July 1st – Beginnings and Delays!

June 26, 2016

Generally July 1st signals the implementation of the actions taken by the General Assembly during their Session earlier in the year; it is the beginning of the state fiscal year (in this case SFY17).  We will try to summarize some of the major items which will (or will not) impact our members and include a couple of things that are new but only coincidental to the beginning of the Fiscal  Year! Legislative Issues:

• HB691 – D. Every employer shall report to the Virginia Department of Labor and Industry within eight hours any work-related incident resulting in (i) a fatality, (ii) or within 24 hours any work-related incident resulting in (i) the inpatient hospitalization of one or more persons, (iii)(ii) an amputation, or (iv) (iii) the loss of an eye, as prescribed in the rules and regulations of the Safety and Health Codes Board.
• HB342/SB466 – E. A guardian shall, to the extent feasible, encourage the incapacitated person to participate in decisions, to act on his own behalf, and to develop or regain the capacity to manage personal affairs. A guardian, in making decisions, shall consider the expressed desires and personal values of the incapacitated person to the extent known and shall otherwise act in the incapacitated person’s best interest and exercise reasonable care, diligence, and prudence. A guardian shall not unreasonably restrict an incapacitated person’s ability to communicate with, visit, or interact with other persons with whom the incapacitated person has an established relationship.
• HB675 –  Extends eligibility for auxiliary grants to include individuals residing in supportive housing, provided that the supportive housing provider has entered into an agreement for the provision of supportive housing with the Department of Behavioral Health and Developmental Services. The bill establishes requirements for providers of supportive housing that enter into agreements with the Department and limits participation to 60 individuals.
• HB536 – Establishes a requirement for a national fingerprint-based background check for providers of sponsored residential and shared living services. Legislation requested by VNPP to permit the checks to be done; existing code was not permissive.  We have inquired if DBHDS-OL intends to provide guidance on how they plan to implement.
• HB646 – The Commissioner of DBHDS shall: Submit a report for the preceding fiscal year by December 1 of each year to the Governor and the Chairmen of the House Appropriations and Senate Finances Committees that provides information on the operation of Virginia’s publicly funded behavioral health and developmental services system. The report shall include a brief narrative and data on the number of individuals receiving state facility services or community services board services, including purchased inpatient psychiatric services; the types and amounts of services received by these individuals; and state facility and community services board service capacities, staffing, revenues, and expenditures. The annual report shall describe major new initiatives implemented during the past year and shall provide information on the accomplishment of systemic outcome and performance measures during the year.

Of the 778 legislative actions other than the two Budget Bills the above five are most relevant – others will have a significant impact on the CSBs. Budget Issues – Medicaid #306: With the exception of that noted below all items are delayed until at least August 1 or pending the approval of CMS which ever is later!

• CCCC.1. The Department of Medical Assistance Services shall adjust the rates and add new services in accordance with the recommendations of the provider rate study and the published formula for determining the SIS levels and tiers developed as part of the redesign of the Individual and Family Developmental Disabilities Support (DD), Day Support (DS), and Intellectual Disability (ID) Waivers. The department shall have the authority to adjust provider rates and units, effective July 1, 2016, in accordance with those recommendations with the exception that no rate changes for Sponsored Residential services shall take effect until January 1, 2017. The rate increase for skilled nursing services shall be 25 percent.
• 2. The Department of Medical Assistance Services shall have the authority to amend the Individual and Family Developmental Disabilities Support (DD), Day Support (DS), and Intellectual Disability (ID) Waivers, to initiate the following new waiver services effective July 1, 2016: Shared Living Residential, Supported Living Residential, Independent Living Residential, Community Engagement, Community Coaching, Workplace Assistance Services, Private Duty Nursing Services, Crisis Support Services, Community Based Crisis Supports, Center-based Crisis Supports, and Electronic Based Home Supports; and the following new waiver services effective July 1, 2017: Community Guide and Peer Support Services, Benefits Planning, and Non-medical Transportation. The rates and units for these new services shall be established consistent with recommendations of the provider rate study and the published formula for determining the SIS levels and tiers developed as part of the waiver redesign, with the exception that private duty nursing rates shall be equal to the rates for private duty nursing services in the Assistive Technology Waiver and the EPSDT program. The implementation of these changes shall be developed in partnership with the Department of Behavioral Health and Developmental Services.
• 3. Out of this appropriation, $328,452 the first year and $656,903 the second year from the general fund and $328,452 the first year and $656,903 the second year from nongeneral funds shall be provided for a Northern Virginia rate differential in the family home payment for Sponsored Residential services. Effective January 1, 2017, the rates for Sponsored Residential services in the Intellectual Disability waiver shall include in the rate methodology a higher differential of 24.5 percent for Northern Virginia providers in the family home payment as compared to the rest-of-state rate. The Department of Medical Assistance Services and the Department of Behavioral Health and Developmental Services shall, in collaboration with sponsored residential providers and family home providers, collect information and feedback related to payments to family homes and the extent to which changes in rates have impacted payments to the family homes statewide.
• 4. For any state plan amendments or waiver changes to effectuate the provisions of paragraphs CCCC 1 and CCCC 2 above, the Department of Medical Assistance Services shall provide, prior to submission to the Centers for Medicare and Medicaid Services, notice to the Chairmen of the House Appropriations and Senate Finance Committees, and post such changes and make them easily accessible on the department’s website.
• 5. The department shall have the authority to implement necessary changes upon federal approval and prior to the completion of any regulatory process undertaken in order to effect such changes.

• DDDD. The Department of Medical Assistance Services shall amend the 1915 (c ) home-and-community based Intellectual Disabilities waiver to add 390 slots effective July 1, 2016 and an additional 415 slots effective July 1, 2017. The Department of Medical Assistance Services shall seek federal approval for necessary changes to the ID waiver to add the additional slots.

• EEEE.1. The Department of Medical Assistance Services shall amend the Individual and Family Developmental Disabilities Support (DD) waiver to add 140 new slots effective July 1, 2016 and an additional 25 slots effective July 1, 2017. The Department of Medical Assistance Services shall seek federal approval for necessary changes to the DD waiver to add the additional slots.
• 2. Effective July 1, 2016, the Department of Medical Assistance Services shall amend the Individual and Family Developmental Disabilities Support (DD) waiver to add 200 slots in fiscal year 2017 for individuals at the top of the chronological waiting list as of June 30, 2016. [This item is not delayed and should go on as planned]
• 3. Out of this appropriation, $632,040 the first year and $632,040 the second year from the general fund and $632,040 the first year and $632,040 the second year from nongeneral funds shall be used for up to 40 emergency reserve slots for emergencies, for individuals transferring between waivers and for individuals transitioning from an Intermediate Care Facility (ICF) or state nursing facility (SNF) to the community to ensure the health and safety of individuals in crisis. The Department of Medical Assistance Services shall amend the appropriate waiver to add up to 40 emergency reserve slots across the Intellectual Disability (ID) waiver, Individual and Family Developmental Disabilities Support (DD) waiver and Day Support (DS) waiver within the limits of this appropriation, effective July 1, 2016. The Department of Medical Assistance Services shall seek federal approval for necessary changes to the ID, DD and DS waivers to add the additional emergency reserve slots.

Budget Issues – DBHDS #311:

• AA. Out of this appropriation, $4,270,500 the first year and $4,270,500 the second year from the general fund is provided for permanent supportive housing to support rental subsidies and services to be administered by community services boards or private entities to provide stable, supportive housing for persons with serious mental illness. The Department of Behavioral Health and Developmental Services shall report by October 1, 2016, the number of individuals being served through Permanent Supportive Housing, how the funds are allocated by organization, the average rental subsidy, and any available outcome-based data to determine effectiveness in preventing hospitalizations, incarceration or homelessness.

• BB.1. Out of this appropriation, up to $4,000,000 the first year shall be provided from the Behavioral Health and Developmental Services Trust Fund for one-time expenses related to developing housing options, specialized services and making capital improvements to enhance and expand services for individuals with intellectual and developmental disabilities. A minimum of 60 percent of the appropriation shall be used to build additional capacity in Northern Virginia for Virginia citizens with intensive behavioral and/or medical needs who currently are not able to access needed services or residential supports. The remaining funding shall be for projects that address the needs of individuals who are transitioning to the community from the Southwestern Virginia Training Center. Such projects shall be located in Virginia within 100 miles of the Southwestern Virginia Training Center. The Department of Behavioral Health and Developmental Services shall give preference to projects involving existing Virginia providers to expand service capacity.
• 2. The Department of Behavioral Health and Developmental Services shall report on the use of the funds from the Trust Fund by December 1, 2016 to the Chairmen of the House Appropriations and Senate Finance Committees.
• 3. Pursuant to language contained in Item 312, paragraph C., any unexpended funds in the Trust Fund shall remain in the Trust Fund and are subject to an appropriation in an appropriation bill passed by the General Assembly.

• CC. Out of this appropriation, $400,000 the first year and $400,000 the second year is provided for rental subsidies and associated costs for individuals served through the Rental Choice VA program.

• DD. Out of this appropriation, $1,875,000 the first year and $3,750,000 the second year from the general fund shall be used to implement a program of rental subsidies for individuals with intellectual and developmental disabilities.

• EE. Out of this appropriation, $636,000 the first year and $480,000 the second year from the Behavioral Health and Developmental Services Trust Fund is provided for the transitional costs of individuals moving from state intellectual disability training centers into alternate settings.