The Arc of Virginia is sending this communication to provide Virginians with developmental disabilities and their families with a comprehensive summary of proposed changes to the Intellectual Disability (ID) and Development Disability (DD) Wavier programs (referred to as “I/DD Waiver Redesign”). Our goal was to make this summary as family-friendly as possible, but there are many changes being proposed and some are somewhat complicated. For this reason, we will also be traveling around the state to host local and regional trainings on the new DD Waiver program to help people with DD and their families further understand the changes coming to the DD Waiver program.
If you are currently on the waiting list for an Intellectual Disability (ID) waiver or Developmental Disability (DD) waiver, or are receiving services offered through the ID, DD or DS Waiver programs, we recommend that you set aside time to review the changes that are being proposed. This will help you be prepared for changes and will help you advocate for the services you need in the new system. We also suggest that you forward and share this communication with others in your network so that they have access to information about the new DD Waiver program too.
While this update is MUCH lengthier than what we typically send, we felt it was important that the information put all of the proposed changes together in one place. Please consider it a reference document. The Arc of Virginia will notify you if there are any changes.
What is I/DD Waiver Redesign?
The Department of Behavioral Health and Developmental Services (DBHDS) and the Department of Medical Assistance Services (DMAS) have proposed changes to the existing ID Waiver, DD Waiver and DS Waiver and will be combining these three Waivers into one program that serves Virginians with developmental disabilities (regardless of diagnosis). The program will now be called the DEVELOPMENTAL DISABILITY (DD) WAIVER PROGRAM.
The new DD Waiver program will be composed of three new Waivers: the Community Living (CL) Waiver, the Family and Individual Support (FIS) Waiver and the Building Independence (BI) Waiver. These Waivers will replace the existing ID, DD and DS Waivers (details below). The services offered under the new DD Waiver program will differ significantly from what is currently offered under the ID, DD and DS Waiver programs. While there are still three Waivers instead of one, the state has reported that individuals will be able to move “seamlessly” between Waiver programs so that they can access the supports they need, when they need them.
Why are the I/DD Waivers being redesigned?
Due to a number of systemic barriers, Virginians with developmental disabilities continue to face great difficulty accessing community-based services, particularly those in the most integrated settings. More than 10,700 Virginians with DD are on waiting lists for I/DD Waiver services and over half of these individuals are in urgent need. Other systemic barriers include inadequate reimbursement rates, a lack of providers who offer integrated services, a system that is confusing for families to navigate, inconsistent access to case management services that facilitate true person-centered planning and a lack of service options that promote independence and community inclusion.
Virginia is seeking to address many of these barriers, and comply with federal requirements related to community integration such as the Department of Justice (DOJ) Agreement and CMS Rule, through the redesign of the IDD Waiver program.
The stated 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 recipients of services may live full lives in the community. Some of the changes being proposed are related to this stated goal, others might not be. The Arc of Virginia will continue to advocate throughout implementation of DD Waiver Redesign to ensure systematic barriers are addressed (not created) and waiver redesign meets its intended goals.
When is Waiver Redesign going to be implemented?
The General Assembly approved the Waiver Redesign proposal in the 2016 legislative session. Virginia has since submitted applications to the Center for Medicaid Services (CMS), the federal agency responsible for overseeing Waiver programs, so that it can receive federal matching funds to support the program. The applications must be approved by CMS before Virginia can begin implementation of the new DD Waiver program.
August 12, 2016 Hot News from the VA Department of Medical Assistance Services: Waiver Redesign amendments for the Day Support, ID and DD Waivers have been approved by the Centers for Medicaid and Medicare to take effect September 1, 2016. The Arc of VA looks forward to sharing information as it becomes available. We will continue to update ourwebsite with new information regarding DD Waiver Redesign,
Summary of Changes in the New DD Waiver Program
New Names for the ID, DD and DS Waivers
The Day Support Waiver (DS) will change its name to the Building Independence Waiver, which will provide supports for adults (18+) who live independently in their own homes. Supports offered under the waiver will be complemented by non-waiver funded rent subsidies. Children on the DS Waiver will transition to the new Family and Individual Supports Waiver (see below).
The Individual and Family Developmental Disabilities Support (DD) Waiver will change its name to the Family and Individual Supports (FIS) Waiver, which provides supports for children and adults living with their families, friends, or in their own homes.
The Intellectual Disability waiver will become the Community Living Waiver, which provides the same services as what is offered in FIS waiver, but also includes sponsored residential and group home residential services options.
If you are on the ID, DD or DS waiver, you will stay in your current waiver during the name change. You can request to move to a different Waiver if you need services that are offered under that particular waiver program. To do so, please let your case manager know of this request so that the state can plan to meet your support needs.
New Services and an Emphasis on Integrated Supports
Each Waiver (Building Independence, Family and Individual Support and Community Living) will differ based on the services they offer. Many new services have been added that seek to promote greater independence, community integration and inclusion. These new services will include:
- Community engagement
- Community coaching
- Workplace assistance
- Community-based crisis supports
- Center-based crisis supports
- Independent living supports
- Shared living
- Supported living
- Private duty nursing
- Electronic home-based services
To view a description of each new service offered under each of the new waiver programs click: Services, Definitions and Waiver Type 2016
Note: On July 1, 2017 these new services will be added: Benefits Planning, Community Guide and Non-Medical Transportation.
You can request any of these new services when you update your “person centered individual service plan (PC-ISP) at your annual service planning meeting or you can initiate a meeting at any time to discuss and change services. If you are in need of services that are not offered in your current Waiver program (sponsored residential for example), you can request that you be moved to that another Waiver program that does offer those services. A goal of waiver redesign is for recipients of services to be in the waiver that best matches their individual support needs.
Important Note re: Access to Services:
You have the right to receive any service in the new DD Waiver program that helps you to live, work, or recreate in the most integrated setting that meets your support needs. In addition, you have the right to receive services in non-disability specific settings (meaning in the community where anyone with or without a disability would go). If you are having trouble accessing integrated services, for any reason including a lack of providers, DBHDS has a team of Community Resource Consultants tasked to trouble-shoot access issues, and Regional Support Teams tasked to trouble-shoot unresolved access issues and record data. If you have complex support needs, either medical or behavioral, the Complex Case Consultation Team will help trouble shoot complex access issues, including negotiating a reimbursement rate to providers to cover the cost of care. If you are unable to access services, please ask your case manager to contact your local CRC to help troubleshoot.
Changes in the Eligibility Process:
- Single point of entry: In the current system, where one goes to first request services has been based on diagnosis (i.e. CSBs for ID diagnosis, Child Development Centers for people with DD who do not have an ID diagnosis). In the new system, everyone entering the program with a developmental disability (regardless of intellectual disability diagnosis) will contact their local Community Services Board in order to request DD services. This became effective July 1.
- Non-diagnosis specific eligibility: The new system will serve people with (a universal term that includes the diagnosis of intellectual disability) under one program with three waivers. Developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas. Examples of some developmental disabilities are: Down syndrome, Autism, Cerebral Palsy, Muscular Dystrophy, Intellectual Disability, etc. Please visit the link above for the state definition of “developmental disability.”
In order to participate in the DD Waiver program, Virginians with DD will need to meet the following eligibility criteria:
1) (New) Functional Assessment: Virginia Individual DD Eligibility Survey (VIDES – link will take you to assessment)
-The VIDES is the screening tool used to determine eligibility that will replace the Level of Functioning Survey, the assessment tool that is currently being used.
-A representative, usually a case manager (also known as support coordinator), from the Community Services Board will meet with the individual and family to complete the assessment in order to determine eligibility. This will need to take place prior to being placed on a DD Waiver waiting list.
-To receive a waiver slot, the VIDES must be up-to-date within six months, therefore, this assessment may need to done again before receiving a slot.
-If on the waiver, the VIDES is done every year to maintain eligibility for the waiver.
-If you are currently on the ID or DD waiver or the ID/DD waiver waiting list, you have been found eligible for a waiver under the Level of Functioning Survey. You should also be found eligible under the VIDES. If you are found ineligible under the new VIDES assessment, contact DBHDS’s Regional Support Specialist staff right away to resolve this issue.
– Individuals who are currently on a waiting list, OR new individuals going through eligibility, have the right to appeal the VIDES if they are found ineligible. If found ineligible under the VIDES, you should receive a stand letter (not yet released) detailing your right to appeal and the process. If you do not, contact DBHDS’s Regional Support Specialist staff to resolve this issue.
2) Diagnostic Eligibility- Proof of Developmental Disability
Your diagnosis of developmental disability (term includes the diagnosis of intellectual disability) will need to be documented. DBHDS, in consult with DMAS, is writing a guidance document detailing which relevant sources of documentations are needed. We will post this information on our website as soon as it becomes available. A psychological evaluation (with an IQ score) is not mandatory in the new program and may not be relevant to your specific diagnosis. Click for: Definition of Developmental Disability
3) Financial Eligibility for Adults 18+
Adult individuals receiving waiver services must meet Medicaid Long-term Eligibility Requirements of monthly income and assets being no more than 300% of the SSI amount for an individual, or $2,163 per month. Locate local departments of social services here: Virginia Department of Social Services (Note- financial eligibility did not change in the I/DD Redesign).
Changes in Waiting List Management and Slot Allocation:
Currently, there two separate waiting lists for the DD and the ID waiver. The DD waiver waiting list is chronologically based, which means people are served based on the order they are placed on the list. The ID waiting list is based on urgency and grouped by status: urgent and non-urgent.
- Single waiting list: In the new system, the ID and DD Waiver waiting lists will be combined into one, waiting list. The waiting list will be maintained at the local level by the Community Services Boards (CSB). This waiting list will be urgency-based with three prioritization categories. If you are on a waiting list, please review the criteria in the link and make sure your case manager (also called a support coordinator) has the most up to date information on you and your family.
If you are currently on the ID or DD Waiver waiting list: You should receive a letter or a phone call from your local CSB informing you of your priority status. If you have not received a notification, call your CSB and ask for your status. If you disagree with your status, you have the right to update your information or formally appeal, if necessary. You should receive a standard letter (still in development) detailing the appeals process. If you do not, you can call your CSB and request this information or call your Regional Support Specialist.
- If you are in the priority one category, your case manager (support coordinator) will fill out a Critical Needs Summary to document your level of urgency. You can ask to review this form and update all relevant information. Always make sure your case manager (support coordinator) has the most updated information.
- Slot Assignment: There are a limited numbers of waivers approved each year through the General Assembly budget process. If you are one of the most urgent cases in priority one status, determined by the points in the Critical Needs Summary, then your case manager (support coordinator) will complete a Slot Assignment Review Form. This form will be used by a local Waiver Slot Assignment Committee (WSAC). When waiver slots become available, the local WSAC, will use the form to select the recipients of the available waivers. You should always be offered a waiver that best matches your support needs. Refer to the services by waiver document: Services, Definitions and Waiver Type 2016 to understand what services are available according to waiver.
Emergency Slot Criteria: In the new Waiver program, DBHDS will manage “emergency waivers” that will be allocated at the state level should an emergency arise. In order to be eligible for an emergency waiver, an individual must meet the following criteria:
- Protective Services (Children or Adult) has substantiated abuse/neglect against the primary caregiver and has removed the individual from the home; or for adults, where abuse/neglect has not been substantiated but corroborating information from other sources (agencies) indicates there is an inherent risk present. There are no other unpaid caregivers available to provide support services to the individual.
- Death of primary caregiver and/or lack of alternate unpaid caregiver coupled with the individual’s inability to care for him/herself and will be dangerous to self or others without supports.
Supports Intensity Scale (SIS):
Once you receive a waiver slot, you will have The Support Intensity Scale (SIS) Assessment performed by Ascend, a contractor for the state. The SIS is being used by DBHDS to assign the individual a support level. There are seven support levels. The individual’s support level is being used in a new rate structure to determine a provider’s reimbursement rate for some services, primarily residential and day services. The goal of implementing support levels and a tiered rate structure is so that as individual support needs increase, reimbursement rates increase to cover the cost of providing supports. Click to see the Support Levels and Tiers ADULTS.
If you are on the waiver, a SIS will need to be updated every three years. Your case manager (support coordinator) will facilitate scheduling the appointment. If you are on the waiting list, a SIS will be done around the time a waiver slot is assigned to you. Visit the link and click on the SIS tab to prepare for the assessment. This is a deficit based assessment, answer honestly and as though no one would be available to provide any natural support.
Two weeks after the SIS is performed ask the CSB for the SIS score and the support level. If you think the score and the support level do not properly reflect the individual’s support needs, there may have been an issue with the assessment process. You can appeal the “standard operating procedures” by turning in this application to your Regional Support Specialist. Note: The SIS score is not appealable; only the standard operating procedures can be appealed.
New Reimbursement Rates:
One of the major changes in the new DD Waiver is that there will be new reimbursement rates for many DD services. The goal of the waiver redesign is to transform the existing service system to be more person centered. The waivers will increase reimbursement rates for many services that promote community inclusion and family support. Some reimbursement rates will be tied to level of support needs, in an effort to ensure that people with complex needs have access to community-based support. These services will include: The level of support need will be determined by the SIS (see below).
- Chart of Support Levels and Tiers for Reimbursement click: Support Levels and Tiers ADULTS
- Chart of New DD Waiver Reimbursement Rates click: Rates for Reimbursement
- Rates Account for Level of Support Need– A goal of the new rate structure is to have rates increase as an individual’s level of support needs increase, in order to cover additional costs associated with support. This will be done for certain services in the Waiver program including: Group Home, Sponsored Residential, Supported Living, Independent Living (2 tiers), Group Day Services, Community Engagement and Group Supported Employment. The Supports Intensity Scale (see above) will determine the level of reimbursement.
- Rates Aim to Support Smaller Settings– A goal of the new rate structure is to have rates that support the costs associated with providing smaller staff to individual ratio- and more person centered services. Many integrated services provide a higher reimbursement rate than more segregated services. There are some services that may have gotten left behind however (see sponsored residential and supported living below).
- Rate Structure Amended to Increase Flexibility in Supports Offered: A new rate structure will be implemented as part of DD Waiver Redesign. Providers of residential services will move to a daily reimbursement rate. Day and employment services will change to an hourly billing structure so the individual can chose the type of service and duration that best supports their job and recreation activities. An individual can use up to 66 day and employment services per week, depending on support needs
- Sponsored Residential and Supported Living Rates: The new rates for Sponsored Residential will be implemented in January 2017.
- The bottom line for individual’s receiving services: the new rate structure should be responsive to individual support needs and allow the provider to offer more person-centered supports. As stated before, DBHDS has a team of Community Resource Consultants tasked to trouble-shoot access issues, and Regional Support Teams tasked to trouble-shoot unresolved access issues and record data. If you have complex support needs, either medical or behavioral, the Complex Case Consultation Team will help trouble shoot complex access issues, including negotiating a reimbursement rate to providers to cover the cost of care.
How Can I Learn More about the Proposed Changes?
The Arc of VA’s Local/Regional Presentations
The Arc of Virginia is traveling around the state to help individuals with developmental disabilities and their families further understand the changes being proposed to the I/DD Waiver program. A schedule of upcoming presentations can be found here. If you were/are unable to attend a local presentation, we are recording the presentation and will post it to our website. We will send an email with a link once it is posted.
Much of The Arc of Virginia’s upcoming Convention will be focused on providing people with developmental disabilities, family members and providers with the information they need to know about I/DD Waiver Redesign. There will be presentations geared specifically for self-advocates, family members and private providers. The Convention will be held August 8-10 in Williamsburg, VA. For more information, please click here.