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D B H D S Virginia Department of Behavioral Health and Developmental Services My Life, My Community! Waiver Redesign Update with HSRI Recommendations Connie.

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Presentation on theme: "D B H D S Virginia Department of Behavioral Health and Developmental Services My Life, My Community! Waiver Redesign Update with HSRI Recommendations Connie."— Presentation transcript:

1 D B H D S Virginia Department of Behavioral Health and Developmental Services My Life, My Community! Waiver Redesign Update with HSRI Recommendations Connie Cochran Assistant Commissioner & Dawn Traver Waiver Operations Manager Virginia Department of Behavioral Health and Developmental Services

2 Page 2 DBHDS Virginia Department of Behavioral Health and Developmental Services Virginia is Shifting the Array of Services Nursing Facilities, ICF, Day Support More Integration and Options for Independence Group Homes Prevocational Sponsored Residential Family Home Group Supported Employment Individual’s Own Home or Apartment, Individual Supported Employment Current Array of Services Future Array of Services

3 Page 3 DBHDS Virginia Department of Behavioral Health and Developmental Services Four Main Areas of Settlement Agreement Serving individuals with DD in the most integrated setting and building quality community-based alternatives for individuals, particularly individuals with complex needs Quality and risk management system, including monitoring and evaluating services, and implementing quality improvement processes at an individual, provider, and state-wide level Supporting independent housing and employment options for individuals with DD Transitions from training centers

4 Page 4 DBHDS Virginia Department of Behavioral Health and Developmental Services Individuals Served By Virginia’s Developmental Disability System February 5, ,797 8,115

5 Page 5 DBHDS Virginia Department of Behavioral Health and Developmental Services Waiver Transformation Activities On July 1, 2013, DBHDS & DMAS awarded a contract to the Human Services Research Institute (HSRI) to study Virginia’s HCBS Medicaid Waivers for persons with ID and DD. The study was named “My Life, My Community!”

6 Page 6 DBHDS Virginia Department of Behavioral Health and Developmental Services Goals of My Life, My Community! 1.Evaluate the efficiency, effectiveness and flexibility of the current waivers. 2.Recommend approaches for system changes including waver enhancement, and the potential efficacy of one comprehensive waiver and one supports waiver. 3.Conduct a study of current Medicaid rates. 4.Recommend new rate structure based on the study and exploring an individual resource allocation system for efficient distribution of waiver funds. 5.Aid in implementing the new system.

7 Page 7 DBHDS Virginia Department of Behavioral Health and Developmental Services My Life, My Community: Two Phases Phase I Evaluate the waivers Hold public stakeholder forums and report on results Evaluate SIS administration and create process for data use Develop a plan to reduce the number of waivers Review policy changes Report on findings

8 Page 8 DBHDS Virginia Department of Behavioral Health and Developmental Services My Life, My Community: Two Phases (cont’d) Phase II Conduct a cost study and propose a more appropriate rate structure Explore a resource allocation framework Create a rate structure Evaluate SIS data Analyze the potential impact of the proposed waiver system Align with the Quality Management System Develop a communication plan

9 Page 9 DBHDS Virginia Department of Behavioral Health and Developmental Services Public Forums HSRI held 8 stakeholder meetings across the state between 9/23 and 10/10/13 All were welcome: self advocates, family members, providers, CSBs, advocacy reps The resulting report is available at: The information gathered helped inform the Phase I report

10 Page 10 DBHDS Virginia Department of Behavioral Health and Developmental Services My Life, My Community Public Forums Conclusions Primary Principle: One Unified, Needs- Based Waiver The waiver needs to address the increasing demand for services in the state The waiver should offer a flexible array of services that allow for choice, control & creativity to meet individual needs & preferences

11 Page 11 DBHDS Virginia Department of Behavioral Health and Developmental Services My Life, My Community Public Forums Conclusions (cont’d) Waiver rates need to be commensurate with the costs of providing services The waiver needs a uniformly implement, sound infrastructure for screening, providing case management/service coordination services that enable users to access services free of conflict of interest

12 Page 12 DBHDS Virginia Department of Behavioral Health and Developmental Services December 20, 2013: HSRI Phase I Recommendations Phase I report included a series of short and long term recommendations Available at DBHDS will evaluate each of these recommendations, in conjunction with stakeholder input, before making policy decisions or final recommendations Final recommendations to Governor for General Assembly consideration at 2015 session

13 Page 13 DBHDS Virginia Department of Behavioral Health and Developmental Services Major HSRI Recommendation VA should initiate the development of two new 1915(c) Waivers that include eligibility for people with ID, DD and related conditions –Comprehensive waiver with wide service array, including residential –Support waiver with similar supports array but no 24-hour residential option

14 Page 14 DBHDS Virginia Department of Behavioral Health and Developmental Services Waiting List Recommendations Long Term Recommendation A single set of waiting list criteria should be created Short Term Recommendations DD Waiver emergency slots should be available on a continual basis DBHDS/CSBs should perform continual outreach to ensure people know how to apply for services/WL Review WL data to determine which individuals are receiving services through other sources/not receiving any services Stakeholders should contribute to revised policies that integrate WLs

15 Page 15 DBHDS Virginia Department of Behavioral Health and Developmental Services CSB Recommendations Long Term Recommendations Clarify & strengthen the oversight role of the state in contract with CSBs & practice related to Medicaid funded activities CSBs as single point of entry for individuals with DD added to statute Expand role of CSBs as case management entities for those with DD & related conditions Develop long-term plan for transitioning CSBs into case management providers vs. Waiver services providers

16 Page 16 DBHDS Virginia Department of Behavioral Health and Developmental Services Case Management Recommendations Long Term Recommendations Address conflicts of interest within the current case management system Shift all case management to the public CSB system Develop 2 new State Plan Amendments o Case management for those on I/DD waivers o Case management for those not receiving waiver services

17 Page 17 DBHDS Virginia Department of Behavioral Health and Developmental Services Case Management Recommendations (cont’d) Short Term Recommendations Enable ID & DD Waiver case managers to bill for activities up to 6 months prior to transition to the community Administration of the SIS should be done by an independent entity

18 Page 18 DBHDS Virginia Department of Behavioral Health and Developmental Services Service Array Recommendations Long Term Recommendations Enhance and encourage Positive Behavioral Support services Remove restrictions on “general supervision” in Congregate and In-home Residential Support services Consider stakeholder forum feedback on transportation services

19 Page 19 DBHDS Virginia Department of Behavioral Health and Developmental Services Service Array Recommendations (cont’d) Long Term Recommendations Consider adding Caregiver Retention payments or vacancy factor to rates Consider adding a “Community Guide” service to promote community integration Add dental services to the waivers

20 Page 20 DBHDS Virginia Department of Behavioral Health and Developmental Services Service Array Recommendations (cont’d) Short Term Recommendations Streamline the process for preventing and addressing crises for those served in the community Ensure access to Skilled Nursing services for those with significant medical issues Continue to support self-directed service options

21 Page 21 DBHDS Virginia Department of Behavioral Health and Developmental Services Employment Recommendations Long Term Recommendations Revise employment service definitions to align with CMS 2011 employment informational bulletin Make discussions about individuals’ career interests a priority before determining day/employment services

22 Page 22 DBHDS Virginia Department of Behavioral Health and Developmental Services Quality Improvement Strategies Recommendations Long Term Recommendation DMAS & DBHDS should create a unified Quality Improvement System for the two new waivers to safeguard individuals and improve their quality of life Short Term Recommendation VA should proceed with revisions to the ID Waiver QIS for the 2014 renewal per draft guidance issued by CMS in August 2013

23 Page 23 DBHDS Virginia Department of Behavioral Health and Developmental Services Incident/Risk Management Recommendations Long Term Recommendations Develop a critical incident manual that clarifies the roles and responsibilities of everyone in the system Automatically notify SCs/CMs of critical incidents reported in CHRIS Clarify DBHDS role & responsibility for conducting certain types of investigations

24 Page 24 DBHDS Virginia Department of Behavioral Health and Developmental Services Incident/Risk Management Recommendations (cont’d) Long Term Recommendations Expand Death Reporting and Mortality Reviews to all I/DD waiver recipients whose death is unanticipated or unexplained

25 Page 25 DBHDS Virginia Department of Behavioral Health and Developmental Services Next Steps Response to Phase I recommendations Stakeholder meetings to further discuss DBHDS’/DMAS’ response to major issues Phase II began in January Burns & Associates to met with a committee of provider stakeholders for input into the development of a survey for all providers regarding ID/DD Waiver rates –“Provider Advisory Committee”

26 Page 26 DBHDS Virginia Department of Behavioral Health and Developmental Services Stakeholder Groups Being Formed Waiver Development Advisory Committee Overarching committee to provide input to the process of new waiver development Subcommittees: –Provider Advisory Committee –Eligibility Requirements –Waiting Lists –Case Management

27 Page 27 DBHDS Virginia Department of Behavioral Health and Developmental Services SIS Related Next Steps ID support coordinators no longer administering the SIS to individuals receiving ID and DS Waiver services DBHDS contracted with an external vendor (AAIDD) to complete the SIS on individuals receiving ID, DD & DS waiver Approximately 1,450 SIS interviews to be completed through June, 2014 The information will be used to inform the rate study.

28 Page 28 DBHDS Virginia Department of Behavioral Health and Developmental Services Timeline for Implementation of My Life, My Community Renew Intellectual Disability (ID) Waiver (January 2014 – July 2014) –only make small modifications to the current program Design New Developmental Disability Waiver(s) (January 2014 – January 2016) –The WDAC and subcommittees will provide consultation and guidance in development of these solutions

29 Page 29 DBHDS Virginia Department of Behavioral Health and Developmental Services Questions?


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