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Regulations governing placement of children in residential treatment delayed

In August 2016, the Department of Medical Assistance Services (DMAS) announced changes to the process by which children would be placed in residential treatment via Medicaid. DMAS had determined that the current Family Assessment and Planning Team process may not be in compliance in all localities with federal regulations governing the composition of the team, choice of providers, and appeals, and sought to change the process by having an independent team (Independent Assessment, Certification, and Coordination Team, or IACCT) determine medical necessity for admission to residential treatment. Localities could contract with Magellan, the state’s behavioral health administrator, to have their local Community Policy and Management Teams serve as the IACCT, or Magellan would assemble the team by contracting with the local Community Services Board, or with representatives from its network of private providers.

DMAS initially asked for expressions of interest from localities in August with a deadline of September 2016, and with the new regulations set to take effect December 1, 2016; these deadlines were subsequently delayed until November 2016 and January 2017, respectively. Throughout the fall, VACo expressed serious concerns to the Administration about the speed with which the regulatory process was proceeding, particularly given the number of unanswered questions that remained as the implementation deadline approached, and advocated a delay until July 1, 2017, to allow time for questions to be answered. Local government representatives on the State Executive Council similarly advocated for a delay.

In mid-December, official guidance from the Office of Children’s Services was issued, but very little time remained between the issuance of such guidance and the January 1 implementation deadline to train local staff on new procedures. Late in December, the regulations were delayed until further notice; in early January, representatives from VACo and other organizations met with the Governor’s staff and representatives from DMAS to outline concerns with the new process, and local representatives held several subsequent meetings with DMAS staff.

Earlier this month, DMAS announced that the effective date of the regulations would be delayed until July 1, 2017, as requested by VACo. The regulations have now been posted on the state’s Town Hall site and the public comment period is open until March 22. It should be noted that despite the delayed effective date, the Administration is still encouraging localities to ensure compliance with federal regulations; the Governor’s approval memo states, “While the regulation approved here will not be effective until July 1, 2017, full compliance must be achieved as quickly as possible, and I encourage DMAS to take all reasonable steps to encourage early compliance.”

DMAS staff have committed to continuing to work with VACo and VML and other local government representatives this spring to develop a basic Memorandum of Understanding through which interested localities could demonstrate compliance with the federal regulations without major changes to existing processes. The option to contract with Magellan to serve as the IACCT would remain, as would the option to have Magellan handle the admissions process with private providers.

VACo Contact: Katie Boyle

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