On July 8, Department of Behavioral Health and Developmental Services (DBHDS) Commissioner Hughes Melton briefed members of the Joint Subcommittee to Consult on the Plan to Close State Training Centers, outlining the state’s progress in complying with the 2012 Settlement Agreement with the U.S. Department of Justice and providing an update on the scheduled closure of the Central Virginia Training Center. The state has invested significant resources in complying with the provisions of the Settlement Agreement, but additional costs remain in order for the state to achieve full compliance and exit the Agreement in 2021, a goal outlined by Commissioner Melton in his presentation.
Under the Settlement Agreement, which resolved an alleged violation of the Americans with Disabilities Act, Virginia must rebalance its system of services for individuals with intellectual and developmental disabilities to prioritize community-based services, rather than relying on care provided at the state’s training centers. The Settlement Agreement requires individuals to be served in the most integrated setting appropriate to meet their needs, consistent with their informed choice. Virginia opted to close four of its five training centers in order to direct resources toward community-based care. Southside Virginia Training Center closed in 2014, followed by Northern Virginia Training Center in 2016 and Southwest Virginia Training Center in 2018. Most residents of these centers opted for living arrangements in group homes, where services are provided through redesigned Medicaid waivers. Southeastern Virginia Training Center is planned to remain open, with a capacity of 75 beds to serve individuals whose needs cannot be met in the community.
Central Virginia Training Center (CVTC), which is scheduled to close by June 2020, still houses 45 individuals, of whom 24 have identified homes or are making final decisions on their choice of provider. Nine individuals are still in discussions with DBHDS about an appropriate placement. There have been concerns throughout the process of closing CVTC about whether individuals with high-level medical needs can be appropriately cared for in the community, and Joint Subcommittee members were particularly concerned about whether proposed alternatives to CVTC would offer a comparable level of care. Twelve CVTC residents could be served in an intermediate care facility (ICF) on the property under a proposal submitted under the Public-Private Education and Infrastructure Act (PPEA) to DBHDS last fall. DBHDS is in the process of reviewing the proposal, which, as outlined in Commissioner Melton’s presentation, would reuse two buildings on the site, one for the ICF and one for an eight-bed children’s residential crisis stabilization unit. Uncertainty remains about reuse of the property, which includes buildings that will likely require special precautions to abate or raze due to their age and expected contamination with asbestos. In addition, approximately $25 million in bonds related to earlier renovations on the property remain outstanding.
The state continues to make progress in complying with the terms of the Settlement Agreement, according to Commissioner Melton, but needs to expand its crisis services, improve its use of integrated settings, and work on quality assurance and risk management. The most recent report to the United States District Court for the Eastern District by the Independent Reviewer appointed to monitor the state’s progress notes that the state has exceeded its requirements for the creation of home and community-based services waiver slots, which allow individuals to live in community-based settings with appropriate supports. The Independent Reviewer’s June 2019 report cites day support and residential service capacity as areas for improvement, as well as case management and the state’s ability to serve individuals with intellectual or developmental disabilities in crisis in home or community-based settings.
Commissioner Melton made a similar assessment of the state’s crisis system in his briefing, noting that the state needs to enhance its community-based crisis stabilization capacity. The state currently offers the Regional Education Assessment Crisis Services Habilitation (REACH) program, which provides crisis assessment and intervention for individuals with developmental disabilities who are at risk for homelessness, incarceration, or hospitalization; the Independent Reviewer points out that REACH services are taxed by increasing numbers of individuals in crisis. Enhanced mobile offerings are needed, as well as crisis stabilization programs to provide short-term supports to children. Commissioner Melton suggested in his presentation that a comprehensive crisis system that invests in prevention and aims to serve people closer to home, in addition to being an element of the Settlement Agreement, would dovetail with two other major initiatives underway at DBHDS: implementation of STEP-VA, which includes a crisis services component, and efforts to address the overcrowding at state hospitals.
Commissioner Melton told the Joint Subcommittee that the state is working towards exiting the Settlement Agreement in 2021, which would require achieving full compliance with the components of the Agreement in 2020 and maintaining compliance for a full year. DBHDS is currently working with the Court and the Department of Justice on agreed-upon indicators for the remaining elements of the Agreement. Joint Subcommittee members strongly encouraged Commissioner Melton to provide estimates of expected costs for compliance to the legislature as soon as possible. Legislators plan to discuss the issue further at a future meeting of the Joint Subcommittee on Health and Human Resources Oversight, which consists of members from the “money committees” and has a broad mandate to review the Medicaid program and the operations of agencies within the Health and Human Resources secretariat.
VACo Contact: Katie Boyle