• 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.

• 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.

• 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.

• 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.

• RSA will identify resources for funding opportunities for modifications to living spaces and disseminate that information to consumers of independent living services.

• 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.

• 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.

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.

• 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.

Department of Education

• 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.

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.

• 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.

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:

• DOT will work with the Department of Health and Human Services to revitalize the DOT/HHS Council on Access and Mobility.

• 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.

• RSA, through partnerships with other public agencies, will seek resources to assist independent living service providers to establish and operate transportation systems.

• 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.

• 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.

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:

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

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 21^st century. Key federal agency actions in the area of education are set out below.

• 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.

• 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.

• 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 21^st century workforce.

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 Afully 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.

• 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 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.

• 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 work with DOJ on technical assistance to improve housing providers= understanding of the Fair Housing Act.

• 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.

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.

• 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 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.

• 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.

• 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.

• 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.

• 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.

• 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.

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 orderto acquire, assess and use data aboutpeople with disabilities.

• 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.

• 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.

• 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.

• 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.

• 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.

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.

• 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.

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.

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.

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 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.

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.