12VAC30-122-240. Services covered in the Building Independence Waiver.

• Add Agency and CD Companion and Personal Assistance, and Individual & Caregiver Training to the BIS waiver.  With the addition of these services, there may be more interest in utilizing this lower cost waiver by persons on the Priority 1 waiting list.

12VAC30-122-250. Services covered in the Community Living Waiver.

• Add Family and Caregiver Training.  This service is applicable to all individuals and families and should not be limited to the FIS waiver.

12VAC30-122-260 – Services covered: Family and Individual Support Waiver.

• Add Independent Living Services to the FIS waiver.  This service can assist individuals living on their own or wishing to live on their own.

12VAC30-122-270 - Assistive technology service.

• A.(ii)- STRIKE “with the environment in which they live” and ADD a new (iii) “actively participate in other waiver services that are part of their plan.”  Renumber the current item (iii) to item (iv).   AT should be available to support any service in a person’s ISP.  It should not be limited to the environment in which the individual lives.  It should be available to support an individual in any approved service and promote inclusion in all aspects of an individual’s life.

12VAC30-122-280 - Benefits Planning Services (reserved).

• This service is now available (Medicaid Memo Sept. 4, 2018).  It should be included in the final DD Waiver regulations out for public comment.

 

12VAC30-122-300 - Community-based crisis support service.

 

• 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.

 

12VAC30-122-310 - Community coaching service.

• 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 sentence is not necessary and has the potential the individual from learning how to interact and communicate with others in a community engagement setting – the entire purpose of the service.  Requiring the service to be one-on-one is sufficient.

 

12VAC30-122-320 - Community Guide Service. (reserved);

• This service is now available (Medicaid Memo Sept. 4, 2018).  It should be included in the final DD Waiver regulations out for public comment.

 

12VAC30 – 122-350 - Crisis Support service.

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

12VAC20-122-370 - Environmental Modification Service.

• C.2. See comment under Payment for covered services

12VAC30-122-380 - Group Day Service.

• B.1. Support the addition of the following that are included in the new CL waiver renewal application but are not currently included in the proposed final regulations:
  • Participation in community volunteer opportunities or education programs;
  • Staff coverage for transportation of the individual between service activity sites. Transportation is included as part of the service.  The provider may be reimbursed for the time spent transporting the individual to community locations as part of the waiver billing
  • Personal types of activities (i.e. assistance with ADLs). These allowable activities are critical for individuals that need them but are not necessarily “skill building”.
• C. Add 6.  Recommend annual allocation for Group Day and Community Engagement hours to allow increased flexibility.  Currently, Group Day hours and Community Engagement hours are authorized on a monthly basis with additional estimated “flex hours”.  We recommend that there period of authorization be lengthened to allow more flexibility and consumer choice.  For example, individuals choose whether they want to go out in the community or stay in a center on any given day.  Because of weather or other personal circumstances of the individual, the individual may want to stay in the center more often in the winter and in the community more often in the Spring/Summer/Fall.  Hours could then be drawn from a quarterly, semi-annual or annual “pool” of hours based on their person-centered plan.

 

12VAC30-122-390 - Group Home Residential Service.

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

 

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

 

• 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”.  Should read as follows:  “For time limited and service authorized periods (not to exceed 24 hours) individual supported employment service may be provided in combination with  concurrently with other waiver services for purposes of job discovery.”  This revision helps with clarity.
• 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”.

 

12VAC30-122-410 - In-Home Support Service.

• C5- Add “Back up plan may include agency support”. This is the most viable option for individuals who do not have a primary caregiver. While not specifically stated in the current regulations, families and individuals have historically been advised by case managers that the back-up plan must be a family member.  Since an agency is providing the in-home service, it makes sense that a provider could also provide the back-up support.  But, it should be optional and clarified that it is an option.
• Recommend that In-Home Services hours be authorized quarterly, semi-annually or annually – a “pool” of hours that would include and accommodate “periodic support hours”. Current regulations do not limit adding an average number of “periodic support hours”.  However, in practice, this is an ongoing implementation issue with additional flexible hours not being approved.  A longer period of authorization would help allow flexibility when an individual must stay home from group day or employment, community engagement. Most importantly, it supports choice.

 

12VAC30-122-440 - Nonmedical Transportation Service (Reserved).

• This service is now available (Medicaid Memo Sept. 4, 2018).  It should be included in the final DD Waiver regulations and out for public comment.
• The name of this service needs to be consistent.  Is it Employment and Community Transportation or Nonmedical Transportation Service.  Needs to be consistent between DD Waiver renewals and regulations.

 

12VAC30-122-460 - Personal assistance service.

• A.3. – Add “Personal Assistance can be provided simultaneously with supported employment services and can be billed concurrently”.  The provision currently states that an additional component of personal assistance services is to aid and supports to individuals in the work place, with the final sentence stating, “Work related personal assistance service shall not duplicate supported employment service.” The addition of the suggested sentence at the end of this section clarifies that both can be provided at the same time and that they are distinctly different services.
• A.4- Change to “in all DD waivers”.  As previously stated, it is unclear why this service is not available in the BI waiver.  Individuals in the BI waiver are more likely individuals with physical developmental disabilities who may require personal assistance services in order to live independently in their homes.  PA services can be critical to this population.
• C.7.a & b.- Strike “Companion” Add “Personal Assistance”.  This is a typographical error.

 

12VAC30-122-570 - Workplace Assistance Service (12VAC30-122-570).

• B.4. – Add (e) at the end of the lettered list which adds “Phone, media and in-person contacts with a Job Coach” as an allowable/billable activity. There may be times when a workplace assistant may need to consult with the individual’s job coach in order to meet the needs of the individual and to ensure consistency of strategies to support the individual to be successful in the workplace.
• D.3. – Providers of Workplace Assistance that are CARF accredited employment vendors of DARS satisfy staff competency requirements for Workplace Assistance Services.