informal caregivers play in supplying services to people with disabilities. Recent studies confirm that the vast majority of direct care (about 64 percent) is provided by families, friends, and neighbors. Among elderly persons needing assistance with activities of daily living, 95 percent have family members involved in their care. Unfortunately, despite the enormous contribution of family and informal caregivers to the community integration of people with disabilities, these caregivers receive little direct assistance and often face tremendous financial and emotional pressures. Inadequacies in family and caregiver supports such as respite services pose significant challenges to community integration for individuals with disabilities and their families.
A growing body of evidence confirms that the provision of supportive services can diminish caregiver burden, permit caregivers to remain in the workforce, and enable people with disabilities to remain in community settings -- possibly delaying or avoiding institutionalization. Federal government efforts to provide supportive services to family and informal caregivers are highlighted below.
Department of Health and Human Services
- HHS will use the Administration on Aging's (AoA) National Family Caregiver Support Program (NFCSP) to assist states in the implementation of Olmstead. The NFCSP was launched in February 2001 and is currently funded at an annual appropriation of $125 million. It provides innovative and flexible service options for families and other informal caregivers of older persons, as well as for older caregivers of relative children, including children with Developmental Disabilities. The goal of the program is to help families maintain their loved ones at home and in the community. The program is being implemented in all 50 states and 6 territories through AoA's national network of State Units on Aging, Area Agencies on Aging, Tribal Organizations, and local service providers. States can use the program to serve caregivers of the non-Medicaid elderly population. The program serves an "early intervention" that can help caregivers early in their caregiving careers, long before they burn out.
- HHS will provide states with a simplified model waiver on electronic media (for 1115 and other waivers) that offers both person-centered planning and self-directed service options. HHS will also develop technical assistance materials outlining existing options for states to develop flexible, cost-effective and consumer-driven methods of providing home health or personal assistance services.
- HHS will seek authorization and funding from Congress to conduct a national demonstration that would allow states to include respite care (temporary care that offers support to family caregivers) for adults as a fixed budget demonstration. Unrelieved caregiver burden is a major contributing factor to institutionalization of individuals with disabilities. Respite care is the service most often requested by families in an effort to keep their family member with a disability at home.
- HHS will seek authorization and funding from Congress to implement an evaluated, ten-year demonstration to provide essential relief to caregivers of children who have a substantial disability. The demonstration would be limited by the total national number of enrollees and would allow states to establish flexible respite services for such caregivers, tailored to the needs of individual families. This demonstration will help caregivers cope with the burdens and challenges of caring for a child with a disability, and allow HHS and states to obtain and evaluate specific data about the cost and utilization of these services.
Accessible transportation is necessary for people with disabilities to go to work, get an education, receive medical care, and to have an active, inclusive role in society. The most commonly used mode of transportation by individuals moving from institutions into the community is likely to be public transportation. The ADA requires basic transportation services such as public transit services (including paratransit services), over-the-road buses, and passenger railroads to be accessible. Over-the-road bus accessibility is being phased in. Rental cars and taxis are covered to a lesser extent.
Barriers to transportation supports and services for people with disabilities generally fall into two major categories: a lack of available transportation options (due in large part to shortages of public transportation in rural and suburban areas) and a lack of access to existing transportation services (due to physical inaccessibility, limited or no travel training for individuals with cognitive disabilities, little coordination among transportation providers).
The following agencies will address these barriers through a number of activities:
Department of Transportation
- As part of the President's New Freedom Initiative effort, DOT submitted a budget request for $145 million in FY 2002 for the establishment of two grant programs that would promote innovative transportation solutions for people with disabilities. If funded, each state will fund community-based organizations, non-profits, and other transportation providers to conduct a range of activities, including purchasing specialty vans, promoting ridesharing options, developing community assessment plans, and expanding existing transportation resources. While Congress did not appropriate funds for this FY 2002 initiative, the President will review this program again to determine if the Administration should propose funding again in FY 2003.
- DOT will work with the Department of Health and Human Services to revitalize the DOT/HHS Council on Access and Mobility.
- DOT has issued its final rule on lifts for aircraft with 31 or more seats, thus requiring air carriers and airports to work jointly to make lifts or other boarding devices available for persons with a disability on aircraft of any size where level entry loading bridges or existing lifts are not currently available.
- DOT is considering the issuance of a Notice of Proposed Rulemaking that will require air carriers to file with DOT detailed information on the disability-related complaints they receive, to be used for enforcement, educational, and other relevant purposes by DOT, disabled air travelers, and Congress.
- DOT is considering the issuance of a Notice of Proposed Rulemaking to ensure that foreign air carriers operating to or from the United States or sharing codes with U.S. air carriers do not discriminate on the basis of disability.
- DOT is considering proposals to establish two new safety standards for motor vehicles: first, an equipment standard specifying requirements for platform lifts, and, second, a vehicle standard for all vehicles equipped with lifts. The proposal would regulate platform lifts installed on all motor vehicles, including over-the-road buses, school buses, and multi-purpose vehicles and would impose additional interlock requirements, improved wheelchair retention and platform slip resistance tests, and, in some instances, lesser compliance standards for lifts installed on vehicles typically used solely for private transport.
- DOT will continue to ensure that the nation's paratransit systems meet all requirements under the Americans with Disabilities Act. Under the ADA and section 504 of the Rehabilitation Act, DOT's Federal Transit Administration (FTA) is responsible for receiving, investigating, and responding to administrative complaints and conducting compliance reviews concerning the implementation and operations of paratransit systems.
Department of Labor
- DOL's Office of Disability Employment Policy (ODEP) will support collaboration with ETA, the Department of Housing and Urban Development, and the Department of Transportation, to develop strategies to encourage integration of housing and transportation services for people with disabilities within One-Stop Centers.
Department of Education
- ED's Rehabilitation Services Administration (RSA) will establish a partnership with the Joint Council on Mobility and Access, as well as relationships with transportation agencies, to investigate transportation problems and complaints and promote a network of alternative transportation through community-based and other providers.
- RSA, through partnerships with other public agencies, will seek resources to assist independent living service providers to establish and operate transportation systems.
Department of Justice
- DOJ will look for opportunities to participate in private lawsuits as amicus curiae on issues involving paratransit services and accessible public transportation and will continue its efforts to expand the available modes of accessible transportation nationwide.
- Working collaboratively with DOT, DOJ will develop a list of criteria to guide DOT to refer appropriate paratransit complaints to DOJ for enforcement purposes.
Department of Health and Human Services
- HHS will work with DOT and other federal agencies to devise and implement strategies on transportation issues as part of the activities of the Interagency Council on Community Living.
If people with disabilities are to fully access and be a part of their communities, they must have the opportunity to work. Work is so essential that without it people with disabilities often face isolation and segregation from the very communities in which they wish to participate. The dignity, responsibility, and economic independence resulting from gainful employment is the most effective way of reducing dependency on public benefits, enhancing self-reliance, changing attitudes, and promoting community acceptance of persons with disabilities.
The multiple barriers to employment and economic empowerment of adults with disabilities include the fragmentation of existing employment services; the isolation and segregation of people with disabilities from mainstream programs and services; the lack of access to health insurance; the complexity of existing work incentives; the lack of control and choice in selection of providers and other agents; inadequate work opportunities resulting from attitudinal barriers based on historical and erroneous stereotypes; and the lack of accurate data on employment of people with disabilities needed to measure progress in eliminating barriers to their employment. The following actions are planned to help address these barriers and to increase employment opportunities for people with disabilities.
Department of Labor
Assuming that the President's FY 2002 Budget is passed in its proposed form, the following activities will be funded out of existing budgetary resources:
- DOL's Office of Disability Employment Policy (ODEP) will initiate an Olmstead Community Employment Initiative, developing and implementing a coordinated strategy to ensure that all DOL policies and activities fully address the employment and training needs of people with disabilities who are at risk of institutionalization, or who are transitioning from institutions into the workplace and the community.
- ODEP will award Olmstead Community Employment Planning and Implementation Grants to states that (1) develop an employment focus for persons with disabilities in their Olmstead state implementation plans and activities, and (2) incorporate activities coordinating employment and related supports at the state and local level. Recipients will be consortia of nonprofit advocacy or service agencies and Local Workforce Investment Boards (Local Boards). Activities will focus on increased capacity and coordination, as well as the provision of ongoing feedback to ODEP and other DOL agencies on effective implementation strategies.
- DOL's ETA and ODEP will work together to disseminate promising practices and successful strategies being identified under the Work Incentive Grant Program, and to ensure close collaboration and the dissemination of information and technical assistance throughout the workforce system gleaned from the new ODEP Technical Assistance Grants.
- ODEP will expand the Customized Employment Grant Initiative to 10 additional sites in FY 2002. These grants support Local Boards in systematically reviewing their policies and practices in terms of services to persons with disabilities, incorporating new and innovative practices, as appropriate, and developing comprehensive models of customized employment services and supports for individuals with significant disabilities.
- ODEP will collaborate with ESA∆s Wage and Hour Division to develop training and technical assistance on increasing earnings and customized employment for individuals with significant disabilities earning commensurate wages under section 14(c) of the Fair Labor Standards Act, and disseminate this assistance to their stakeholder networks.
- The Presidential Task Force on the Employment of Adults with Disabilities will convene the Youth Advisory Committee, composed of 15 young people (ages 14 to 28) with diverse disabilities and backgrounds to advise the Secretary of Labor and her designees (which include the Office of the 21st Century Workforce and the Office of Disability Employment Policy) on education, transition, employment, health, rehabilitation, and independent living issues affecting young people with disabilities.
- ODEP will work with other DOL agencies, the Department of Education, and other appropriate federal departments on activities that promote the transition of young people with disabilities from school to post-secondary opportunities and/or employment, including researching, demonstrating, and disseminating successful strategies for transitioning young adults with significant disabilities into employment, and initiation of policy actions and implementation ensuring such strategies are utilized within DOL programs and activities.
- Recipients of ODEP grants to fund model youth demonstration programs to increase the participation of youth with disabilities in workforce development activities will develop, implement, evaluate and disseminate new and/or improved strategies and techniques to increase youth participation and positive outcomes.
- DOL will expand self-employment, small business, micro-enterprise development, and other entrepreneurial opportunities for people with disabilities who want to transition from institutions to their communities, or who are at risk of institutionalization or segregation. ODEP, in concert with the Task Force, will develop and implement an action plan with multiple DOL agencies to promote self-employment and small business development among people with disabilities, particularly those with the most significant disabilities.
- DOL, with ODEP in the lead, will work with other agencies to increase One-Stop center employment services for people with psychiatric disabilities, including those transitioning to the community from institutions or those at risk of placement in residential facilities.
Department of Education
- ED's Office of Special Education and Rehabilitation Services (OSERS) will coordinate with appropriate components within ED, state vocational rehabilitation (VR) agencies, and state education agencies to evaluate and improve transition services provided to youth with disabilities who are making the transition from school to work or postsecondary education.
- ED will establish a "prime study group" under the Institute on Rehabilitation Issues and develop a publication targeted to VR counselors and other service providers on transition from school to work for young adults with disabilities.
- OSERS will continue to actively enforce the new VR regulation that eliminates extended employment as a final employment outcome under the State Vocational Rehabilitation Services Program, so that an employment outcome may only be counted if an individual with a disability is working in an integrated setting in the community.
Department of Health and Human Services
- HHS will work with SSA, DOL, and HUD and with other federal agencies to devise and implement strategies on employment issues as part of the Interagency Council on Community Living.
- HHS will initiate a Disability Fellows Program to bring more individuals with direct experience with disability into the HHS workforce.
Social Security Administration
- The Ticket to Work and Self-Sufficiency Program is the cornerstone of SSA's current efforts to support work. Continued swift implementation of the Ticket Program is a key commitment of the President's New Freedom Initiative, and SSA is working aggressively toward that end.
- SSA will continue to work with private and public organizations in each state through grants, cooperative agreements, and contracts to provide benefit planning and assistance to Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) beneficiaries to assist them in their efforts to work.
- SSA is expanding its corps of employment support representatives (ESRs). The ESRs are specially trained to facilitate the efforts of SSDI and SSI beneficiaries to work by ensuring that SSA's employment support policies are used to maximum effect and that the public receives full and accurate information about the effect of work on benefits.
- SSA will conduct research and demonstration projects to explore new ways to encourage the employment of SSDI and SSI beneficiaries.
Office of Personnel Management
- OPM will conduct a campaign to disseminate widely to federal employers information about hiring, retaining and working with individuals with disabilities. Among the information to be disseminated is guidance that may help agencies facilitate "telework" by individuals with disabilities.
- OPM will consider revisions to its regulations in order to allow the Social Security Administration to certify that a federal job applicant has a disability.
- OPM will revise its Employment Guide for People with Disabilities in the Federal Government to incorporate regulatory changes that allow individuals with psychiatric disabilities to become permanent federal employees, and will revise its guidance in order to make it easier for individuals with disabilities to apply for federal employment.
Young people with disabilities face particular barriers to succeeding in school, going to college, becoming employed and living independently. Low educational attainment, low education and employment expectations, and confusing government programs and benefits with conflicting eligibility criteria have resulted in many young people with disabilities not making successful transitions from school to post-secondary education, employment, and independent living.
The U.S. Department of Education reports that national high school graduation rates for students with disabilities are far below that of youth without disabilities. It is also estimated that only one-third of young people with disabilities receives needed job training and assistance. These persistent barriers to the achievement of positive outcomes relating to education must be addressed if young people with disabilities are to have the knowledge and skills they need to function independently in their communities and in the workplace of the 21st century. Key federal agency actions in the area of education are set out below.
Department of Education
- The ED Office for Civil Rights (OCR) Program Legal Group is preparing a resource document for nationwide distribution targeted to parents and students that clarifies the rights of students and the obligations of schools as students with disabilities transition from high school to postsecondary education.
- OCR is also conducting technical assistance and training initiatives, through its 12 field offices throughout the country, to stakeholders regarding transition of students from secondary school to postsecondary institutions and improved vocational education services to students with disabilities so that they can progress further in education and employment.
- The ED Office of Vocational and Adult Education (OVAE) Programs will determine the extent to which states' use of vocational education funds authorized under the Carl D. Perkins Vocational and Technical Education Act to support state institutions for persons with disabilities is consistent with Executive Order 13217 and the extent and the purposes for which this authority is used. OVAE expects to make recommendations for amending the authority based on the information collected as part of its forthcoming proposal to reauthorize the Perkins Act.
- OVAE will seek to address any barriers in adult education programs due to statutory requirements under the Adult Education and Family Literacy (AEFLA) Act, which provides more than $500 million annually to states to support community-based adult basic education, English literacy and adult secondary educational instruction. Currently, due to ambiguity in the language of the AEFLA, some out-of-school youth with disabilities between the ages of 16 through 21 may not be receiving both adult education and the special education services under the IDEA to which they are entitled. Several critical factors, including both programmatic and physical accessibility issues, may limit the effectiveness of services for students with disabilities.
- OSEP will seek to improve the post-school results of students with disabilities by continuing to provide guidance to education and other services providers on and to enforce the requirements in IDEA for transition planning and transition services so that students and families may be better prepared for the challenges and complexities of the adult world, including post-secondary school, employment and independent living.
Department of Labor
- The DOL Office of Disability Employment Policy (ODEP) will work with other DOL agencies, the Department of Education and other appropriate federal departments on activities that promote the transition of young people with disabilities from school to post-secondary opportunities and/or employment, including researching, demonstrating, and disseminating successful strategies for transitioning young adults with significant disabilities into employment, and initiation of policy actions and implementation ensuring such strategies are utilized within DOL programs and activities.
- The DOL Employment and Training Administration (ETA) will work to implement the July 2001 Memorandum of Understanding (MOU) between DOL and the Department of Education regarding the development of a coordinated, interagency initiative to improve the employment opportunities and earnings of current workers and new labor market entrants who currently do not possess the reading and math skills essential to participate successfully in the 21st century workforce.
Access To Technology
Access to technology is an essential component of ensuring that people with disabilities are able to be a part of the community and are not placed unnecessarily in institutions like nursing homes, hospitals, and other segregated settings. Assistive devices and universal design concepts provide a means by which people with disabilities may live independently or reduce their need for assistance services. Technology also provides a gateway to a wealth of information about employment opportunities, community events, and educational forums, and has fundamentally changed the workplace and the requisite skills and knowledge needed to fully participate in the 21st century workplace.
While the accelerated development and use of electronic and information technologies in the home, school, and workplace appears to offer seemingly endless possibilities, it also has the potential to create new challenges. Technology can be a great equalizer, but it also has the capacity to further divide the class of citizens with significant disabilities who are neither computer literate nor connected to information.
The New Freedom Initiative promises to level the playing field by ensuring that Americans with disabilities have affordable access to the best technologies of today and that even better technologies are available in the future. In order for people with disabilities to maximize the opportunities that technology presents, it is also imperative that adequate training and skills development be provided. The following actions are planned to ensure that people with disabilities affected by the Olmstead ruling have access to technology and the ability to use it:
Department of Labor
- The DOL Office of Disability Employment Policy (ODEP) will work with the ED, HHS, the Department of Agriculture (USDA), and other agencies and departments, as appropriate, to coordinate and implement a plan that improves the availability, affordability, and accessibility of technology in the school, home, and workplace for youth and adults with significant disabilities.
- ODEP will expand its DisAbilityDirect.gov web site to better serve the employment-related needs of people with disabilities. This interagency portal will give employment information and links; provide educational and life-long learning opportunities for people with disabilities, employers, organizations, and other interested people; and aggregate federal resources providing access to assistive and universally based technologies.
- ODEP will work with other DOL agencies to expand opportunities in the critical high-tech area for young people and adults with significant disabilities, and to provide information and technical assistance to employers about the benefits of hiring people with disabilities as employees.
Department of Education
- The National Institute on Disability and Rehabilitation Research (NIDRR) will establish and implement innovative programs and policies that lead to greater access to assistive technology, employment, and transportation through increased interagency workgroups and rehabilitation research.
Department of Health and Human Services
- HHS will work with other federal agencies to devise and carry out activities regarding assistive technology through the work of the Interagency Council on Community Living.
Accountability and Legal Compliance
In Executive Order 13217, President Bush said that the federal government "must assist States and localities to implement swiftly the Olmstead decision, so as to ensure that all Americans have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment and to participate in community life." The President also directed the Attorney General and Secretary of the Department of Health and Human Services to "fully enforce Title II of the ADA," including by investigating and resolving individual complaints of alleged discrimination, and to work cooperatively with states to resolve these complaints whenever possible.
The federal agencies' self-evaluation process required by the Executive Order and the public input obtained during this process revealed the need for an array of activities to promote compliance with the Olmstead decision, including: greater federal oversight of programs that serve people with disabilities; stronger enforcement of laws that protect the rights of people with disabilities; greater and more effective technical assistance to assist states in appropriately serving individuals in the most integrated setting appropriate to their needs; guidance to states on effective planning to provide services in the most integrated setting; and greater and more effective outreach to assist individuals with disabilities and their family members in understanding the ADA and Olmstead's requirements.
Federal agencies will take the following actions to promote and ensure compliance with the ADA and the Olmstead decision:
Department of Justice
- DOJ will engage in stepped-up enforcement efforts of the federal laws and regulations that protect individuals with disabilities from discrimination, including the ADA and its integration regulation, the Civil Rights of Institutionalized Persons Act (CRIPA) and the Fair Housing Act.
- DOJ will use its Fair Housing Testing program to identify patterns or practices of discrimination against individuals with disabilities by persons and entities engaged in the sale or rental of housing.
- DOJ will have increased participation as amicus curiae (friend of the court) in Olmstead-type lawsuits.
- DOJ will expand the use of its mediation program for Olmstead-related claims, including providing additional training to mediators regarding Olmstead, investigating ways to train lay advocates to assist individuals with certain kinds of disabilities that may affect the equality of bargaining power, and investigating and working toward implementing a formal arrangement under which HHS' Office for Civil Rights would refer for mediation appropriate unresolved individual administrative complaints that allege a violation of the ADA's integration regulation.
- DOJ will work to increase compliance with the ADA by private institutions, including by collaborating with HHS to ensure that private institutions acting on behalf of the states are providing services in a manner consistent with states' obligations under Olmstead, and by efforts to ensure that private institutions comply with their own obligations under the ADA not to discriminate on the basis of disability.
- DOJ will engage in additional outreach and research to determine how the Department should address the need to provide community services for children with significant disabilities so that such children may remain with their families and within the community.
- DOJ will encourage state and local officials to review plans for multi-family housing and public housing for compliance with federal accessibility requirements or, alternatively, to provide developers, builders, architects, engineers, and others involved in the design and construction of housing with literature outlining federal accessibility requirements and notice that plans have not been reviewed for compliance with these requirements.
- DOJ will initiate a nation-wide effort to enforce rights of individuals with disabilities to access mental health services, focusing in particular on individuals with communications-related disabilities, and individuals with developmental or cognitive disabilities, as part of an effort to make necessary services within communities accessible to individuals leaving institutional settings.
- DOJ will use its Department-wide resources in communities with disadvantaged persons and communities with recent immigrants, in order to distribute the technical assistance pieces that inform individuals with disabilities of their rights under the ADA and Olmstead.
- DOJ will consider mechanisms that would give it greater investigative abilities under CRIPA, address issues arising from community placements, and address allegations of discrimination in purely private institutions.
Department of Health and Human Services
- HHS will collaborate with the Department of Justice to enhance alternative dispute resolution options available to individuals who file ADA administrative complaints with HHS that allege non-compliance with Olmstead.
- HHS will expand its dissemination to states, tribes and other stakeholders of information about: a) voluntary compliance with the ADA's most integrated setting regulation and the Olmstead decision; b) promising practices in the provision of services in the most integrated setting to individuals with disabilities; and c) specific examples of individuals with disabilities who have moved from institutional to community life and other relevant developments.
- HHS will provide technical assistance and guidance to states and tribes regarding options available to devise and implement innovative service systems to best meet the needs of older individuals.
- HHS will ensure the provision of a national program of technical assistance to states to promote the most efficient use of existing Medicaid authority in order to enhance opportunities for community living and community participation.
- HHS will work with states and persons with disabilities to improve the quality of home and community-based services.
Department of Education
- ED's Office of Special Education and Rehabilitation Services (OSERS) will coordinate, where appropriate, joint agency monitoring of state VR agencies and state education agencies regarding transition services from school to the world of work for adolescents and young adults, in accordance with Title I of the Rehabilitation Act and the Individuals with Disabilities Education Act (IDEA).
- ED will implement a variety of technical assistance and public information activities to promote better understanding of Olmstead's implications for people with disabilities who utilize Department of Education programs, including: (a) expansion of an ongoing training project to provide information to the disability community on Olmstead-related issues; (b) coordination of technical assistance activities to be provided to individuals with disabilities and the parents of children with disabilities regarding the Olmstead decision, community living options, community-based resources and related issues; (c) development of technical assistance documents to promote the involvement of Protection and Advocacy of Individual Rights programs (authorized to protect the legal and human rights of people with disabilities) in community integration activities; (d) preparation of a resource document for parents and students identifying the rights of students and the obligations of schools as students transition from high school to post-secondary education; (e) targeted technical assistance and training concerning the transition from high school to post-secondary school; and (f) technical assistance and workshops for states to facilitate their ability to improve vocational education programs.
- ED's Office for Civil Rights (OCR) vigorously enforces two Federal statutes -- Title II of the ADA and Section 504 of the Rehabilitation Act -- that prohibit discrimination on the basis of disability. OCR also engages in a number of proactive technical assistance and training initiatives with states, local school districts, advocacy organizations, parents, educators, and other stakeholders.
Department of Housing and Urban Development
- HUD will remind its field offices of their duty to concurrently process all disability and other complaints under all applicable laws and regulations and will provide training and other technical assistance to its field offices.
- HUD will coordinate efforts with DOJ to devote substantial resources to investigations and enforcement actions against developers, architects and site engineers who design and/or construct multi-family housing that does not comply with the accessibility requirements of the Fair Housing Act.
- HUD will work with DOJ to increase accessibility of public housing by improving enforcement of the nondiscrimination requirements of Section 504 of the Rehabilitation Act and the Fair Housing Act against Public Housing Authorities.
- HUD will implement the provisions of a Memorandum of Understanding between DOJ and IRS in order to ensure that housing providers who discriminate against persons with disabilities do not benefit from low income housing tax credits.
- HUD will enhance its guidance to public housing agencies, private landlords and persons with disabilities who participate in the housing choice voucher program, to remind agencies and landlords of their responsibility to provide reasonable accommodations to persons with disabilities, and inform persons with disabilities of their right to reasonable accommodations.
- HUD will work with DOJ on technical assistance to improve housing providers' understanding of the Fair Housing Act.
Department of Labor
- The DOL Office of Disability Employment Policy (ODEP), in collaboration with the DOL Employment and Training Administration and the Office of the Assistant Secretary for Administration and Management's Civil Rights Center (CRC), will conduct disability-focused reviews and evaluations of implementation of the nondiscrimination and equal opportunity obligations of Section 188 of the Workforce Investment Act (WIA). Under the leadership of the CRC, these evaluations will enable DOL to identify further areas in which federal training and technical assistance activities are needed to eliminate barriers and to prevent disability discrimination in the WIA programs.
- The Employment and Training Administration will collaborate with the Department of Education's Rehabilitation Services Administration on conducting comprehensive, on-site state reviews of One-Stop Centers and development of a state guide. These reviews will enable DOL to identify further areas in which federal training and technical assistance activities are needed to enhance services to individuals with disabilities.
- ODEP will work with other DOL agencies to provide information and technical assistance to employers about the benefits of hiring young people with disabilities as employees.
Public Awareness, Outreach and Partnerships
Many individuals with disabilities and their families have yet to fully appreciate the implications of the Olmstead decision. Many families are not aware of the full range of community services that are available for individuals with disabilities as alternatives to institutionalization. Furthermore, service providers, employers, and others often have similar gaps in their knowledge. Outreach to provide these stakeholders with information, and to incorporate the views of stakeholders into federal policy and other actions when appropriate is one means of addressing this knowledge gap and of better informing federal activities.
In addition, pervasive misconceptions, prejudices, and attitudes exist which must be addressed that prevent many individuals with disabilities from becoming employed or self-employed, and otherwise fully participating in American society. Information and familiarity are key to defeating these negative images, myths, and stereotypes.
Facilitating the full inclusion of people with disabilities in American society will also require more than government programs. Innovative partnership initiatives must be developed and implemented at the national level if the inclusion of people with disabilities in the workplace and the community is to become a routine part of how employers, businesses, and people with and without disabilities go about their normal activities. Effectuating such broad sweeping change will require that government work cooperatively and collaboratively, through appropriate legal arrangements, with private industry and problem solvers representing all sectors of the community.
The following activities are planned in the areas of public awareness, outreach and partnerships.
Department of Labor
Assuming that the President's FY 2002 Budget is passed in its proposed form, the following activities will be funded out of existing budgetary resources:
- DOL's Office of Disability Employment Policy (ODEP) will launch a comprehensive and coordinated public awareness/education campaign to decrease stigma, eliminate attitudinal barriers, and increase employment opportunities for adults and youth with significant disabilities that will target business and industry, lenders, small businesses, families, and others, with a particular emphasis on hiring people with significant disabilities. The campaign will also focus on making people with disabilities aware of mainstream employment-related services, letting them know that these services are available to them, and providing highly visible role models. Successful entrepreneurs who have disabilities will also be profiled through a variety of mainstream media outlets to increase awareness about the self-employment potential of people with disabilities.
- DOL's Office of Small Business Programs (OSBP) will target businesses owned by persons with disabilities by conducting at least two procurement vendor outreach sessions. OSBP will also conduct training targeted for veterans with disabilities (both service-connected and nonservice-connected) in the new small business procurement initiatives.
- DOL's Women's Bureau (WB), in collaboration with ODEP, will provide outreach to women with disabilities who are interested in self-employment.
- ODEP, in collaboration with ETA and/or the Office of the Assistant Secretary for Administration and Management's Civil Rights Center (CRC), will conduct joint listening sessions with customers of the workforce investment system, including individuals with disabilities, employers, parents and family members, providers of employment supports and services, and other relevant stakeholders, about changes needed to ensure meaningful and effective service delivery to people with significant disabilities.
- The DOL Pension and Welfare Benefits Administration (PWBA) will expand its education campaigns and programs to provide more education and outreach directed toward Americans with disabilities who are entering the workplace. PWBA will develop new material, building on its current materials which address the importance of health benefits coverage and the important choices to be made about health benefits when entering the workforce, to address specific information/questions to assist Americans with disabilities. PWBA will also expand its materials addressing the importance of saving for a secure future and help on how to do it as well as information on retirement benefit plan rights to address any specific information/questions to assist Americans with disabilities. PWBA will work with its partners, as well as continuing to add new partners, to expand its outreach and provide more focused assistance to the disabled community through wider dissemination and more direct delivery of this important information.
Department of Education
- ED's Rehabilitation Services Administration (RSA) will develop and disseminate public service announcements to increase awareness of community-based living options.
- RSA and ED's Office of Special Education Programs (OSEP), as appropriate, will coordinate technical assistance activities designed to provide information about the importance of the Olmstead decision and how Parent Training and Information (PTI) projects may serve parents and their children with disabilities when information and assistance is needed on home and community living options.
- RSA will re-evaluate current methods for providing in-service training for independent living service providers and, as appropriate, implement identified improvements.
- RSA will increase outreach and recruitment efforts to attract individuals of diverse backgrounds (e.g., race, gender, age, culture, disabilities) to serve as peer counselors for consumers of independent living services.
- RSA will develop a Technical Assistance Circular to promote the involvement in community integration activities by the Protection and Advocacy of Individual Rights programs (PAIR) and to suggest ways through which PAIRs can help to increase community options for individuals with disabilities.
- RSA funds two regional Rehabilitation Continuing Education Programs to develop and implement training for vocational rehabilitation and independent living professionals as well as community organizations on the New Freedom Initiative and the Olmstead decision in order to improve outreach to consumers.
- ED's Office of Special Education and Rehabilitative Services (OSERS), in conjunction with DOL and HHS, funds the Olmstead Project in which cross-disability leaders and advocates are trained to work with states to develop and implement the comprehensive state plans providing for consumer-directed home and community based services for persons with significant disabilities.
Department of Justice
- DOJ will hold a meeting with disability rights advocates and the Assistant Attorney General for Civil Rights to open improved lines of communication regarding Olmstead-related issues.
- DOJ will consider additional outreach targeted at determining what specific barriers keep children in institutions, and away from family settings. Specifically, DOJ would like to meet with advocacy groups and others to assess whether the problem of children residing within institutions lies chiefly in a lack of accessibility in child care settings, or other similar barriers that are covered by the ADA. DOJ will also work with childcare organizations and educators to promote the delivery of services to people with disabilities. DOJ intends to collaborate with ED on this issue.
- DOJ will develop three technical assistance documents: (1) a "Know Your Rights" piece for individuals with disabilities currently living in institutions; (2) a similar document targeted for people at risk of institutionalization; and (3) a document designed to assist states in implementing their responsibilities under Olmstead.
Department of Housing and Urban Development
- HUD's Office of Fair Housing and Employment Opportunities (FHEO) will take steps to increase the amount of information on its web sites related to laws like Section 504 of the Rehabilitation Act, the ADA, and the Fair Housing Act. In addition, FHEO will develop an easy to understand chart of the various disability rights laws and their requirements; and will develop a Section 504 consumer-oriented booklet.
Department of Health and Human Services
- HHS' Centers for Disease Control and Prevention (CDC), through the Department of Education and others, will continue its educational and self-help curriculum, pioneered with the nation's Independent Living Centers, entitled "Living Well with a Disability."
- HHS will provide technical assistance to states to maximize the use of existing Medicaid authority to promote opportunities for community living and community participation, including productive employment. The program may include developing a "Promising Practices" website for community services.
- HHS will establish a Disability Advisory Committee that includes substantial representation by all of the constituencies described in Executive Order 13217, including individuals with disabilities, family members of individuals with disabilities, advocacy organizations, providers and state and local government representatives. The Disability Advisory Committee will also include representation from the National Council on Disability. The Disability Advisory Committee will review and advise HHS on the implementation of other solutions set out in HHS' report, and will provide information and advice to HHS on community integration issues.
Cash and medical benefits can be critical to an individual's ability to live in the most integrated appropriate setting. Cash benefits, often in conjunction with food stamps and housing subsidies, can provide for basic needs such as food, clothing, and shelter. Medical benefits can enable someone to obtain treatment that may be critical to his or her ability to function in a community setting.
Work can also contribute significantly to an individual's ability to thrive in a community setting. As advances in medicine and assistive technology make it possible for people with disabilities to do more and to be more independent, technology is creating new kinds of work and new pathways to it, such as through homebased businesses and telecommuting. Self-sufficiency through work is an increasingly realistic goal for many people with disabilities despite even severe impairments.
The Social Security Administration (SSA) operates two programs that pay cash benefits to a total of more than ten million people with disabilities. The Social Security Disability Insurance (SSDI) program is a social insurance program with benefits based on prior earnings. The Supplemental Security Income (SSI) program is a means-tested income-assistance program. SSDI beneficiaries are eligible for Medicare after a two-year waiting period. Most SSI beneficiaries are immediately eligible for Medicaid.
The SSI program contains many provisions that facilitate the transition from an institution to a community setting and otherwise promote community living. The SSDI and SSI programs provide a comprehensive package of supports that are designed to assist beneficiaries in their efforts to take advantage of work opportunities.
Some of the actions that SSA will take to ensure that these provisions are being used to maximum effect include:
- Providing special training to staff who serve the public directly, including those in field offices, program service centers, and telephone service centers, emphasizing the importance of key policies and procedures in promoting the goals of Olmstead.
- Training state disability examiners, administrative law judges, and quality reviewers on Olmstead-related issues, stressing disability evaluation policies that are of particular relevance to individuals who do not reside in institutions.
- Maintaining good working relationships with local medical institutions and state agencies in order to facilitate the continuation of SSI benefits during periods of temporary institutionalization.
- Upgrading operating instructions on waiving parental deeming for children requiring an institutional level of care, a key provision that (in states that elect this option) protects SSI benefits and Medicaid coverage for these children, enabling them to remain at home if they can be adequately cared for there.
- Emphasizing to field offices the importance of processing applications for benefits before an individual leaves an institution, and of maintaining with institutions' and state agencies' agreements that make this possible.
- Continuing to improve the selection and accountability of the representative payees who receive and manage benefits on behalf of SSDI and SSI beneficiaries.
Gathering, Assessment and Use of Data
The successful integration of people with disabilities into community settings requires consistent data collection to measure the progress of existing programs and initiatives and to determine the specific needs of people with disabilities. With statistical data about various aspects of disability, federal agencies, the disability community, and other stakeholders can formulate public policy and programs that support, encourage, and maintain the transition of individuals with disabilities from institutional settings to the community. The following actions are planned in order to acquire, assess and use data about people with disabilities.
Department of Education
- The Office of Special Education and Rehabilitative Services (OSERS) will assess the feasibility of revising the reporting requirements of Centers for Independent Living (CIL) programs so that the programs would collect data on housing and related needs.
- ED's Rehabilitation Services Administration (RSA) will survey Centers for Independent Living to ascertain what they have done to expand accessible transportation and disseminate information on promising practices.
Department of Health and Human Services
- HHS' Centers for Medicare and Medicaid Services (CMS) will work with states, universities, foundations and others to ensure that there is an adequate base of applied research and knowledge to inform public policy-making with regard to: (a) the impact of the Medicaid and Medicare actions under the President's Executive Order; (b) state initiatives to improve community living services; (c) methods for designing long-term care systems so that they promote the ADA and are capable to address the population growth expected due to demographic changes; and (d) methods for designing quality assurance and improvement systems uniquely suited for services in one's own home.
Department of Housing and Urban Development
- HUD will conduct a "Housing Choice Voucher Tenant Accessibility Study," which will: (1) assess the feasibility of conducting an ongoing nationwide mail survey of successful voucher program enrollees with physical disabilities about their experiences in searching for accessible units; and (2) examine the quality of the experiences that these enrollees have in their search for accessible units.
- HUD will continue its study, "Assessment and Analysis of Multifamily Buildings' Conformity with Fair Housing Accessibility Provisions," which will provide: (1) a quantitative assessment of the extent to which these buildings conform to the accessibility provisions of the Fair Housing Act; and (2) an examination of the reasons for the extent of conformity, including explanations for patterns of non-conformity.
Department of Labor
- The Office of Disability Employment Policy (ODEP), in collaboration with the Employment and Training Administration, and the Office of the Assistant Secretary for Administration and Management's Civil Rights Center (CRC), will explore collecting data about people with disabilities who are accessing both services and employment through the workforce investment system. The Bureau of Labor Statistics (BLS) is testing a set of questions to see if it can identify the disability population in the context of a labor force survey. Policymakers may be able to use this data to help determine where to target future Federal money on behalf of people with disabilities seeking employment.
- ODEP will secure information from its national Workforce Investment Act (WIA) Disability Technical Assistance Consortium, designed to assist One-Stop Centers and other WIA-assisted programs to better serve youth with disabilities, including youth with significant disabilities who are making the transition from residential and other segregated environments to the community. This Consortium will provide ongoing data on outcomes, strategies, and other information needed to inform ODEP of needed policy-related actions.
Department of Transportation
- The Bureau of Transportation Statistics will conduct a survey of individuals with disabilities to determine their views of the accessibility of transportation in their lives.
Cross-Agency Collaboration and Coordination
In order effectively to meet the needs of individuals with disabilities and to efficiently utilize federal resources, the various federal agencies that devise disability policy and provide, fund and support community-based services should communicate about and collaborate on policy and programmatic objectives. Unfortunately, agencies involved in community support funding and activities have historically operated independently, with little or no coordination of their policy and program development activities. As a result, many individuals with disabilities have struggled with multiple federal programs containing inconsistent and often conflicting policies and program requirements. State and local governments and community organizations attempting to create coordinated systems of community supports for people with disabilities have also faced barriers due to lack of adequate coordination and collaboration across agencies and programs. For these reasons, the lack of a comprehensive and coordinated federal policy on community supports was identified through the agency self-evaluation and public input process as one of the most significant barriers to community living for people with disabilities.
Executive Order 13217 provided federal agencies with a much-needed impetus to work together to identify barriers to community living for individuals with disabilities policies, statutes and regulations. In order to ensure that the goals of the Executive Order are realized, and that activities to promote community integration are carried out in a coordinated, collaborative manner, agencies propose the following activities:
Department of Health and Human Services
- HHS proposes that the President formalize permanently the Interagency Council on Community Living (ICCL), convened by HHS Secretary Thompson in July 2001 to accomplish the tasks set out in Executive Order 13217. The ICCL would be comprised of all agencies involved in implementation of the Executive Order, with the addition of other agencies as appropriate, including the Equal Employment Opportunity Commission (EEOC). Designated members would be Secretaries, agency heads, or their functional equivalents. In addition, staff would be assigned to meet regularly to conduct the ongoing interagency work. HHS proposes that the Council articulate a strategic interagency plan to expand and promote home and community-based services, and to address, at a minimum, issues related to: housing; workers with disabilities; the long-term care workforce; assistive technology; transportation; and education.
- HHS' Office for Civil Rights (OCR) will work with the Department of Justice to implement a formal arrangement under which OCR would refer to DOJ's mediation program appropriate unresolved individual administrative complaints that allege a violation of the ADA's integration regulation.
Department of Education
- The Office of Special Education and Rehabilitative Services (OSERS) recommends the establishment of an ad hoc federal work group to address the housing needs of individuals with disabilities, and to assist OSERS-funded Centers for Independent Living (CILs) in assisting individuals with disabilities in moving from institutional to community life.
- OSERS will establish a partnership with the Joint Council on Access and Mobility to investigate transportation problems and complaints and promote a network of alternative transportation for individuals with disabilities through community-based and other providers, in order to assist CILs in providing individuals with disabilities with appropriate referrals to transportation services or in establishing or operating their own transportation services.
- OSERS will explore partnerships with other agencies in order to expand training opportunities regarding the recruitment, hiring and supervision of providers who furnish personal assistance services (e.g., assistance with bathing, dressing, toileting and other self-care tasks), and to explore how individuals with disabilities can have more control in the utilization of funds for personal care services.
Department of Housing and Urban Development
- HUD will coordinate efforts with DOJ to devote substantial resources to investigations and enforcement actions against developers, architects, and site engineers who design and/or construct multi-family housing that does not comply with the accessibility provisions of the Fair Housing Act.
- HUD will work with DOJ to increase the accessibility of public housing by improving enforcement of the nondiscrimination requirements (including accessibility and reasonable accommodation requirements) of Section 504 of the Rehabilitation Act and the Fair Housing Act against Public Housing Authorities.
Department of Justice
- DOJ will work with HHS to implement a formal arrangement under which HHS would refer to DOJ's mediation program appropriate unresolved individual administrative complaints that allege a violation of the ADA's integration regulation.
Department of Labor
- DOL's Office of Disability Employment Policy (ODEP) will facilitate the development of an employment-focused memorandum of understanding (MOU) between agencies and departments that are essential partners to the workforce investment system. The purpose of the MOU would be to (1) clarify integrated employment as a goal for adults with significant disabilities; (2) coordinate agency resources and capacity building initiatives at the federal level; and (3) serve as a model for state level coordination to ensure that employment becomes part of the planning process for people transitioning from institutional care into the community.
- ODEP will work with other relevant agencies, including the Small Business Administration, the Social Security Administration, the Treasury Department, and the ED's Rehabilitation Services Administration, to educate lenders about the viability of small business ownership for people with disabilities. Given that access to capital is the cornerstone of any effort to start a business, any strategy addressing this area must consider the effects of current policy.
- DOL will work with other agencies to promote the full inclusion of people with psychiatric disabilities in workforce investment programs and services. ODEP will consult with the Task Force, HHS' Substance Abuse and Mental Health Services Administration, the Small Business Association and the Office of Personnel Management, as well as relevant stakeholders.
- PWBA will work with the other agencies with which it shares jurisdiction in administering the health laws to provide expanded education and outreach, guidance, and other activities to provide a coordinated and comprehensive program for the disabled community, including the provision of more focused information and outreach made more widely available and accessible.
Department of Transportation
- DOT will work with HHS to reinvigorate the Joint Council on Access and Mobility.
- DOT will work with DOJ and the National Council on Disability on an outreach plan to air carriers regarding carriers' obligation under federal law not to engage in discrimination on the basis of disability.
Office of Personnel Management
- OPM will strengthen its relationship with the Social Security Administration to promote the implementation of the Ticket to Work program, in order to facilitate Social Security disability recipients' return to employment.
- OPM will strengthen its relationship with the Department of Education's Rehabilitation Services Administration in order to promote federal government employment of individuals who receive state vocational rehabilitation services.
- OPM will work with DOL to ensure that DOL-funded One-Stop Centers promote the use of a workforce recruitment program for college students with disabilities, promote the use of a DOL referral network for employers interested in filling jobs with candidates with disabilities, and provide One-Stop Centers with information on federal employment.
This part of the Preliminary Report describes the specific provisions of Executive Order 13217, concerning community-based alternatives for individuals with disabilities, and President Bush's New Freedom Initiative, a larger, multi-pronged strategy to address the rights and needs of individuals with disabilities. This part of the Report also discusses the legal and policy developments that led to Executive Order 13217, including the Americans with Disabilities Act and the Supreme Court decision in Olmstead v. L.C.. Programmatic and factual information about the need for community-based care for individuals with disabilities is included here as well. Finally, this part of the Report describes federal agency activities undertaken in accordance with the requirements of the Executive Order to conduct a self-evaluation of agency programs, policies, statutes and regulations, and to ensure public input in the self-evaluation process.
- Executive Order 13217 -- The Legal and Factual Backdrop
Executive Order 13217 on Community-Based
There are approximately 54 million individuals with disabilities in the United States. The General Accounting Office (GAO) recently estimated that at least 1.8 million of these individuals are being served in institutional settings, including 1.6 million individuals in nursing facilities, 106,000 individuals in institutions for people with mental retardation and developmental disabilities, and 57,000 individuals in state and local facilities for individuals with mental illness.2 Approximately 52 million individuals with disabilities reside in the community. The GAO estimated that an additional two million individuals are at risk of entering an institution in order to receive care.3
Alternatives for People with Disabilities
Executive Order 13217 is founded upon five guiding findings and principles to address the needs of individuals with disabilities. The Order states:
- The United States is committed to community-based alternatives for individuals with disabilities and recognizes that such services advance the best interests of Americans;
- The United States seeks to ensure that America's community-based programs effectively foster independence and participation in the community for Americans with disabilities;
- Unjustified isolation or segregation of qualified individuals with disabilities through institutionalization is a form of disability-based discrimination prohibited by Title II of the Americans with Disabilities Act of 1990 (ADA). 42 U.S.C. §12101 et seq. States must avoid disability-based discrimination unless doing so would fundamentally alter the nature of the service, program, or activity provided by the state;
- In Olmstead v. L.C., 527 U.S. 581 (1999), (the "Olmstead" decision), the Supreme Court construed Title II of the ADA to require states to place qualified individuals with disabilities in community settings, rather than in institutions, whenever treatment professionals determine that such placement is appropriate, the affected individuals do not oppose such placement, and the state can reasonably accommodate the placement, taking into account the resources available to the state and the needs of others with disabilities; and
- The Federal Government must assist states and localities to implement swiftly the Olmstead decision, so as to help ensure that all Americans have the opportunity to live close to their families and friends, to live more independently, to engage in productive employment and to participate in community life.
Exec. Order No. 13217, 66 Fed. Reg. 33,155 (2001) at Section 1
Executive Order 13217 calls upon participating agencies to undertake a range of activities to promote community-based living for qualified individuals with disabilities and to ensure swift implementation of the Olmstead decision. These activities broadly fall into three categories: (1) coordinated technical assistance to states; (2) the identification of specific barriers in federal law, regulation, policy and practice; and (3) enforcement activities, including the investigation and resolution of complaints brought under Title II of the ADA.
Executive Order 13217 directs the participating agencies to work cooperatively to ensure that the Olmstead decision is implemented in a timely manner. The Order mandates the agencies to work with states to "help them assess their compliance with the Olmstead decision and the ADA in providing services to qualified individuals with disabilities in community-based settings[.]" Specifically, the agencies are directed to provide "technical guidance," and to "work cooperatively with states to achieve the goals of Title II of the ADA, particularly where states have chosen to develop comprehensive, effectively working plans to provide services to qualified individuals with disabilities in the most integrated settings." These agencies also must ensure that existing federal resources are used in the most effective manner to support the goals of the ADA.
Review of Federal Policies, Programs, and Laws
Next, Executive Order 13217 directs participating agencies to "evaluate the policies, programs, statutes, and regulations of their respective agencies to determine whether any should be revised or modified to improve the availability of community-based services for qualified individuals with disabilities." The review is to focus on identifying affected populations, improving the flow of information about supports in the community and removing barriers that impede opportunities for community placement. The Order obligates the agencies to involve consumers, advocacy organizations, providers, and relevant agency representatives in the self-evaluation processes.
ADA Title II Enforcement
Finally, the Order instructs the Attorney General and the Secretary of Health and Human Services to "fully enforce Title II of the ADA, including investigating and resolving complaints filed on behalf of individuals who allege that they have been the victims of unjustified institutionalization." These two federal agencies are encouraged to "work cooperatively" with the states whenever possible and to use alternative dispute resolution to bring complaints to a quick and constructive resolution.
The New Freedom Initiative
As stated, Executive Order 13217 on Community-Based Alternatives for Individuals with Disabilities is part of a larger, multi-pronged disability initiative developed by the Bush Administration. The New Freedom Initiative includes the following key components:
- Increasing Access to Assistive and Universally Designed Technologies: Provides for a major budget increase for research on assistive technology, and a new fund to market these technologies. Funding for low-interest loan programs to buy assistive technology will also increase.
- Expanding Educational Opportunities: Provides for increased funding to states for the Individuals with Disabilities Education Act, and grant eligibility for states that establish a comprehensive reading program for students, including those with disabilities.
- Promoting Homeownership: Provides for implementation of Public Law 106-569, which allows local Public Housing Authorities to provide recipients of Section 8 vouchers with disabilities with up to one year's worth of vouchers in a lump-sum payment to finance a down-payment on the purchase of a home.
- Integrating Americans with Disabilities Into the Workforce: Ensures that federal matching funds will be available to states to guarantee low-interest loans for individuals with disabilities to purchase computers and other equipment to work from home. In the New Freedom Initiative, President Bush committed to sign an order that directs swift implementation of "Ticket to Work," the law that gives Americans with disabilities the ability to maintain health benefits and choose their own support services when they return to work.
- Promoting Full Access to Community Life: Promotes community integration for people with disabilities. The President signed the Order pursuant to which this Report is submitted, requiring federal agencies to assist states with the "swift implementation" of Olmstead. The President also committed to create a National Commission on Mental Health, which will recommend improvements to the nation's mental health service delivery system.
Roots of the New Freedom Initiative:
The ADA is the foundation for the New Freedom Initiative. It was signed into law 11 years ago by President George W. Bush and has been hailed since then as the most significant civil rights legislation since enactment of the Civil Rights Act of 1964.
The ADA and the Olmstead Decision
The ADA serves as a "comprehensive national mandate for the elimination of discrimination against individuals with disabilities." 42 U.S.C. 12101(b)(1). Based on extensive fact-finding and study by Congress -- some 14 congressional hearings and 63 field hearings by a special congressional task force were held in the three years prior to passage of the ADA -- Congress found in the ADA that:
- Historically, society has tended to isolate and segregate individuals with disabilities, and despite some improvements, such forms of discrimination against individuals with disabilities continue to be a serious and pervasive social problem;
- Discrimination against individuals with disabilities persists in such critical areas as employment, housing, public accommodations, education, transportation, communication, recreation, institutionalization, health services, voting and access to public services;
- Individuals with disabilities continually encounter various forms of discrimination, including outright intentional exclusion, the discriminatory effects of architectural, transportation, and communication barriers, overprotective rules and policies, failure to make modifications to existing facilities and practices, exclusionary qualification standards and criteria, segregation, and relegation to lesser services, programs, activities, benefits, jobs or other opportunities;
- Census data, national polls, and other studies have documented that people with disabilities, as a group, occupy an inferior status in our society, and are severely disadvantaged socially, vocationally, economically, and educationally; [and]
- Individuals with disabilities are a discrete and insular minority who have been faced with restrictions and limitations, subjected to a history of purposeful unequal treatment, and relegated to a position of political powerlessness in our society, based on characteristics that are beyond the control of such individuals and resulting from stereotypic assumptions not truly indicative of the individual ability of such individuals to participate in, and contribute to, society;
- 42 U.S.C. 12101(a). Based on these findings, Congress "invoke[d] the sweep of congressional authority" to address the major areas of discrimination faced day-to-day by people with disabilities. Accordingly, the ADA targets three major areas of discrimination against persons with disabilities. Title I addresses discrimination by employers; Title II addresses discrimination by governmental entities; and Title III addresses discrimination in public accommodations (e.g., stores, restaurants, etc.) operated by private entities.
Since its enactment, the ADA has opened doors and created opportunities for millions of children and adults with disabilities to participate fully in the rich fabric of their own communities. This year, with the unveiling of the New Freedom Initiative, President George W. Bush reminded us that despite significant progress, enormous challenges remain. The New Freedom Initiative calls upon all Americans to rededicate themselves to promoting the full inclusion of people with disabilities in American society and to fulfilling the promises of the ADA.
The Integration Regulation and Olmstead v. L.C.
In the ADA, Congress required the Attorney General to promulgate regulations to implement the statute. One of those regulations, the integration regulation, provides that: "[a] public entity shall administer services, and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities." 28 C.F.R. 35.130(b) (1996). In the preamble to the regulations, the Attorney General explained that "the most integrated setting" is "a setting that enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible." 28 C.F.R. Pt. 35 App. A. 35.130, at 469. It is the integration regulation which was at issue in Olmstead v. L.C., the landmark decision affirming the rights of individuals with disabilities to live and receive treatment in community settings whenever appropriate.
Olmstead v. L.C., 527 U.S. 581 (1999), was brought by two Georgia women whose disabilities include mental retardation and mental illness. At the time the suit was filed, both plaintiffs lived in state-run institutions, although their treatment professionals had determined that they could be appropriately served in a community setting. The plaintiffs asserted that continued institutionalization was a violation of their right under the ADA to live in the most integrated setting appropriate. The Supreme Court agreed, holding that "[u]njustified isolation . . . is properly regarded as discrimination based on disability."
The Court's findings regarding the harms of institutionalization are unequivocal:
[I]nstitutional placement of persons who can handle and benefit from community settings perpetuates unwarranted assumptions that persons so isolated are incapable or unworthy of participating in community life.
Confinement in an institution severely diminishes the everyday life activities of individuals, including family relations, social contacts, work options, economic independence, educational advancement, and cultural enrichment.
Olmstead, 527 U.S. at 600-01.
Based on these factual findings, the Court held that unnecessary segregation of people with disabilities in institutions is a form of discrimination under the ADA, and that individuals with disabilities have a civil right to receive services in the community in certain circumstances.
Under the Court's decision, states are required to provide community-based services for persons with disabilities who would otherwise be entitled to institutional services when: (a) treatment professionals reasonably determine that such placement is appropriate; (b) the affected persons do not oppose such treatment; and (c) the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of others who are receiving state-supported disability services. The Court cautioned however, that nothing in the ADA condones termination of institutional settings for persons unable to handle or benefit from community settings. Moreover, the state's responsibility, once it provides community-based treatment to qualified persons with disabilities, is not unlimited. Under ADA regulations, states are obliged to "make reasonable modifications in policies, practices, or procedures when the modifications are necessary to avoid discrimination on the basis of disability, unless the public entity can demonstrate that making the modifications would fundamentally alter the nature of the service, program or activity." 28 C.F.R. 35.130(b)(7).
The Supreme Court opinions in Olmstead suggest that evaluation of whether a modification entails "fundamental alteration" of a program takes into account three factors: the cost of providing services to the individual in the most integrated setting appropriate; the resources available to the state; and how the provision of services affects the ability of the state to meet the needs of others with disabilities. Significantly, a plurality of the Court suggests that a state could establish compliance with the ADA's reasonable modification requirement if it shows that it has:
- a comprehensive, effectively working plan for placing qualified persons with disabilities in less restrictive settings, and
- a waiting list that moves at a reasonable pace not controlled by the state's endeavors to keep its institutions fully populated.
Olmstead, 527 U.S. at 605-06.
The States' Response to Olmstead
Historically, state and local governments have taken the lead to develop innovative programs to serve people with disabilities in their own homes and communities. Funding for these programs comes from a variety of sources including federal block grants, competitive grants, state and local revenues and the Medicaid and Medicare programs. However, as is reflected in the many comments received from state and local government authorities, efforts by states to develop and operate community-based programs for individuals with disabilities have been hampered by a variety of factors that range from inadequate funding to lack of flexibility in federal rules that govern the Medicaid program -- a key source of funding for home and community-based care. As a result, community-based care remains a patchwork and is often inadequate to ensure against inappropriate institutionalization. Today, while there are a number of states operating model programs, and even some that have closed all state institutions, individuals with disabilities still face enormous variability in the availability, accessibility and quality of community-based care.
For states, the Olmstead decision has spurred renewed activity to address these systemic barriers and to increase and improve access. At a recent hearing before the Senate Aging Committee, one state official characterized Olmstead as a catalyst for change:
The 1999 U.S. Supreme Court decision, Olmstead v. L.C., had a dual effect on the state of Louisiana. First, it became the legal basis for Louisiana's version of Olmstead, the Barthelemy v. Department of Health and Hospitals lawsuit. Second, it was [the] central force that led to a partnership between the aging and disability communities in the state of Louisiana.
Testimony of Laura Brackin, M.A., Executive Director, Governor's Office of Disability Affairs, state of Louisiana, Before the Special Committee on Aging, U.S. Senate. September 24, 2001.
The Barthelemy case referenced by Ms. Brackin demonstrates how Olmstead caused a sea-change in a state's long-term care system. Among other things, the recent settlement reached by the parties in the Barthelemy lawsuit calls for significant and unprecedented expansions in three home and community-based waiver programs serving the elderly and people with disabilities in Louisiana. Louisiana has also committed to expanding personal care services in its Medicaid program. In the wake of the Olmstead decision, a state-wide, cross disability coalition has formed. This coalition has worked collaboratively with the legislature and the Governor to enact legislation that calls for further planning to reform long-term care in the state.
According to the National Conference of State Legislatures (NCSL), which is tracking state responses to Olmstead, the majority of states, like Louisiana, are responding affirmatively to Olmstead. Most are engaged in service planning and are moving toward implementation of system reforms and service expansions. The GAO reported "[a]s of September 2001, an estimated 40 states and the District of Columbia had task forces or commissions that were addressing Olmstead issues."4 Approximately 14 states have completed draft or initial plans. According to NCSL, the goal for most states is to complete initial plans by the end of this year or early 2002.5 Significantly, many of these states are working closely with consumers, family members and other stakeholders to formulate and draft their plans for system reform.
The Public Input Process
A key directive of the President's Executive Order was to include public input in the evaluations conducted by each agency. HHS Secretary Thompson sent an open letter to all interested parties inviting such input, and emphasized in a press release and throughout the public input process the desire to "listen to the people who know the barriers better than anyone could" -- those who have first-hand experience with disability. To ensure the involvement of consumers, advocacy organizations, providers and relevant agency representatives, HHS, in conjunction with the other participating agencies in the Interagency Council on Community Living, developed a multi-pronged strategy for soliciting public comments. Four complementary methods to obtain public input for the federal agency self-evaluations were adopted, as pictured below.
Information Gathering Activities
For The Executive Order
More than 800 individuals and organizations provided comments through the mechanisms established by HHS in response to the Executive Order. Many comments were quite detailed and contained multiple ideas and observations, resulting in the collection of several thousand ideas or observations through the public input process. Most of the comments (678) were received during the period of formal written comment. Eighty individuals and organizations provided testimony at the National Listening Session, while another 47 participated in the National Teleconference call. Respondents represented a broad cross-section of interest groups, including consumers, family members, advocacy organizations, providers and provider associations, state and local governments, national government agency associations, and researchers. Respondents also represented a broad spectrum of disabilities, including mental retardation and developmental disabilities, mental health and substance abuse, physical disabilities, including spinal cord injury, traumatic brain injury, HIV/AIDS, visual and hearing impairments, autism, Alzheimer's and various learning disabilities.
See Appendix B (listing all entities participating in the public input process). Components within HHS and the other participating federal departments conducted short-term outreach efforts to alert their network and the general public about the opportunity to provide input. These efforts included mass mailings and emails, announcements at already scheduled events, and alerts posted on agency websites. For example, HHS provided and disseminated one-page flyers in both English and Spanish that described the three public input opportunities and solicited comments.
- Written Comments: Through a Federal Register notice published on July 27, 2001, HHS announced a 30-day, formal public comment period, inviting members of the public to submit written comments to the New Freedom Initiative Group. (See Notice, attached as Appendix C.)
Consumers, family members, advocacy organizations, service providers, and others were asked to identify barriers to community integration that exist in federal policies, programs and statutes, and to identify solutions to address these barriers. Individuals were given the option of providing input through the New Freedom Initiative email address or by submitting written comments by mail. The full text of each communication was entered into the public input database and categorized for analysis. The categorization involved identification of the source of input (i.e., consumer, family member, advocacy organization, etc.), the main topics of input (i.e., housing, health care, education, etc.), and the barriers and solutions described in the communication.
A total of 678 individuals and organizations provided 754 separate written communications during the public input period. As depicted in the graph below, individuals with a disability (50) or family members (157) together accounted for about one-third of the comments. They represented all ages and consumer groups. National organizations representing elderly, children, or adults with a disability accounted for about 21% of the comments. Comments were received from 24 state agencies, from 6 national associations of state government agencies, and from 7 local governments.
- National Teleconference: On August 15, 2001, HHS sponsored a National Teleconference and invited individuals and organizations to call a toll-free number to share comments and concerns. Individuals registered to provide time-limited comments prior to the scheduled Teleconference. Simultaneous webcasting of the Teleconference was provided through the New Freedom Initiative website to enable those individuals with hearing impairments to participate in this opportunity. Key listeners during the Teleconference included agency heads from participating federal departments. The full text of all comments received was added to the overall analysis of the public input. Forty-seven individuals made observations about the long-term care system or their own experiences during the national teleconference.
- National Listening Session: On September 5, 2001, HHS hosted a National Listening Session on Community-Based Alternatives for People with Disabilities in Washington, D.C. More than 25 top federal officials from 10 different federal agencies participated in the day-long national meeting, which was designed to give consumers, family members, advocacy organizations, providers and other stakeholders the opportunity to speak directly to federal officials from the various agencies about barriers to community living and recommendations for overcoming them. Simultaneous captioning was provided throughout the session to ensure that all individuals participating could follow the discussion. To ensure that everyone attending the Session was able to provide input, individuals were given the opportunity to provide written input through laptop computers, with the assistance of staff from the various participating agencies. A total of 80 individuals testified. All input received during the Listening Session was also analyzed and added to the overall analysis of the public input.
- Existing Studies: HHS conducted an overview of hundreds of existing studies conducted in both the public and private sectors regarding barriers to community living for people with disabilities. Attention was focused on studies completed within the past three years and those considered significant because they represent a comprehensive, in-depth or unique review of the issues.
This Preliminary Report to the President represents only the beginning of an unprecedented federal government-wide effort to ensure that all Americans have the opportunity to live as independently as possible in their own communities. Through an intense collaborative process that included the input and participation of not only federal, state and local governments but also people with disabilities, their families and service providers, this Report establishes a blueprint for action that will make a measurable impact on the lives of people with disabilities as they work to secure appropriate health care, housing, transportation, employment, education and other opportunities in their communities. As noted previously, each agency involved in this process will soon issue its own in-depth report regarding Executive Order 13217. When President Bush signed the Executive Order, he noted that when people with disabilities have the tools they need to live their lives fully and as active participants in community life, the entire nation benefits. Thus, in order to ensure that our nation continues to benefit from the full involvement of individuals with disabilities, the agencies submitting this Preliminary Report look forward to working with people with disabilities and other stakeholders in carrying out the activities described in the Report, and in other efforts to facilitate community integration.
National Vocational Rehabilitation Act of 1920.
Summary of Disability-Related Legislative Initiatives
Established state/federal system of rehabilitation services.
Social Security of Act of 1935
Established federal/state system of health services for "crippled" children; permanently authorized civilian rehabilitation program.
Wagner-O'Day Act of 1938.
Authorized federal purchases from workshops for people who are blind.
Randolph-Sheppard Act of 1938.
Authorized federal program to employ people who are blind as vendors on federal property.
Vocational Rehabilitation Act of 1954.
Authorized innovation and expansion grants, and grants to colleges and universities for professional training.
Wagner-Peyser Act Amendments of 1954.
Required federal/state employment security offices to designate staff members to assist people with severe disabilities.
Social Security Amendments of 1956.
Established Social Security Disability Insurance Trust Fund and provided for payments to eligible workers who became disabled.
National Defense Education Act of 1958.
Authorized federal assistance for preparation of teachers of children with disabilities.
Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963.
Provided grants for construction of mental retardation research centers and facilities; provided for training of educational personnel involved with youth with disabilities; authorized grants to states for construction of community mental health centers.
Mental Retardation Facilities and Community Mental Health Centers Construction Act Amendments of 1965.
Established grant program to cover initial staffing costs for community mental health centers.
Social Security Act Amendments of 1965.
Established Medicaid program for elderly people and for blind persons and other persons with disabilities.
Elementary and Secondary Education Act of 1965.
Authorized federal aid to states and localities for educating deprived children, including children with disabilities.
Elementary and Secondary Education Act Amendments of 1966.
Created National Advisory Committee on Handicapped Children; created Bureau of Education for the Handicapped in U.S. Office of Education.
Fair Labor Standards Amendments of 1966
Established standards for employment of workers with disabilities, allowing for subminimum wages.
Elementary and Secondary Education Amendments of 1967
Authorized regional resource centers; authorized centers and services for deaf-blind children.
Handicapped Children's Early Education Assistance Act of 1968
Established grant program for preschool and early education of children with disabilities.
Vocational Education Act Amendments of 1968.
Required participating states to earmark 10 percent of basic vocational education allotment for youth with disabilities.
Architectural Barriers Act of 1968.
Required most buildings and facilities built, constructed, or altered with federal funds after 1969 to be accessible.
Developmental Disabilities Services and Facilities Construction Amendments of 1970.
Expanded services to individuals with epilepsy and cerebral palsy; authorized new state formula grant program; defined "developmental disability" in categorical terms; established state-level planning council.
Urban Mass Transportation Act Amendment of 1970.
Authorized grants to states and localities for accessible mass transportation.
Javits-Wagner-O'Day Act of 1971.
Extended purchase authority to workshops for people with severe disabilities in addition to blindness; retained through 1976 preference for workshops for people who are blind.
Social Security Amendments of 1972.
Extended Medicare coverage to individuals with disabilities; established Supplemental Security Income program for elderly people and for blind persons and other persons with disabilities.
Small Business Investment Act Amendments of 1972.
Established the "Handicapped Assistance Loan Program" to provide loans to nonprofit sheltered workshops and individuals with disabilities.
Rehabilitation Act of 1973.
Prohibited disability discrimination in federally assisted programs and activities and federal agencies; required affirmative action programs for people with disabilities by federal agencies and some federal contractors; established the Architectural and Transportation Barriers Compliance Board.
Education Amendments of 1974.
Required states to establish plans and timetables for providing full educational opportunities for all children with disabilities as condition of receiving federal funds.
Headstart, Economic Opportunity, and Community Partnership Act of 1974
Required that at least 10 percent of children enrolled in Headstart be children with disabilities.
Housing and Community Development Act of 1974.
Established Section 8 housing program for low-income families, including individuals with disabilities and/or their families.
Developmentally Disabled Assistance and Bill of Rights Act of 1975.
Described congressional findings regarding rights of persons with developmental disabilities; established funding for protection and advocacy systems; added requirement that state plan include deinstitutuionalization plan; required states to develop and annually review rehabilitation plans for all clients.
Education for All Handicapped Children Act of 1975.
Required states to establish policy assuring free appropriate public education for children with disabilities as condition for receiving Part B funds; established procedural safeguards, procedures for mainstreaming children with disabilities to the maximum extent possible, and procedures for nondiscriminatory testing and evaluation practices.
Rehabilitation, Comprehensive Services, and Developmental Disabilities Amendments of 1978.
Established National Institute of Handicapped Research; established National Council on the Handicapped; authorized grant program for independent living services; replaced categorical definition of developmental disability with functional definition; established minimum funding level for protection and advocacy services.
Civil Rights Commission Act of 1978.
Expanded jurisdiction of Civil Rights Commission to disability discrimination.
Department of Education Organization Act of 1979.
Established Office of Special Education and Rehabilitative Services in new cabinet-level Department of Education.
Civil Rights of Institutionalized Persons Act of 1980.
Empowered Department of Justice to bring suit against states for allegedly violating rights of institutionalized persons with disabilities.
Job Training Partnership Act of 1982.
Authorized training and placement services for "economically disadvantaged" individuals, including persons with disabilities.
Education of the Handicapped Act Amendments of 1983.
Authorized grants for training parents of children with disabilities.
Child Abuse Prevention Treatment Act Amendments of 1984.
Required states' child protection agencies to develop procedures for responding to reports that newborns with disabling conditions were being denied treatment; established conditions for requiring such treatment.
Developmental Disabilities Act of 1984.
Shifted emphasis to employment in priority services; required Individual Habilitation Plan for consumers; increased minimum funding for protection and advocacy services.
Rehabilitation Act Amendments of 1984.
Established Client Assistance Programs as formula grant programs; made National Council on the Handicapped an independent agency.
Consolidated Omnibus Budget Reconciliation Act of 1985.
Expanded the definition of "habilitation" for Home and Community-Based Waiver recipients with developmental disabilities to cover certain pre-vocational services and supported employment for previously institutionalized individuals; authorized states to cover ventilator-dependent children under the waiver program if they would otherwise require continued inpatient care.
Education of the Handicapped Act Amendments of 1986.
Authorized a new grant program for states to develop an early intervention system for infants and toddlers with disabilities and their families, and provide greater incentives for states to provide preschool programs for children with disabilities between the ages of three and five.
Handicapped Children's Protection Act of 1986.
Authorizes courts to award reasonable attorneys fees to parents who prevail in due process proceedings and court actions under Part B of the Education of the Handicapped Act.
Employment Opportunities for Disabled Americans Act of 1986.
Made the Section 1619(a) and 1619(b) work incentives a permanent feature of the Social Security Act; added provisions to enable individuals to move back and forth among regular SSI, Section 1619(a) and Section 1619(b) eligibility status.
Education of the Deaf Act of 1986.
Updated statute establishing Gallaudet College and changed name to Gallaudet University; authorized Gallaudet University to operate demonstration elementary and secondary schools for deaf children; established Commission on Education of the Deaf.
Rehabilitation Act Amendments of 1986.
"Severe disability" definition expanded to include functional (as well as categorical) criteria; defined "employability" for first time; added formula grant program for supported employment; renamed research branch the National Institute on Disability and Rehabilitation Research.
Air Carrier Access Act of 1986.
Prohibited disability discrimination in provision of air transportation.
Protection and Advocacy for Mentally Ill Individuals Act of 1986.
Authorized formula grant program for statewide advocacy services for person with mental illness, provided directly by, or under contract with, the protection and advocacy system for persons with developmental disabilities.
Developmental Disabilities and Bill of Rights Act Amendments of 1987.
Raised minimum allotment levels for basic state grant program and protection and advocacy systems; increased minimum allotment for university-affiliated programs, basic state grant program, and protection and advocacy systems.
Technology-Related Assistance for Individuals with Disabilities Act of 1988.
Provided grants to states to develop statewide assistive technology programs.
Fair Housing Act Amendments of 1988.
Added persons with disabilities as a group protected from discrimination in housing and ensures that persons with disabilities are allowed to adapt their dwelling place to meet their needs.
Omnibus Reconciliation Act of 1989.
Included major expansion in required services under Medicaid's Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT).
Television Decoder Circuitry Act of 1990.
Required new television sets to have capability for close-captioned television transmission.
Americans with Disabilities Act of 1990.
Prohibited disability discrimination in employment, public services and public accommodations operated by private entities; requires that telecommunication services be made accessible.
Rehabilitation Act Amendments of 1992.
Changed eligibility requirements and procedures for determining eligibility; strengthened requirements for interagency cooperation; strengthened consumer involvement requirements.
Family and Medical Leave Act of 1993.
Allowed workers to take up to 12 weeks of unpaid leave to care for newborn and adopted children and family members with serious health conditions or to recover from serious health conditions.
National Voter Registration Act of 1993.
Required states to liberalize their voter registration rules to allow people to register to vote by mail, when they apply for driver's licenses or at offices that provide public assistance and programs for individuals with disabilities such as vocational rehabilitation programs.
Goals 2000: Educate America Act of 1994.
Provided framework for meeting national educational goals and carrying out systemic school reform for all children with disabilities.
Telecommunications Act of 1996.
Required telecommunications manufacturers and service providers to ensure that equipment is designed, developed and fabricated to be accessible to and usable by individuals with disabilities, if readily achievable.
Health Insurance Portability and Accountability Act of 1996.
Improved access to health care for some Americans by guaranteeing that private health insurance is available, portable and renewable; limiting pre-existing condition exclusions and increasing the purchasing clout of individuals and small employers through incentives to form private, voluntary coalitions to negotiate with providers and health plans.
Mental Health Parity Act of 1996.
Included a provision that prohibits insurance companies from having lower lifetime caps for treatment of mental illness compared with treatment of other medical conditions.
Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
Required work in exchange for time-limited assistance; Temporary Assistance to Needy Families (TANF) replaced the former welfare programs, ending the federal entitlement to assistance; states, territories, and tribes receive a block grant allocation with a requirement on states to maintain a historical level of state spending known as maintenance of effort.
Balanced Budget Act of 1997.
Section 4733 provided a new Medicaid buy-in option for people with disabilities. This provision gives states the option to allow individuals with disabilities who return to work the ability to purchase Medicaid coverage as their earnings increase up to 250% poverty, based on an individual's net rather than gross income.
Individuals with Disabilities Education Act of 1997 (IDEA) Reauthorization.
Formally called P.L. 94-142 or the Education of All Handicapped Children Act of 1975, IDEA required public schools to make available to all eligible children with disabilities a free appropriate public education in the least restrictive environment appropriate to their individual needs.
Workforce Investment Act of 1998.
Required consolidation of several federal education, training, and employment programs; reauthorized Rehabilitation Act programs through fiscal year 2003 and linked those programs to state and local workforce development systems.
Quality Housing and Work Responsibility Act of 1998.
The Quality Housing and Work Responsibility Act of 1998, affecting HUD-funded public and assisted housing, eliminated previously required Federal preferences shown to people with disabilities and some other groups but left any such previous preferences intact or optional at the local level. Public housing agencies, which provide HUD-funded public and assisted housing, must also develop Annual Plans and 5-Year Plans reflecting their preferences and other matters such as changes in the "disability-related tenant composition" of the housing those agencies offer and accessibility issues. Public housing agencies must also certify that their plans and implementation comply with all Federal civil rights and fair housing laws including those which cover persons with disabilities in addition to cove ring other protected classes.
Assistive Technology Act of 1998.
Authorized State grant programs and protection and advocacy systems to address the assistive technology needs of people with disabilities; authorized the development of alternative financing mechanisms to assist people with disabilities in purchasing assistive technology.
Ticket to Work and Work Incentives Improvement Act of 1999.
Allowed for Medicaid and/or Medicare benefits for many people with disabilities who go to work; provided for a "ticket to work and self-sufficiency" which allows Social Security beneficiaries with disabilities choice and expanded options in pursuing employment and employment supports.
* This chart is a reprint of the information in Appendix C to Re-Charting the Course: Turning Points, The Third Report of the Presidential Task Force on Employment of Adults with Disabilities (2000), and is used with the permission of the Task Force. This chart was adapted from Kay F. Schriner and Andrew I. Batavia, "Disability Law and Social Policy," Encyclopedia of Disability and Rehabilitation, NewYork: Simon & Schuster Macmillan, 1995, with summaries of legislation enacted since 1995 contributed by Carri George, Rebecca Ogle, Bobby Silverstein, and the Department of Justice's 1997 publication, A Guide to Disability Rights Laws. This chart includes laws and amendments to laws significant to the context of this report and is not intended to be exhaustive or all inclusive.
Entities that Provided Input Into
Federal Agencies' Self-Evaluation Process
- Ability Center of Greater Toledo
- Access to Independence
- Action for RHCs, Washington
- ADA Steering Committee, Indiana
- ADAPT of Southern California
- Rochester ADAPT
- Addictions Treatment Facilities, Bloomington, IN
- Administrative Support Unit Leader
- Advocacy, Inc.
- Advocacy Unlimited, Inc.
- Alaska Mental Health Board
- American Association for Homecare
- American Association of Homes and Services for the Aging
- American Congress of Community Supports and Employment Services
- American Council of the Blind of Maine
- American Federation of State, County and Municipal Employees (AFSCME)
- American Health Care Association
- American Indian Rehabilitation Rights Organization of Warriors
- American Network of Communities Options and Resources (ANCOR)
- American Physical Therapy Association
- American Public Health Services Association
- Appalachian Legal Services
- Area Board XI on Developmental Disabilities Services, Santa Ana, CA
- The Association of Retarded Citizens (ARC)
- The Arc of Arapahoe & Douglas
- The Arc of Baltimore
- The Arc of Cass County
- The Arc-CCD Housing Task Force
- The Arc Connecticut
- The Arc of Contra Costa
- The Arc of Frederick County
- The Arc of High Point
- The Arc of Indiana
- The Arc of Loudoun County
- The Arc of Maryland
- The Arc of Minnesota
- The Arc of North Carolina
- The Arc of Southeastern Minnesota
- The Arc of Texas
- The Arc of Utah
- The Arc-Wisconsin Disability
- ARCIL, Inc.
- Association of Tech Act Projects
- The Association for Persons in Supported Employment
- Autism Society of North Carolina
- Bazelon Center for Mental Health Law
- Becoming Independent
- Birmingham Independent Living Center
- Boston University Medical Center, Department of Family Medicine
- Brain Injury Association
- Brain Injury Association of Wisconsin
- California Association for the Retarded
- California Department of Corrections
- Career Connections
- Center for Accessible Living
- Center for Autism and Related Disabilities
- The Center for Career Freedom, Inc.
- Center for Disability Rights
- Center for Housing and New Community Economics, Institute on Disability, University of New Hampshire
- Center for Living and Working, Inc.
- The Center for Medicare Advocacy, Inc.
- Center for Mental Health Services
- Central Stak ICF/MR Family Group
- The Cerebral Palsy Council
- CES Community Connector
- C.H.A.N.C.E., Inc.
- Citizens Advisory Commission, Florida Division of Blind Services
- Citizens Advisory Commissions, Arlington County, VA
- Coalition of Families and Friends
- Coalition to Promote Independence for People with Disabilities
- Coalition of Texans with Disabilities
- The Coastal Area Support Team
- Colorado Department of Human Services, Supportive Housing & Homeless Programs
- Colorado Governor's Advisory Council for Persons with Disabilities
- Columbia Lighthouse for the Blind
- Community Intersections
- Community Outreach, Inc.
- Concerned Advocates
- Connecticut Association of Personal Assistants
- Connecticut Council on Independent Living
- Connecticut Department of Mental Health and Advocacy Services
- Connecticut Office of Protection and Advocacy for Persons with Disabilities
- Consortium of Developmental Disabilities Councils
- Consortium for Citizens with Disabilities (CCD)
- Construction Management Department, University of Arkansas
- Consumer Research and Evaluation
- Corporation for Independent Living
- COSP Multisite Project, FL
- Cumberland County Office for the Disabled, NJ
- Deborah's Place
- Department of Social Services (location unknown)
- Disabled Rights Action Committee
- Disability Community Small Business Development Center
- Disability Housing Advocates of Northern Virginia
- Disability Management, Inc.
- District of Columbia Center on Disability and Health
- District of Columbia Department of Mental Health
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Federal Register: July 27, 2001 (Volume 66, Number 145)
July 27, 2001 Federal Register Notice Seeking Public
Input Into Federal Agencies' Self-Evaluation Process
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
Community-Based Alternatives for Individuals with Disabilities
AGENCY: Office of the Secretary, HHS.
SUMMARY: Under Executive Order 13217, the Departments of Health and Human Services (HHS), Labor, Education, Justice, Housing and Urban Development and the Social Security Administration are undertaking an evaluation of each agency's policies, programs, statues and regulations to determine whether any should be revised or modified to improve the availability of community-based services for qualified individuals with disabilities. As the designated lead agency, HHS seeks public comments to inform each agency's evaluation.
FOR FURTHER INFORMATION CONTACT: Kari Benson, New Freedom Initiative Group, 202-205-0624.
DATES: All comments must be received on or before the close of business on August 27, 2001.
ADDRESSES: All comments should be addressed to the New Freedom Initiative Group, Department of Health and Human Services, P.O. Box 23271, Washington, D.C. 20036-3271. If possible, please send an electronic version of the comments on a 3-1/2 inch DOS format floppy disk in a format that is accessible to everyone, including persons with disabilities, such as HTML, ASCII text, or popular word processor format (Microsoft Word, Corel WordPerfect). Comments may also be sent electronically via email to: email@example.com.
SUPPLEMENTARY INFORMATION: On June 18, 2001, President Bush signed Executive Order No. 13217 on Community-based Alternatives for Individuals with Disabilities. The Order commits the United States to community-based alternatives for individuals with disabilities and recognizes that such services advance the best interests of the United States. The Order calls upon the federal government to assist states and localities to swiftly implement the decision of the United States Supreme Court in Olmstead v. L.C. and directs specific federal agencies to review their policies, programs, statutes and regulations to determine whether any should be revised or modified to improve the availability of community-based services for individuals with disabilities. The review must focus on identifying affected populations, improving the flow of information about supports in the community, and removing barriers that impede opportunities for community placement. The review must also ensure the involvement of consumers, advocacy organizations, providers, and relevant agency representatives. The results of the evaluation must be reported, through the Department of Health and Human Services, to the President by October 16, 2001.
The specific agencies charged with undertaking this review are: the Department of Justice (DOJ), the Department of Health and Human Services (HHS), the Department of Education (DOE), the Department of Labor (DOL), Housing and Urban Development (HUD), and the Social Security Administration (SSA).
The agency self-evaluations focus upon identifying the appropriate role of the federal government to promote the ability of people with disabilities to live more independently in the community (close to families and friends), to engage in productive employment, and participate in community life. To assist federal agencies in their review and self-evaluation, we invite the public to submit to us your specific written comments on issues such as barriers in federal law, policy and programs that limit the ability of people of any age who have a disability to achieve the above goals; actions that each of the designated agencies can take to address those barriers, improve the flow of information about community supports or aid in fulfillment of the ADA; and how federal programs can work together in support of enabling an individual with a disability to participate fully in the social end economic life of the community (e.g., health coverage, mental health services, social services, affordable and accessible housing, employment, caregiver support, and other services).
All comments should be submitted to the Department of Health and Human Services at the address noted above. As the coordinating federal agency, the Department will ensure that comments relating to programs administered by any of the other designated federal agencies will be submitted to those agencies for review in conjunction with that agency's review and self-evaluation.
Dated: July 25, 2001
Tommy G. Thompson,
Secretary, Health and Human Services
1 Four additional agencies, including the Department of Transportation, Veterans Affairs, the Small Business Administration, and the Office of Personnel Management, although not originally named in the Order, joined the implementation effort on a voluntary basis. Other agencies, including the Equal Employment Opportunity Commission and the National Council on disability, share some responsibility for activities that the Order addresses and also have offered to help implement it and achieve its goals.
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2 "Long-Term Care: Implications of Supreme Court's 47 Olmstead Decision Are Still Unfolding." United States General Accounting Office, Testimony of Kathryn G. Allen before U.S. Senate Special Committee on Aging, at pp. 6-7 (Sept 24, 2001)("GAO Testimony").
3 GAO Testimony at 7.
4 GAO Testimony at 19.
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