November 10, 2020

TO:    Emily McClellan, Regulatory Manager, Division of Policy and Research, Department of Medical Assistance Services

FROM: Teri Morgan, Executive Director, Virginia Board for People with Disabilities

RE:    Public Comment on the High Needs Support Benefit Delivery System Design

The Virginia Board for Disabilities serves as Virginia's Developmental Disabilities (DD) Council. Part of federally-funded network in every state and territory of the United States, Councils work for the benefit of individuals with DD and their families to identify needs of people with disabilities and help develop policies, programs and services that will meet these needs in a manner that respects dignity and independence.

The Board has reviewed DMAS’ policy paper, High Needs Supports: Operational Design and Implementation Planning, detailing the High Needs Supports (HNS) benefit, which will provide housing and employment support services to the Commonwealth’s high-need Medicaid enrollees as part of Virginia’s Section 1115 Medicaid demonstration. As advocates for people with disabilities, the Board supports a HNS program that empowers individuals to fully participate in their communities through stable housing and integrated employment.

Based on our review of the policy paper, we seek additional clarification from DMAS in the areas described below.  Answering these questions will help provide clear guidance about the program’s proposed eligibility and implementation.

ELIGIBILITY

1. Page 3: The policy paper states individuals must be enrolled in the CCC Plus program to be eligible for the HNS benefit. However, it does not mention individuals enrolled in the CCC Plus Section 1915(c) waiver for HCBS. Are CCC Plus Waiver participants eligible to participate in this program?

2. Page 3: The HNS benefit could improve housing and employment outcomes for eligible individuals with intellectual and developmental disabilities. The policy paper states that individuals on the DD waivers waitlist are eligible for the HNS benefit; however, the impact on their waitlist status is not discussed. What will the impact of HNS program participation be on their waitlist status?

3. Page 5: In defining eligibility, the paper states that “[i]ndividuals must meet at least one health needs-based criteria, at least one housing or employment specific risk factor, and be expected to benefit from supports necessary to obtain and maintain stable housing or employment, as summarized below and further detailed in the appendix.” What factors will be considered when determining if someone is “expected to benefit?”

4. Question: One of the outcomes of HNS participation is stable, competitive employment. Is the High Needs Supports benefit compatible with the Medicaid Works program, which has flexible income requirements for employed participants? If no, why not? If yes, can more details be provided?

DISENROLLMENT

5. Question: Based on the policy paper, it is unclear if the HNS benefit is time-limited. Is there estimated amount of time an individual will be enrolled in the program? Has DMAS identified criteria for disenrollment such as securing competitive employment or achieving stable secure housing?

NETWORK ADEQUACY & COMPLIANCE STANDARDS

6. Page 8: Currently, there are areas of the state that lack provider capacity. What, if any, incentives are being considered to increase provider and network adequacy for the High Need Supports benefit?

7. Page 7: Training on the HCBS Setting Rule was referenced on page 7 of the policy paper. Can DMAS confirm that housing and employment options will be in compliance with the HCBS Setting Rule requirements?

ASSESSMENT AND REASSESSMENT

8. Pages 10-12: The policy paper references Person-Centered planning activities. The Board has concerns about quality assurance regarding the development and delivery of these plan. Will there be a standardized template for the person-centered care plan? Will care coordinators be required to complete training on person-centered practices and person-centered care planning? How will care coordinators track implementation, adequacy and progress? Will providers be required to report to care coordinators on a monthly and/or quarterly basis? Clarifying these questions will ensure the planning process is truly and consistently person-centered.

COVERAGE POLICIES

9. Page 11: On page 11, the paper states “MCOs will be required to provide services at least in equal amount, duration, and scope as available under Medicaid FFS, and any service limits will be placed in a manner that is no more restrictive than FFS.” It’s unclear if this statement is referring to the HNS services specifically or broader Medicaid service options.   A clear explanation of the coverage policy with examples would be helpful.

QUALITY IMPROVEMENT

10.  Page 13: The Board recommends DMAS identify measures that reflect the quality of services provided. To evaluate these measures, DMAS could implement an annual survey of service recipients on, for example, satisfaction, positive outcomes, and barriers addressed.  Currently, the measures provided focus more on processes than quality and impact.

The Board appreciates the opportunity to comment on the HNS program, which will help Virginians secure stable housing and integrated employment. In addition to the comments above, we echo and support the comments of our colleagues at the disability Law Center of Virginia.

Please do not hesitate to contact Clare Huerta, Deputy Director of Policy and Legislative Affairs, at clare.huerta@vbpd.virginia.gov if you have additional questions. Thank you for the opportunity to provide input.