The Virginia Medicaid Waiver Network offers the following public comment on proposed changes to the Intellectual Disability (ID) Waiver regulations.

General comment regarding the term mental retardation

The final regulations should refer to the waiver as the Intellectual Disability Waiver. Maintaining the inappropriate term of mental retardation is demeaning and antiquated as well as inconsistent with the Commonwealth’s commitment to the use of person-centered language.

12 VAC 30-120-1000     DEFINITIONS

In-home residential support

Recommendation

Include a definition of this service.

Rationale

The regulations include definitions of congregate residential support and residential support services. In-home residential support is a distinct service.

Residential support services

Recommendation

The definition should clarify how residential support services are different from congregate and in-home residential services. Or if this definition is intended to only be a description of congregate and in-home residential services, the definition should clearly delineate this.

Skilled nursing services

This modified definition is clear and improved over current regulations.

Transition services

Recommendation

Expand the definition to include the first sentence of 12VAC30-120-2010 and maintain the reference to that regulation. The new definition would be as follows:  Transition services “means set-up expenses for individuals who are transitioning from an institution or a licensed or certified provider-operated living arrangement to a living arrangement in a private residence, which may include an adult foster home, where the person is directly responsible for his own living expenses.”

Rationale

The one sentence definition will help to clarify that these services are for individuals who are either transitioning from “an institution or licensed or a certified provider-operated living arrangement.”

12 VAC 30-120-1005     WAIVER DESCRIPTION AND LEGAL AUTHORITY

1005 D. (evaluation before the age of seven)

Recommendation

Allow a standardized developmental assessment to substitute for a psychological evaluation for children who are not yet seven years of age.

Rationale

The proposed regulation states, “Psychological evaluations confirming diagnoses must be completed less than one year prior to transferring to the IFDDS Waiver.”  A few sentences further into the proposed regulation is the following statement: “The case manager shall submit the current Level of Functioning Survey, Individual Support Plan, and psychological evaluation (or standardized developmental assessment for children under six years of age) to DMAS for review.” This language indicates that DMAS will allow a standardized developmental assessment to be used in place of a psychological assessment. Accepting the standardized developmental assessment will minimize the number of evaluations the child will be required to participate.  This will reduce stress for the child and family, save the Commonwealth resources, and eliminate delays in the waiver process.

1005 D. (transfer from ID Waiver to DD Waiver)

Recommendation

Include a clear timeline for DMAS to make a determination of whether an individual is appropriate for transfer to the Individual and Family Developmental Disability Support (IFDDS) Waiver and if an IFDDS Waiver slot available for the child.

Rationale

Without a timeline, individuals, their families and case management organizations are unaware of whether or not the process is proceeding in a timely manner.

1005 F. (use of the term “waiver”)

Recommendation

Clarify that an individual cannot be enrolled in or simultaneously receive services from more than one home and community based waiver program.

Rationale

Individuals can be enrolled in the Ticket to Work program and other waiver programs while they are simultaneously enrolled in a home and community based waiver. The regulation should clarify that individuals cannot be enrolled simultaneously in more than one home and community waiver program.

1005 H. (process before services initiated)

Recommendation

Clarify whether or not services can be reimbursed before approval and authorization of services has been completed.