UPDATE on the
US v. Virginia Settlement
Agreement and National
Enforcement Efforts
U.S. Department of Justice
Civil Rights Division
Special Litigation Section
Background
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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
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Waivers
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
Waivers
FY 2014
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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
Florida
• 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
nursing)
• 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
ID/DD
in
Nursing
Homes
Texas
• 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
Centers
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
transportation
• 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
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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
Staffing
Coordination with CSB Emergency Services
Integrated Housing
FY 2014
• Increased specificity of March 6, 2013 Housing
Plan
• 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
institution)
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:
Integrated
Days
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
week.
National Perspective:
Integrated Days
Oregon
• 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
Family-to-family/Peer-to-peer
FY 2014
• Activities of Family Recourse Consultant
• Meeting with Family and Peer Mentors
• Waitlist mentoring, as well as training center
mentoring
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
Modifications
Quality Assurance & Risk
Management
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
Center
Websites
• 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
Kyle.Smiddie@usdoj.gov
202-307-6581
Jason Hilliard
Jason.Hilliard@usdoj.gov
202-353-1106
Bo Tayloe
Benjamin.Tayloe@usdoj.gov
202-514-8103
Richard Farano
Richard.Farano@usdoj.gov
202-307-3116
Alison Barkoff
Alison.Barkoff@usdoj.gov
202-307-3216