Overview of CMS Home and Community Based Services Regulations

Sharing the latest from the VA Dept. of Behavioral Health and Developmental Services . . . 

In January 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for home and community based services (HCBS) that requires states to review and evaluate home and community based (HCB) settings, including residential and non-residential settings. The HCBS final regulation, published January 16, 2014 and available at http://www.gpo.gov/fdsys/pkg/FR-2014-01-16/pdf/2014- 00487.pdf, requires states to prepare and submit a Statewide Transition Plan. CMS asked that statewide transition plans specifically address only the settings requirements of the HCBS regulations.

According to the HCBS regulations (section 441.530), the following characteristics must be present in all settings where HCBS are provided in order for a setting to be considered HCB[1]:

  • It is integrated in and supports full access to the greater community;
  • It is selected by the individual from among a variety of setting options;
  • It optimizes autonomy and independence in making life choices;
  • It facilitates individual choice in selecting both services and service providers; and,It ensures individuals rights of privacy, dignity, respect, and freedom from coercion and restraint.

Furthermore, individuals living in provider owned or operated residential settings must:

  • Have a lease or other signed legally enforceable agreement providing similar protections;
  • Have access to privacy in their sleeping units;
  • Have entrances lockable by the individual, with keys provided to appropriate staff as needed;
  • Have a choice in selecting their roommate(s), if they share a room;
  • Have the freedom to decorate and furnish their sleeping and/or dwelling unit;
  • Have the ability to control their daily schedules and activities and have access to food at any time;
  • Be able to have visitors at any time; and,
  • Be able to physically maneuver within the setting (e.g., setting is physically accessible).

Any modifications made to any of the above criteria for provider-owned and operated residential settings must be the result of identified individual-specific needs discovered through an independent assessment, and then documented and justified in a person-centered service plan.

The HCBS regulations give states time to “transition” to meet settings requirements. States have until March 2019 to assure compliance of all settings. Virginia’s Statewide Transition Plan expects to reach full compliance by March 2019. During the period covered by the Statewide Transition Plan, Virginia can continue to operate waivers in existing settings that do not yet meet the HCBS regulation’s settings requirements.

Virginia has redesigned its Medicaid HCBS Waivers for people with intellectual or developmental disabilities (I/DD). Effective September 1, 2016, the ID Waiver became the Community Living (CL) Waiver, the Individual and Family Developmental Disabilities Support (DD) Waiver became the Family and Individual Supports (FIS) Waiver, and the Day Support Waiver became the Building Independence (BI) Waiver. These waivers are currently operating under emergency regulatory authority. The permanent regulations will require compliance with each of the setting provisions in the HCBS regulations. The permanent regulations are targeted to become effective in February 2018. Upon the effective date of the permanent regulations, all providers will need to be in full compliance with the HCBS settings requirements.

CMS requires states to report on the current compliance status of HCBS settings. Beginning in March of 2017, ALL providers of Medicaid CL, FIS or BI waiver services in impacted settings will be required to complete and submit a HCBS compliance self-assessment for each setting where they provide HCBS services. Impacted settings include: group home residential settings, sponsored residential settings, supported living settings, group day settings and group supported employment settings.

The state will provide service providers with technical assistance and guidance to assist their efforts of bringing non-compliant settings into full compliance. Providers should take the initiative to become educated on the CMS HCBS regulations’ settings provisions and requirements. There are many resources and technical assistance documents available on CMS, DBHDS and DMAS websites.

Information & Resources

Frequently Asked Questions Regarding the Heightened Scrutiny Review Process and Other Home and Community-Based Settings Information

[1] This is an abbreviated list, see CFR section 441.530 for entire list of requirements.

overview-cms-hcbs-regulations-updated-002

Waiver Redesign Summary, July 2016

Summary of Major I/DD Items in the Conference Committee Report

 

The Budget Conference Committee completed its work on Virginia’s Budget Bill this week and posted their amendments on Wednesday evening.  The House and Senate members now have 48 hours to review, which means the final vote on the budget bill will take place this evening or tomorrow morning.

Once the General Assembly has its vote on the conference committee report, the Governor will have the opportunity to review all budget items, suggest amendments or veto an item.  The General Assembly will convene again on April 20 to vote on the Governor’s amendments to the final budget bill.  The state budget is to take effect July 1.

Major I/DD Items in the Conference Committee Report:

  • Provides additional funding for the Early Intervention- Part C program ($1.7M in FY17  and $2.5M in FY18).

 

 

  • Provides additional I/DD Waiver slots.  Supports the Governor’s proposal to provide 855 Waivers required by the DOJ agreement, but eliminates the 100 proposed “reserve” Waivers that the Governor recommended.  Instead, the Conference Committee provides 355 I/DD Waivers above the DOJ agreement in FY17 for individuals and families on the I/DD Waiver waiting lists ($5.2M GF total).  200 of these Waivers are reserved for the first 200 people on the DD Waiver waiting list as of June 30,  2016. The total I/DD Waiver allocation will be as follows:
                              I/DD Waivers Included in the Budget Bill FY17 FY18 Total

 

 

Community Living (CL)Waivers for Waiting List

 

 

300

 

325

 

625

 

Individual and Family Support (IFS) Waivers for Waiting List

 

 

340*

 

25

 

365

 

Community Living (CL) Waivers for Individuals Leaving Training Centers

 

 

90

 

90

 

180

 

Reserve Waivers for emergencies, transitions from other institutional settings  and movement between waivers

 

 

40

 

40

 

  • Limits the hours a single consumer-directed attendant works to no more than 40 hours per week per employer. This would affect individuals and families receiving consumer-directed respite, personal care and companion services.  Attendants would not be allowed to work more than 40 hours per week for an individual/family.

 

  • Moves forward with I/DD Waiver Redesign, but includes some amendments.  In total, provides $34M SGF to increase I/DD waiver reimbursement rates and implement new waiver services as part of the redesign: 
FY17 FY18
General Fund $11.8M $22.2M
Non-General Fund $11.8M $22.2M
Total $23.6 $44.4M

 

The Conference Committee report includes the following amendments for Waiver Redesign:

 

  • Accepts the rates and models proposed in the Burns study (available here), with the exception of the following:

 

  • The rate increase for   skilled nursing offered in I/DD Waiver will be 25%.

 

  • Private duty nursing  offered under I/DD Waiver, EPSDT  and Tech Waiver will receive a 11.5% increase (rate increase for private duty nursing in I/DD Waiver was originally 40%).

 

  • Provides a 24.5% Northern Virginia rate differential for Sponsored Residential services effective January 1, 2017.
  • Initiates the following services as of July 1, 2016:  Shared Living Residential, Supported Living Residential, Independent Living Residential, Community Engagement, Workplace Assistance Services, Private Duty Nursing Services, Crisis Support Services, Community Based Crisis Supports, Center-based Crisis Supports, and Electronic Based Home Supports;
  • Delays implementation of the following services until July 1, 2017:  Community Guide and Peer Support Services, Community Coaching, Benefits Planning, and Non-medical Transportation (for a description of all NEW services available in the redesigned I/DD Waiver, click here).

 

  • Requires DMAS and DBHDS, in collaboration with sponsored residential providers and family home providers, to collect information and feedback related to payments to family homes and the extent to which changes in rates have impacted payments to the family homes statewide.

 

  • Requires an independent review of the Commonwealth’s options for continued operation of Central Virginia Training Center in the event that sufficient community capacity is not available or is insufficient to meet the care needs of individuals.  (Note-the DOJ agreement requires the Commonwealth to ensure community-based care meets the needs of Training Center residents).

 

  • Requires that expenditures from the Behavioral Health and Developmental Services Trust Fund be appropriated through an appropriations bill passed by the General Assembly.  The budget also allows funds to be carried forward to the subsequent fiscal year and authorizes funding to build community capacity in FY16 and FY17.

 

  • Authorizes $750,000 in FY16 for one-time capital and transition cost associated with the development of community-based waiver group homes and/or community-based intermediate care facilities for individuals with intellectual disabilities who are transitioning to community living from Southwestern Virginia Training Center and who choose to remain in Southwest Virginia.  The housing options shall be located in Virginia no farther than 100 miles from the Southwestern Virginia Training Center.  The Department of Behavioral Health and Developmental Services shall give preference to projects involving existing Virginia Providers to expand service capacity.

 

  • Authorizes $4 million in FY17 for one-time expenses related to developing housing options and specialized services, and making capital improvements to enhance and expand services for individuals intellectual and developmental disabilities.  A minimum of 60 percent of the funding will be used to build community capacity in NOVA and the remaining funding will be used to build community capacity for individuals who are transitioning from the community from SWVTC.  Language specifies that projects addressing SWVTC are to be located in VA within 100 miles of the facility.  DBHDS is required to give preference to projects involving existing VA providers to expand capacity.  Language also requires the  agency to report on expenditures from the Trust Fund by 12/1/2016

 

  • Provides rental assistance programs for people with intellectual and developmental disabilities.   Provides funds for the 300 rental vouchers and provides ongoing funds for Rental Choice VA subsidy program
  • Provides DBHDS with 35 new staff positions.  Provides funds for 10 prior authorization specialists, 5 prior authorization team leads and one administrative assistant to support the prior authorization team for the new I/DD Waiver program.   15 additional positions are created to facilitate compliance with the DOJ.
  • Provides $9.6M to strengthen crisis programs for children and adults with I/DD.  Provides funds to build two, eight bed therapeutic homes, in additional to funds for mobile crisis services, respite services for children and crisis coordinators in each region.  Funds are included for three crisis specialists to work in state mental health facilities to reduce unnecessary institutionalization.  The Independent Reviewer charged with monitoring the state’s compliance with this agreement has noted that the state continues to be noncompliant in this area particularly as it applies to children.
  • Requires a review of CSA to increase integration of children with disabilities into their home school districts. Requires the CSA State Executive  Council to review and develop a robust set of options for (i) increasing the integration of children receiving special education private day treatment services into their home school districts, including mechanisms to involve local school districts in tracking, monitoring and obtaining outcome data to assist in making decisions on the appropriate utilization of these services and (ii) funding the educational costs with local school students whose placement in or admittance to state or privately operated psychiatric or residential treatment facilities for the non-educational reasons has been authorized by Medicaid.  The SEC shall continue its review with the assistance of relevant stakeholders including representatives of the ODE, DMAS the Office of Comprehensive Services, DBHDS, local school districts, local governments and public an private service providers.  The SEC shall present a robust set of options and recommendations that include possible changes to policies, procedures, regulations and statues, including any fiscal impact for consideration by the Governor and the chairmen of the House Appropriations and Senate Finance Committees by November 1, 2016.
  • Provides $375,000 from the general fund each year for the Long Term Employment Support Services (LTESS) program to support individuals with disabilities.
  • Requires DOE to convene an interagency workgroup to assess the barriers to serving students with disabilities in their local public schools.   The workgroup shall assess existing policies and funding formulas including school divisions’ program requirements, localities’ composite indices, local CSA match rate allocations, local CSA rate setting practices, the impact of caps on support positions, policies for transitioning students back to the public school, and funding for local educational programming based on models which are collaborative and create savings for both local and state government while providing youth an educational option within their communities. Membership shall include a balance of local and state representatives, all impacted state agencies, local education agency (LEA) representatives, local CSA representatives, local government officials, local special education administrators, stakeholder organizations, parent representatives, the Arc of Virginia, the Coalition for Students with Disabilities, and members of the Virginia General Assembly. The workgroup shall make recommendations to the Virginia Commission on Youth prior to the 2017 General Assembly Session.”

 

For a full summary of all I/DD related budget items, including a side-by-side comparison of Governor, House, Senate and Conference Committee budgets, Side by Side 2016 Budget Bill- Conference Committee Report FINAL

 

The House briefing on the Conference Committee report, which includes an overview of all major items in the budget bill, can be found here.

DBHDS Letter To Individuals and Families Re: I/DD Waiver Redesign

The Department of Behavioral Health and Developmental Services (DBHDS) is amending the three Medicaid Waivers (ID, DS, & DD) and the changes will be effective July 1, 2016. Today, DBHDS released the following letter and attachment outlining the proposed new services array.

Letter to Individuals and Families Re: I/DD Waiver Redesign

Proposed New Service Array

The Arc of Virginia continues to be involved in the I/DD Waiver Redesign effort.  We will be holding a training series this Spring and Summer. Stay tuned!

Court Hearing For Tuesday, January 12, CANCELED

The court hearing scheduled for Tuesday, January 12 has been canceled.  The U.S. Department of Justice and the Commonwealth of Virginia are currently negotiating specific implementation schedules, including time frames, interim steps, and performance indicators, for specific areas of the agreement.  The Honorable John Gibney, the federal judge presiding over implementation of the agreement, posted the following today:

UNITED STATES’WITHDRAWAL OF MOTION FOR A COURT-ORDERED

SCHEDULE AND JOINT SUBMISSION OF SCHEDULES

 “Pending before this Court is the United States’ Statement of Issues and Motion for Court-Ordered Schedule, ECF No. 186 (“Motion for Schedule”). In that motion, the United States described its concerns about delays in the implementation of the Settlement Agreement, ECF No. 112, August 23, 2012 (“Agreement”), including delays in developing a functional crisis system, integrated day and supported employment programs, and integrated housing. Id. at 1-2. The United States’ concerns were amplified by delays in the Commonwealth of Virginia’s restructuring of its Home and Community-Based Services Waivers (“HCBS Waivers”). Although not required by the Agreement, this restructuring is a strategy presented by the Commonwealth to achieve compliance with many of the Agreement’s provisions. Defendant’s Response to the United States’ and Intervenors’ Statements of Issues and in Opposition to the United States’ Motion for Court-Ordered Schedule, ECF No. 191, at 3. Consequently, the United States requested in the motion that the Court require the Commonwealth to provide a schedule setting out reasonable time frames for implementation of the Agreement’s provisions, consistent with the Agreement’s underlying requirements. Motion for Schedule at 3, 29.

At a public status conference on October 23, 2015, addressing the implementation of the Agreement, the Court set a hearing for the Motion for Schedule but encouraged the United States and the Commonwealth to address the issues underlying the motion and determine whether further proceedings were necessary. Since the October hearing, the Commonwealth and the United States have held numerous discussions and have reached agreement on specific implementation schedules, including time frames, interim steps, and performance indicators, for four discrete areas of the Agreement that the United States highlighted in its Motion for Schedule: Supported Employment, Community Engagement (i.e., “Integrated Day”), Crisis Services for Adults, and Crisis Services for Children. The Commonwealth and the United States jointly submit these schedules as Attachment A hereto. The Parties hereto do not intend for these schedules to be modifications or addenda to the Agreement, or entered as court orders at this time. However, the Parties agree that, if implemented, these schedules should significantly facilitate implementation of the Agreement itself.

Moreover, the Parties have committed to continue to negotiate schedules for the remaining areas identified in the United States’ motion, including: integrated housing options, children in nursing facilities and large intermediate care facilities, individuals with complex medical needs, and quality and risk management. The Parties intend to submit similar implementation schedules for those areas during the next several months. In addition, since the October hearing, the Commonwealth has submitted a budget to the General Assembly that, if approved, should enable the Commonwealth to proceed with the restructuring of its HCBS Waivers to help continue efforts to implement the Agreement. In light of the foregoing, the United States submits that proceedings at this time on the United States’ pending Motion for Schedule are not necessary, and the United States herewith withdraws its Motion for Schedule without prejudice. However, the United States may renew its motion if anticipated progress fails to occur.”

Governor McAuliffe Unveils Proposed Budget

 

Governor McAuliffe Unveils Proposed Budget:

Yesterday, Governor McAuliffe released his proposed 2016-2018 state budget, which includes funding for several intellectual and developmental disability (I/DD) priorities, including funding for the I/DD Waiver Redesign.  Unfortunately, the Governor’s proposed budget does not provide enough I/DD Waiver slots to adequately meet the needs of Virginia’s families who are on waiting lists for services.

Members of Virginia’s House and Senate money committees will be hosting regional hearings on January 7 to obtain feedback from Virginia’s citizens on Governor McAuliffe’s budget  proposal.  The Arc of Virginia is preparing a Budget Hearing Toolkit with sample talking points to help individuals with I/DD and family members prepare for these hearings – so you can advocate for I/DD services.  Please plan to attend these hearings, as they are a critical advocacy opportunity.  Your participation can help increase I/DD funding for the waiting list and protect the funds proposed in this budget!

More information on the Budget Hearings can be found in The Arc’s last edition of Insider:  http://us6.campaign-archive2.com/?u=ece9e0333c&id=e607a12a55

Summary of I/DD Items Governor  McAuliffe’s Budget:

  • Provides funding requested for I/DD Waiver Redesign (new rate structure and new services).  Increases the base appropriation for I/DD Waiver Services by $23 million in state general funds (SGF).
  • Provides 855 I/DD Waiver slots required by the agreement (675 for waiting lists, 180 for Training Centers) and 100 additional “reserve” slots to address emergencies.
  • Allows DMAS to limit overtime hours for CD services (personal care, respite, companion)  at 56 hours/week per attendant in order to comply with the US Department of Labor rule.
  • Provides 300 rental subsidies for Virginians with I/DD population and provides ongoing funds for Rental Choice VA program.  The base budget for housing subsidies will be $4.15 million/year.
  • Provides most of funding needed to close gap in Part C Services based on the average annual growth rate of 4.9 percent over the last four years.  ($959,057 general fund in FY 2016, $1.7 million general fund in FY 2017, and $2.5 million general fund in FY 2018).

BUDGET SPECIFICS:

I/DD Waiver Waiting List and Support for Training Center Transitions

  • Provides 855 I/DD Waiver slots that are required by the DOJ Agreement. The distribution of these slots is as follows:
Waiver Type FY17 FY18
ID Waiver Waiting List 300 325
DD Waiver Waiting List 25 25
Leaving Training Centers 90 90
TOTAL 415 440

               

2017 2018
General Fund 14,217,361 31,758,543
Non-General Fund 14,217,361 31,758,543
Total 28,434,722 63,517,068

 

Provides 100 “reserve waiver slots” across three waivers:  Intellectual Disability (25), Developmental Disability (50) and Day Support (25) Effective July 1, 2016.  Reserve slots will be used for emergencies, for individuals transferring between waivers and for individuals transitioning from an Intermediate Care Facility or a state nursing facility (SNF) into the community, in compliance with the requirements of the 2012 Settlement with the U.S. Department of Justice.

2017 2018
General Fund 1,886,913 1,886,913
Non-General Fund 1,886,913 1,886,913
Total 3,773,826 3,773,826

 

  • Provides community supports for individuals in training centers not covered by Medicaid. Provides funds to transition four individuals currently residing in state ID training centers into the community. These four individuals are not eligible for Medicaid, but are still required to be offered under the settlement agreement with the federal Department of Justice. These individuals will be transferred in FY17.
2017 2018
General Fund 503,204 503,204
Non-General Fund

 

I/DD Waiver Redesign and I/DD Services

  • Provides funding to increase I/DD waiver reimbursement rates and implement new I/DD waiver services as part of the I/DD Waiver redesign. The costs include an average rate increase of 5.4% percent for waiver services, the addition of new services to assist in increasing the number of individuals who can live in integrated settings, an increase in the developmental disability case management rate, and additional funds for more intensive services for individuals who have complex medical and/or co-occurring behavioral health needs. The redesigned waivers will address the concerns raised by the DOJ and US District Court in relation to the state’s compliance with the settlement agreement.
2017 2018
General Fund 13,154,660 23,049,569
Non-General Fund 13,154,660 23,049,567
TOTAL 26,309,320 46,099,138

 

 

  • Provide transitional funding for individuals leaving the training centers. Provides support for transitional needs for an estimated 180 individuals leaving the training centers during the biennium. There is currently no base funding dedicated to this need. All transitional needs have been reported through carry forward requests in FY2015 and FY2016. The requested funding will support needs that are covered by Medicaid including assistive technology, home and vehicle modifications, and specialized durable medical equipment.
2017 2018
General Fund 636,000 480,000
Non-General Fund

 

  • 2% increase for agency-directed and consumer-directed personal care, respite and companion services. Provides funding to increases rates for consumer and agency directed personal care, respite care and companion care by two percent in FY2017 in the EDCD Waiver, I/DD Waiver and Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program.
2017 2018
General Fund 7,124,799 7,972,821
Non-General Fund 7,124,799 7,972,821
14,249,598 15,945,642

 

  • Increase private duty nursing rates by 2%. Increase rates for private duty nursing by two percent in Tech and EPSDT in FY17 to cover a larger percentage of provider expenses.
2017 2018
General Fund 563,265 656,490
Non-General Fund 563,265 656,490
Total                1,126,530 1,126,530

 

  • Provide authority to limit overtime hours for consumer-directed attendants. Authorizes the Department of Medical Assistance Services (DMAS) to limit overtime hours that may be provided by attendance who are providing care under the consumer-directed service option in the Medicaid waivers. Funding the DMAS to comply with this new federal rule is included in the Official Consensus Medicaid forecast beginning in FY2016. The Department shall authorize time and a half up to 56 hours for a single attendant who works more than 40 hours per week. The Department shall have the authority to implement this and any necessary changes effective July 1, 2016, in order to confirm state regulations to allay any fiscal impact associated with DOL rule.
2017 2018
General Fund 5,700,000 6,200,000
Non-General Fund 5,700,000 6,200,000
Total 11,400,000 12,400,000

 

 

Housing

  • Expand rental assistance programs for people with intellectual and developmental disabilities.   Provides funds for the 300 rental vouchers, and funding for two positions to manage the rental subsidy program. This request will phase in the new rental subsidies by adding 150 in FY17 and an additional 150 and FY18.
2017 2018
General Fund 1,875,000 3,750,000
Non-General Fund
Positions 2 2

 

  • Provide ongoing funds for Rental Choice VA subsidy program. Provides on-going funds for Rental Choice VA subsidy program. Provides ongoing funds for the Rental Choice VA program established pursuant to the settlement agreement with the DOJ. Individuals being served by this program currently have no stable funding source for the subsidies being provided, as the program was originally funded with 1-time 800K appropriation. If ongoing funds are not appropriated, they will lose their subsidy and will likely end up in a more expensive, congregate setting.
2017 2018
General Fund 400,000 400,000
Non-General Fund

 

Training Centers:

  • “Rebase training center budgets to reflect anticipated closures.” Total reduction in the Biennium budget is $41.4 and decreases the base budget by $21.8/year. Adjusts the budget for training center reimbursements to account for on-going facility closure costs and savings resulting from compliance with the DOJ agreement. Packages reflect the estimated impact of closing Northern Virginia Training Center and SWVTC by FY18.
2017 2018
General Fund (9,832,972) (10,907,845)
Non-General Fund (9,832,972) (10,907,845)
Total (19,665,944) (21,815,690)

 

  • “Realign funds between facilities.” Transfers funds from Intellectual Disability Training Centers to the Virginia Center for Behavioral Rehabilitation. These funds were moved administratively in FY12-15 and will be moved again in FY16.
2017 2018
General Fund 2,792,375 2,792,375
Non-General Fund

 

  • Reduces position levels at training centers.” Reduces the position levels at the training centers from 2664 to 2125 a reduction of 539 positions. The reduction is the result of the closing of NVTC in 2016 (453 positions) and the continued downsizing of CVTC and SWVTC.
2017 2018
General Fund
Non-General Fund
Positions 539 539

 

  • Reduce special fund appropriation to align with revenue collections.
2017 2018
General Fund
Non-General Fund (25,000,000) (32,000,000)

 

  • “Transfers general fund appropriation from DBHDS to DMAS to support training center operations.” Transfers general fund appropriations from DBHDS to the facility appropriation at DBHDS to the state facility appropriation with DMAS. This transfer will provide additional general fund match associated with Medicaid reimbursement necessary to generate special fund revenue for the state operation of training centers. These funds are derived from amounts appropriated to DBHDS from central accounts for increases in salary, workers comp, retirement and health insurance costs
2017 2018
General Fund
Non-General Fund 8,000,000 8,000,000

 

  • “Transfers funds within facility system to address critical needs.” Transfers funds within agency’s facility system to accommodate the needs of individual facilities. Growing costs in pharmaceuticals support services at Central State Hospital, and overtime costs associated with increased admissions have increased the needs at state MH facilities. In previous years, the agency has transferred nongeneral funds to offset some of the increased costs but the closure of training centers will reduced nongeneral fund balances available for such transfers. This adjustment will permanently move funds to the facilities where they are most need and reduce the need for administrative transfers.
2017 2018
General Fund
Non-General Fund 8,848,744 8,848,744

 

  • “Address settlement agreement costs for facility closure, mental health backfill.” Provides funds for retention bonuses and the separation costs of employees at NVTC and SWVTC during the closure process of each facility. Because many of the payments are made in the fiscal years after a facility has closed, they are not eligible for Medicaid reimbursement. Funds are also included to maintain unoccupied buildings until they can be sold.
2017 2018
General Fund 4,805,510 3,938,627
Non-General Fund

 

I/DD Community-Based Crisis Services

  • Expand crisis stabilization program consistent with requirements. Funds crisis stabilization programs required by the settlement agreement with the federal Department of Justice (DOJ). This amendment includes funds to build two, eight bed therapeutic homes, in additional to funds for mobile crisis services, respite services for children and crisis coordinators in each region. Funds are included for three crisis specialists to work in state mental health facilities to reduce unnecessary institutionalization. The Independent Reviewer charged with monitoring the state’s compliance with this agreement has noted that the state continues to be noncompliant in this area particularly as it applies to children.
2017 2018
General Fund 4,330,000 5,327,000
Non-General Fund

 

I/DD Community-Based Medical Services

  • Fund DD Health Support Networks in Southwest VA. Support a DDHSN in the southwest region. Current base funding for DDHSNs in FY16 in $2.6 million, which funds network that replace the services that were previously provided by the SVTC and NVTC. The services provided include health education, dental serves, and equipment repair. More information on the DD Health Support Network can be found at: http://www.dbhds.virginia.gov/individuals-and-families/developmental-disabilities/health-services
2017 2018
General Fund 1,300,000 1,300,000
Non-General Fund
Positions 8.75 8.75

 

Early Intervention (Part C)

 

  • Address increasing caseload in the Early Intervention- Part C program.   Provide funds for anticipated caseload growth in Early Intervention. The average growth over the last four years was 4.9 percent. The federal Individuals with Disabilities Education Act requires that the state must identify and enroll all eligible children. These funds are supplement by federal and local funds.
2017 2018
General Fund 1,716,961 2,512,001
Non-general Fund

 

Funds for DBHDS Central Office and Infrastructure Development

  • Fund additional positions to support DOJ administrative requirements. Provides funds to increase licensing and quality management staff in the central office. The position include 10 licensing specialist, five position to assist in the development and execution of improved case management and service needs evaluation processes, two positions related to internal review and data quality assurance and tow positions tasked with the implementation of a rental subsidy program for individuals with intellectual and developmental disabilities.
2017 2018
General Fund 1,360,098 1,813,382
No-General Fund 516,838 585,228
Positions 19 19

 

  • Support administrative needs for the increase in Waiver services. Provides funds for 10 prior authorization specialists, 5 prior authorization team leads and one administrative assistant to support the prior authorization team. These positions will be responsible for working with CSBs and case managers to assist in the transition of individuals into the proposed newly designed I/DD Waiver system. Specifically, these positions will monitor the mix of services offered to individuals, provide technical support to produce service utilization data , perform quality management and monitor waiver recipients’’ individual support plans to ensure the transition to more integrated day and residential services.
2017 2018
General Fund 659,193 712,690
No-General Fund 649,690 703,414
Positions 16 16

 

  • Provide additional positions for the Individual and Family Supports program. Provides funds for the five additional positions in the IFSP. The revamped IFSP will include staff in each region to help link individuals on the intellectual and developmental disability waitlists with the available services and supports in their area.
2017 2018
General Fund 366,160 488,213
Non-General Fund
Positions 5 5

 

Managed Care

  • Implement the Managed Long-Term Services and Support (MLTSS) Initiative. Provide funding for five positions and adjust the budget for anticipated management contract expenses associated with start up. The estimated saving represents the discontinuance of the current fee for service transportation contract as these services will move to managed care and will be incorporated into future payments. The package only reflects MLTSS administration and start up adjustment. It is expected that the programmatic and service impact will be reflect in next year’s Medicaid forecast.

ABA

  • Cover Applied Behavioral Analysis (ABA) services under FAMIS. Adds coverage for ABA and other behavioral therapy services, for children in Family Access to Medical Insurance Security Plan (FAMIS). Virginia covers ABA and other behavioral therapy treatment services in the EPSDT program, but not in FAMIS.
2017 2018
General Fund 145,754 121,793
Non-General Fund 675,393 893,145

 

DOJ

  • Address increasing workload for the independent reviewer. Provides general fund support to address the anticipated increase in workload of the Independent Reviewer that monitors the settlement agreement between the federal DOJ and the Commonwealth. The original Settlement Agreement did not require any serious incident review of related reports to the court. As a result, those responsibilities were not taken into consider.
2017 2018
General Fund 63,734 72,544
Non-General Fund

 

DARS

 

  • Fund adult services and adult protective services case management system operations. Covers ongoing operating costs associate with replacing current case management system being used by adults services and adult protective service (APS) workers. While the Department of Aging and Rehabilitative Services is leveraging federal grant funds to implement the new system, ongoing general fund support is needed to cover licensing and support costs. In addition, one-time funding is provided in the first year to provide training for local worker.
2017 2018
General Fund 500,000 975,000
Non-general Fund

 

Education:

    • Provides 139.1 million to hire 2,500 new teachers across the Commonwealth.
  • Provide onetime funding to expand computer adaptive testing. Provides one‐time funding to transition the grades three‐through five mathematics tests and grades three‐through‐eight reading tests to a computer adaptive testing (CAT) format that adapts to the student’s ability level, shortens the length of tests, and provides more flexible test administration.  
2017 2018
General Fund 3,400,000 1,600,000
Non-general Fund

 

 

  • Enhances funding for the At‐Risk program, which provides funding as a percentage add‐on to basic aid to support the additional costs of educating at‐risk students
2017 2018
General Fund 24,806,792 24,886,579
Non-general Fund

 

 

CSA:

  • Provides 36.2 million to support caseload and expenditure growth for services provided to at-risk children and youth through the Children’s Services Act. . Growth is assumed at a two year average from FY 2015 to FY 2016, and held steady through the biennium until it can be determined if unusually large increases in FY 2015 reflect a pattern after years of declining or flat program costs. Expenditures in special education day placements were a primary driver in expenditure growth last year.
2017 2018
General Fund 18,082,051 18,082,051
Non-general Fund

 

 

The full budget document can be accessed at https://solutions.virginia.gov/pbreports/rdPage.aspx?rdReport=BDOC2016_FrontPage