The Management and Operations Committee of the Hammond Commission met at the Region Ten Community Services Board in Charlottesville, Virginia on Monday, July 12, 1999. Members present were: The Honorable Stephen Martin, Senate of Virginia; The Honorable Charles Colgan, Senate of Virginia; The Honorable Emmett Hanger, Senate of Virginia; Olivia Garland, First Health Services Corporation; and Vickie Fisher, Mental Health Association of Virginia. The meeting was called to order at 10:10 A.M. by the Chairman, Senator Martin, and introductions were made. Also present were: Julie Stanley, Executive Advisor to the Commissioner of the Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS) and Administrator of the Commission; Joy Yeh, acting Associate Commissioner for Finance and Administration for the DMHMRSAS and liaison to the Committee; Garland Bigley, Office of the Attorney General; and Virginia Dofflemyer, State Mental Health, Mental Retardation, and Substance Abuse Board.

James Peterson, Executive Director of the Region Ten Community Services Board, welcomed the Committee and gave an overview of the Region Ten CSB and its facilities and programs. He said that 1999 is the 30^th Anniversary of their CSB and that many changes have occurred over the years in the clients who are served and the services that are provided. Region Ten serves the City of Charlottesville and the Counties of Albemarle, Louisa, Fluvanna, Nelson, and Greene. It currently has three major projects underway: a new facility for mental retardation day programs, a new building to house Blue Ridge Clubhouse, the first psycho-social program in Virginia; and the renovation of a facility for substance addiction programs. The projects are being financed through fundraising efforts and low interest bonds. Mr. Peterson introduced three Region Ten Board members.

Dr. Peter Sheras, Vice Chairman of the Region Ten CSB, also welcomed the Committee and said that he was very proud of the staff at Region Ten. He believes that they do exceptional work, have the support of the community, and deserve a higher level of compensation than they currently receive.

Ms Anthony showed the Committee a video prepared by Channel 10 in Fairfax for the Voice of the Retarded (VOR). It filmed the residents and staff of the Northern Virginia Training Center doing activities of daily living and recreation and also featured representatives of the advocacy organizations in support of training centers. VOR and PAIR believe that training centers are appropriate for the severely mentally retarded, who are medically fragile and represent a small percentage of the MR population.

Ms Wunsh has a son who is mentally retarded and has been on the waiting list for services for 17 years. Her son can work but requires transportation from their home in Louisa to Charlottesville. Ms Wunsh believes that mental health services receive more attention and resources than MR does. She expressed concern about the following MR issues:

• Inadequate funds to provide services for individuals who need them;
• Those individuals who are mildly to moderately retarded and don't qualify for the MR waiver receive few services;
• Families who keep their children at home are less likely to receive services;
• Services should be provided while family members are able to support and provide help;
• Rural areas are tremendously underserved;
• There are no reciprocal services across jurisdictions which limits access; and
• There should be a full continuum of services available for the differing needs of consumers.

Mr. Belair said that Louisa County allocates its share of support for the Region Ten CSB unlike some of the other jurisdictions. He believes that the Commonwealth is capable of taking care of its vulnerable citizens, but the level of state funding is inadequate. He expressed the following concerns:

• Virginia reimburses CSBs for services provided if they meet specified criteria. There are no discretionary funds to help other individuals; and
• Funds should be available to make in-home modifications for accessibility.

Ms Bergeron discussed a collaborative effort by the VACSB, ARC of Virginia, and other organizations to gain funding for services for those young adults who are transitioning from high school special education. They identified those individuals who were graduating in 1999 from each school system in Virginia and provided this profile with a funding recommendation to the General Assembly. An allocation was approved to serve those identified.

Ms Wilson informed the Committee that the ARC of VA had developed a five-year plan to eliminate the waiting list for MR services and that the 1999 allocation was a beginning step.

Mr. Peterson said that since 1990, when the Commonwealth moved to Medicaid, CSBs have no flexibility with their resources. The clients served and the services provided are dependent upon whether they are Medicaid reimbursable, and the eligibility is narrowly defined.

Ms Bryant has twins who are residents of the Central Virginia Training Center and is satisfied with the care her children receive there. However, she has concerns about other disabled children in Virginia and believes that:

• Children are not a priority to the state and that they are not served well;
• There are funding gaps in the services provided to children, especially with the medically intensive;
• The community and the schools are not prepared to provide these services;
• There should be a brochure for families to inform them about MR services and programs that are available; and
• Respite care is needed for families of the disabled.

The Committee discussed the questions under Section 10: "Sustaining Awareness" in the Work Plan for 1999 and recommended that:

1. The Commonwealth ensure consumer and family member representation and participation on all state and local MH, MR, and SA boards and committees; and
2. The HJR 225 Subcommittee continue with its work on the legislative level and the Governor establish another workgroup on the executive level to continue the work of the Hammond Commission and to work with 225.

The other areas assigned to the Committee were "Resource Management" and "Access to Care," and the following recommendations were discussed:

3. A full continuum of services with choices should be provided for consumers.
4. Medicaid criteria should be broadened to allow for flexibility with accountability to serve more of the Medicaid eligible individuals in need of services and provide for the most effective technologies and medications.
5. Family support and caregiving for individuals with mental disabilities should be encouraged.
6. Provisions should be made for non-mandated populations of children that are not served through the Comprehensive Services Act.
7. Waiting lists that are chronologically based should consider medical necessity as well.
8. CSB services should be available to individuals with health insurance only when appropriate services are unavailable from private providers.
9. The DMHMRSAS should consider contracting with a private company to operate state facilities and include provisions to maintain ultimate control.
10. Given the movement toward more community-based care, decisions need to be made regarding realigning resources, capital needs for facilities, and alternative uses for available space. The Commission should assist HJR 225 with this issue.
11. The establishment of transitional living centers should be encouraged.

The meeting was adjourned at 1:45 P.M.