HD61 - A Report on the Mental Retardation Waiver

Executive Summary:

CHPS Consulting (CHPS) has prepared this report on the Medicaid funded Waiver program for mental retardation services for the Commonwealth of Virginia's Department of Medical Assistance Services (DMAS) and Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS).

Virginia funds community support services for individuals with mental retardation through its Medicaid Home and Community Based (HCB) Waiver, which was granted to DMAS by the Health Care Financing Administration (HCFA) under section 1915(c) of the Social Security Act. The Waiver provides funding for individuals in the community who would otherwise require the level of care provided in an intermediate care facility for the mentally retarded (ICF/MR). To qualify for the MR Waiver, individuals must:

• be financially eligible for Medicaid services;
• have a diagnosis of mental retardation or a related condition or be developmentally at risk if under age six, and
• need services provided at the ICF/MR level of care.


This study was mandated by the Virginia General Assembly in the 1998 Appropriations Act at House Bill Item 341, which states,

"The Department of Mental Health, Mental Retardation and Substance Abuse Services and the Department of Medical Assistance Services, in cooperation with community mental retardation service providers, shall study the current Medicaid waiver for mental retardation services and possible changes that will lead to maximum service efficiencies and greater cost containment. Emphasis shall be placed on developing waiver services focused on individualized supports, that would complement and maximize personal resources and natural supports while ensuring that the least intrusive or restrictive services are provided to eligible individuals. A report shall be provided to the Governor and the Chairmen of the House Appropriates and Senate Finance Committees by December 1, 1998."

As indicated in the language from House Bill Item 341, the purpose of this study was to review the current Waiver for the mental retardation (MR) population and identify and explore potential changes. There were three specific objectives for this review of the Waiver:

• to examine ways to maximize MR service efficiencies,
• to identify opportunities for greater cost containment in serving the MR population, and
• to review the array of services covered under the Waiver.


This report is presented in four chapters and ten appendices. The following chapter discusses the methodology that was used to conduct the study and presents the data sources that were consulted. Chapter Three describes the current Waiver for MR services, including administration of the Waiver, service array and delivery, and financial management issues. Chapter Four presents study findings and recommendations regarding Waiver administration, service array and delivery, financial management, and other issues.

The appendices include an overview of MR/DD service delivery in the United States and a discussion of MR/DD services in Virginia and the United States. MR Waivers in other states are discussed including states with innovative Waivers and states in the same geographic area as Virginia. Draft recommendations, as developed by the Waiver Advisory Committee, for the Waiver renewal are presented. A list of the interviews conducted by the project team is provided, followed by the interview guides and consumer interview summaries. A review of recent case law regarding MR services is presented. Copies of the documents distributed to the Project Advisory Group and the minutes of weekly telephone conferences are included. One appendix provides a short glossary of terms used in the report.