Edward O'Brien The ARC of Northern Virginia
DD Waiver Regulations
One Plan of Supports per Individual to Streamline Quarterly Reviews: DMAS and DBHDS should create the option for a single organization to have one Plan for Supports per individual regardless of the number of individual services are provided to an individuals in order to streamline documentation and to reduce the number of quarterly reviews per individual required. This was a unanimous recommendation of the DBHDS’s own Provider Issues Resolution Workgroup (PIRW) in its report published August 2018. This recommendation has also been proposed and documented in many workgroup recommendations and previous Town Hall public comment opportunities.
Documentation Requirements: Throughout the regulations, Section (E) for most services, describes documentation and states “For the annual review and every time supporting documentation is updated, the supporting documentation shall be reviewed with the individual and/or family/caregiver, as appropriate, and such review shall be documented.” Under 122-20 - Definitions, “Supporting Documentation” includes, as examples, a number of relevant documents as well as many other examples including progress notes, attendance logs, contact logs, etc. Some of these documents are changed daily and should not have to be reviewed, documented and reviewed by individual/family with each change. This is administratively burdensome and does not add value to the provision of services. RECOMMEND amendment to current language included in each service Section (E) as “For the Annual Review, and any time the plan for supports is changed or updated, the supporting documentation shall be reviewed with the individual and/or family/caregiver and such review shall be documented.”
12VAC30-122-60 - Financial Eligibility Standards for Individuals
Recommend Spend-down for all Long-term Care waiver categories. This language is already in the CCC+ waiver. This language should be moved to all categories.
Recommend the Patient Pay be considered an Income Related Work Expense (IRWE). IRWEs are already considered when countable earned income is considered. Reasoning - without waiver services, an individual would not be earning at the level they are earning. But earning at a higher level is forcing them to incur a Patient Pay. This is a disincentive to earn wages at a higher level.
Recommend Special Group Category Consideration - SSI/SSDI waiver recipients increasingly have retired, disabled or deceased parents and the waiver recipient’s income increases because their parent’s FICA account is opened and a portion of this account is received by the waiver recipient. This amount (SSDI) often puts the waiver recipient over the 300% of SSI gross income limit. The first thing the individual does is quit work if working. These individuals should be put in a “protected category” which will disregard the amount of the new income (SSDI) that will cause them to become ineligible for waiver services. This protection is considered when looking at continued Medicaid eligibility.
Recommend Subsidies and Special Conditions as deduction for wages earned (oer SSA definitions). If the individual is not fully earning his or her wages because the work is performed under special conditions (e.g. close and continuous supervision, on the job coaching, etc,) then we should deduct that part of his or her wages that are not “earned” by the individual from his/her average gross wages. This is true whether or not the employer or some else provides the special on-the-job conditions. However, under current Medicaid LTC regulations, if they earn over 300% of federal benefit rate (FBR), they are penalized. Many individuals do not have the out-of-pocket expenses that are needed to bring down countable earned income due to the LTC supports that they are receiving at no cost to them. However, they would not be earning at the level that they are earning without the waiver provided supports. Subsidies and Special Conditions would give value to the supports that are provided to the individual that enables them to work and earn income.
C. AMEND - 30 calendar days to no later than 90 calendar days for individuals assigned slots to meet with their Support Coordinators This will allow individuals to avoid Medicaid re-determination.
12VAC30-122-180 - Orientation Testing; Professional Competency Requirements; Advanced Competency Requirements
SUBSTANTIVE CHANGE not Supported or Authorized by Current Statute DELETE Individual and Group Supported Employment from list of services. Unless the law is changed, DBHDS/DMAS does not have the authority to require Supported Employment providers to adhere to these requirements if they are DARS vendors of SE services and are CARF accredited. This language is statutory and was originally adopted by the General Assembly, signed by the Governor and chaptered in April 2019. Also see comments in Section 12VAC300122-400 (Group and Individual SE) to add the following language as a Staff Competency exception.