Settlement Agreement Provision
The Commonwealth shall serve individuals in the target population in the most integrated setting consistent with their informed choice and needs.
About Integrated Living Options
The Commonwealth is committed to serving individuals with development disabilities in the most integrated settings appropriate to their needs and consistent with their informed choice. The state’s capacity to serve individuals with development disabilities across Virginia in integrated community based settings continues to grow. The DD waivers as redesigned in 2016 increase the services options available to support individuals to live in more integrated settings. The redesign also realigned the waivers funding structures to provide incentives to provider agencies that serve individual in integrated residential settings.
The Settlement Agreement uses the benchmark of four beds or less as an indicator of an integrated residential setting. Since the signing of the Agreement, Medicaid has issued final rules with respect to integrated settings for residential service types that must be met to receive Home and Community Based (Waiver) funding. The reports provided track both the movement of the DD Waiver population as they move to more integrated residential settings and the capacity of the service system to provide integrated residential options.
The other aspect of Integrated Community Living Options is the focus Virginia is placing on individuals who reside in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) and children in nursing homes. DBHDS has focused efforts to ensure that individuals seeking placements in these community institutional settings are informed about options in community. In addition there are dedicated staff working with individuals already in these settings, their families, Community Service Boards and other community resources to facilitate discharges to integrated community based services.
Trend Data
Compliance Indicator 18.9 Language:
DBHDS established a baseline annual utilization rate for private duty (65%) and skilled nursing services (62%) in the DD Waivers as of June 30, 2018 for FY 2018. The utilization rate is defined by whether the hours for the service are identified as a need in an individual’s ISP and then whether the hours are delivered. Data will be tracked separately for EPSDT and waiver funded nursing. Seventy percent of individuals who have these services identified in their ISP (or, for children under 21 years old, have prescribed nursing because of EPSDT) must have these services delivered within 30 days, and at the number of hours identified in their ISP, eighty percent of the time.
Compliance Indicator 29.20 Language:
The Commonwealth shall meet the following: a. At least 86% of the people supported in residential settings will receive an annual physical exam, including review of preventive screenings, and at least 86% of individuals who have coverage for dental services will receive an annual dental exam.
Authorizing Authority
Americans with Disabilities Act, 42 U.S.C. § 12101 et seq.
US Supreme Court Olmstead Decision
- DMAS/DBHDS COV Inter-Agency Agreement 137-09 (Modification #20)
- ICF/IID regulations: 42 CFR 456.360; 370; 380
- ICF/IID regulations: 42 CFR 456.351; 360
Delegation
Processes, Protocols and Standards
- 2018 Person Centered Individual Support Plan (“ISP”) Guidance
- SOP Community Transition Support for Individuals in ICFs/IID
- Virginia Individual Development Disability Eligibility Survey (VIDES) Adults
- Virginia Individual Development Disability Eligibility Survey (VIDES) Children
- Virginia Individual Development Disability Eligibility Survey (VIDES) Infant
- Single Point of Entry Screening for ICF/IID Admissions
Guidelines, Charters, Plans, Other
Instruments and Tools
- Community Transition Guide Letter
- Contact Sheet
- CSB Notification of Active Discharge Letter 2023
- Family Outreach Plan
- Family to Family Network Referral
- Level of Care Compliance Letter 2023
- Level of Care Non Compliance Letter 2023
- Post Move Monitoring Form
- Single Point of Entry VIDES Request
- Individual Service Plan (ISP)
- ICF/IID Facilities-DMAS Quality Review Tool
- DBHDS DDS Provider Data Summary Baseline Measurement Tool
- Virginia Informed Choice Form 5.2023
- CSB Awareness Letter 2024
- CSB Action Letter 2024
- Family Outreach Letter with RNCC Numbers 2024