7/28/2019 VA's Waiver Services Executive Summary_FINAL

1/4

7/28/2019 VA's Waiver Services Executive Summary_FINAL

2/4

Virginias Waiver Services Currently Provide Inadequate Funding to Implement the DOJ Agreement

1

Background: In February 2011, the U.S. Department of J ustice (DOJ ) published a finding thatVirginia was not developing a sufficient quantity of community services. A State SettlementAgreement was approved in August 2012.

As primary stakeholders along with individuals and families, private providers fully support thevalues and goals of integrated community services for citizens with developmental disabilitiesand support a person centered planning process to develop and provide these services. Currentproviders have experienced a long-standing collaborative relationship with public agencies suchas Department of Behavioral and Developmental Services (DBHDS), Department of MedicalAssistance Services (DMAS) and Community Services Boards (CSBs). In fact, many serviceproviders pre-date CSBs and subsequently became Waiver providers when Virginia initiallybegan participating in Waivers in May 1991. Additionally, some providers currently operate ascommunity Intermediate Care Facilities (ICFs) and therefore have the infrastructure necessaryto comply with those regulatory requirements.

Many service providers understand the needs of Training Center (TC) residents since they

either provide day services for current Northern Virginia Training Center (NVTC) residents undercontract with NVTC or they have successfully transitioned and continue to serve formerresidents of NVTC or Central Virginia Training Center (CVTC) with both residential and daysupports. This has resulted in a strong network of committed regional providers who have theknowledge, skills and abilities necessary to safely and effectively implement the StateSettlement Agreement in Region 2.

Issue:A serious economic barrier now challenges Vi rg in ia p rivate service p roviders.

Virginias Medicaid Waiver programs do not adequately financially support community servicesfor Virginians with disabilities as identified in the DOJ Settlement Agreement. This lack ofsupport is an economic barrier to those who want to be transferred to community-based

services. At the same time, Virginias Waiver programs do not support Virginians currently livingin the community who require complex and intense supports.

Donald Fletcher, the Independent Reviewer appointed by the Court, highlighted this issue byexplaining that the inadequacy of the existing ID Waiver funding rates and rate structure inVirginia create[s] incentives that promote congregation and result[s] in limited providercapacity to serve those with the most complex needs.

While individuals reside at a TC, they are funded by comprehensive ICF funding. When theyare discharged, their funding is transferred to an array of Medicaid Waiver services withinadequate rates resulting in their funding being reduced by more than half. In the January2013 report to the VA J oint Subcommittees, DBHDS reported the estimated FY12 cost to serve

a TC resident transitioning to Waiver services at $105,860 compared to the average FY12 costof $224,225 to serve a resident while at a TC. While this direct contrast of funding support isshocking, the report does not, however, take into account the specific intensive behavioraland/or medical supports for those transitioning from the TCs. With less than half the funding,private providers are not in a position to deliver comparable community based services whileensuring health and safety and accommodating numerous regulatory requirements. Privateproviders are committed to providing comparable supports to ensure safety in the community forindividuals with complex medical and behavioral needs but must be adequately compensated.

7/28/2019 VA's Waiver Services Executive Summary_FINAL

3/4

EXECUTIVESUMMARY

2

While Waiver reform is necessary, based on the proposed timeline offered by DBHDS, theNVTC will be closed before any action can be legislated by the General Assembly. To ensurequality of services, the barriers described above should be eliminated now.

Values of Providers: The Independent Reviewer specifically noted the commitment ofproviders to work diligently to deliver quality and individualized services. Providers have

agreed to: Commitment to an integrated team approach, including person-centered planning,

communication, coordination and transition strategies Collaboration on developing and implementing the Agreement as well as the requirement of

effective and timely communication from VA leadership

Summary and Recommendations: Current Medicaid waiver reimbursement will notcompensate providers for the cost of necessary community services nor will the currentMedicaid waiver methodology provide for a safe and effective transition of needed supports forthis most vulnerable and specialized population. The Commonwealth of Virginia should insurethat current funding resources follow the person into their local community. The NVTC has 139residents as of April 2013. Inadequate Waiver funding impacts all of them including the 59

already receiving community day supports as well as the other 80 that will need community daysupports when they transition into the community.

Options already exist for short-term resolution. Providers are committed and willing to workcollaboratively with State stakeholders to identify and develop long-term strategies forresolution.

Providers recommended the following existing options:

Development of ICF community funded homes along wi th Waiver funded homes;

DMAS modification of Waiver rate methodology consistent with existingDepartment of Rehabilitative Services (DARS) and regional protocols;

Specialized individualized rate setting for TC outplacements; and Redeployment of existing NVTC resources to community prov iders.

The complex needs of the individuals transitioning from TCs require ongoing funding supportsfrom Virginia to ensure health and safety so that providers are compensated for serviceprovision.

Providers will no longer be able to collect additional local funding from CSBs to accommodatethe inadequate Medicaid Waiver rate. This gap is as much as 40 percent of the currentreimbursement rate provided through regional rate setting processes for specific programs.

As long standing providers of quality service, we have the knowledge, capability credentials and

commitment to ensure a safe transition of TC individuals. Immediate resolution of theseeconomic barriers is required to commence the tenets of the State Settlement Agreement.Support is needed from DBHDS and DMAS for both short term and long-term resolution ofthese barriers so we can immediately commence a safe transition process for all TC residents.

7/28/2019 VA's Waiver Services Executive Summary_FINAL

4/4

EXECUTIVESUMMARY

3

Submitted by Northern Virginia Providers for Real Medicaid Waiver Reform

The Arc of Greater PrinceWilliam/INSIGHT, Inc.

Woodbridge, VA

Chimes Inc., VirginiaFairfax, VA

Community Residences, Inc.Chantilly, VA

Community Systems, Inc.McLean, VA

Didlake Inc.Manassas, VA

ECHOLeesburg, VA

Job Discovery Inc.Fairfax, VA

The Hartwood FoundationSpringfield, VA

Langley ResidentialVienna, VA

L'Arche Greater Washington, D.CArlington, VA

Linden ResourcesArlington, VA

MVLESpringfield, VA

PRS, Inc.McLean, VA

Resources for Independence ofVirginia, Inc.Fairfax, VA

ServiceSourceAlexandria, VA

St. Coletta of Greater WashingtonAlexandria, VA

St. Johns Community ServicesAnnandale, VA

Volunteers of America ChesapeakeWoodbridge, VA