1. The Department of Medical Assistance Services Barbara R. Seymour, BSW, HCCS 1

2.  BIAV – Brain Injury Association of Virginia  CM – Case Management  DARS – Department of Aging and Rehabilitative Services  DBHDS – Department of Behavioral Health and Developmental Services  DD – Individual and Family Developmental Disabilities (DD) Support Waiver  DMAS – Department of Medical Assistance Services  EDCD – Elderly or Disabled w/ Consumer Direction Waiver  GA – General Assembly  JLARC – Joint Legislative Audit and Review Commission  NF – Nursing Facility  TBI/BI – Traumatic Brain Injury/Brain Injury  VBIC – Virginia Brain Injury Council 2

3.  2006 Enrollment of Kindred Health Corporation's Braintree Rehabilitation & Nursing Center to meet the complex neurobehavioral needs of BI individuals  2007 Participation in provision of data for Joint Legislative Audit and Review Commission (JLARC) report  2008 – 2012  DMAS, with input from stakeholders, submits Traumatic Brain Injury Waiver (TBI) proposals 2008-20012; funding was not appropriated  Collaborated with DARS & BIAV towards development of an “intervention program” for NF’s * DMAS efforts for TBI waiver have continued for over 10 years 3

4.  2011- 2012 Due to competing service needs, TBI Waiver requests were not approved through the budget process Efforts continue towards pursuit of alternative service options to address unmet neurobehavioral needs of BI population 4

5.  2013 Health Care Reform-adding 400 thousand to Medicaid population; shift in focus will be to “shape and transform” existing waivers and meet BI needs DMAS work with providers and stakeholders resulted in the 2013 GA Budget Amendment Item 307 which directed DMAS to establish a pilot program for a 20-bed neurobehavioral treatment program in a licensed NF or residential treatment center. This item did not pass. Neuropsychological/Behavioral Services is recognized as a need by the Governor; however, lack of funding is the biggest issue; thought process is establishment of a neurobehavioral program should address multiple diagnoses, not just BI 5

6.  DMAS subject matter expert CM’s provide: BI resource information to consumers, service providers, stakeholders, survivors and caregivers CM services for complex cases and out of state placements  DMAS internal agency review of possible alternatives in absence of a TBI Waiver: Services under EDCD to address BI needs Possible BI worksheet to guide UAI screening team Consider adding neurobehavioral services to specialized care category (NF based) Nursing facility based TBI Unit 6

7.  Collaboration with NF industry BI service providers to work with NF’s willing to admit BI individuals  Neurobehavioral Workgroup  Discussions with Stakeholders, service providers, survivors/families regarding BI system of care to address the unmet neurobehavioral needs  Commonwealth Coordinated Care (Duals Project)  EDCD Waiver participants receiving coordinated care for Long Term Support Services (LTSS) who are Medicare and Medicaid eligible)  FY 12 data shows 111 BI individuals enrolled in the EDCD Waiver 7

8.  Service focus is shifting from institutional to community; enhanced integration and options for independence  Four main areas of DOJ Agreement  Transitions from training centers  Integrated setting - building quality community-based alternatives for individuals, particularly those with complex needs  Implement quality and risk management system to monitor and evaluate services; a quality improvement process at all levels (individual, provider, and state-wide)  Support independent housing & employment options for individuals with I/DD 8

9.  Stimulated discussions between DBHDS and DMAS to continue review of the existing waivers and opportunities for enhancements  DBHDS and DMAS awarded RFP to a national organization to study possible improvements for ID/DD/DS waiver changes over the next two (2) years  Move to needs based waivers (not dx, i.e. I/DD)  Recommend rate study and changes to serve those with the most complex needs 9

10.  START-Systemic Therapeutic Assessment Respite and Treatments model  Statewide implementation of a crisis system for those with I/DD (includes BI individuals enrolled in DD Waiver ~ FY12 = 36 BI individuals enrolled in the DD Waiver)  To maintain individuals in their homes and avoid crisis  Operational in all 5 health planning regions in July 2012  Provides 24 hr mobile crisis support  Three (3) regions provide crisis stabilization programs  Blended funding between state general funds and Medicaid 10

11. Barbara R. Seymour, BSW, HCCS, Project Lead Long Term Care Division Main Line: 804-225-4222 Direct Line: 804-786-1835 E-Mail: barbara.seymour@dmas.virginia.gov barbara.seymour@dmas.virginia.gov 11

12. 12 Nobody can go back and start a new beginning, but anyone can start today and make a new ending. ~ Maria Robinson