While the reference material outlines very narrowed examples to guide provider agencies in the implementation of HCBS modifications, it does not take into account, like numerous previous commenters noted, the conflicting and stringent regulations currently in place in the state of Virginia.

While this commenter values the focus of person-centeredness, self-determination, dignity of risk, and community connectedness, this document makes an assumption that provider agencies assume no risk associated with such recommendations.  As a matter of personal experience that is just not true.  All provider agencies in the state of Virginia are held accountable by Legal Guardianship requests, Licensing Regulations, Human Rights Regulations, and DMAS Waiver Regulations to prevent and mitigate risk daily or face the potential payback of funds or revocation of the agency license.  

In addition, this document was not developed through a collaborative approach with people receiving HCBS services, Legal Guardians, other stakeholders, or the agency providers that deliver the service.  Actually, there is no indication given within this document as to who developed this or who to direct questions to, other than the CRC that may or may not be familiar with the other regulatory requirements impacting service delivery.  Therefore, when provider agencies are left to respond to licensing reports or other punitive actions, there is no ability to obtain support with those responses.

If the developer of this document seeks to create a collaborative document that could be developed to truly offer support/guidance to provider agencies, this commenter would be supportive of that.  One recommendation would be to allow documentation of said modifications to be completed within the ISP as opposed to an additional document.  This commenter welcomes collaborative efforts that streamline the administrative burden on provider agencies so that the focus can be put back on supporting the people receiving HCBS services to gain independence and have the quality of life one desires.