12VAC30-120-900 Definitions

Employer of record

Revise the definition to maintain the current practice of allowing the employer of record (EOR) to be a family member, caregiver or other person chosen by the individual.

Guardian

Revise the definition to clarify that guardianship decision making authority could be limited and not include all of the decision items listed at the end of this definition.  This could be accomplished by adding “/or” before the last word in the definition.

Preadmission screening

The proposed regulations add “for long term care services” to item (i). Preadmission screening as described in this definition does not include screening for all long term care services. The proposed regulation should specify preadmission screening is for the Alzheimer’s, EDCD and Tech Waivers, PACE and nursing facilities.

Add a statement that the screening process includes the provision of a description of agency-directed and consumer-directed services to ensure that individuals are making informed choices.

Primary caregiver

Clarify the regulation to reflect that not all individuals will have a primary caregiver, that there is no requirement to have a primary caregiver, and that documentation of a primary caregiver is not required.

Prior authorization, Service authorization

The proposed definition states that prior authorization would be required before a service “is rendered or reimbursed”. Several services are not authorized prior to the service before provided. For example, transition coordination is provided during the day of enrollment into Money Follows the Person. However, the service is not approved (authorized) before the service is provided. The request for prior authorization is requested the day of service, but the service authorization does not occur before the service is rendered.

12VAC30-120-905 Waiver description and legal authority

E. The proposed regulation would require prior authorization when services are provided outside of the Commonwealth, except for brief illnesses or vacations. This new requirement is unnecessary so long as the services continue to be needed as documented on the plan of care and the total number of service hours does not change.

12VAC30-120-920 Individual eligibility requirements

C.2. Insert “for people 55 years of age or older” before PACE to clarify that PACE is not available to younger people.

C.9. Clarify that transition coordination and transition services can be provided to an individual while they reside in a Psychiatric Residential Treatment Facility, so long as the individual meets other Money Follows the Person eligibility criteria.

D.1. Revise the last sentence in this item to read: “Individuals unable to or who elect not to manage their own care may have a family member, caregiver or designated person of their choice serve as the EOR on their behalf.” Current regulation does not limit others from the list of people the individual can have act on their behalf as the EOR. The proposed regulation assumes that the only people who may want or need to have someone act as their EOR are people who have cognitive impairments.

12VAC30-120-924 Covered services: limits on covered services

B.1.c. Amend the proposed regulation by adding at the end of the sentence: “or other service”. As drafted, the proposed regulation would prohibit individuals from beginning or continuing consumer-directed (CD) services even if the individual’s medical or behavioral needs could be met by another service. For example, Medicaid State Plan home health benefits could provide skilled services for the individual’s nursing needs. The skilled services would not “be met through CD services”, yet the skilled services could still be provided.

D.1. Add a new item d to require “The agency document the waiver individual’s choice of the agency model.” A similar requirement is in the proposed regulation at F.1. for services facilitation.

D.2.b. (3) Supervision should be permitted in work or postsecondary schools if the supervision is not being provided as a reasonable accommodation as part of the Americans with Disabilities Act or the Rehabilitation Act. (This comment also applies to 12VAC30-120-924 G.3.c.)

F.1. Delete “waiver individual and family/caregiver” from the third sentence in this item. The training should be provided to the EOR.

H.4.b. Replace “Chapter 790 of the 2010 Acts of Assembly” with “54.1-2901.A.32”. This more specific citation provides information needed to implement this option when appropriate.

12VAC30-120-930 General requirements for home and community-based participating providers

I. The proposed regulation omits language describing the required knowledge, skills and abilities for services facilitators. The description of required knowledge, skills and abilities in the current regulations should be maintained in the new regulations.

I.4.c.(8) and I.5.i. The proposed reference to TB screening states that screening should be “as specified in the criteria used by the VDH.” The document or citation for the specific required criteria should be included in this regulation.

12VAC30-120-935 Participation standards for specific covered services

H.3.b. The proposed regulation regarding personal care would require a “face-to-face meeting with the waiver individual and family/caregiver”. The regulation should not require the family/caregiver and services facilitator to meet face-to face. Sufficient information can be gathered by the services facilitator by meeting with the waiver individual face-to-face and then speaking with the individual or family caregiver by telephone. Some families prefer this manner of meeting to minimize their time away from their jobs.

The last sentence of this item addresses review visits for respite. The proposed regulation states that the face-to-face meeting could be “with the individual or family/caregiver, or both.” It is important to maintain the current requirement for the meeting with the individual to be face-to-face.

H.3.c.(3) The services facilitator would be required to include in their meeting summary information about “special tasks performed by the attendant”. The regulation should describe “special tasks”.

H.4. Add that the results of the check of records by a local DSS to determine if the attendant has been found to have abused, neglected, or exploited an adult 60 year of age or older or an adult who is 18 years of age or older who is also incapacitated should be reported to the EOR.

H.4. The end of this sentence requires that the findings of records checks to be reported to the waiver individual or the family/caregiver or EOR. This should be changed to require the information be provided to the EOR.

H.6.b. References to the “POC goals, objectives, and activities” should be omitted from the regulation. Goals, objectives and activities are not a part of EDCD Waiver services facilitation.

H.10.a. The fourth sentence should be modified to state “Waiver individuals unable to or who elect not to manage their own care may have a family member, caregiver or designated person of their choice serve as the EOR on their behalf.”

12VAC30-120-945 Payment for covered services

B.5.a. The last sentence in this item should be changed to clarify that if the individual switches to another waiver that offers AT, the individual will have access to needed AT according to the limits in the new waiver. The exception would be if the individual has already used the maximum allowable amount for AT during the year of MFP enrollment, they then would not have access to AT in the new waiver for one year.