Moms In Motion has thoroughly reviewed the CL application that is out for public comment currently.  The following are our comments.

Throughout the application, the word “provider” is used interchangeably to mean either ‘Paid Attendant’ or ‘Provider Organization’. The language needs to be altered throughout the application to purposefully distinguish between the two.

Management Training - Page 93, 3rd paragraph, Employer Management Training is discussed. The current regulations around this state that it should be conducted “upon the individual’s or the EOR’s request” (12VAC30-122-500. Services Facilitation Service. C-4). In other words, there are no limitations as to how many units per year, it’s simply whenever they need it. In this application; however, the language reads, “management training which is limited to up to four visits per six month period.” Firstly, Management Training is not a visit. It is measured in time units. Secondly, the General Assembly gave no direction to make this change to regulation this past session. DMAS is making this regulatory change without the express guidance of the Governor or the General Assembly. This limitation needs to be removed unless or until the The General Assembly creates the legislative change to impose such a limitation in the regulations.

SF Educational Requirement - Page 94, 2nd paragraph, 2nd sentence, the application says, “To be enrolled, the services facilitator shall also meet the combination of work experience and relevant education…”. This requirement was removed by the General Assembly this past session via Item 288.CCCCC (2024). The educational requirement for Services Facilitators needs to be removed from this application. Also, please note, in the FIS Waiver Application out for public comment currently, this section reads, “To be enrolled, the services facilitator meet the work experience…”. There is no mention of education, as should be the case in the CL Waiver Application and the CCC+ Waiver Application.

Definition of EOR - Page 248, 2nd paragraph, this application is changing the definition of Employer of Record (EOR). The current regulations (12VAC30-122-150, A, 2, a) read:  “If an individual is unable to direct his own care or is younger than 18 years of age, he shall designate another person older than 18 years of age to serve as the EOR on his behalf.” In this application, that is being changed to this, “If the individual is unable to independently manage his/her own consumer-directed services, or if the individual is under 18 years of age, a family member/caregiver must serve as the employer of record (EOR) on behalf of the individual.” This effectively removes the individual’s ability to choose a friend or neighbor to be their EOR. This language needs to be restored to the current regulation language to include “another person” so that the right of the individual to choose whomever they would like stays in place.

Medication Administration - Page 288, paragraph 5, the application states, “Consumer-directed personal assistance or respite employees may assist with the administration of medication that would typically be self-administered, but because of a disability, they are unable to do so.” In paragraph 6, it states, “State policy requires that all nonmedical provider personnel responsible for medication administration successfully complete the 32-hour medication course in accordance with the Board of Nursing Regulations 18VAC90-21-10 through 40.” It is unclear, because of the use of the words “provider personnel”, whether that means Agency- Directed Providers that employ Direct Support Professionals (DSPs- aka their provider personnel), or whether that means a nonmedical Personal Care Attendant (also referenced as providers throughout this application) as the EOR’s provider personnel. If it is Consumer-Directed, then this change would require any paid attendant who  administers medications, including the LRI of a minor, to attend 32 hours of training and “pass a written and practical exam”. This language should be updated to clearly indicate whether this requirement applies to any paid attendant under any model or just the personnel of agencies. Also, if the intent is for any PCA helping to administer medications takes this course, there is no clarification around whether or not DBHDS/DMAS will be paying that PCA to take that course.