qm_fall_2015

irginia

apitol

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2015

Thank you for your service on this Subcommittee. My name is

Rikki Epstein. I amExecutive Director of TheArc of NorthernVirginia.

I am delighted to be joined today by Jane Anthony, Co-President of

Parents and Associates of the Northern Virginia Training Center. We

appear today on behalf of organizations in Northern Virginia that

represent individuals with Intellectual and Developmental Disabilities

(I/DD) and their families. Today, we share a common interest in seeing

that both the Department of Behavioral Health and Developmental

Services (DBHDS) plan to implement the Settlement Agreement and

the quality assurance provisions of SB 627 are carried out in the best

way to meet the needs of Northern Virginians.

Specifically, we believe success requires three things:

1. Revise the DBHDS Trust Fund provisions to assure that the revenues

from the sale of the Northern Virginia Training Center (NVTC)

property are used to serve the needs of people with I/DD who reside

in this region, and assure that the proceeds from the sale of other

Training Centers’ property go to support people in their respective

regions;

2. Make sure the outcome of Medicaid Waiver Reform is a system

that provides funding that is appropriate to each region of the State.

Equity requires that sufficient funds be made available so that people

with I/DD, either moving from NVTC or from the waiting list, are

able to find local placements in Region II to remain in contact with

their families and communities of natural supports, just as people

with I/DD from other regions of the Commonwealth have the

resources to remain in their local regions; and

3. Assure that all people with I/DD who receive services from the

state benefit from a robust quality management system based on

scientifically sound methods and establishing performance baselines

to ensure people’s health, safety, and well-being.

The Trust Fund.

As the planned closure deadline for NVTC fast

approaches, we have some increasingly urgent concerns about the

current Trust Fund that is slated to receive and distribute proceeds from

the sale of the NVTC property. As the language for the Trust Fund is

currently written, the funding from the NVTC sale could be used in

areas of the state outside Northern Virginia or could be diverted for

other purposes entirely.

The Trust Fund must assure regional equity. As you all know,

Northern Virginia is a more expensive area to live in than many other

parts of the State. The service providers and Community Services

Boards in this area have consistently said that the very high cost of

living in the NorthernVirginia region is a substantial hurdle to opening

more residential settings, especially on tight timelines. Statewide, the

waiting list for community waiver slots is well over 10,000 people,

almost exceeding those receiving waiver supports, and in Northern

Virginia the waiting list for ID Waivers already exceeds the number

receiving supports by 34%. Clearly, there is a need for start up money

to serve people with disabilities within all regions and especially

Region II and for revisions to protect the Trust Fund assuring that it

serves its intended purposes.

NVTC families have researched the history of the creation of

NVTC and affirmed that many of their families were involved in

donating some of the land NVTC was built upon. Their very purpose

was to enable the State to build a local facility so that they could spend

more time with their loved ones with disabilities. Out of a basic sense

of fairness for those families and the thousands of Northern Virginians

with I/DD on waiting lists for services due to funding shortages, we

ask you to ensure that the DBHDS Trust Fund is protected and used

as intended.

In protecting the Trust Fund, this Subcommittee and the General

Assembly at large will be taking a big step towards fulfilling the

promise of appropriate, quality care in the community and offering

choice for people with intellectual and developmental disabilities. To

secure these protections, we request that you take the following actions:

1. Reestablish the Trust Fund through a constitutional amendment that

requires funding derived from the sale of Training Center lands be

used only for people with I/DD in the region from which funding

originated for one-time needs such as start-ups and unforeseen

emergencies; and

2. Require that DBHDS submit a clearly detailed report annually to

this Subcommittee and the General Assembly on all deposits into the

Trust Fund and all expenditures.

FundingMedicaidWaiver Reform toAssure Local Placements.

With the new reforms not scheduled to be implemented until after

the March 2016 closure date for NVTC, local providers have been

reluctant to assume the long-term obligations for the residents with the

most significant disabilities leaving NVTC and those coming off of the

waiting lists. To underscore this concern, there have been anecdotes

of people opting for placements outside the region in order to get the

services they need. According to the Department’s data, only 24%

of those discharged from NVTC in 2015 found local placements in

contrast with 74% for the rest of the state. A recent DOJ letter supports

this conclusion. Given the importance of keeping those with I/DD near

their families and natural supports, we request that the Subcommittee:

• Secure from DBHDS the information necessary to understand the

magnitude of this problem so that the General Assembly will be

better able to understand how Medicaid Waiver Reform must be

crafted to meet the needs of Northern Virginians.

• Establish a Quality Management system that assures the safety,

health and integration of people with I/DD. The settlement agreement

contains detailed requirements for Virginia to collect new data, to

greatly expand its quality management for those in the community,

and to report on instances of mortality and significant harm to those

who transition fromTraining Centers into the community. In addition,

SB 627 requires that DBHDS certify that the residents of Training

Centers who move into the community receive supports and services

that are “comparable” to the ones being received in the Training

Center. These basic provisions of the settlement agreement and SB

627 are essential for the health, safety and well-being of those with

I/DD receiving waiver supports in the community. They will benefit

both those moving from the Training Centers and off the waiting

lists. Unfortunately, the necessary quality management measures do

not track the closure schedule for either SVTC or NVTC or with

the schedule in the settlement agreement. It is vital that DBHDS

expedite quality management employing scientifically valid data and

methods.

To enhance quality management, we ask that the Subcommittee

request DBHDS to take the following action:

Describe and report to the Subcommittee and the public, within 3

months, the scientifically valid performance measures DBHDS plans

to use to address each important aspect of health, safety, and well-being

for people with intellectual and developmental disabilities currently

served by DBHDS. This report should include an analysis of mortality

data for individuals who have left Training Centers. Thank you for

your dedication to ensuring that all individuals with intellectual and

developmental disabilities inVirginia receive the supports and services

they need to live healthy, safe, and fulfilling lives in Virginia.

Testimony provided September 2, 2015.

Joint Statement of The Arc of Northern Virginia and

Parents and Associates of the Northern Virginia Training

Center to Members of the Special Joint Subcommittee to

Consult on the Plan to Close State Training Centers