Update on Waiver Redesign Activity and Timelines

Big changes are coming to the ID/DD Waiver programs.  It is important that self-advocates, family members, providers and professionals understand why these changes are occurring, what is being proposed, and ways that you can be involved.  We recognize that much of this information is new and there will be lots of questions.  Additional updates will follow as more information becomes available.  The Arc of Virginia will remain committed to ensuring that individuals and families understand what is being proposed and can have meaningful participation in the process moving forward.

Background:
For many years, The Arc of Virginia has called for changes in Virginia’s ID/DD system in order  to improve access to and quality of community based services.  Virginians with I/DD and their families have reported that Virginia’s waiver programs are difficult to access, lack a person centered method of providing supports, and do not promote meaningful inclusion of individuals with ID/DD in their community.  In February 2011, the Department of Justice agreed, finding the Commonwealth to be in violation of the ADA as interpreted by the Olmstead decision.

The January 2012 U.S. v Virginia consent decree that resulted from the DOJ Findings Letter requires the Commonwealth to provide services for individuals with intellectual and developmental disabilities in the most integrated setting appropriate to meet their needs.  In order to comply with this requirement, Virginia must redesign its ID/DD Waiver Programs.

In the Fall 2013, The Department of Behavioral Health and Developmental Services (DBHDS) contracted with the Human Services Research Institute (HSRI) to evaluate the State’s current service delivery system for individuals with ID/DD and make recommendations to move the system towards a more person focused needs-based system of care.  In conjunction with that evaluation, HSRI was charged with reviewing the existing rates paid to service providers and the current method of allocating resources to support individuals receiving services.  DBHDS has been working with HSRI’s subcontractor, Burns and Associates, and a Provider Advisory Committee, to develop new rate models for new and existing waiver services.

Waiver Design Advisory Committee (WDAC) and Subcommittees:

Starting in Spring 2014, DBHDS established a Waiver Design Advisory Committee (WDAC) and related subcommittees to consider the recommendations made by HSRI, provide input on the waiver redesign, and make suggestions regarding means of enhancing system processes.  The WDAC and subcommittees’ membership were comprised of self-advocates with ID/DD, family members, representatives from CSBs, provider agencies, advocacy groups, and parent groups from across the Commonwealth. Subcommittees were formed on Case Management, Eligibility, Waiting Lists and Services Array.  For information about the subcommittee recommendations on these topics, click here.

The WDAC Services Array Subcommittee was charged with proposing, reviewing, and discussing new and existing waiver definitions and service options to be incorporated into the redesigned waivers. The full WDAC Committee then reviewed the service definitions recommended by the Services Array Subcommittee and responded to additional service options that were proposed by WDAC members at the group’s last meeting on October 29th.  A copy of these draft service descriptions can be found here.

Following the October 29 WDAC review, DBHDS staff revised the service descriptions and presented them to the WDAC for another review on December 4.  DBHDS also presented recommendations to the WDAC regarding which of the services would be provided in each of the three waivers.  Following the Dec. 4 meeting, The Arc of Virginia developed a chart to help communicate the proposed service packages being discussed. Once finalized, the recommended service definitions and options will be incorporated into the final I/DD Waiver service packages that include the new rate model developed by DBHDS in collaboration with HSRI, Burns and Associates, and the Provider Advisory Committee.

DBHDS will need to finalize its Waiver Redesign proposals soon in order for the needed language and funding to be included into the Governor’s introduced budget. The  preliminary report on the new rate structures has been posted on the DBHDS website and are available at the following link:   http://www.dbhds.virginia.gov/individuals-and-families/developmental-disabilities.  Public comments on the rate structure will be accepted until December 15.

Proposal for an Integrated Waiver Program: 

The Commonwealth is seeking to revamp the ID/DD waiver program into an integrated waiver structure consisting of three waivers that will employ a single eligibility criterion.   This means that all people with intellectual and developmental disabilities (ID/DD) will be served under the new waivers.   The financial eligibility requirements will be the same as used in the existing waivers; however, the diagnostic and functional criteria are changing to better identify the specific supports an individual needs to live in the community.

The three waivers are currently being referred to as the Building Independence Waiver, the Family and Individual Supports Waiver, and the Community Living/Comprehensive Waiver.   There are many components that are still being developed and it is likely that the waiver names will continue to evolve over the course of the next few months.  The new proposed waivers will be replacing the existing ID/DD waiver program (the Day Support, Developmental Disability, and Intellectual Disability waivers). DBHDS provided a Waiver Revision Graphic handout to understand the new, proposed structure of the I/DD Waiver program.

The Independence Waiver is intended to provide support to individuals who wish to live independently in the community.  Supports will be complemented by non-waiver-funded rent subsidies.  It will broadly focus on creating opportunities for independent living, supported employment and integrated day.  The Family and Individual Support Waiver will focus on providing additional supports to individuals living with their families, friends, or in their own homes, including supports for those with some medical or behavioral needs.  The Community Living/Comprehensive Waiver would provide the most intensive services for people with I/DD, primarily those with complex support needs, in a variety of settings.  DBHDS has stated that individuals they will have the opportunity to move from the Independence or Family and Individual Support Waiver to the Community Living/Comprehensive Waiver when assessed needs are determined to be higher than can be met under their current waiver.

An updated Supports Intensity Scale® (SIS®) will be administered to all individuals currently receiving waiver services using a phased approach.  The Supports Intensity Scale® is an instrument, developed by the American Association on Intellectual and Developmental Disabilities, used to measure the frequency and intensity of supports needed by an individual with an intellectual or developmental disabilities in order to achieve quality of life goals.  The SIS® score, along with a person-centered plan, will determine an individual’s need and supports budget level.  An exceptions process will be available for review of individuals’ situations that are in question, as necessary. An individual’s waiver (Independence, Supports, or Comprehensive) will be determined by the individual’s support needs, budget level, age, where he or she lives, and what he or she does during the day.

DBHDS provided an overview of its vision for Virginia’s I/DD service system at the September 30 WDAC meeting.  Their presentation can be downloaded at the following link:  http://www.dbhds.virginia.gov/library/document-library/dds%20wdac%20slides%209%2030%202014_%20final%20for%20posting.pdf

As the discussion of the Waiver structure and services has evolved, several themes have surfaced regarding the redesign of Virginia’s I/DD system:

  • As stated earlier, Virginia must amend its ID/DD Waiver programs in order to ensure that Virginians with ID/DD have access to integrated, community-based services- regardless of the complexity of their support needs.
  • Virginia must restructure the Waivers to move towards compliance with the new CMS Home and Community Based Services Final Rule.  The Commonwealth will have five years to be in full compliance.  For more information on the CMS rule, please visit:  http://www.thearc.org/document.doc?id=4596
  • Virginia must take additional action to help the 9,200 individuals and families who are on waiting lists for community-based care.  While providing “comprehensive” Waivers  to all of these individuals and families within a reasonable time continues to be a significant financial  challenge, there is interest in providing services to as many families  as possible, as early as possible.
  • The rationale for the integrated three waiver structure is for General Assembly budget allocation purposes.  The thought is to have three waivers with differing cost options in order to allocate monies to serve those on the waiting list that need less expensive support options.  If an individual’s level of need increases or decreased once they are one of the three waivers, they will be moved to the appropriate alternate waiver.

 DBHDS’ tentative timeline for moving forward is as follows:

  • The proposals will be reflected in the Governor’s Budget, which is expected to be announced on December 17, 2014;
  • The amended waivers will be submitted to CMS in March 2015 (once the General Assembly has passed the budget);
  • The Day Support Waiver will be amended to the Independence Waiver and will be phased in  January 2016;
  • On or around March 1, 2016 the following waivers will be phased in and reflect the tiered reimbursement system.  All people with ID/DD who meet eligibility criteria will be eligible for one of the three waivers.  Some individuals will transition to new services and the new fee schedule according to their plan year.

-The current Developmental Disability Waiver will be amended to the new Supports Waiver.
-The current Intellectual Disability Waiver will be amended to the Comprehensive Waiver.

  • In July 2016, group homes will begin to receive a new, per diem rate. The rate that may be billed for an individual will be based on SIS® score.
  • In October 2016, non-congregate (supported living) residential services will begin to receive a new, per diem rate. The rate that may be billed for an individual will be based on SIS® score.
  • In January 2017, sponsored residential services will begin to receive a new per diem rate. The rate that may be billed for an individual will be based on SIS® score.
  • In March 2017, individuals with ID/DD on the Elderly and Disabled Consumer Directed (EDCD) waiver may have the opportunity to move to one of the three ID/DD waivers.

Learn More and Stay Connected:  

The Arc of Virginia’s Advocacy Webinar Series   The Arc of Virginia is hosting a webinar series to help self-advocates, family members, and professionals understand the changes occurring in Virginia’s ID/DD system and learn about ways they can continue to promote “A Life Like Yours” through collective advocacy.

The Webinar Series is as follows:

DD Advocacy Day January 26 Rally begins at 10 am to 11 am — Bell Tower at Virginia Capital Square, Richmond, VA

Clearly, ID/DD Waiver Services will be a major topic of this year’s General Assembly Session.  It is critical that individuals, families and concerned citizens take this opportunity to join together and speak up in support of “A Life Like Yours.”  The Arc of Virginia, Virginia Chapters of the Autism Society, Virginia Down Syndrome Alliance, and Voices of Virginia will be hosting a grassroots advocacy day on January 26, the 3-year anniversary of the U.S. v Virginia Consent Decree.  Please mark your calendars and join us in taking action to ensure Virginians have the support they need to live a full life in the community!

The rally will take place 10am – 11am at the Bell Tower on Capitol Square (corner of Bank & 9th Streets, Richmond VA). Meet with your legislators after the rally to share your story!  To register for DD Advocacy Day – please visit www.thearcofva.org/events or https://www.eventbrite.com/e/developmental-disabilities-advocacy-day-tickets-14584066335

We suggest scheduling appointments in advance, if possible. Use this link to find your legislators. http://whosmy.virginiageneralassembly.gov/   For more information about the event, please contact Rebecca King of The Arc of Virginia at: rking@thearcofva.org or 804-649-8481 ext 105

DBHDS Waiver Redesign Updates   An email address has been established by the Virginia Department of Behavioral Health & Developmental Services  (DBHDS) for providers, families and individuals with disabilities interested in getting electronic updates on Virginia’s Waiver Redesign Initiative. If you would like to join this listserve, all you have to do is send an email to waiverupdates@dbhds.virginia.gov and provide your email address in the body of the email.

BOTTOM LINE– This is a historic time to influence our ID/DD service system in Virginia into one that works for people with ID/DD and their families.   Please stay tuned for additional information and some very important action alerts!   As always, thank you for your advocacy!

  -The Arc of Virginia

DBHDS Announcement: 32 Housing Choice Vouchers (HCV) to be made available for Virginians with I/DD in DOJ Target Population

DBHDS has asked us to share the announcement below re: the 32 Housing Choice Vouchers (HCV) for people with I/DD in DOJ Target Population:

___________________________________________________________________________________________________________________________________________________________

Housing Choice Voucher Admissions Preference for the DOJ Target Population – 32 Vouchers Available

The Department of Behavioral Health and Developmental Services (DBHDS) has been notified by the Virginia Housing Development Authority (VHDA) that it has received approval from the U.S. Department of Housing and Urban Development (HUD) to implement a special admissions preference for the DOJ target population within its Housing Choice Voucher program (formerly known as Section 8).

VHDA has set aside 32 housing choice vouchers for eligible individuals in Virginia. A rental housing subsidy is paid to the landlord on behalf of the participating family. The family then pays the difference between the actual rent charged by the landlord and the amount subsidized by the program.
The unit must meet the program’s housing and safety standards, and the rent must be appropriate for the area. The total rent for the unit size approved for your household must be the lower of the Fair Market Rent or the rent of comparable units in the neighborhood.

DBHDS is currently accepting referrals from ID or DD Support Coordinators, Community Integration Managers or Centers for Independent Living for individuals who are included in the DOJ target population and who can move into their own rental housing within 60 days of receiving a voucher. The referral form is available at this link.

VHDA has received approval to make 32 Housing Choice Vouchers available immediately for individuals with I/DD that are referred by DBHDS. Unlike many other Housing Choice Voucher Programs, individuals that are referred by DBHDS will not have to put their name on a waiting list and go through the standard process, which could take a year or more.

DBHDS will allocate referral slots on a first come, first served basis across each of the Commonwealth’s Health Planning Regions according to the schedule below; until January 16, 2015.  After January 16, 2015, all referrals to VHDA will be made on a first come, first served basis statewide.

  • Health Planning Region 1:  7 slots
  • Health Planning Region 2:  6 slots
  • Health Planning Region 3:  7 slots
  • Health Planning Region 4:  6 slots
  • Health Planning Region 5:  6 slots

DBHDS plans to maintain a referral list of approximately 90 individuals.  Eligible individuals will be moved up on the list as referrals are made to VHDA at the onset of this initiative or via program turnover.  If DBHDS receives more than 90 referrals, those referrals will also be tracked to gauge potential demand for additional housing resources, as they become available.

Individuals must reside in legal dwelling units that contain a full kitchen and bathroom. Units may be in a multi-family apartment building, a single family home (e.g., a 2 BR house), etc. Referrals will not be made for individuals who desire to live in any of the following settings:

 

  • group home,
  • boarding house,
  • rooms for rent, or
  • rental housing shared by more than 3 people with a disability.

 

For additional information, please download the FAQ document by clicking  here or you may email Eric Leabough, DBHDS Housing Specialist, at: eric.leabough@dbhds.virginia.gov.

 

For a copy of the public notice, please click here.

 

Eric Leabough

Administrative Community Operations- Housing

Virginia Department of Behavioral Health and Developmental Services

1220 Bank Street Richmond, VA 23219

Email: eric.leabough@dbhds.virginia.gov

Office: 804-786-1393

Waiver Redesign Update: New I/DD Rate Structure Posted on the DBHDS Website

The Department of Behavioral Health and Developmental Services has posted the following information on its website re: the new, proposed rate structure for the  I/DD Waiver program:


 

As many of you are aware, My Life, My Community is a DBHDS  initiative to improve services for people with intellectual and other developmental disabilities (I/DD). As part of this initiative, DBHDS is reviewing various aspects of the programs serving individuals with I/DD.

This review includes the rates paid to providers of waiver services. With the assistance of a national consultant – Burns & Associates, Inc. (B&A) – DBHDS has developed proposed rate models. DBHDS is now seeking comments on these proposals and B&A is assisting in the coordination of this process. The following materials have been prepared and are available online.

Overview of Proposed Waiver Rates 

Information Brief on the Supports Intensity Scale (SIS)

Estimated Fiscal Impact of Proposed Rate Models

Proposed Waiver Rate Models

Provider Survey Analysis

We welcome your comments on any of the proposed changes to reimbursement rates. Comments and any supporting documentation should be submitted to WaiverRates@burnshealthpolicy.com. Comments will be accepted until December 15, 2014.

EVENTS

To explain the proposed rates and related materials, Burns & Associates will be hosting a webinar:

Time: Friday, November 21, 2014 from 1:00 PM to 4:00 PM
Webinar address: http://goo.gl/QEDA96 – use password: DBHDS
(Note: the webinar address and password are case sensitive)
Call-in number: (415) 655-0045 – use access code: 669333743

The webinar will be recorded and posted online for those who are unavailable at the scheduled time.

Action Alert from the Coalition for the Improvement of School Safety (CISS)

VIRGINIA TO CONSIDER ACTION ON RESTRAINT AND SECLUSION

COMMISSION ON YOUTH MEETING RELEASES STUDY TUESDAY 9/16/14

It is time to take action to prevent the use of restraint and seclusion in Virginia’s schools. These dangerous procedures have killed, injured, and traumatized students nationwide. On September 16, 2014, the Virginia Commission on Youth will release its study about these procedures in our state. This study will be used by the General Assembly as it considers laws and regulations to limit restraint and seclusion in schools. Virginia has no laws now!

Please come to the Commission on Youth Meeting!

Please attend the Commission meeting at 10 a.m. on Tuesday, Sept. 16 at the General Assembly meeting (corner of 9th and Grace Streets in Richmond). The Commission needs to see as many parents, people with disabilities, service providers and advocates who support strong action on restraint and seclusion. Be present and be counted! No public comment will be heard at this meeting, but a public comment process is expected to be announced at that time. Share your views and support the recommendations of the Virginia Coalition for the Improvement of School Safety (CISS). If you represent an organization that can sign on to these statements, please send your contact information (including organization name) to Emily Dreyfus, JustChildren Community Organizer, emily@justice4all.org. The Coalition for Improving School Safety is happy to welcome additional groups to the table; please let us know if you are interested in participating; also, please let us know if you are an individual who would like to continue learning about this issue and upcoming events.  

More Information

In 2014, the General Assembly requested that the Virginia Commission on Youth conduct a study of restraint and seclusion in Virginia’s schools.  This report will come out on September 16 and will be used as the Assembly writes legislation. Public comments will matter a lot, and the public comment period is expected to start after the meeting. It is very important for the public to come out to support strong recommendations.

It is important that the Virginia Commission on Youth make strong recommendations to protect students. Virginia currently has no statewide laws or regulations governing restraint and seclusion in schools. Restraint and seclusion should only be used in emergencies when they are necessary to protect someone from serious physical harm–if they are used at all. Parents must be informed the same day when they are used.  Schools must use less dangerous techniques if they would prevent an emergency, and stop using them when the emergency ends.

The Coalition for the Improvement of School Safety also urges the following: Virginia officials should forbid the most dangerous restraints, including those that impair breathing and harmful mechanical and chemical restraints. School staff need additional training to help support students. Schools must collect data and share it with the public. Together, Virginia can shift from using these dangerous techniques to positive behavioral interventions that evidence shows will keep students safe.   For more information and recommendations, see the comments of the Virginia Coalition for the Improvement of School Safety (CISS).

Why is action needed? Countless students have been injured and traumatized in restraint and seclusion nationally, according to studies. A Congressional Agency report found that 20 students died in restraint; others have died and been injured in seclusion. Four students who died in restraint stated they could not breathe while they were being restrained. In Southeastern Virginia, 5 school staff forced a 10 year old child with disabilities into a locked seclusion room. His hand and foot bones were broken, according to media reports. One 7 year old in Central Virginia was locked in storage closet again and again, begging his parents each day not to send him to school. Prince William County schools were recently found to have repeatedly restrained and secluded children under “one-size-fits-all” behavior management policies that denied them a free appropriate public education. The schools put students in restraint and seclusion even though they were not physically harming anyone.

Data is not currently collected in Virginia, so we do not know how many students are restrained and secluded. Nationally, over 110,000 students were subjected to these techniques in 2011-12. The data showed that restraint and seclusion were used disproportionately upon students with disabilities and minority students. Nationally, students with disabilities make up 12% of all students but 75% of those physically restrained and 58% of those secluded.

What can be done? By enacting legislation, Virginia can shift schools toward preventing problematic behavior through evidence-based positive behavioral interventions and supports, in order to keep students and staff safe. In many cases, the use of positive supports and interventions greatly diminishes and even eliminates the need to use restraint and seclusion. For example, Montgomery County, Virginia used “easily accessible, evidence-based practices” that have reduced crisis-level behaviors by 78% and targeted problem behaviors by 81%, according to Senate testimony. Restraint and seclusion are rarely used there. The Centennial School in Pennsylvania cut restraint and seclusion use from over 1,000 instances a year to less than ten through the use of positive intervention plans. Schools are also starting to include “trauma informed care” as part of their professional development.

The first and important step to be present at the Commission on Youth meeting if you can, to show your interest in this issue. Although there will not be an opportunity for public comment, it will be helpful to show you care. The Commission needs to give a strong recommendation for protective legislation. And you can help make that happen!

Webinars on the Transition Plan

 

In the Commonwealth’s draft Transition Plan Regarding Compliance with the HCBS Final Rule Elements, the state announced that it would be holding webinars to provide an overview of the plan, answer questions and solicit feedback.  While a webinar was held on August  12, registration information was not disseminated to all stakeholder groups  (including many self-advocate and family organizations).  A copy of the August 12 powerpoint presentation is available at this link.

DMAS has since announced that it will be holding two more webinars on August 26.  The DMAS memo containing webinar registration information has been posted below.

PLEASE NOTE:  Although the webinar says “Intellectual Disability Waiver,” we are encouraging DD Waiver and DS Waiver stakeholders to participate as well.  Please also know that this information is very important to all individuals and families, not just the providers who are explicitly mentioned in the announcement.


 

Dear Medicaid Provider/Stakeholder:

The Department of Medical Assistance Services will be conducting a WebEx session (webinar) entitled Intellectual Disability (ID) Waiver Transition Plan for the HCBS Final Rule for Medicaid providers who are classified as providers of ID Waiver services at DMAS and other affected stakeholders. This session is specifically targeted for staff who are involved in implementing ID Waiver plans for support and other ID waiver stakeholders. Please share this information with other ID Waiver providers and interested stakeholders. The agenda is as follows:

  • Review of the elements of the HCBS Final Rule
  • Review of the elements of the ID Waiver Transition Plan
  • Comments and input regarding the proposed Transition Plan

 Registration Link

August 26,2014 – 9:00 am – 11:30 pm – Go to https://dmas.webex.com/dmas/k2/j.php?MTID=t76037eab2d1e66467255eae910f7ffc6 and register.

August 26,2014 – 1:00 pm – 3:30 pm – Go to https://dmas.webex.com/dmas/k2/j.php?MTID=td45d7deefd54f001f81d1dad1d0514fe and register.

Upon approval of registration, you will receive a confirmation email with all of the training details. The number of participants allowed in each session is limited. Due to this, it is requested that, if you have multiple attendees within your organization, have one person register and participate as a group in an office or conference room, if possible. Once a session is full, additional registration requests will be waitlisted. Waitlisted individuals will be registered if a confirmed participant cancels. If you do not receive the confirmation email please call 804-371-6327. If you have any problems logging in on the day of the session please call 1-866-229-3239.

We look forward to your participation in our Medicaid Seminar. If you have any questions regarding these sessions, please call (804) 804-371-6327.

NOTE: It is recommended that on the day of the training you begin logging onto WebEx at least 15-30 minutes prior to the start of the session, as you may need assistance from your information technology personnel in downloading the Web-Ex product. There is no fee for the download or for the session. You will need access to a computer (to view the power point presentations) and a telephone (to hear the audio portion of the meeting).

TO JOIN THE TELECONFERENCE

You must join the WebEx and the Teleconference (2 steps) for the WebEx to work in its entirety. However, if you want only to listen to the audio portion of the presentation, you may just join the Teleconference.

To join the teleconference please:

  1. Dial 1-866-842-5779
  2. When prompted, enter the conference code – 2025387321

 

 

 

 

Waiver Redesign Update

 

Waiver Redesign Summary

The U.S. v Virginia Settlement Agreement requires the Commonwealth to provide services and supports to people with intellectual and developmental disabilities in the most integrated setting, regardless of the complexity of their support needs.

On January 16, 2014, the Centers for Medicare and Medicaid Services (CMS) in the U.S. Department of Health and Human Services issued final rules defining and describing Waiver-funded home and community services and as defining person-centered planning.   The Arc of US has published a “What You Need to Know” document regarding this new rule. A coalition of national disability organizations also hosted a webinar on the topic, which can be accessed here.

In order to comply with the DOJ agreement, comply with CMS rule and improve access to integrated services, Virginia must make significant changes to its Intellectual Disability (ID) Waiver, Developmental Disability (DD) Waiver and Day Support (DS) Waiver programs.

As we have noted in earlier posts, Virginia has been working on this “Waiver Redesign” initiative for more than a year. The update that follows will provide an overview of activities and progress that has been made thus far.

HSRI- Report and Recommendations:

In Fall 2013, DBHDS and HSRI held 16 stakeholder forums across Virginia to collect public input. In November 2013, Human Services Research Institute (HSRI), the Commonwealth’s contractor, provided an analysis of Virginia’s I/DD Waiver program with recommendations for waiver redesign. One of HSRI’s chief recommendations in the report was to “establish a cohesive ID and DD system under DBHDS, taking steps to integrate services across the two populations and eliminate separations based on diagnosis and/or IQ.” As part of this effort, HSRI recommended that the Commonwealth should create two needs- based waivers for Virginians with I/DD which would be referred to as a:

  • Comprehensive waiver which provides more intense services, which require more oversight, rules/regs as individuals’ needs increase, and
  • Supports waiver which provides supplemental services that allow an individual to live independently or with family/friends.

More information about these and other recommendations that were made by HSRI can be found in HSRI’s full report. The Arc of Virginia has also created a document that provides a summary of these recommendations, which can be viewed at this link. 

Timeline:

It is anticipated that the Commonwealth will need to finalize its Waiver Redesign proposals by early fall in order for the needed language/funding to be incorporated into the Governor’s introduced budget. The General Assembly will then take action on proposed budget/legislative changes in the 2015 session (January-February 2015). Other changes may occur through the regulatory process, outside of the General Assembly session. DBHDS has also announced it will hold broad-based stakeholder meetings prior to submission of the Waiver application to CMS.

CMS requires that the Commonwealth submit a “transition plan” on compliance with the new rule on HCBS services when a new waiver amendment/application is submitted (which will occur this Summer/Fall) . Last week, DBHDS released its transition plan re: the HCBS Rule. This transition plan (which includes an updated timeline re: the Commonweath’s plans to comply with the rule) was posted on the DBHDS website and we are now in a 30 day public comment period which will end September 5.  Those wishing to comment should do so through the following email: MyLifeMyCommunity@dbhds.virginia.gov

DBHDS held a webinar on this rule earlier today and although the webinar was not recorded, slides can be accessed at the this link. The Arc of Virginia will be posting a separate update about the HCBS rule and the transition plan fairly soon. Please stay tuned.

Waiver Design Advisory Committee and Related Subcommittees:

In early Spring 2014, the Department of Behavioral Health and Developmental Services (DBHDS) created a Waiver Design Advisory Committee (WDAC) and related subcommittees to “consider the recommendations made by HSRI, provide input on the new waiver redesign, and make suggestions regarding means of enhancing system processes.”   DBHDS has stated that the work of these groups is “crucial to ensuring transparency and a well vetted waiver.”

The WDAC subcommittees include: Case Management, Services Array, Waiting List Management and Eligibility. The WDAC and its subcommittees are comprised of people with I/DD, family members, providers, CSBs and advocacy/parent groups. The groups have been facilitated by DBHDS staff (with some involvement of HSRI) and the agendas have typically set by DBHDS staff.

While people with I/DD and families represent the majority in some of these subcommittees (waiting list, eligibility), this standard was not applied consistently across all list of the WDAC workgroups.  For instance, family members and advocates were very underrepresented on the Case Management committee. There is also no self-advocate/family member on the Provider Advisory Committee who is representing the perspective of someone using self-directed services.   A full list of the WDAC and subcommittee members can be found here.

Comments regarding the proposed recommendations may be submitted to: MyLifeMyCommunity@dbhds.virginia.gov.

 

Summary of WDAC/Subcommittee Charges and Activity:

 

Waiver Design Advisory Committee:

Charges:

  1. Developing a new waiver concept paper from which elements of the CMS waiver application(s) will be drawn.
  2. Provide input to the new waiver development process particularly with regard to training, implementation, and evaluation.

Activities:

The WDAC has met three times thus far. The majority of the meetings have focused on briefings/status updates regarding Subcommittee activities.  Once recommendations of the subcommittees are considered by the Waiver Design Advisory Committee (WDAC), the WDAC proposals will be relayed to DBHDS and DMAS to “flesh out the services, attach rates, and determine the structure.”


Eligibility Subcommittee:

Charges:

  1. Clarifying & creating one set of criteria for eligibility for ID/DD services in Virginia.
  2. Advising on related policy and regulation development, as well as training and implementation strategies.

Activities:

The eligibility subcommittee has recommended a single eligibility criterion for the two new waivers. They also recommend the adoption of a functional definition of DD modeled on the Administration on Intellectual and Developmental Disabilities [114 Stat. 1684 Public Law 106-402-Oct. 30, 2000] definition, which can be found at the end of this update. Basically, this definition represents one of the first steps in moving towards a needs-based (vs. diagnosis-based) waiver.

The committee also recommended changes to the current functional assessment tool, the “Level of Functioning.” An amalgam of the best parts of level of care tools from other states was developed by HSRI staff and reviewed by the Eligibility Subcommittee.  DBHDS intends to pilot the revised tool and further edits will be made to ensure efficacy. The Subcommittee then made the following recommendations re: changes to the LOF:

  • Added an additional category: “Self-Direction”
  • Altered language to be more person-centered and more reflective of community structures
  • Provide a guidance document, training and standards for those who administer the revised tool.

The Arc remains concerned that broader eligibility for I/DD services (those in addition to I/DD Waiver) has not been addressed in the Eligibility discussions. While this was raised as an issue of concern by members of the committee (and was an HSRI recommendation), it was not added as an agenda item for the workgroup. The Arc of Virginia believes that with looking at the system as a whole, navigation of services may continue to be fragmented. Access to services must be streamlined and beginning with the eligibility for I/DD services in state code would be an important step.


Case Management Subcommittee:

Charges:

  1. Clarifying & creating one set of criteria for effective support coordination/case management for individuals with ID/DD, including individuals who do not receive waiver services.
  2. Reviewing and recommending changes to guidelines, policies and regulations for the provision of support coordination/case management.

Activities:

To accomplish the merger of the public (ID/DS waivers) and private (DD waiver) case management systems, the case management subcommittee recommends that the Commonwealth move to:

  • Establish the Community Services Boards (CSBs) as the single point of entry for both new waivers (comprehensive and supports).
  • Require (via the Performance Contract) CSBs to contract with private case management providers to offer individuals on either waiver their choice of case management provider.

The workgroup did not address many of the other issues regarding case management that were raised by The Arc of Virginia and other family/self-advocate organizations. This includes criteria for effective support coordinators case management for individuals, who do not receive waiver services. For more information about these concerns, please see The Arc of Virginia’s 2013 Waiver Redesign comments.


Waiting List Management Subcommittee:

Charges:

  1. Clarifying & creating one set of criteria for managing the ID/DD waiting list for services in Virginia.
  2. Proposing and evaluating the impact of combining the current ID/DD waiting lists.
  3. Advising on policy and regulation development.
  4. Advising on a means of meeting inter-rater reliability standards as well as to securing a valid assessment via the Supports Intensity Scale.

Activities:

The waiting list subcommittee recommended:

  • One set of criteria for the new ID/DD waivers with one waiting list for both the supports and comprehensive waivers. The Waivers would be designed to allow people to move from one waiver to another as necessary (i.e., as individuals’ needs change). Once in a waiver, there would be no more waiting to get needed services.
  • A system of regional (3 – 7 regions) slot assignment based on urgency of need (vs. a chronological basis) is recommended. Regional committees would review the scored needs of those on the waiting list when a slot is available. This will enables a wider perspective of addressing needs until we can eliminate waiting lists.
  • A transitional and fair process to align management of the waiting lists by:

–Providing those on the existing DD waiver chronological waiting list the option to move to the   needs-based list or to stay on the current chronological list with one opportunity to revisit the choice within one year of the initial decision.

–Placing all newly screened individuals (regardless of diagnosis) on the needs-based list.

— Ensuring that a percentage of all newly created slots go towards reducing the chronological list until its census is zero, at which time it will be permanently closed.

  • The Commonwealth recognizes that we are still triaging resources. Therefore, the Waiting List Subcommittee recommends changes (in bold) to the urgent needs criteria with the following additions:

–  The applicant is 55 years of age or older;

 – There is a clear risk (e.g., reports made) for the applicant of abuse, neglect, or exploitation or the individual has been determined by APS/CPS to have been abused, neglected or exploited;

 -There is a risk to the health or safety of the applicant, primary caregiver, or other person living in the home due to either of the following conditions:

(1)    The applicant’s behavior or behaviors present a risk to himself or others that cannot be effectively managed by the primary caregiver or unpaid provider even with generic or specialized support arranged or provided by the CSB/BHA; or

(2)    The individual lives in an institutional setting and has a viable discharge plan in place.

These changes would be in addition to existing criteria for the ID Waiver Waiting list.

The committee did not discuss how to improve access to services for people on the waiting list, whether it is though waiver or other formal/informal supports, as it was not outlined in the DBHDS charges.


Services Array Subcommittee:

(No charge posted for the Services Array Subcommittee)

The Services Array Subcommittee is currently working on recommending services for the new waivers and drafting the definitions of these services for the CMS application. Their work will continue through the summer.

Members of The Arc and other advocates on the committee have been requesting increased options for self-directed services and individualized budgeting.  Others suggestions have been improving access to assistive technology, environmental modification and transportation. The Committee will also be working from the stakeholder feedback that was provided in forums and in comments.


Provider Advisory Subcommittee:

Charge:

  1. Offering guidance, from a provider perspective, to Burns & Associates (HSRI’s subcontractor) in their work of gathering and synthesizing information for the rate study portion of the overall waiver study.

The Provider Advisory Committee assisted Burns and Associates (HSRI’s subcontractor) in developing a provider survey to help B&A develop a rate methodology to set or adjust rates in the new waivers. A report is due by the end of August to match up rates with proposed/existing services that were recommended by the Services Committee.


*Proposed DD Definition of Eligibility

“The term ‘developmental disability’ means a severe, chronic disability of an individual that:

o   Is attributable to a mental or physical impairment or combination of mental and physical impairments [not to include mental illness];

o   Is manifested before the individual attains age 22;

o   Is likely to continue indefinitely;

o   Results in substantial functional limitations in 3 or more of the following areas of major life activity:

o   Self-care

o   Receptive and expressive language

o   Learning

o   Mobility

o   Self-direction

o   Capacity for independent living

o   Economic self-sufficiency; and

o   Reflects the individual’s need for a combination and sequence of special interdisciplinary or generic services, individualized supports or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated.”