On behalf of our Board of Directors, Local Chapters, and Membership, The Arc of Virginia appreciates the opportunity to submit the following comments and respectfully requests that they be considered prior to the amendment submission.

TOPIC:  Expansion of Telehealth (Virtual Supports) 

COMMENT:  Virtual support (telehealth services) is a valuable option for enhancing the flexibility, accessibility, and quality of support people can receive. 

ISSUES:  

• The parameters for Group Day, In-Home, and Community Engagement that are outlined in the FIS application should also be included in the CL application. 

• Peer Mentoring (as a virtual option) is missing from the BI application.

TOPIC:  Combining CAPS for AT/EHBS

COMMENT:  This is an important step to providing people with greater flexibility and buying power. 

ISSUES:  None

TOPIC: Allowance for individuals offered a Developmental Disabilities Waiver slot to delay enrollment into the waiver for up to 1 year.

COMMENT:  This is a change that will allow people more time to find and secure the right services for their lives. 

ISSUES:  None

TOPIC:  Rules regarding Payments to Legally Responsible Individuals 

COMMENT:  The policy change to allow legally responsible individuals (LRIs) to provide personal assistance services recognizes the valuable role of family caregivers in keeping families together and stable, leading to better overall health and well-being of families, including spouses and children. We also recognize that paid family caregivers help to minimize the burden on the State when there is a substantial lack of a qualified workforce. 

• ISSUE 1:  We recommend that the language regarding the EOR be consistent in all 3 applications to avoid confusion and misunderstanding. There is no reason that another “chosen person” can’t be the EOR when a family is using CD Respite. 

P. 62 of CCC+:  If the individual is unable to independently manage his/her own CD services, or if the individual is under 18 years of age, a spouse, guardian, adult child or parent of a minor child must serve as the employer on behalf of the individual.

P. 88 of FIS:  If the individual is unable to independently manage his/her own consumer-directed services, or if the individual is under 18 years of age, he/she must an (typo) adult family member/caregiver or other chosen person serve as the employer of record (EOR) on behalf of the individual. 

P. 86 of CL:  If the individual is unable to independently manage his/her own consumer-directed services, or if the individual is under 18 years of age, he/she must an (typo) adult family member/caregiver or other chosen person serve as the employer of record (EOR) on behalf of the individual.

• ISSUE 2:  We recommend that Respite be an available service for families utilizing a paid Legally Responsible Individual (LRI) for personal care services. The fact that a family member provides care as a paid LRI does not negate their need for additional respite throughout the year. While they cannot provide relief for themselves, there is no reason they should be unable to access respite care from another source during the year.  

TOPIC:  Disregard Social Security Disability Insurance (SSDI)

COMMENT:  This change will remove the penalty for those who receive SSDI benefits, potentially risking Medicaid eligibility. This is a very important update to the policies around pre-eligibility treatment of income. The receipt of SSDI benefits should never be a disqualifying factor to receiving needed Medicaid Waiver long-term services and support and employment opportunities.

ISSUES:  We will be working with stakeholders to ensure this change remains in place permanently. 

TOPIC:  Shared Living Service

COMMENT:  None

ISSUES:  The language of the CL Waiver should be used in both FIS/BI

• The language used to describe this service is inconsistent across waiver applications. In the FIS and BI waiver applications, the term “live-in companion” is used, whereas the CL waiver refers to a “roommate.” The intent of this service aligns more closely with the concept of a roommate. This discrepancy is more than a matter of semantics—the entire description of the service differs between the FIS/BI and CL waivers, potentially leading to confusion or misinterpretation of the service's purpose.

• Inconsistent rule:  The CL waiver states “roommate must not be the individual's parent, spouse, grandparent, or guardian, while the FIS/BI states “the live-in companion must not be the individual's parent or spouse”. 

TOPIC:  Peer Mentoring Service

COMMENT:  We provide this comment every time an application is submitted.  The “last resort” requirement is both a barrier and a statement of the value placed on peer mentoring. 

ISSUES:  The fact that Peer Mentoring is identified in the DOJ Settlement Agreement as a key indicator that Virginia has appropriately ensured informed choice before an individual selects a congregate setting demonstrates the value placed on Peer Mentoring as a service. This, however, contradicts Virginia's requirement that 'prior to accessing funding for this waiver service, all other available and appropriate funding sources must be explored and exhausted.'

DOJ requirement: “III.D.5 Individuals in the target population shall not be served in a sponsored home or any congregate setting unless such placement is consistent with the individual’s choice after receiving options for community placements, services, and supports.,,”

DOJ Indicator for that Requirement:  “The Commonwealth will achieve compliance with this provision of the Settlement Agreement when:  1. At least 86% of individuals on the waiver waitlist as of December 2019 have received information on accessing Family-to-Family and Peer Mentoring resources. 2.  The Virginia Informed Choice Form is completed upon enrollment in the Developmental Disability waiver and as part of the annual ISP process.  DBHDS will update the form to include a reference to the Family-to-Family Program and Peer Mentoring resources so that individuals and families can be connected to the support when initial services are being discussed or a change in services is requested. 3. The Commonwealth will track and report on outcomes with respect to the number of individuals receiving DD waiver services with whom family-tofamily and the peer-to-peer supports have contact and the number who receive the service.”