Governor McAuliffe Unveils Proposed Budget

 

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).

BUDGET SPECIFICS:

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:
Waiver Type FY17 FY18
ID Waiver Waiting List 300 325
DD Waiver Waiting List 25 25
Leaving Training Centers 90 90
TOTAL 415 440

               

2017 2018
General Fund 14,217,361 31,758,543
Non-General Fund 14,217,361 31,758,543
Total 28,434,722 63,517,068

 

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.

2017 2018
General Fund 1,886,913 1,886,913
Non-General Fund 1,886,913 1,886,913
Total 3,773,826 3,773,826

 

  • 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.
2017 2018
General Fund 503,204 503,204
Non-General Fund

 

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.
2017 2018
General Fund 13,154,660 23,049,569
Non-General Fund 13,154,660 23,049,567
TOTAL 26,309,320 46,099,138

 

 

  • 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.
2017 2018
General Fund 636,000 480,000
Non-General Fund

 

  • 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.
2017 2018
General Fund 7,124,799 7,972,821
Non-General Fund 7,124,799 7,972,821
14,249,598 15,945,642

 

  • 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.
2017 2018
General Fund 563,265 656,490
Non-General Fund 563,265 656,490
Total                1,126,530 1,126,530

 

  • 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.
2017 2018
General Fund 5,700,000 6,200,000
Non-General Fund 5,700,000 6,200,000
Total 11,400,000 12,400,000

 

 

Housing

  • 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.
2017 2018
General Fund 1,875,000 3,750,000
Non-General Fund
Positions 2 2

 

  • 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.
2017 2018
General Fund 400,000 400,000
Non-General Fund

 

Training Centers:

  • “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.
2017 2018
General Fund (9,832,972) (10,907,845)
Non-General Fund (9,832,972) (10,907,845)
Total (19,665,944) (21,815,690)

 

  • “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.
2017 2018
General Fund 2,792,375 2,792,375
Non-General Fund

 

  • 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.
2017 2018
General Fund
Non-General Fund
Positions 539 539

 

  • Reduce special fund appropriation to align with revenue collections.
2017 2018
General Fund
Non-General Fund (25,000,000) (32,000,000)

 

  • “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
2017 2018
General Fund
Non-General Fund 8,000,000 8,000,000

 

  • “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.
2017 2018
General Fund
Non-General Fund 8,848,744 8,848,744

 

  • “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.
2017 2018
General Fund 4,805,510 3,938,627
Non-General Fund

 

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.
2017 2018
General Fund 4,330,000 5,327,000
Non-General Fund

 

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
2017 2018
General Fund 1,300,000 1,300,000
Non-General Fund
Positions 8.75 8.75

 

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.
2017 2018
General Fund 1,716,961 2,512,001
Non-general Fund

 

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.
2017 2018
General Fund 1,360,098 1,813,382
No-General Fund 516,838 585,228
Positions 19 19

 

  • 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.
2017 2018
General Fund 659,193 712,690
No-General Fund 649,690 703,414
Positions 16 16

 

  • 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.
2017 2018
General Fund 366,160 488,213
Non-General Fund
Positions 5 5

 

Managed Care

  • 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.

ABA

  • 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.
2017 2018
General Fund 145,754 121,793
Non-General Fund 675,393 893,145

 

DOJ

  • 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.
2017 2018
General Fund 63,734 72,544
Non-General Fund

 

DARS

 

  • 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.
2017 2018
General Fund 500,000 975,000
Non-general Fund

 

Education:

    • Provides 139.1 million to hire 2,500 new teachers across the Commonwealth.
  • Provide onetime 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.  
2017 2018
General Fund 3,400,000 1,600,000
Non-general Fund

 

 

  • 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
2017 2018
General Fund 24,806,792 24,886,579
Non-general Fund

 

 

CSA:

  • 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.
2017 2018
General Fund 18,082,051 18,082,051
Non-general Fund

 

 

The full budget document can be accessed at https://solutions.virginia.gov/pbreports/rdPage.aspx?rdReport=BDOC2016_FrontPage

DMAS/DBHDS Webinar about Virginia’s plan to comply with the CMS Rule

 

The Departments of Medical Assistance Services and Behavioral Health and Developmental Services will conduct a webinar to discuss Virginia’s response to the CMS Rule on Thursday, June 25th from 9:30-11:30a.m.  It appears the state is viewing this webinar as the first meeting of the Compliance and Monitoring Team, an entity discussed in the Virginia Statewide Transition plan.  The webinar announcement and registration details can be found here.

The Arc of Virginia’s March 2, 2015 comments on the Statewide Transition Plan can be found here.

The Arc of Virginia will be discussing the CMS Rule and other federal policies that are impacting I/DD Waiver Redesign at our upcoming State Convention which will be held Aug. 10-12 in Virginia Beach.  For more information about the State Convention,  click here.

65 Housing Choice Vouchers for DOJ Population

Beginning July 1, 2015, the Virginia Housing Development Authority (VHDA) is planning to make an additional 65 housing choice vouchers available to people in the DOJ target population. These vouchers will be available to individuals who are referred to VHDA by the Department of Behavioral Health and Developmental Services (DBHDS). Learn more about the vouchers, including how you can apply, in this DBHDS memo

2015 General Assembly 2014-2016 Biennium Budget: Post Conference Committee Report

 

Earlier this week, the House and the Senate money committees released their conference report on their amendments to the state budget. Governor McAuliffe released his proposed budget bill on Wednesday, December 17.  The state budget covers Fiscal Year 2015 (July 2014-June 2015) and Fiscal Year 2016 (July 2015-June 2016).  A summary of his proposed amendments that would impact the intellectual and developmental disability (I/DD) services system can be found here.

On February 8, the House Appropriations Committee and Senate Finance Committee released their respective amendments to the state budget bill.  Elements of the governor’s proposed budget that were not amended or eliminated remain in the budget bill.  Differences in the House and Senate proposed amendments were negotiated through a conference process, resulting in the conference committee reporting the budget bill for General Assembly approval.  The budget bill will be sent to the Governor where he may sign it, veto the entire bill or certain line items, or recommend amendments.

Medicaid Waivers:
  • The budget bill retains the funding required by the U.S. v Virginia Settlement Agreement for 450 new I/DD Waiver slots for individuals on waiting lists and in Training Centers. These slots will be available beginning July 1, 2015. These slots were included in the budget passed by the 2014 General Assembly and remained in the Governor’s proposed budget this year. The breakdown of these Waivers is as follows:
    • 325 ID Waivers for individuals on the ID Waiver Waiting List
    • 40 DD Waivers for individuals on the DD Waiver Waiting List
    • 85 ID Waivers for individuals exiting Training Centers
  • The budget bill does not increase funding for I/DD Waiver slots.
  • The conference committee report eliminates the Day Support Waiver Redesign language from the Governor’s proposed budget bill and eliminates the 200 “Building Independence” Waiver slots which is likely to result in delaying the implementation of the redesign initiative by The Department of Behavioral Health and Developmental Services (DBHDS). (301 #5c).
FY 2015 FY 2016
General Fund -$1,200,000
Non-General Fund -$1,200,000
  •  A companion amendment in the conference report requires DBHDS, in consultation with the Department of Medical Assistance Services (DMAS), to report on its plans to redesign the I/DD Waiver program prior to the submission of a request to CMS to amend the waivers. The Department must submit the report to the Governor and the Chairmen of the House Appropriations and Senate Finance Committees by November 1, 2015, which has the potential to delay the implementation of the department’s redesign initiative. (301 #6c).
  • An additional amendment adds language to Waiver redesign to include individuals with Traumatic Brain Injury in the initiative. (307 #1c).
  • The conference report eliminates the language from the Governor’s budget that limited overtime hours for consumer-directed (CD) and required consumer-directed workers to only have one Employer of Record (EOR). The language was initially included in the Governor’s budget amendments to achieve compliance with a U.S. Department of Labor (DOL) Rule that has since been largely vacated through federal court rulings. (301 #4c).
  • The budget bill does not include language to fold all I/DD long-term services and supports, including public and private ICF/IDDs and I/DD waiver services, into a Medicaid managed-care plan operated by private, profit-making companies.
Training Centers:
  • The budget bill does not include language that would require Training Centers to remain open.
  • The conference report directs a Special Joint Subcommittee to consult on the plan to close state training centers in collaboration with the Secretary of Health and Human Resources and the Department of Behavioral Health and Developmental Services. The Special Joint Subcommittee is instructed to continue to monitor and review the closure plans for the three remaining training centers scheduled to close by 2020.  This Subcommittee will be reviewing options to ensure that the appropriate supports and safeguards are in place for individuals that transition from training centers into the community.  A reporting requirement is also added so the Special Joint Subcommittee will receive detailed information on the current costs of operating the training centers. (307 #2c).
  • The budget bill provides additional facility closure funds to accommodate changes in discharge schedule. Increased funds are needed because of the delay in closing Northern Virginia Training Center (NVTC) and for delayed discharges at state training centers.  NVTC was originally slated to close at the end of fiscal year 2015. The Commissioner had announced the April 1, 2016 closure date earlier this year.  These funds would keep the facility operational through April 1, 2016.
FY 2015 FY 2016
General Fund  $1,345,692
Non-General Fund

 

Housing:
  • The conference report eliminated the rental subsidies in the Governor’s amendments that would have been provided to individuals receiving the Building Independence Waiver. (307 #8c).
FY 2015 FY 2016
General Fund -$675,000
Non-General Fund

 

  • The budget bill retained the rental subsidies in the Governor’s proposed amendments to fund the Rental Choice VA housing subsidy and provide on‐going support for programmatic costs associated with the Rental Choice VA program. The Settlement Agreement with the U.S. Department of Justice required the Commonwealth to provide $800,000 for rental subsidies for current individuals with I/DD receiving waiver services.
Part C (Early Intervention):
  • The conference report increased funding for Part C Early Intervention Services for infants and toddlers with developmental delays ages birth to age three. This funding is necessary to meet the increase in the number of referrals and to prevent waiting lists for needed services. (308 #5c).
FY 2015 FY 2016
General Fund $605,000
Non-General Fund

 

  • The budget bill retains the language to change the date of the Part C report to General Assembly to November 15 in order to better align with reporting from localities.
Licensing, Quality and Oversight:
  • The conference report removes the language in the Governor’s proposed amendments that granted DBHDS the authority to establish licensing fees for adult behavioral health and developmental services licensed by the department. (305 #1c).
  • The conference report includes language to increase budget transparency in the I/DD Waiver program. This amendment requires DBHDS to post on the agency’s web page a report on the budget, costs and numbers of recipients receiving intellectual disability and developmental disability services for each fiscal year.  The purpose of this amendment is to increase the budget and spending transparency related to these services for the public. (307 #3c).
  • The conference report directs DBHDS to assess the service and support needs of all Virginians on waiting list for I/DD Waivers. This measure will allow the Commonwealth to accurately establish enrollment priorities, project services costs and develop capacity needed to serve such individuals. (307 #7c).
  • The budget bill retains funding for DBHDS to create a new and consolidated system for managing the I/DD Waiver program.
FY 2015 FY 2016
General Fund $453,888
Non-General Fund $453,888

 

Other Funding
  • The conference report increases the reimbursement rates for I/DD Waiver services. This amendment increases rates paid to providers for in-home residential services (5.5%), day services (2%), therapeutic consultation services (10%), congregate residential services (2%), and skilled nursing services (15.7%), effective July 1, 2015.  (301 #6c).
FY 2015 FY 2016
General Fund $8,179,904
Non-General Fund $8,179,904

 

  • The conference report provides a 2% rate increase for agency and consumer directed personal and respite care services, effective July 1, 2015. Currently, the rate for consumer-directed is $11.47 per hour in Northern Virginia and $8.86 per hour in the rest of the state. For agency-directed, the rate is $15.20 per hour in Northern Virginia and $12.91 per hour in the rest of the state. (301 #7c).
FY 2015 FY 2016
General Fund $3,459,081
Non-General Fund $3,459,081

 

  • The conference report restores funding for Long Term Employment Support Services (LTESS). LTESS provides support services to persons with significant disabilities at their place of work. (325 #5c).
FY 2015 FY 2016
General Fund $500,000
Non-General Fund
  • The conference report restores funding for the Vocational Rehabilitation (VR) program under the Department for Aging and Rehabilitative Services (DARS). The VR program assists individuals with disabilities prepare for, find, and maintain jobs by providing training, placement, and job-coaching services along with work placement accommodations. (325 #2c).
FY 2015 FY 2016
General Fund $1,000,000
Non-General Fund

 

  • The conference report restores funding to Centers for Independent Living (CILs). CILs provide individuals with disabilities peer mentoring, independent living skills training, information and referral, and advocacy services. (325 #3c).
FY 2015 FY 2016
General Fund $580,000
Non-General Fund

 

  • The conference report adds language requiring a review of integrated employment opportunities. This amendment directs the DARS to review employment support services programs and make recommendations on options that would increase integrated employment opportunities for individuals with the most significant disabilities. (325 #6c)
  • The conference report includes funding for individuals who were previously forced by the Commonwealth to undergo sterilization. (307 #9c).
FY 2015 FY 2016
General Fund $400,000
Non-General Fund

 

As always, thank you for your advocacy.
-The Arc of Virginia

 

Stay the Course on State Training Center Closures

Today, The Arc of Virginia sent a letter to the members of the House Appropriations and Senate Finance Committees urging them to stay the course on state plans to close three remaining state training centers for persons with Intellectual Disabilities (ID).  Citing the movement away from institutional to community-based care that has occurred over the past fifty years in Virginia and nationwide, The Arc expressed its opposition to any attempts to delay state plans to close training centers in Fairfax, Hillsville and Lynchburg.

We reminded committee members that fourteen states have already closed all of their state facilities while many other states are down to one facility.  Virginia’s training center census has dropped from 1,198 in 2010 to a current census of 545.  Virginia successfully closed its first training center last summer—the Southside training center in the Petersburg area.

State training centers now cost an average of almost $320,000 per resident per year.  This cost is twice as much as community care for persons with similar levels of disability.  The state has estimated cumulative training center closure savings of almost half a billion dollars over the next seven years.  These projected savings are earmarked to pay for Medicaid waiver services in the community for persons discharged from training centers or on current waiver waiting lists.

Significantly delaying or not closing the three state institutions would require new state dollars to pay for community waiver slots to comply with the state’s 2012 settlement agreement with the Department of Justice (DOJ).  Because the state is responsible for half the Medicaid cost, a quarter of a billion state dollars would be required if the facilities do not close as scheduled.

Our families know too well that the long waiting list for a community waiver slot will get even worse if scarce state dollars are redirected to keep costly training centers open.  Virginia’s waiting lists for persons with an intellectual or developmental disability have grown from 7,584 two years ago to 9,421 today–a 24 percent increase in just two years.

Virginia has put in place vigorous discharge planning and follow-up requirements for persons leaving training centers to live in the community.  These community placements are backed up by the oversight of the federal court to ensure the health and safety of persons leaving training centers to live in the community.

The Arc of Virginia’s message to state legislators is to stay on course with training center closures.

Read the letter : Stay the Course

Preliminary Summary of Governor McAuliffe’s Proposed Budget

 

Governor McAuliffe released his proposed budget bill on Wednesday, December 17. The state budget covers Fiscal Year 2015 (July 2014-June 2015) and Fiscal Year 2016 (July 2015-June 2016). A summary of all proposed amendments can be found here. A summary of proposed amendments that are specific to Health can be found here.

The budget continues to be hampered by the $2 billion loss in state revenue loss due to federal sequestration. In his presentation to the money committees, Governor McAuliffe summarized actions taken in response to the budget shortfall and highlighted his spending priorities which included expanding access to healthcare, no cuts to education funding, retirement pay for teachers, increased regulation of daycare facilities, tourism, ending veteran homelessness and pay raises for public safety.

The General Assembly will act on the budget bill in the upcoming 2015 session, which begins on January 14. Delegates and Senators will have the opportunity to propose amendments to the budget bill, which are then acted on by the money committees before going to the floor for a vote. The House and Senate will then negotiate one, near-final budget bill which will be sent to the Governor for action.

The state budget is very important because it determines the number of individuals with I/DD who will gain access to essential long-term services and supports over the next 18 months. It also determines the scope of services and supports that will be available and the quality of those services. The following is a preliminary summary of actions taken (or not taken) in the budget that affect Virginians with I/DD and their families. We will post another update next week discussing advocacy moving forward.   Please continue to stay tuned.

SUMMARY OF PROPOSED BUDGET ACTIONS

Medicaid Waivers

  • Changes the Day Support Waiver to the “Building Independence” Waiver effective January 1, 2016 and provides 200 “Building Independence” Waiver slots effective January 1, 2016. These slots would be in addition to the existing 300 slots already allocated to the Day Support Waiver. This language is a part of the I/DD Waiver redesign initiative.
FY 2015 FY 2016
General Fund $1,200,000
Non-General Fund $1,200,000

 

o   This budget language allows the Day Support Waiver to be renamed as the Building Independence Waiver effective January 1, 2016. It also allows the Waiver to be amended to include new services and supports, such as independent living and integrated day, if sufficient funding is appropriated.

o   The purpose of the new Building Independence Waiver will be to “promote independent community living at a lower per person cost than the other two waivers for individuals with I/DD, with existing and proposed new services all aligned to achieve this goal.”  The Building Independence Waiver will be limited to individuals age 18 or older.      

o   Separate budget language provides rent subsidies to individuals with I/DD receiving the Building Independence Waiver.

o   Budget language also requires DMAS to provide a report, detailing changes and estimated costs of the new Waiver, to Governor and Chairmen of the money committees at least 30 days prior to submitting the application to CMS.

  • Limits overtime hours for consumer-directed (CD) workers in response to U.S. Department of Labor Rule. Requires consumer-directed workers to only have one Employer of Record (EOR).
FY 2015 FY 2016
General Fund ($325,702)
Non-General Fund ($325,702)

 

o   The U.S. Department of Labor (DOL) recently issued a new rule that affects home care services for people with disabilities and seniors. Previously, most home care workers (also known as domestic service employees, personal attendants or home aids) were exempt from the Fair Labor Standards Act’s (FLSA) minimum wage and overtime requirements. The rule narrows the categories of home care workers who are exempt from the FLSA requirements, meaning more home care workers, including consumer-directed employees, will be entitled to these protections.

o   States and other joint employers in their home care programs have until the rule’s effective date of January 1, 2015 to make budget adjustments and/or program changes to comply with the new rule.

o   On December 15, the U.S. DOJ and the HHS Office of Civil Rights released a joint letter discussing compliance with the ADA when implementing the new Home Care Rule.

o   The proposed budget language authorizes DMAS to limit overtime hours that may be provided by attendants who are providing care under the consumer-directed services option in Medicaid Waivers for personal assistance, respite and companion services. Specifically, the language authorizes:

  1. Time and a half up to 56 hours for a single attendant who works more than 40 hours a week.
  2. Requires that an Employer of Record (EOR) act on behalf of only one individual except when there is more than one individual in the same household receiving those services.
  1. Limits attendants to be employed by only one Employer of Record (EOR).

o   The proposed language gives DMAS the authority to implement the necessary changes effective July 1, 2015 in “order to conform state regulations to allay any fiscal impact associated with the October 1, 2014 changes to 20 CFR 552.”

o   There is a total reduction of $653,059 in FY 2016 that is associated with this particular budget item.

o   Item #3 is very concerning because it has potential to significantly reduce access to services.  The Arc of Virginia will be meeting with other advocates, national policy experts and state agency staff to discuss alternative strategies in order to ensure that individuals with I/DD do not lose access to care. Our recommendations will be reflected in The Arc of Virginia Legislative Priorities, which will be released in next week’s update.

  • Includes funding for 450 new I/DD Waiver slots for individuals on waiting lists and in Training Center, beginning July 1, 2015, as required by the U.S. v Virginia Settlement Agreement. These slots were included in the budget passed by the 2014 General Assembly and have remained in the budget that is proposed. The breakdown of these Waivers is as follows:

o   325 ID Waivers for individuals on the ID Waiver Waiting List

o   40 DD Waivers for individuals on the DD Waiver Waiting List

o   85 ID Waivers for individuals exiting Training Centers

  • Provides DBHDS with $906,776 in FY 2016 to create a new and consolidated system for managing the intellectual and developmental disability waivers. The system will include wait list and waiver enrollment management as well as incorporate a citizen portal that will allow individuals to view waiver eligibility options, apply for waivers online, and identify licensed service providers.  This system is anticipated to replace what is currently in use, but should allow for improved data collection.
FY 2015 FY 2016
General Fund $453,888
Non-General Fund $453,888

 

Housing:

  • Expands the use of bond authorization to support community housing development for individuals with I/DD. Modifies language from Item C‐103.05 A.5, Chapter 781, 2009 Acts of Assembly that will allow the $4.7 million in remaining bond proceeds to be used to subsidize the costs associated with the construction, rehabilitation, and/or acquisition of single‐family or multi‐family rental housing that is dedicated to individuals with an intellectual or developmental disability (I/DD). Language will also allow entities other than Community Service Board’s (CSBs) or local governmental entities to hold title to the community housing.
  • Funds the Rental Choice VA housing subsidy and provides on‐going support for programmatic costs associated with the Rental Choice VA program. Rental Choice VA is a housing subsidy for individuals with I/DD who live in the Northern Virginia and Virginia Beach areas. The budget language captures a $400,000 anticipated balance in FY 2015 in the Rental Choice VA program and increases the FY 2016 appropriation by a corresponding amount so that funding will be included in the base budget going forward. This amendment will allow the program to continue to offer rental subsidies in future years.
FY 2015 FY 2016
General Fund ($400,000) $400,000
Non-General Fund

 

  • Provides rent subsidies for up to 250 individuals that will transition to the planned Building Independence Medicaid Waiver. Rental subsidies are not covered by Medicaid and would not be eligible for federal reimbursement so they are listed separately in the state budget.
FY 2015 FY 2016
General Fund 0 $675,000
Non-General Fund

 

Education:

  • Provides principal training at under-performing schools. The budget provides an appropriation of $713,000 to increase the capacity of principals in under-performing schools. The funding amount covers training for 40 principals at schools which have failed to meet accreditation standards.
FY 2015 FY 2016
General Fund 0 $713,000
Non-General Fund

 

Licensing, Quality and Oversight:

  • Grants DBHDS authority to establish licensing fees for adult behavioral health and developmental services licensed by the department. The Commissioner would charge a $750 nonrefundable fee per service for the initial application and a nonrefundable renewal fee of $500 per service, consistent with the schedule licensure renewal set out in regulation. The budget language requires DBHDS to transfer funds received into the general fund. (No figures provided).
  • Increases funding for quality service reviews required by the settlement agreement with the United States Department of Justice (DOJ) by $364,000. The amount previously included was an estimate of necessary funds to contract for the provision of reviews. The addition of this funding brings the total general fund support for Quality Service Reviews to $591,000.
FY 2015 FY 2016
General Fund $91,000
Non-General Fund $273,000

 

  • Increases funding for the Independent Reviewer. Increases the available funding for the Independent Reviewer assigned by the court to monitor the state’s compliance with the settlement agreement between the United States Department of Justice and the Department of Behavioral Health and Developmental Services. The total budget for the Independent Reviewer is increased to $377,000 per year.
FY 2015 FY 2016
General Fund $49,000
Non-General Fund

 

Part C/Early Intervention:

  • Changes the date of the Part C report to General Assembly to November 15 in order to better align with reporting from localities.

Training Centers:

  • Provides additional facility closure funds to accommodate changes in discharge schedule.  Provides additional funds for the delay in closing Northern Virginia Training Center (NVTC) and for delayed discharges at state training centers. NVTC was originally slated to close at the end of fiscal year 2015, however “transition of individuals into the community has not occurred at the rate necessary in order to close the facility until the middle of fiscal year 2016.” The Commissioner had announced the April 1, 2015 closure date earlier this year. These funds would keep the facility operational through April 1, 2015.
FY 2015 FY 2016
General Fund $1,345,692
Non-General Fund

 

  • Provides $157,251 in State General Funds (SGF) to address the needs of individuals not covered by Medicaid currently residing in state operated training centers to transition into the community as needed.
FY 2015 FY 2016
General Fund $31,450 $125,801
Non-General Fund

 

  • Adjusts Medicaid budget to account for Training Center closure costs.   Adjusts the Medicaid appropriations for reimbursement for state mental health and intellectual disabilities facilities. The adjustments are the result of changes in the forecast of facility discharges. This request reflects the Medicaid portion of the facility transition waivers, the on-going facility closure costs and associated facility savings resulting from compliance with the Department of Justice (DOJ) settlement agreement. The funding estimates include facility transition wavier expenses, severance costs, post closure costs, pre-closure costs and training center facility and Medicaid savings.
FY 2015 FY 2016
General Fund $535,369 $5,146,644
Non-General Fund $535,369 $5,146,644

 

DARS Disability Determinations:

  • Provides funding to cover the state match for Medicaid disability determinations at the Department of Aging and Rehabilitative Services (DARS).  The DDS unit mainly processes disability determinations for the Social Security Administration, but a small portion of their workload includes processing of disability determinations for Medicaid eligibility. Beginning in FY 2014, the agency implemented a cost allocation plan for the Medicaid costs of disability determinations. Based on this plan, the agency requires additional state funding to meet Medicaid match requirements.
FY 2015 FY 2016
General Fund $228,235 $228,235
Non-General Fund $228,235 $228,235

 

  • Increase federal appropriation and position level for Social Security disability determinations. Increases federal appropriation for the costs of DDS unit. DDS processes disability determinations for the Social Security Administration (SSA) with federal funding. After several years of SSA limits on states hiring DDS workers, the agency has directed Virginia to hire additional staff to help with the significant backlog of pending determinations. This adjustment is necessary to ensure adequate appropriation to cover the cost of the new staff and avoid administrative actions.
FY 2015 FY 2016
General Fund $3,500,000 $3,500,000
Non-General Fund

 

Other Notes:

  • Part C funding was not adjusted to account for the increase in the number of infants/toddlers receiving services.
  • Crisis funding for children and adults with I/DD was not adjusted to facilitate compliance with the Department of Justice settlement agreement.
  • The budget still “sweeps” proceeds from the sale of Training Center land from the DBHDS Trust Fund. The Trust Fund had been established to use the proceeds of these land sales to strengthen and improve access to home and community-based services.
  • While the budget addresses the Building Independence Waiver, the budget does not reflect changes to the other two I/DD Waivers that are also part of the I/DD Waiver Redesign Initiative. This is because the timeline was adjusted new waivers in July 2016 (which occurs in the next Biennium budget). Current budget language still allows DBHDS to amend the Waivers before FY 2017.

MOVING FORWARD:

  • The Arc of Virginia will hold a webinar on the budget to review items and discuss advocacy on Tuesday, December 30 at 1pm. Click here to register.
  • The Arc of Virginia and our advocacy partners will be hosting a Developmental Disability Advocacy Day at the General Assembly on January 26.   Click here for more information.