DMAS/DBHDS Webinar about Virginia’s plan to comply with the CMS Rule

 

The Departments of Medical Assistance Services and Behavioral Health and Developmental Services will conduct a webinar to discuss Virginia’s response to the CMS Rule on Thursday, June 25th from 9:30-11:30a.m.  It appears the state is viewing this webinar as the first meeting of the Compliance and Monitoring Team, an entity discussed in the Virginia Statewide Transition plan.  The webinar announcement and registration details can be found here.

The Arc of Virginia’s March 2, 2015 comments on the Statewide Transition Plan can be found here.

The Arc of Virginia will be discussing the CMS Rule and other federal policies that are impacting I/DD Waiver Redesign at our upcoming State Convention which will be held Aug. 10-12 in Virginia Beach.  For more information about the State Convention,  click here.

65 Housing Choice Vouchers for DOJ Population

Beginning July 1, 2015, the Virginia Housing Development Authority (VHDA) is planning to make an additional 65 housing choice vouchers available to people in the DOJ target population. These vouchers will be available to individuals who are referred to VHDA by the Department of Behavioral Health and Developmental Services (DBHDS). Learn more about the vouchers, including how you can apply, in this DBHDS memo

2015 General Assembly 2014-2016 Biennium Budget: Post Conference Committee Report

 

Earlier this week, the House and the Senate money committees released their conference report on their amendments to the state budget. Governor McAuliffe released his proposed budget bill on Wednesday, December 17.  The state budget covers Fiscal Year 2015 (July 2014-June 2015) and Fiscal Year 2016 (July 2015-June 2016).  A summary of his proposed amendments that would impact the intellectual and developmental disability (I/DD) services system can be found here.

On February 8, the House Appropriations Committee and Senate Finance Committee released their respective amendments to the state budget bill.  Elements of the governor’s proposed budget that were not amended or eliminated remain in the budget bill.  Differences in the House and Senate proposed amendments were negotiated through a conference process, resulting in the conference committee reporting the budget bill for General Assembly approval.  The budget bill will be sent to the Governor where he may sign it, veto the entire bill or certain line items, or recommend amendments.

Medicaid Waivers:
  • The budget bill retains the funding required by the U.S. v Virginia Settlement Agreement for 450 new I/DD Waiver slots for individuals on waiting lists and in Training Centers. These slots will be available beginning July 1, 2015. These slots were included in the budget passed by the 2014 General Assembly and remained in the Governor’s proposed budget this year. The breakdown of these Waivers is as follows:
    • 325 ID Waivers for individuals on the ID Waiver Waiting List
    • 40 DD Waivers for individuals on the DD Waiver Waiting List
    • 85 ID Waivers for individuals exiting Training Centers
  • The budget bill does not increase funding for I/DD Waiver slots.
  • The conference committee report eliminates the Day Support Waiver Redesign language from the Governor’s proposed budget bill and eliminates the 200 “Building Independence” Waiver slots which is likely to result in delaying the implementation of the redesign initiative by The Department of Behavioral Health and Developmental Services (DBHDS). (301 #5c).
FY 2015 FY 2016
General Fund -$1,200,000
Non-General Fund -$1,200,000
  •  A companion amendment in the conference report requires DBHDS, in consultation with the Department of Medical Assistance Services (DMAS), to report on its plans to redesign the I/DD Waiver program prior to the submission of a request to CMS to amend the waivers. The Department must submit the report to the Governor and the Chairmen of the House Appropriations and Senate Finance Committees by November 1, 2015, which has the potential to delay the implementation of the department’s redesign initiative. (301 #6c).
  • An additional amendment adds language to Waiver redesign to include individuals with Traumatic Brain Injury in the initiative. (307 #1c).
  • The conference report eliminates the language from the Governor’s budget that limited overtime hours for consumer-directed (CD) and required consumer-directed workers to only have one Employer of Record (EOR). The language was initially included in the Governor’s budget amendments to achieve compliance with a U.S. Department of Labor (DOL) Rule that has since been largely vacated through federal court rulings. (301 #4c).
  • The budget bill does not include language to fold all I/DD long-term services and supports, including public and private ICF/IDDs and I/DD waiver services, into a Medicaid managed-care plan operated by private, profit-making companies.
Training Centers:
  • The budget bill does not include language that would require Training Centers to remain open.
  • The conference report directs a Special Joint Subcommittee to consult on the plan to close state training centers in collaboration with the Secretary of Health and Human Resources and the Department of Behavioral Health and Developmental Services. The Special Joint Subcommittee is instructed to continue to monitor and review the closure plans for the three remaining training centers scheduled to close by 2020.  This Subcommittee will be reviewing options to ensure that the appropriate supports and safeguards are in place for individuals that transition from training centers into the community.  A reporting requirement is also added so the Special Joint Subcommittee will receive detailed information on the current costs of operating the training centers. (307 #2c).
  • The budget bill provides additional facility closure funds to accommodate changes in discharge schedule. Increased funds are needed because of the delay in closing Northern Virginia Training Center (NVTC) and for delayed discharges at state training centers.  NVTC was originally slated to close at the end of fiscal year 2015. The Commissioner had announced the April 1, 2016 closure date earlier this year.  These funds would keep the facility operational through April 1, 2016.
FY 2015 FY 2016
General Fund  $1,345,692
Non-General Fund

 

Housing:
  • The conference report eliminated the rental subsidies in the Governor’s amendments that would have been provided to individuals receiving the Building Independence Waiver. (307 #8c).
FY 2015 FY 2016
General Fund -$675,000
Non-General Fund

 

  • The budget bill retained the rental subsidies in the Governor’s proposed amendments to fund the Rental Choice VA housing subsidy and provide on‐going support for programmatic costs associated with the Rental Choice VA program. The Settlement Agreement with the U.S. Department of Justice required the Commonwealth to provide $800,000 for rental subsidies for current individuals with I/DD receiving waiver services.
Part C (Early Intervention):
  • The conference report increased funding for Part C Early Intervention Services for infants and toddlers with developmental delays ages birth to age three. This funding is necessary to meet the increase in the number of referrals and to prevent waiting lists for needed services. (308 #5c).
FY 2015 FY 2016
General Fund $605,000
Non-General Fund

 

  • The budget bill retains the language to change the date of the Part C report to General Assembly to November 15 in order to better align with reporting from localities.
Licensing, Quality and Oversight:
  • The conference report removes the language in the Governor’s proposed amendments that granted DBHDS the authority to establish licensing fees for adult behavioral health and developmental services licensed by the department. (305 #1c).
  • The conference report includes language to increase budget transparency in the I/DD Waiver program. This amendment requires DBHDS to post on the agency’s web page a report on the budget, costs and numbers of recipients receiving intellectual disability and developmental disability services for each fiscal year.  The purpose of this amendment is to increase the budget and spending transparency related to these services for the public. (307 #3c).
  • The conference report directs DBHDS to assess the service and support needs of all Virginians on waiting list for I/DD Waivers. This measure will allow the Commonwealth to accurately establish enrollment priorities, project services costs and develop capacity needed to serve such individuals. (307 #7c).
  • The budget bill retains funding for DBHDS to create a new and consolidated system for managing the I/DD Waiver program.
FY 2015 FY 2016
General Fund $453,888
Non-General Fund $453,888

 

Other Funding
  • The conference report increases the reimbursement rates for I/DD Waiver services. This amendment increases rates paid to providers for in-home residential services (5.5%), day services (2%), therapeutic consultation services (10%), congregate residential services (2%), and skilled nursing services (15.7%), effective July 1, 2015.  (301 #6c).
FY 2015 FY 2016
General Fund $8,179,904
Non-General Fund $8,179,904

 

  • The conference report provides a 2% rate increase for agency and consumer directed personal and respite care services, effective July 1, 2015. Currently, the rate for consumer-directed is $11.47 per hour in Northern Virginia and $8.86 per hour in the rest of the state. For agency-directed, the rate is $15.20 per hour in Northern Virginia and $12.91 per hour in the rest of the state. (301 #7c).
FY 2015 FY 2016
General Fund $3,459,081
Non-General Fund $3,459,081

 

  • The conference report restores funding for Long Term Employment Support Services (LTESS). LTESS provides support services to persons with significant disabilities at their place of work. (325 #5c).
FY 2015 FY 2016
General Fund $500,000
Non-General Fund
  • The conference report restores funding for the Vocational Rehabilitation (VR) program under the Department for Aging and Rehabilitative Services (DARS). The VR program assists individuals with disabilities prepare for, find, and maintain jobs by providing training, placement, and job-coaching services along with work placement accommodations. (325 #2c).
FY 2015 FY 2016
General Fund $1,000,000
Non-General Fund

 

  • The conference report restores funding to Centers for Independent Living (CILs). CILs provide individuals with disabilities peer mentoring, independent living skills training, information and referral, and advocacy services. (325 #3c).
FY 2015 FY 2016
General Fund $580,000
Non-General Fund

 

  • The conference report adds language requiring a review of integrated employment opportunities. This amendment directs the DARS to review employment support services programs and make recommendations on options that would increase integrated employment opportunities for individuals with the most significant disabilities. (325 #6c)
  • The conference report includes funding for individuals who were previously forced by the Commonwealth to undergo sterilization. (307 #9c).
FY 2015 FY 2016
General Fund $400,000
Non-General Fund

 

As always, thank you for your advocacy.
-The Arc of Virginia

 

Stay the Course on State Training Center Closures

Today, The Arc of Virginia sent a letter to the members of the House Appropriations and Senate Finance Committees urging them to stay the course on state plans to close three remaining state training centers for persons with Intellectual Disabilities (ID).  Citing the movement away from institutional to community-based care that has occurred over the past fifty years in Virginia and nationwide, The Arc expressed its opposition to any attempts to delay state plans to close training centers in Fairfax, Hillsville and Lynchburg.

We reminded committee members that fourteen states have already closed all of their state facilities while many other states are down to one facility.  Virginia’s training center census has dropped from 1,198 in 2010 to a current census of 545.  Virginia successfully closed its first training center last summer—the Southside training center in the Petersburg area.

State training centers now cost an average of almost $320,000 per resident per year.  This cost is twice as much as community care for persons with similar levels of disability.  The state has estimated cumulative training center closure savings of almost half a billion dollars over the next seven years.  These projected savings are earmarked to pay for Medicaid waiver services in the community for persons discharged from training centers or on current waiver waiting lists.

Significantly delaying or not closing the three state institutions would require new state dollars to pay for community waiver slots to comply with the state’s 2012 settlement agreement with the Department of Justice (DOJ).  Because the state is responsible for half the Medicaid cost, a quarter of a billion state dollars would be required if the facilities do not close as scheduled.

Our families know too well that the long waiting list for a community waiver slot will get even worse if scarce state dollars are redirected to keep costly training centers open.  Virginia’s waiting lists for persons with an intellectual or developmental disability have grown from 7,584 two years ago to 9,421 today–a 24 percent increase in just two years.

Virginia has put in place vigorous discharge planning and follow-up requirements for persons leaving training centers to live in the community.  These community placements are backed up by the oversight of the federal court to ensure the health and safety of persons leaving training centers to live in the community.

The Arc of Virginia’s message to state legislators is to stay on course with training center closures.

Read the letter : Stay the Course

Preliminary Summary of Governor McAuliffe’s Proposed Budget

 

Governor McAuliffe released his proposed budget bill on Wednesday, December 17. The state budget covers Fiscal Year 2015 (July 2014-June 2015) and Fiscal Year 2016 (July 2015-June 2016). A summary of all proposed amendments can be found here. A summary of proposed amendments that are specific to Health can be found here.

The budget continues to be hampered by the $2 billion loss in state revenue loss due to federal sequestration. In his presentation to the money committees, Governor McAuliffe summarized actions taken in response to the budget shortfall and highlighted his spending priorities which included expanding access to healthcare, no cuts to education funding, retirement pay for teachers, increased regulation of daycare facilities, tourism, ending veteran homelessness and pay raises for public safety.

The General Assembly will act on the budget bill in the upcoming 2015 session, which begins on January 14. Delegates and Senators will have the opportunity to propose amendments to the budget bill, which are then acted on by the money committees before going to the floor for a vote. The House and Senate will then negotiate one, near-final budget bill which will be sent to the Governor for action.

The state budget is very important because it determines the number of individuals with I/DD who will gain access to essential long-term services and supports over the next 18 months. It also determines the scope of services and supports that will be available and the quality of those services. The following is a preliminary summary of actions taken (or not taken) in the budget that affect Virginians with I/DD and their families. We will post another update next week discussing advocacy moving forward.   Please continue to stay tuned.

SUMMARY OF PROPOSED BUDGET ACTIONS

Medicaid Waivers

  • Changes the Day Support Waiver to the “Building Independence” Waiver effective January 1, 2016 and provides 200 “Building Independence” Waiver slots effective January 1, 2016. These slots would be in addition to the existing 300 slots already allocated to the Day Support Waiver. This language is a part of the I/DD Waiver redesign initiative.
FY 2015 FY 2016
General Fund $1,200,000
Non-General Fund $1,200,000

 

o   This budget language allows the Day Support Waiver to be renamed as the Building Independence Waiver effective January 1, 2016. It also allows the Waiver to be amended to include new services and supports, such as independent living and integrated day, if sufficient funding is appropriated.

o   The purpose of the new Building Independence Waiver will be to “promote independent community living at a lower per person cost than the other two waivers for individuals with I/DD, with existing and proposed new services all aligned to achieve this goal.”  The Building Independence Waiver will be limited to individuals age 18 or older.      

o   Separate budget language provides rent subsidies to individuals with I/DD receiving the Building Independence Waiver.

o   Budget language also requires DMAS to provide a report, detailing changes and estimated costs of the new Waiver, to Governor and Chairmen of the money committees at least 30 days prior to submitting the application to CMS.

  • Limits overtime hours for consumer-directed (CD) workers in response to U.S. Department of Labor Rule. Requires consumer-directed workers to only have one Employer of Record (EOR).
FY 2015 FY 2016
General Fund ($325,702)
Non-General Fund ($325,702)

 

o   The U.S. Department of Labor (DOL) recently issued a new rule that affects home care services for people with disabilities and seniors. Previously, most home care workers (also known as domestic service employees, personal attendants or home aids) were exempt from the Fair Labor Standards Act’s (FLSA) minimum wage and overtime requirements. The rule narrows the categories of home care workers who are exempt from the FLSA requirements, meaning more home care workers, including consumer-directed employees, will be entitled to these protections.

o   States and other joint employers in their home care programs have until the rule’s effective date of January 1, 2015 to make budget adjustments and/or program changes to comply with the new rule.

o   On December 15, the U.S. DOJ and the HHS Office of Civil Rights released a joint letter discussing compliance with the ADA when implementing the new Home Care Rule.

o   The proposed budget language authorizes DMAS to limit overtime hours that may be provided by attendants who are providing care under the consumer-directed services option in Medicaid Waivers for personal assistance, respite and companion services. Specifically, the language authorizes:

  1. Time and a half up to 56 hours for a single attendant who works more than 40 hours a week.
  2. Requires that an Employer of Record (EOR) act on behalf of only one individual except when there is more than one individual in the same household receiving those services.
  1. Limits attendants to be employed by only one Employer of Record (EOR).

o   The proposed language gives DMAS the authority to implement the necessary changes effective July 1, 2015 in “order to conform state regulations to allay any fiscal impact associated with the October 1, 2014 changes to 20 CFR 552.”

o   There is a total reduction of $653,059 in FY 2016 that is associated with this particular budget item.

o   Item #3 is very concerning because it has potential to significantly reduce access to services.  The Arc of Virginia will be meeting with other advocates, national policy experts and state agency staff to discuss alternative strategies in order to ensure that individuals with I/DD do not lose access to care. Our recommendations will be reflected in The Arc of Virginia Legislative Priorities, which will be released in next week’s update.

  • Includes funding for 450 new I/DD Waiver slots for individuals on waiting lists and in Training Center, beginning July 1, 2015, as required by the U.S. v Virginia Settlement Agreement. These slots were included in the budget passed by the 2014 General Assembly and have remained in the budget that is proposed. The breakdown of these Waivers is as follows:

o   325 ID Waivers for individuals on the ID Waiver Waiting List

o   40 DD Waivers for individuals on the DD Waiver Waiting List

o   85 ID Waivers for individuals exiting Training Centers

  • Provides DBHDS with $906,776 in FY 2016 to create a new and consolidated system for managing the intellectual and developmental disability waivers. The system will include wait list and waiver enrollment management as well as incorporate a citizen portal that will allow individuals to view waiver eligibility options, apply for waivers online, and identify licensed service providers.  This system is anticipated to replace what is currently in use, but should allow for improved data collection.
FY 2015 FY 2016
General Fund $453,888
Non-General Fund $453,888

 

Housing:

  • Expands the use of bond authorization to support community housing development for individuals with I/DD. Modifies language from Item C‐103.05 A.5, Chapter 781, 2009 Acts of Assembly that will allow the $4.7 million in remaining bond proceeds to be used to subsidize the costs associated with the construction, rehabilitation, and/or acquisition of single‐family or multi‐family rental housing that is dedicated to individuals with an intellectual or developmental disability (I/DD). Language will also allow entities other than Community Service Board’s (CSBs) or local governmental entities to hold title to the community housing.
  • Funds the Rental Choice VA housing subsidy and provides on‐going support for programmatic costs associated with the Rental Choice VA program. Rental Choice VA is a housing subsidy for individuals with I/DD who live in the Northern Virginia and Virginia Beach areas. The budget language captures a $400,000 anticipated balance in FY 2015 in the Rental Choice VA program and increases the FY 2016 appropriation by a corresponding amount so that funding will be included in the base budget going forward. This amendment will allow the program to continue to offer rental subsidies in future years.
FY 2015 FY 2016
General Fund ($400,000) $400,000
Non-General Fund

 

  • Provides rent subsidies for up to 250 individuals that will transition to the planned Building Independence Medicaid Waiver. Rental subsidies are not covered by Medicaid and would not be eligible for federal reimbursement so they are listed separately in the state budget.
FY 2015 FY 2016
General Fund 0 $675,000
Non-General Fund

 

Education:

  • Provides principal training at under-performing schools. The budget provides an appropriation of $713,000 to increase the capacity of principals in under-performing schools. The funding amount covers training for 40 principals at schools which have failed to meet accreditation standards.
FY 2015 FY 2016
General Fund 0 $713,000
Non-General Fund

 

Licensing, Quality and Oversight:

  • Grants DBHDS authority to establish licensing fees for adult behavioral health and developmental services licensed by the department. The Commissioner would charge a $750 nonrefundable fee per service for the initial application and a nonrefundable renewal fee of $500 per service, consistent with the schedule licensure renewal set out in regulation. The budget language requires DBHDS to transfer funds received into the general fund. (No figures provided).
  • Increases funding for quality service reviews required by the settlement agreement with the United States Department of Justice (DOJ) by $364,000. The amount previously included was an estimate of necessary funds to contract for the provision of reviews. The addition of this funding brings the total general fund support for Quality Service Reviews to $591,000.
FY 2015 FY 2016
General Fund $91,000
Non-General Fund $273,000

 

  • Increases funding for the Independent Reviewer. Increases the available funding for the Independent Reviewer assigned by the court to monitor the state’s compliance with the settlement agreement between the United States Department of Justice and the Department of Behavioral Health and Developmental Services. The total budget for the Independent Reviewer is increased to $377,000 per year.
FY 2015 FY 2016
General Fund $49,000
Non-General Fund

 

Part C/Early Intervention:

  • Changes the date of the Part C report to General Assembly to November 15 in order to better align with reporting from localities.

Training Centers:

  • Provides additional facility closure funds to accommodate changes in discharge schedule.  Provides additional funds for the delay in closing Northern Virginia Training Center (NVTC) and for delayed discharges at state training centers. NVTC was originally slated to close at the end of fiscal year 2015, however “transition of individuals into the community has not occurred at the rate necessary in order to close the facility until the middle of fiscal year 2016.” The Commissioner had announced the April 1, 2015 closure date earlier this year. These funds would keep the facility operational through April 1, 2015.
FY 2015 FY 2016
General Fund $1,345,692
Non-General Fund

 

  • Provides $157,251 in State General Funds (SGF) to address the needs of individuals not covered by Medicaid currently residing in state operated training centers to transition into the community as needed.
FY 2015 FY 2016
General Fund $31,450 $125,801
Non-General Fund

 

  • Adjusts Medicaid budget to account for Training Center closure costs.   Adjusts the Medicaid appropriations for reimbursement for state mental health and intellectual disabilities facilities. The adjustments are the result of changes in the forecast of facility discharges. This request reflects the Medicaid portion of the facility transition waivers, the on-going facility closure costs and associated facility savings resulting from compliance with the Department of Justice (DOJ) settlement agreement. The funding estimates include facility transition wavier expenses, severance costs, post closure costs, pre-closure costs and training center facility and Medicaid savings.
FY 2015 FY 2016
General Fund $535,369 $5,146,644
Non-General Fund $535,369 $5,146,644

 

DARS Disability Determinations:

  • Provides funding to cover the state match for Medicaid disability determinations at the Department of Aging and Rehabilitative Services (DARS).  The DDS unit mainly processes disability determinations for the Social Security Administration, but a small portion of their workload includes processing of disability determinations for Medicaid eligibility. Beginning in FY 2014, the agency implemented a cost allocation plan for the Medicaid costs of disability determinations. Based on this plan, the agency requires additional state funding to meet Medicaid match requirements.
FY 2015 FY 2016
General Fund $228,235 $228,235
Non-General Fund $228,235 $228,235

 

  • Increase federal appropriation and position level for Social Security disability determinations. Increases federal appropriation for the costs of DDS unit. DDS processes disability determinations for the Social Security Administration (SSA) with federal funding. After several years of SSA limits on states hiring DDS workers, the agency has directed Virginia to hire additional staff to help with the significant backlog of pending determinations. This adjustment is necessary to ensure adequate appropriation to cover the cost of the new staff and avoid administrative actions.
FY 2015 FY 2016
General Fund $3,500,000 $3,500,000
Non-General Fund

 

Other Notes:

  • Part C funding was not adjusted to account for the increase in the number of infants/toddlers receiving services.
  • Crisis funding for children and adults with I/DD was not adjusted to facilitate compliance with the Department of Justice settlement agreement.
  • The budget still “sweeps” proceeds from the sale of Training Center land from the DBHDS Trust Fund. The Trust Fund had been established to use the proceeds of these land sales to strengthen and improve access to home and community-based services.
  • While the budget addresses the Building Independence Waiver, the budget does not reflect changes to the other two I/DD Waivers that are also part of the I/DD Waiver Redesign Initiative. This is because the timeline was adjusted new waivers in July 2016 (which occurs in the next Biennium budget). Current budget language still allows DBHDS to amend the Waivers before FY 2017.

MOVING FORWARD:

  • The Arc of Virginia will hold a webinar on the budget to review items and discuss advocacy on Tuesday, December 30 at 1pm. Click here to register.
  • The Arc of Virginia and our advocacy partners will be hosting a Developmental Disability Advocacy Day at the General Assembly on January 26.   Click here for more information.

 

Update on Waiver Redesign Activity and Timelines

Big changes are coming to the ID/DD Waiver programs.  It is important that self-advocates, family members, providers and professionals understand why these changes are occurring, what is being proposed, and ways that you can be involved.  We recognize that much of this information is new and there will be lots of questions.  Additional updates will follow as more information becomes available.  The Arc of Virginia will remain committed to ensuring that individuals and families understand what is being proposed and can have meaningful participation in the process moving forward.

Background:
For many years, The Arc of Virginia has called for changes in Virginia’s ID/DD system in order  to improve access to and quality of community based services.  Virginians with I/DD and their families have reported that Virginia’s waiver programs are difficult to access, lack a person centered method of providing supports, and do not promote meaningful inclusion of individuals with ID/DD in their community.  In February 2011, the Department of Justice agreed, finding the Commonwealth to be in violation of the ADA as interpreted by the Olmstead decision.

The January 2012 U.S. v Virginia consent decree that resulted from the DOJ Findings Letter requires the Commonwealth to provide services for individuals with intellectual and developmental disabilities in the most integrated setting appropriate to meet their needs.  In order to comply with this requirement, Virginia must redesign its ID/DD Waiver Programs.

In the Fall 2013, The Department of Behavioral Health and Developmental Services (DBHDS) contracted with the Human Services Research Institute (HSRI) to evaluate the State’s current service delivery system for individuals with ID/DD and make recommendations to move the system towards a more person focused needs-based system of care.  In conjunction with that evaluation, HSRI was charged with reviewing the existing rates paid to service providers and the current method of allocating resources to support individuals receiving services.  DBHDS has been working with HSRI’s subcontractor, Burns and Associates, and a Provider Advisory Committee, to develop new rate models for new and existing waiver services.

Waiver Design Advisory Committee (WDAC) and Subcommittees:

Starting in Spring 2014, DBHDS established a Waiver Design Advisory Committee (WDAC) and related subcommittees to consider the recommendations made by HSRI, provide input on the waiver redesign, and make suggestions regarding means of enhancing system processes.  The WDAC and subcommittees’ membership were comprised of self-advocates with ID/DD, family members, representatives from CSBs, provider agencies, advocacy groups, and parent groups from across the Commonwealth. Subcommittees were formed on Case Management, Eligibility, Waiting Lists and Services Array.  For information about the subcommittee recommendations on these topics, click here.

The WDAC Services Array Subcommittee was charged with proposing, reviewing, and discussing new and existing waiver definitions and service options to be incorporated into the redesigned waivers. The full WDAC Committee then reviewed the service definitions recommended by the Services Array Subcommittee and responded to additional service options that were proposed by WDAC members at the group’s last meeting on October 29th.  A copy of these draft service descriptions can be found here.

Following the October 29 WDAC review, DBHDS staff revised the service descriptions and presented them to the WDAC for another review on December 4.  DBHDS also presented recommendations to the WDAC regarding which of the services would be provided in each of the three waivers.  Following the Dec. 4 meeting, The Arc of Virginia developed a chart to help communicate the proposed service packages being discussed. Once finalized, the recommended service definitions and options will be incorporated into the final I/DD Waiver service packages that include the new rate model developed by DBHDS in collaboration with HSRI, Burns and Associates, and the Provider Advisory Committee.

DBHDS will need to finalize its Waiver Redesign proposals soon in order for the needed language and funding to be included into the Governor’s introduced budget. The  preliminary report on the new rate structures has been posted on the DBHDS website and are available at the following link:   http://www.dbhds.virginia.gov/individuals-and-families/developmental-disabilities.  Public comments on the rate structure will be accepted until December 15.

Proposal for an Integrated Waiver Program: 

The Commonwealth is seeking to revamp the ID/DD waiver program into an integrated waiver structure consisting of three waivers that will employ a single eligibility criterion.   This means that all people with intellectual and developmental disabilities (ID/DD) will be served under the new waivers.   The financial eligibility requirements will be the same as used in the existing waivers; however, the diagnostic and functional criteria are changing to better identify the specific supports an individual needs to live in the community.

The three waivers are currently being referred to as the Building Independence Waiver, the Family and Individual Supports Waiver, and the Community Living/Comprehensive Waiver.   There are many components that are still being developed and it is likely that the waiver names will continue to evolve over the course of the next few months.  The new proposed waivers will be replacing the existing ID/DD waiver program (the Day Support, Developmental Disability, and Intellectual Disability waivers). DBHDS provided a Waiver Revision Graphic handout to understand the new, proposed structure of the I/DD Waiver program.

The Independence Waiver is intended to provide support to individuals who wish to live independently in the community.  Supports will be complemented by non-waiver-funded rent subsidies.  It will broadly focus on creating opportunities for independent living, supported employment and integrated day.  The Family and Individual Support Waiver will focus on providing additional supports to individuals living with their families, friends, or in their own homes, including supports for those with some medical or behavioral needs.  The Community Living/Comprehensive Waiver would provide the most intensive services for people with I/DD, primarily those with complex support needs, in a variety of settings.  DBHDS has stated that individuals they will have the opportunity to move from the Independence or Family and Individual Support Waiver to the Community Living/Comprehensive Waiver when assessed needs are determined to be higher than can be met under their current waiver.

An updated Supports Intensity Scale® (SIS®) will be administered to all individuals currently receiving waiver services using a phased approach.  The Supports Intensity Scale® is an instrument, developed by the American Association on Intellectual and Developmental Disabilities, used to measure the frequency and intensity of supports needed by an individual with an intellectual or developmental disabilities in order to achieve quality of life goals.  The SIS® score, along with a person-centered plan, will determine an individual’s need and supports budget level.  An exceptions process will be available for review of individuals’ situations that are in question, as necessary. An individual’s waiver (Independence, Supports, or Comprehensive) will be determined by the individual’s support needs, budget level, age, where he or she lives, and what he or she does during the day.

DBHDS provided an overview of its vision for Virginia’s I/DD service system at the September 30 WDAC meeting.  Their presentation can be downloaded at the following link:  http://www.dbhds.virginia.gov/library/document-library/dds%20wdac%20slides%209%2030%202014_%20final%20for%20posting.pdf

As the discussion of the Waiver structure and services has evolved, several themes have surfaced regarding the redesign of Virginia’s I/DD system:

  • As stated earlier, Virginia must amend its ID/DD Waiver programs in order to ensure that Virginians with ID/DD have access to integrated, community-based services- regardless of the complexity of their support needs.
  • Virginia must restructure the Waivers to move towards compliance with the new CMS Home and Community Based Services Final Rule.  The Commonwealth will have five years to be in full compliance.  For more information on the CMS rule, please visit:  http://www.thearc.org/document.doc?id=4596
  • Virginia must take additional action to help the 9,200 individuals and families who are on waiting lists for community-based care.  While providing “comprehensive” Waivers  to all of these individuals and families within a reasonable time continues to be a significant financial  challenge, there is interest in providing services to as many families  as possible, as early as possible.
  • The rationale for the integrated three waiver structure is for General Assembly budget allocation purposes.  The thought is to have three waivers with differing cost options in order to allocate monies to serve those on the waiting list that need less expensive support options.  If an individual’s level of need increases or decreased once they are one of the three waivers, they will be moved to the appropriate alternate waiver.

 DBHDS’ tentative timeline for moving forward is as follows:

  • The proposals will be reflected in the Governor’s Budget, which is expected to be announced on December 17, 2014;
  • The amended waivers will be submitted to CMS in March 2015 (once the General Assembly has passed the budget);
  • The Day Support Waiver will be amended to the Independence Waiver and will be phased in  January 2016;
  • On or around March 1, 2016 the following waivers will be phased in and reflect the tiered reimbursement system.  All people with ID/DD who meet eligibility criteria will be eligible for one of the three waivers.  Some individuals will transition to new services and the new fee schedule according to their plan year.

-The current Developmental Disability Waiver will be amended to the new Supports Waiver.
-The current Intellectual Disability Waiver will be amended to the Comprehensive Waiver.

  • In July 2016, group homes will begin to receive a new, per diem rate. The rate that may be billed for an individual will be based on SIS® score.
  • In October 2016, non-congregate (supported living) residential services will begin to receive a new, per diem rate. The rate that may be billed for an individual will be based on SIS® score.
  • In January 2017, sponsored residential services will begin to receive a new per diem rate. The rate that may be billed for an individual will be based on SIS® score.
  • In March 2017, individuals with ID/DD on the Elderly and Disabled Consumer Directed (EDCD) waiver may have the opportunity to move to one of the three ID/DD waivers.

Learn More and Stay Connected:  

The Arc of Virginia’s Advocacy Webinar Series   The Arc of Virginia is hosting a webinar series to help self-advocates, family members, and professionals understand the changes occurring in Virginia’s ID/DD system and learn about ways they can continue to promote “A Life Like Yours” through collective advocacy.

The Webinar Series is as follows:

DD Advocacy Day January 26 Rally begins at 10 am to 11 am — Bell Tower at Virginia Capital Square, Richmond, VA

Clearly, ID/DD Waiver Services will be a major topic of this year’s General Assembly Session.  It is critical that individuals, families and concerned citizens take this opportunity to join together and speak up in support of “A Life Like Yours.”  The Arc of Virginia, Virginia Chapters of the Autism Society, Virginia Down Syndrome Alliance, and Voices of Virginia will be hosting a grassroots advocacy day on January 26, the 3-year anniversary of the U.S. v Virginia Consent Decree.  Please mark your calendars and join us in taking action to ensure Virginians have the support they need to live a full life in the community!

The rally will take place 10am – 11am at the Bell Tower on Capitol Square (corner of Bank & 9th Streets, Richmond VA). Meet with your legislators after the rally to share your story!  To register for DD Advocacy Day – please visit www.thearcofva.org/events or https://www.eventbrite.com/e/developmental-disabilities-advocacy-day-tickets-14584066335

We suggest scheduling appointments in advance, if possible. Use this link to find your legislators. http://whosmy.virginiageneralassembly.gov/   For more information about the event, please contact Rebecca King of The Arc of Virginia at: rking@thearcofva.org or 804-649-8481 ext 105

DBHDS Waiver Redesign Updates   An email address has been established by the Virginia Department of Behavioral Health & Developmental Services  (DBHDS) for providers, families and individuals with disabilities interested in getting electronic updates on Virginia’s Waiver Redesign Initiative. If you would like to join this listserve, all you have to do is send an email to waiverupdates@dbhds.virginia.gov and provide your email address in the body of the email.

BOTTOM LINE– This is a historic time to influence our ID/DD service system in Virginia into one that works for people with ID/DD and their families.   Please stay tuned for additional information and some very important action alerts!   As always, thank you for your advocacy!

  -The Arc of Virginia