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Department of Medical Assistance Services
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Board of Medical Assistance Services
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Waivered Services [12 VAC 30 ‑ 120]
Action Three Waivers (ID, DD, DS) Redesign
Stage Final
Comment Period Ends 3/31/2021
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3/30/21  11:53 pm
Commenter: Katie Knipple, The Choice Group

DD Waiver Regulation Public Comment
 

12VAC30-122-20 Definitions

 

 

Progress Notes – Recommend removing the language indicating that progress notes are signed and dated on the day the supports were provided and returning to previously utilized language that indicates “progress notes are signed and dated as soon as is practicable but no longer than one week after the referenced service.”

Remove “Documentation that occurs after the date supports were provided shall be dated for the date the entry is recorded and the date of supports delivery shall be noted in the body of the note. ]”

12VAC30-122-120 Provider requirements

 

A. 12. c. (4) e. - Recommend removing the language indicating that progress notes are signed and on dated on the day the supports were provided and returning to previously utilized language that indicates “progress notes are signed and dates as soon as is practicable but no longer than one week after the referenced service.”

Remove “Documentation that occurs after the date supports were provided shall be dated for  the date the entry is recorded and the date of supports delivery shall be noted in the body of the note. ]”

12VAC30-122-180 Orientation testing; professional competency requirements; advanced competency requirements.

 

Recommend that these DSP competencies are not applied to Individual Supported Employment for non-licensed providers who operate under CARF accreditation specific to no recommendations in the Workforce Development section of the CARF manual regarding competency based training requirements. Supported Employment professionals are not direct support professionals, are educated with Bachelors and Master’s degrees and trained to a professional standard. Many of these competencies result in redundancy with other required training and evaluation. 

Additionally, requiring these competencies in addition to the competencies set forth by CARF results in an increased administrative burden for agencies that already meet CARF accreditation and may result in fewer providers of waiver funded Individual Supported Employment.

C. 1. through C. 8. – In the “Direct Support Professional (DSP) and DSP Supervisor DD Waiver Orientation and Competencies Protocol” dated March 6, 2020 from DBHDS, as well as information presented in the Informational Webinars from DBHDS in November 2020, it is stated that non-DBHDS licensed providers are not subject to advanced competency requirements. This is not indicated in the proposed DD waiver regulations.

 

A.            DELETE Individual and Group Supported Employment from list of services.  Unless the law is changed, DBHDS nor DMAS has the authority to require Supported Employment providers to adhere to these requirements if they are DARS vendors of SE services and are CARF accredited. This language was originally adopted by the General Assembly, signed by the Governor and chaptered in April 2019.

 

As originally adopted in Chapter 854, Acts of the Assembly 2019, the Department of Medical Assistance Services and the Department of Behavioral Health and Developmental Services shall recognize the Certified Employment Support Professional (CESP) and Association of Community Rehabilitation Educators (ACRE) certifications in lieu of competency requirements for supported employment staff in the Medicaid Community Living, Family and Individual Support and Building Independence Waiver programs and shall allow providers that are Department for the Aging and Rehabilitative Services vendors that hold a national three-year accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF) to be deemed qualified to meet employment staff competency requirements, provided the provider submits the results from their CARF surveys including recommendations received to the Department of Behavioral Health and Developmental Services so that the agency can verify that there are no recommendations for the standards that address staff competency.

 

In addition, Supported Employment staff do not meet the definition of a Direct Support Profession (DSP) as included in 12VAC30-122-20 - Definitions.  “Direct support professional,” “direct care staff,” or “DSP” means staff members identified by the provider as having the primary role of assisting an individual on a day-to-day basis with routine personal care needs, social support, and physical assistance in a wide range of daily living activities so that the individual can lead a self-directed life in his own community.  This term shall exclude consumer-directed staff and services facilitation providers.

 

 

12VAC30-122-280 Benefits planning service.  [ (Reserved.) ]

 

B. Recommend amending this section from “calendar year” to “ISP year” to meet the individualized needs of those served and be consistent across other services.

C. Service Units and Limitations: Recommend eliminating the hours limitations per activity as how many hours are required varies drastically from one individual/situation to another, and allowing the service to be completed up to the maximum of $3,000 per ISP year.

E. Documentation: Recommend expressly adding that collateral contacts made during service provision are allowable activities for reimbursement.

Recommend that in this section, language be added to reflect the ability to complete this service virtually and/or telephonically. I.e. “Benefits Planning services may be provided in person, over the phone, or virtually via video feed consistent with and in according with the requirements of the Health Insurance Portability and Accountability Act(HIPAA) as is appropriate for each individual served. Written resource materials are to be provided to the individual regardless of the modality of service provision.”

12VAC30-122-400 Group and individual supported employment service

 

B Criteria and Allowable Activities

 

4. Recommend adding language that expressly indicates that individual supported employment may be completed virtually and/or telephonically as is appropriate for each individual served.

 

I.e. “Individual Supported Employment services may be provided in person, over the phone, or virtually via video feed consistent with and in according with the requirements of the Health Insurance Portability and Accountability Act(HIPAA) in order to support individuals to obtain and maintain competitive, integrated employment.

 

C. 4. Recommend removing “may be provided in combination with”(in regards to day and residential services) and adding language that expressly states that “can be provided simultaneously with supported employment services and can billed concurrently” to  be consistent with other services and regulations.

 

C 6. Recommend changing to “can be provided simultaneously with the workplace assistance service” to “can be provided simultaneously and can be billed concurrently with the workplace assistance service” to be consistent with other services and regulations.

 

E. e. Requires additional information related to what is considered “supporting documentation” that must be communicated to the individual/guardian. In the definition of supporting documentation in 122-20, supporting documentation includes “any written or electronic materials used to record and verify the individual's support needs, services provided, and contacts made on behalf of the individual and may include, for example, the personal profile, individual support plan, providers' plans for supports, progress notes, reports, medical orders, contact logs, attendance logs, and assessments.”

 

Recommend clarifying what is meant by “as appropriate” as this is up to interpretation between providers. Would recommend removing “For the annual review and every time supporting documentation is updated, the supporting documentation shall be reviewed with the individual or family/caregiver, as appropriate, and such review shall be documented” due to clarity issues as well as practicality concerns related to communicating with the individual/guardian for every progress note, attendance log, etc.

 

Recommend adding more specific information such as “Documentation to include the annual review, updates to the plan for supports, and person centered reviews shall be reviewed with the individual or family/caregiver and such review will be documented.”

 

12VAC30-122-430 Individual and family/caregiver training service

 

A. Recommend adding this service to the Community Living and Building Independence waiver as individuals with these waiver options also benefit from opportunities to participate in opportunities to better understand their disability and increase self-determination and self-advocacy skills.

 

B. 2. Recommend adding an exception to this definition to allow for family members to be individuals who are compensated, provided they are not concurrently billing during service facilitation. Requesting this exception for Individual and Family Caregiver Training as many family members who otherwise meet the definition of family and are instrumental in delivery of this service are excluded due to providing personal assistance or companion services to their enrolled family member. Due to this exclusion, individuals who require assistance or support to participate in the training are also therefore excluded and have decreased opportunities to understand their disability and increase self-determination and self-advocacy. 

 

 

12VAC30-122-440  [ Nonmedical Employment and community ]  transportation service.  [ (Reserved.) ]

 

1. Recommend adding language that includes “paratransit or specialized transportation services.”

E. g. Recommend adding language that includes “paratransit or specialized transportation services.”

 

 

12VAC30-122-550 Therapeutic consultation service

 

Recommend that Therapeutic Consultation services be provided to individuals on the Building Independence waiver to increase their inclusion in the community and work environments.

A. Consider adding Therapeutic Consultation to BI waiver as a means to further create and maintain independence for individuals living and working in the community.

C. 3. Additional information is requested to clarify and define the meaning of “written preparation” that is considered an in-kind expense.

C. 6. Additional information is requested to clarify when direct intervention can be provided in the absence of family members/staff or if they must be present for demonstrations.

D. 1. Recommend allowing for the addition of Registered Behavior Technician’s to be allowable practitioners of this service when supervised by a BCBA. At present, there is a documented shortage of providers for Therapeutic Consultation and ever increasing demand for services in order to support individuals to fully achieve inclusion goals and meet health and safety needs. Allowing for this service would significantly increase provider capacity to meet the needs of more individuals. The Virginia Department for Aging and Rehabilitative Services allows for Registered Behavior Technicians to implement behavior-analytic services which have been designed by the BCBA, who in turn supervises the RBT and makes appropriate changes to the plan for the supports. The BCBA is responsible for the work performed by the RBT on the cases they are overseeing/supervising.

E. 1. (2) e. (1) Recommend modifying this to remove the requirement for graphing for the following reason: It can not be reasonably expected that each individual served can collect adequate or accurate data, nor can it be expected that family members, co-workers, or community members in settings these services are delivered can provide accurate data. In many circumstances, data can only be obtained through monthly observation, whole, partial interval data or momentary time samples, which is not considered to be comprehensive. This sort of data presented in graphs is often inconclusive and may inadequately reflect an individuals progress or lack thereof. The requirement for data may cause for discontinuation of services for families or individuals who are not able to comply for the request for documentation.  

E. 1. (2) e. (2) See comment in E. 1. (2) e. (1) related to graphing/tabling data.

12VAC30-122-570 Workplace assistance service

 

  1. Recommend adding this service to the Building Independence waiver as all individuals as there may be support needs related to health and safety or job maintenance needs.

B. 4. Recommend addition of telephonic communication with the job coach as an allowable activity as it is required for effective service delivery. Subsection (D.4. Provider Requirements) requires this.

CommentID: 97575