The Endependence Center is a disability advocacy organization. We have reviewed the 2019 EOR Manual and offer the following comments:
Add that instrumental activities of daily living (IADLs) can be provided, in addition to activities of daily living. Page 4
When using the generic term of “waivers”, clarify that the reference is specific to Medicaid home and community based waivers. Page 4
Include Medicaid Works in the list of which Medicaid programs that offer consumer-directed (CD) services. Pages 4 and 5
Complete the term of Services Facilitator (SF) by adding assessing and monitoring of services to the description of the SF’s responsibility. Page 4
Explain what an “MCO Contractor” is as used in the Section “Terms to Know”. Page 4
Correct the title at the bottom of the page. Change “Benefits of Consumer-Direction Services” to Benefits of Consumer-Directed Services. Page 4
Clarify that the local departments of social services determine financial eligibility. Page 5, second paragraph, second sentence
Correct the term EPSDT to be Early and Periodic Screening, Diagnostic and Treatment. Page 5
Clarify that the reference to the CCC Plus “program” is the managed care program. Page 6, first paragraph, first line
Clarify that the MCO health care coordinator can perform the duties of the services facilitator. Page 6, first paragraph
Eliminate the reference to Virginia Premier’s change in F/EA since the change is now effective. Page 6
Change the terminology the of the first sentence under Companion Services to read as follows: are available only to individuals aged 18 years or older who are enrolled in the CL or FIS Waiver. Page 6
Add to the Note that companion services are not available in the BI Waiver, EPSDT or Medicaid Works. Page 6
Add that instrumental activities of daily living (IADLs) can be provided, in addition to activities of daily living. Page 6, fifth paragraph
When referring to the provision of a skilled task, clarify that skilled nursing services might be provided by a consumer-directed attendant through nurse delegation. In addition, add that skilled nursing services can be performed as allowed by 54-1-2901.A.31. which allows for health care tasks to be directed in limited circumstances based on the capability of the individual to direct the skilled service. Page 6, sixth paragraph third sentence; Page, 7 first paragraph
Add that the support coordinator, case manager or health care coordinator can also respond to questions about nursing services. Page 7, fifth sentence
Clarify that people who use the CL or FIS Waiver can use nursing services and personal care simultaneously, if authorized in this manner. Page 7, second paragraph
Clarify that the SF completes the annual level of care only if the individual is exempt from CCC Plus managed care and not at all for individuals enrolled in the CL or FIS Waiver. Page 9, second bullet
Add to the list of SF’s role that they are to review timesheets. Page 9
Change the second sentence under the header “Role of the F/EA” to clarify that these are Medicaid funds. If limiting this sentence to waiver funds, EPSDT and Medicaid Works funds would be omitted. Page 9
Add to the F/EA responsibilities the role they play with the Virginia Employment Commission (VEC) if a claim is filed with VEC about CD services. Page 9
Under the section, “Role of the Attendant” first paragraph, first sentence, remove the word “waiver” before the word “individual”. Page 10
Include references to personal care provided as a EPSDT service or to individuals who are enrolled in Medicaid Works. Page 10, fifth paragraph, first sentence
Include in the description of the comprehensive visit, a requirement to determine if the individual or the selected EOR are capable of serving as the EOR. The DMAS-95 was developed for this purpose. Page 10
Describe what constitutes a “successfully processed” “Welcome Packet”. Page 11, third paragraph, fourth sentence
Clarify that the “SF Follow-Up Visits” are to be conducted, 30, 60 and 90 days after the first comprehensive visit. As it reads now, two visits are required with no description of when those two visits must occur. Page 11, seventh paragraph
Clarify that the SF visits must occur no less than every 90 days for people who use personal care services and more often, only if needed. Page 12
Remove the reference to “Quarterly Services Reports”. Page 12
Clarify that the service plan for the CCC Plus Waiver does not include goals. Page 13, third bullet
Clarify that the individual can have more than two attendants. Change the word “two” to “several”. Page 13, third paragraph, third sentence
Clarify that the plan of care must be kept in the home. Page 13, fourth paragraph, first sentence
Clarify that services are paid for only if authorized and that services are only paid for if provided. Page 13, fourth paragraph, second sentence, last several words
Clarify what is meant by “FFS”. Page 13, fifth paragraph, second sentence
Add the entity responsible for authorizing EPSDT and Medicaid Works CD services. Page 13, fifth paragraph
Clarify that the case manager or health care coordinator may be the entity to request changes. Page 14
Clarify under the Eligibility section that the individual might be eligible for EPSDT or Medicaid Works. Page 15, second paragraph
Clarify in the section titled “documentation” that the timesheets may be electronic and if so, copies of timesheets do not need to be maintained. Also clarify that the TB reference is for TB screening, not necessarily testing. Page 15
Add that the F/EA also submits the unemployment taxes. Page 15, eighth paragraph
Medical supplies should be requested of the MCO health care coordinator. Page 16, fourth paragraph
Remove the reference to paper timesheets. Page 16
Expand the language about Medicaid fraud and provide the contact information to report potential fraud. Page 18, third paragraph
Clarify that the individual, if convicted of fraud, would be prohibited from Medicaid participation in the future, may be required to pay a fine or could be imprisoned. Page 18, third paragraph, last sentence
Add to the section on “Hiring an Attendant” that employment references, in addition to the background checks, should be obtained. Page 18, first paragraph
Add a bullet to the section, “Who Can Be an Attendant” that the attendant must complete a TB screening. Page 19
Add disability to the list of categories questions should not be asked. Page 23
Add to the section on “Background Checks” that the criminal history record form must be notarized. Page 24
Remove reference to paper timesheets in the section regarding record keeping. Page 26
Add to the section “Training New Attendants” the requirements for training and documentation when nurse delegation is used. Page 27
Clarify that job evaluations are recommended, but not required. Pages 28 and 29
Add that abuse or neglect should also be reported to the individual’s MCO health care coordinator, if they have a health care coordinator. Page 32, sixth paragraph
Clarify that Appendix C includes some forms that are required and some that are sample forms. Page 38
Change TB “testing” to TB “screening” throughout the document.
Add the electronic visit verification process. In doing so, allow the greatest degree of flexibility allowed by the federal administration and Congress.
Individuals who use the FIS, CL and CCC Plus Waivers are not required to use services facilitation. This fact should be clarified throughout the Manual. Guidance for individuals who elect not to use services facilitation should be included in the Manual. Most sections need to be changed to include a description of the applicability of that section when someone has elected not to use services facilitation.
Include a description of what should happen when the case manager or services facilitator decides to end CD services for a specific individual due to CD services no longer being appropriate or because there is no one qualified to perform the EOR functions.
Thank you for your consideration.
Maureen Hollowell
Director of Advocacy and Services
Endependence Center
6300 E. Virginia Beach Blvd.
Norfolk, VA 23502
mhollowell@endependence.org
757-351-1584