VNPP Spring 2017 Our thanks to Lutheran Family Services, Richmond Residential Services, Community Residences, ServiceSource and Support Services of Virginia Who served as Host and Sponsor for the lunches

Agenda for Today Update on the General Assembly Session Roundtable Discussion on Measurable Outcomes for Standards of Care Lunch Updates on CCC+, ARTS and all things Waiver!

2017 General Assembly Legislation of Interest SB1005/HB1549 - Same Day Access  The Governor put in $6.9M for 25 CSBs to expand capacity to provide same day access; The conference report stripped $2M based on a faulty assumption that increasing GAP to 100% of FPL would divert enough individuals to reduce the demand for SDA, and Added “outpatient primary care screening” with no additional funding Delayed enactment to July 2019  

Legislation con’t SB1008/HB1491 – both background check bills which will be combined; SB1008 completely reorganizes the code on this matter and HB1491 provides the exception for shared living and sponsored placements HB1508/SB894 – Requires DBHDS to provide data to dLCV on serious injuries or deaths within 15 days of the incident. We will work with dLCV to help them interpret the data they may receive. HB1943/1944 – Both add a provision for DPB to gain input into the fiscal impact of proposed regulations on providers; HB1944 also contains additional requirements for DMAS and DBHDS in enactment clauses.

Legislation con’t HB2095/SB1020 – This is the legislation requiring registration of peer support specialists and QMHPs; regulations are still to be developed HB2417 – Requires pre-payment review of claims for FFS providers; we will talk about this later SB1373 – This was the NIMBY bill that was “left in committee” SB1551/HB1583 – Both bills to keep either CVTC or SWVTC open in different forms; neither survived

2017 General Assembly Budget In the Medicaid budget - The Department of Medical Assistance Services, in collaboration with the Department of Behavioral Health and Developmental Services, shall convene a stakeholder workgroup, to meet at least once annually, with representatives of the Virginia Association of Community Services Boards, the Virginia Network of Private Providers, the Virginia Association of Centers for Independent Living, Virginia Association of Community Rehabilitation Programs (VaACCSES), the disAbility Law Center of Virginia, the ARC of Virginia, and other stakeholders including representative family members, as deemed appropriate by the Department of Medical Assistance Services. The workgroup shall: (i) review data from the previous year on the distribution of the SIS levels and tiers by region and by waiver; (ii) review the process, information considered, scoring, and calculations used to assign individuals to their levels and reimbursement tiers; (iii) review the communication which informs individuals, families, providers, case managers and other appropriate parties about the SIS tool, the administration, and the opportunities for review to ensure transparency; and (iv) review other information as deemed necessary by the workgroup.  The department shall report on the results and recommendations of the workgroup to the General Assembly by October 1 of each year.  

Budget con’t Effective upon enactment of this act, the Department of Medical Assistance Services, in collaboration with the Department of Behavioral Health and Developmental Services, shall make sponsored residential services eligible for customized rates. The department may implement any changes necessary to implement this provision prior to the promulgation of regulations undertaken in order to effect such changes. This amendment modifies language in the introduced budget approved by the 2016 General Assembly to have the Department of Medical Assistance Services, in cooperation with the Department of Behavioral Health and Developmental Services, collect information and feedback related to payments to family homes and the impact of changes to the rates on family homes statewide from sponsored residential providers and family home providers. Language extends collaborative efforts to collect information and feedback to other provider groups and specifies additional data elements to review. Language also requires a report on the findings of this analysis to the Governor and the Chairmen of the money committees  

Budget con’t This amendment adds 144 Family and Individual Support Waiver slots in the second year. Funding is contained in the introduced budget to provide funding for these slots. Projections of utilization of the newly designed Building Independence, Family and Individual Supports and Community Living Waivers programs have resulted in the ability to serve more individuals than originally anticipated. Language in the introduced budget is eliminated which would have delayed access to additional waiver slots in fiscal year 2018   This amendment adds language regarding the Medicaid appeals process to: (i) amend regulations to clarify that the informal appeals agent shall have the ability to close an informal appeal based on settlement between the parties up to $250,000; (ii) direct the agency to convene a workgroup to develop a plan to avoid or adjust retractions of Medicaid payments for non-material breaches of the Provider Participation Agreement when the provider has substantially complied with it; and (iii) require the agency to report on the status of the plan to avoid retractions to the Chairmen of House Appropriations and Senate Finance Committees.

Budget con’t In the DBHDS Budget –   This amendment eliminates language in the introduced budget which authorizes the Department of Behavioral Health and Developmental Services to promulgate emergency regulations to establish a licensing fee per application for all adult behavioral health and developmental services licensed by the agency. A companion amendment in Item 313 eliminates the funding and one position to collect and process these fees. Revenue assumed from the fees is also eliminated in Item 0

Budget con’t We did not support the following -   HB 2417: This amendment adds $371,000 from the general fund and $3.0 million from matching federal Medicaid funds for the fiscal impact of House Bill 2417 which directs the Department of Medical Assistance Services to establish a program using prepayment analytics to mitigate the risk of improper payments to providers of services furnished under the state plan for medical assistance who commit fraud, abuse, or errors And it appears that the following is not included in the Conference Report - Implementation Plan to Transfer CSA Funding for Students with Disabilities to DOE (language only) – however, a workgroup is formed.

Questions?

Roundtable Tasks Answer One or More of the Questions: What is the standard of care for ____________ service? For each service you pick – list one or two outcomes and describe how you would measure each What topics would you like to have presented at the Fall Conference and in what format? What specific issues/concerns do you have about the Service Definitions and Descriptions for the DD Waiver Services? For each service you pick - outline the issue/concern and suggest a change

Ideas! Develop and disseminate a package of educational material which providers can use with local businesses, restaurants, religious organizations, medical professionals and others to explain what community integration should look like Encourage interpretations that actually support services that allow integration in a way that is manageable for the provider – ie a ratio of 1:3 is not a group size of 3 and does not require switch billing between CE and GD if there is “proximity” for 8 minutes or more! Conference topic – Panel discussion on integration including a local business, a volunteer placement and a religious organization

Report/Lunch

CCC+, ARTS and all things Waiver Waiver Updates

Questions?