vaACCSES Overall Combination of Priorities Include:

HCBS 10% FMAP ARPA Funds (approx. $273.2M available):

• Supplemental provider rate increase to sustain and build capacity for an established period of time - preferably through March 2022 - at a minimun. The DD Waiver system is in a workforce crises - exacerbated by the COVID pandemic. Programs are reducing capacity and even closing. Others are not reopening specific services. Low rates result in low wages. Low wages result in high vacancy rates. Without staff, service capacity can not be maintained or built. Individuals that receive waiver slots can not be served without providers. The DD waiver community-based system is in crisis.
  • Will help serve as a "bridge" to current rate rebase underway.
  • Retention and survival of providers
• $2M for one-time adjustment to align Supportive Living rate to current Group Home Rate. Change would increase provider interest in providing this service vs other residential options for individuals. Rates should not dictate options or the choice of individuals between living in a congregate setting versus one's own home. (Increase utilization of service option.)

ARPA State General Relief ($4.3B availble)

Request DMAS Support because of limited funding in 10% FMAP pool of funds:

• DD Waiver Infrastructure Support - Economic Recovery - Provider Capacity Payments - 2% of FY19 DD Waiver billing in lump sum. (pre-COVID) Sustainability and “Build Back” infrastructure funding for use over the next several months while programs reopen in phases and build capacity. On-boarding new staff and smaller staff to waiver member ratios while reopening in phases will be more expensive. Funding preferred - similar to retainer payments or federal Medicaid/CHIP provider relief payment request & structure. Lump sum payment & parrallel federal traunch one-time reporting requirements after expenditure. Needs to be simple and flexible to allow providers to spend based on their individualized needs - workforce, program capacity sustainability and capacity building, and COVID mitigation. Based on provider authorizations pre-COVID. There has been significant attrition of authorizations because of COVID and DBHDS authorization policy. (Infrastructure & Capacity building - Build Back Better)
• COVID Expense Reimbursement - Reinstate full Phase 2 reimbursement through December 2021. Expand to additional DD Waiver Services and Providers other than Day Services and Residential. Recommend elimination of cap per person calculation or adjust calculations for per person cap. Reimburse previous certified expenses from Phase 1 that were not reimbursed because of previous arbitrary per person cap. (Additional pandemic expenses not covered by current rates)

Each of these funding requests serve different purposes. Our preliminary strategy is to endorse these different funding priorities from different sources of ARPA funding - to support a holistic approach to provider survival and recovery from the current pandemic.