General Comments

Benefits Planning, Community Guide, Non-medical Transportation, Peer Support are not included; we recognize that including them at this stage is a substantive change, however, to continue on without regulatory authority is unacceptable.  Likewise, requiring providers to comply with provider manuals that are not available is unacceptable.

20 – Definitions

• Assistive Technology- add following environment “, actively participate in other waiver services which are part of their plan.”; delete “in which they live”
• Challenging Behavior – change definition to behavior of FID (Frequency, Intensity, and Duration) that limits the person from living a life of their choosing as defined by their ISP.
• Community Coaching – add following participating “or to support an individual when there is an ongoing barrier to participation . . .”    [This is a issue of access to the Community Engagement service; individuals with chronic medical, sensory or mobility issues, challenging behavioral issues or a condition which is progressively more debilitating will be barred from Community Engagement as 1:1 staff exceeds the parameters of the service.]
• High Intensity/Crisis Behavior - Behavior of FID that places the physical safety of the individual or others serious jeopardy. This may include withdrawal or directed aggression to self, others or property. 
• Positive Behavior Supports – use the definition a data-based system of functional assessment within accepted person-centered practices to design plans that enhance the person’s ability to use positive behavior to communicate and meet their needs in order to enhance their quality of life and enable them to lead a self-directed life in community.
• Progress Note – We support this definition as written and object to the variations contained in the Provider Requirement sections of the several service descriptions.
• Service Authorizations- Strike the word “medically” [While we understand the Medicaid standard of “medical necessity” for payment, it implies that services must have a physician’s order and not be developed by the Person-Centered planning process]

80 – Waiver approval process

• C.3. - add at the end “and other service plans as applicable.”
• C.4.- Following initiated within change “30 days” to “90 days,”
• C.6.c.- Following approve change “suspend” to “pend”

120 – Provider requirements

• A.4.- Change “30 calendar days” to “90 calendar days” [See comment above in Section 80]
• A.4. - Clarify this section. Providers should be prepared to provide services at the agreed upon date indicated on the service authorization
• A.5.- Strike “medically necessary services and supplies” and add “services and supports”
• A.6.- Strike “supplies” and add “supports”
• A.10.d- Strike “Such documentation shall be written on the date of service delivery.” in the 3rd sentence and the last sentence. [This is not in keeping with the definition of Progress Note]
• A.10.d- Strike “medical” in the first sentence
• A.10.f- Add “if applicable” within the parenthetical phrase “including specific timeframe”
• A.13- Change 37.2-600 to 37.2-607
• A.14- Strike “-s of Licensing and” [Abuse and neglect are reported to the Office of Human Rights not the Office of Licensing]
• B.-Strike ‘may’
• D- Strike “may” add “shall” in last sentence [If the purpose is to improve or remove poor providers then this should not be an option].
• D - Include a specific timeframe or frequency that the Department will use to determine a history of noncompliance such as “during the current license period

180 – Orientation testing

• Strike “most intensive need” from this section. Stating level 6 or 7 is suffice.
• C.1., 3. 4.- Include that DMAS forms may be adapted to increase ease of completion for providers as long as all elements of original form are present.
• D.1- The reference should to the “personnel file” not the “provider record”
• D.2- Change sentence to “Completed documentation from the online certificate shall be maintained in the Personnel File.”
• E.7.,8.- Include that DMAS forms may be adapted to increase ease of completion for providers as long as all elements of original form are present
• E.5.- Should be in the customized rate section and not here
• E.7- Add “only” before specific to the needs; and following specific to the needs strike “and level”
• E.8- add “only” before “specific to the needs”; strike “and service levels” [These changes clarify the intent to have the advanced competencies applicable as the needs of the individual requires.]

190 – Individual support plan

• A.8- Add “by the support coordinator” before with a copy of the

200 – Supports Intensity Scale® requirements

• A.1- Delete “to 72” and add “or older” after “years of age.”  [If the SIS is only validated to age 72 then language should be added to automatically assign all individuals age 72 or older to Level 5, Tier 4]
• A.2.a - Change “three” to “four” to stay consistent with the CL application
• A.4. - The specific scoring protocol should be in a Medicaid Memo, not in the regulations.
• D - Strike entre paragraph
• Add a new D – “Requires that the results of the SIS be provided within 10 days of scoring in an understandable format and that the service coordinated be required to explain the results and implications of the SIS score and avenues of appeal.”
• Add a new E. - “An automatic, independent review of the SIS administration process and results when an individual’s SIS Score changes despite a lack of change in their health or other circumstances, upon request.”

210 – Payment for covered services

• A.4.b.- Strike ‘with higher qualifications (e.g. direct support professionals with four-year degree) and replace with ‘that have received the training consistent with section 180’

240 – Services covered: Building Independence Waiver

• B.19.-Include therapeutic consultation services as a covered service
• B.19.-Include in-home support services as a covered service

260 – Services covered: Family and Individual Support Waiver

• Add Independent Living

1. – Assistive technology

• A.(ii)- Strike “with the environment in which they live”
• A. - Add a new (iii) “actively participate in other waiver services which are part of their ISP.”
• B.1.- Increase the limit of AT service per calendar year and allow for carryover when the AT item exceeds the limit set per calendar year
• B.1.- Strike “to specifically improve the individual’s personal functioning’ and replace with ‘increase their ability to control their environment, support ISP outcomes as identified and live safely and independently in the least restrictive community setting.

1. – Community coaching

• A- After barriers add “or to support an individual’s participation when there is an ongoing barrier to participation” [See definition]

360 – Electronic home-based support

• A.- Strike ‘while decreasing’ and add ‘which may decrease’
• B.1.- Strike “physically”
• C.- Increase the limit of EHBS service per calendar year and allow for carryover when the EHBS identified the meet the support and service need exceeds the limit set per calendar year

370 – Environmental modifications

• Strike ‘of a remedial or medical benefit offered’
• Strike ‘specifically improve the individual’s personal functioning’ and replace with ‘increase their ability to control their environment, support ISP outcomes identified and live safely and independently in the least restrictive community setting.
• C.2.- Increase the limit of EM service per calendar year and allow for carryover when the EM item exceeds the limit set per calendar year

410 – In-home support

• C5- Add “Back up plan may include agency support” [This is the most viable option for individuals who do not have a primary caregiver]

420 – Independent living support

• A – Add following receiving this service “lives, or is preparing to live, alone . . .”
• A- Add “or FIS waiver” at the end of the last sentence.
• C.1. - Add “If the hours consistently exceed 21 hours per month, the individual shall be immediately eligible for a reserve slot.”
• E.1.c. – add “observations of individual’s responses to services shall be available in Progress notes”
• E.1.d – strike “and the documentation will correspond with billing”

470 – Personal emergency response system services

• B. Strike ‘when there is no one else in the home with the individual enrolled in the wavier who is competent or continuously available to call for help in an emergency’ and replace with ‘when the need is identified in the individual’s ISP and will support the individual living safely and independently in the least restrictive community setting’.

540 – Supported living residential

• A- First sentence, match the definition in section 20

550 – Therapeutic consultation

• C.3- Strike “written preparation and telephone communication”