240 – Services covered: Building Independence Waiver

• Add Agency and CD Companion and Personal Assistance, and Individual & Caregiver Training

250 – Services covered: Community Living Waiver

• Add Family and Caregiver Training

260 – Services covered: Family and Individual Support Waiver

• Add Independent Living

270 – Assistive Technology

• A.(ii)- Strike “with the environment in which they live”
• A.- Add a new (iii) “actively participate in other waiver services which are part of their plan.”

1. – Community-based crisis support

• A- After means add “planned crisis prevention and emergency crisis stabilization services provided to”; strike “a service”  [This brings it in line with Center-based Crisis

1. – Community coaching

• A- After barriers add “or to support an individual’s participation when there is an ongoing barrier to participation” [See definition]
• C.3- Strike “This service shall not be provided within a group setting.”  [This is not necessary and potential prevents the individual from learning how to interact with others as in a community engagement setting]

320 – Community Engagement

• D – correct numbering

340 – Companion

• C.1- Strike second sentence [While the occasions might be rare, this service can support those who can otherwise function reasonably independently at a modest cost – the 8 hour per day limitation can interfere with that]
• D.4.b- Replace with “Providers that are licensed by DBHDS, a supervisor meeting the requirements of 12VAC35-105 shall provide supervision of direct support professional staff.”  [This brings it in line with other similar services]

350 – Crisis support

• The three level described here are not included in the two other crisis support services – they should be consistent!

360 – Electronic home-based support

• B.1.- Strike “physically”

370 – Environmental modifications

• C.6.- We recommend that an exception process be put into place for the uncommon circumstance in which the expansion of square footage to the home (which is prohibited) is an incidental result of a modification that will enable the individual to remain in the home, e.g., a larger, accessible bathroom. Limits could be put into place for how much additional square footage would be allowable in an exceptions process.

390 – Group home residential

• E.1.c- Change “at least a daily note” to “a Progress Note” [This makes it consistent with other requirements]
• Move C.3 under letter D [It is under this section in other service descriptions]

400 – Group and individual supported employment

• Add Employment Services Organizations (ESOs) as qualified providers of Employment & Community Transportation Services.
• Add Employment Services Organizations (ESOs) as qualified providers of Peer Mentor Support Services.
• Add Employment Services Organizations (ESOs) as qualified providers of Community Guide Services.
• A.3.a. – Strike “limited” after but reimbursement shall not. (2nd sentence, 4th line)
• B.1. – Add “and enrolled in school” after for individuals younger than 22 years of age.  Strike “for the individual enrolled in the waiver”.
• C.3. – Strike “and individual”. Individual SE must be able to be provided in an individual’s home for purposes of self-employment or other individuals that work from home for other employers (telecommuting, etc.)
• C.4. – Strike “service” after employment. Strike “in combination with other day service or residential service” and Change to “concurrently with other waiver services for purposes of job discovery”.
• D.4. – Second paragraph under this Provider Requirements section is duplicative to 400.A.3.b (Service Description) and is not related to Provider Requirements.
• E.1.c. – Sentence needs to be reworked.  “Documentation confirming the individual’s time in service” is for Group Supported Employment (GSE) only.  “Daily note” is only applicable to GSE as well. Strike “daily note” and insert “progress note” to be consistent with other sections and definition of “progress note” in Section 122-20.
• E.1.f. - Sentence needs to be reworked.  Should read “Documentation that indicates the date, type of service rendered, and the number of hours provided, including specific timeframe.  An attendance log or similar document shall be maintained for Group Supported Employment”.  An attendance log or similar document is not required for ISE since the individual is competitively employed. 
• E.1.i. – After group, Insert “for Group Supported Employment”.

410 – In-home support

• C5- Add “Back up plan may include agency support” [This is the most viable option for individuals who do not have a primary caregiver]

420 – Independent living support

• A – Add following receiving this service “lives ,or is preparing to live, alone . . .”; strike “typically”
• A- Add “or FIS waiver” at the end of the last sentence.
• C.1.- Add “If the hours consistently exceed 21 hours per month, the individual shall be immediately eligible for a reserve slot.”
• E.1.c. – add “observations of individual’s responses to services shall be available in Progress notes”
• E.1.d – strike “and the documentation will correspond with billing”

430 – Individual and family-caregiver training

• A- Strike “FIS waiver” Add “all waivers”
• Strike C.1

460 – Personal assistance

• A.4- Change to “all waivers”
• B.4.e. correct spelling of “activities”
• C.7.a & b.- Strike all references to “Companion”  and replace with “Personal Assistance”

530 – Sponsored residential

• E.1.c.- Strike “confirming the amount of the individual’s time in service and”
• E.1.c.- End of second sentence strike “at least a daily note” add “in a progress note” [This makes documentation consistent]

540 – Supported living residential

• A- First sentence, match the definition in section 20

550 – Therapeutic consultation

• B.2.i - Support Dr. Walker’s comments
• C.3- Strike “written preparation and telephone communication”