12VAC30-122-390 includes  language which appears to be a substantive addition and revision since the publication of this section in the “proposed stage.”  The language restricts the number of licensed beds in a setting reimbursed for group home residential to 6 (six) or fewer.  We do not support large congregate settings, however, we are mindful that the level of support needed by individuals in any size home is dependent on many factors out of the immediate control of the provider.  Those factors include;

• the reimbursement rates paid by Medicaid which are directly controlled by the General Assembly

• wage or benefit mandates imposed by law or regulation that drive costs higher

• other inflationary factors including housing costs, insurance costs or utility costs

Providers have experienced years of rate stagnation while trying to accommodate the rising costs – the only remedy  has been to increase the number of operating beds in the home  to gain some economy of scale – the only  alternative is to close the home and remove an option for community living.  Since 1990, the Code of Virginia at §15.2-2291 has supported Group Homes of 8 beds of fewer by classifying them as “single family residences.”  To impose a regulatory limit that is more restrictive is both short-sighted and unnecessary. 

The rate structure, which makes smaller homes financially more practical,  has brought down the number of people living in a home  as it was intended to do, without imposing a top limit. 

Therefore, based on the fact that imposing a restriction which limits a provider’s ability to conduct business in “final” regulations and limiting the opportunity for comment by affected parties:

• will pose a potential threat to the entities which are the subject of the regulation

• in a substantive change from the previous version of the regulation, and

• is likely not necessary to achieve the goal of reducing the size of Group Home Residential settings in the long term

We object to the inclusion of this provision as a substantive change not previously reviewed as part of public comment, however, recognize that requesting further opportunity for comment is unlikely to change the outcome.  We will strongly request modifications of the language in the Manual to mitigate the most damaging impact.