Consideration #1 Under the heading Defining Direct Support Professional (DSP): “This term (DSP) shall exclude consumer-directed staff and services facilitation providers.

 Consumer Direct (CD) services include Personal Assistance, Respite, and   Companion services.

 Personal Assistance, Respite, and Companion services can also be Agency directed.

The reimbursement rates for CD AND agency directed Personal Assistance, Respite, and Companion are the same, yet, DMAS is holding a higher standard of training and competency verification creating an administrative burden on agencies for the same reimbursement rate as CD services.

Solution 1 – Require the same level of training and competence for CD services as is for agency directed services, or raise the reimbursement rate for agency directed services to match the administrative financial and resource burden.

 Solution 2 – Provide, free of charge, web based training and competency testing to Agency and CD services staff.

Consideration #2 Supplemental / least restrictive services for both children and adults is a stated goal and expectation yet is underrepresented with greater a expectation of compliance than CD services for similar supports.  

According to the most recent independent reviewer report, it has been noted

“…by the Independent Reviewer highlighted system-wide problems that the Commonwealth has not yet adequately addressed. The Commonwealth does not have either a sufficient quantity or the needed geographic distribution of the most integrated community-based residential services options. It also does not have enough services providers to support individuals in these options, especially the members of the target population with particular needs. These individuals include adults … and children…who need and are able to live in settings that provide more independence and in their own home with more integrated daily lives…”

The expansion of least restrictive services is hindered by failure to acknowledge agencies willing and able to do the work and expand services but are silenced by administrative and financial burdens that focus on trainings that are not shared with Consumer Directed Services. Furthermore, the DSP Orientation manual focuses solely on 24 hour residential services provided to adults. IE supplemental services is given a nod on slide 15 as a goal (moving persons from a service life to a community life) within the orientation yet children services are omitted both in the training and on the test.  Again, I will point out that the DSP Orientation training is not required for CD services offering the same level of supports to ID/DD persons meeting the same criteria as those receiving the same agency directed supports for the same reimbursement.

Solution #1 – include supplemental services and supports of children in the DSP orientation.

Solution #2 – look at the system that places additional burdens who are ready and willing to provide least restrictive services and adjust the financial burden and expectations accordingly.

Solution #3 - DMAS provides the expected training through an online learning environment so that the intended information is properly communicated. From there, supervisors can confirm through their ongoing observation if the DSP continues to meet proficiency

Consideration #3 - Competency and proficiency is fluid. A person can be determined competent and proficient in one setting but lack the same in another. Making the portability of the competencies less than person centered. Furthermore, one can pass a test and have the appearance, though observation, that staff are proficient. However, passing a test, having received training and observing compliance does not preempt criminal, amoral, or unethical behavior. I understand the purpose of competencies and have no qualms with using tools to guide training and supervision efforts. However, licensing requirements for training and supervision already exists and should be enforced.

Solution #1 - enforce regulation and law already in place rather than creating overlap where none may in fact be needed.

Solution #2 - prohibit portability of DSP Orientation and Competencies to limit opportunities to reemploy staff who were dismissed due to failure to meet job requirements and to limit opportunities for staff to "job hop" once their competencies and training requirements were met.