12VAC120 Waiver Services

We are in general agreement that revision of these regulations is long overdue.  In many cases, the regulations are in conflict with current best practice standards and are inconsistently applied to a variety of programs that have been consolidated.  For example:

1.  “Agency-directed” model of services is now required to be a licensed home care organization and that definition should be consistent across both OLC and DMAS regulations. 
2. The definition of “direct marketing” which is not being changed creates an unfair potential inducement situation for those receiving consumer directed services.
3. The definition of “Employer of Record” is confusing.
4. The definition of “Level of care” needs additional specificity in this regulation.
5. The definition of “Medication administration” is in conflict with the Drug Control Act.
6. The definition of “Participating providers” is not supported as written.  All new language should be stricken. 
7. The definition of “service facilitator” needs to be enhanced to reflect knowledge, skills, and ability requirements.
8. 12VAC30-120-910 mixes verbiage from waiver services, state plan, and federal regulations in a way that is difficult to follow.
9. 12VAC30-120-924 is missing LPN respite services
10. There appear to be a number of inequities between consumer directed care and agency directed care that needs to be addressed throughout the regulations.  
11. 12VAC30-120-930A 19 (a) should read “For reasons of Medicaid individuals; safety and welfare, all employees shall have a satisfactory work record.”
12.  12VAC30-120-930B should be rewritten to reflect the federal Do Not Hire language. 
13. 12VAC30-120-930 I should be removed from agency requirements as they are now a requirement of licensure with the Virginia Department of Health. 
14. 12VAC30-120-930 A I 5 (e) should prohibit individuals that have been convicted of barrier crimes from employment. 
15. Payment for services furnished by family members or other live-in caregivers living under the same roof as the waiver individual must have specific requirements established by DMAS rather than “objective documentation.”
16. 12VAC30-120-945 A.  DMAS should pay for training hours of staff given the current reimbursement structure.    
17. The regulations should specifically included language that allows providers to utilize telephony, electronic tracking, and recognizes the use of electronic signatures and electronic records. 
18. As written the regulations are very difficult to read and somewhat disorganized in the way that they have been consolidated.
19. We strongly urge that the regulations included more detailed oversight for consumer directed care, how it is used by consumers, who are accountable for service delivery and the level of DMAS oversight for quality.