Public comments about the 'HCBS Modification Process' Guidance Document

There are numerous legal and clinical implications surrounding restricting the rights of individuals. Which legal and clinical authorities or expertise were consulted or involved in developing this “guidance”? There are no references or authoritative basis for any of the examples, which are very prescriptive and contradictory to the other responsibilities and requirements with which providers have to comply, as well as industry best practices.

Please clearly identify the author, audience, and regulatory basis of this “guidance” document.

The contradictions within the guidance are as troubling as the gross omissions of other competing authorities, such as legal guardianship, facility accreditation criteria, and licensing requirements. The document fails to provide clarification of any regulation or decision-support for providers who need to navigate complex, real-world issues as representatives of the Virginia waiver system. Instead, it increases both provider and DMAS vulnerabilities to non-compliance with the DOJ Settlement and violations of state law and federal human rights.

This guidance should be announced properly, specifically to providers, to not only allow useful public comment and provider feedback, but also to comply with procedures for establishing guidance about how regulations that are part of state law should be interpreted and implemented. Why wasn’t it announced in the provider listserv? Will public comments and provider feedback be incorporated before it is established as official guidance, and if so, how exactly?

On behalf of all of the individuals DMAS serves, please seek out expert consultation and carefully consider provider feedback as part of the proper process for developing official guidance that is helpful instead of riddled with high risk.