As a provider of multiple Developmental Disability (DD) Waiver services, SOAR365 agrees with most changes proposed. Those that update language and increase consistency are positive changes without negative impact to individuals served or providers. Allowing individuals to delay enrollment for a longer period promotes choice of provider and recognizes that a lack of available providers may be a factor in ceding a waiver slot by a person in need of and willing to engage in services. While Virginia’s intention of adding a significant number of DD Waiver slots allows for the possibility that more individuals will be able to access service, even a phase in approach may not adequately consider the number of Support Coordinators, providers and the ability for both to assess and complete the intake process for new participants. An influx of eligible individuals applying to services may not be able to move through the process within the current time limit. Disregarding Social Security Disability Insurance benefits above the maximum Social Security Insurance benefits may help more individuals choose to participate in Supported Employment services.

As one of the few providers of respite services in Virginia licensed by DBHDS (approximately 20 only six of which provide services for youth), SOAR365 does not support amending the rules to disallow receipt of respite services to a paid Legally Responsible Individual (LRI). By definition, an LRI providing personal assistance is doing so under circumstances that are, “extraordinary in nature, which is above and beyond what they are obligated to provide.” This change will deprive families of necessary, intermittent relief from the extensive burden and responsibility of being a caregiver to individual with high needs. Paying LRIs to provide support to loved ones could appropriately be viewed as a means of financially compensating a family system unable to benefit from having a member of the family obtain outside employment. Compensation for up to 40 hours per week of work in no way diminishes the degree of effort needed to meet the needs of the individual with a disability. If considered as a form of employment, it is standard for employees to receive some type of time off. If viewed as a family system, parents/caregivers need to be afforded opportunities to engage in normative activities such as “date night,” “weekend getaways,” or other brief periods of respite from caregiving in the same way as families caring for loved ones without extraordinary needs. Such breaks provide opportunities to decompress, decrease burnout and depression, and decrease the risk of abuse or neglect for the individual. These families are generally less able to take advantage of natural or community supports, such as family members and babysitters, making professionals resources an important support.

Plans to increase the number of waiver slots is intended to address the Priority One waitlist – meaning those in the greatest need of services, which implies these individuals require the highest levels of support. Therefore, Virginia would benefit from looking at ways to increase the availability of respite services, not decrease them. Improving reimbursement rates, and eliminating administrative burdens (e.g., removing the requirement for quarterly progress reviews for this intermittent service not intended to serve a rehabilitative or habilitative function) are ways to facilitate this, as is allowing all those in need to access the service.