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.
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:
- Overview of Waiver Redesign (12/16/2014, 1:00 pm – 2:00 pm)
Register here: https://cc.readytalk.com/r/xxs3vpuuftav&eom
- Governor’s Budget Update (12/30/2014, 1:00 pm – 2:00 pm)
Register here: https://cc.readytalk.com/r/fds9zcd632m7&eom
- Advocacy Issues for the 2015 General Assembly Session (01/13/2014,11:00 am – 12:00 pm)
Register here: https://cc.readytalk.com/r/j81epn6aothu&eom
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: firstname.lastname@example.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 email@example.com 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