12VAC30-122-280 - Benefits Planning Service

ADD language in this section to reflect the ability to complete this service virtually and/or telephonically - “Benefits Planning Services may be provided in person, over the phone, or virtually via video as is appropriate for each individual serviced. Written resource materials are to be provided to the individual regardless of the modality of service provision.”

B. DELETE “calendar year” and INSERT “ISP year” to better meet the individualized needs of individuals served and to ensure consistency across services.

B. ADD - expressly state that “collateral contacts” made during service provision are allowable activities for reimbursement.

C. Service Units & Limitations:
1. INSERT “ISP” between “annual” and “year” for clarification. This should be an ISP year vs. calendar year,
2. DELETE the “Hourly Limits Per Activity”. Hours per activity vary drastically from one individual’s situation to another. RECOMMEND allowing the overall service to be limited to maximum of $3,000 per ISP year without “Hourly Limits Per Activity”. This will allow maximum individualized and person-center services to be provided but still retain the cap of $3,000.

12VAC30-122-440 - Nonmedical Employment and Community Transportation Services

Although a critical and needed service, the service as written is operationally a nightmare for any provider to provide. This includes documentation requirements, supporting documentation such as “Google Maps/MapQuest print-outs to support trip mileage”, driver requirements, no administering agency overhead reimbursement for the administrative provider, and the exclusion of flexible modes of transportation available in the community including para-transit, Lyft, Uber, cab, etc. There are also cost reimbursement issues that do not reflect current rates via public transportation, etc. Additional comment will be provided in response to DMAS Medicaid Memo FAQ and

12VAC30-122-570 - Workplace Assistance Service

RECOMMEND adding this service to the Building Independence Waiver. There are individuals with significant support needs related to health and safety or job maintenance that may need this level of flexibility in supports to maintain their employment.

B.4. ADD “telephonic or virtual communication with the job coach” as an allowable activity to ensure effective service delivery. Consistent with Subsection D.4. Provider Requirements.

12VAC30 - 122-360 Electronic Home-Based Support Service

B.3. Criteria and allowable activities. AMEND 3. Electronic home based supports may be billed solely for purposes of monitoring the individual or training the individual, family members, caregivers, and relevant others in the use of the electronic home based supports electronic home based supports service shall support training in the use of these goods and services, ongoing maintenance, and monitoring to address an identified need in the individual’s ISP, including improving and maintaining the individual’s opportunities for full participation in the community.

C. Service units and limit.

ADD 5. The service unit for electronic home-based supports equipment shall be one for the total cost of all electronic home-based supports equipment being requested for a specific timeframe. The unit of service for electronic home-based supports services that include ongoing training and monitoring shall be one hour.

REASON: Allowable services under electronic home-based supports include both one-time equipment that is delivered and billed once and ongoing monitoring and training services that are provided incrementally throughout the duration of the ISP year. One-time delivery of items may be billed one time with one unit, but services provided over time shall be subsequently billed as they are delivered, and therefore need authorized as more than only one unit. Without allowing multiple units of service, all training and monitoring for the duration of the ISP year can only be billed one time, either before it is all provided or after it is all provided. Neither is sustainable for any provider nor compliant with multiple billing regulations.

E. Service documentation and requirements.
1.c. AMEND - Documentation of the recommendation for the item [item(s) and/or service(s)] by an independent professional consultant, [the dates one-time items and ongoing services will be provided, and the desired outcomes ongoing training or monitoring will support];

REASON: electronic home based supports is not a stand-alone service and when it includes ongoing services, like training or monitoring, including a proposed plan of support or desired outcomes as part of the request for service authorization and/or the ISP will facilitate collaboration and planning with other service providers.

1.d. AMEND - Documentation of the date [one-time equipment or items are delivered] and dates and amount of ongoing training and monitoring electronic home-based supports] service is [are] rendered and the amount of service that is needed;

REASON: Documentation of completion of delivery is appropriate for equipment or items that are delivered one-time, but ongoing training or monitoring services should provide commensurate service-based documentation, such as dates and amounts of service provided.