A workgroup convened to evaluate and recommend alternative options for individuals with neurocognitive disorders and neurodevelopmental disabilities who may otherwise be admitted to state psychiatric hospitals presented its draft recommendations to the Joint Subcommittee on HHR Oversight on October 31.
Legislation considered by the 2024 General Assembly directed the establishment of this workgroup; these bills were sparked by a 2023 Joint Legislative Audit and Review Commission (JLARC) study of the state hospital system, which found that individuals with neurocognitive disorders (such as dementia or traumatic brain injuries) or neurodevelopmental disorders (such as autism) were not well served by state hospitals. JLARC’s report recommended that behaviors and symptoms that are solely the result of these disorders be excluded from the definition of “mental illness” for the purposes of temporary detention orders (TDOs) and civil commitments, and that state hospitals be allowed to deny admission to an individual under a TDO or civil commitment whose behaviors resulted solely from these disorders. However, JLARC staff suggested that such a policy change be enacted with a delayed effective date, due to concerns about the lack of alternative placements for individuals with neurocognitive or neurodevelopmental disorders who are in crisis. In keeping with this recommended delay in implementation, language in the bills required them to be passed again in 2025 in order to take effect; the bills also contained language directing the convening of the workgroup.
Deputy Secretary of Health and Human Resources Leah Mills presented the key findings and recommendations of the workgroup, which met five times over the summer and fall; these proposals are being finalized and a report is being drafted as required by the legislation. The workgroup recommended against re-enacting the 2024 legislation, given the current lack of alternative services for individuals with these disorders and conditions; instead, the workgroup recommended improving the state’s continuum of care, including pursuing a Medicaid waiver to cover services for brain injury and other neurocognitive disorders; enhancing the ability of crisis services, such as the REACH program, to serve individuals with neurodevelopmental disorders; building private sector capacity to serve individuals with these disorders who also have behavioral health needs, including establishing a treatment and rehabilitation center, similar to the Kennedy Krieger Institute in Maryland; and enhancing workforce training on serving individuals with neurodevelopmental or neurocognitive disorders. The workgroup also strongly encouraged additional support for caregivers, including respite care and clear protocols regarding family or caregiver involvement in crisis response or intervention.
Legislators on the Joint Subcommittee commended the workgroup on its efforts but encouraged strengthening its recommendations, expressing some frustration that individuals may continue to be hospitalized at state facilities in the absence of other options, and encouraging a sense of urgency in developing alternative placement options. Delegate Mark Sickles, who chairs the Joint Subcommittee, exhorted representatives of long-term care facilities to work with the Department of Behavioral Health and Developmental Services to develop a proposal for consideration in the 2025 Session that would improve their capacity to serve individuals in the community.
The Joint Subcommittee also received a presentation on long-term care insurance in Virginia, as well as an update on implementation of the state’s health benefit exchange.
VACo Contact: Katie Boyle