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

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 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

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?

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.