HD27 - Interim Report of the Commission on the Coordination of the Delivery of Services to Facilitate the Self-Sufficiency and Support Persons with Physical and Sensory Disabilities in the Commonwealth

  • Published: 1991
  • Author: Study Commission
  • Enabling Authority: House Joint Resolution 45 (Regular Session, 1990)

Executive Summary:
Authority

The Joint Subcommittee Studying the Needs of Head and Spinal Cord Injured Citizens, the Need for Research, and the Needs of All Physically Handicapped Persons (Mayer·1989) proposed the creation of a blue ribbon Commission to continue the study of services and programs for persons with physical and sensory disabilities in the Commonwealth. The Commission's charge was to identify the need, availability, costs, quality, and adequacy of services for the physically and sensory disabled and develop a blueprint for the Commonwealth's service delivery system for the next decade and into the twenty-first century. House Joint Resolution 45 adopted by the 1990 General Assembly established the Commission on the Coordination of the Delivery of Services to Facilitate the Self-Sufficiency and Support of Persons with Physical and Sensory Disabilities in the Commonwealth. The resolution identified the following areas for study:

• Availability, accessibility, and coordination of essential services;

• Interagency coordination in the delivery of services;

• Regionalized service continuum in the "least restrictive environment";

• Program, services, and resources of public agencies serving persons with physical and sensory disabilities;

• Eligibility, waiting periods, exclusions, waiting periods, and gaps in benefits in public and private third-party health insurance;

• Fragmentation, inadequacies, or duplications in the existing service delivery system; and

• Accountability in an integrated service system.

Study Methodology

The Commission adopted a workplan which organized the study activities under three subcommittees: Services, Administration and Management Requirements, and Financing. The membership of each subcommittee is comprised of five Commission members, consumers, parents of consumers, and representatives with expertise in the areas of study. Technical assistance is provided through a state agency advisory group and five Volunteer Planners. The Commission is staffed through the Office of the Secretary of Health and Human Resources.

Current Service System

The Commission has focused its study on the three primary service agencies for persons with physical and sensory disabilities:

Department of Rehabilitative Services,
Department for the Visually Handicapped, and
Department for the Deaf and Hard of Hearing.

The Department for Rights of Virginians with Disabilities is responsible for providing advocacy for protection of consumer rights.

The Department of Education is a critical part of the study on issues affecting infants and youth with physical and sensory disabilities.

Principles

The Commission adopted five principles as guidelines for its deliberations:

1. There are individuals with physical and sensory disabilities who may need both short and long term services at some point in their rehabilitation.

2. The Commission must maintain the integrity of the current system for rehabilitation which addresses the short term needs and expand or enhance this system to serve individuals who need a system of extended support services.

3. There should be no new, unnecessary bureaucracy created in the service delivery system.

4. The Commission must define the continuum of services required by persons with physical and sensory disabilities to achieve independence in the context of eligibility, decision-maker, role of government (state and local), and rights and responsibilities of the consumer.

5. The service delivery system must have streamlined access, enhanced interagency coordination, and a continuum of community based services.

Findings

Through public testimony the Commission has identified the following problems which are facing persons with physical and sensory disabilities in the Commonwealth:

• There are insufficient community support services to facilitate individuals with physical and sensory disabilities in achieving their maximum independence.

• Case management is needed by many individuals with physical and sensory disabilities to assist them in accessing appropriate services.

• Often the potential loss of public health benefits such as Medicaid or Medicare discourages individuals with physical and sensory disabilities from seeking full-time employment.

• Insurance policies often offer inadequate coverage for certain disabilities, particularly traumatic brain injuries.

• Vocational rehabilitation services under Workers' Compensation need to be clarified.

• Many special education programs for persons with physical and sensory disabilities require costly related services and finite resources.

• Independent Living Centers need additional resources to meet the need statewide.

• Resources for assistive technology or rehabilitation engineering are insufficient to meet the need.

• There needs to be enhanced public awareness concerning the availability and means of access to services for persons with physical and sensory disabilities.

• Different locations of services and varying eligibility criteria for services often inhibit access to services.

• Incentives are needed to foster interagency coordination of the delivery of services.

• Attention should be given to early intervention and prevention of physical and sensory disabilities.

• Local involvement in planning and fiscal issues should be enhanced.

Recommendations

The Commission has received several recommendations from each of the three subcommittees. While action has been taken by the Commission on the majority of these recommendations most of the budget and legislative proposals will be introduced in the 1992 General Assembly or later. The following legislation will be introduced in the 1991 General Assembly:

1. A joint legislation resolution will be introduced which requests that all proposed health insurance changes be forwarded to the Special Advisory Commission on Mandated Benefits; and that budget recommendations contained in the Commission's final report be considered in the Executive Budget review for the 1992-1994 biennial budget and also considered by the 1992 General Assembly in their biennial budget deliberations.

2. A bill to amend Section 65.1-88 of the Code of Virginia to clarify the types of services which may be included under vocational rehabilitation for work-related injuries.

3. A joint legislative resolution requesting a study to be conducted of the Second Injury Fund.

Other recommendations from each of the subcommittees include:

Services Subcommittee proposed the adoption of several recommendations from the HJR 287 study relative to improved tracking methods for youth with physical and sensory disabilities in the public education system. These were adopted by the full Commission. Recommendations concerning core services, eligibility, and service access are still pending action by the Commission.

Administration and Management Requirements Subcommittee proposed the adoption of recommendations to address these issues:

1. Improvement of public awareness concerning persons with disabilities and increased emphasis on educating persons with disabilities on available services and programs.

2. Improvement of data collection and its utilization in human service agencies' information management systems.

3. Improvement of the training and professional standards of services providers who work with persons with physical and sensory disabilities.

4. Achieve the maximum standardization of eligibility for services within federal, state, and local rules and regulations.

5. Investigate the feasibility of co-location of service agencies on the local level.

6. Development of incentives for interagency coordination to foster more consistency on policy and planning development.

7. Development of quality assurance mechanisms to ensure accountability in the service delivery system.

8. Development of legislative safeguards to ensure consumer rights protection.

9. Investigate the feasibility of special appointments for persons with disabilities through a state model of the federal Schedule A appointments systems.

All of the recommendations on these issues were adopted by the full Commission.

The service delivery system structure issue is still pending in the subcommittee. A proposal will be made subsequent to public hearings in March.

Financing Subcommittee proposed the legislative actions on Workers' Compensation insurance referenced as 1991 legislative proposals. These were adopted by the full Commission. Six health insurance recommendations from HJR 287 were recommended for no action. The Commission voted for no action. The Commission adopted a definition for physical rehabilitation.

The subcommittees of the Commission will continue their deliberations through March, 1991. Final subcommittee recommendations will be submitted to the Commission on April 1, 1991. The Commission on the Coordination of the Delivery of Services to Facilitate the Self-Sufficiency and Support of Persons with Physical and Sensory Disabilities in the Commonwealth will complete its report by October 31, 1991 for submission to the 1992 General Assembly.