Integrated Living Options

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

Delegation

Processes, Protocols and Standards

Case Management Manual

Guidelines, Charters, Plans, Other

Instruments and Tools

Training Materials