ࡱ>  bjbj xx5"( ( kk$PS`???AJ#@;##kk85)5)5)#`kR5)#5)5)Zȵ"p$Tzp0κ-&x-p-p?:y 5)Y! "???(0???####-?????????( 1:  Virginias Olmstead Strategic Plan  A comprehensive, cross-governmental plan to assure continued community integration of Virginians with disabilities. 2012 Approved by the Community Integration Implementation Team on August 21, 2012. Submitted to Governor Robert McDonnell on August 31, 2012. Table of Contents Page Importance of Olmstead in Virginia ..3 Background.....4 Community Living Supports..6 Housing...8 Employment and Community Engagement....10 Appendices Community Integration Advisory Commission Code Authority ...12 Executive Directive 6 (2007)..15 Additional Community Integration Implementation Team Members.......18 Identified Barriers to Community Integration20 Community Living Supports Action Items....23 Housing Action Items.....30 Employment and Community Engagement Action Items..36 Glossary of Acronyms..42 Importance of Olmstead in Virginia Virginians with disabilities have a right to enjoy the same benefits of society and freedoms of everyday life that Virginians without disabilities enjoy. The Commonwealth has an obligation under the U.S. Supreme Courts Olmstead v. L.C. decision, the Americans with Disabilities Act, and the Virginians with Disabilities Act to provide appropriate opportunities for people with disabilities to become fully integrated into the community if they choose to do so. Executive Directive 6 (2007) Background Formalized efforts organized by the Commonwealth have sought to coordinate efforts to support individuals with disabilities in the community in compliance with the Supreme Courts decision in Olmstead v. L.C. Since 2002 various stakeholders including, individuals with disabilities, providers, state agencies, and local partners worked to create the One Community report in 2004 and the Comprehensive, Cross-Governmental Strategic Plan to Assure Continued Community Integration of Virginians with Disabilities in 2007 and which has been annually updated. Although in existence in various forms since 2002, Virginias Olmstead stakeholder advisory group was codified in 2006 by the General Assembly with the creation of the 21 member Community Integration Advisory Commission (CIAC). (2.2-2524-2.2-2529) (Appendix A) The Community Integration Implementation Team (CIIT), consisting of state agencies and local partners also had its genesis soon after the creation of the stakeholder group. The Team now operates under the authority of Executive Directive 6 issued by Governor Tim Kaine in 2007 with the charge to complete and annually update a strategic plan for community integration of Virginians with disabilities with the input of the Commission. (Appendix B) Over time, changes in services, needs, demographics, and other important factors have influenced the provision of community supports for individuals with disabilities in Virginia. In recognition of the changes, both positive and negative, and the future vision of a Commonwealth that supports all individuals with disabilities who wish to live in their communities, a new Olmstead strategic plan that reflects the most pressing community integration issues facing the Commonwealth is included in the following pages. The issues are divided into three main categories; community living supports, housing, and employment and community engagement. After careful review and consideration, the most pressing issues are listed with recommendations to address the identified issues. (For some individuals other barriers to community living pose a far more significant challenge. Appendix D contains a list of additional identified barriers that the Commonwealth will also work to address.) Like a three legged stool, if one of the components of the plan is missing, be it community living supports, housing, or employment and community engagement, then successful community integration is compromised. In addition, recognizing the dignity that comes with choice and its associated risk is imperative to moving Virginia towards a Commonwealth that provides opportunities for its citizens regardless of disability. By creating this new document in consultation with the Advisory Commission, the Team hopes to provide a more accessible, usable blue-print for ensuring all Virginians with disabilities have the opportunity to be active participants in their communities. Recognizing the recent settlement agreement between the Commonwealth and the United States Department of Justice concerning Virginias system of services for individuals with intellectual and developmental disabilities, Virginias Olmstead Strategic Plan supports many of the conditions laid out in the settlement. However, it is imperative that the Commonwealth harness the energy and learning opportunities provided by the agreement to expand and improve community living options to all individuals with disabilities. Community Living Supports Community living supports assist individuals with disabilities to remain in or move to communities of their choice. From policy and administrative issues to allocation of resources there are a number of changes Virginia could make to address the issues listed below and further support community living. In addition, current policies and requirements that support community living and choice should be reviewed to ensure that procedures already in place are functioning correctly. (Appendix E provides specific action items to implement the recommendations below.) Systemic institutional bias. Decouple the provision of services and housing. Support waiver services to remove current financial incentives favoring congregate settings. Provide immediate and timely support to individuals and families throughout changes in the lifespan. Prevent initial institutionalizations and revolving readmissions. Ensure community services are offered and provided at numerous system points of entry from physicians offices to hospitals. Access to waiver slots and services. Focus on the needs of the individual and not the diagnosis. Reduce and eliminate waiver waiting lists. Determine service caps based upon the needs of the individual. Explore other home and community based service options outside of the 1915(c) waivers. Ensure that access, referral, and entry points to the system are working effectively. Provider choice, capacity, and training. Reduce and eliminate conflict of interest amongst providers. Ensure financial incentives and service program design do not limit or prohibit individual choice. Ensure provider rates accurately reflect the cost of services provided. Improve oversight of community living settings. Create, promote and conduct training on community-based options, accommodating specific needs, and physical and operational accessibility for providers as well as state and local agencies. Lack of services for individuals not eligible for Medicaid. Educate individuals, families, providers, and communities about available options. Secure additional funding to support unserved and underserved populations that do not meet the stringent financial, medical and functional criteria or target population of Virginias Medicaid home and community-based services waivers and services that support community integration. Support of these services could help prevent or delay some individuals enrollment in Medicaid. Focus on the needs of the individual and not programmatic barriers and funding silos. Choice, coordination and continuity of care. Improve coordination and continuity of care to ensure the needs of the individual met from the uniform assessment instrument (UAI)/ level of functioning (LOF) and discharge planning processes to the integration of acute and long-term care models. Ensure integrated models include person-centered planning, consumer choice, and consumer direction. Educate providers, individuals, families and state and local agencies on UAI, LOF, community-based options, and consumer-direction. Begin community discharge planning before institutionalization for a non-emergent situation or upon admission for a crisis situation. Housing For many individuals, access to and choice of housing is the missing link for a successful transition from an institution or for those already living in the community, life in a more independent and integrated setting. For years, room and board were covered with services in institutions. As the Commonwealth moves away from a predominately institutional model to one that embraces community inclusion, the availability of affordable, safe, and accessible housing is crucial. Even with the most robust package of support services, shelter is a basic human need that must still be met for an individual to live and thrive in their community. Listed below are significant housing barriers with recommendations to address the identified issues. (Appendix F provides specific action items to implement the recommendations below.) Need to decouple funding for housing and support services to support choice and options. Reallocate room and board costs used to support congregate care to fund community based housing programs such as rental assistance and gap funding. Coordinate housing and community integration efforts around housing, Medicaid, and disability service agencies to achieve desired outcomes. Prioritize housing waitlists. (Public housing) Educate state and local governments, individuals, families, and communities about available options. Lack of coordinated housing planning, including transportation access. Educate localities on the need for coordinated planning and potential opportunities for funding, collaboration, best practices, and transportation alignment. Allocate housing resources efficiently and effectively to support individual choice. Shortage of housing options fed by a growing demand and a lack of affordability and accessibility. Encourage the use of nontraditional housing and other options such as microboards. Reinvestment of the profits from state institution land sales into community housing options and other community supports. Inadequate compliance with fair housing practices. Provide training to property managers and individuals while developing strategies for reaching the broader public. Creation and support of partnerships between state agencies such as the Department of Professional and Occupational Regulation and local entities such as Centers for Independent Living, Community Services Boards, and Area Agencies on Aging. Continued local community resistance. Educate localities, homeowners associations, and others regarding federal and state law as well as address common misperceptions. Employment and Community Engagement Merely residing outside of an institution does not equate to community integration. Individuals must be afforded opportunities and choices to be active participants in their communities. From employment to social engagement, it is critical that community housing options do not become institutions of a smaller size and different locale. The issues below identify several critical factors to reduce social isolation and improve employment and community engagement opportunities. (Appendix G provides specific action items to implement the recommendations below.) Inadequate state agency coordination which creates a multitude of challenges ranging from the potential expansion of non-community integrated employment and non-employment waiver services, to inequitable and inaccessible services, as well as issues coordinating transition services. The Commonwealth accepts and promotes Employment First as a statewide policy. Support a seamless employment process that could be used for referral or eligibility. Eliminate duplication amongst agencies. Improve collaboration at the leadership level. Create an education and employment system that is known nationwide for its best-practices. Negative effect of waiting lists for vocational rehabilitation services. Provide adequate funding to reduce/remove waiting list. Ensure individuals and other stakeholders, including teachers and vocational rehabilitation staff, are educated about order of selection, what it means and other available services. Financial disincentives to employment. Promote and support Employment First. From children to older adults, educate individuals and families about timelines for applying for services and waitlists. Distribute information about work incentives. Ameliorate or remove systemic issues which make non-employment options more convenient and financially viable for providers, families, and individuals. Inadequate focus on career development in comparison with immediate job placement. Encourage the attainment of transferable, stackable skills and ensure measures of accountability are in place. Educate individuals on the difference between career development versus job placement and available resources, supporting individuals and families throughout the process and changes in situation. Use person centered practices across the service spectrum to ensure options are available that address changes throughout an individuals life. Exploration of alternative work placements such as self-employment or teleworking. Social isolation. Assess waiver best practices for ensuring community engagement. Ensure appropriate community safeguards. Educate individuals, families, providers, and communities about other options and opportunities Ensure person centered practices are employed to address the interests of the individual. Prepare and plan for emergency situations. Train and educate licensure, APS, human rights, eligibility, and ombudsman staff on person centered practices and ensure related regulations reflect a move to person centered practices. Appendix A Community Integration Advisory Commission Code Authority 2.2-2524. (Expires July 1, 2014) The Community Integration Advisory Commission; purpose. The Community Integration Advisory Commission (the Commission) is established as an advisory commission in the executive branch of state government. The purpose of the Commission shall be to monitor the progress of all executive branch state agencies toward community integration of Virginians with disabilities in accordance with all applicable state and federal laws in order that persons with disabilities may enjoy the benefits of society and the freedoms of daily living. (2006, c.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?061+ful+CHAP0894" 894.) 2.2-2525. (Expires July 1, 2014) Membership; terms; quorum; meetings. The Commission shall have a total membership of 21 nonlegislative citizen members to be appointed as follows: four nonlegislative citizen members, of whom two shall be persons with disabilities, one shall be the relative of a citizen of the Commonwealth with a disability, and one shall be a provider of services to citizens of the Commonwealth with disabilities or an advocate for persons with disabilities or for services to such persons to be appointed by the Senate Committee on Rules; six nonlegislative citizen members, of whom three shall be persons with disabilities, one shall be the relative of a citizen of the Commonwealth with a disability, and two shall be providers of services to citizens of the Commonwealth with disabilities or an advocate for persons with disabilities or for services to such persons to be appointed by the Speaker of the House of Delegates; and 11 nonlegislative citizen members, of whom three shall be persons with disabilities, one shall be an individual receiving services in a state hospital operated by the Department of Behavioral Health and Developmental Services, one shall be an individual receiving services in a state training center, one shall be a resident of a nursing facility, two shall be the relatives of citizens of the Commonwealth with disabilities, and three shall be providers of services to citizens of the Commonwealth with disabilities or an advocate for persons with disabilities or for services to such persons to be appointed by the Governor. Nonlegislative citizen members of the Commission shall be citizens of the Commonwealth. Nonlegislative citizen members shall serve a term of four years; however, no nonlegislative citizen member shall serve more than two consecutive four-year terms. Appointments to fill vacancies, other than by expiration of a term, shall be for the unexpired terms. Vacancies shall be filled in the same manner as the original appointments. All members may be reappointed. The remainder of any term to which a member is appointed to fill a vacancy shall not constitute a term in determining the member's eligibility for reappointment. The Commission shall elect a chairman and vice-chairman from among its membership. A majority of the members shall constitute a quorum. The Commission shall meet not less than four times each year. The meetings of the Commission shall be held at the call of the chairman or whenever the majority of the members so request. (2006, c.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?061+ful+CHAP0894" 894; 2012, cc.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?121+ful+CHAP0476" 476,  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?121+ful+CHAP0507" 507.) 2.2-2526. (Expires July 1, 2014) Compensation; expenses. Members shall serve without compensation. However, all members shall be reimbursed for all reasonable and necessary expenses incurred in the performance of their duties as provided in  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?000+cod+2.2-2813" 2.2-2813 and  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?000+cod+2.2-2825" 2.2-2825. Funding for the costs of expenses of the members shall be provided by such executive branch agencies as the Governor designates. (2006, c.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?061+ful+CHAP0894" 894.) 2.2-2527. (Expires July 1, 2014) Powers and duties of the Commission. The Commission shall have the following powers and duties: 1. To monitor the implementation of state and federal laws pertaining to community integration of Virginians with disabilities; and 2. To make appropriate recommendations to the Governor concerning community integration of Virginians with disabilities. (2006, c.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?061+ful+CHAP0894" 894.) 2.2-2528. (Expires July 1, 2014) Staffing. The Department for Aging and Rehabilitative Services, and such other executive branch agencies as the Governor may designate, shall provide staff support to the Commission. All agencies of the Commonwealth shall provide assistance to the Commission, upon request. (2006, c.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?061+ful+CHAP0894" 894; 2010, c.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?101+ful+CHAP0342" 342; 2012, cc.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?121+ful+CHAP0803" 803,  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?121+ful+CHAP0835" 835.) 2.2-2529. (Expires July 1, 2014) Sunset. This article shall expire on July 1, 2014. (2006, c.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?061+ful+CHAP0894" 894; 2009, c.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?091+ful+CHAP0548" 548; 2010, c.  HYPERLINK "http://lis.virginia.gov/cgi-bin/legp604.exe?101+ful+CHAP0342" 342.) Appendix B ve Directive 6 (2007) ner COMMUNITY INTEGRATION TEAM Virginians with disabilities have a right to enjoy the same benefits of society and freedoms of everyday life that Virginians without disabilities enjoy. The Commonwealth has an obligation under the U.S. Supreme Courts Olmstead v. L.C. decision, the Americans with Disabilities Act, and the Virginians with Disabilities Act to provide appropriate opportunities for people with disabilities to become fully integrated into the community if they choose to do so. This is more than a legal obligationit is a moral imperative. State government must continue to have appropriate structures and plans in place to facilitate the integration of Virginians with disabilities into every community in the Commonwealth. By virtue of the authority vested in me as Governor under Article V, Section 1 of the Constitution of Virginia and Sections 2.2-103 and 2.2-104 of the Code of Virginia, I hereby direct the following Cabinet Secretaries and their respective executive branch agencies and councils to continue their collaborative efforts to complete and annually update a comprehensive, cross-governmental strategic plan designed to assure continued community integration of Virginians with disabilities: Secretary of Commerce and Trade Department of Housing and Community Development Department of Professional and Occupational Regulation Virginia Housing Development Authority Virginia Employment Commission Secretary of Education Department of Education State Council of Higher Education for Virginia Virginia Community Colleges System Secretary of Health and Human Resources Department for the Blind and Vision Impaired Department of Health Professions Department of Medical Assistance Services Department of Mental Health, Mental Retardation and Substance Abuse Services Department of Professional and Occupational Regulation Department of Rehabilitative Services Department of Social Services Mental Health Planning Council Office of Comprehensive Services for At-Risk Youth and Families Statewide Independent Living Council Virginia Board for People with Disabilities Virginia Department for the Aging Virginia Department for the Deaf and Hard of Hearing Virginia Department of Health Secretary of Public Safety Department of Veterans Services Secretary of Transportation Department of Rail and Public Transportation Virginia Department of Transportation Special Advisor to the Governor for Workforce Development Strategic Plan for Individuals with Disabilities The goals of this strategic plan shall be to provide individuals with disabilities the opportunity to choose to move from institutions to appropriate, more integrated settings and to avoid unwanted institutionalization. The plan shall contain strategies that comprehensively address community services and supports, housing, transportation, employment and workforce issues, and shall be accompanied by a report on statewide progress in addressing these issues. The plan shall be submitted to me for my approval no later than August 31, 2007, and shall be updated and submitted annually by August 31 of each succeeding year. I hereby direct the Cabinet Secretaries, executive branch agencies and councils to work in close collaboration with the Community Integration Advisory Commission established pursuant to 2.2-2524 2529 of the Code of Virginia, and to provide any information requested by the Commission to carry out its charge of monitoring community integration in the Commonwealth. I further direct the Cabinet Secretaries, executive branch agencies and councils to work in close collaboration with local governments and local government agencies in the Commonwealth. The Director of Community Integration for People with Disabilities shall coordinate and oversee this initiative and provide staff support to the Community Integration Advisory Commission. This executive directive will remain in full force and effect unless amended or rescinded by further executive action. Given under my hand and under the Seal of the Commonwealth of Virginia, this 18th day of May, 2007. Timothy M. Kaine, Governor Appendix C Additional Community Integration Implementation Team Members Other entities included in the Implementation Team but not listed in Executive Directive 6 include: Area Agencies on Aging Centers for Independent Living Community Services Boards Virginia Association of Counties Virginia First Cities Virginia Municipal League Appendix D Identified Barriers to Community Integration Community Living Supports Institutional bias, including institutional entitlements, of the disability services system Children being served in NF and ICF-ID Concern over the growth of institutions Inadequate UAI process and discharge planning/case management Access to waivers slots and services existence and administration of waiting lists service caps Provider choice and capacity conflict of interest qualifications reimbursement rates oversight of community living settings experience working with individuals with disabilities shortages physical and operational accessibility Need for individualized budgeting and increased consumer direction Low personal maintenance allowance (PMA) Lack of funding stream for individuals not eligible for HCBS waivers Inadequate funding for Centers for Independent Living (CILs), Area Agencies on Aging (AAAs), local Departments of Social Services, Brain Injury supports, etc. Inadequate access to assistive technology (AT) Inadequate communication access Fragmentation of disability services system Lack of a developmental disabilities system Guardianship and use of alternatives to guardianship Education Inadequate information provided to individuals with disabilities and their families Erroneous perceptions regarding care and support of individuals who have complex medical needs Persistent attitudinal and cultural barriers Lack of health insurance and dental care Need to improve coordination and continuity of care and ensure that integrated acute and ltc models meet the needs of individuals. Transportation service segregation (each agency operates its own fleet of vehicles and transports only its clientele) Inadequate rider safety, accommodations, and accessibility of related transportation infrastructure Transportation service limitations and access, especially in rural areas Continued challenges with the Medicaid transportation brokerage system Lack of planning or implementation of local comprehensive plans that support community living. Housing Need to decouple funding for housing and support services to support choice and options Lack of coordinated housing planning Lack of housing options Inadequate compliance with fair housing practices Growing demand combined with lack of affordability/accessibility Need for transportation to be aligned with housing Continued community resistance Lack of awareness of universal design and visitability Employment and Community Engagement Inadequate state agency coordination Effect of order of selection for vocational rehabilitation services Concern over potential expansion of non-community integrated employment and non-employment waiver services Financial disincentives to employment Inequitable and inaccessible services Inadequate focus on career development vs. job placement Challenges with transition services for students with disabilities Social isolation Appendix E Community Living Supports Action Items IssueRecommendation Long-Term Action ItemShort-Term Action ItemSystemic institutional bias.a. Decouple the provision of services and housing. Explore AG portability. Explore other models of support.b. Support waiver services to remove current financial incentives favoring congregate settings.Reinstitute COPN process for all ICFs.Examine waiver rate structure and service definitions.c. Provide immediate and timely support to individuals and families throughout changes in the lifespan.Review different definitions of imminent risk and how they are operationalized.d. Prevent initial institutionalizations and revolving readmissions.Reinstitute COPN process for all ICFs.Review feasibility for establishing a quarterly review/survey for individuals in an ICF to determine if individuals are interested in transitioning to the community. Provide current web-based training for preadmission screeners on the screening process and home and community based options for children and adults. Provide guidance and explore incentives for hospital discharge planners on home and community based options.e. Ensure community services are offered and provided at numerous system points of entry from physicians offices to hospitals.Work with provider associations to educate their membership on community based alternatives, (Ex: MSV, VHHA, etc.) particularly focusing on the hospital discharge process. Train law enforcement and judicial officers to ensure individuals access appropriate services. Community Living Supports IssueRecommendation Long-Term Action ItemShort-Term Action ItemAccess to waiver slots and services.Focus on the needs of the individual.Transform the ID, DD, and DS waivers into a larger waiver that focuses on needs, not diagnosis. DBHDS and DMAS to educate stakeholders and seek their input on waiver changes to ensure optimal outcomes.Reduce and eliminate waiver waiting lists.Annually add additional waiver slots to eliminate the waiver waiting list and address future needs. (projected 1339 ID and 254 DD waiver slots needed annually over a 10 year period)Provide services based upon the needs of the individual.Enhance services provided under the waivers to support community living. Determine the feasibility of additional waiver services including but not limited to chore, homemaker, and assistive technology. Explore a basic supports waiver that would reduce the intensity of future service needs. Explore other home and community based service options outside of the 1915(c) waivers.Seek state and federal authority to implement appropriate and new HCBS options.Review new as well as previous HCBS service support options including but not limited to Community First Choice, personal assistance (agency and consumer directed) as a state plan option, and individualized budgeting.Ensure that access, referral, and entry points to the system are working effectively.Build transition coordinator network.Formalize the referral process to ensure individuals referred under Section Q but who do not qualify for MFP are still referred to the appropriate transition coordinators. Create a formal agreement amongst the CILs to temporarily serve areas of the state not currently covered by a CIL, with funding to support the expanded service areas.  Community Living Supports IssueRecommendationLong-Term Action ItemShort-Term Action ItemProvider choice, capacity, and training. Reduce and eliminate conflict of interest amongst providers.Ensure no further growth of COI situations in new Medicaid programs.Broaden public and private case management choices in the ID and DD waivers.Ensure financial incentives and service program design encourage individual choice.Restructure HCBS waivers to promote and encourage the growth of HCBS options.Review the current service provision process from intake, screening, and case management to the services provided.Ensure provider rates accurately reflect the cost of services provided. Ensure that individuals who have access to case management are accessing the service. Improve oversight of community living settings.Create incentives for providers who meet certain quality measures.Hire and train additional licensing and human rights staff.Create, promote and conduct training on community-based options, accommodating specific needs, and physical and operational accessibility for providers as well as state and local agencies.Develop a web based core training for providers and local agencies on community based options. Community Living Supports IssueRecommendationLong-Term Action ItemShort-Term Action ItemLack of services for individuals not eligible for Medicaid.Educate individuals, families, providers, and communities about available options.Check on status and upkeep of VA Easy Access. Explore marketing strategies for VA Easy Access.Secure additional funding to support unserved and underserved populations that do not meet the stringent financial, medical and functional criteria or target population of Virginias Medicaid home and community-based services waivers and services that support community integration. Support of these services could help prevent or delay some individuals enrollment in Medicaid.Restore adult services funding at the local DSS level. Provide funding to support CSBs, AAAs, CILs, and brain injury programs that serve individual not eligible for Medicaid. Establish funding to create service microboards.Focus on the needs of the individual and not programmatic barriers and funding silos.Continue work on SILAS and ADRCs. Community Living Supports IssueRecommendationLong-Term Action ItemShort-Term Action ItemChoice, coordination, and continuity of care.Improve coordination and continuity of care to ensure the needs of the individual are met, from the uniform assessment instrument (UAI)/ level of functioning (LOF) and discharge planning process to the integration of acute and long-term care models.Ensure integrated models include person-centered planning, consumer choice, and consumer direction. Explore the use of consumer-directed services within the PACE and MCO models and determine the satisfaction of services and supports.Educate providers, individuals, families, and state and local agencies on UAI, LOF, community-based options, and consumer-direction.Target hospitals to ensure UAIs are performed. Review options for ensuring hospitals complete the UAI.Begin community discharge planning before institutionalization for a non-emergent situation or upon admission for a crisis situation.Investigate the use of other community based screeners. Appendix F Housing Action Items IssueRecommendationLong-Term Action ItemShort-Term Action ItemNeed to separate funding for housing and support services to support choice and options.a. Reallocate room and board costs used to support congregate care to fund community based housing programs such as rental assistance and gap funding. Develop programs to support various community housing options. rental subsidy environmental modifications throughout the lifespan portability more accessible units Auxiliary Grant (AG) portabilityTrack where institutional room and board costs are going once an individual transitions to the community (Ex: back to GF ) Explore the feasibility of AG portability, including needed changes and what other states have done. Coordinate housing and community integration efforts around housing, Medicaid, and disability service agencies to achieve desired outcomes. Creation of successful applications for additional housing funding. Creation of an MOU between various housing and human services agencies that outlines each entities responsibilities.Establish a core team of interagency and other stakeholders. Prepare state and local groundwork for future funding opportunities including development of local regional structures. Conduct meetings between state and local housing and human services agencies. Address programmatic and systemic agency barriers to ensure successful applications and future endeavors. Develop a mechanism to better utilize EDCD waiver MFP and DHCD environmental modification dollars. Expand MFP housing opportunities and improve transition process and services. Improve Section Q process and procedures to better facilitate effective transitions.Prioritize housing waitlists. (Public housing) Provide opportunities to share best practices between public housing authorities (PHAs). (Ex: using HOME funds for vouchers) Continue education efforts at the local level. Encourage collaboration between service providers and PHAs.Educate state and local governments, individuals, families, and communities about available options. Begin discussions with private developers about the need for integrated housing. (Ex: not all units should be allocated for individuals with disabilities) Housing IssueRecommendationLong-Term Action ItemShort-Term Action ItemLack of coordinated housing planning, including transportation access. Educate localities on the need for coordinated planning and potential opportunities for funding, collaboration, best practices, and transportationAllocate housing resources efficiently and effectively to be commensurate with community needs.Remove transportation scoring factors that do not accurately assess available transportation (such as line frequency or door to door service) when reviewing housing applications. Develop a long-term memorandum of understanding (MOU) that provides strategic and policy guidance to Virginias housing agencies from human services agencies and other relevant state agencies and local partners, for purposes of housing planning, creating a more structured collaboration Develop more cohesive local transportation systems that allows for travel across localities that is affordable and efficient.Review VHDAs current application scoring system and how it allocates points for accessible transportation to remove unintended regional and local barriers. Build upon the DOJ housing workgroup and plan to create a more expansive group that includes a broader range of stakeholders that would assist in the creation of principles and guidance for future housing development in the Commonwealth. Continued distribution of the Transportation and Housing Alliance (THA) Toolkit. Develop a sustainability plan for the THA Toolkit. Develop strategies for door to door transportation service. Housing IssueRecommendationLong-Term Action ItemShort-Term Action ItemShortage of housing options fed by a growing demand and a lack of affordability and accessibility. Encourage the use of nontraditional housing and other options such as housing microboards.Develop an information dissemination strategy including a basic packet of information. Locate new partners to share information with. Provide education and promotion of microboards and other housing opportunities such as co-housing, ensuring that information is posted on currently available resources such as websites. Educate state and local agencies about microboards and other housing options.Reinvest the profits from state institution land sales into community housing options and other community supports for individuals with disabilities. Housing IssueRecommendationLong-Term Action ItemShort-Term Action ItemInadequate compliance with fair housing practices.Provide training to property managers and individuals while developing strategies for reaching the broader public.DPOR to continue educational efforts.Create and support partnerships between state agencies such as DPOR and local entities like CILS, CSBs, and AAAs. Ensure accessibility and fair housing laws are enforced.Continued local community resistance.Educate localities, homeowners associations, and others regarding federal and state law as well as address common misperceptions.Explore and develop the most effective strategy for responding to local issues. Appendix G Employment and Community Engagement Action Items IssueRecommendation Long-Term Action ItemShort-Term Action ItemInadequate state agency coordination which creates a multitude of challenges ranging from the potential expansion of non-community integrated employment and non-employment waiver services, to inequitable and inaccessible services, as well as issues coordinating transition services. (Integrated employment is defined as working alongside individuals without disabilities at a competitive wage.)The Commonwealth accepts and promotes as a statewide policy Employment First, making integrated community-based competitive employment the first option explored when discussing service options.Educate local agencies, schools, providers, individuals, families, and advocates on Employment First.Support a seamless employment process that could be used for referral or eligibility. Ensure data collection efforts are not duplicative and where feasible allow for the exchange of information. Assess the interoperability of agency databases.To provide temporary assistance, create a model form that can be used by an individual as they move from agency to agency that provides basic information.Eliminate duplication amongst agencies. Review current data collection efforts and collaborate amongst agencies when possible. Align definitions, policies, and procedures where feasible. Assess current funding streams and their source.Education amongst and within state agencies on various programs. Assess current services to discover gaps and overlaps in services to identify how to better serve individuals. Improve collaboration at the state agency head leadership level. Collaborative work to become a standard part of an agency heads job profile.Schedule initial meeting with cross Secretariat agency heads and key staff.Create an education and employment system that is known nationwide for its best-practices. Use data to identify and support evidence based practices. Address quality disparity across the state and within localities.Encourage collaboration amongst local agencies including providing supporting evidence of best practices from around the state. Employment and Community Engagement IssueRecommendation Long-Term Action ItemShort-Term Action ItemNegative effect of waiting lists for vocational rehabilitation services.Provide adequate funding to reduce/remove waiting list.Eliminate vocational rehabilitation current waiting list of 1500.Ensure individuals and other stakeholders, including teachers, case managers, and vocational rehabilitation staff, are educated about order of selection, what it means and other available services.Ensure that individuals under the age of 22 are encouraged to be screened for vocational rehabilitation services and if eligible placed on the waiting list for order of selection while still receiving educational services.Financial disincentives to employment. Promote and support Employment First.From children to older adults, educate individuals and families about timelines for applying for services and waitlists.Ensure that individuals under the age of 22 are encouraged to be screened for vocational rehabilitation services and if eligible placed on the waiting list for order of selection while still receiving educational services.Create, access, and update concise documents regarding work incentives for individuals across the age spectrum Encourage the use of Work World. Distribute information about work incentives.Create and conduct targeted education efforts around incentives to employment at both the state and local agency level.Ameliorate or remove systemic issues to better support employment options.Restructure the ID, DS, and DD waivers to support employment options. Employment and Community Engagement IssueRecommendationLong-Term Action ItemShort-Term Action ItemInadequate focus on career development in comparison with immediate job placement.Encourage the attainment of transferable, stackable skills and ensure measures of accountability are in place.Educate individuals on the difference between career development versus job placement and available resources, supporting individuals and families throughout the process and changes in situation.Use person centered practices across the service spectrum to ensure options are available that address changes throughout an individuals life.Exploration of alternative work placements such as self-employment or teleworking. Employment and Community Engagement IssueRecommendationLong-Term Action ItemShort-Term Action ItemSocial isolation.Ensure appropriate community safeguards are in place. Prepare and plan for emergency situations.Train and educate licensure, APS, human rights, eligibility, guardians, public safety, and ombudsman staff on person centered practices and ensure related regulations reflect a move to person centered practices.Educate individuals, families, providers, employers, and communities about other options and opportunities.Reach out to employers and the business community around social isolation issues in the workplace. (Ex: break room isolation)Assess best practices for ensuring community engagement.Ensure person centered practices are employed to address the interests of the individual.Ensure access to accessible, affordable, reliable transportation.Follow up on current grant opportunities and current committee work surrounding transportation. Appendix H Glossary of Acronyms AAAs Area Agencies on Aging ADRC Aging and Disability Resource Center AG Auxiliary Grant ALF Assisted Living Facility ARRA American Recovery and Reinvestment Act CILs Centers for Independent Living COPN Certificate of Public Need CSBs Community Services Boards DARS Department for Aging and Rehabilitative Services DBHDS Department of Behavioral Health and Developmental Services DBVI Department for the Blind and Vision Impaired DD Developmental Disability DHCD Department of Housing and Community Development DHP Department of Health Professions DMAS Department of Medical Assistance Services DPOR Department of Professional and Occupational Regulation DRPT Department of Rail and Public Transportation DRS Division of Rehabilitative Services DS Day Support DSS Department of Social Services DVS Department of Veterans Services EDCD Elderly or Disabled with Consumer Direction (Medicaid Waiver) ESO Employment Services Organization FTA Federal Transit Administration GA General Assembly GF State General Funds HUD U.S. Department of Housing and Urban Development IHE Institutions of Higher Education ID Intellectual Disability ICF/ID Intermediate Care Facility for Individuals with Intellectual Disabilities IT Implementation Team MFP Money Follows the Person MH Mental Health MHSS Mental Health Support Services MOU Memorandum of Understanding MSV Medical Society of Virginia OCI Office of Community Integration OSHHR Office of the Secretary of Health and Human Resources PAS Personal Assistance Services PCP Person-Centered Practices PHA Public Housing Agency RFP Request for Proposals SCHEV State Council of Higher Education for Virginia SILAS Strengthening Independent Living and Aging Services SILC Statewide Independent Living Council STG Systems Transformation Grant TBD To Be Determined THA Transportation and Housing Alliance UAI Uniform Assessment Instrument VACIL Virginia Association of Centers for Independent Living VACO Virginia Association of Counties VBPD Virginia Board for People with Disabilities VCCS Virginia Community Colleges System VDA Virginia Division for the Aging VDDHH Virginia Department for the Deaf and Hard of Hearing VDH Virginia Department of Health VDOE Virginia Department of Education VDOT Virginia Department of Transportation VEC Virginia Employment Commission VHDA Virginia Housing Development Authority VHHA Virginia Hospital and Healthcare Association VML Virginia Municipal League      PAGE \* MERGEFORMAT 1  Executive Directive 6 (2007) %&'()2 D O s    1 > @ b   ! _ ٸvvvvvvvjbbbhI-CJaJhI-hI-5CJaJhI-5CJaJhI-h \5CJaJhI-h \5>*CJaJh \CJaJh8h \CJaJh}-h \5CJ$aJ$h}-h \56CJ$aJ$$jh8h \CJ0UmHnHuh}-h \CJ8aJ8h}-h \5CJ8aJ8h \CJ8aJ8h \CJ$aJ$&%&()1 D E T   gd \ $ & F9a$gd \$a$gd \$a$gd \gd \ J K " n 5 y $a$gdw$ $ & F9a$gd \gd \ $ & F9a$gd \_ i k m 0 2 4 g x ugYhh,m5>*CJaJhh@l5>*CJaJhhw$CJ aJ hh,m6CJ aJ hh@l56CJ aJ hh,m56CJ aJ hh,mCJ aJ hh=75>*CJ aJ hh,m5>*CJ aJ h5>*CJ aJ h \5>*CJ aJ h#7h \CJaJh \CJaJhI-CJaJ"  abklmnoo  & Fgdd & Fgdzgdu$a$gd\   1CI}K`̶ti^hhx 6CJaJhh}!CJaJhhuCJaJhh'CJaJhh1CCJaJhh{CJaJhhxCJaJhhyDCJaJhhQ\CJaJhh_i4CJaJhhmuCJaJhLcCJaJhhWInCJaJhh@CJaJhh@lCJaJ#%FOQp{a`a<lpnɾ߳ꒇyk`UUhh'fCJaJhhzCJaJhh5>*CJaJhhz5>*CJaJhhCJaJhhuCJaJhhmuCJaJhhx 6CJaJhh}!CJaJhhlbCJaJhhCJaJhhyDCJaJhh~CJaJhh}cCJaJhh07CJaJn~opZe !^!! 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