Department of Mental Retardation
At a Glance
PETER H. O’MEARA, Commissioner
Kathryn duPree, Deputy Commissioner
Established – 1975
Statutory authority –
Conn. Gen. Statutes Chap. 319b – 319c
Central office – 460 Capitol Avenue,
Hartford, CT 06106
(total filled count as of June 15, 2005)
expenses - $753,094,326
Organizational structure – Services and Supports to over 19,000 individuals and their families, including birth-to-three services, are provided through a network of public and private providers across Connecticut. The Office of the Commissioner Oversees and directs the following divisions: Administrative Services; Family and Community Services; Legal and Government Affairs; Strategic Leadership Center; Chief of Staff and Human Resources; Affirmative Action; and the Office of the Ombudsperson. The Department operates three regional offices, various campus programs, and an Operations Center in Central Office, which coordinates all contracted services. In addition, the Department is the lead agency for the Connecticut Birth-to-Three Program.
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.
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 under contract or enrolled with the Department, in addition to the state operated services. These services include residential placement and in-home supports, day and vocational programs, early intervention, family support, respite, case management, and other periodic services such as transportation, interpreter services, and clinical services.
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. Continued significant improvements were introduced to risk management systems, including enhancements to risk screening procedures through the development of an enhanced Health and Safety Assessment, a revised Individual Planning document, new critical incident management protocols for services delivered in personal homes, and, staff training materials and fact sheets for individuals and families who self-direct their own services. These and other system initiatives are designed to meet the increasing expectations of the Centers for Medicare and Medicaid Services (CMS) to meet health and welfare and quality improvement protocols for the operation of Home and Community Based waivers. The new Quality Review and Improvement system under development went through 5 separate field tests and will be initiated to review non-licensed services in FY 06. The system expands the Department’s oversight to include a formal review of supported living, individual support and day services in addition to licensed settings. As a result of the CMS Systems Change Grant funding awarded in October 2003, the department awarded a contract to develop the information management system that will produce the performance benchmarks and provider profiles that consumers and their families can access to help to inform their decisions in selecting providers of service.
The Connecticut Department of Mental Retardation (CT DMR) and the Connecticut Department of Emergency Management and Homeland Security (CT DEMHS) established a collaborative relationship in 2002. Since then CT DMR has participated in several CT DEMHS emergency drills associated with nuclear safety and homeland security. DMR has tested the CT DMR Special Operations Plan for Emergency Management within the confines of emergency management exercises. In the fall of 2004, CT DMR participated in a Federal Emergency Management Agency (FEMA) evaluated nuclear plume and ingestion pathway exercise. In the spring of 2005, CT DMR participated, along with other state agencies and municipalities, in the biological terrorism exercise TOPOFF 3, which included participation with the State of New Jersey and with the United Kingdom and Canada. CT DMR staffed emergency operations centers around the state. This included participation with the statewide emergency operations team at the State Armory in Hartford. In addition, CT DMR is collaborating with CT DEMHS, FEMA and the Nuclear Regulatory Commission (NRC) to establish a Host Community for Special Populations, operating at the Southbury Training School, in Southbury, CT. The host community will be a reception, triage and decontamination site in the event of a radiological event. To establish the host community, CT DMR has received three grants from the Nuclear Safety Emergency Preparedness (NSEP) fund for physical plant renovations, equipment and training.
DMR hired 27 Case Managers during the fiscal year and redistributed caseloads to create more manageable caseload size for Case Managers supporting individuals who receive waiver services. Case Managers received training in the new Individual Planning process and related waiver requirements. The Governor’s Budget proposed to add an additional 20 Case Management positions in FY06 which was adopted in the Legislative Budget. DMR has created nine paid self advocate coordinator positions in the Department. These individuals are responsible for helping to lead change efforts in Connecticut. The work responsibilities of the Self Advocate Coordinators include 1) helping to promote self advocacy in Connecticut, 2) representing consumer viewpoints on agency committees and workgroups, 3) providing training and education to consumers, family members, providers, and community members on the rights of people with disabilities and on all aspects of self advocacy and self determination, 4) training and mentoring peers to become public speakers, 5) developing fact sheets, resource guides and other material that is written for and by people with intellectual disabilities, and 5) assisting DMR staff within the region to better understand and apply best practices in self advocacy and self determination for all people served by the department. Speaker Bureaus have been formed to help teach self advocates how to publicly speak out on issues that are important to them.
The new Individual and Family Support waiver was developed and approved as an Independence Plus waiver in January 2005 under the federal government’s New Freedom Initiatives. Connecticut DMR received the 10th such approval in the nation. The Department also submitted a new Comprehensive waiver application to the legislature to replace the original DMR due to expire in October 2005. The waiver application was authorized by the legislature on June 28, 2005, and was submitted to CMS for final approval. Both waivers will enhance the variety of individualized support options available for individuals and families that are eligible for federal financial participation, and the new Comprehensive waiver requests authorization to offer Assisted Living as an alternative for DMR consumers as they age. 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 submissions. This project completed three pilot tests of an assessment tool with guidance provided by the Steering Committee comprised of representatives of all DMR stakeholders. Final tool development and individual budgeting financial analysis will be completed in FY 06 that will provide for valid and equitable resource allocation for individuals seeking support from DMR.
Our new waiver request represents a very important step forward from several perspectives. The waiver is an integral component of our 5-year waiting list initiative introduced and supported by the state legislature in the 2004 regular session of the Connecticut General Assembly. The Waiting List Initiative provides services for 150 individuals who are on the Waiting List each year using new funding at an average of $50,000 per person in addition to enhanced family support for an additional 100 families per year whose sons or daughters are on the Planning List at an average of $5,000 annually. This is a new program that started in FY05 with funding available mid year for only 6 months. This enhancement to DMR’s funding is a significant initiative in supporting the much needed respite and other family support services for our families. It also represents the opportunity to gain access to Medicaid federal financial participation drawn from the expanded state appropriations as these services are now included in the new Individual and Family Support Home and Community Based Waiver. Additionally, the department makes funded vacancies available for additional individuals on the Waiting List with a goal of serving an additional 75 individuals from the Waiting List each year. Subsequent to the funding of the Waiting List Initiative, the Waiting List Settlement was approved by the U.S District Court on May, 19, 2005 (ARC/Connecticut v. O’Meara, 3:01CV1871, March 30, 2005).
During this past year the department made significant strides serving individuals on the Waiting List for residential services. New development funds were used to support 172 people. Of this group 128 came from home. Of those on the Waiting List who lived with their families or independently, 69 received supports to stay with their families and the remaining 59 receive residential services outside the family home. The remaining 44 individuals were on the Waiting List because they needed additional funding to support their change in need. The department was also able to provide residential placement for another 132 people through the use of funded vacancies in existing residential settings. In addition, the Waiting List initiative specifically includes increased rent subsidy funding to help facilitate new residential support options for those adults who would like to move out of their family home.
DMR also provided adult day services to over 200 high school graduates and transitioned more than 50 young adults from DCF who were in need of either residential support or day services. The Governor’s Budget included a proposal to transfer the responsibility of serving children with mental retardation who participate in the DCF Voluntary Services Program to DMR. This was included in the Legislative Budget for FY06.
During FY 2005, the Department generated $ 308,293,153.41 in federal Medicaid reimbursement. This is $ 5.1 million more than in fiscal year 2004. 6766 people participated in the Home and Community Based Services Waiver during fiscal year 2005, a net growth of 204 individuals over fiscal year 2004 enrollment. The waiver allows for federal reimbursement for residential habilitation, day programs, and support services provided in the community. On February 1, 2005 a new Individual and Family Support Waiver was initiated. The Department will continue to examine ways to maximize federal reimbursement through these waivers and other federal programs, and the new Quality Review and Improvement System will assure full compliance with a new CMS waiver protocol.
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. Additionally, both DMR Public and Private providers are required to conduct cultural competence organizational self assessments and improvement plans.
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 2004-2005, the Council budget was $685,216 for initiatives on inclusive child care, education, and recreation, employment, housing, self-advocacy with kids, a family conference, culturally appropriate supports, social role valorization training, community building and transportation.
To assure continued participation in Part C of the IDEA, the Department submitted proposed amendments to 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 had 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 but this new provision was later withdrawn. The regulations without the credentialing provisions were approved by the Regulation Review Committee on August 24, 2004 and were received, filed and made effective by the Office of the Secretary of State on August 30, 2004.
Pursuant to Public Act 03-146, the Commissioner of Mental Retardation was 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 to make the necessary changes to these regulations and clear them through the Office of the Attorney General. These regulations are still being developed and the Department plans to submit them as soon as possible.
Section 57(a) of PA 05-251 (the budget act) allows for $250,000 appropriated to the Judicial Department for FY 05, to be continued and transferred to the Department of Mental Retardation for a pilot program for autism services. Funding will support a new position within the department that will be responsible for coordinating various initiatives for adults with autism who do not have mental retardation.
The new position will be responsible for coordinating the various components of developing a program plan and system design for adults with autism, including but not limited to: researching opportunities for grants and federal waivers; examining previous reports and studies already completed on this topic; coordinating with other state agencies the opportunities and best way to serve this population; reviewing and updating previous findings and recommendations regarding serving individuals with autism; establishing a service coordination plan and developing a supported employment program plan. The new position shall coordinate and collaborate with existing department staff, other state agencies that can best serve individuals with autism and various stakeholders. This may include maximizing available resources for individuals with autism in Connecticut. Funding will also support training service opportunities for providers or individuals who provide support to adults with autism. The Autism Coordinator shall submit a report on the progress of the autism initiatives identified above to the joint standing committee on Appropriations and the Office of Fiscal Analysis no later than January 2, 2006.
Public Act 05-150, An Act Concerning Medication Administration in Department of Mental Retardation Residential Facilities and Programs, passed during the 2005 legislative session. The legislation expands the DMR staff training program for medication administration to include staff providing individual and family support services funded by the department. Current regulations will be amended to incorporate this change.