1. UPDATE on the US v. Virginia Settlement Agreement and National Enforcement Efforts U.S. Department of Justice Civil Rights Division Special Litigation Section

2. Background CRIPA investigation Expanded investigation – Apr. 2010 Findings – Feb. 2011 Negotiations – 2011-2012 Agreement – Jan. 2012 Approval by court – Mar. & Aug. 2012 Implementation / Enforcement – Now

3. Activities of the DOJ FY 2013 Meetings w/ Stakeholders (500+) Families (waitlist, TC, waiver recipients) Providers Organizations CSB’s Case managers Employment coordinators Crisis services

4. Activities of the DOJ FY 2013 Reviewing Data Meetings with Independent Reviewer Meetings with State of Virginia including drill downs on specific topics

5. Topics we’ll discuss today 1.Waivers 2.Transition Planning 3.Indv. & Family Supports 4.Crisis System 5.Integrated Housing 6.Integrated Employment and Day Activities 7.Family-to-family and peer-to-peer programs 8. Case Management 9.Access and Availability 10.Quality Assurance

6. Waivers FY 2014 225 ID Waivers 25 DD Waivers 160 TC Waivers 40 prioritized for Youth in Nursing Homes/large ICFs Independent Reviewer reported Virginia has allocated many more waivers than required in FY 2014

7. National Perspective: Youth with ID/DD in Nursing Homes Florida 2012 Findings Letter – Found hundreds of children with significant medical needs resided unnecessarily in nursing homes & many more at-risk of entering nursing homes because lack of community alternatives and cuts to in-home supports (esp. in-home nursing) After six months of negotiations United States filed suit in July 2013. – Lawsuit seeks a comprehensive remedy, including offering community alternative s to all children in nursing homes, effective transition planning, expansion of community-based and in-home services as alternatives to nursing home care, and changes to policies/practices re in-home supports. It also seeks damages for affected children.

8. National Perspective: Adults with ID/DD in Nursing Homes Texas Intervened in Steward v. Perry, a class-action regarding the unnecessary institutionalization of thousands of people with ID/DD in and at-risk of entering private nursing homes Litigation implicates intersection of ADA and PASRR Reached Interim Agreement (to be filed for Court approval in Aug 2013) that requires Texas to: – identify people with ID/DD in NHs, inform them about community alternatives, and establish necessary services and transition those who want to move to the community – create hundreds of new Medicaid waivers to transition people from, and divert people from entering, NHs – expand community-based medical services – establish a system to divert people from unnecessary NH admissions (including regional diversion coordinators) Continuing to finalize a final comprehensive agreement

9. Transition Planning FY 2014 Individualized, person-centered plans Essential supports and Barrier-busting Both the DOJ and the Independent Reviewer will continue to focus on: – Adequate Community Options for those receiving waivers from the ID/DD waitlists and from Training Centers

10. Indv. & Family Supports FY 2014 In FY 2013 established the program and met targets of 700 individuals Commonwealth reports that typical requests in FY 2013 were for respite, summer camps, or transportation In FY 2014 required to support 1000 individuals Commonwealth reports there will be an online application in addition to the paper application

11. Crisis System FY 2014 Mobile crisis response times Crisis plans Region 4 & 5 stabilization units Transportation to the stabilization units Number of regional stabilization units Serving children with ID/DD Staffing Coordination with CSB Emergency Services

12. Integrated Housing FY 2014 Increased specificity of March 6, 2013 Housing Plan Section 811 application $800,000 Rental Assistance Pilot Program Coordination with local housing entities Increased development of living options

13. National Perspective: Housing for People with Disabilities June 2013 HUD Guidance – HUD-funded affordable housing programs are a critical resource for Olmstead implementation – HUD is committed to ensuring that HUD-funded housing gives choice, self-determination, and opportunities for people with disabilities to live and interact with people without disabilities – Provides guidance on how to structure preferences that relate to state Olmstead implementation (VA has a HUD-approved preference for US v. VA implementation)

14. National Perspective: Housing for People with Disabilities CMS Regulations re HCBS Settings – CMS finalizing regulations defining characteristics of community-based settings for HCBS authorities (1915c, 1915i, Community First Choice (1915k)) – NPRM has list of required positive characteristics for all HCBS settings, additional requirements for provider-owned settings, list of non-HCBS settings (eg, ICFs, NHs), and presumptively non-HCBS settings (eg, on grounds of or adjacent to public institution)

15. Integrated Employment FY 2014 December 2012 Employment First Policy Increased specificity of November 7, 2012 Employment Implementation Plan Sufficiency of March 29, 2013 supported employment targets Implementation of training initiatives

16. National Perspective: Integrated Days Rhode Island -- Investigation regarding adults with ID/DD in state’s largest sheltered workshop and pipeline of students from school-based SW to this adult SW -- Interim Settlement Agreement June 2013 Integrated supported employment (individual placements, at least min. wage) and integrated day services for more than 200 people currently in SWs “40-20” Integration Standard Requirement of average of at least 20 hours a week across the group Requirement of integrated day activities when not working, for a total of 40 hours of integrated work and non-work activities per week.

17. National Perspective: Integrated Days Oregon Findings Letter June 2012 – Found segregation in sheltered workshops of people who could and want to work in integrated settings – Focus on people unnecessarily in sheltered workshops and people at risk (esp. transition age students) – Seeks expansion of integrated supported employment (individual, at least min. wage) Complaint and Motion to Intervene March 2013 – Over-reliance on segregated employment settings -- 61% of people receiving e-ment svs are in SWs; only 16% are in indiv. supp. employment – No real opportunity to leave segregated e-ment -- People remain in SWs an average of 11-12 years, up to 30 years. – Pipeline from school to segregated e-ment

18. Family-to-family/Peer-to-peer FY 2014 Activities of Family Recourse Consultant Meeting with Family and Peer Mentors Waitlist mentoring, as well as training center mentoring

19. Case Management FY 2014 Regular face-to-face meetings Individual Support Plans Enhanced case management – Safety – Increased integration Role of case manager

20. Access & Availability FY 2014 Guidelines for families seeking services Easy Access website Transportation oversight Access to Adaptive Equipment/ Environmental Modifications

21. Quality Assurance & Risk Management FY 2014 Expanded reporting: Computerized Human Rights Information System Quality Improvement Committee Regional Quality Council development Quality Service Reviews development Licensure Process for Corrective Action Plans

22. Independent Reviewer Next Report- Dec 2013 Crisis Services Case Management Quality and Risk Management Transition & Discharge Planning from Southside & Northern Virginia Training Center

23. Websites www.ada.gov/olmstead – All of DOJ’s Olmstead enforcement efforts nationally (findings letters, settlements, briefs, etc.) [includes US v. Virginia] – Guidance documents – Speeches – Faces of Olmstead www.justice.gov/crt/about/spl/virginia- ada.php www.justice.gov/crt/about/spl/virginia- ada.php US v. Virginia specific website – Independent reviewer’s reports – Settlement agreement and summary – Findings letter

24. Contact Information Kyle Smiddie Kyle.Smiddie@usdoj.gov 202-307-6581 Bo Tayloe Benjamin.Tayloe@usdoj.gov 202-514-8103 Richard Farano Richard.Farano@usdoj.gov 202-307-3116 Alison Barkoff Alison.Barkoff@usdoj.gov 202-307-3216 Jason Hilliard Jason.Hilliard@usdoj.gov 202-353-1106