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Virginia Regulatory Town Hall
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Department of Medical Assistance Services
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Board of Medical Assistance Services
chapter
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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3/31/21  1:53 pm
Commenter: Kimberly Heath, Eggleston

Employment Services
 
DD Waiver Regulations: Employment Services Comments
 

SUBSTANTIVE CHANGE - not authorized by Virginia Statute
Supported Employment - Required Staff competency Training & Monitoring -
DBHDS and DMAS have no authority to require Supported Employment providers to adhere to proposed staff competency requirements if SE providers are DARS vendors of SE services and are CARF accredited. This is protected by statute originally adopted by the General Assembly and signed by the Governor under Chapter 854, Acts of the Assembly 2019. We have included language deletion in Section 122-180 (Orientation Testing, Professional Competency et.al) and language amendment inserting this exception in Section 122-400 - Group and Individual Supported Employment.   

 

12VAC30-122-20 - Definitions

“Progress Notes” - DELETE language indicating that progress notes are signed and dated on the day the supports were provided and REINSTATE 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 services”.  It is unrealistic and impracticable to expect that documentation shall be entered, dated and signed on the date that supports are delivered for most services. 

 

12VAC30-122-180 - Orientation Testing; Professional Competency Requirements; Advanced Competency Requirements

    SUBSTANTIVE CHANGE not Supported or Authorized by Current Statute
DELETE Individual and Group Supported Employment from list of services. 
Unless the law is changed, DBHDS/DMAS does not have 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 is statutory and was originally adopted by the General Assembly, signed by the Governor and chaptered in April 2019.  Also see comments in Section 12VAC300122-400 (Group and Individual SE) to add the following language as a Staff Competency exception.   

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 rec eived 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 Professional (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

ADD language in this section to reflect the ability to complete this service virtually and/or telephonically - “Benefits Planning Services may be provided in person, over the phone, or virtually via video as is appropriate for each individual serviced. Written resource materials are to be provided to the individual regardless of the modality of service provision.”

B. DELETE “calendar year” and INSERT “ISP year” to better meet the individualized needs of individuals served and to ensure consistency across services.

B. ADD - expressly state that “collateral contacts” made during service provision are allowable activities for reimbursement.

C. Service Units & Limitations:
1. INSERT “ISP” between “annual” and “year” for clarification. This should be an ISP year vs. calendar year,
2. DELETE the “Hourly Limits Per Activity”. Hours per activity vary drastically from one individual’s situation to another. RECOMMEND allowing the overall service to be limited to maximum of $3,000 per ISP year without “Hourly Limits Per Activity”. This will allow maximum individualized and person-center services to be provided but still retain the cap of $3,000.

 

12VAC30-122-400 Group and Individual Supported Employment Service

 

B. Criteria and Allowable Activities

4. ADD language that expressly indicates that individual supported employment may be completed virtually and/or telephonically as is appropriate for each individual served. ADD “Individual Supported Employment may be provided in person, over the phone or virtually via video in order to support individuals to obtain and maintain competitive, integrated employment.”

 

4.a. - ADD - “and Customized Employment” to the end of “Vocational or job-related discovery or assessment

 

j. REMOVE “The job coach shall be present with the individual during the provision of transportation.” And ADD “Employment Specialist Travel to/from work site” as is allowable by DARS (limited to individual supported employment service only)

 

C.4. DELETE “may be provided in combination with” (in regards to day and residential services) and ADD language that expressly states that “services can be provided simultaneously with supported employment services and can be billed concurrently” to be consistent with other services and regulations”. “Simultaneously with” is preferred and provides additional clarity vs “in combination with”. “Billed concurrently” also adds additional clarity.

 

C.6. DELETE language - “can be provided simultaneously with the workplace assistance service”. ADD language - “can be provided simultaneously and can be billed concurrently with the workplace assistance service” to be consistent with other services and regulations.

 

D. Provider Requirements

ADD D.5. Staff Competency Exception

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 recommendat ions 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

 

12VAC30-122-570 - Workplace Assistance Service

RECOMMEND adding this service to the Building Independence Waiver. There are individuals with significant support needs related to health and safety or job maintenance that may need this level of flexibility in supports to maintain their employment.

B.4. ADD “telephonic or virtual communication with the job coach” as an allowable activity to ensure effective service delivery. Consistent with Subsection D.4. Provider Requirements.

CommentID: 97621
 





 

 

CommentID: 97626