Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
Waivered Services [12 VAC 30 ‑ 120]
Action Alzheimer's Assisted Living Waiver Update
Stage Proposed
Comment Period Ended on 1/7/2011


All comments for this forum
Back to List of Comments
11/13/10  5:02 am
Commenter: Margaret Bates, Carriage Hill Retirement, Bedford, VA

Changes to DMAS AAL waiver

After reviewing the proposed changes, we are very pleased.  These changes will eliminate an additional burden to providers of services to AAL recipients, while not affecting the overall quality of care to the recipients.   These changes mirror the current services and standards for the assisted living and alzheimers private pay residents.   The true benefit  of the changes will come to the elderly seniors of the Commonwealth of Virginia by encouraging more providers of assisted living services to participate in DMAS AAL waiver program.

CommentID: 14638

11/28/10  7:52 pm
Commenter: Frankie Minor Administrator Chestnut Grove Assisted Living ,Lee County

This is great ,more waivers needed for persons needing assisted living.

This is great and great to see changes  that are  more user freindly

I run a 98 bed facility in extreme Southwest Virginia .I accept auxiliary grant.The auxiliary grant rate is currently $37.00 per day.With recent budget cuts ,a medicaid supported program that paid an additional $3.00 per day was elliminated .

The rate had been $3.00 per day since it's existence in 1996.Southwest Virginia is known to have a large amount of auxiliary grant residents.A lot of providers do not except the below market rate and choose to select to serve the private pay.Most auxiliary grants are more work intensive than the private pay as well.Documented studies by J.L.A.R.C.and Area on Aging ,from June 2005.supports the more work intensive,they refer to them as ,special circumstances,refering to a,g,operators working long hours and performing multiple tasks .they are probable working for below minimum wage.This should not be a requirment for a.g.home.They should be able to afford to pay staff.I ask anyone reading this where could you go stay and get 3 meal,and snack between meals,medication dispensing ,personal care and overall monitored for your health and well being.Today if I can get a hotel for $70.00 ,I consider myself lucky.

To sum the a.g.rate up.You have to work harder with a more difficult population and do 10 times the paper work. Some better and appreciative residents live in Tn.But the state wants  to outlaw this because ,they want to save the bed for the Virginian in need for this bed.It's probable law by now.Most operator's are tied in to their business and just wanting to pay off debt service.Once that is they will probable close down and retire and rest .No newer young population gona do that.What will happen? 47th in the nation in  medicaid spending.Good management or is the state  just not providing services 1 of 7 states not having waiver service for ALFs.

The governor wants more cuts.Everythings going to be more ten years from now .more people in need of more everything.

New healthcare reform allows more user friendly Community Based Waiver  programs and incentives for States to participate in them.Will Virginia participate ? Doesn't look so .

A waiver program for disabled people in need for assisted living should have been done years ago.I strongly support a general waiver program for  the poorer people in need for assisted living .

I've never seen nothing like this .I hope someone will help these provider's and residents.

Programs should not be based on the sore politician word, "special interest ",but it is .Its not based on need.

Thank You ,Frankie Minor ,20 year advocate in caring for the poor and disabled people and treating them with kindess ,love and respect.

CommentID: 14682

11/30/10  4:01 pm
Commenter: May Fox, VALA

Ahlzeimers waiver for ALFs

VALA supports these regulations and urges their adoption and earliest possible effective date.

CommentID: 14691

12/2/10  2:03 pm
Commenter: Rich Lewis

Alzheimer's Assisted Living Waiver Update

I strongly agree with these proposed changes. There is an obvoius need for waiver services in Virginia and these changes will help to help to deliver a higher quality of care. These changes will greatly benefit the current ALF population residents as well as the future residents. 

CommentID: 14699

12/16/10  12:37 pm
Commenter: MicAnd Assisted Living

ALF-Alzheimer's Waiver

This change will allow more facilities to accept those with dimentia that otherwise would not have been able to find placement.

CommentID: 14783

12/16/10  1:01 pm
Commenter: Speaking Up For Those Who Can't

It's About Time!

It's as if the the current funding rates for assisting the elderly, are based on a cost of living audit from 50 years ago. So many of our elders are disposed back into the system because even the families can't afford to support them. Because those with dementia have been unable to voice their concerns or there has been too much red tape just getting through the system, it's nice to know that someone out there is looking out for their best interests!!!!

CommentID: 14784

12/16/10  1:14 pm
Commenter: Lee's Hill Catering at MicAnd ALF


We have been working with ALF for 3 years now and are amazed at how many come and go from the lack of funding and support. We do what we do, because we learn more about our services visit us at



CommentID: 14785

1/4/11  3:09 pm
Commenter: Sharon DeBoever/DSS Licensing


To better coordinate with licensing who will also be looking at these facilities would you consider:

1)Individualized Service plan instead of Plan of Care 2) recognize that if a resident meets the criteria for a nursing facility and it is noted as such they are not eligible for assisted living - not even a secure unit if licensed under assisted living 3) delete reference to skilled nursing LHCP such as on page 6 4) under 4-c leave the requirement at 19 hours for activities but could remove one-to-one time (this is a new recommendation from RAP looking at standards for secure units) 5) 1630 B-7 is going to require two sets of forms unless the DMAS forms include all info required by Standards (have not seen forms) 6) check references to administrator training with requirements by Long Term Care Board and under new RAP recommendations 7) allow training by personel other than LHCP or clarify that is an option F-2 8) J-standards require a minimum of two people if five or more residents 9) check RAP through DSS for new training recommendations.  This is a welcome opportunity for more elderly persons to be served but if it becomes too heavily laden as a medical model many facilities still will not be able to afford to provide services to these individuals. Thank you to those who were willing to consider changes.


CommentID: 14878

1/7/11  9:43 pm
Commenter: Carter Harrison, Alzheimer's Association

Steve Ankiel
Virginia Department of Medical Assistance Services
600 East Broad Street
Richmond, VA 23219
            RE:    Alzheimer’s Assisted Living Waiver
                        12 VAC 30-120-1600 through 1660
Dear Mr. Ankiel:
We write to comment upon the proposed changes to the Alzheimer’s Assisted Living Waiver which would, if approved, bring the waiver criteria in sync with Department of Social Services licensing standards. Because we believe these changes lessen protections for a very vulnerable population which is by definition eligible for nursing home level of care, we oppose the proposed changes.
The various organizations represented in these comments all advocate for nursing home and assisted living residents. We came to the examination of the proposed regulations with the belief that housing and treating people in the least restrictive environment is a desirable outcome and that greater utilization of the Alzheimer’s Assisted Living Waiver is also a desirable outcome. If the proposed regulations would increase provider participation in the waiver and if they did that without compromising resident care, we would support the proposed changes. However, as we reviewed the proposed regulations and discussed them further, we came to the conclusion that the changes probably would not significantly increase provider participation; and, regardless of their impact on provider participation, the proposed regulations would compromise necessary care for residents in assisted living facilities who have nursing home level acuity needs.
From the provider participation perspective, most of the existing Alzheimer’s units have significant waiting lists. Providers can likely draw largely from private pay residents to fill their beds. We question whether the changes in the proposed regulations would, in reality, attract additional providers. Furthermore, these changes suggest that providers should be paid more to provide no additional services. To receive the enhanced payment rate, providers should be required to provide more staffing and more services than are required for other assisted living residents. Instead, the proposed regulations reduce staffing and services to the same level received by all assisted living residents, providing nothing new in return for the additional funding. This does not make sense from a fiscal perspective. It makes even less sense from a care perspective. By definition, the people served by the Alzheimer’s Assisted Living Waiver have functional and medical/nursing needs which are at the nursing home level. They need more care than do other assisted living residents. To maintain them in assisted living facilities without providing the additional care they need puts them at risk.
In particular, we have serious concerns about the elimination of the requirement that an RN complete the initial comprehensive assessment and monthly assessments, develop the plan of care, supervise medication administration, and provide training, consultation and oversight of direct care staff. The proposed regulations effectively eliminate the need for any RN involvement in the care of the waiver participants. If the residents’ only diagnosis was Alzheimer’s this might be sufficient. However, to qualify for the waiver, the resident must have other medical nursing needs. The revised regulations do not ensure that properly trained RN staff will be involved in the development of the plan of care and in the day-to-day monitoring of the residents’ treatment and care needs. We are concerned that residents could develop significant medical problems which could go unnoticed without effective RN monitoring. By eliminating even the requirement that at least a certified nursing assistant be present at all times, the proposed regulations further weaken existing protections. In short, we do not think that the proposed regulations adequately address the greater medical and treatment needs that this population of residents has such that resident safety and health are put at risk.
Though a lesser concern, we are also concerned about the reduction in activity hours. Those with Alzheimer’s have a greater need for stimulation and attention to keep them engaged and functioning at the highest possible level of cognition. The provision of activities is the primary source of such stimulation. To increase the level of reimbursement to serve this group of residents while reducing the level of services offered them through a reduction in the hours of offered activities is neither fiscally sound nor fair to this population of residents.
We applaud DMAS’s effort to find ways to encourage greater provider participation in the Alzheimer’s Assisted Living Waiver and hope that other ways to enhance provider participation can be found. However, we think that these proposals risk resident safety and health without ensuring greater provider participation. We urge you not to implement the proposed regulations. Thank you for your consideration of these comments.
Carter Harrison
Alzheimer’s Association
Joani Latimer
State Long Term Care Ombudsman
Claire Curry
The Community Partnership for Improved Long-Term Care, an initiative of the Legal Aid Justice Center
Kathy Pryor
Virginia Poverty Law Center


CommentID: 14904