Governor’s Budget – Step #1

October 04, 2021

Agencies are asked to submit their requests for items to be included in the Governor’s Budget; those items are then posted by the Department of Planning and Budget (DPB) for public view.  Many of the items were posted at the end of last week – here are some highlights:

DBHDS:

 

• A pilot project to “remove pipeline barriers” by funding the cost for supervision for 200 MSWs and MCs to become licensed in Virginia; the project will also fund 30 licensed clinicians to obtain the certification to provide the supervision. [$3M GF]
• Continue funding for census reduction pilot programs. [$20.1M each year]
• Create and fund a “hearing officer” position to conduct informal fact finding conferences (required when actions are appealed) for the Office of Licensing. [$120K each year]; also a request to fund 15 additional staff in Licensing [$1.8M each year]
• Conduct a comprehensive review of DBHDS licensing regulations, policies and requirements which would require stakeholder involvement and make “recommendations to shift the current structure and operations to a system that is both more provider friendly and assures quality . . . over time.”  [$450K]
• The overwhelming majority of the requests are related directly or indirectly to the state hospital census issue

DMAS:

• Eliminate Medicaid resource requirements for SSI recipients – by entering into at 1634 Agreement with SSA, the state give the authority to the Commissioner of SSA to determine eligibility for SSI recipients thereby eliminating the state level application process for Medicaid. [Majority is NGF]
• Establish a comprehensive critical incident system (as required by 1915c Waivers) for CCC Plus [~$1M in GF] and fund “Cardinal Care.”
• Fund rate study for behavioral health services with eight components including:
  • “Prioritized services for Behavioral Health Enhancement /Project BRAVO which will include any updates to services implemented in 2021 as well as tiered school-based services, evidence-based models of outpatient and in-home services for youth, High Fidelity Wraparound Service for youth, Coordinated Specialty Care (CSC) including Early Psychosis Intervention (EPI), Therapeutic Foster Care case management model, and Peer Recovery Support Services for ARTS and Mental Health including a tiered approach that would allow for short-term intervention such as emergency department settings and to incorporate new service delivery models identified by the Peer Supports Workgroup.”
• Fund 1,200 DD Waiver slots (100 CL, 500 FIS each year) 
  • “The Impact of the Pandemic
    It is estimated that, even if the recommended reimbursement rates are fully funded in FY23, it will take two years to mitigate the effects of the pandemic and the limitations of the reimbursement rates that have been in use in recent years. These factors have resulted in a severe contraction in the number of providers of key developmental disability waiver services; therefore, too great of an expansion in the number of slots may further unduly stress the system or leave individuals without providers of needed services. Instead increased rates and boosting the number of providers needs to be prioritized. Thus, in these first two years, funding 600 slots per year is recommended in order to keep pace with the annual growth of the waiting list, which varies from year to year but was 595 in FY 20 and 507 in FY 21 (a lower than normal year due to COVID)”
• A significant number of the requests are administrative in nature re DMAS, notably there is no mention of increased rates for dental services.

There is also, as yet, nothing specific about the DD Waiver rate rebase; we still have assurance that it is “in the pipeline” and will be posted soon!