Introduction

To Whom It May Concern,

At Home Your Way/Moms In Motion, consumer directed service facilitation provider, would like to thank you in advance for your time as you review and reply to the following questions and comments proposed. We hope that the following commentary assists with creating adequate and appropriate regulation for service facilitation to ensure the health, safety and well-being of those that have chosen the consumer directed model of care. Additionally, we look forward to our own requests for clarification to ensure compliance with the consumer directed service facilitation model of care.

Sincerely,

Jessica “Flip” Grey

Compliance Analyst and Advocate

At Home Your Way/Moms In Motion

JessicaG@MomsInMotion.Net

1(800)417-0908

 

General Questions and Comments Regarding Proposed CD SF Proposed Regulations

1. When will these proposed changes to regulation be effective?
2. The proposed regulations reference the EDCD waiver which was integrated with the Technology Assisted waiver as of July 1st 2017; now CCC+ waiver. We suggest that EDCD and Technology Assisted waiver be replaced by CCC+ waiver.
3. The May 10th 2016 Agency Statement (Form TH-02) states that the proposed regulations will be applied to EDCD, and EPSDT. For consistency of consumer directed service facilitation across waivers, would this not apply to CCC+, EPSDT, CL and FIS?

Questions and Comments to Proposed Text_20170414_Consumer Directed Services Facilitators

Definitions:

d. Community-based services for children and adolescents under 21 years of age (Level A) pursuant to 42 CFR 440.031 (d)

9. Services facilitators shall be required for all consumer-directed personal care services consistent with the requirements set out in 12VAC30-120-935

• Under H2b. of Consumer-directed (CD) services facilitation for personal care and respite services, it states that the degree requirements are “preferred” while the service facilitator “must possess” the KSAs which are documented in the attendant’s application.

 

C. School Health Services.

4. d. _Proposed regulation states that “the personal care assistant is supervised by a DMAS recognized school-based health professional who is acting within the scope of licensure. The practitioner develops a written plan for meeting the needs of the child, which is implemented by the assistant.”_

• Is this a service separate from CD services under EPSDT? What role does the school maintain? Who are “DMAS recognized school-based health professionals”? If this service is provided through CD services, would the parent not be an eligible EOR that hires their own PCAs, directs and manages the plan of care with support of a service facilitator? Does this support need to be included in the student’s IEP or 504 plan as well as supported by a doctor through DMAS7/7A?

12VAC30-120-900

Part IX

Elderly or Disabled with Consumer Direction Waiver

General Questions

1. Are Assisted Tech waiver services now open to those previously on EDCD and vice versa?
2. In lieu of a provider manual or Medicaid memo, what is the guiding documentation to be followed for waiver services now available through CCC+ waiver?
3. When should providers expect a manual for CCC+?

12VAC30-120-900 Definitions

Assistive Technology- Is this limited to MFP eligible individuals only or extended to all on CCC+?

Consumer-Directed Attendant- Mentions companion care as a CD service. Will this be an option for those on the CCC+ waiver?

Consumer-Directed Services Facilitator- Should this definition include consumer directed companion care as mentioned in the definition of services that the CD attendant may provide as defined above?

Elderly or Disabled with Consumer Direction Waiver- The EDCD waiver is obsolete as of July 1st, 2017 when it merged with the Technology Assisted waiver to form the CCC+ waiver.

Environmental Modifications- EM is necessary for more than those transitioning through MFP. Please consider the inclusion of EM/AT for those on CCC+, previously EDCD and Technology Assisted waivers.

Personal Care Attendant- Should this not also include companion care as mentioned in the definition of services that the CD attendant may provide as defined above under Consumer-Directed Attendant.

Preadmission Screening- (iv) Preadmission screening means the process to “provide a list to individuals of appropriate providers for Medicaid-funded nursing facility or home and community-based care for those individuals who meet nursing facility level of care.”_ There is concern regarding the process of “providing a list of providers” as it has been uncovered that the lists of providers provided by preadmission screeners at DSS and DOH are often not accurate. It has also been identified that some preadmission screeners provide only preferred providers of their choice which limits the choice of providers available to the individual. How may the state assist with ensuring that lists of current providers and service areas are accurate and in support of provider choice?

Service Authorization Contractor- Will the DMAS contractor be Kepro until phase in of contracted MCOs through the CCC+ program?

Services Facilitation- Assistance with “arranging for” services was stricken from this definition. However, a required knowledge is “(d) Various long-term care program requirements, including nursing facility and assisted living facility placement criteria, Medicaid waiver services, and other federal, state, and local resources that provide personal care and respite services;” and a required skill is “(d) Identifying services within the established services system to meet the individual's needs.” In discussion with DMAS and the contracted MCOs for CCC+ program, this knowledge and skill have been described in the context of the care coordinator’s role.

12VAC30-120-935. Participation standards for specific covered services.

A.- Suggest changing the following sentence to support a person centered approach and to meet assessment of the individual requirements in planning and meeting: “Such plan shall be developed in collaboration with the waiver individual OR the individual AND the individual’s family caregiver/EOR, as appropriate.”

C2.- What qualifications are being referenced here? Is this relative to 42CFR 440 167?

D. – In regards to the addition, “provide the required services, conduct the required reviews”, there is concern that service facilitation visits are, at times, cancelled by the individual/EOR/PCG and are thus late despite the services facilitators attempts. While these incidents are kept to a minimum there are situations in which unexpected life events occur. What documentation of these unexpected cancellations or need to reschedule should be maintained by the service facilitator to avoid audit charges or repayments?

H. Consumer-directed (CD) services facilitation for personal care and respite services.- Should this include companion care as listed in the definition for consumer-directed attendant services?

            3b1.- In reference to the SF requirement to have “two references from prior job experience from any human services work”; suggest changing “human services work” to “direct care experience” as stated in 3d1.“possess a minimum of two years satisfactory direct care experience supporting individuals with disabilities or older adults”. Direct care experience with the required educational requirements, successful completion of the state’s service facilitation training, and KSAs is more appropriate for an entry level position such as service facilitation.

1. Initiation of services and service monitoring.

4a.- Suggest changing the following sentence to support a person centered approach as well as adding EOR: “For consumer-directed model of service, the consumer-directed services facilitator shall make an initial comprehensive home visit at the primary residence of the individual to collaborate with the individual OR the individual AND the individual’s family/caregiver/(EOR), as appropriate, to identify the individual’s needs…”

• Request to add that initial comprehensive home visit should also occur when a new EOR is designated as they would require comprehensive training.
• Request that SFs may bill for SF Consumer Training visit (S5109) with new EOR and with individuals that have newly transferred to a new SF as the new SF is accountable for ensuring that the EOR understands their and the SFs roles and responsibilities, and CD PAS processes as outlined in the Employer of Record manual.

4c3._Request that DMAS clarifies the qualifications for “special tasks performed” by a personal care attendant (ie. Med management?) for CD services. Does the PCA need to take a med management course, have experience or simply follow the individual/EOR’s instructions?

4c6.- This requirement of documentation indicates that documentation of the PCA presence “in the home” during the CDSF visit. However, PCA services can be delivered at home or in the community.  Thus, we suggest extension of the ability to conduct SF visits in the community for the CCC+ waiver and EPSDT program as allowable under the DD waivers (CL, FIS). Flexibility in conducting SF visits at home and in the community, supports a holistic view of waiver supports. It also provides the SF with the opportunity to assess and monitor the individuals across multiple environments for more accurate documentation of services and verification that CD supports are being utilized to support ADL/IADLs at work, school and in the community(social). 4c referenced as support of extending SF visits to the community as well: “c. During visits with the individual, the services facilitator shall observe, evaluate, and consult with the individual/EOR and may include the family/caregiver, and document the adequacy and appropriateness of CD services with regard to the individual's current functioning, cognitive status, and medical and social needs. The consumer-directed services facilitator's written summary of the visit shall include at a minimum:”

6._ “The consumer-directed services facilitator shall review and verify copies of timesheets during the face-to-face visits to ensure that the hours approved in the plan of care are being provided and are not exceeded.”_Suggest omitting “and are not exceeded” as this is an antiquated task since PPL implemented safeguards to deny timesheets that have exceeded approved hours and hours over the 40h/wk limit for non-live-in attendants.

• Please provide clarification about billing Management Training for time sheet review.

8._Who at DMAS is to be conferred with before transferring CD services to an agency or other service options and what is their contact information? What is the time line that a CD SF should expect directional response from the DMAS representative?

J. Assistive technology and environmental modification.

J.-AT and EM are described as being only available to those in the MFP program. With the merge of EDCD and Technology Assisted waiver into CCC+, would all individuals not be eligible for these services?

 

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