Waiver Redesign Delayed July 2016
Virginia has redesigned its Medicaid Intellectual Disability (ID), Developmental Disabilities (DD) and Day Support (DS) Waivers into a single Developmental Disabilities Waiver program. The Centers for Medicare and Medicaid (CMS) are required to review and approve Virginia’s Developmental Disabilities Waiver program application. In June 2016, the VA Dept. of Behavioral Health and Developmental Services (DBHDS) announced that implementation of Waiver Redesign is delayed and the anticipated date of implementation is now August 1, 2016 from the original date of July 1, 2016. The delayed implementation is because CMS is reviewing the Developmental Disabilities Waiver program application.
The redesign of the Developmental Disabilities system involves systemic changes that are complex and will take time to evolve and become fully implemented. The Arc of Virginia is committed to educating those affected by the Developmental Disabilities system with up to date information as it becomes available from the administering public agencies.
Who will be affected by Waiver Redesign?
Children and adults and their families who are receiving the current ID, DD and/or DS waivers.
Children and adults and their families who are on the ID and DD Waiver Wait List will be placed into one waiting list. Waivers will be allocated based on an individual’s need, not on a chronological basis.
Waiver redesign does not affect other waivers, such as EDCD or Tech.
What is Waiver Redesign and why is it happening?
The goal of the waiver redesign is to transform the existing ID, DD and DS waivers so that they offer new supports and services that promote inclusion and family support with reimbursement rates that respond to individual needs so that they may live full lives in the community. The redesign is needed to comply with the Dept. of Justice VA Settlement Agreement and new federal requirements, known as the “CMS Rule” governing home and community based services. The CMS Rule requires that people with disabilities receiving waiver services have full access to the benefits of community living and receive services in the most integrated setting appropriate.
Individuals currently receiving the ID, DD or DS waiver will transition seamlessly to the corresponding waivers below:
The Day Support Waiver becomes the Building Independence Waiver which includes supports for adults (18+) who live independently in their own homes. Supports are complemented by non-waiver funded rent subsidies and/or other types of support. Children on the DS Waiver will transition to the Family and Individual Supports Waiver.
The Individual and Family Developmental Disabilities Support (DD) Waiver becomes the Family and Individual Supports Waiver which includes supports for children and adults living with their families, friends, or in their own homes.
The ID Waiver becomes the Community Living Waiver which includes up to 24/7 residential services and additional supports for adults and children with exceptional medical and/or behavioral support needs. This is the only waiver that provides the sponsored residential and group home residential services options.
What is delayed until August 1, 2016?
New services and the reimbursement structure for new and existing services will be delayed.
Prevocational services will continue in July, until new waiver services are approved.
The CSB waiver slot selection committee will continue to operate to assign ID waiver turnover slots. The VA Dept. of Behavioral Health and Developmental Services (DBHDS) will continue to assign turnover DD waiver slots according to the existing process.
What changes on July 1, 2016 that is not affected by the delayed implementation?
The Community Services Boards (CSB)/BHAs will perform all screenings for individuals seeking a Developmental Disabilities Waiver. Individuals and families who need to be screened should contact their local CSB for screening. You may find your CSB location here: http://www.vacsb.org/directory.html
Note that Virginia is in Waiver Redesign Transition until the end of 2016. We encourage you to visit this site often as we expect updates and new information to become available during the transition. The Arc of VA will bring you up to date information as it becomes available.
Learn more about the New DD Waiver Program:
Updates on Waiver Redesign Activity
Update: March 16, 2016
The Department of Medical Assistance Services (DMAS) and Department of Behavioral Health and Developmental Services (DBHDS) welcomed public comment regarding the submission to the Centers for Medicare and Medicaid Services (CMS) amendments to the following 1915(c) Home and Community Based Services (HCBS) Medicaid Waivers: Intellectual Disability (ID); Individual and Family Developmental Disability (DD) Supports; Day Support (DS).
The public comment period was officially January 29th – February 29th, 2016.
Update: December 3, 2014
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.
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 here. 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 Building 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 here
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.