SUBJECT:     VACSB Comments Regarding NOIRA to Publish Omnibus Waiver Regulations

On behalf of the Virginia Association of Community Services Boards (VACSB), thank you for the opportunity to comment upon the intention of DMAS to publish Omnibus Waiver Regulations. 

The VACSB appreciates the intention to streamline regulations; however, it is our strong and enduring belief that, while there may be some cause for certain components of the Regulations to be consolidated, the MR Waiver and MR Day Support Waiver regulations should remain entirely separate beginning with 12 VAC 30-120-211 through 12 VAC 30-120-249 and 12 VAC 30-120- 1500 through 12 VAC 30-120-1550.

The VACSB has been an active and critical participant in the development, design, implementation, and revisions of the MR Waiver and, more recently, the MR Day Support Waiver.  These Waivers have many unique and significant features that must be retained.  Additionally, these two Waivers have figured highly in public policy discussions and decisions made by Virginia’s elected officials since the MR Waiver was first developed in the early 1990’s. 

The MR Waiver, at the direction of the General Assembly and the Administration, was developed by DMHMRSAS, in consultation with CSBs, DMAS, and advocates.  Within DMHMRSAS resided the experience and leadership for services for persons with Mental Retardation.  As a result, the MR Waiver was intended to offer services and supports for people with Mental Retardation who could and chose to live in their communities and was based upon the best expertise and knowledge of the needs of individuals with Mental Retardation.   The history of its development, oversight, and implementation, all of which occurred in the public eye and was the focus of two important legislative subcommittees, is too lengthy to describe in these comments. The results of this history constitute the reasons why these Waivers should be entirely separate:

• Among the very unique features of the waivers include the assessment process and instruments used in assessment, the preauthorization process and authority, and the criteria used in developing and managing the waiting lists.
• Unique is the MR case management system and roles played by the Case Managers.  If any citizen is seeking information regarding the MR Waiver or the MR Day Support Waiver, a separate set of regulations is going to be most helpful and will assist in that citizen’s understanding of the Waiver features. 
• The oversight of the MR Waiver and the MR Day Support Waiver is unique.  The Virginia General Assembly mandated a secure partnership between DMAS and DMHMRSAS.  Each agency has roles specific to these Waivers and which are outlined within the DMAS-DMHMRSAS Interagency Agreement.  Such roles have been affirmed time after time by Virginia’s elected leaders.
• Since responsibility is shared for the implementation, administration, and oversight of the MR Waiver and the MR Day Support Waiver, integration of the Waivers into Omnibus regulations would result in all sections of these Waivers being opened each time the agency needed to suggest changes to any Waiver, for example, the AIDS Waiver.  Such a continuous regulatory process would result in a burden upon the agencies, consumers, advocates, families, and providers.  Instead of streamlining anything with regards to these Waivers, the result would be increased process and work for everyone involved, including the very DMAS staff proposing such a move.  As the regulations are constructed at present, changes needed in one Waiver can occur with no need to open all sections of 12 VAC 30-120.
• While there may be exceptions, most families are concerned with only one Waiver and separating those Waivers by section would appear to be the most informative and user-friendly way to accomplish information sharing.
• The history of the MR Waiver and MR Day Support Waiver, with its legacy of strong interest and affirmation by Virginia’s elected leaders, should indicate that the very features that have made them vital and effective Waivers, whether they are phrased as “inconsistencies” or by any other term, cannot be lost if the Waivers are to remain strong systems of support for citizens of Virginia and their families.
• Are the Waivers complex?  Yes.  Can the complexity be managed?  Yes.  Through confusing Omnibus Regulations?  No, emphatically No!

Thank you again for this opportunity.