12VAC30-50-440. Support coordination/case management for services with intellectual disability

12VAC30-50-490. Support coordination/case management for individuals with developmental disabilities, including autism

Individuals with developmental disabilities, including individuals with intellectual disabilities, should have access to the same choice of support coordination/case management providers. The historical bifurcation of support coordination/case management is confusing, burdensome and primarily continues because of the significant difference in provider rates between these two services. VACIL recommends that DMAS convene a group of individuals receiving these services, community services boards and providers of private case management organizations to establish a path for combining these services and allow broader choice of case management/support coordination for all individuals with developmental disabilities, including individuals with intellectual disabilities and to resolve existing administrative and fee structure obstacles to permitting choice of providers.

12VAC30-122-10. Purpose: legal authority: covered services: aggregate cost effectiveness: required individual and provider enrollment: individual costs.

F. VACIL commends DMAS for establishing regulatory language that clarifies DMAS nor DBHDS may require evaluations that would require a cost to be borne by the individual.

12VAC30-122-20. Definitions.

“Companion services”: The second sentence of this definition should be clarified by separating recreational support from ADLs. The intent is to clarify that the service is no purely for recreational purposes and separately that the services does not include routine support with ADLs.

“Individual”: The end of the first sentence in this definition should refer to DD Waivers (plural).

“Personal assistance service”: Supervision should be included in this definition.

“Personal assistant”: Previous versions of these regulations referred to staff who provide consumer-directed personal assistance as “attendants”. The proposed regulation does not include a definition of “attendant” and this definition of personal assistant excludes consumer-directed staff. Either the term attendant should be added and defined or the clarification that a personal assistant cannot be consumer-directed staff should be changed.

“Qualified developmental disabilities professional”: If it is the intention of DMAS to require or to permit DBHDS or community services boards to require DD case managers to be a QDDP, the definition should include the same allowance in 12VAC30-50-490 E.5.

12VAC30-122-30. Waiver populations: single waiver enrollment: waiver termination upon loss of eligibility.

B. Update reference to the Commonwealth Coordinated Care Plus Waiver.

12VAC30-122-90. Waiting list: criteria: slot assignment: emergency access: reserve slots.

C.1.d. Reference to the individual no longer being eligible for IDEA services should be expanded to include individuals who are no longer eligible for 504 plan services.

H. Include a statement that the individual has the right to appeal a decision of the community services board or DBHDS to not place the individual on the reserve slot waiting list. Individuals have the right to appeal a denial of services. If an individual is requesting transition to a different waiver in order to receive a specific service not available in the waiver they are currently using, then denying them placement on the reserve slot waiting list is a denial of the service they are seeking.

12VAC30-122-120. Provider requirements.

A.13.a. The first sentence states that the criminal history records check is “conducted” by the FEA. Clarify this sentence to show that the FEA submits the information to the State Police, but does not actually conduct or perform the check. The second sentence states that the CD employee must submit to a CPS check, but does not include the statement that the FEA actually conducts the CPS check, similar to the responsibility the FEA has for the criminal history check.

12VAC30-122-150. Requirements for consumer-directed model of service delivery.

Change “DD Waivers” to the FIS and CL Waivers. The BI Waiver does not offer a CD model of services.

2.e. The regulation should provide additional information about the duties of the person who will perform the duties of the services facilitator, if the individual or EOR elects not to use services facilitation.

12VAC30-122-200. Supports Intensity Scale requirements: Virginia Supplemental Questions: levels of support: supports packages.

A.1. Modify the first sentence to reflect that the SIS does not identify services required by the individual. In practical application, the SIS assessors are not always familiar with the DD Waivers services, available providers and other factors that impact service availability or service choices made by the individual.

D. Clarify that the supports packages are not established ranges of service types, services hours or other restrictions that impact how an individual chooses to live.

1VAC30-122340. Companion service.

C.3. Clarify whether the individual may have more than one EOR.

12VAC30-122-460. Personal assistance services.

C.6. Add that skilled nursing services can be performed as allowed by 54-1-2901.A.31. which allows for health care tasks to be directed in limited circumstances based on the capability of the individual to direct the skilled service.

C.10. The personal assistance service should be permitted under the FIS or CL Waiver, if the specific task the individual under 21 needs to have performed is not covered by EPSDT.

12VAC30-122-500. Services facilitation service.

Previous regulation required the use of a DMAS-95 Addendum to assist with determining if the individual could be the EOR. If this document is no longer required, a similar process should be established.