COMMENTS - DD Waiver Regs - Part 2

12VAC30-122-410 In-Home Support Services 

B. 4. - REVERSE and REINSTATE Stricken Language
JUSTIFICATION: In-Home Support Services needs the flexibility of episodic supports for all the reasons stated in the stricken language.  Without the inclusion and flexibility of episodic supports, the individual will have no support if these events occur.  Example - If school is cancelled on Thursday, but In-Home Supports are authorized for 3 hours on Thursday evening - those hours can be adjusted regarding the time of day provided but cannot exceed the 3 hours that is authorized despite the need increasing due to events beyond the control of the individual, family or provider. Examples may also include when Day Support and/or job site or employer is closed.) 

12VAC30-122-430 - Individual and Family/Caregiver Training Service

RECOMMEND - Adding this service to the Community Living and Building Independence Waiver.  Individuals included in these waivers would also benefit to participate in these training opportunities to better understand their disability and increase self-determination and self-advocacy skills.

B.2.  ADD exception to this service’s definition of “family” to allow individuals who are compensated, provided they are not concurrently billing during service facilitation.  This would include family members who otherwise meet the definition of “Family” and are instrumental in the delivery of this service but 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.

12VAC30-122-440 - Nonmedical Employment and Community Transportation Services 

Although a critical and needed service, the service as written is operationally a nightmare for any provider to provide.  This includes documentation requirements, supporting documentation such as “Google Maps/MapQuest print-outs to support trip mileage”, driver requirements, no administering agency overhead reimbursement for the administrative provider, and the exclusion of flexible modes of transportation available in the community including para-transit, Lyft, Uber, cab, etc. There are also cost reimbursement issues that do not reflect current rates via public transportation, etc. Additional comment will be provided in response to DMAS Medicaid Memo FAQ and Guidance Document public comment opportunity.

12VAC30-122-460 - Personal Assistance Service 

E.  Agency-Directed Service Documentation and Requirements
Assessment of “emotional condition” - clarification needed - Is this outside of basic training for a DSP?

12VAC30-122-490 - Respite Service

B. Allowable Criteria and Allowable Activities
ADD B.6. Providing general supports as needed.

D.2. INCLUDE previous option for providers of other residential services to provide respite services. This service is vastly under supported by providers because of the low reimbursement rate.  By allowing residential providers to provide respite services when staff or availability allows, this much needed support would be able to be provided to more individuals throughout the state that are request respite services.

12VAC30-122-560 - Therapeutic Consultation Services

RECOMMEND that Therapeutic Consultation Services be provided to individuals on the Building Independence Waiver to further create and maintain independence and inclusion for individuals living and working in the community. increase their inclusion in the community and work environments.

C.3.  Clarification is needed to 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.  ADD “Registered Behavior Technicians” to be allowable practitioners of this service when supervised by a BCBA.  There is a current documented shortage of providers for this critical and needed service as well as an ever-increasing demand for services in order to support individuals to fully achieve inclusion goals and to meet health & safety needs. Allowing this change would significantly increase provider capacity. DARS currently 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 cases that they are overseeing/supervising.

E.1. (2) e. (1) - MODIFY the requirement of “the quarterly review shall include graphed data and a summary of the data”. ADD “as appropriate” and “or may include an alternative means to document qualitative data according to current best practices”.  Graphing is specific to one model only. Broader language in this section will allow for ever changing best practices. The graphing of data requirement may also cause consultant to have to discontinue services for families who are not able to comply with request for documentation from consultant.

E.1. (2) e. (2) - See comment above regarding E.1.(2) e. (1) related to graphing/tabling data.

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.