~Settlement Advances Existing Efforts to Transition to Community-Based Care and Concludes Investigation Dating Back to 2008~
RICHMOND — Governor Bob McDonnell announced today that a settlement agreement has been reached between the Commonwealth and the U.S. Department of Justice (DOJ) regarding Virginia’s compliance with the Americans with Disabilities Act (ADA) and the 1999 Supreme Court decision in the Olmstead case.
The investigation, which began in 2008 at the state-run Central Virginia Training Center in Lynchburg, was expanded in 2010 to cover Virginia’s comprehensive system of services for individuals with intellectual and developmental disabilities, including all five state training centers and community-based services. DOJ issued a findings letter to Governor McDonnell in February 2011 that concluded Virginia is not providing services in the most integrated and appropriate setting, not developing a sufficient quantity community services, and that Virginia has a flawed discharge process at training centers. Virginia then began good-faith negotiations to reach a settlement agreement with DOJ while not subjecting the Commonwealth to a costly and lengthy legal battle.
“The settlement agreement reflects Virginia’s long-term goal of improving treatment for intellectually and developmentally disabled Virginians,” said Governor McDonnell. “For decades we have said we ought to move to a community-based system for individuals with developmental disabilities and reduce our dependence on state-run training centers, the most costly and restrictive form of services available. In fact, when I was a delegate, I patroned legislation to help set the policy to ensure Virginia was providing the most compassionate, least-restrictive, community-based care for these individuals to ensure their highest possible quality of life. While we have made progress, and would have continued to make progress without this agreement, this agreement accelerates those efforts in a fiscally responsible and strategic manner. This agreement will ultimately provide the necessary services so more individuals with intellectual and developmental disabilities can live successfully in their home communities and it will lead to a more effective use of public funds.”
In addition, Virginia is required to provide a plan to the Chairmen of the House of Delegates Appropriations and Senate Finance Committees within one year of the agreement to cease residential operations at four of Virginia’s training centers. This is consistent with Virginia’s longstanding policy of transitioning individuals from an institutional model of care to a community-based system to meet the needs of the population served by the training centers. The population of the training centers has declined from 6,000 individuals to approximately 1,000 individuals. Virginia’s latest projections show there will be fewer than 1,000 residents in training centers by March 31, 2012, with the census dropping to less than 600 by 2015. The continued operation of residential services at current levels is fiscally impractical due to the significant and ongoing decline in population.
Major highlights include:
Expanding Community-Based Services
· Adds 4,170 new Intellectual Disability (ID) waiver slots over 10 years to transition individuals currently living in training centers to community services and to provide for continued growth of slots for individuals in the community who are on the waiting list for waiver slots
Supporting Quality Community-Based Services
· Strengthens quality and risk management systems for community services
· Expands the role of licensing specialists and the responsibilities of case management services
Transitioning from Training Centers
· Helps guide and support individuals moving from training centers to new homes by creating teams to facilitate communication and planning with individuals and families, and to resolve any problems delaying discharges
· Virginia is required to provide a plan to cease residential operations at four of Virginia’s training centers. Plans have been developed and include timeframes for training center closures as follows: Southside Virginia Training Center in Petersburg (to close by June 30, 2014), Northern Virginia Training Center in Fairfax (by June 30, 2015), Southwestern Virginia Training Center in Hillsville (by June 30, 2018), and Central Virginia Training Center in Lynchburg (by June 30, 2020). Southeastern Virginia Training Center in Chesapeake will continue to downsize to 75 beds.
Secretary of Health and Human Resources Bill Hazel said, “Throughout negotiations, we took painstaking efforts to ensure the final result would be the best possible outcome for Virginians with intellectual and developmental disabilities and that it would be fiscally responsible. I believe we’ve achieved both objectives. Our focus now turns to working closely with individuals in training centers and their families to help them choose the best community setting that meets their unique needs and preferences, and to ensure safe, successful transitions to their new homes. Meanwhile, we will be developing new services and improving oversight in communities statewide. It will be challenging, but our goal is to close training centers safely while simultaneously adding community waiver slots so we are steadily reducing the waiver waiting list.”
The Department of Behavioral Health and Developmental Services (DBHDS), which operates the training centers, will also be maximizing options for training center staff. There are approximately 3,050 employees at the four training centers that will close between 2014 and 2020. DBHDS will provide information and explain options, answer questions and help employees find positions at other DBHDS facilities, other state agencies or community-based services wherever possible.
“We want to help training center staff as they determine their next steps,” said Secretary Hazel. “Training center staff are among the most qualified to fill the positions that will be needed when more community homes and programs open to support training center closures and waiver waiting list reduction. We hope they will work in the new homes or even become providers themselves.”
In the 2011 General Assembly session, Governor McDonnell and legislators together added $30 million to the Behavioral Health and Developmental Services Trust Fund to transition individuals from training centers to the community in preparation for the pending settlement agreement with DOJ.
This year, Governor McDonnell included an additional $30 million in his proposed budget for the coming session to continue to meet the terms of the agreement.
Background on Virginia’s developmental disability system includes:
· The combined census of the five state-run training centers for individuals with intellectual disability has dropped 42 percent. Today, there are 1,018 training center residents statewide (as of Jan. 5, 2012) in facilities with a combined capacity of 6,000. Statewide, these facilities average 70 discharges annually as a result of residents moving to the community and natural deaths, and average only 13 long-term admissions annually as more families choose community-based services.
· Training center costs account for 63.8 percent of appropriations for individuals with intellectual disability and support only 15.6 percent of the population with intellectual disabilities served in Virginia.
· Currently, the statewide average per-person cost in training centers is $216,000 which includes direct services, administrative support and high infrastructure requirements.
· Virginia provides alternatives to institutional services through the use of Medicaid “waivers” which enable individuals with intellectual disability to receive services while living in the community. 8,621 people (as of Jan. 6, 2012) receive services through a Medicaid Home and Community-Based Intellectual Disability (ID) Waiver. There is a waiting list for ID waiver services which now stands at 5,932 individuals; of these, 3,316 are considered urgent.
· Because smaller community homes’ administration and infrastructure costs are significantly lower than training centers, the statewide average per-person cost in the community is $138,000 for individuals with comparable care needs as training center residents.