Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
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9/28/22  11:53 pm
Commenter: Karen Tefelski - vaACCSES

Waiver Amendment to CMS - Telehealth Flexibilities

COMMENTS: Virginia Association of Community Rehabilitation Programs Dba vaACCSES

HCBS Medicaid Waivers – Amendment to CMS

Continued Permanent Use of Telehealth (Virtual Services) Platforms in Service Delivery

In the General Assembly budget language the following is written:

313.DDDDDD. The Department of Medical Assistance Services, in coordination with the Department of Behavioral Health and Developmental Services, shall submit a request to the Centers for Medicare and Medicaid Services to amend its 1915(c) Home & Community-Based Services (HCBS) waivers to
allow telehealth and virtual and/or distance learning as a permanent service option and accommodation for individuals on the Community Living, Family and Individual Services and Building Independence Waivers. The amendment, at a minimum, shall include all services currently authorized for telehealth and virtual options during the COVID-19 pandemic. The departments shall actively work with the established Developmental Disability Waiver Advisory Committee and other appropriate stakeholders in the development of the amendment including service elements and rated defined methodologies. The department shall have the authority to implement these changes prior to the completion of the regulatory process.


As the original advocacy group that asked Delegate Sickles and Senator Hanger to patron this budget amendment, we were clear that our intention, as well as our patrons, was to include group day services, community engagement and supported employment as services that were to be included in the provision of HIPAA compliant telehealth (virtual) methods of service delivery.


  1. Group day services is missing from the list of services to be able to do face-to-face and/or telehealth (virtual) delivery of services in the Waiver application to CMS.

It has been almost two years since the amendment was approved by the General Assembly. 

Group Day Services should be included in this submission of the amendment to CMS and should not have to wait for another opportunity for an amendment to CMS.  CMS can approve this flexibility as they approve the other flexibilities proposed for Benefits Planning, Community Engagement, Community Guide, Individual & Family/Caregiver Training, Independent Living Support Services, In-Home Support Services, Peer Mentor Services, Service Facilitation, and Therapeutic Consultation.  All have to be further developed through regulations and Manual revisions – to include Group Day Services is not only efficient but fulfills the intent of the General Assembly and the two leadership patrons.

The amendment can’t be more clear in requiring all services authorized during the pandemic that were delivered virtually during the pandemic – which included Group Day Services. Distance learning (telehealth) is a viable service delivery option and must be available to all DD Waiver recipients in the future. This will allow individuals to continue acquiring skills as authorized in their individualized plans as well as attain new skills and socialization opportunities needed in today's virtual environment. This is especially critical for individuals that have stamina issues that would like a combination of face-to-face and virtual (telehealth) options.  We are not asking for 100% time to be telehealth.  We understand that there must be “guard rails” or limits to virtual delivery of services.  We are asking that a portion of their plans be able to include virtual delivery of services and skill building activities.  For example, 3 days per week in person and 2 days a week of limited telehealth (virtual) hours in the morning/afternoon.

  1. All CD services provided by Service Facilitators must be included in the amendment to CMS


We are not asking that all CD services be included as 100% telehealth.  There can be parameters that define both face-to-face requirements and telehealth (virtual) requirements by combining the two to allow the greatest flexibility on behalf of individuals and families.


DMAS is misrepresenting the fact that they have included Service Facilitation in their amendment by ONLY including 1 of our 5 services.  Management Training, which is the only service under SF that was included in this draft amendment, is not typically a stand-alone service.  It is usually done in conjunction with a Routine or Reassessment visit when the EOR requests retraining during a visit.  Therefore, the reality of the amendment the way it is written is that DMAS has not included Service Facilitation at all in its request to continue to allow Telehealth as a delivery method after the PHE has ended.  

CommentID: 179696