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UPDATE�US v. VA Settlement Agreement�

U.S. Department of Justice

Civil Rights Division

Special Litigation Section

Aug 2, 2022

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Background

Investigation – April 2010

Findings – February 2011

Settlement Agreement Approved – Aug 23, 2012

Implementation / Enforcement - 10+ years

GOALS: Integration

Self-determination

Quality services

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Background

“To prevent the unnecessary institutionalization of individuals with ID/DD and to provide them opportunities to live in the most integrated settings appropriate to their needs.”

Section III. A. of Settlement Agreement

“To ensure that all services for individuals receiving services under this Agreement are of good quality, meet individual needs, and help individuals achieve positive outcomes in all domains of life.”

Section V. A. of Settlement Agreement

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DOJ Actions

Meet with Stakeholders

Review Data, Documents, Records

Meet with Virginia Leadership

Meet with Independent Reviewer-

Donald Fletcher

Status Conferences with the Court

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PART 1: �BIG PICTURE �AND � COURT STUFF

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Is DOJ still here?

YES

Settlement Agreement was anticipated to end June 30, 2021.

But the Settlement Agreement does not end until Virginia is in full compliance.

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“Accordingly, the Court extends the anticipated end of the Consent Decree to July 1, 2022…”

March 11, 2021

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March 18, 2021

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May 23, 2022

“Accordingly, the Court EXTENDS the anticipated end of the Consent Decree to December 31, 2023...”

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REWIND TO THIS TIME LAST YEAR

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Independent Reviewer’s 18^th report showed noncompliance with 54 out of 129 provisions.

June 13, 2021

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July 19, 2021 DOJ Non-Compliance Letter

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WHAT’S HAPPENED IN THE LAST YEAR?

SO what happened in the last year, after that letter was sent? DOJ pushed Virginia to agree to more.

All in all we filed 16 documents with the Court on more than 30 areas where VA committed to do more specific tasks that will benefit you:

2.16 Case management – improving case management

7.18; 29.21 Preventative Behavioral Services – identifying who actually is in need of Therapeutic Consultation and whether they get it within 30 days or at all and holding VA’s feet to fire over the next year if people can’t get this service

7.20 Improving Therapeutic Consultation – so the staff you interact with actually add value and help you and your loved ones and aren’t just a waste of money

36.1 Do we believe their Data – we’ve looked behind their process and made them come up with process to validate and verify it. Mr. Fletcher is getting closer to feeling better about some of it.

18.9 Nursing Services - identifying who actually is in need of Nursing and whether they got it at least 80% of the hours in their ISP (with current data)

[33.16 Looking at deaths and learning from them ]

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Arc’s website

has these “curative action” documents

www.thearcofva.org/va_doj_settlement_agreement

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Independent Reviewer’s 20^th report showed noncompliance with 52 out of 129 provisions.

June 13, 2022

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317 Compliance Indicators

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Public Status Hearing

Thur. Aug 11, 2022

1pm

Federal Courthouse

701 E. Broad St, Richmond

Courtroom 6000

Judge John Gibney, Jr.

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PART 2: �AGREEMENT TOPICS

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Settlement Agreement Topics

Individual and Family Supports Prog (IFSP)
People with Complex Behavioral Needs
People with Complex Medical Needs

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Individual and Family Supports Program (IFSP)

Provision II.D “comprehensive and coordinated set of strategies”

Later on page 7 of the Agreement:

“minimum of 1000 individuals supported”

“whom the Commonwealth determines to be the most at risk of institutionalization”

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IFSP

Source: FY 20 Combined Satisfaction Survey Results for FY20 2.18.21

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Independent Reviewer (IR) pointed out a big concern:

“First-come, first-serve” approach does not meet the “most at risk for institutionalization” requirement – Virginia must come up with an alternative. As of June 2022 IR Report, no clear alternative.

ALSO:

“Following the shut-down of the Portal [in the fall of 2021] when the data breach occurred, and given the large number of applications saved, DBHDS staff reported they chose to approve all of the IFSP application drafts that were saved as of October 4, 2021, with each applicant being awarded $1,000. This utilized funds from both FY 2021 and FY 2022. In all, DBHDS awarded $4,036,000 during this most recent funding period.”

https://dbhds.virginia.gov/ifsp-data-breach/

IFSP

Source: IR 20^th Report, June 2022, page 37; 355; 371

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“IFSP is developing a new process to accept requests for assistance. We expect to be able to receive applications in early 2022. Once we are ready to launch, we will provide notice through the IFSP Listserve.”

https://dbhds.virginia.gov/ifsp-data-breach/

IFSP

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Settlement Agreement Topics

Individual and Family Supports Prog (IFSP)
People with Complex Behavioral Needs
People with Complex Medical Needs

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People with Complex Behavioral Needs�

Compliance Indicator #7.8: “86% of children and adults who are known to the system will receive REACH crisis assessments at home, the residential setting, or other community setting (non-hospital/CSB location).”

Source: IR 20^th Report, June 2022, page 27

FY 22 Q1: 51%
FY 22 Q2: 36%
FY 22 Q3: 40%
FY 22 Q4: none yet

FY 21 Q1: 53%
FY 21 Q2: 34%
FY 21 Q3: 35%
FY 21 Q4: 42%

OUTCOME:

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Compliance Indicator #7.18: “[By March 31, 2022], 86% of those identified as in need of the Therapeutic Consultation service (behavioral supports) are referred for the service (and a provider is identified) within 30 days.”

Source: IR 20^th Report, June 2022, page 300

Sept 2020 - Feb 2021: (271/601) 45%

Mar 2021 - Aug 2021: (222/639) 35%

Sept 2021 - Jan 2022: (231/387) 60%

OUTCOME:

People with Complex Behavioral Needs

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Compliance Indicator #7.20 & #29.21:

First, DBHDS will report the total number of people identified who needed Therapeutic Consultation in their ISP and how many of those people actually received it.

Second: At least 86% of people who needed Therapeutic Consultation in their ISP must receive services that were “adequate and appropriately delivered” (i.e. good quality)

Source: FY22 Q3 Behavioral Supports Report, p. 8

No data yet on #1 – expected October 2022

July 2021 - March 2022: Based on 100 sets of Therapeutic Consultation records = 13%

OUTCOME:

People with Complex Behavioral Needs

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People with Complex Behavioral Needs�

Source: Provider Data Summary Report May 2022, p. 23

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Settlement Agreement Topics

Individual and Family Supports Prog (IFSP)
People with Complex Behavioral Needs
People with Complex Medical Needs

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Compliance Indicator #18.9: 70% of individuals with nursing needs will receive at least 80% of their authorized nursing hours.

Source: Nursing Services Data Report - FINAL 10.16.20;

Nursing Services Data Report - FINAL 2.14.22

July 2018 - June 2019: (311/648) 48%

July 2019 - June 2020: (372/736) 51%

OUTCOME:

People with Complex Medical Needs

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Rates increased for LPN and RN (Skilled Nursing and Private Duty Nursing) as of July 1, 2022. You can see details on the $$ here:

www.dmas.virginia.gov/for-providers/long-term-care/waivers/

Scroll down the page until you see:

People with Complex Medical Needs

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Public Status Hearing

Thur. Aug 11, 2022

1pm

Federal Courthouse

701 E. Broad St, Richmond

Courtroom 6000

Judge John Gibney, Jr.

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Contact Information

Kyle Smiddie (Attorney)

Kyle.Smiddie@usdoj.gov

202-307-6581

Bo Tayloe (Deputy Chief)

Benjamin.Tayloe@usdoj.gov

202-514-8103

Jessica Polansky (Attorney)

Jessica. Polansky@usdoj.gov

202-353-1280