Insider News for Members

A little bit of background on the strategy to influence to budget because of the dramatic increase in base wage for overtime eligibility which will be effective on January 1st:
  • It is a given that no one likes being bothered with details when they are already overwhelmed by a project, and
  • As a matter of what I think is good and effective practice, and which has proved reasonably successful in years past, I deliberately do not nag at members of the General Assembly when they have all the information they need and are in the negotiation phase of the budget.
  • I will get in their field of vision, ask how their day is going, comment on the weather, their attire (if appropriate) or the great news article about something in their district — but I do not repeat the “ask” unless they have questions!
  • And we are very careful that there is always a “one pager” that is clean, clear, bulleted, and to the point!

And then the DOL OT Rule came along!  We did a News Post which was the text that I sent to key members of the “Money” Committees and staff, there were (much against my better judgement) three attachments to provide a little more information on a complicated topic.  Step 2 was to wait 24 hours and reach out as a follow-up, and Step 3 was to schedule a call with key staff of the most critical legislator and explain the issue.
  • We always support that our staff get well paid (the Legislator is a Democrat), and
  • This does not affect our DSPs (if we are paying them a base that is this high and not paying OT, that is a problem for many reasons), but it does impact our critical mid-level supervisors in DD Services who keep services running and fill all of the gaps . . ., and
  • We did not expect this increase (July will be OK, but January will stretch our capacity and it is before a new budget) AND we actively worked with our partners to have HHS/CMS and DOL coordinate their approach, etc., and
  • We have only had a couple of days to analyze this, can’t really firm up the impact yet, but one of my members said . . . , and
  • A simple ask is to move the 3% targeted for July 1, 2025 up to January 1, 2025 – 6 months more money, but if we can’t meet the DOL requirements, we can’t expand to serve all those new slots – – there will be some savings there!

The quote below is the Governor’s comment on the legislators adjourning with a budget and on time!  It is a bit of af a backhanded compliment and clearly shows his displeasure about the budget, but it was inevitable given he has a different vision and has been forced to accept that on some things he is not in charge!    So far the Democratic majority and leadership has shown itself to be quite capable of managing all by themselves! 

“Thank you to all 140 legislators that made the huge commitment, sacrificing time away from their families, their careers and their livelihoods, to serve the Commonwealth and all Virginians,” said Governor Glenn Youngkin. “The General Assembly sent me more than a thousand bills plus backward budgets that need a lot of work. We’re going to have a busy 30 days going into the reconvene session. Nonetheless, I’m grateful for the tremendous commitment and sacrifice that our General Assembly and their staffs have made on behalf of the Commonwealth.” 

The central focus of the workforce initiative mention below is the creation of two new position types:

“Behavioral health technician” means a person who has completed, at a minimum, an associate
 degree and registered with the Board to practice in accordance with the provisions of § 54.1-3518 and
regulations of the Board and provides collaborative behavioral health services. A “behavioral health
technician” shall provide such services as an employee or independent contractor of the Department of
Behavioral Health and Developmental Services, the Department of Corrections, or the Department of
Education or a provider licensed by the Department of Behavioral Health and Developmental Services.

“Behavioral health technician assistant”
means a person who has completed a high school diploma

or equivalent, at a minimum, and registered with the Board to practice in accordance with the
regulations of the Board and the provisions of § 54.1-3519 to provide collaborative behavioral health
services. A “behavioral health technician assistant” shall provide such services as an employee or
independent contractor of the Department of Behavioral Health and Developmental Services, the
Department of Corrections, or the Department of Education or a provider licensed by the Department of
Behavioral Health and Developmental Services.

And a new “service” description:

“Collaborative behavioral health services” means those supportive services that are provided by a
registered behavioral health technician, registered behavioral health technician assistant, registered
qualified mental health professional, or registered qualified mental health professional-trainee under the
direction of and in collaboration with either a mental health professional licensed in the Commonwealth
or a person under supervision as a prerequisite for licensure who has been approved by the Board of
Counseling, Board of Psychology, or Board of Social Work

There are also significant (positive) changes for QMHPs, such as, eliminating the “A” and “C” and allowing Q’s to supervise others under certain circumstances.   Details of the scope of practice for all of these positions is in SB403  beginning on line 185. 

So here is the question – given qualifications and scope of practice, will you have positions within your organizations for the new positions that will enhance your services or your bottom line?

While we have been talking about “workforce” for literally years, it has become the bright shiny object this session and a real favorite of the Governor’s Office; now don’t get me wrong – I am glad that we are no longer singing solo, but have a virtual chorus behind us.  But it is not yet clear, if the results will be helpful.  We have set the standard of “do no harm.”  A very low bar!

This weekend, I will try to post an analysis of the most recent version of the Workforce Bill; I wouldn’t hold out too much hope that it won’t change again – we have had at least four version in the past  week!  And if you hear a rumor that I was called out in committee to day with a thank you for my input and contributions, it’s true.  I have made suggestions, unfortunately it sounded like I had “approved” the version du jour and I had not even seen it!  And, by the way, I have concerns.


As is not uncommon, the General Assembly members rather quickly come to talking a lot about the “themes” of a particular Session and that has happened in this Session as well.  Tax policy (a push for the administration) vs minimum wage increases and paid leave to benefit those who make the least; funding for existing services to expand access vs the creation of new services (because clearly what exists is not “solving” the problem); looking at the treatment/support options from the perspective of the individual or the perspective of the family; expansion of gun rights vs expansion of gun control/safety; and then there is the TikTok issue!

An amazing number of these issues become our issues at some point – guns barred from our facilities and possession becoming a misdemeanor seems ok, until you think of the Sponsored Residential provider who is a life long hunter; raising the minimum wage is the right thing to do, until you can not get the Medicaid rates to keep up; funding new services seems right, until you realize that they will not allow a provider to have a sustainable business model.  

So far, we seem to be balancing between the options pretty well, and that, we hope will continue!
We are only at the end of the first week of the 2024 Session (nevermind it was a 3 day week!);
it feels both like, it hasn’t really started yet and like it has been forever!   There are many things that make this Session a little different:
  • The new building which is, as one wise AA said this week, a work in progress
  • The large number of new members in both the House and the Senate
  • The first black Speaker of the House in the 400+ year history of the Assembly
  • The most diverse group of legislators ever and control of both chambers by the same party, but different from the Governor’s
We have some legislative themes, which is not unusual, and you can pick those out by reviewing the list of bills posted above.    I am generally pleased that I do not have to be the first one to bring up the capacity challenges, and that everyone seems to “get” the need to actually pay for services if you want access and quality!


With more than a bit of cynicism, David Ress (General Assembly Reported for the RTD) gave voice this morning the to growing wave of opinion that soon the Virginia State House will be no less dysfunctional the the US Capitol.  That is, at best, a depressing thought. 

But the points made by the several political science experts he interviewed were valid.   We have a Governor whose one complete budget needs to be a stepping off point, a revived Democrat majority and a lot of new members who, by necessity, ran on “positions” and not their experience or their records (many have neither!)

So, we will need to push through the chatter and try to keep our focus!

2 January, 2024


As we were wrapping up the discussion of the recent QIC Meeting this morning. and I read the last update to the revisions of the Key Performance Areas (KPAs), I suddenly realized how significant the change in language actually was!   From the previous version of the Provider Capacity/Competency KPA Outcome:

Provider maintain a stable and competent workforce, are able to meet initial licensing regulations and maintain compliance, and individuals have access to an array of services that meet their needs.

DBHDS has now moved to a Revised KPA Provider Capacity/Competency Outcome:

Having enough providers, who are knowledgeable, trained, and experienced, in our network to ensure equitable and timely access to supports/services.

Does this mean that there really is a capacity problem?

15 December, 2023


Some things are predictable, annoyingly so!  The Richmond paper carried a story this morning that captured exactly what the Governor’s Coms teams wanted — all of the items mentioned in his speech yesterday magically were rolled into a list of  “what is being proposed in his budget!”    Not a new phenomenon — every Governor does it, but nevertheless for those of us who need to keep the story straight for our members – it is very frustrating.  

New in the Governor’s budget for this year: $300M for slots, something for Special Olympics ($600K) and the funding for the AT blend that was actually in the budget last year, but apparently not funded.    He did not include any funding for a rate increase!

14 December, 2023


JLARC Reports,
which seem in recent years to often focus on the world of behavioral health services, do drive a fair amount of the legislative focus in any given Session.  It looks like this year will be no exception with the report which was presented this week to the Commission.   The Executive Summary of Findings and the Recommendations can be found here. 

It is worth a read for several reasons:
  • It will become a part of the foundation for the expected DOJ investigation of the State Hospitals; only wrapping up the rest of the current DOJ investigation seems to be holding them back!
  • While many of the issues are staffing related, the proposed solutions seem to focus more on “forcing” the system to work better [Recommendations #3, #5, #9, #10, #11, #12] rather than working out ways to improve the quality.  
  • And, in the current environment, it will become a very hot topic for the General Assembly!

12 December, 2023


As is the norm, 
Governor Youngkin will preview significant items which will be included in his budget prior to its release on the 20th of December.    This gives him the opportunity to publicize the priorities of his administration in a venue that is not overseen by the members of “the other party” and without a great deal of concern about how it fits into the overall plan of the “money” committees.   

This week we will hear about his funding for two aspects of his Right Help Right Now initiative – additional slots for the DD Waivers and additional funding for Crisis Services.   We will share the details as they are available and there will be also considerable publicity!

The insider, however, will remember that the Governor’s Budget is just the first step of the process;  there will be many proposals,  discussions, and negotiations before the final budget is published.   It will, however, be important for VNPP to finalize a position on the relevant proposals so that we can include our position in our Legislative Agenda!

9 December, 2023 


Committee Chairs
 are a key element in how bills progress through the House and the Senate, with the considerable turnover in both chambers and the Democrats having the majority (admittedly a small majority) in both, the Chairs will play perhaps a larger role this year guiding bills the rough the process.  

We are making efforts to connect with the key committee chairs and their staff to make sure that, as much as will be relevant in each committee, we have the relationships needed to be able to share our concerns and priorities.   Most of our policy issues are heard by the House Welfare and Institutions Committee (now to be called Health and Human Services Committee) will be chaired by Delegate Mark Sickles,  (Northern Virginia) and in the Senate by Senator Gzazala Hashmi (Chesterfield County).   They are both individuals we have worked with in the past.  

The “Money Committees” will be chaired by Senator Louise Lucas (Portsmouth) and Delegate Luke Torian (Northern Virginia).  The Senate Finance and Appropriations HHR Sub-committee will be chaired by Senator Creigh Deeds, also Chair of the Behavior Health Commission!  He is very knowledgeable and passionate!  The comparable House Appropriations Committee Sub-committee will likely be chaired by Delegate Sickles, though I do not believe that has been announced as yet.

6 December, 2023


The Issue with Minimum Wage!

We support the efforts to increase the minimum wage in 2024 as we did in 2020 with the same caveat – if the Commonwealth determines that the minimum wage is to be increased, the Commonwealth must proactively increase the Medicaid Rates paid for services which are dependent on lower wage workers.  Not only is there potentially a direct impact on the wages for those workers, but

  • Wage increases in other sectors (which can be offset with price increases) increase the competition for qualified workforce at a time when the workforces challenges are already impacting access to service;
  • An increase in the minimum wage forces increases for mid-level and upper level supervisory staff to avoid the destructive impact of wage compression,
  • There are additional costs associated with wages (increases in Worker’s Compensation, etc) which must be covered by the providers.

We are concerned that with the reenactment, there will be no further attention to the requirements of the plan for annual adjustments in January based on an adjusted state hourly minimum wage determined just three months earlier

The rhythm and sequencing as outlined will not afford the Commonwealth the time or a mechanism to make the Medicaid rate adjustment which will be needed.

4 December, 2023