The Arc of Virginia is submitting comments regarding Virginia's Request for an Amendment to a 1915(c) Home and Community-Based Services Waiver: Community Living, Family and Individual Supports and Commonwealth Coordinated Care Plus waivers.  The Arc appreciates this opportunity to provide comments on the waiver applications.  

We appreciate DMAS' recognition and action to revise the applications to allow Legally Responsible Individuals (LRIs) to use the consumer direction model

Our comments are focused on Appendix C of the three above mentioned waivers.
1.  "Reimbursement may be made to LRIs for up to 40 hours per week.

Comment and Recommendation:
The population eligible for personal care have extraordinary care needs and for some the activities of daily living take an extraordinary of time and support such as eating, bathing and mobility.  Each waiver member's situation is to be person-centered reflecting the entire amount of time personal care is needed.  It is recommended that the limit on time that an LRI can provide be increased to 56 hours per week.  Children with chronic health conditions miss greater amounts of time from school and may not be able to access other services, thus requiring more personal care hours.  The lack of care providers other than LRIs often makes it difficult if not impossible to hire attendants leaving children and families vulnerable. 

2. "The person acting as the Employer of Record(EOR) must reside in the individual's local community within a 50-mile radius. "
"The Employer of Record may not be another LRI."

Comment and Recommendation:
These two requirements make it very difficult for families to find an EOR due to the various circumstances of families - moving frequently due to military or civilian jobs.  The EOR volunteer role involves knowing highly personal information about the waiver member, leaving families worried about finding a trusted person within a 50 mile radius.  By prohibiting the other LRI to be an EOR, the difficulty of obtaining an EOR is compounded.  It is recommended that these two requirements be removed or that an alternative is provided to address what will be a hardship or impossibility for children and spouses needing personal care.  

ADDITIONALLY, The Arc of Virginia ENDORSES AND STRONGLY SUPPORTS THE VA BOARD FOR PEOPLE WITH DISABILITIES' RECOMMENDATION REGARDING:
"The legally responsible individual must document all tasks for each shift on DMAS authorized forms and submit all work shift entries through the fiscal employer agent's Electronic Verification method."

VBPD's Comment and Recommendation:
"DMAS should extend the same exception from Electronic Visit Verification (EVV) requirements to legally responsible i

ndividuals (LRIs) as it does to live-in caregivers.  The requirement that LRIs use EVV imposes an overly rigid medical model into a family's life on a daily basis.  This expectation of parents or spouses to constantly clock in and out throughout the day disrupts natural and normal interactions, which are crucial for fostering well-being and building trusted family relationships.  It is neither practical nor realistic to expect a parent or spouse to clock in and out multiple times a day.  In addition, the emotional well-being of the person receiving services will likely be impacted by the perception that their needs are a burden and intrusion into everyday life.  There are numerous states that exempt live-in caregivers, including LRIs, from EVV including Colorado, New Jersey, and Rhode Island.  The Board recommends that LRIs be exempted from the requirement to use EVV."