On February 22, House and Senate budget conferees released their report on Virginia’s budget bill. The House and Senate are scheduled to vote on the budget bill tomorrow evening. The bill will then go to the Governor for his review and action. A summary of budget items can be found below and a more detailed side-by-side document (with amendment links) can be accessed here.
Includes 144 additional Family and Individual Support (FIS) Waivers, which combined with those included in the Governor’s budget, will provide a total of 494 Waivers for individuals and families on the Developmental Disability (DD) Waiver waiting list. These Waivers are expected to become available July 1, 2017.
Conference Committee Budget
Community Living (CL) Waivers for Waiting List
Family and Individual Support (FIS) Waivers for Waiting List
Building Independence (BI) Waivers
for Waiting List
Waivers for Waiting List- Total
Community Living (CL) Waivers Created for Training Center Transitions
Directs DBHDS to provide a report on the management and characteristics of individuals on the waiting list for services through the Developmentally Disabilities (DD) Waiver programs. The report shall include (i) the age of individuals on the waiting list, and (ii) the number of individuals designated as Priority 1, 2 and 3 on the waiting list. The department shall submit this report by October 15, 2017 to the Chairmen of the House Appropriations and Senate Finance Committees.”
Developmental Disability (DD) Waiver Redesign:
Directs DBHDS to implement a customized rate for individuals with complex support needs who receive sponsored residential services.
Directs the DMAS and DBHDS to establish and convene an annual stakeholders workgroup on issues related to the developmental disability waiver programs. Specifically, the workgroup will examine issues related to the tools to assess individual support needs, the assigned payment levels for providers, and the communication of these matters to individuals, families, case managers, providers and others.
Requires a study to collect information and feedback related to payments to “family homes” and the impact of changes to the rates on family homes statewide from sponsored residential providers and family home providers.
Directs DBHDS to provide a progress report on the implementation of the Developmental Disability (DD) Waiver programs to include information about the population served by the waivers, the level and reimbursement tier, and service utilization and expenses for (i) individuals who have used waiver services for less than one year and (ii) individuals who have used waiver services for 1-5 years. The department shall submit this report by October 15, 2017 to the Chairmen of the House Appropriations and Senate Finance Committees.
Proceeds with the closure of Southwestern Virginia Training Center (SWVTC) and Central Virginia Training Center (CVTC).The three bills to keep Training Centers open (SB1551, HB 1583 and HB 1972) were all defeated.
Allocates revenues obtained from sale of Training Center land to further expand community services for people with significant medical or behavioral support needs.
Requires the Joint Committee on Training Center closures and the Department of Behavioral Health and Developmental Services (DBHDS) to develop and evaluate a plan for consideration of operating a smaller state Training Center. The Joint Subcommittees must take review “operating costs, capital costs and other relevant factors into consideration.”
Requires the Department of General Services (DGS) to conduct an environmental assessment needed to assess real property at CVTC.
The budget provides a 2% raise for positions at Training Centers that are high turnover.
Cost-Sharing (and other JLARC Recommendations):
Requires DMAS to develop a proposal for cost sharing requirements based on family income for individuals with long term services and supports and submit to the Centers for Medicare and Medicaid Services to determine if such a proposal is feasible. Adds language clarifying that no cost sharing requirements shall be implemented unless approved by the General Assembly.
Requires DMAS to assess and report on additional or different resources need to implement recommendations in the Joint Legislative Audit and Review Committee (JLARC) report “Managing Spending in Virginia’s Medicaid Program.”
Under the Joint Subcommittee for Health and Human Resources Oversight, establishes a workgroup to examine the options and determine actions necessary to better manage the equality and costs of private day educational programs currently funded through CSA (see side-by-side document for details)
Shifts $150,000 each year from principal training to assistance for teacher professional development on the subject of issues related to high-needs students.
DBHDS Trust Fund:
Provides $8,550,000 from the DBHDS Trust Fund to be used for: (i) development of behavior/medical intense programs; (ii) subsidies for capital costs associated with rental units; (iii) establishment of a House Call Program in Northern Virginia; (iv) support for individual crisis events; and (v) development of providers in Virginia for individuals with intellectual and developmental disabilities with significant behavioral and mental health needs.
Consumer Directed Services:
Reinstates the prohibition on overtime for consumer-directed services.
Also requires DMAS to establish an “Electronic Visit Verification” program.
Special Joint Committee for Health and Human Resources Oversight:
Establishes a Joint Subcommittee for Health and Human Resources Oversight to respond to federal health care changes, provide oversight of the Medicaid and children’s health insurance programs, and provide oversight of Health and Human Resources agency operations.)
Health and Human Resources Systems Transformation:
Provides $250,000 for the HHR Systems Transformation Initiative:
Restores $200,000 in fiscal year 2017 from the general fund for the Long -Term Employment Support Services (LTESS) program.
Yesterday, several developmental disability (DD) organizations sent a letter to members of the House Appropriations Committee and the Senate Finance Committee expressing concern about budget proposals that would keep the Southwestern Virginia Training Center (SWVTC) and the Central Virginia Training Center (CVTC) open. The full letter can be found below.
February 19, 2017
Dear Members of the House Appropriations and Senate Finance Committees:
The undersigned organizations write to express our opposition to proposals that would keep the Southwestern Virginia Training Center (SWVTC) and the Central Virginia Training Center (CVTC) open. These proposals represent a retreat from the Commonwealth’s stated commitment to community-based services, and would cause harm to Virginians with developmental disabilities and their families. We urge you to proceed with the closures as planned and invest in community-based care.
The Commonwealth has already completed the closure of two state-operated institutions, the Southside Virginia Training Center (SVTC) and the Northern Virginia Training Center (NVTC). As a result of these closures, hundreds of citizens with developmental disabilities – including those with the most complex medical and behavioral needs – are now living safely and successfully in the community. Many of these individuals lived in the Training Centers for most of their lives; some for more than fifty years. Today, they are living “A Life Like Yours” in the community.
The families of former Training Center residents have expressed satisfaction with the community-based services their loved ones have received, and report that quality of life and well-being improved as a result of the transition. Since moving to the community, many individuals have made gains in adaptive skills (such as responding to a handshake, eating solid foods, or speaking words for the first time) and have seen decreases in maladaptive behaviors (such as eloping or self-abuse). In his December 2016 report to the court, the Independent Reviewer found that individuals with intense medical needs had positive health care outcomes as well. Families have shared that relationships with their loved ones have grown stronger, and that they are now able to see family members more frequently than they had in the past.
The system has felt the positive effects of closure as well, and community-capacity has significantly increased since the process first began. More than 2,000 DD Waivers have been provided as a result of the closures. The DD Waiver was redesigned to increase reimbursement rates for services provided to those with significant support needs. There are now community providers in every region offering medical and behavioral supports that exceed what is available in the state Training Centers. Some of these providers are located just a few miles away from CVTC, but their services are integrated in the community and offer an equivalent level of care for one-third of the cost of the Training Center.
Keeping the Training Centers open would limit the Commonwealth’sability to respond to the DD Waiver waiting list crisis. More than 11,000 Virginians with developmental disabilities are still on the DD Waiver waiting list. Many of these individuals have equivalent, if not greater, support needs as those currently living in the Training Centers. They require assistance with feeding, toileting, bathing and dressing, yet are still waiting for the services they need. Nearly 3,000 are in the Priority 1 status for reasons such as an elderly or ill caregiver. Maintaining SWVTC and/or CVTC would require millions of dollars in new, unbudgeted operational and capital expenses. Investing in institutions, when we know those dollars can be used to provide an equivalent level of service in a more cost-effective manner, is not fiscally responsible for our Commonwealth, especially given the unmet needs in community where funding is desperately needed.
Virginia’s plan to close the institutions puts us on the right path. Virginia is ranked 39th in the country for its developmental disability services (which places us up 10 rankings from when the closures first began). The low ranking is primarily due to the long waiting lists for services and slow transition to community-based care. Other states have transitioned to community-based services because it has allowed them to serve more people and provide a higher quality of care. As a result, more than 200 state-operated institutions have closed nationwide. Fourteen states have already closed all of their state institutions, and several other states are in the transition process.
Average Costs of Institutional Care vs. Community-Based Care:
The average annual cost per person for Training Centers is now $343,267 per person per year.
The average annual cost per person for community services (former residents) is $103,998 per year.
The average cost of the new Family and Individual Support (FIS) Waiver is $21,000 per person, per year.
The total census of Training Centers has declined by 74% since 2010, and is now close to only 300 residents statewide.
As the census declines, the average cost per person for Training Centers has risen by nearly 50%.
To summarize, it is simply not justifiable to invest in institutions when we know that, (1) equivalent (if not better) care is being provided in the community, (2) community-based care is more cost-effective than institutional care, and (3) the waiting list for community services continues to grow. These factors, combined with Virginia’s experience in shifting care to the communities, demonstrate that closing the institutions is not an “either/or” between families with needs. Rather, the transition to community-based care is about ensuring that all Virginians with developmental disabilities have access to the care they need. We are on the right path to get there, and ask that you keep going.
Thank you for your time and consideration of this matter.
disAbility Law Center of Virginia
Down Syndrome Association
Parent to Parent of Virginia
The Arc of Virginia
Virginia Association of Centers for Independent Living
Both the House and Senate have appointed the budget conferees. This is the small group of legislators who will negotiate the final budget bill. The conference committee will begin meeting tomorrow and will likely complete its work by early next week. This means we need to act NOW.
Once you have called your Delegate and Senator, please call as many of the budget conferees as you can. The message can be simple: “Invest in Community Services for People with Developmental Disabilities, Not Institutions” Let the legislators know that even though you are not a constituent, you and your family are directly affected by the issues being discussed.
While Virginia has been making steady progress in its transition to a community-based system since entering into the DOJ Agreement in 2012, actions taken in the Virginia General Assembly last week indicate that the Commonwealth may be close to taking a step backwards.
On Thursday, the House of Delegates passed a budget amendment that could potentially keep the Southwest Virginia Training Center (SWVTC) open, even though that institution is already scheduled to close June 30, 2018. Later that same day, the Senate voted to pass legislation that requires (1) a plan to keep the Central Virginia Training Center (CVTC) open and (2) a plan to implement family cost sharing for Medicaid long-term care services (which includes Waivers).
Training Centers and Waiver Waiting Lists:
The House and Senate provided 144 and 150 Family and Individual Support (FIS) Waivers, respectively. The Arc of Virginia appreciates the House and Senate making these Waivers a priority. We do remain concerned about the unmet needs of thousands of people who continue to wait. Nearly 3,000 of these individuals have been identified as being in “Priority 1” status and the Commonwealth has determined that they will need services within the next year. The DD Waiver waiting list continues to grow by hundreds of people each year.
Keeping the Training Centers open will limit the Commonwealth’s ability to respond to the DD Waiver waiting list crisis. Maintaining the state facilities will cost the Commonwealth millions of new dollars due to unbudgeted operating and capital expenses that will be incurred. Such actions would negatively impact the individuals who currently reside in the state institutions, as well as the 11,230 Virginians who are on the DD Waiver waiting list.
Virginia is ranked 39th in the country for its developmental disability services. The low ranking is primarily due to the long waiting lists for services and over-reliance on expensive and outdated state institutions. Fourteen states have already closed ALL of their state operated institutions because community-based care is cost-effective (allowing the state to serve more people) and greatly improves the quality of life of individuals who transition to community-based services. Several others states are in the transition process. Virginia was one of the last states in the country to initiate closure of it state-operated institutions.
The statewide Training Center census has been declining at a rapid rate due to community transitions and natural attrition. Meanwhile, the annual cost per person for the Training Centers continues to rise and now averages $343,267 per person statewide. Community-based services for the hundreds of people who have recently left the Training Centers (and thousands of other individuals with similar support needs) average 100-120k per person per year- which is one-third of the cost of the institutional services. Furthermore, the demand is for community-based services, not institutional care, as evidenced by the 11,230 person waiting list for community-based services.
The Arc of Virginia believes if new dollars are going to be invested in the DD system, these dollars must be directed to respond to unmet need in the community system.It is simply not fiscally responsible to invest in expensive and outdated institutions when we know that (1) people can be served safely and successfully in the community and (2) these dollars can be used more cost-effectively in order to respond to unmet needs in the community.
Family Cost Sharing:
The impact and parameters of the “family cost sharing” plan remain uncertain because the budget language is silent on this. The Arc of Virginia has been told that the plan would not take effect unless it was approved by the 2018 General Assembly. We urge you to continue to express your concerns to legislators because your advocacy could affect the conversation moving forward- both now and in the 2018 session.
Advocacy Needed Now-
The House and Senate budget bills are about to go to “conference committee”, where a small group of Delegates and Senators will negotiate a final budget bill. The “conferees” will be appointed tomorrow and are anticipated to complete their work on the budget within the next week. Your legislator can reach out to these conferees on your behalf, asking them to ensure that the final budget bill proceeds with the Training Center closures as scheduled, supports families and commits to community-based care.
What Can You Do?
Call your state Senator and Delegate TODAY. To find out who your legislators are, click here. Please note- it is highly unlikely you will be talking with the legislator directly. You will simply be asking to leave a message for him/her.
When you call, let your legislator know that:
You are very concerned about proposals that may keep the Training Centers open (326#2h, 284#6s) and the proposal to implement family cost sharing (306#14s)- these items represent a move in the wrong direction.
Investing in expensive outdated state institutions is not fiscally responsible. With two closures already completed, it is well documented that Virginians with complex needs can be served safely, successfully and more cost-effectively in the community.
Keeping the institutions open will require millions of new state dollars needed to pay for the unbudgeted operating and capital expenses, making it more difficult for the state to address the needs of the 11,000 person DD Waiver waiting list- a list that is already growing by hundreds of people per year.
The people who live in Training Centers do not have disabilities that are different from those who live in the community. For every person residing in the Training Center, there are hundreds, if not thousands, of people withequivalent (or greater) support needs who areon waiting lists for community-based services.
Urge your legislator to proceed with the closures as planned and if there is additional funding available, then it should be used to take further action on the waiting list crisis (not keep outdated institutions open).
If you have time, VISIT your legislator at the Virginia General Assembly building. Contact The Arc of Virginia office (804.649.8481, ext. 104) if you would like assistance. Remember- we only have a week to act, but constituent visits during session can make a big impact.
Plan to attend your state legislators’ town hall meetings. These may be occurring soon or could take place later this spring. Local town hall meetings are really important advocacy opportunities. If you don’t know when your legislators’ town hall meeting is, visit his/her website, follow him/her on social media or ask when you call the legislator’s office. Some legislators even have telephone town halls where constituents can call in with their concerns.
Help Virginia get on the right track- please take action right away.
The progress we’ve made over the last few years has not always advanced as quickly as we would have liked, but at least it was moving in the right direction. These amendments represent a move in the wrong direction and are being proposed at a time when the future of funding for community-based services is already fairly uncertain. Please make your calls today to help Virginia get “back on track” and strengthen its commitment to community-based care.
On Sunday, the House Appropriations Committee (HAC) and the Senate Finance Committee (SFC) released their respective versions of the state budget bill. The House and Senate amendments are now available online. A side-by-side comparison of the Governor, House and Senate bills is available at the link below. We will be sending an action alert very soon regarding two particular budget items that are of concern. This alert will be time sensitive so please be sure to take action TODAY. Stay tuned!
The House and Senate will hold a floor vote on their respective budget bills tomorrow afternoon. Once each body completes action on the budget bills, the bills will go to “conference committee”- where a final budget bill will be negotiated by a small group of Delegates and Senators. We will send out an alert after the House/Senate floor votes, letting you know where we stand and what you can do to help ensure that the conference committee incorporates the best of both budget bills. Please stay tuned for this alert as well.