Although I support the intent of the MFP regulations I strongly object to its regulations concerning Supported Employment services.

First, Supported Employment providers must meet stringent requirements from State agencies in order to bill for services. Those requirements ensure that the services rendered to persons with disabilities are effective –that they achieve what they are meant to achieve; efficient – that they make the best possible use of taxpayer monies by achieving results in a  timely manner; and accountable –that when providers consistently fail to render services that are effective and efficient  State agencies exercise the option of no longer doing business with them, thus ensuring that other persons with disabilities are not subjected to substandard services. Although under Consumer Directed services individuals with disabilities have the option of "firing" a provider who is not delivering proper services, there is no way of tracking down the performance history of any individual who provides poor services, thus exposing other persons with disabilities to the same incompetence. Moreover, the tremendous amount of time and money that State agencies dedicate to the development and tracking of outcome measures would be negated by a system where any untrained individual can provide a service that requires specific knowledge, skills and abilities to properly serve some of the Commonwealth's most vulnerable citizens without being accountable for the results.

Second, the extremely broad and general requirements for a person to provide Consumer Directed Supported Employment do not incorporate the depth and breadth of knowledge, skills and abilities that Supported Employment professionals must possess to obtain successful outcomes for the persons served. Among many others, for a person with a disability to be well served, professionals in the field of Supported Employment must have knowledge of medical, sensory, psychological and psychiatric issues to identify and develop proper support systems, including adaptive technology, and he or she must understand the impact of employment income on government benefits and entitlements. He or she must have outstanding people skills to work effectively with a wide variety of people, as well as good communication in writing and orally to ensure there is a track record of the services provided to the client.  SE professionals must have  the ability to work well with the individual's coworkers and supervisors to ensure that she is well integrated and supported at the site once the job coach leaves. MFP allows for payment to coworkers. This, though well intentioned, destroys the principle behind natural supports, does not mesh with the reality of worksites with high turnover, and worst, diminishes the image of the worker with a disability as a member of the team, who is supported and valued by ALL other team members, not only the one being paid. The idea of paying a natural supporter does little for integration; in fact, it would encourage isolation.  Lastly, SE professionals must have the ability to coordinate the requirements that the supported employee must meet at the job with other services he or she may be receiving. For employment services to be effective, the myriad details that must be arranged and monitored at the client's worksite to ensure his or her success and health and safety must take place at the source, in a timely manner. Neither of these elements can be properly addressed by a case coordinator removed from the day to day reality of the client's workplace.

Thirdly, currently, SE providers are expected -and often, mandated- to attend trainings that develop and sharpen the knowledge, skills and abilities needed to ensure the success, health, and safety of individuals with disabilities in the workplace. These trainings also develop an attitude of respect, self-assurance, poise, and professionalism essential to the image that SE providers project to the business community. Business people are assured that when they allow a job coach to help a worker with disabilities learn the job, that job coach is sensitive to the needs of the business, knowledgeable about the needs of the worker, and capable of handling any crisis that arise on the job. Moreover, business people are assured that the job coach will not present a liability to the business if he or she where injured at the worksite, because the job coach is covered under their employer's Workers Compensation plan. In addition to potentially weakening the professional image earned through meeting stringent national accreditation and State requirements, the MFP regulations for SE Waiver severely erode the trust of employers willing to hire persons with disabilities because they are reassured by the level of professional support provided to the person and the fact that their business would not be liable for injury to the job coach. One very negative experience would be enough to ruin the hard earned reputation of professional Supported Employment providers, and by extension, the image of persons with disabilities as valuable additions to any workforce, as well.

As written, these regulations do not provide for any accountability towards the State, the taxpayer, and least of all, towards the person in need of services and the businesses willing to give him or her the opportunity to become a valued member of the workforce. I urge you to strike the provisions related to Supported Employment and work closely with SE professional organizations in crafting regulations that capture the spirit of MFP while avoiding the dangerous pitfalls in the current language. Most unfortunately, they exemplify the unintended negative consequences that can result from the best of intentions.

Thank you for the opportunity to comment on the regulations for Waiver Services – Section 12 VAC 30-120.

Respectfully,

Carmen I. Mendez

MHMR Supervisor II

VBDHS Community Employment Options

cmendez@vbgov.com