Update on the U.S. v. Virginia Settlement Agreement and National

UPDATE on the
US v. Virginia Settlement
Agreement and National
Enforcement Efforts
U.S. Department of Justice
Civil Rights Division
Special Litigation Section
CRIPA investigation
Expanded investigation – Apr. 2010
Findings – Feb. 2011
Negotiations – 2011-2012
Agreement – Jan. 2012
Approval by court – Mar. & Aug. 2012
Implementation / Enforcement – Now
Activities of the DOJ
FY 2013
• Meetings w/ Stakeholders (500+)
• Families (waitlist, TC, waiver recipients)
• Providers
• Organizations
• CSB’s
• Case managers
• Employment coordinators
• Crisis services
Activities of the DOJ
FY 2013
• Reviewing Data
• Meetings with Independent Reviewer
• Meetings with State of Virginia
• including drill downs on specific topics
Topics we’ll discuss today
8. Case Management
Transition Planning
9. Access and Availability
Indv. & Family Supports 10. Quality Assurance
Crisis System
Integrated Housing
Integrated Employment and Day Activities
Family-to-family and peer-to-peer programs
FY 2014
225 ID Waivers
25 DD Waivers
160 TC Waivers
40 prioritized for Youth in Nursing
Homes/large ICFs
• Independent Reviewer reported Virginia has
allocated many more waivers than required in
FY 2014
National Perspective: Youth with
ID/DD in Nursing Homes
• 2012 Findings Letter
– Found hundreds of children with significant medical needs
resided unnecessarily in nursing homes & many more at-risk
of entering nursing homes because lack of community
alternatives and cuts to in-home supports (esp. in-home
• After six months of negotiations United States filed suit
in July 2013.
– Lawsuit seeks a comprehensive remedy, including offering
community alternative s to all children in nursing homes, effective
transition planning, expansion of community-based and in-home
services as alternatives to nursing home care, and changes to
policies/practices re in-home supports. It also seeks damages for
affected children.
National Perspective: Adults with
• Intervened in Steward v. Perry, a class-action regarding the
unnecessary institutionalization of thousands of people with
ID/DD in and at-risk of entering private nursing homes
• Litigation implicates intersection of ADA and PASRR
• Reached Interim Agreement (to be filed for Court approval in
Aug 2013) that requires Texas to:
– identify people with ID/DD in NHs, inform them about
community alternatives, and establish necessary services and
transition those who want to move to the community
– create hundreds of new Medicaid waivers to transition people
from, and divert people from entering, NHs
– expand community-based medical services
– establish a system to divert people from unnecessary NH
admissions (including regional diversion coordinators)
• Continuing to finalize a final comprehensive agreement
Transition Planning
FY 2014
• Individualized, person-centered plans
• Essential supports and Barrier-busting
• Both the DOJ and the Independent
Reviewer will continue to focus on:
– Adequate Community Options for those receiving
waivers from the ID/DD waitlists and from Training
Indv. & Family Supports
FY 2014
• In FY 2013 established the program and met
targets of 700 individuals
• Commonwealth reports that typical requests in
FY 2013 were for respite, summer camps, or
• In FY 2014 required to support 1000 individuals
• Commonwealth reports there will be an online
application in addition to the paper application
Crisis System
FY 2014
Mobile crisis response times
Crisis plans
Region 4 & 5 stabilization units
Transportation to the stabilization units
Number of regional stabilization units
Serving children with ID/DD
Coordination with CSB Emergency Services
Integrated Housing
FY 2014
• Increased specificity of March 6, 2013 Housing
• Section 811 application
• $800,000 Rental Assistance Pilot Program
• Coordination with local housing entities
• Increased development of living options
National Perspective: Housing for
People with Disabilities
June 2013 HUD Guidance
– HUD-funded affordable housing programs are a
critical resource for Olmstead implementation
– HUD is committed to ensuring that HUD-funded
housing gives choice, self-determination, and
opportunities for people with disabilities to live
and interact with people without disabilities
– Provides guidance on how to structure
preferences that relate to state Olmstead
implementation (VA has a HUD-approved
preference for US v. VA implementation)
National Perspective: Housing for
People with Disabilities
CMS Regulations re HCBS Settings
– CMS finalizing regulations defining characteristics
of community-based settings for HCBS authorities
(1915c, 1915i, Community First Choice (1915k))
– NPRM has list of required positive characteristics
for all HCBS settings, additional requirements for
provider-owned settings, list of non-HCBS settings
(eg, ICFs, NHs), and presumptively non-HCBS
settings (eg, on grounds of or adjacent to public
Integrated Employment
FY 2014
• December 2012 Employment First Policy
• Increased specificity of November 7, 2012
Employment Implementation Plan
• Sufficiency of March 29, 2013 supported
employment targets
• Implementation of training initiatives
National Perspective:
Rhode Island
-- Investigation regarding adults with ID/DD in
state’s largest sheltered workshop and pipeline of
students from school-based SW to this adult SW
-- Interim Settlement Agreement June 2013
• Integrated supported employment (individual
placements, at least min. wage) and integrated day
services for more than 200 people currently in SWs
• “40-20” Integration Standard
• Requirement of average of at least 20 hours a week across the group
• Requirement of integrated day activities when not working, for a
total of 40 hours of integrated work and non-work activities per
National Perspective:
Integrated Days
• Findings Letter June 2012
– Found segregation in sheltered workshops of people who
could and want to work in integrated settings
– Focus on people unnecessarily in sheltered workshops and
people at risk (esp. transition age students)
– Seeks expansion of integrated supported employment
(individual, at least min. wage)
• Complaint and Motion to Intervene March 2013
– Over-reliance on segregated employment settings -- 61% of
people receiving e-ment svs are in SWs; only 16% are in indiv.
supp. employment
– No real opportunity to leave segregated e-ment -- People
remain in SWs an average of 11-12 years, up to 30 years.
– Pipeline from school to segregated e-ment
FY 2014
• Activities of Family Recourse Consultant
• Meeting with Family and Peer Mentors
• Waitlist mentoring, as well as training center
Case Management
FY 2014
• Regular face-to-face meetings
• Individual Support Plans
• Enhanced case management
– Safety
– Increased integration
• Role of case manager
Access & Availability
FY 2014
• Guidelines for families seeking services
• Easy Access website
• Transportation oversight
• Access to Adaptive Equipment/ Environmental
Quality Assurance & Risk
FY 2014
• Expanded reporting: Computerized Human
Rights Information System
• Quality Improvement Committee
• Regional Quality Council development
• Quality Service Reviews development
• Licensure
• Process for Corrective Action Plans
Independent Reviewer
Next Report- Dec 2013
• Crisis Services
• Case Management
• Quality and Risk Management
• Transition & Discharge Planning from
Southside & Northern Virginia Training
• www.ada.gov/olmstead
– All of DOJ’s Olmstead enforcement efforts nationally (findings letters,
settlements, briefs, etc.) [includes US v. Virginia]
– Guidance documents
– Speeches
– Faces of Olmstead
• www.justice.gov/crt/about/spl/virginiaada.php
• US v. Virginia specific website
– Independent reviewer’s reports
– Settlement agreement and summary
– Findings letter
Contact Information
Kyle Smiddie
[email protected]
Jason Hilliard
[email protected]
Bo Tayloe
[email protected]
Richard Farano
[email protected]
Alison Barkoff
[email protected]