TO ASSURE CONTINUED COMMUNITY INTEGRATION
OF VIRGINIANS WITH DISABILITIES
2009 Updated Plan
Adopted June 23, 2009
Pursuant to Executive Directive 6 (2007) By the Community Integration Implementation Team and the
Community Integration Advisory Commission
Submitted to The Honorable Timothy Kaine, Governor of Virginia
August 10, 2009
Table of Contents
I. INTRODUCTION 2
A. Our Mission 2
B. Our Vision 3
C. Our Goals 3
D. Our Critical Success Factors 3
II. Goals #1 and #2: Action Plans That Apply to 6
All Four Types of Facilities
Critical Success Factor #1: Plan, Understand, Choose and 6
Self-Direct Services and Supports
Critical Success Factor #2: Choose Among Quality Community 8
Providers and Direct Support Professionals
Critical Success Factor #3: Obtain Housing 9
Critical Success Factor #4: Locate and Obtain a Job 13
Critical Success Factor #5: Access Transportation 15
Critical Success Factor #6: Surrogate/Supportive Decision-Making 17
Critical Success Factor #7: Access Ongoing Supports 18
III. Goals #1 and #2: Action Plans That Apply to a
Specific Type of Facility 20
Critical Success Factor #7: Access Ongoing Supports 20
Appendix I Definition of Planning Terms Appendix II A Guide to Acronyms Used in This Plan Appendix III Executive Directive 6 (2007)
VIRGINIA’S COMPREHENSIVE, CROSS-GOVERNMENTAL
STRATEGIC PLAN TO ASSURE CONTINUED COMMUNITY INTEGRATION
OF VIRGINIANS WITH DISABILITIES
2009 Updated Plan
On August 2, 2007 the four Secretariats, two Councils, 21 Executive Branch entities, and seven local government and agency representatives comprising the Community Integration Implementation Team (Team), and the 21-member stakeholder Community Integration Advisory Commission (Commission) jointly adopted Virginia’s first Comprehensive, Cross-
Governmental Strategic Plan to Assure Continued Community Integration of Virginians with Disabilities (the Plan) pursuant to Executive Directive 6 (2007). This Plan was submitted to the Honorable Timothy Kaine, Governor, on August 31, 2007.
Executive Directive 6 charges the Team to prepare annual Plan updates by August 31 of each year. The original Plan was first updated in 2008. The Team respectfully submits this 2009 Updated Plan.
How the Updated Plan Was Prepared
The Team divided into three smaller groups, each of which included a liaison and an alternate liaison from the Advisory Commission:
; Services and Supports (Critical Success Factors #1, 6 and 7)
; Workforce and Employment (Critical Success Factors #2 and 4)
; Housing and Transportation (Critical Success Factors #3 and 5)
The three groups met from March through June 2009 to develop proposed updates to the Plan. The updates included the work of four Team Task Groups that developed recommendations on portability of the auxiliary grant, family members as providers, housing barriers, and proposed amendments to the Nurse and Medical Practices and Drug Control acts. The updates were presented to and acted on by the Team and Commission on June 23, 2009.
Definitions of planning terms and acronyms used in this Plan Update appear at Appendices I and II, respectively. Executive Directive 6 (2007) appears at Appendix III.
A. Our Mission
The Team shall continue its “collaborative efforts to complete and annually update a comprehensive, cross-governmental strategic plan designed to assure continued community integration of Virginians with disabilities....The plan shall be submitted to (the Governor) for (his) approval no later than August 31, 2007, and shall be updated and submitted annually by August 31 of each succeeding year….The Plan shall be accompanied by a report on 1 statewide progress in addressing these issues.”
Executive Directive 6 (2007)
1 At the request of the Commission, the 2009 Progress Report was developed as a stand-alone document and will be available at www.olmsteadva.com by August 31, 2009.
2009 Updated Strategic Plan: Community Integration for Virginians with Disabilities 2
B. Our Vision
We envision Virginia as “one community” for all citizens—one that welcomes individuals with
disabilities and supports them as active members of their own communities. By “own
community,” we mean any location an individual with a disability chooses that affords the individual the opportunity for maximum possible autonomy over his or her daily life. We believe that individuals, of all ages and with any disabilities, have the right to decide where to live, and live as independently as possible, in the most integrated setting. This is the same right—no more and no less—enjoyed by individuals who do not have disabilities.
—One Community: Final Report of the Task Force to Develop an Olmstead Plan for Virginia (August 28, 2003), as adopted in 2004/2005 by the EO 61 and EO 84 Oversight Advisory Committee, in 2006 by the EO 2 Oversight Advisory Board, and in 2007, 2008 and 2009 by the Team and Commission.
C. Our Goals
Goal #1: Virginians with disabilities who currently reside in a mental health, mental
retardation (now intellectual disability), nursing or assisted living facility will have the opportunity to choose to move from these facilities to an appropriate, more integrated setting and stay there.
Goal #2: Virginians with disabilities who are at risk of unwanted admission to a mental health, mental retardation (now intellectual disability), nursing or assisted living facility, will have the opportunity to receive services and supports that prevent admission.
D. Our Critical Success Factors
1. Virginians with disabilities plan, fully understand and choose among services and supports they need, self-directing them to the extent possible.
Choices must be meaningful and driven not by disability “labels,” but by the unique needs
and preferences of individuals with disabilities. We believe that, in order to assure meaningful choices, the Commonwealth must:
; Provide services and supports that are appropriate to and respectful of the individual,
affordable, accessible, available, diverse, reliable, safe and accountable;
2; Allow self-determination and consumer direction of services and supports to the extent
; Provide maximum opportunities for individuals with disabilities and their families to
participate in planning and developing services and supports as well as policy planning; ; Assure that individuals with disabilities and their families know about these services and
supports and the choices that are available to them;
; Encourage independence and community involvement through livable/walkable 3communities, beginning with local comprehensive plans and continuing through
implementation that provides transportation, housing, employment and access to
; Address the institutional bias in the State Medicaid Plan by balancing community and
2 In this Plan, the term “consumer direction” and the term “self direction” are synonymous. 3 A “livable/walkable community” is one that has affordable and appropriate housing, supportive community features and services, adequate mobility options and encourages employment opportunities for all who want to work, which together facilitate the public sense of safety, personal independence and engagement of residents in civic and social life.
2009 Updated Strategic Plan: Community Integration for Virginians with Disabilities 3
2. Virginians with disabilities choose among individuals and agencies qualified to provide the services and supports they select.
In order that individuals with disabilities have the opportunity to live, work, and participate in activities in the community of their choosing, needed services and supports must be available from qualified providers. Qualified providers can be individuals or organizations that have a variety of backgrounds, professional expertise and skills that maximize the ability and capacity of individuals with disabilities to live independently in the community of their choosing, with a quality of life that empowers them to fully participate in society. To increase the availability of qualified providers, Virginia should embrace creative solutions, including public/private partnerships, and ensure that adequate compensation is provided for services rendered.
3. Virginians with disabilities locate and obtain housing appropriate to their needs and preferences.
Services and supports mean little unless Virginians with disabilities have access to housing that enables them to live as independently as possible according to their individual needs and preferences. A full array of permanent and transitional housing options must, therefore, be available. Transitional and permanent housing for individuals with disabilities must be affordable and accessible to all individuals who are: 1) institutionalized; 2) living in a setting they consider to be restrictive; 3) at risk of institutionalization; 4) on residential services waiting lists; and 5) homeless. Housing should be separate from supportive services and not be contingent on the receipt of services; however, supportive services must be available, accessible if needed and desired, flexible and individualized. The use of Universal and EasyLiving Home Design should become standard practice in the development of new housing. If embraced at the beginning of the planning process, Universal and EasyLiving Home Design can be an affordable development option.
4. Virginians with disabilities locate and obtain a job if appropriate.
A true measure of integration into the community, for every individual who is able and wants to do so, is the individual’s opportunity to work. The dignity, responsibility, and economic
independence resulting from gainful employment is the most effective way of reducing dependence on public benefits, enhancing self-reliance, changing attitudes, and promoting full community integration of individuals with disabilities.
5. Virginians with disabilities access transportation appropriate to their needs. Transportation is basic in the integration into and survival in community living for individuals with disabilities; it is what allows all citizens to work, go to the doctor, visit friends, shop, and participate in activities in the manner they choose. Transportation of all kinds must be consistently available, affordable, accessible, reliable, and safe, and meet the needs of individuals with disabilities throughout the Commonwealth, in both rural and metropolitan areas. Transportation also includes safe and appropriate pedestrian and bicycle facilities (“complete streets”) and paratransit, which provides complete needs of all individuals
participating within the community.
6. Virginians with disabilities—if they lack capacity to make decisions—have the same
choices, options and benefits as other Virginians with disabilities through a surrogate/supportive decision-maker qualified to act on their behalf.
Most individuals with disabilities are fully capable of making choices and decisions for themselves, just as individuals without disabilities are. We acknowledge that some individuals with disabilities lack the capacity to make some or all decisions and choices for 2009 Updated Strategic Plan: Community Integration for Virginians with Disabilities 4
themselves. Every such individual should have a means by which decisions and choices may be made on his or her behalf. Among many other examples, some individuals may have an advance directive, and others may need a surrogate decision-maker appointed and available to act on their behalf. The surrogate/supportive decision-maker could be a family member chosen in the order set forth in the Health Care Decisions Act (Va. Code ? 54.1-2986), a guardian, or other legally authorized representative. Unless the context indicates otherwise, wherever reference is made to a decision or choice by an individual with a disability in the report that follows, the decision or choice may be made by an appropriate surrogate/supportive decision-maker if the individual cannot make the decision or choice independently.
7. Virginians with disabilities access ongoing supports in order to stay in the most integrated setting of choice, self-directing them to the extent possible. In order to assure choices to individuals with disabilities, ongoing community support and services must be available and reflect the importance of Virginia's full continuum of care.2009 Updated Strategic Plan: Community Integration for Virginians with Disabilities 5
II. GOALS #1 AND #2: ACTION PLANS THAT APPLY TO ALL FOUR TYPES OF FACILITIES
Critical Success Factor #1: Plan, Understand, Choose and Self-Direct Services and Supports
Action Plan #1.1
Expectation Individuals with disabilities will plan, fully understand, choose and direct their own services.
Identify individuals with disabilities or their families who have had successful experiences with directing their services and supports and include them in state and local Strategy
initiatives (for example, training and mentor programs) to assure that service providers and disability communities share a commitment to maximize principles of self-
direction and choice.
Measurable 1) The number of individuals with disabilities who plan, fully understand, choose and direct their own services will increase.
outcomes 2) The number of individuals with disabilities living in the most integrated setting will increase.
3) Education and training of community service providers, individuals with disabilities and families is well coordinated and consistently provided.
4) The media is educated.
Implementation Actions Date/s Responsible agency/cies Cost/s 1. Incorporate self-direction language and promotion of person-centered practices (PCP) in policies and documents of state Ongoing IT $0 and local agencies, including training materials. Follow progress of Systems Transformation Grant (STG) implementation.
2. Develop strategies to identify and address the disparity among communities with regard to knowledge about self-direction Agencies collaborating on 2011 $0 and PCP. Follow progress of STG implementation, including major outreach and training initiatives; development of a technical STG assistance cadre; development and disbursement of PCP Toolkits, training materials, and conference events related to self-
3. Identify responsible entities to coordinate statewide education and training efforts. Follow progress of STG implementation, Agencies collaborating on 2011 $0 including major outreach and training initiatives; development of a technical assistance cadre; and development and STG disbursement of PCP Toolkits, training materials, and so forth.
Ongoing 4. Encourage IHEs to include a curriculum that places priority on concepts of self direction and PCP in all appropriate fields. SCHEV $0 Support requests for technical assistance and training on curriculum development.
7/09 5. Explore the possibility of developing formal linkages between the VBPD Partners in Policy-Making, Youth Leadership Forum, OCI, VBPD, DBHDS $0 and Consumer Empowerment Leadership Training (CELT) graduates and membership on state level planning groups.
2009 Updated Strategic Plan: Community Integration for Virginians with Disabilities 6
Action Plan #1.2
Expectation Individuals with disabilities will have a variety of choices to support their selected community integration option.
Strategy #1.2.1 Expand self-direction options in all service environments to increase utilization.
Measurable outcome The number of individuals using self-direction options will increase.
Implementation Actions Date/s Responsible agency/cies Cost/s 1. Develop new self-direction community integration options for Virginians, including, where applicable, adding self-2011 Agencies collaborating on the STG TBD direction to home and community-based waivers.
Current ; Support current efforts to address Goal 2 within the STG. Current 4; Use recommendations from the DBHDS PCP Leadership Team to support this strategy. Ongoing
; Promote awareness of the “best practice” models identified in 2008.
2. Promote increased usage of self-direction options through education and outreach. Ongoing Agencies collaborating on the STG TBD 3 Involve the SILC, the CILs, AAAs, CSBs, and private case management organizations in creating implementation plans Ongoing Agencies collaborating on the STG TBD for new targeted community integration best practices referenced above including transitional start-up costs.
; Compile a summary of new services and changes to be made through adoption of best practice models.
; Collaborate on establishing priorities based on populations in need, funding, and implementation plans.
; Work with identified agencies to determine options for funding the models.
; Implement the models.
; Assure that Virginia policy reflects the expanded options and funding mechanisms.
Strategy #1.2.2 Develop an infrastructure to support individuals with disabilities to choose how their allocated funding is spent, with appropriate accountability. Measurable outcome The number of individuals using individualized budgeting will increase.
Implementation Actions Date/s Responsible agency/cies Cost/s 1. Adopt Money Follows the Person(MFP) initiatives. Follow progress of Systems Transformation Grant (STG) Agencies collaborating on 2011 TBD implementation: the STG ; Determine budget authority and methodology; amend waivers.
; Design and field test pilots by waiver.
; Define roles of fiscal employer/agent and broker.
; System change complete.
4 Department of Behavioral Health and Developmental Services, formerly the Department of Mental Health, Mental Retardation and Substance Abuse Services. 2009 Updated Strategic Plan: Community Integration for Virginians with Disabilities 7
Critical Success Factor #2: Choose Among Quality Community Providers and Direct Support Professionals
Action Plan #2.1
An environment conducive to attracting and maintaining an adequate network of quality community providers and direct support professionals will be Expectation
Strategy #2.1.1 Publish/communicate complete career ladder of certifications and licensure for individuals serving individuals with disabilities. Measurable outcome The number of quality community providers and direct support professionals in Virginia will increase.
Implementation Actions Date/s Responsible agency/cies Cost/s
IT, DBVI, DRS, DBHDS, 1. Continue to support existing career pathways for direct support professionals: Ongoing TBD
DMAS ; As funding for the College of Direct Support was recently cut, continue to advocate for funding restoration. Inquire whether
ARRA funding could be used for this purpose.
; Support DBVI’s two- year succession plan effort, “Investing in Our Workforce,” designed to ensure an educated and full
workforce at DBVI.
2. Track the implementation of recommendations from the Health Reform Commission. Work with OSHHR regarding disability-IT, DBVI, DRS, DBHDS, Ongoing TBD related recommendations and any implementation progress. DMAS Strategy #2.1.2 Adequately reimburse quality community providers and direct support professionals so that they can afford to do business. Measurable outcome Reimbursement of quality community providers and direct support professionals in Virginia will increase.
Implementation Actions Date/s Responsible agency/cies Cost/s 1. Continue to monitor compensation and pay rate for direct support professionals. Ensure that all Personal Care, Respite, and Ongoing DRS, DMAS, DSS TBD Companion Services through DRS, DMAS, and DSS are allotted new funds for comparable increases.
2. Advocate and educate the Governor’s Office and the General Assembly (GA) about the need. Support advocacy groups, who Ongoing OCI, IT $0 will continue to advocate with the Governor and the GA for additional rate increases.
3. Facilitate activity between public and private entities to encourage collaboration and create a cohesive effort to increase rates. Summer DMAS, DRS, DBHDS TBD Convene a meeting with all agencies/groups supporting direct support providers to ensure that requests for increases are made 2009
collaboratively during the 2010 GA session to ensure parity of increases.
4. Convene a short-term Team task group to determine how to implement a 25% differential in ID and IFDDS Medicaid Waiver Fall DBHDS, DMAS TBD reimbursement rates for providers of residential services who serve four or fewer people per home to make smaller settings more 2009
financially feasible and promote the Money Follows the Person initiative.
2009 Updated Strategic Plan: Community Integration for Virginians with Disabilities 8
Identify methods of encouraging exemptions of publicly-funded skilled services where appropriate so that individuals who direct their own services have Strategy #2.1.3
sufficient flexibility to choose to have a direct support professional to perform the duties.
Measurable outcome The number of quality community providers and direct support professionals in Virginia will increase.
Implementation Actions Date/s Responsible agency/cies Cost/s 1. Request Governor to consider introducing a legislative proposal in the 2010 GA Session amending Code ? 54.1-2901(A) and 2009 IT, DRS, DMAS, OCI, DHP $0 Code ? 54.1-3001 to increase the flexibility of individuals to direct their own publicly-funded skilled care that would not counter current nurse and medical practices delegation regulations.
2. Include in the above legislative proposal amendments to Section 54.1-3408 (P) of the Drug Control Act to say “normally self-2009 OCI, IT, DHP $0 administered drugs” and not limit the route of administration.
3. Implement stakeholder legislative education activities planned by Task Group. 07/09 to IT $0
4. Work with the GA to provide tax incentives for private care providers for employee training and certification. Talk with private 2009 OCI TBD providers to ask what kinds of incentives they envision.
5. Continue to explore paid family members serving as personal assistants in publicly funded programs. Recommend specific Fall DRS, DMAS, DBHDS $0 regulatory, policy and procedural changes (with safeguards) to the DRS PAS program and Consumer Directed services in the 2009
DMAS Waivers that would allow family members over age 18 to be employed as personal assistants. The same standard currently used in the MR/ID Waiver should be considered for use in the other waivers.
Critical Success Factor #3: Obtain Housing
Action Plan #3.1
Expectation Housing will be accessible for individuals leaving institutions or at risk of becoming institutionalized.
Eliminate physical, social and other barriers that impede an individual’s ability to live in the most integrated environment possible. (Accessibility means different Strategy
things for different individuals. For an individual with a mobility limitation the elimination of structural barriers might result in accessibility. For an individual with
a developmental disability, accessibility might be a system of supports that mitigate limitations and perhaps include a congregate living model.) Measurable 1) The number of individuals getting accessible housing will increase.
outcomes 2) The number of individuals in supportive housing will increase.
Implementation Actions Date/s Responsible agency/cies Cost/s 1. Continue to identify the barriers to accessible housing and determine how best to address them. Ongoing DPOR, VHDA, DHCD TBD ; Work with building code officials who are responsible for ensuring that buildings are in compliance to develop
recommendations on addressing barriers through programmatic responses.
; Promote acceptance of Universal and EasyLiving Home Design as the standard for development of new housing;
2009 Updated Strategic Plan: Community Integration for Virginians with Disabilities 9