Virginia Regulatory Town Hall View Comments

Department of Medical Assistance Services

Board of Medical Assistance Services

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9/3/24 11:55 am

Commenter: Seth Whitten, disAbility Resource Center

dRC Comment on Proposed Waiver Changes

The disAbility Resource Center (dRC) in Fredericksburg, Virginia, appreciates the opportunity to provide feedback on the proposed amendments to the 1915(c) Home and Community-Based Services (HCBS) Medicaid Waivers. As a Center for Independent Living (CIL) dedicated to empowering individuals with disabilities to live independently and participate fully in their communities, we understand the critical importance of these waivers in supporting individuals with disabilities across the Commonwealth.

We recognize the efforts of the Department of Medical Assistance Services (DMAS) and the Department of Behavioral Health and Developmental Services (DBHDS) to update and amend these waivers to better serve the needs of Virginians with disabilities. However, we have several concerns and recommendations regarding specific amendments that we believe could impact the quality and accessibility of services provided to individuals with disabilities.

Combining the Annual Service Limits for Assistive Technology and Electronic Home-Based Services
We are supportive of combining the annual service limits for Assistive Technology and Electronic Home-Based Services into one $10,000 limit if doing so allows individuals more flexibility in accessing these services. However, we believe DMAS needs to assess the usage rates of these services to determine if consumers are utilizing them, and if not, to investigate the reasons why. We are aware that in some areas of the state, provider options for environmental modification services under the waivers are incredibly limited, which we believe affects consumers' ability to access these critical services. Therefore, we strongly urge DMAS to focus on ensuring that there is a sufficient number of providers to meet the need for Assistive Technology, Electronic Home-Based Services, and environmental modification services.
Delay in Enrollment into Developmental Disabilities Waivers
We support the proposal to allow individuals offered a Developmental Disabilities Waiver slot to delay enrollment for up to one year. This flexibility is crucial in accommodating the unique circumstances of individuals and their families. However, we urge DMAS and DBHDS to provide clear guidelines on how this delay will impact service planning and the continuity of care, to prevent potential gaps in services during the delay period.
Disregarding SSDI Benefits Above SSI Limits for Pre-Eligibility Treatment of Income
We commend the state’s proposal to disregard SSDI benefits above the maximum SSI benefit limit for pre-eligibility treatment of income. This amendment is a positive step toward ensuring that individuals with disabilities are not unfairly penalized in their eligibility for vital services, and it aligns with our mission of promoting economic independence for people with disabilities.
Amendments Regarding Paid Aides/Attendants by Legally Responsible Individuals
We fully support the amendment to allow legally responsible individuals, such as spouses or parents of minors, to be paid aides or attendants for personal care. It can often be difficult to find personal care attendants, particularly in more rural areas of the state, and this change will help ensure more flexibility in situations where individuals are unable to find personal care attendants or where specific circumstances make legally responsible individuals the best option.
Educational Requirements for Services Facilitation Providers
We support the removal of educational requirements for Services Facilitation providers. However, we believe that DMAS could do more to develop comprehensive training programs to ensure that high standards of care are maintained. Such programs would help ensure that Services Facilitation providers have the necessary skills and knowledge to effectively coordinate services for individuals with disabilities.
Aligning Quality Measures Across Waivers and Updating Language
We support efforts to align quality measures across the Developmental Disabilities Waivers and to update language in waiver documents. Consistency and clarity in service plans and assessments are essential for effective service delivery and for ensuring that individuals with disabilities receive the care they need. We encourage continued collaboration with stakeholders to refine these quality measures and language updates to reflect the lived experiences and needs of waiver participants.

In conclusion, the disAbility Resource Center strongly believes that the proposed amendments should be carefully considered in light of their potential impacts on individuals with disabilities. We appreciate the opportunity to contribute to this public comment process and urge DMAS and DBHDS to prioritize the needs and voices of people with disabilities in their final decisions.

Thank you for your attention to these important issues.

CommentID: 227584