EXECUTIVE

SUMMARY

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

Submitted by Northern Virginia Providers for Real Medicaid Waiver Reform

July 2013

The Arc of Greater Prince William/INSIGHT, Inc. Woodbridge, VA Chimes Inc., Virginia Fairfax, VA Community Residences, Inc. Chantilly, VA Community Systems, Inc. McLean, VA Didlake Inc. Manassas, VA ECHO Leesburg, VA

Job Discovery Inc. Fairfax, VA The Hartwood Foundation Springfield, VA Langley Residential Vienna, VA L'Arche Greater Washington, D.C Arlington, VA Linden Resources Arlington, VA MVLE Springfield, VA

PRS, Inc. McLean, VA Resources for Independence of Virginia, Inc. Fairfax, VA ServiceSource Alexandria, VA St. Coletta of Greater Washington Alexandria, VA St. Johns Community Services Annandale, VA Volunteers of America Chesapeake Woodbridge, VA

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

Background: In February 2011, the U.S. Department of Justice (DOJ) published a finding that Virginia was not developing a sufficient quantity of community services. A State Settlement Agreement was approved in August 2012. As primary stakeholders along with individuals and families, private providers fully support the values and goals of integrated community services for citizens with developmental disabilities and support a person centered planning process to develop and provide these services. Current providers have experienced a long-standing collaborative relationship with public agencies such as Department of Behavioral and Developmental Services (DBHDS), Department of Medical Assistance Services (DMAS) and Community Services Boards (CSBs). In fact, many service providers pre-date CSBs and subsequently became Waiver providers when Virginia initially began participating in Waivers in May 1991. Additionally, some providers currently operate as community Intermediate Care Facilities (ICFs) and therefore have the infrastructure necessary to 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 under contract with NVTC or they have successfully transitioned and continue to serve former residents of NVTC or Central Virginia Training Center (CVTC) with both residential and day supports. This has resulted in a strong network of committed regional providers who have the knowledge, skills and abilities necessary to safely and effectively implement the State Settlement Agreement in Region 2. Issue: A serious economic barrier now challenges Virginia private service providers. Virginias Medicaid Waiver programs do not adequately financially support community services for Virginians with disabilities as identified in the DOJ Settlement Agreement. This lack of support 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 living in the community who require complex and intense supports. Donald Fletcher, the Independent Reviewer appointed by the Court, highlighted this issue by explaining that the inadequacy of the existing ID Waiver funding rates and rate structure in Virginia create[s] incentives that promote congregation and result[s] in limited provider capacity to serve those with the most complex needs. While individuals reside at a TC, they are funded by comprehensive ICF funding. When they are discharged, their funding is transferred to an array of Medicaid Waiver services with inadequate rates resulting in their funding being reduced by more than half. In the January 2013 report to the VA Joint Subcommittees, DBHDS reported the estimated FY12 cost to serve a TC resident transitioning to Waiver services at $105,860 compared to the average FY12 cost of $224,225 to serve a resident while at a TC. While this direct contrast of funding support is shocking, the report does not, however, take into account the specific intensive behavioral and/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 while ensuring health and safety and accommodating numerous regulatory requirements. Private providers are committed to providing comparable supports to ensure safety in the community for individuals with complex medical and behavioral needs but must be adequately compensated.

EXECUTIVE SUMMARY While Waiver reform is necessary, based on the proposed timeline offered by DBHDS, the NVTC will be closed before any action can be legislated by the General Assembly. To ensure quality of services, the barriers described above should be eliminated now. Values of Providers: The Independent Reviewer specifically noted the commitment of providers 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 not compensate providers for the cost of necessary community services nor will the current Medicaid waiver methodology provide for a safe and effective transition of needed supports for this most vulnerable and specialized population. The Commonwealth of Virginia should insure that current funding resources follow the person into their local community. The NVTC has 139 residents 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 day supports when they transition into the community. Options already exist for short-term resolution. Providers are committed and willing to work collaboratively with State stakeholders to identify and develop long-term strategies for resolution. Providers recommended the following existing options: Development of ICF community funded homes along with Waiver funded homes; DMAS modification of Waiver rate methodology consistent with existing Department of Rehabilitative Services (DARS) and regional protocols; Specialized individualized rate setting for TC outplacements; and Redeployment of existing NVTC resources to community providers.

The complex needs of the individuals transitioning from TCs require ongoing funding supports from Virginia to ensure health and safety so that providers are compensated for service provision. Providers will no longer be able to collect additional local funding from CSBs to accommodate the inadequate Medicaid Waiver rate. This gap is as much as 40 percent of the current reimbursement 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 these economic 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 of these barriers so we can immediately commence a safe transition process for all TC residents.

EXECUTIVE SUMMARY

Submitted by Northern Virginia Providers for Real Medicaid Waiver Reform

The Arc of Greater Prince William/INSIGHT, Inc. Woodbridge, VA Chimes Inc., Virginia Fairfax, VA Community Residences, Inc. Chantilly, VA Community Systems, Inc. McLean, VA Didlake Inc. Manassas, VA ECHO Leesburg, VA Job Discovery Inc. Fairfax, VA The Hartwood Foundation Springfield, VA Langley Residential Vienna, VA L'Arche Greater Washington, D.C Arlington, VA Linden Resources Arlington, VA MVLE Springfield, VA PRS, Inc. McLean, VA Resources for Independence of Virginia, Inc. Fairfax, VA ServiceSource Alexandria, VA St. Coletta of Greater Washington Alexandria, VA St. Johns Community Services Annandale, VA Volunteers of America Chesapeake Woodbridge, VA