Summary of DD-Related Items in Gov. McAuliffe’s Proposed Budget Waiting List
- Changes allocation of DD Waiver slots in FY18
- Reduces Community Living Waivers for waiting list from 325 to 90 in FY18 (-235)
- Increases Family and Individual Support Waivers from 25 to 200 in FY18 (+175)
- Increases the Building Independence (BI) Waivers by 60 in FY18 (+60)
- No change in number of people served, but cost savings are not used to serve more people.
- Allows DMAS to reallocate funds to create new waivers. In the event that DMAS can demonstrate that additional Waivers mentioned above (CL, FIS and BI) can be added within appropriations, the Governor may authorize DMAS to amend the CL or FIS Waivers to add such slots. DMAS shall seek federal approval for changes upon receiving approval from the Governor. DMAS will report the creation of any additional Waiver slots to the Chairmen of Appropriations and Finance within 10 days.
Overtime for Consumer Directed Service Attendants:
- Allows DMAS to authorize overtime for attendants providing CD services. Provides $8.5 million GF ($17) million to pay overtime compensation to attendants providing consumer-directed services under the Medicaid Waivers. This amendment replaces language prohibiting overtime hours being worked by consumer-directed attendants with language that allows DMAS to pay time and half for up to 56 hours for a single attendant.
DBHDS/CSB System Assessment:
- Provides $4.5 million to hire an independent contractor to “expedite transformation of Virginia’s community mental health system.” Funds will be used to conduct an assessment of currently available services and a gap study, in addition to a high‐level design of efforts to ensure same‐day access for individuals accessing services (mental health) through community services boards. In addition, the study will include an assessment of the effectiveness and efficiency of the Department of Behavioral Health and Developmental Services’ organizational structure. The assessment shall also review the department’s management of the services delivered by the agency or through the CSBs. Full excerpt of budget language included at the end of this document.
DBHDS Trust Fund:
- Appropriates 8.6 million in trust fund dollars to be used for “expenditures needed to comply with the Department of Justice Settlement Agreement, including crisis stabilization services, improving quality management, and expanding availability of community‐based housing options. These funds are anticipated to be available due to the planned sale of Northern Virginia Training Center. The majority of funds will be expended on services to individuals in the NVTC catchment area.”
Children’s Services Act (CSA):
- Fund increasing caseload and service costs in the CSA program. Provides $44.1 million in FY17 and $44.5 million in FY 18 to fund anticipated caseload and expenditure growth for services provided to youth through the Children’s Services Act. “The program is anticipated to grow at approximately 6 percent each year, with the majority of growth occurring in the area of private special education services, which are mandated by federal law.”
- Provides funding to conduct readiness reviews for new managed care organizations (MCO). The new organizations would operate as part of the re‐procured Medallion (4.0) program, which currently serves more than 700,000 individuals. A readiness review is an impartial assessment to assess a health plan’s preparedness to operate as a Medicaid MCO.
- Expands Ombudsman services to meet federal MLTSS requirements. Adds 6 positions to expand the State Office of Long-Term Care Ombudsman to support Medicaid Managed Long Term Services and Supports (MLTTS) program, known as CCC Plus when it is implemented in Virginia.
- Provide for $1M “to divert and discharge children from the Commonwealth Center for Children and Adolescents.” HHR Budget Summary states that it will be used to purchase private inpatient beds and create community‐based service plans for those children who have been deemed ready for discharge.
- Make infrastructure repairs at state facilities ($7 million). Provides funds for the repair and/or replacement of deteriorating infrastructure, failing HVAC systems, and outdated security systems at facilities operated by the Department of Behavioral Health and Developmental Services.
- Reduce unobligated funding at state training centers ($2,500,000 GF). Captures unobligated funding available as a result of the closure of Northern Virginia Training Center.
- Licensing Fee. Directs DBHDS to promulgate emergency regulations establishing a nonrefundable fee for the initial application and a nonrefundable license renewal fee per application for all adult behavioral health and developmental services licensed by the department.
- Fund adult services and adult protective services case management system operations. Covers the on‐going operating costs associated with replacing the current case management system being used by adult services and adult protective services) workers. While the Department for Aging and Rehabilitative Services (DARS) is leveraging federal grant funds to implement the new system, on‐going general fund support is needed to cover licensing and support costs.
- Reduces Long Term Employment Support Services (LTESS) by $375,000 in FY17 by $10,661 in the second year.
- Reduces funding for training individuals whose cost cannot be covered by federal vocational rehabilitation
- Provides $250,000 to contract with Birmingham Green for long term care.
- Adjust institutional rate setting/auditing scope of work consistent with payment methodology changes. Transitions to more price‐based (less cost‐based) payment systems has reduced the need to audit costs, so the agency can revise the scope of institutional provider rate setting and auditing.
- Conduct audits of “DME” and pharmacy services with agency staff. Assumes that more durable medical equipment (DME) and pharmacy audits will be performed using agency staff. The shift to managed care reduces fee‐for‐service business, lowers the volume of services DMAS needs to audit, and makes it possible for the agency to complete more audits using agency staff and a reduced number of contracts with vendors.
EXCERPTS OF BUDGET LANGUAGE:
Medicaid Expansion Language;
“5. a. Notwithstanding §30-347, Code of Virginia, or any other provision of law; should the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010) be continued, amended or replaced through federal law or regulation, such that an enhanced federal medical assistance percentage (FMAP) rate is available for newly eligible individuals, the Governor, on or after October 1, 2017, shall have the authority to direct the Department of Medical Assistance Services (DMAS) to amend the State Plan for Medicaid Assistance under Title XIX of the Social Security Act, and any waivers thereof, to implement such changes.
- The department shall have authority to implement the coverage provisions outlined in JJJ.5.a. of this Item prior to the completion of any regulatory process in order to effect such changes.
- All savings accruing to any state agency of the Commonwealth of Virginia due to the implementation of the provisions included in JJJ.5.a. or JJJ.5.b. of this Item shall not be expended but shall be unallotted and reserved for appropriation by the General Assembly.”
ITEM 284- System Assessment
E.1. Out of this appropriation, $4,500,000 the second year from the general fund shall be used for the Office of the Secretary of Health and Human Resources (OSHHR) to procure an independent contractor to expedite transformation of Virginia’s community mental health system. Such contract shall be entered into in consultation with the Virginia Association of Community Services Boards (VACSB), the Virginia Department of Corrections, the Virginia Sheriffs Association, and the Virginia Association of Regional Jails. The goal of Virginia’s community mental health system transformation is to ensure access, quality, consistency, and accountability across all forty Community Services Boards (CSBs) and Behavioral Health Authorities. The contract shall include a current state assessment, gap analysis, and high-level design of Same Day Access. The request for proposals shall be issued as soon as possible, but not later than 45 days after the enactment of this act, and include requirements for the following components: (1) Documented Vision of Transformation including expectations for partnerships with private providers; case management; care coordination; primary care and behavioral health integration; mobile crisis; and services for children, geriatrics, and veterans. The vision shall be based on the STEP-VA plan for system transformation, excellence, and performance in Virginia. (2) A Current State Analysis of all forty CSBs and Behavioral Health Authorities that includes an understanding of existing community resources; population needs including the behavioral health needs of incarcerated or otherwise criminal justice involved individuals; availability of private providers; transportation resources; governance; culture; challenges; and current processes, technology, and data and analytic capabilities. (3) A Gap Analysis indicating the difference between the Vision of Transformation and the Current State for each CSB. (4) High-Level Design to support implementation for Same Day Access including development of a clinical process flow, administrative process, and job design. (5) An analysis of the cost of such design compared to existing resources and funding streams.
- The contract shall also include an assessment of the efficiency and effectiveness of the Department of Behavioral Health and Developmental Services’ organizational structure. The assessment shall review the department’s management of the services delivered by the agency or through the community services boards. The study shall include an evaluation of the adequacy of existing administrative resources and identify gaps in funding and staffing required to perform assigned statutory responsibilities, including the management of the community contracting division and operation of state mental health facilities and training centers, and recommendations for improved performance. The assessment shall also review and make recommendations as to the optimal agency service delivery structure including the creation of separate behavioral health and developmental disability agencies. In developing recommendations, the contractor shall incorporate the transformation of the service delivery system referenced in paragraph E.1 of this Item.
- The Department of Behavioral Health and Developmental Services in partnership with the CSBs and VACSB shall provide necessary information in a timely manner as requested by the contractor. The contract shall require that the contractor submit a preliminary report within 90 days after signing the contract that includes its detailed project plan and progress to date. The contract shall also require that the assessment, design and analysis be completed by July 1, 2018, and a final report submitted by October 1, 2018, to the Governor and the Chairmen of the House Appropriations and Senate Finance Committees.
- In developing the report, the contractor shall examine and include information and recommendations provided by the Joint Subcommittee to Study Mental Health Services in the Twenty-first Century, established pursuant to SJ 47 (2014 General Assembly).
- The Governor shall appoint a committee comprised of eleven members to include six gubernatorial appointees, three appointees of the Speaker of the House of Delegates, and two appointees of the President Pro Tem of the Senate to oversee progress on the specific actions funded in this Item as well as progress on transformation of the mental health system in Virginia and the evaluation of the department. Gubernatorial appointees shall include the Secretary of Health and Human Resources and the Secretary of Finance. The Contractor shall provide periodic progress reports to the committee at the call of the committee chair.