October 12, 2018

Emily McClellan, Regulatory Manager

Department of Medical Assistance Services

600 E. Broad St, Suite 1300

Richmond, VA 23219

RE: CCC Plus Manual

Dear Ms. McClellan,

The disAbility Law Center of Virginia (dLCV) is the Commonwealth’s federally mandated protection and advocacy system.  We respectfully submit the following public comment in relation to modifications of the Commonwealth Coordinated Care Plus (CCC Plus) Waiver Manual.  This manual is a combination of the former Elderly or Disabled with Consumer Directed Services (EDCD) and the Technology Assisted (TECH) Waiver and private Duty Nursing Services Provider Manuals.  We ask the Department to consider the following issues:

• The Manual requires multiple waiver recipients residing in the same home or household to share funds for environmental modification (EM) “to the extent practicable consistent with the type of requested modification.”  The Manual further provides that “EM shall be available for a maximum Medicaid-funded amount of $5,000 per household per SFY (State Fiscal Year – July 1 to June 30).”

(CCC Plus Waiver Manual, Covered Services and Limitations, Chapter IV, page 75).

The requirement to share funds, with a limit of $5,000 per household, as opposed to per individual, is inconsistent with the State Plan, which does not require the sharing of benefits.  (12 Va. Admin. Code § 30-120-758, 762 (2014)).  This restriction would penalize individuals who reside in the same household, but whose EM needs may be entirely distinct, by reducing the funds available to each individual.

• The manual requires that when “two or more individuals” receiving waiver services reside “in the same home,” then the assistive technology (AT) “shall be shared to the extent practicable consistent with the type of AT.” The Manual further states that the “maximum Medicaid-funded expenditure per individual for all AT covered procedure codes combined shall be $5,000 per individual per SFY . . .”

(CCC Plus Waiver Manual, Covered Services and Limitations, Chapter IV, page 81).

Individuals receiving waiver services may receive up to $5,000 in AT per fiscal year. (12 Va. Admin. Code § 30-120-758, 762 (2014).)  The proposed requirement that individuals shall share AT is unclear and ambiguous, and in effect lessens the benefit available to an individual beneficiary.  Although the Manual does not expressly state that the AT limit is per household, providers could interpret this language to mean that multiple Medicaid recipients in the same home must share any AT within their $5,000 maximum allowance.

The Department should revise the proposed CCC Plus Waiver Manual to comply with the intent of the State Plan and VAC. 12 Va. Admin. Code § 30-120-758, 762 (2014). Specifically,

• Eliminate the requirement that individuals residing in the same household must share EM funds, and eliminate the household limitation of $5,000.  Revise the section on EM to recognize a maximum $5,000 annual benefit per individual beneficiary, consistent with the approved State Plan.

• Revise the section on AT to clarify shared AT does not reduce an individual’s benefit of $5,000 per year, and is not intended to create a maximum household limitation of $5,000.

dLCV is concerned that these proposed requirements will effectively reduce benefits to Medicaid waiver recipients, and deny them the individualized AT and EM that they need.  These requirements as proposed would  also penalize individuals by reducing the Medicaid waiver benefits of recipients who, through choice or necessity, share a home or household with other individuals with disabilities, or reside in a congregate setting.

Thank you for your thoughtful consideration of dLCV’s public comment.

Sincerely,

Colleen Miller

Executive Director