12VAC30-50-440

12VAC30-50-490

Several inconsistencies between Support Coordination requirements and expectations for ID vs. DD with no clear explanation for said differences.  We echo the detailed description of the inconsistencies as described by Lisa Snyder (Loudoun County) in an earlier public comment.

An additional discrepancy is added:

Unit of service for both is one month; however, for ID Support Coordination/Case Management preceding discharge from an institutional setting may be billed for no more than two pre-discharge periods within 12 months.  For DD Support Coordination/Case Management, services may be billed for no more than two months in a 12-month cycle. Also, for ID SC, case management (reimbursement) is limited to 30 days immediately preceding discharge from an institutional setting.  Recommend consistency regardless of ID vs DD Support Coordination.

12VAC30-50-490-E.5

For CSBs that hire Master’s level Support Coordinators/Case Managers, (to minimize confusion) please clarify that a Master’s in a human services field may replace the minimum requirement for a bachelor’s degree in a human services field.

12VAC30-50-490-E.6.c.7

Support clarification that supervision is offered within the employing agency.  This is helpful for CSBs that contract with private case management providers.

12VAC30-122-20 (Definitions)

Sponsored Residential Services ­ – Recommend you clarify “non-relative” families   “. . .and safety supports provided in the homes of non-relative families or persons (sponsors). . .”

12VAC30-122-30

Waiver populations: single waiver; enrollment; waiver termination upon loss of eligibility

B. Correct "Elderly or Disabled with Consumer Direction" and "Technology Assisted" Waivers to CCC Plus Waivers.

C.  Assuming no longer meeting VIDES eligibility is a reason for loss of a DD Waiver, recommend addressing this here. 

Also, what is the recommended practice for re-doing a VIDES?  If someone does not meet, should DMAS and DBHDS be notified immediately (e.g., within 24 hours, three business day, etc.)?  Should a supervisor re-do the VIDES and then notify DMAS/DBHDS, if necessary? Shall the CSB seek an independent VIDES completion by another CSB?  Improved and consistent guidance in this area would be helpful.

12-VAC30-122-80

Waiver approval process: authorized and accessing services

C.3 – second to last sentence, recommend clarifying family/caregiver if not the guardian.  Currently reads, “. . .the individual enrolled in the waiver, or the family caregiver as appropriate, and support coordinator shall sign and date the ISP.”  My understanding has always been that the individual always signs his or her ISP unless he or she has an Authorized Rep, legal guardian, or someone appointed with Power of Attorney.  The wording in the proposed waiver regulations suggest that the individual “OR” the family/caregiver may sign the ISP whether or not the family caregiver is a legal guardian or Authorized Rep.

12-VAC30-122-80

Waiver approval process: authorized and accessing services

5.b – Recommend increasing up to a maximum of five or six consecutive extensions for a maximum of 150 – 180 days.  This allows the Department greater flexibility for special, extenuating circumstances.  The extension to 180 days in no ways suggests that the Department has to always approve extensions up to 180 days.

12-VAC30-122-90

Waiting list

F.

“If the individual determines at any time he no longer wishes to be on the DD Waiver waiting list, he may contact his support coordinator to request removal from the waiting list.  The SC shall notify DBHDS so that the individual’s name can be removed from the waiting list.”  Shall the SC provide the appeals notice giving the individual time to change his or her mind?  Or, would the person be re-screened or simply added back in the event that he or she changes his or her mind?  And, if so, is there a minimum or maximum amount of time that should pass to determine the manner by which the individual should be added back to the waitlist if he changes his mind?

12-VAC30-122-90

Waiting list: emergency slots

G.2.a – comment pertains to the “the next non-emergency waiver slot that becomes available at the CSB or BHA in receipt of an emergency slot shall be re-assigned to the emergency slot pool to ensure emergency slots remain to be assigned to future emergencies within the Commonwealth’s fiscal year.”  Is there a process wherein a slot made available by a CSB for emergency purposes is returned to that CSB once more slots/emergency slots are made available to DBHDS?  Or, is the slot not returned to the CSB?  Can this point be clarified?

12-VAC30-122-90

Waiting lists: Reserve slots

H.1.c – Recommend adding in timeframe by which DBHDS notifies the Support Coordinator (from date request is submitted) of decision to add or not add the individual to the reserve waitlist.  Recommend ten days.

12-VAC30-122-90

Waiting lists: Reserve Slots

4. “When a slot is vacated in one of the DD Waivers (e.g., due to death of an individual) the slot shall be assigned to the next individual in that CSB’s chronological queue for a reserve slot in accordance with the procedures outlined in subdivision 3 of this section.  My only concern about this is that in subdivision 3, “if there is not an individual in that CSB’s chronological queue for a reserve slot, the vacated slot will be assigned to an individual on the statewide waiting list who resides in the CSB’s or BHA’s catchment area.”  So, under this, the waiver for a deceased person could be used by a CSB or BHA in the “catchment area” as opposed to convening a WSAC and assigning that same waiver to someone on the originating CSB’s Priority lists.  Is it really intended that all of subdivision 3 is applicable to subdivision 4?  If not, please clarify (or better yet, state in subdivision 4 what is applicable without reference to subdivision 3).

12-VAC30-122-120

Provider Requirements

14.

Consider adding, “and, if applicable, to the local police” (in reference to reporting suspicions of abuse and neglect.

12-VAC30-122-190

Individual support plans: plans for support; re-evaluation of service needs

C.a. “The ISP shall be revised as appropriate . . .the support coordinator shall inform DMAS and DBHDS that that the individual must be terminated from waiver services.”

How shall this notification be made to DMAS and DBHDS? By notice of appeal?  Does this include when the VIDES is not met in conjunction with the annual planning meeting?  Can the regs address this area: Under what circumstances, if any, shall a VIDES be redone?  If an individual, at the time of the annual planning, no longer meets the VIDES, what procedures should be followed?  Should DMAS/DBHDS be notified right away that waiver services need to be terminated?  Should a supervisor complete the VIDES?  Should the CSB reach out to a neighboring CSB to complete an objective VIDES?  My experience is that there have been a number of variations (for this scenario) across CSBs and perhaps across regions.  Can the regs offer some guidance and consistency on what steps should be followed when someone does not meet the VIDES “at the time of annual planning”?

C.d. “A new psychological or other diagnostic evaluation shall be required whenever the individual’s functioning has undergone significant change, . . .”

Is this a funded mandate?  I think I know the answer is, “No,” but concerned that not all CSBs will be able to absorb costs for re-evaluations such as this (and individuals might not be able to absorb the cost).  Depending on the area, it may not be feasible to find a Medicaid provider for such evaluations.  Just a thought.