Commenter:
Thalia Simpson-Clement, St. John's Community Services
DMAS Waiver Regulation Comments
In response to feedback shared by my professional colleagues representing individuals, families, advocacy groups, associations and others engaged in the pursuit of improving the regulations governing the MR/ID waiver, I would like to reiterate the need to address issues in the following areas:
Clarification of Language and Definitions-
·Community integration is now removed from the definition, I request that consideration be given to either the reinstatement of the concept as part of the definition or state the proposed language “skill-building” to include the concept of community integration as a approved outcome.
·There appears to be inconsistency in the current regulation which states “The designated provider shall periodically monitor the DMAS-designated system…….” The manual states “monthly”. I support the recommendation to either change both to periodically or monthly.
·Please clarify the wording which suggests that any preparation such as administering and analyzing the SIS would not be reimbursable. There is a need for providers to be compensated for SIS analysis and administration. The SIS should absolutely be considered an allowable and billable service.
·I would request that there be clear communication regarding the future intent of the SIS scores and levels as it relates to future reimbursement rates. As a provider of services in other states, which use the SIS for this purpose, I am concerned regarding the failure of such communication, if this is the future intent.
·Consider the inclusion of an In-home residential support service definition as a separate, distinct service area.
·Re-word Transition services to include a definition that includes 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.
·Regarding the issue of Assistive Technology continue to authorize assistive technology by the plan year. Do not change the year to a calendar year. There appears to be some confusion regarding dates and plan year. Services authorizations should all be by plan year to avoid confusion.
·(Assistive technology limit)
Correct the annual limit to $5,000.
·(Environmental modifications limit)
·Correct the annual limit to $5,000.
·Regarding the issue of Environmental Modifications continue to authorize modifications by the plan year. Do not change the year to a calendar year.
·Delete “Prevocational services”. It is not a service that providers find flexible but one that limits the individuals who seek services and contrary to the concept of employment first concepts if individuals are compensated for work performed at less than 50% of minimum wage.”
Clarification of Hour/Unit/Block Unit and service provision-
·Consider changing the new respite limits from the proposed limit of 240 hours in each of two six month increments to a capped 480 total hours for a year. This would eliminate confusion and allow flexibility for individuals and families.
·In the area of Covered Services Page 105, there needs to be changes from seconds to minutes throughout the entire section.
·I also fully support the current change from “Unit” to “Unit Block”.
Clarification regarding Process
·I submit that waiver service initiation should be modified from the current 30 day expectation to a more flexible and reasonable timeframe of 60 days. This allows for the completion of all the necessary activities and assessments in order to ensure the proper supports are in place and ready for implementation.
·Clarify that an individual cannot be enrolled in or simultaneously receive services from more than one home and community based waiver.
Clarification to issues specific to Supported Employment-
·Please clarify in regulations that funding for Individual SE, the Waiver reimbursement rate is specific to each provider as approved by DRS and indicated on the DMAS rate schedule.
·On page 115, please delete “intensive” and change to “ongoing support” to
clarify that ongoing supports may be intensive or may be periodic depending upon the individual’s circumstances and employer requirements and/or changes.
·There is a similar concern regarding N.2.a. “Intermittent”. The recommendation is to delete “Intermittent” and change to “Individual supported employment shall be defined as intermittent support, usually provided……”
·N.2.a. also refers to “collateral contacts by providers”. This term/phrase needs to be further defined in the Manual. Inconsistent interpretations & TA have been provided to providers.
·N.3.a. The wording in this section is also problematic and does not allow for maximum flexibility in job development tasks on behalf of an individual. Regulations should be as broad as possible to allow further definition in Manual to correspond to SE best practices with allowable activities accepted by DRS SE practices and CARF accreditation in SE.
·DELETE “specifically include” and “search”. CHANGE to – “Only job development tasks that specifically include are specific to the individual shall be allowable job developmentsearch activities under the ………..”
·Job search is only one aspect of job development.
