Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
Waivered Services [12 VAC 30 ‑ 120]
Action Three Waivers (ID, DD, DS) Redesign
Stage Final
Comment Period Ended on 3/31/2021
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3/31/21  10:58 am
Commenter: John Walker - President SOAR365

Comments - DD Waiver Regs 2

12VAC30-122-320 - Community Engagement

B. 2. c.  Routine and Safety Supports must not be limited to transportation only. These supports may be necessary for and apply to other allowable activities.

12VAC30 - 122-360 Electronic Home-Based Support Service

B.3. Criteria and allowable activities.

AMEND - Electronic home based supports may be billed solely for purposes of monitoring the individual or training the individual, family members, caregivers, and relevant others in the use of the electronic home based supports electronic home based supports service shall support training in the use of these goods and services, ongoing maintenance, and monitoring to address an identified need in the individual’s ISP, including improving and maintaining the individual’s opportunities for full participation in the community.


C. Service units and limit.

ADD 5. The service unit for electronic home-based supports equipment shall be one for the total cost of all electronic home-based supports equipment being requested for a specific timeframe. The unit of service for electronic home-based supports services that include ongoing training and monitoring shall be one hour.

JUSTIFICATION: Allowable services under electronic home-based supports include both one-time equipment that is delivered and billed once and ongoing monitoring and training services that are provided incrementally throughout the duration of the ISP year. One-time delivery of items may be billed one time with one unit, but services provided over time shall be subsequently billed as they are delivered, and therefore need authorized as more than only one unit. Without allowing multiple units of service, all training and monitoring for the duration of the ISP year can only be billed one time, either before it is all provided or after it is all provided. Neither is sustainable for any provider nor compliant with multiple billing regulations.


E. Service documentation and requirements.
1.c. AMEND - Documentation of the recommendation for the item [item(s) and/or service(s)] by an independent professional consultant, [the dates one-time items and ongoing services will be provided, and the desired outcomes ongoing training or monitoring will support];

JUSTIFICATION: electronic home-based supports is not a stand-alone service and when it includes ongoing services, like training or monitoring, including a proposed plan of support or desired outcomes as part of the request for service authorization and/or the ISP will facilitate collaboration and planning with other service providers.


1.d. AMEND - Documentation of the date [one-time equipment or items are delivered] and dates and amount of ongoing training and monitoring electronic home-based supports] service is [are] rendered and the amount of service that is needed;

JUSTIFICATION: Documentation of completion of delivery is appropriate for equipment or items that are delivered one-time, but ongoing training or monitoring services should provide commensurate service-based documentation, such as dates and amounts of service provided.


12VAC30-122-400 Group and Individual Supported Employment Service


B. Criteria and Allowable Activities

4. ADD language that expressly indicates that individual supported employment may be completed virtually and/or telephonically as is appropriate for each individual served. ADD “Individual Supported Employment may be provided in person, over the phone or virtually via video in order to support individuals to obtain and maintain competitive, integrated employment.”


4.a. - ADD - “and Customized Employment” to the end of “Vocational or job-related discovery or assessment


C.4. DELETE “may be provided in combination with” (in regards to day and residential services) and ADD language that expressly states that “services can be provided simultaneously with supported employment services and can be billed concurrently” to be consistent with other services and regulations”. “Simultaneously with” is preferred and provides additional clarity vs “in combination with”. “Billed concurrently” also adds additional clarity.


C.6. DELETE language - “can be provided simultaneously with the workplace assistance service”. ADD language - “can be provided simultaneously and can be billed concurrently with the workplace assistance service” to be consistent with other services and regulations.


D. Provider Requirements

ADD D.5. Staff Competency Exception

As originally adopted in Chapter 854, Acts of the Assembly 2019, the Department of Medical Assistance Services and the Department of Behavioral Health and Developmental Services shall recognize the Certified Employment Support Professional (CESP) and Association of Community Rehabilitation Educators (ACRE) certifications in lieu of competency requirements for supported employment staff in the Medicaid Community Living, Family and Individual Support and Building Independence Waiver programs and shall allow providers that are Department for the Aging and Rehabilitative Services vendors that hold a national three-year accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF) to be deemed qualified to meet employment staff competency requirements, provided the provider submits the results from their CARF surveys including recommendations received to the Department of Behavioral Health and Developmental Services so that the agency can verify that there are no recommendations for the standards that address staff competency


12VAC30-122-410 In-Home Support Services


B. 4. - REVERSE and REINSTATE Stricken Language
JUSTIFICATION: In-Home Support Services needs the flexibility of episodic supports for all the reasons stated in the stricken language.  Without the inclusion and flexibility of episodic supports, the individual will have no support if these events occur.  Example - If school is cancelled on Thursday, but In-Home Supports are authorized for 3 hours on Thursday evening - those hours can be adjusted regarding the time of day provided but cannot exceed the 3 hours that is authorized despite the need increasing due to events beyond the control of the individual, family or provider. Examples may also include when Day Support and/or job site or employer is closed.)


12VAC30-122-430 - Individual and Family/Caregiver Training Service


RECOMMEND - Adding this service to the Community Living and Building Independence Waiver.  Individuals included in these waivers would also benefit to participate in these training opportunities to better understand their disability and increase self-determination and self-advocacy skills.

B.2.  ADD exception to this service’s definition of “family” to allow individuals who are compensated, provided they are not concurrently billing during service facilitation.  This would include family members who otherwise meet the definition of “Family” and are instrumental in the delivery of this service but are excluded due to providing personal assistance or companion services to their enrolled family member.  Due to this exclusion, individuals who require assistance or support to participate in the training are also therefore excluded and have decreased opportunities.


12VAC30-122-440 - Nonmedical Employment and Community Transportation Services


Although a critical and needed service, the service as written is operationally a nightmare for any provider to provide.  This includes documentation requirements, supporting documentation such as “Google Maps/MapQuest print-outs to support trip mileage”, driver requirements, no administering agency overhead reimbursement for the administrative provider, and the exclusion of flexible modes of transportation available in the community including para-transit, Lyft, Uber, cab, etc. There are also cost reimbursement issues that do not reflect current rates via public transportation, etc. Additional comment will be provided in response to DMAS Medicaid Memo FAQ and Guidance Document public comment opportunity.


12VAC30-122-460 - Personal Assistance Service


E.  Agency-Directed Service Documentation and Requirements
Assessment of “emotional condition” - clarification needed - Is this outside of basic training for a DSP?


12VAC30-122-490 - Respite Service


B. Allowable Criteria and Allowable Activities
ADD B.6. Providing general supports as needed.


D.2. INCLUDE previous option for providers of other residential services to provide respite services. This service is vastly under supported by providers because of the low reimbursement rate.  By allowing residential providers to provide respite services when staff or availability allows, this much needed support would be able to be provided to more individuals throughout the state that are request respite services.


12VAC30-122-560 - Therapeutic Consultation Services

RECOMMEND that Therapeutic Consultation Services be provided to individuals on the Building Independence Waiver to further create and maintain independence and inclusion for individuals living and working in the community. increase their inclusion in the community and work environments.

C.3.  Clarification is needed to define the meaning of “written preparation” that is considered an “in-kind” expense.

C.6. Additional information is requested to clarify when “direct intervention” can be provided in the absence of family members/staff or if they must be present for “demonstrations”.

D.1.  ADD “Registered Behavior Technicians” to be allowable practitioners of this service when supervised by a BCBA.  There is a current documented shortage of providers for this critical and needed service as well as an ever-increasing demand for services in order to support individuals to fully achieve inclusion goals and to meet health & safety needs. Allowing this change would significantly increase provider capacity. DARS currently allows for Registered Behavior Technicians to implement behavior-analytic services which have been designed by the BCBA, who in turn supervises the RBT and makes appropriate changes to the plan for the supports. The BCBA is responsible for the work performed by the RBT on cases that they are overseeing/supervising.

E.1. (2) e. (1) - MODIFY the requirement of “the quarterly review shall include graphed data and a summary of the data”. ADD “as appropriate” and “or may include an alternative means to document qualitative data according to current best practices”.  Graphing is specific to one model only. Broader language in this section will allow for ever changing best practices. The graphing of data requirement may also cause consultant to have to discontinue services for families who are not able to comply with request for documentation from consultant.

E.1. (2) e. (2) - See comment above regarding E.1.(2) e. (1) related to graphing/tabling data.

12VAC30-122-570 - Workplace Assistance Service

RECOMMEND adding this service to the Building Independence Waiver.  There are individuals with significant support needs related to health and safety or job maintenance that may need this level of flexibility in supports to maintain their employment.

B.4. ADD “telephonic or virtual communication with the job coach” as an allowable activity to ensure effective service delivery.  Consistent with Subsection D.4. Provider Requirements.

CommentID: 97607