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AR RIGHTS OF CHOICE AND STATE PRACTICES

Current law does not prohibit consolidation of the five training centers. We want the General Assembly to look at other options, however, and that is what our proposed legislation is about. We want to convince the legislature that closing the training centers could ultimately be more costly than leaving them open but "right-sized" to reflect their current and future populations. This would involve selling or leasing unused buildings on TC grounds as well as unused land. We also hope to stop DBHDS in its tracks until the JLARC has done a cost study to verify DBHDS numbers and price alternatives. We have a federal right to institutional (or ICF) placements for our relatives, and that right will not go away if the General Assembly repeals the targeted protective Virginia statute and closes training centers. It's not just a matter of TCs versus community. The state is pushing waiver placements in the community, which require that we waive our relatives' federal right to ICF care, which is intensive, comprehensive, and requires an individualized program of active treatment designed by an interdisciplinary team of treatment professionals. You must know that TCs are ICFs (Intermediate Care Facilities), but DBHDS does not want you to know that there are also some small ICFs in the community as well (some private and for-profit, some owned by CSBs) -- and that there are not nearly enough of them to serve all of our relatives. Those few community ICFs are more expensive per person than the training centers because they lack an economy of scale. Under federal regulations, states receiving Medicare funds from the feds must provide assurance that everyone who qualifies for an ICF and accepts an HCBS waiver was offered an ICF placement and declined it, so if the state wants to continue to receive funding from the feds (about 50% of the cost of maintaining our relatives), then they have to offer ICF placements for them. This is the federal regulation that inspired the VA statute that the state will try to repeal. (§ 37.2-837 Guarantees that

anyone who is receiving services in a training center may choose to continue to receive services in a training center.)
By pettifogging the issue, the state does not want parents informed of their federal right to ICF placements, because they hope to corral us all into group homes instead. They're much cheaper, they do not offer active treatment programs devised by interdisciplinary teams, and they are not strictly regulated and overseen annually by the feds.

Excerpt from 42 CFR §441.302 --- State Assurances
Unless the Medicaid agency provides the following satisfactory assurances to CMS, CMS will not grant a waiver under this subpart and may terminate a waiver already granted . . .

(d) Alternatives—Assurance that when a recipient is determined to be likely to require the level of care provided in a hospital, NF, or ICF/MR, the recipient or his or her legal representative will be— (1) Informed of any feasible alternatives available under the waiver; and (2) Given the choice of either institutional* or home and community-based services. *CMS uses the terms “institution” and “ICF/MR” interchangeably, with no lower limit on population. Thus, an ICF with four beds, or even two beds, is classified an institution.