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COMMONWEALTH OF VIRGINIA - April 1, 2019 - September 30, 2019","","Report provides an independent reviewer’s assessment of the Commonwealth of Virginia’s compliance with the Settlement Agreement in United States District Court, Eastern District of Virginia, during the fifteenth review period (April 1, 2019–September 30, 2019). It outlines strategic initiatives that reshaped community-based services for individuals with intellectual and developmental disabilities, summarizes areas where compliance has been achieved, and identifies ongoing obstacles that slow progress. 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COMMONWEALTH OF VIRGINIA  \nUnited States District Court for  \nEastern District of Virginia  \nCivil Action No. 3:12 CV 059  \nApril 1 , 2019 – September 30, 2019  \nRespectfully Submitted By  \nDonald J. Fletcher Independent Reviewer December 15, 2019  \nTABLE OF CONTENTS  \nI .  EXECUTIVE SUMMARY…………………………………………….…. 3  \nII .  SUMMARY OF COMPLIANCE………..………………………..…….. 6  \nSection III. Serving Individuals with IDD in the most integrated settings ……….…6  \nSection IV. Discharge Planning and Transition from Training Centers …...….…. 16  \nSection V. Quality and Risk Management ………….………………..…………... 24  \nSection VI. Independent Reviewer…………………………………..…………..... 31  \nSection IX. Implementation …………………………………………..……….…... 31  \nIII .  DISCUSSION OF COMPLIANCE FINDINGS…………………....…32  \nA. Methodology …………………………………………………………................. 32  \nB. Compliance Findings ………………………………………………………….... 33  \n1. Serving Individuals with Intense Behavioral Needs ......................... 33  \n2. Behavioral Supports and Programming…………………………. 35  \n3. Integrated Day Activities and Supported Employment…..…............ 37  \n4. Regional Support Teams…….…………………...……….…... 47  \n5. Transportation……………………………………………..... 49  \n6. Investigations-Office of Licensing/Office of Human Rights..…...... 53  \n7. Mortality Review …………………………………………...... 56  \n8. Provider Training……………….…………..……….….....…59  \n9. Quality and Risk Management……….……………………...... 62  \nIV.  CONCLUSION .………………………………………….…….….….... 74  \nV.  RECOMMENDATIONS…………..……………………………..……. 75  \nVI . APPENDICES……………………………………………….…...…..…. 77  \nA. Individual Services Review – Individuals with Intense Behavioral Needs ..... 78  \nB. Behavioral Supports and Programming …………………………………...... 86  \nC. Integrated Day Activities and Supported Employment ……………..…........ 97  \nD. Regional Support Teams..……………………………………….....…..….. 161  \nE. Transportation…………………...……………………….……............…... 167  \nF. Investigation-Office of Licensing/Office of Human Rights ..…….............. 175  \nG. Mortality Review ………………………….………...………..……......……184  \nH. Training……….………………………………………………….….......….. 204  \nI. Quality and Risk Management …………………………….…..……...….... 210  \nJ. List of Acronyms ……………………………………..…...……..…............. 240  \nI. EXECUTIVE SUMMARY  \nThis is the Independent Reviewer’s fifteenth Report on the status of compliance with the provisions of the Settlement Agreement (Agreement) between the Parties to the Agreement: the Commonwealth of Virginia (the Commonwealth) and the United States, represented by the Department of Justice (DOJ). This Report documents and discusses the Commonwealth’s efforts and the status of its progress and compliance during the fifteenth review period from April 1, 2019, through September 30, 2019.  \nDuring the past four years, to reform and restructure its community-based service system for individuals with intellectual and developmental disabilities (IDD), the Commonwealth developed and executed three strategic initiatives. In part, these initiatives allow the Commonwealth to fulfill certain provisions of the Agreement. These initiatives are:  \n• Redesigning Home-and Community-based (HCBS) waiver programs;  \n• Revising the Department of Behavioral Health and Developmental Services (DBHDS) Licensing Regulations; and  \n• Transforming Community Service Board’s (CSB) case management services. The design of these strategic initiatives set the stage for the Commonwealth to advance implementation of a broad array of improvements to the structure, performance expectations and services provided by its community-based services system. By redesigning its HCBS waiver program, and by developing and approving new regulations that align with the requirements of the Agreement, the Commonwealth acknowledged its responsibility and strengthened its ability to ensure improvements in areas that are critical and that have been resista","cbCaikbp5QAlnAb2","https://ap.wps.com/l/cbCaikbp5QAlnAb2","pdf",2575928,242,"English","# I. EXECUTIVE SUMMARY\n# II. SUMMARY OF COMPLIANCE\n## Section III. Serving Individuals with IDD in the most integrated settings\n## Section IV. Discharge Planning and Transition from Training Centers\n## Section V. Quality and Risk Management\n## Section VI. Independent Reviewer\n## Section IX. Implementation\n# III. DISCUSSION OF COMPLIANCE FINDINGS\n## A. Methodology\n## B. Compliance Findings\n## 1. Serving Individuals with Intense Behavioral Needs\n## 2. Behavioral Supports and Programming\n## 3. Integrated Day Activities and Supported Employment\n## 4. Regional Support Teams\n## 5. Transportation\n## 6. Investigations-Office of Licensing/Office of Human Rights\n## 7. Mortality Review\n## 8. Provider Training\n## 9. Quality and Risk Management\n# IV. CONCLUSION\n# V. RECOMMENDATIONS\n# VI. APPENDICES","[{\"question\":\"What period does the fifteenth compliance review cover?\",\"answer\":\"The fifteenth review period runs from April 1, 2019 through September 30, 2019.\"},{\"question\":\"What three strategic initiatives supported Virginia’s efforts to comply?\",\"answer\":\"They include redesigning HCBS waiver programs, revising DBHDS licensing regulations, and transforming CSB case management services.\"},{\"question\":\"What factors slowed implementation progress toward full compliance?\",\"answer\":\"The report cites insufficient staff and provider capacity, inability to enforce standards for consistently noncompliant CSBs and providers, and lack of implementation of two required external monitoring mechanisms.\"}]","REPORT OF THE INDEPENDENT REVIEWER ON COMPLIANCE WITH THE SETTLEMENT AGREEMENT - UNITES STATES v. COMMONWEALTH OF VIRGINIA - April 1, 2019 - September 30, 2019 | PDF",1790377771,85]