RD78 - Update to the Training Center Closure Plan Pursuant to per Item 314.L. of the 2013 Appropriation Act - January 10, 2014

Executive Summary:
Item 314. L. of the 2013 Appropriation Act requires the following:

"L. The Commissioner of the Department of Behavioral Health and Developmental Services shall provide a plan to the General Assembly, developed in consultation with the Secretary of Health and Human Resources and the Chairmen of the House Appropriations and Senate Finance Committees, related to the closure of state training centers by the end fiscal year 2021, in compliance with the settlement agreement relating to United States of America v. Commonwealth of Virginia (Civil Action No. 312cv0059-JAG), subject to judicial approval. In developing the plan, the Commissioner shall solicit input from all relevant stakeholders including, but not limited to, individuals with intellectual or developmental disabilities or their guardians, and public and private providers. The plan shall be completed within one year of the effective date of the settlement agreement."

This report provides the plan to close four of Virginia’s five state training centers by FY 2020. This report is an update to the plan that was submitted on February 13, 2012 to the General Assembly, pursuant to § 37.2-319 of the Code of Virginia (Report Document 86, 2012). The Department of Behavioral Health and Developmental Services (DBHDS) and the Secretary of Health and Human Resources provided a draft copy of this current report update to the Chairmen of the House Appropriations and Senate Finance Committees on October 2, 2013 for their consultation and input.

The population of the training centers has declined over the last thirty years from 6,000 individuals to fewer than 750 individuals statewide today. There are currently over 11,000 individuals served in community settings through Medicaid ID or DD waivers and an additional 7,500 people are on a waiting list for these services. Statewide, 296 people have transitioned from the training centers to the community since July 2011 - 101 in FY 2012, 155 in FY 2013 and 40 during the first three months of FY 2014.

As the training center population drops, the cost per person is rising. In FY 2012, the statewide average training center cost per person, per year was $224,245. In FY 2013, with a declining census, that cost rose to $261,000 annually per person. The continued operation of training center residential services at current levels is fiscally impractical due to the significant and ongoing decline in population.

Consistent with Virginia's long-standing commitment to a community-based system for those with disabilities, over the next eight months, 240 individuals will use Medicaid waivers to move out of training centers to community homes, closer to family and natural support networks. Since 2010, Virginia’s statewide training center census has decreased over 38% from 1,198 to less than 750 individuals. Southside Virginia Training Center in Petersburg will close by the end of this fiscal year and three of the four remaining training centers are anticipated to close by FY 2020.

Working with families to identify the right community setting is an individualized process. DBHDS works intensively with each individual and family to identify every support they believe is needed to live in the community and to identify providers that can currently meet those needs or can develop services or supports to meet those needs. DBHDS researches and identifies the most appropriate option from the assortment of choices individuals and families have for new homes that best meets their specific needs and preferences. Those settings include living in their own or their family's home with the proper services and supports; group homes; sponsored residential homes where the individual lives with an actual family; or intermediate care settings, which provide the same level of services as training centers but in smaller, community settings.

The decision to move to the community is made by the individual’s authorized representative. No individual is discharged without full discussion of medical and behavioral needs and ensuring that each support need is met at the time of discharge, and no individual is discharged from a training center to a community setting unless they so choose. Detailed and careful discharge processes have been put into place in all of the training centers so that the individuals living there can be safely moved to appropriate settings in communities closer to their homes.

Once an individual and authorized representative selects a community provider, staff from the DBHDS central office, the training center, and the local community services board work with the provider on the implementation of the discharge plan. The individual’s adjustment is heavily monitored and, whenever needed, the provider is offered recommendations and additional support to help the individual in his or her new home. Also, individuals are closely and frequently monitored once they move to community homes. This involves a set schedule of visits for case managers from the local community services board and from licensing and human rights staff from DBHDS. DBHDS has also bolstered quality and risk management systems for community services. In addition, DBHDS is also implementing a real-time, web-based incident reporting system and reporting protocol. As a result, oversight of community providers has been and will continue to be strengthened. This will benefit individuals who are living in the community using the ID Waiver, those who have transitioned from training centers, and individuals who will transition from training centers to new community homes during the training center closure process.