MEDICAID WAIVERS. THE FOLLOWING CHART OF CURRENT WAIVER SERVICES IS AVAILABLE AT:

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1 MEDICAID WAIVERS I. Overview a. Medicaid Waivers are authorized by 1915(c) of the Social Security Act; 42 USC 1396 et seq. b of the Code of Virginia c. 12 VAC et seq. II. Available Waivers in Virginia Today a. Intellectual Disability (ID) Waiver THE CADILLAC - 12 VAC i. Age 6+ with an intellectual disability diagnosis ii. Children under age 6 with a developmental risk of intellectual disability iii. Imminent risk of institutional placement iv. Urgency of need based waiting list---4,943 urgent people and 3,224 non-urgent people on list as of January b. Individual and Family Developmental Disabilities (DD) Support Waiver 12 VAC i. Age 6+ ii. Developmental disability diagnosis (autism) iii. No intellectual disability diagnosis iv. Imminent risk of institutional placement v. Chronologically based waiting list---2,035 people as of August 2015 c. Elderly or Disabled with Consumer Direction Waiver (ED/CD) - 12 VAC i. Individual requires a nursing facility level of care ii. Lacks functional capacity for activities of daily living iii. Has medical/nursing needs iv. Imminent risk of nursing facility placement d. Day Support Waiver for Individuals with Mental Retardation - 12 VAC et seq. i. Must be on the ID Waiver waiting list e. Alzheimer s Waiver - 12 VAC et seq. f. Home and Community-Based Services for Technology Assisted (TA) Individuals Waiver - 12 VAC et seq. i. Individual requires acute hospitalization or specialized skilled nursing case ii. Dependent on technological support g. AIDS Waiver h. Children s Mental Health Waiver (demonstration project; no new enrollments allowed since 2012) THE FOLLOWING CHART OF CURRENT WAIVER SERVICES IS AVAILABLE AT:

2 Insert ARC Waiver Services Chart Here

3 III. Waiver Redesign in Virginia COMING SOON!! a. Overview i. Effective July 1, 2016 ii. Old Waivers to New Waivers iii. Community Service Board ( CSB ) now the single point of entry and one assessment procedure for I/DD eligibility and case management iv. New unified/shared waiver waiting list and selection process b. Department of Justice Settlement Agreement with VA ( DOJSA ) and Waiver Redesign i. On January 26, 2012, Virginia and the DOJ reached a settlement agreement to resolve an investigation of the Central Virginia Training Center under the Civil Rights of Institutionalized Persons Act ( CRIPA ) started in 2008, and Virginia s compliance with the Americans With Disabilities Act ( ADA ) and the U.S. Supreme Court ruling in Olmstead v. L.C. ex. Rel. Zimring, 527 U.S. 581 (1999). 1 Outcomes include: c. Closing Training Centers there were five in 2000 and there will be only 1 (Southeastern VA Training Center) with 75 beds after since 2000 one center has closed (Southside Training Center) and the total census in all facilities has dropped by 76%. 2 d. Enhanced Case Management e. Changes to comply with the Settings Rule by 2018 or Medicaid disenrollment for waiver services f. Conflict Free Case Management g. Beginning of Employment First and moving away from facility based programs h. Preference for smaller more integrated settings ii. As training centers close and waiver redesign is adopted, more focus will be on the CSBs to successfully implement DOJSA specifics in the local community c. Waiting List Management i. Once CSB determines eligibility for the I/DD Waiver, individuals will placed on (1) unified waiting list categorized by Priority 1, Priority 2 or 3 rather than Urgent or Non-Urgent ii. DBHDS will establish and train an impartial body, the Waiver Advisory Selection Committee (WSAC). The WSAC is responsible for determining which individuals will receive a waiver slot based upon the urgency of need iii. WSAC Members are: 1. Nominated to DBHDS by the CSB and CANNOT be current CSB Board Members or CSB employees 1 Va. Dep t of Behav. Health and Dev. Serv., DOJ SETTLEMENT AGREEMENT, (last visited May 6, 2016). 2 Va. Dep t of Behav. Health and Dev. Serv., Presentation: TC Closure (Dec. 16, 2015),

4 2. Members CANNOT be employees, owners or board members of any agency providing waiver services 3. Members CANNOT be a family member of an individual on the I/DD Waiver Waiting List seeking services IV. Old Waiver vs. New Waiver a. OLD: Day Support Waiver (day support, employment, and pre-vocational for individuals with an Intellectual Disability diagnosis) NEW: Building Independence Waiver (for adults 18+ to live independently in the community where supports are episodic or periodic in nature) iv. Community Guide / Peer Supports v. Independent Living vii. Community Engagement viii. Community Coaching b. OLD: Developmental Disability Waiver (a variety of services excluding group residential for individuals ages 6+ with a DD diagnosis) NEW: Family and Individual Supports Waiver (for children and adults living with their family, friends, or on their own to meet medical/behavioral needs) iv. Community Guide / Peer Supports v. Private Duty Nursing vii. Workplace Assistance viii. Community Engagement ix. Community Coaching c. OLD: Intellectual Disability Waiver (a variety of services including group residential for children and adults with an ID diagnosis) NEW: Community Living Waiver (24/7 supports and services for children or adults with complex medical and/or behavioral support needs, including residential supports)

5 iv. Community Guide / Peer Supports v. Private Duty Nursing vii. Workplace Assistance viii. Community Engagement ix. Community Coaching