DEPARTMENT OF MENTAL RETARDATION

Mission

The mission of the Department of Mental Retardation is to join with others to create the conditions under which all people with mental retardation can experience presence and participation in Connecticut town life, opportunities to develop and exercise competence, opportunities to make choices in the pursuit of a personal future, good relationships with family members and friends, and respect and dignity.

Statutory Responsibility

The Department of Mental Retardation, with the advice of the Council on Mental Retardation, is responsible for the planning, development, and administration of complete, comprehensive, and integrated statewide services for persons with mental retardation and persons medically diagnosed as having Prader-Willi Syndrome. DMR provides services within available appropriations through a decentralized system that relies on private provider agencies with which the Department contracts. These services include residential placement, day programs, early intervention, family support, respite and case management.

Public Service

During the last fiscal year, the Department engaged in a number of activities designed to improve services and the management of its public and private programs. Significant improvements were introduced to risk management systems, including enhancements to the mortality review and investigations procedures that contributed to full compliance with the Governor’s Executive Order No. 25. A new Quality Review and Improvement system continues to be developed. The system will expand the Department’s oversight to include a formal review of supported living, individual support and day services in addition to licensed settings. The concept of program integrity is being expanded to include consistent measure for both private and public settings. The new system will give the Department the ability to produce benchmarks and provider profiles that consumers and their families can access. This system incorporates personal outcomes as a critical indicator of service quality and agency performance, and is designed to provide more focused evaluation of services in non-licensed settings and programs. The Department applied for and was awarded a Centers for Medicare and Medicaid (CMS) Systems Change Grant for $499,000 over three years in October 2003 in support of this new system. The grant provides funds for DMR to design a new information management system to support analysis and reporting of quality indicators, and to track follow-up recommendations from various quality oversight functions to ensure completion.

Improvements/Achievements 2003-04

The Department proposed a comprehensive Waiting List initiative to the Governor based on a planned strategy to gain increased federal revenue and the development of a new Individual and Family Support Home and Community-Based Medicaid waiver. This initiative was supported by both the Governor as a five-year initiative, and the Legislature for fiscal year (FY) 2005 resulting in new funding for 150 individuals to receive residential supports, and 100 individuals who will receive enhanced family supports through the proposed new waiver. The Department worked with advocacy and provider groups throughout the year on key elements of the proposed new waiver, and it was submitted to the Legislature in July for approval.

During FY 2004, the Department generated $ 303,196,022.11 million in federal Medicaid reimbursement. This is $ 14.8 million more than in fiscal year 2003. 6562 people participated in the Home and Community Based Services Waiver during fiscal year 2004, a net growth of 527 individuals over fiscal year 2003 enrollment. The waiver allows for federal reimbursement for residential habilitation, day programs, and support services provided in the community. The Department will continue to examine ways to maximize federal reimbursement through the waiver and other federal programs and the new Quality Review and Improvement System will assure full compliance with a new CMS waiver protocol.

The new Individual and Family Support waiver has been developed as an Independence Plus waiver under the federal government’s New Freedom Initiatives. The Department applied for and was awarded a second Systems Change Grant for $175,000 over three years in October 2003 to design an assessment tool and individual budgeting methodology to support the new waiver submission. This project will result in a Level of Need process that will provide for valid and equitable resource allocation for individuals seeking support from DMR.

Effective June 2, 2003, the agency consolidated from five regions to three and announced Regional and Assistant Regional Directors. The three new regions are: West, a combination of the existing Northwest and Southwest Regions, including Southbury Training School, the North, which is the existing North Central Region and the northern half of the Eastern Region which includes Windham and Tolland Counties and finally, the South, which encompasses the existing South Central Region and the southern half of the Eastern Region including New London County. The regional offices are located in Waterbury, (West Region), Wallingford, (South Region) and Farmington, (North Region) with satellite offices being maintained for case managers, Early Connections staff, family support and residential support staff.

On June 19th, 2004, the final home in the CLA Conversion Project was transferred to the private sector. As a result of these efforts, significant savings were generated and those savings were used to assist people on the DMR Waiting List.

On June 19th, 2004, the final home in the CLA Conversion Project was transferred to the private sector. We would like to thank all who were involved with this project. It was a great example of what can be accomplished through cooperation and teamwork. As a result of these efforts, significant savings were generated and a portion of those savings were used to assist people on the DMR Waiting List. This project was necessitated in response to the loss of a significant number of employees through the ERIP.

During FY 2004, the DMR continued to utilize CTHealthjobs.org, a public/private workforce development initiative that was implemented in 2002. The initiative showed steady increases in all areas, including employer participation and applicant activity. As a result of extensive recruitment efforts, which included participation in several career fairs across the State, CTHealthjobs.org received 4,072 new applications from individuals who are interested in working in the field of developmental disabilities. The applications were made available to the network of public/private agencies that subscribe to cthealthjobs.org, free of charge. CTHealthjobs.org continues to serve as a valuable recruitment tool for over 75 agencies that participate in the network.

DMR has developed a long-range plan to continue to maximize the department’s LAN system and browser based technologies to increase efficiencies in communication, planning, forecasting, printing and in the work force at large. Projects include the development of browser based Incident Reporting and Management, browser based message boards, browser based communication and access to Department information such as Provider Directories and performance profiles, electronic policy and procedure manuals, family newsletters and provider updates, and electronic billing systems.

The Department's Focus Team on Aging, a group that included representation from state agencies, providers, family members and professionals, was issued in October 2003. The report identified issues and concerns facing people with mental retardation who are aging and detailed specific recommendations for the Department in the areas of Health, Housing, Transportation, Retirement and Leisure, Education and Training, Research, and End-of-Life issues. In response to a key recommendation, DMR established a position responsible for coordinating elder services for the Department and developed a detailed action plan to address the team's recommendations.

During the year, the Department opened its 9^th Respite Center, which is in the West Region. In addition, DMR has plans to open another Respite Center in the fall of 2004. These Respite Centers allow numerous families to experience a rest or a break from the ongoing role of caring for a family member who has mental retardation by providing temporary care. Respite may be provided for an afternoon, an evening, a weekend, a planned vacation, or in response to an emergency situation or illness. DMR Respite Centers are a welcome opportunity for caregivers so that they may have an opportunity to have some personal time for themselves as they continue to care for their relatives in their homes.

In 2003, the Department increased its focus on Forensic Services by forming a statewide steering committee to review existing practices and service delivery models. In April 2004, the steering committee was replaced by a Statewide Forensic Admissions Committee, consisting of Central Office staff, three regional forensic liaisons and three regional resource directors. The new committee meets monthly and its recommendations for placements and support services are informed by the Steering Committee’s work.

Information Reported as Required by State Statute

Affirmative Action

Commitment to affirmative action is incorporated into all aspects of DMR’s employment process including recruitment, selection, hiring, training, promotions, benefits, compensation, layoffs, and terminations. It is the objective of the Department to achieve the full and fair participation of women, African-Americans, Hispanics, persons with disabilities, and other protected groups in our workforce.

The Department’s affirmative action posture is reflected in its practices for selecting outside contractors. In line with this commitment, the Department will not knowingly do business with any contractor, sub-contractor, bidder or supplier of materials who discriminates against members of a protected class. Additionally, DMR has established goals for the use of small businesses and minority and women-owned businesses and actively solicits their participation.

The Department strives to provide services and programs in a fair and impartial manner. To achieve this the Department has developed strategies to nurture the development of a culturally diverse workforce, expand outreach efforts, and provide services and communications that are sensitive to the language and cultural preferences of individuals and families from diverse backgrounds.

Developmental Disabilities

The Council on Developmental Disabilities is an independent entity, operating under the federal Developmental Disabilities Act (PL 106-402), composed of Governor-appointed members, and attached administratively to the Department of Mental Retardation. The mission of the Council is to promote full inclusion of all people with disabilities in community life. In 2003-2004, the Council budget was $690,715 for initiatives on the Americans with Disabilities Act and Olmstead implementation, Partners In Policymaking, a family conference, personal assistance, inclusive education, inclusive child care, employment, culturally appropriate supports, respite care, social role valorization training and self-advocacy with kids.

Regulations/ Studies

Pursuant to Public Act 01-154, the Department promulgated regulations to establish and implement DMR’s policies with respect to the placement and care of clients who may pose threats to others in the absence of appropriate supervision and security. These regulations were approved with technical corrections and deletion by the Regulation Review Committee on September 23, 2003. Said regulations were filed with the Secretary of State and has an effective date of September 29, 2003.

Pursuant to Public Act 03-146, the Commissioner of Mental Retardation is required to include new requirements in its regulations regarding the comfort, safety, adequate medical care and treatment of persons at DMR residential facilities. On July 1, 2004, the Department requested an extension of three months to make the necessary changes to these regulations and clear them through the Office of the Attorney General.

Pursuant to June Special Session, Public Act 03-3, “The Commissioner of Mental Retardation, in conjunction with the Commissioner of Social Services, shall, within available appropriations, prepare a plan to establish and operate a pilot program to provide residential accommodations with assisted living services to individuals on the Department of Mental Retardation’s waiting list for residential placement or support. Such plan shall describe the necessary elements of such a pilot program, including, but not limited to, coordination of staffing issues and applications for federal Department of Health and Human Service Demonstration Grants, and any necessary Medicaid waivers. Not later than January 1, 2004, the Commissioner of Mental Retardation shall submit a report containing such plan, in accordance with section 11-4a of the general statutes, to the joint standing committees of the General Assembly having cognizance of matters relating to public health & human services.” The final report was issued on February 24, 2004 after being granted an extension by the Committees of Cognizance.

In response to this legislation, the Department of Mental Retardation (DMR) developed a representative committee to assist in the process. On this committee, staff from the Department of Mental Retardation were joined by representatives from the Department of Social Services, Office of Policy & Management, Department of Public Health, Private Provider Trade Associations, Assisted Living Services Agencies, Legislators, advocates and family members. The committee was involved in the process of outlining the task of the committee, proposing elements of the plan, discussing other assisted living ventures, setting a timeline for completion, reviewing the recommendations contained in this proposal and framing the objectives to be accomplished by the pilot. The proposed pilot program described in the final report will add an additional option to the array of residential supports available to individuals who need our services. When the current HCBS waiver is renewed we will include assisted living as a service which may expand the opportunity to use it for more people in the future.

To assure continued participation in Part C of the IDEA, the Department submitted proposed amendments to Connecticut General Statute Sections 17a-248-1 to 17a-248-14, inclusive, of the Regulations of State Agencies pertaining to Early Intervention Services for Infants and Toddlers and their Families to the Regulation Review Committee on July 2, 2004. In addition, the Department has proposed Sections 17a-248-15 to 17a-248-22, inclusive, of the Regulations of State Agencies pertaining to Implementation of Credentialing Provisions for all Early Intervention Service Providers. Notice of Intent to Amend and Adopt Regulations was published in the Connecticut Law Journal on December 23, 2003. Public hearings to receive testimony concerning the proposed amendments and new regulations were convened on January 21, 2004 at the Legislative Office Building. In addition, written comments were received and considered by the Department through January 23, 2004. In response to the testimony and comments received, some changes were made to the proposed amendments and new regulations. These regulations are expected to be on the Regulation Review Committee’s August 24, 2004 agenda.