Thank you for the opportunity to comment on the intention of the Department of Medical Assistance Services (DMAS) to publish Omnibus Waiver Regulations. 

Danville-Pittsylvania Community Services (DPCS) appreciates the intention to streamline regulations; however, it is our belief that while there may be some cause for certain components of the regulations to be consolidated, the Mental Retardation (MR) Waiver and MR Day Support Waiver regulations should remain entirely separate beginning with 12 VAC 30?120-211 through 12 VAC 30-120-249 and 12 VAC 30-120-1500 through 12 VAC 30-120-1550.  These two Waivers have many unique and significant features that must be retained.  In addition, these Waivers have played a major part in public policy discussions and decisions made by Virginia’s elected officials since the MR Waiver was first developed in the early 1990’s. 

The Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) developed the MR Waiver, at the direction of the General Assembly and the Administration, in consultation with Community Services Boards, DMAS, and various advocates.  Within DMHMRSAS resided the experience and leadership for services for persons with Intellectual Disabilities.  As a result, the MR Waiver was intended to offer services and supports for people with Intellectual Disabilities who were able and chose to live in their communities, and it was based upon the best expertise and knowledge of the needs of individuals with Intellectual Disabilities.   The history of the MR Waiver’s development, oversight, and implementation, all of which occurred in the public eye and was the focus of two important legislative subcommittees, is too lengthy to describe in these comments.  The results of this history, listed below, constitute the reasons why the MR Waiver and the MR Day Support Waiver should be entirely separate:

• Among the very unique features of the Waivers are the assessment process and instruments used in assessment, the preauthorization process and authority, and the criteria used in developing and managing Waiver waiting lists.
  
  
• The MR Case Management system and the roles played by Case Managers are unique.  If any citizen is seeking information regarding the MR Waiver or the MR Day Support Waiver, a separate set of regulations will be most helpful and will assist in that citizen’s understanding of the Waiver’s features. 
  
  
• The oversight of the MR Waiver and the MR Day Support Waiver is unique.  The Virginia General Assembly mandated a secure partnership between DMAS and DMHMRSAS.  Each agency has roles specific to these Waivers which are outlined within the DMAS-DMHMRSAS Interagency Agreement.  Such roles have been affirmed time after time by Virginia’s elected leaders.
  
  
• While there may be exceptions, most families are concerned with only one Waiver, and separating the Waivers by section would appear to be the most informative and user-friendly way to accomplish information sharing.
  
  
• The history of the MR Waiver and MR Day Support Waiver, with its legacy of strong interest and affirmation by Virginia’s elected leaders, should indicate that the very features that have made these Waivers vital and effective, whether they are phrased as “inconsistencies” or by any other term, cannot be lost if the Waivers are to remain strong systems of support for citizens of Virginia and their families.

Thank you again for this opportunity to offer comments.