Governor McAuliffe Unveils Proposed Budget:
Yesterday, Governor McAuliffe released his proposed 2016-2018 state budget, which includes funding for several intellectual and developmental disability (I/DD) priorities, including funding for the I/DD Waiver Redesign. Unfortunately, the Governor’s proposed budget does not provide enough I/DD Waiver slots to adequately meet the needs of Virginia’s families who are on waiting lists for services.
Members of Virginia’s House and Senate money committees will be hosting regional hearings on January 7 to obtain feedback from Virginia’s citizens on Governor McAuliffe’s budget proposal. The Arc of Virginia is preparing a Budget Hearing Toolkit with sample talking points to help individuals with I/DD and family members prepare for these hearings – so you can advocate for I/DD services. Please plan to attend these hearings, as they are a critical advocacy opportunity. Your participation can help increase I/DD funding for the waiting list and protect the funds proposed in this budget!
More information on the Budget Hearings can be found in The Arc’s last edition of Insider: http://us6.campaign-archive2.com/?u=ece9e0333c&id=e607a12a55
Summary of I/DD Items Governor McAuliffe’s Budget:
- Provides funding requested for I/DD Waiver Redesign (new rate structure and new services). Increases the base appropriation for I/DD Waiver Services by $23 million in state general funds (SGF).
- Provides 855 I/DD Waiver slots required by the agreement (675 for waiting lists, 180 for Training Centers) and 100 additional “reserve” slots to address emergencies.
- Allows DMAS to limit overtime hours for CD services (personal care, respite, companion) at 56 hours/week per attendant in order to comply with the US Department of Labor rule.
- Provides 300 rental subsidies for Virginians with I/DD population and provides ongoing funds for Rental Choice VA program. The base budget for housing subsidies will be $4.15 million/year.
- Provides most of funding needed to close gap in Part C Services based on the average annual growth rate of 4.9 percent over the last four years. ($959,057 general fund in FY 2016, $1.7 million general fund in FY 2017, and $2.5 million general fund in FY 2018).
I/DD Waiver Waiting List and Support for Training Center Transitions
- Provides 855 I/DD Waiver slots that are required by the DOJ Agreement. The distribution of these slots is as follows:
|ID Waiver Waiting List||300||325|
|DD Waiver Waiting List||25||25|
|Leaving Training Centers||90||90|
Provides 100 “reserve waiver slots” across three waivers: Intellectual Disability (25), Developmental Disability (50) and Day Support (25) Effective July 1, 2016. Reserve slots will be used for emergencies, for individuals transferring between waivers and for individuals transitioning from an Intermediate Care Facility or a state nursing facility (SNF) into the community, in compliance with the requirements of the 2012 Settlement with the U.S. Department of Justice.
- Provides community supports for individuals in training centers not covered by Medicaid. Provides funds to transition four individuals currently residing in state ID training centers into the community. These four individuals are not eligible for Medicaid, but are still required to be offered under the settlement agreement with the federal Department of Justice. These individuals will be transferred in FY17.
I/DD Waiver Redesign and I/DD Services
- Provides funding to increase I/DD waiver reimbursement rates and implement new I/DD waiver services as part of the I/DD Waiver redesign. The costs include an average rate increase of 5.4% percent for waiver services, the addition of new services to assist in increasing the number of individuals who can live in integrated settings, an increase in the developmental disability case management rate, and additional funds for more intensive services for individuals who have complex medical and/or co-occurring behavioral health needs. The redesigned waivers will address the concerns raised by the DOJ and US District Court in relation to the state’s compliance with the settlement agreement.
- Provide transitional funding for individuals leaving the training centers. Provides support for transitional needs for an estimated 180 individuals leaving the training centers during the biennium. There is currently no base funding dedicated to this need. All transitional needs have been reported through carry forward requests in FY2015 and FY2016. The requested funding will support needs that are covered by Medicaid including assistive technology, home and vehicle modifications, and specialized durable medical equipment.
- 2% increase for agency-directed and consumer-directed personal care, respite and companion services. Provides funding to increases rates for consumer and agency directed personal care, respite care and companion care by two percent in FY2017 in the EDCD Waiver, I/DD Waiver and Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program.
- Increase private duty nursing rates by 2%. Increase rates for private duty nursing by two percent in Tech and EPSDT in FY17 to cover a larger percentage of provider expenses.
- Provide authority to limit overtime hours for consumer-directed attendants. Authorizes the Department of Medical Assistance Services (DMAS) to limit overtime hours that may be provided by attendance who are providing care under the consumer-directed service option in the Medicaid waivers. Funding the DMAS to comply with this new federal rule is included in the Official Consensus Medicaid forecast beginning in FY2016. The Department shall authorize time and a half up to 56 hours for a single attendant who works more than 40 hours per week. The Department shall have the authority to implement this and any necessary changes effective July 1, 2016, in order to confirm state regulations to allay any fiscal impact associated with DOL rule.
- Expand rental assistance programs for people with intellectual and developmental disabilities. Provides funds for the 300 rental vouchers, and funding for two positions to manage the rental subsidy program. This request will phase in the new rental subsidies by adding 150 in FY17 and an additional 150 and FY18.
- Provide ongoing funds for Rental Choice VA subsidy program. Provides on-going funds for Rental Choice VA subsidy program. Provides ongoing funds for the Rental Choice VA program established pursuant to the settlement agreement with the DOJ. Individuals being served by this program currently have no stable funding source for the subsidies being provided, as the program was originally funded with 1-time 800K appropriation. If ongoing funds are not appropriated, they will lose their subsidy and will likely end up in a more expensive, congregate setting.
- “Rebase training center budgets to reflect anticipated closures.” Total reduction in the Biennium budget is $41.4 and decreases the base budget by $21.8/year. Adjusts the budget for training center reimbursements to account for on-going facility closure costs and savings resulting from compliance with the DOJ agreement. Packages reflect the estimated impact of closing Northern Virginia Training Center and SWVTC by FY18.
- “Realign funds between facilities.” Transfers funds from Intellectual Disability Training Centers to the Virginia Center for Behavioral Rehabilitation. These funds were moved administratively in FY12-15 and will be moved again in FY16.
- “Reduces position levels at training centers.” Reduces the position levels at the training centers from 2664 to 2125 a reduction of 539 positions. The reduction is the result of the closing of NVTC in 2016 (453 positions) and the continued downsizing of CVTC and SWVTC.
- Reduce special fund appropriation to align with revenue collections.
- “Transfers general fund appropriation from DBHDS to DMAS to support training center operations.” Transfers general fund appropriations from DBHDS to the facility appropriation at DBHDS to the state facility appropriation with DMAS. This transfer will provide additional general fund match associated with Medicaid reimbursement necessary to generate special fund revenue for the state operation of training centers. These funds are derived from amounts appropriated to DBHDS from central accounts for increases in salary, workers comp, retirement and health insurance costs
- “Transfers funds within facility system to address critical needs.” Transfers funds within agency’s facility system to accommodate the needs of individual facilities. Growing costs in pharmaceuticals support services at Central State Hospital, and overtime costs associated with increased admissions have increased the needs at state MH facilities. In previous years, the agency has transferred nongeneral funds to offset some of the increased costs but the closure of training centers will reduced nongeneral fund balances available for such transfers. This adjustment will permanently move funds to the facilities where they are most need and reduce the need for administrative transfers.
- “Address settlement agreement costs for facility closure, mental health backfill.” Provides funds for retention bonuses and the separation costs of employees at NVTC and SWVTC during the closure process of each facility. Because many of the payments are made in the fiscal years after a facility has closed, they are not eligible for Medicaid reimbursement. Funds are also included to maintain unoccupied buildings until they can be sold.
I/DD Community-Based Crisis Services
- Expand crisis stabilization program consistent with requirements. Funds crisis stabilization programs required by the settlement agreement with the federal Department of Justice (DOJ). This amendment includes funds to build two, eight bed therapeutic homes, in additional to funds for mobile crisis services, respite services for children and crisis coordinators in each region. Funds are included for three crisis specialists to work in state mental health facilities to reduce unnecessary institutionalization. The Independent Reviewer charged with monitoring the state’s compliance with this agreement has noted that the state continues to be noncompliant in this area particularly as it applies to children.
I/DD Community-Based Medical Services
- Fund DD Health Support Networks in Southwest VA. Support a DDHSN in the southwest region. Current base funding for DDHSNs in FY16 in $2.6 million, which funds network that replace the services that were previously provided by the SVTC and NVTC. The services provided include health education, dental serves, and equipment repair. More information on the DD Health Support Network can be found at: http://www.dbhds.virginia.gov/individuals-and-families/developmental-disabilities/health-services
Early Intervention (Part C)
- Address increasing caseload in the Early Intervention- Part C program. Provide funds for anticipated caseload growth in Early Intervention. The average growth over the last four years was 4.9 percent. The federal Individuals with Disabilities Education Act requires that the state must identify and enroll all eligible children. These funds are supplement by federal and local funds.
Funds for DBHDS Central Office and Infrastructure Development
- Fund additional positions to support DOJ administrative requirements. Provides funds to increase licensing and quality management staff in the central office. The position include 10 licensing specialist, five position to assist in the development and execution of improved case management and service needs evaluation processes, two positions related to internal review and data quality assurance and tow positions tasked with the implementation of a rental subsidy program for individuals with intellectual and developmental disabilities.
- Support administrative needs for the increase in Waiver services. Provides funds for 10 prior authorization specialists, 5 prior authorization team leads and one administrative assistant to support the prior authorization team. These positions will be responsible for working with CSBs and case managers to assist in the transition of individuals into the proposed newly designed I/DD Waiver system. Specifically, these positions will monitor the mix of services offered to individuals, provide technical support to produce service utilization data , perform quality management and monitor waiver recipients’’ individual support plans to ensure the transition to more integrated day and residential services.
- Provide additional positions for the Individual and Family Supports program. Provides funds for the five additional positions in the IFSP. The revamped IFSP will include staff in each region to help link individuals on the intellectual and developmental disability waitlists with the available services and supports in their area.
- Implement the Managed Long-Term Services and Support (MLTSS) Initiative. Provide funding for five positions and adjust the budget for anticipated management contract expenses associated with start up. The estimated saving represents the discontinuance of the current fee for service transportation contract as these services will move to managed care and will be incorporated into future payments. The package only reflects MLTSS administration and start up adjustment. It is expected that the programmatic and service impact will be reflect in next year’s Medicaid forecast.
- Cover Applied Behavioral Analysis (ABA) services under FAMIS. Adds coverage for ABA and other behavioral therapy services, for children in Family Access to Medical Insurance Security Plan (FAMIS). Virginia covers ABA and other behavioral therapy treatment services in the EPSDT program, but not in FAMIS.
- Address increasing workload for the independent reviewer. Provides general fund support to address the anticipated increase in workload of the Independent Reviewer that monitors the settlement agreement between the federal DOJ and the Commonwealth. The original Settlement Agreement did not require any serious incident review of related reports to the court. As a result, those responsibilities were not taken into consider.
- Fund adult services and adult protective services case management system operations. Covers ongoing operating costs associate with replacing current case management system being used by adults services and adult protective service (APS) workers. While the Department of Aging and Rehabilitative Services is leveraging federal grant funds to implement the new system, ongoing general fund support is needed to cover licensing and support costs. In addition, one-time funding is provided in the first year to provide training for local worker.
- Provides 139.1 million to hire 2,500 new teachers across the Commonwealth.
- Provide one‐time funding to expand computer adaptive testing. Provides one‐time funding to transition the grades three‐through five mathematics tests and grades three‐through‐eight reading tests to a computer adaptive testing (CAT) format that adapts to the student’s ability level, shortens the length of tests, and provides more flexible test administration.
- Enhances funding for the At‐Risk program, which provides funding as a percentage add‐on to basic aid to support the additional costs of educating at‐risk students
- Provides 36.2 million to support caseload and expenditure growth for services provided to at-risk children and youth through the Children’s Services Act. . Growth is assumed at a two year average from FY 2015 to FY 2016, and held steady through the biennium until it can be determined if unusually large increases in FY 2015 reflect a pattern after years of declining or flat program costs. Expenditures in special education day placements were a primary driver in expenditure growth last year.
The full budget document can be accessed at https://solutions.virginia.gov/pbreports/rdPage.aspx?rdReport=BDOC2016_FrontPage