Commenters have identified numerous excellent ideas. The HCBS system is in crisis due to the lack of qualified DSPs and other waiver staff. People are going without essential supports and for some receiving services, abuse and neglect is being experienced. Trained, competent and fairly compensated staff are essential.

Times have changed - technology is essential and it is time for VA to update their processes.  The requirements to receive basic technology, assistive technology, environmental modifications and electronic home based services are excessive and unnecessary.  Take a hard look at a highly regulated system that is harmful to people who need supports and only keeps bureaucrats on the payroll. 

Address the inequity in reimbursement rates that incentivize congregate residential services.  Match the Supported Living rate to the Group Home rates.  Adults should have the choice to live with supports in the home of their choosing.

Fund more DD Waivers.  For those who disagree, there are services and supports that people could use - personal care, companion, respite, AT, EM.  

Thank you for the opportunity to advocate for remedies to salvage a service system that is in crisis and for the children, adults and families who are left behind.