State Budget Update: Summary of Conference Committee Report

 

On February 22,  House and Senate budget conferees released their report on Virginia’s budget bill.  The House and Senate are scheduled to vote on the budget bill tomorrow evening.  The bill will then go to the Governor for his review and action.   A summary of budget items can be found below and a more detailed side-by-side document (with amendment links) can be accessed here.

 

Summary of the Conference Committee Report:

 

Developmental Disability (DD) Waiver Waiting List:

  • Includes 144 additional Family and Individual Support (FIS) Waivers, which combined with those included in the Governor’s budget, will provide a total of 494 Waivers for individuals and families on the Developmental Disability (DD) Waiver waiting list.  These Waivers are expected to become available July 1, 2017.

 

Waiver Type Governor’s Budget Conference Committee Budget
Community Living  (CL) Waivers for Waiting List 90 90
Family and Individual Support (FIS) Waivers for  Waiting List 200 344
Building Independence (BI)  Waivers

for Waiting List

60 60
Waivers for Waiting List- Total 350 494
Community Living (CL) Waivers Created for Training Center Transitions 90 90
TOTAL 440 584
  • Directs DBHDS to provide a report on the management and characteristics of individuals on the waiting list for services through the Developmentally Disabilities (DD) Waiver programs. The report shall include (i) the age of individuals on the waiting list, and (ii) the number of individuals designated as Priority 1, 2 and 3 on the waiting list. The department shall submit this report by October 15, 2017 to the Chairmen of the House Appropriations and Senate Finance Committees.”

Developmental Disability (DD) Waiver Redesign:

  • Directs DBHDS to implement a customized rate for individuals with complex support needs who receive sponsored residential services.
  • Directs the DMAS and DBHDS to establish and convene an annual stakeholders workgroup on issues related to the developmental disability waiver programs. Specifically, the workgroup will examine issues related to the tools to assess individual support needs, the assigned payment levels for providers, and the communication of these matters to individuals, families, case managers, providers and others.
  • Requires a study to collect information and feedback related to payments to “family homes” and the impact of changes to the rates on family homes statewide from sponsored residential providers and family home providers.
  • Directs DBHDS to provide a progress report on the implementation of the Developmental Disability (DD) Waiver programs to include information about the population served by the waivers, the level and reimbursement tier, and service utilization and expenses for (i) individuals who have used waiver services for less than one year and (ii) individuals who have used waiver services for 1-5 years. The department shall submit this report by October 15, 2017 to the Chairmen of the House Appropriations and Senate Finance Committees.

Training Centers:

  • Proceeds with the closure of Southwestern Virginia Training Center (SWVTC) and Central Virginia Training Center (CVTC).   The three bills to keep Training Centers open (SB1551, HB 1583 and HB 1972) were all defeated.
  • Allocates revenues obtained from sale of Training Center land to further expand community services for people with significant medical or behavioral support needs.
  • Requires the Joint Committee on Training Center closures and the Department of Behavioral Health and Developmental Services (DBHDS) to develop and evaluate a plan for consideration of operating a smaller state Training Center. The Joint Subcommittees must take review “operating costs, capital costs and other relevant factors into consideration.”
  • Requires the Department of General Services (DGS) to conduct an environmental assessment needed to assess real property at CVTC.
  • The budget provides a 2% raise for positions at Training Centers that are high turnover.

Cost-Sharing (and other JLARC Recommendations):

  • Requires DMAS to develop a proposal for cost sharing requirements based on family income for individuals with long term services and supports and submit to the Centers for Medicare and Medicaid Services to determine if such a proposal is feasible. Adds language clarifying that no cost sharing requirements shall be implemented unless approved by the General Assembly.
  • Requires DMAS to assess and report on additional or different resources need to implement recommendations in the Joint Legislative Audit and Review Committee (JLARC) report “Managing Spending in Virginia’s Medicaid Program.”

Education:

  • Under the Joint Subcommittee for Health and Human Resources Oversight, establishes a workgroup to examine the options and determine actions necessary to better manage the equality and costs of private day educational programs currently funded through CSA (see side-by-side document for details)
  • Shifts $150,000 each year from principal training to assistance for teacher professional development on the subject of issues related to high-needs students.

DBHDS Trust Fund:

  • Provides $8,550,000 from the DBHDS Trust Fund to be used for: (i) development of behavior/medical intense programs; (ii) subsidies for capital costs associated with rental units; (iii) establishment of a House Call Program in Northern Virginia; (iv) support for individual crisis events; and (v) development of providers in Virginia for individuals with intellectual and developmental disabilities with significant behavioral and mental health needs.

Consumer Directed Services:

  • Reinstates the prohibition on overtime for consumer-directed services.
  • Also requires DMAS to establish an “Electronic Visit Verification” program.

Special Joint Committee for Health and Human Resources Oversight:

  • Establishes a Joint Subcommittee for Health and Human Resources Oversight to respond to federal health care changes, provide oversight of the Medicaid and children’s health insurance programs, and provide oversight of Health and Human Resources agency operations.)

Health and Human Resources Systems Transformation:

  • Provides $250,000 for the HHR Systems Transformation Initiative:

Employment:

  • Restores $200,000 in fiscal year 2017 from the general fund for the Long -Term Employment Support Services (LTESS) program.

To view The Arc of Virginia’s full side-by-side report, click here.

DD Organizations to Money Committees: Oppose Proposals that Keep Training Centers Open

 

Yesterday, several developmental disability (DD) organizations sent a letter  to members of the House Appropriations Committee and the Senate Finance Committee expressing concern about budget proposals that would keep the Southwestern Virginia Training Center (SWVTC) and the Central Virginia Training Center (CVTC) open.  The full letter can be found below.


February 19, 2017

Dear Members of the House Appropriations and Senate Finance Committees:

The undersigned organizations write to express our opposition to proposals that would keep the Southwestern Virginia Training Center (SWVTC) and the Central Virginia Training Center (CVTC) open. These proposals represent a retreat from the Commonwealth’s stated commitment to community-based services, and would cause harm to Virginians with developmental disabilities and their families. We urge you to proceed with the closures as planned and invest in community-based care.

The Commonwealth has already completed the closure of two state-operated institutions, the Southside Virginia Training Center (SVTC) and the Northern Virginia Training Center (NVTC).  As a result of these closures, hundreds of citizens with developmental disabilities – including those with the most complex medical and behavioral needs – are now living safely and successfully in the community.  Many of these individuals lived in the Training Centers for most of their lives; some for more than fifty years. Today, they are living “A Life Like Yours” in the community.

The families of former Training Center residents have expressed satisfaction with the community-based services their loved ones have received, and report that quality of life and well-being improved as a result of the transition. Since moving to the community, many individuals have made gains in adaptive skills (such as responding to a handshake, eating solid foods, or speaking words for the first time) and have seen decreases in maladaptive behaviors (such as eloping or self-abuse). In his December 2016 report to the court, the Independent Reviewer found that individuals with intense medical needs had positive health care outcomes as well.  Families have shared that relationships with their loved ones have grown stronger, and that they are now able to see family members more frequently than they had in the past.

The system has felt the positive effects of closure as well, and community-capacity has significantly increased since the process first began. More than 2,000 DD Waivers have been provided as a result of the closures. The DD Waiver was redesigned to increase reimbursement rates for services provided to those with significant support needs. There are now community providers in every region offering medical and behavioral supports that exceed what is available in the state Training Centers. Some of these providers are located just a few miles away from CVTC, but their services are integrated in the community and offer an equivalent level of care for one-third of the cost of the Training Center.

Keeping the Training Centers open would limit the Commonwealth’s ability to respond to the DD Waiver waiting list crisis. More than 11,000 Virginians with developmental disabilities are still on the DD Waiver waiting list. Many of these individuals have equivalent, if not greater, support needs as those currently living in the Training Centers. They require assistance with feeding, toileting, bathing and dressing, yet are still waiting for the services they need. Nearly 3,000 are in the Priority 1 status for reasons such as an elderly or ill caregiver. Maintaining SWVTC and/or CVTC would require millions of dollars in new, unbudgeted operational and capital expenses. Investing in institutions, when we know those dollars can be used to provide an equivalent level of service in a more cost-effective manner, is not fiscally responsible for our Commonwealth, especially given the unmet needs in community where funding is desperately needed.

Virginia’s plan to close the institutions puts us on the right path.  Virginia is ranked 39th in the country for its developmental disability services (which places us up 10 rankings from when the closures first began). The low ranking is primarily due to the long waiting lists for services and slow transition to community-based care. Other states have transitioned to community-based services because it has allowed them to serve more people and provide a higher quality of care. As a result, more than 200 state-operated institutions have closed nationwide. Fourteen states have already closed all of their state institutions, and several other states are in the transition process.

Average Costs of Institutional Care vs. Community-Based Care:

  • The average annual cost per person for Training Centers is now $343,267 per person per year.
  • The average annual cost per person for community services (former residents) is $103,998 per year.
  • The average cost of the new Family and Individual Support (FIS) Waiver is $21,000 per person, per year.
  • The total census of Training Centers has declined by 74% since 2010, and is now close to only 300 residents statewide.
  • As the census declines, the average cost per person for Training Centers has risen by nearly 50%.

 

To summarize, it is simply not justifiable to invest in institutions when we know that, (1) equivalent (if not better) care is being provided in the community, (2) community-based care is more cost-effective than institutional care, and (3) the waiting list for community services continues to grow. These factors, combined with Virginia’s experience in shifting care to the communities, demonstrate that closing the institutions is not an “either/or” between families with needs. Rather, the transition to community-based care is about ensuring that all Virginians with developmental disabilities have access to the care they needWe are on the right path to get there, and ask that you keep going.   

Thank you for your time and consideration of this matter.

Sincerely,

 

 

 

 

 

 

Autism Society

disAbility Law Center of Virginia

Down Syndrome Association

Parent to Parent of Virginia

The Arc of Virginia

vaACCSES

Virginia Association of Centers for Independent Living

Virginia Association of Community Services Boards

Virginia Board for People with Disabilities

Virginia TASH

Budget Conferees Appointed

 

Both the House and Senate have appointed the budget conferees.  This is the small group of legislators who will negotiate the final budget bill.  The conference committee will begin meeting tomorrow and will likely complete its work by early next week.  This means we need to act NOW.

Once you have called your Delegate and Senator, please call as many of the budget conferees as you can.  The message can be simple:  “Invest in Community Services for People with Developmental Disabilities, Not Institutions”  Let the legislators know that even though you are not a constituent, you and your family are directly affected by the issues being discussed.

2017 Budget Conferees:

Del. Chris Jones
(804) 698-1076
email: DelCJones@house.virginia.gov

Del. Kirk Cox
(804) 698-1066
email: DelKCox@house.virginia.gov

Del. Steve Landes
(804) 698-1025
email: DelSLandes@house.virginia.gov

Del. John O’Bannon
(804) 698-1073
email: DelJOBannon@house.virginia.gov

Del. Tag Greason
(804) 698-1032
email: DelTGreason@house.virginia.gov

Del. Luke Torian
(804) 698-1052
email: DelLTorian@house.virginia.gov

Sen. Tommy Norment
(804) 698-7503
email: district03@senate.virginia.gov

Sen. Emmett Hanger
(804) 698-7524
email: district24@senate.virginia.gov

Sen. Janet Howell
(804) 698-7532
email: district32@senate.virginia.gov

Sen. Dick Saslaw
(804) 698-7535
email: district35@senate.virginia.gov

Sen. Steve Newman
(804) 698-7523
email: district23@senate.virginia.gov

Sen. Frank Ruff
(804) 698-7515
email: district15@senate.virginia.gov

Sen. Frank Wagner
(804)698-7507
email: district07@senate.virginia.gov

 

Budget Update- Training Centers, Waiting Lists and Cost-Sharing

 

Action Still Needed

While Virginia has been making steady progress in its transition to a community-based system since entering into the DOJ Agreement in 2012, actions taken in the Virginia General Assembly last week indicate that the Commonwealth may be close to taking a step backwards.

On Thursday, the House of Delegates passed a budget amendment that could potentially keep the Southwest Virginia Training Center (SWVTC) open, even though that institution is already scheduled to close June 30, 2018.  Later that same day, the Senate voted to pass legislation that requires (1) a plan to keep the Central Virginia Training Center (CVTC) open and (2) a plan to implement family cost sharing for Medicaid long-term care services (which includes Waivers).

Training Centers and Waiver Waiting Lists:

The House and Senate provided 144 and 150 Family and Individual Support (FIS) Waivers, respectively.  The Arc of Virginia appreciates the House and Senate making these Waivers a priority.  We do remain concerned  about the unmet needs of thousands of people who continue to wait.  Nearly 3,000 of these individuals have been identified as being in “Priority 1” status and the Commonwealth has determined that they will need services within the next year.  The DD Waiver waiting list continues to grow by hundreds of people each year.

Keeping the Training Centers open will limit the Commonwealth’s ability to respond to the DD Waiver waiting list crisis.  Maintaining the state facilities will cost the Commonwealth millions of new dollars due to unbudgeted operating and capital expenses that will be incurred.  Such actions would negatively impact the individuals who currently reside in the state institutions, as well as the 11,230 Virginians who are on the DD Waiver waiting list.

Virginia is ranked 39th in the country for its developmental disability services.  The low ranking is primarily due to the long waiting lists for services and over-reliance on expensive and outdated state institutions.   Fourteen states have already closed ALL of their state operated institutions because community-based care is cost-effective (allowing the state to serve more people) and greatly improves the quality of life of individuals who transition to community-based services. Several others states are in the transition process.   Virginia was one of the last states in the country to initiate closure of it state-operated institutions.

The statewide Training Center census  has been declining at a rapid rate due to community transitions and natural attrition.   Meanwhile, the annual cost per person for the Training Centers continues to rise and now averages $343,267 per person statewide.  Community-based services for the hundreds of people who have recently left the Training Centers (and thousands of other individuals with similar support needs) average 100-120k per person per year- which is one-third of the cost of the institutional services.   Furthermore, the demand is for community-based services, not institutional care, as evidenced by the 11,230 person waiting list for community-based services.

The Arc of Virginia believes if new dollars are going to be invested in the DD system, these dollars must be directed to respond to unmet need in the community system.  It is simply not fiscally responsible to invest in expensive and outdated institutions when we know that (1) people can be served safely and successfully in the community and (2) these dollars can be used more cost-effectively in order to respond to unmet needs in the community.

Family Cost Sharing:

The impact and parameters of the “family cost sharing” plan remain uncertain because the budget language is silent on this. The Arc of Virginia has been told that the plan would not take effect unless it was approved by the 2018 General Assembly.  We urge you to continue to express your concerns to legislators because your advocacy could affect the conversation moving forward- both now and in the 2018 session.

Advocacy Needed Now-

The House and Senate budget bills are about to go to “conference committee”, where a small group of Delegates and Senators will negotiate a final budget bill.  The “conferees” will be appointed tomorrow and are anticipated to complete their work on the budget within the next week.   Your legislator can reach out to these conferees on your behalf, asking them to ensure that the final budget bill proceeds with the Training Center closures as scheduled, supports families and commits to community-based care.

 What Can You Do?

  1. Call your state Senator and Delegate TODAY. To find out who your legislators are, click herePlease note- it is highly unlikely you will be talking with the legislator directly.  You will simply be asking to leave a message for him/her.

When you call, let your legislator know that:

  • You are very concerned about proposals that may keep the Training Centers open (326#2h, 284#6s) and the proposal to implement family cost sharing (306#14s)- these items represent a move in the wrong direction.
  • Investing in expensive outdated state institutions is not fiscally responsible. With two closures already completed, it is well documented that Virginians with complex needs can be served safely, successfully and more cost-effectively in the community.
  • Keeping the institutions open will require millions of new state dollars needed to pay for the unbudgeted operating and capital expenses, making it more difficult for the state to address the needs of the 11,000 person DD Waiver waiting list- a list that is already growing by hundreds of people per year.
  • The people who live in Training Centers do not have disabilities that are different from those who live in the community. For every person residing in the Training Center, there are hundreds, if not thousands, of people with equivalent (or greater) support needs who are on waiting lists for community-based services.
  • Urge your legislator to proceed with the closures as planned and if there is additional funding available, then it should be used to take further action on the waiting list crisis (not keep outdated institutions open).
  1. If you have time, VISIT your legislator at the Virginia General Assembly building. Contact The Arc of Virginia office (804.649.8481, ext. 104) if you would like assistance.   Remember- we only have a week to act, but constituent visits during session can make a big impact.
  1. Plan to attend your state legislators’ town hall meetings. These may be occurring soon or could take place later this spring.  Local town hall meetings are really important advocacy opportunities.   If you don’t know when your legislators’ town hall meeting is, visit his/her website, follow him/her on social media or ask when you call the legislator’s office.  Some legislators even have telephone town halls where constituents can call in with their concerns.

Help Virginia get on the right track- please take action right away.

The progress we’ve made over the last few years has not always advanced as quickly as we would have liked, but at least it was moving in the right direction.  These amendments represent a move in the wrong direction and are being proposed at a time when the future of funding for community-based services is already fairly uncertain.  Please make your calls today to help Virginia get “back on track” and strengthen its commitment to community-based care.

As always, thank you for your advocacy.

 

Update on the State Budget Bills

 

Summary of the House and Senate budget bills:

On Sunday, the House Appropriations Committee (HAC) and the Senate Finance Committee (SFC) released their respective versions of the state budget bill.  The House and Senate amendments are now available online.  A side-by-side comparison of the Governor, House and Senate bills is available at the link below.  We will be sending an action alert very soon regarding two particular budget items that are of concern.  This alert will be time sensitive so please be sure to take action TODAY.  Stay tuned!

Side by Side Comparison of the House and Senate Budget Bills

What happens next?

The House and Senate will hold a floor vote on their respective budget bills tomorrow afternoon.  Once each body completes action on the budget bills, the bills will go to “conference committee”- where a final budget bill will be negotiated by a small group of Delegates and Senators.   We will send out an alert after the House/Senate floor votes, letting you know where we stand and what you can do to help ensure that the conference committee incorporates the best of both budget bills.  Please stay tuned for this alert as well.

As always- thank you for your advocacy!

-The Arc of Virginia

 

 

 

Summary of Governor McAuliffe’s Proposed Budget

 

Summary of DD-Related Items in Gov. McAuliffe’s Proposed Budget Waiting List

  • Changes allocation of DD Waiver slots in FY18
    • Reduces Community Living Waivers for waiting list from 325 to 90 in FY18 (-235)
    • Increases Family and Individual Support Waivers from 25 to 200 in FY18 (+175)
    • Increases the Building Independence (BI) Waivers by 60 in FY18 (+60)
    • No change in number of people served, but cost savings are not used to serve more people.
  • Allows DMAS to reallocate funds to create new waivers. In the event that DMAS can demonstrate that additional Waivers mentioned above (CL, FIS and BI) can be added within appropriations, the Governor may authorize DMAS to amend the CL or FIS Waivers to add such slots.  DMAS shall seek federal approval for changes upon receiving approval from the Governor.  DMAS will report the creation of any additional Waiver slots to the Chairmen of Appropriations and Finance within 10 days.

Overtime for Consumer Directed Service Attendants:

  • Allows DMAS to authorize overtime for attendants providing CD services. Provides $8.5 million GF ($17) million to pay overtime compensation to attendants providing consumer-directed services under the Medicaid Waivers.  This amendment replaces language prohibiting overtime hours being worked by consumer-directed attendants with language that allows DMAS to pay time and half for up to 56 hours for a single attendant.

DBHDS/CSB System Assessment:

  • Provides $4.5 million to hire an independent contractor to “expedite transformation of Virginia’s community mental health system.” Funds will be used to conduct an assessment of currently available services and a gap study, in addition to a high‐level design of efforts to ensure same‐day access for individuals accessing services (mental health) through community services boards. In addition, the study will include an assessment of the effectiveness and efficiency of the Department of Behavioral Health and Developmental Services’ organizational structure. The assessment shall also review the department’s management of the services delivered by the agency or through the CSBs.  Full excerpt of budget language included at the end of this document.

DBHDS Trust Fund:

  • Appropriates 8.6 million in trust fund dollars to be used for “expenditures needed to comply with the Department of Justice Settlement Agreement, including crisis stabilization services, improving quality management, and expanding availability of community‐based housing options. These funds are anticipated to be available due to the planned sale of Northern Virginia Training Center. The majority of funds will be expended on services to individuals in the NVTC catchment area.”

Children’s Services Act (CSA):

  • Fund increasing caseload and service costs in the CSA program. Provides $44.1 million in FY17 and $44.5 million in FY 18 to fund anticipated caseload and expenditure growth for services provided to youth through the Children’s Services Act. “The program is anticipated to grow at approximately 6 percent each year, with the majority of growth occurring in the area of private special education services, which are mandated by federal law.”

Managed Care:

  • Provides funding to conduct readiness reviews for new managed care organizations (MCO). The new organizations would operate as part of the re‐procured Medallion (4.0) program, which currently serves more than 700,000 individuals. A readiness review is an impartial assessment to assess a health plan’s preparedness to operate as a Medicaid MCO.
  • Expands Ombudsman services to meet federal MLTSS requirements. Adds 6 positions to expand the State Office of Long-Term Care Ombudsman to support Medicaid Managed Long Term Services and Supports (MLTTS) program, known as CCC Plus when it is implemented in Virginia.

Children’s Crisis:

  • Provide for $1M “to divert and discharge children from the Commonwealth Center for Children and Adolescents.” HHR Budget Summary states that it will be used to purchase private inpatient beds and create community‐based service plans for those children who have been deemed ready for discharge.

Training Center:

  • Make infrastructure repairs at state facilities ($7 million). Provides funds for the repair and/or replacement of deteriorating infrastructure, failing HVAC systems, and outdated security systems at facilities operated by the Department of Behavioral Health and Developmental Services.

 

  • Reduce unobligated funding at state training centers ($2,500,000 GF). Captures unobligated funding available as a result of the closure of Northern Virginia Training Center.

Licensing:

  • Licensing Fee. Directs DBHDS to promulgate emergency regulations establishing a nonrefundable fee for the initial application and a nonrefundable license renewal fee per application for all adult behavioral health and developmental services licensed by the department.

DARS:

  • Fund adult services and adult protective services case management system operations. Covers the on‐going operating costs associated with replacing the current case management system being used by adult services and adult protective services) workers. While the Department for Aging and Rehabilitative Services (DARS) is leveraging federal grant funds to implement the new system, on‐going general fund support is needed to cover licensing and support costs.
  • Reduces Long Term Employment Support Services (LTESS) by $375,000 in FY17 by $10,661 in the second year.
  • Reduces funding for training individuals whose cost cannot be covered by federal vocational rehabilitation

Other Items:

  • Provides $250,000 to contract with Birmingham Green for long term care.
  • Adjust institutional rate setting/auditing scope of work consistent with payment methodology changes. Transitions to more price‐based (less cost‐based) payment systems has reduced the need to audit costs, so the agency can revise the scope of institutional provider rate setting and auditing.
  • Conduct audits of “DME” and pharmacy services with agency staff. Assumes that more durable medical equipment (DME) and pharmacy audits will be performed using agency staff. The shift to managed care reduces fee‐for‐service business, lowers the volume of services DMAS needs to audit, and makes it possible for the agency to complete more audits using agency staff and a reduced number of contracts with vendors.

EXCERPTS OF BUDGET LANGUAGE: 

Medicaid Expansion Language;

“5. a. Notwithstanding §30-347, Code of Virginia, or any other provision of law; should the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010) be continued, amended or replaced through federal law or regulation, such that an enhanced federal medical assistance percentage (FMAP) rate is available for newly eligible individuals, the Governor, on or after October 1, 2017, shall have the authority to direct the Department of Medical Assistance Services (DMAS) to amend the State Plan for Medicaid Assistance under Title XIX of the Social Security Act, and any waivers thereof, to implement such changes.

  1. The department shall have authority to implement the coverage provisions outlined in JJJ.5.a. of this Item prior to the completion of any regulatory process in order to effect such changes.
  2. All savings accruing to any state agency of the Commonwealth of Virginia due to the implementation of the provisions included in JJJ.5.a. or JJJ.5.b. of this Item shall not be expended but shall be unallotted and reserved for appropriation by the General Assembly.”

ITEM 284- System Assessment

E.1. Out of this appropriation, $4,500,000 the second year from the general fund shall be used for the Office of the Secretary of Health and Human Resources (OSHHR) to procure an independent contractor to expedite transformation of Virginia’s community mental health system. Such contract shall be entered into in consultation with the Virginia Association of Community Services Boards (VACSB), the Virginia Department of Corrections, the Virginia Sheriffs Association, and the Virginia Association of Regional Jails. The goal of Virginia’s community mental health system transformation is to ensure access, quality, consistency, and accountability across all forty Community Services Boards (CSBs) and Behavioral Health Authorities. The contract shall include a current state assessment, gap analysis, and high-level design of Same Day Access. The request for proposals shall be issued as soon as possible, but not later than 45 days after the enactment of this act, and include requirements for the following components: (1) Documented Vision of Transformation including expectations for partnerships with private providers; case management; care coordination; primary care and behavioral health integration; mobile crisis; and services for children, geriatrics, and veterans. The vision shall be based on the STEP-VA plan for system transformation, excellence, and performance in Virginia. (2) A Current State Analysis of all forty CSBs and Behavioral Health Authorities that includes an understanding of existing community resources; population needs including the behavioral health needs of incarcerated or otherwise criminal justice involved individuals; availability of private providers; transportation resources; governance; culture; challenges; and current processes, technology, and data and analytic capabilities. (3) A Gap Analysis indicating the difference between the Vision of Transformation and the Current State for each CSB. (4) High-Level Design to support implementation for Same Day Access including development of a clinical process flow, administrative process, and job design. (5) An analysis of the cost of such design compared to existing resources and funding streams.

  1. The contract shall also include an assessment of the efficiency and effectiveness of the Department of Behavioral Health and Developmental Services’ organizational structure. The assessment shall review the department’s management of the services delivered by the agency or through the community services boards. The study shall include an evaluation of the adequacy of existing administrative resources and identify gaps in funding and staffing required to perform assigned statutory responsibilities, including the management of the community contracting division and operation of state mental health facilities and training centers, and recommendations for improved performance. The assessment shall also review and make recommendations as to the optimal agency service delivery structure including the creation of separate behavioral health and developmental disability agencies. In developing recommendations, the contractor shall incorporate the transformation of the service delivery system referenced in paragraph E.1 of this Item.
  2. The Department of Behavioral Health and Developmental Services in partnership with the CSBs and VACSB shall provide necessary information in a timely manner as requested by the contractor. The contract shall require that the contractor submit a preliminary report within 90 days after signing the contract that includes its detailed project plan and progress to date. The contract shall also require that the assessment, design and analysis be completed by July 1, 2018, and a final report submitted by October 1, 2018, to the Governor and the Chairmen of the House Appropriations and Senate Finance Committees.
  3. In developing the report, the contractor shall examine and include information and recommendations provided by the Joint Subcommittee to Study Mental Health Services in the Twenty-first Century, established pursuant to SJ 47 (2014 General Assembly).
  4. The Governor shall appoint a committee comprised of eleven members to include six gubernatorial appointees, three appointees of the Speaker of the House of Delegates, and two appointees of the President Pro Tem of the Senate to oversee progress on the specific actions funded in this Item as well as progress on transformation of the mental health system in Virginia and the evaluation of the department. Gubernatorial appointees shall include the Secretary of Health and Human Resources and the Secretary of Finance. The Contractor shall provide periodic progress reports to the committee at the call of the committee chair.