Some Key Amendments Which Should Be Part of the 2014-16 Budget

June 13, 2014

Item 1 #1s

Legislative Department General Assembly Of Virginia Language

Language: Page 8, after line 27, insert: “N. The Special Joint Subcommittee to Consult on the Plan to Close State Training Centers shall continue to conduct a review of the assumptions behind the cost and cost savings of implementing the U.S. Department of Justice (DOJ) settlement agreement including but not limited to a review of the cost of providing care in the state intellectual disability (ID) training centers and in the community and an explanation of the difference in costs.”

Explanation: (This amendment requires the Joint Subcommittee to Consult on the Plan to Close State Training Centers to continue reviewing the cost and cost savings of implementing the Department of Justice (DOJ) settlement agreement, including a review of the cost of providing care in state training centers for the intellectually disabled and in the community and an explanation of the difference in costs.)

Item 301 #2s

Health and Human Resources Department Of Medical Assistance Services Language

Language: Page 263, strike lines 49 through 52. Page 264, strike line 1, and insert: “AAAA. The Department of Medical Assistance Services (DMAS) shall not change the unit of service or rate of reimbursement for Mental Health Skill-Building Services (MHSS) until the 2015 General Assembly has reviewed the impact of the December 1, 2013 emergency regulations that changed the eligibility and service description for Mental Health Skill-Building Services. DMAS and the Department of Behavioral Health and Developmental Services shall jointly prepare a report to be delivered by November 1, 2014 to the Chairmen of the House Appropriations and Senate Finance Committees. The report shall document the impact of the MHSS regulations implemented on December 1, 2013 and shall include an assessment of the fiscal impact, consumer and family impact, service delivery impact, and impact upon other agencies and facilities in Virginia.”

Explanation: (This amendment replaces language included in the introduced budget that requires the Department of Medical Assistance Services to amend the State Plan for Medical Assistance to make a budget neutral change to the Mental Health Support Services rate from an hourly unit to a quarter hour unit and instead prohibits DMAS from modifying the unit of service or rate of reimbursement for Mental Health Skill-Building Services (MHSS) prior to review by the 2015 General Assembly. Further, budget language requires a report on the impact of regulations implemented on December 1, 2013 that changed the eligibility and service description for Mental Health Skill-Building Services. The report shall be jointly prepared by DMAS and the Department of Behavioral Health and Developmental Services by November 1, 2014 and include an assessment of the impact of the regulatory changes on financing, consumers and families, service delivery and agencies and facilities.)

Item 301 #4s

Health and Human Resources

Department Of Medical Assistance Services $11,587 GF $11,587 NGF $11,727 GF $11,727 NGF

Language: Page 245, line 42, strike “$8,495,724,272” and insert “$8,495,747,446”. Page 245, line 42, strike “$8,761,183,102” and insert “$8,761,206,556”. Page 264, after line 26, insert: “FFFF. The Department of Medical Assistance Services shall have the authority to amend the 1915 (c) home- and community-based Elderly or Consumer-Direction (EDCD) waiver, Individual and Family Developmental Disabilities (DD) Support Waiver, Intellectual Disabilities (ID) waiver and Technology-Assisted (TECH) waiver, and associated regulations, to specify that transition services includes the first month’s rent for qualified housing as an allowable cost. The department shall have authority to implement this reimbursement change effective July 1, 2014 and prior to the completion of any regulatory process undertaken in order to effect such changes.”

Explanation: (This amendment provides funding to include the first month’s rent for qualified housing as an allowable cost under the home- and community-based Elderly or Consumer-Direction (EDCD) waiver, Individual and Family Developmental Disabilities (DD) Support Waiver, Intellectual Disabilities (ID) waiver and Technology-Assisted (TECH) waiver effective July 1, 2014. This amendment will provide additional assistance for individuals transitioning out of the state Intellectual Disability Training Centers.)

Item 301 #10s

Health and Human Resources FY 14-15

Department Of Medical Assistance Services ($7,839,878) GF ($7,839,878) NGF

Language: Page 245, line 42, strike “$8,495,724,272” and insert “$8,480,044,516”. Page 257, line 46, strike “340” and insert “115”. Page 257, line 49, strike “25” and insert “15”.

Explanation: (This amendment reduces $7.8 million from the general fund and $7.8 million in federal Medicaid matching funds the first year for Medicaid-funded, home- and community-based Intellectual Disabilities (ID) and Developmental Disability (DD) waiver slots consistent with the Department of Justice (DOJ) Settlement Agreement. The introduced budget over-funded the number of community-based ID and DD waiver slots required under the settlement agreement by 225 ID and 10 DD waiver slots in fiscal year 2015. The settlement agreement dictates that the number of slots created in excess of the “requirement shall be counted towards the slots required to be created in the subsequent fiscal year.” In fiscal year 2014, more than 350 ID and 55 DD waivers were created above the settlement agreement’s requirement, therefore fewer slots are required in fiscal year 2015.)

Item 301 #18s

Health and Human Resources FY 15-16

Department Of Medical Assistance Services $235,710 GF $235,710 NGF

Language: Page 245, line 42, strike “$8,761,183,102” and insert “$8,761,654,522”. Page 257, line 50, strike “25” and insert “40”.

Explanation: (This amendment provides funding for 15 new Medicaid home- and community-based waiver slots effective July 1, 2015 for individuals with developmental disabilities to reduce the current waiting list for services. This funding supports 15 slots in addition to the number of slots required pursuant to the U.S. Department of Justice Settlement Agreement.)

Item 301 #19s

Health and Human Resources FY 15-16

Department Of Medical Assistance Services $1,707,250 GF $1,707,250 NGF

Language: Page 245, line 42, strike “$8,761,183,102” and insert “$8,764,597,602”. Page 257, line 47, strike “360” and insert “410”.

Explanation: (This amendment provides funding for 50 new Medicaid home- and community-based waiver slots effective July 1, 2015 for individuals with intellectual disabilities. These new slots are in addition to the number of slots required under the U.S. Department of Justice Settlement Agreement during the 2014-16 biennium.)

Item 308 #6s

Health and Human Resources FY 14-15

Grants To Localities ($5,400,000) GF

Language: Page 270, line 5, strike “$353,662,156” and insert “$348,262,156”.

Explanation: (This amendment reduces $5.4 million from the general fund the first year to reflect the use of funds from the Behavioral and Developmental Services Trust Fund to offset the costs of providing services to individuals pursuant to the U.S. Department of Justice (DOJ) Settlement Agreement. The introduced budget provides additional general fund support for the Commonwealth’s commitment to provide necessary Medicaid waiver intellectual and developmental disability waiver slots, individual and family support services, crisis stabilization services, quality review, and other developmental disability services pursuant to the DOJ Settlement Agreement. The trust fund is estimated to receive $5.4 million in fiscal year 2015 from the sale of surplus state property located at Southeastern Virginia Training Center that can be used to offset additional DOJ costs included in this Act.)