1. Waiver Redesign Impact on Waiting Lists May 13, 2016 Dawn Traver, M.Ed. Director, Waiver Operations Division of Developmental Services

2. Slide 2 My Life, My Community System Redesign People with developmental disabilities living, working, and playing in their own communities is becoming the norm, not the exception

3. Slide 3 Today’s Discussion 1. Quick Overview 2. Screening Process Update 3. Combining ID and DD Waiver Waiting Lists 4. Priority Setting Process 5. Process to Assign New Waiver Slots 6. How to Stay Informed

4. Slide 4 Proposed Integrated I/DD Waiver Redesign Day Support Waiver Building Independence Waiver For adults (18+) able to live independently in the community. Individuals own, lease, or control their own living arrangements and supports with the option of non-waiver-funded rent subsidies. DD Waiver Family & Individual Supports Waiver For individuals living with their families, friends, or in their own homes, including supports for those with some medical or behavioral needs. Available to both children and adults. ID Waiver Community Living Waiver 24/7 services and supports for individuals with complex medical and/or behavioral support needs through licensed services. Includes residential supports and a full array of medical, behavioral, and non-medical supports. Available to adults and some children.

5. Slide 5 Amended waivers with new services and rates New support levels and reimbursement tiers New Waiver Management System (WaMS) replacing IDOLS/KEPRO CSBs to assume single point of entry for all DD waivers New eligibility process and revised tool (Virginia Individual Developmental Disability Eligibility Survey - “VIDES”) Single, statewide, priority-based waitlist Starting on July 1, 2016* When Do Changes Begin? * Pending approval from CMS

6. Screening Process Update

7. Slide 7 Streamlined, Needs-Based Access Individual with ID Individual with DD CSB Child Development Clinic Eligibility Waiting List (based on urgency) Waiting List (based on chronology) Day Support Waiver WaiverIDWaiver DD Current Process Individual with ID or DD CSB Eligibility Single, Consolidated Waiting List (based on urgency) Revised Process Building Independence OR Family & Individual Support OR Community Living Waiver

8. Slide 8 DD Waivers’ Eligibility Factors Possess a diagnosis of DD Meet level of care criteria (determined by the VIDES) Meet Medicaid financial eligibilityEligibility If a slot is not available, the Support Coordinator: Places the person’s name on the waiting list via WaMS Completes a Critical Needs Summary form documenting the person’s level of urgency Determines the individual’s priority needs level

9. Slide 9 Diagnostic Eligibility Code of Virginia [§ 37.2-100] "Developmental disability" means a severe, chronic disability of an individual that (i)is attributable to a mental or physical impairment, or a combination of mental and physical impairments, other than a sole diagnosis of mental illness; (ii)is manifested before the individual reaches 22 years of age; (iii)is likely to continue indefinitely; (iv)results in substantial functional limitations in three or more of the following areas of major life activity: self-care, receptive and expressive language, learning, mobility, self- direction, capacity for independent living, or economic self- sufficiency; and

10. Slide 10 Diagnostic Eligibility (cont’d) (v)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. An individual from birth to age nine, inclusive, who has a substantial developmental delay or specific congenital or acquired condition may be considered to have a developmental disability without meeting three or more of the criteria described in clauses (i) through (v) if the individual, without services and supports, has a high probability of meeting those criteria later in life.

11. Slide 11 Functional Eligibility Level of Functioning Survey replaced by theVirginia Individual Developmental Disability Eligibility Survey (VIDES) Three versions: – Infants’ (birth to three years of age) – Children’s (three through 17 years of age) – Adults’ (18+)

12. Slide 12 Use of the VIDES VIDES to be used for all on combined waiting list for FY17 slots VIDES to be used for initial screenings and annual reassessment of functional eligibility when amended waivers take effect

13. Combining the Waiting Lists

14. All three amended waivers will serve individuals with a diagnosis of DD (inclusive of ID). Individuals seeking waiver services for persons with any developmental disability will have diagnostic and functional eligibility confirmed by their local CSB and, as appropriate, be placed on a single state wide waiting list. Waiver wait lists will be maintained by the local CSB for all individuals under their jurisdiction, including those currently associated with DD CM agencies. o DDS oversight Statewide Waiver Wait List

15. Slide 15 Merging the Waiting Lists ID & DS Waivers Waiting List for Individuals with ID & DD: Priorities 1-3 Waiting List Based on Chronology Waiting List Based on Urgency of Need DD Waiver Determine Level of Priority

16. Slide 16 5 DBHDS Regional Supports Specialists (RSSs) will assist CSBs to manage this process, and support the Waiver Slot Assignment Committees (WSACs). The amended waivers separate the eligibility determining entity (CSBs) from the slot assignment entity (DBHDS-supported committees of community members). WSACs:  Impartial, trained volunteers for each locality/region who assign waiver slots according to urgency of need.  Not affiliated with a CSB or private provider  Knowledge and/or experience with persons with DD or the service system. Wait List Procedure-Increasing Consistency

17. Slide 17 WSACs Update DBHDS staff have received nominees from nearly every CSB for WSAC members. DBHDS staff are reviewing to ensure criteria met and determine group facilitators. Some neighboring CSBs have combined to form joint WSACs. Info at: http://www.dbhds.virginia.gov/professionals- and-service-providers/developmental-disability- services-for-providers/waiver-serviceshttp://www.dbhds.virginia.gov/professionals- and-service-providers/developmental-disability- services-for-providers/waiver-services

18. Priority Setting Process

19. Slide 19 Eligibility Priorities - ONE LevelTimeframeCriteria Priority ONE Status All individuals determined to meet one of the following criteria and require a waiver service within one year. 1.An immediate jeopardy to health and safety due to the unpaid primary caregiver having a chronic or long-term physical/psychiatric condition(s) that significantly limits ability to care for the individual; no other unpaid caregivers available to provide supports; 2.There is a risk to the health or safety of the applicant, primary caregiver, or other person living in the home due to either: a)Individual’s behavior present a risk to self or others unable to be managed by the primary caregiver/unpaid provider even with SC arranged generic or specialized supports, or b)Physical care or medical needs cannot be managed by the primary caregiver even with SC arranged generic or specialized supports; 3.Individual lives in an institutional setting and has a viable discharge plan; or 4.Individual is a young adult transitioning and is no longer eligible for IDEA services (e.g., in a foster care, residential setting, etc.).

20. Slide 20 Eligibility Priorities - TWO LevelTimeframeCriteria Priority TWO Status Individual meets one of the following criteria and a service is needed in one to five years. 1.The health and safety of the individual is likely to be in future jeopardy due to: Unpaid primary caregiver having a declining chronic or long-term physical or psychiatric condition(s) that significantly limits ability to care for the individual, No other unpaid caregivers available to provide supports, and Individual’s skills are declining due to lack of supports; 2.Individual is at risk of losing employment supports; 3.The individual is at risk of losing current housing due to lack of adequate supports and services; or 4.The individual has needs or desired outcomes that with adequate supports will result in a significantly improved quality of life.

21. Slide 21 Eligibility Priorities - THREE LevelTimeframeCriteria Priority THREE Status “Active Planning” A service is being currently sought The system has determined that the individual may not need to access a waiver slot for more than five years as long as the current supports and services remain The system should plan for future needs, as this person may present at any time 1.The individual is receiving a service through another funding source that meets current needs; 2.The individual is not currently receiving a service but is likely to need a service in five or more years; or 3.The individual has needs or desired outcomes that with adequate supports will result in a significantly improved quality of life.

22. Slide 22 Current Prioritization Activities CSB/private case managers and DBHDS staff are in the process of – completing prioritization on all individuals on the ID and DD waiver waiting lists – completing the VIDES on all individuals determined to meet the Priority 1 criteria

23. Slide 23 Notifying Individuals Current DD waiver waiting list individuals: – When 200 slots are distributed, remaining individuals on chronological list will be formally notified of the merging of the waiting list and their priority level Current ID waiver waiting list individuals: – Those who move from “urgent needs” portion of the WL to Priority 2 or 3 will be offered appeal rights

24. Process to Assign New Waiver Slots

25. Slide 25 Slot Assignment-Managed by DBHDS To be considered for slot assignment, an individual must: Meet diagnostic and functional eligibility requirements, Be determined to meet one of the Priority One criteria, Need services within 30 days, and Accept the requested service if it were offered.

26. Slide 26 Slot Assignment (cont’d) When the CSB has slots available for assignment, they contact the WSAC facilitator to call a WSAC meeting. The CSB puts forth for WSAC consideration the top scoring individuals (“Critical Needs Summary”) Case managers (inclusive of private for current DD waiver WL individuals) complete the “Slot Assignment Review Form” This review form is relayed to WSAC members who consider it as well as CM’s responses to their questions at WSAC meeting

27. Slide 27 Slot Assignment (cont’d) WSAC members score urgency of needs on Slot Assignment Scoring Summary: Step 2 Review sheet The individual(s) with the highest score(s) receive the available slot(s) After WSAC slot assignment determination, the CSB proceeds with waiver enrollment in WaMS

28. Slide 28 Which Person to Which Waiver? Process currently under consideration/discussion with Transition Issues Workgroup Recommendations will be reviewed by DBHDS, DMAS and CMS before implementation

29. Slide 29 Reserve Slots Reserve slots are managed by DBHDS Reserve slots support emergencies and movement between the waivers

30. Slide 30 Emergency Slots Emergency Criteria: Child Protective Services or Adult Protective Services has substantiated abuse/neglect against the primary caregiver and has removed the individual from the home; or for adults, where abuse/neglect has not been substantiated but corroborating information from other sources (agencies) indicate there is an inherent risk present. There are no other caregivers available to provide support services to the individual. Death of primary caregiver and/or lack of alternate caregiver coupled with the individual’s inability to care for him/herself and danger to self or others without supports.

31. Slide 31 http://www.dbhds.virginia.gov/individuals-and- families/developmental-disabilities/my-life-my- community Updates at My Life My Community at DBHDS.virginia.gov The following resources are/will be available to address questions: 844-603-9248 (844-603-WAIV) Interactive website later in May Updates at My Life My Community at DBHDS.virginia.gov The following resources are/will be available to address questions: 844-603-9248 (844-603-WAIV) Interactive website later in May My Life, My Community

32. Slide 32 Thank you!