Some people with disabilities barely have enough attendants, because $9.40/hr. is the lowest paying healthcare job, the caregivers cannot work with pay over 40 hours a week, meaning that if we don't have enough staff they are unpaid, and you have no insurance or benefits for them. Some of us rely on caregivers, because we do Not have any natural supports. Even though a back up plan is great, sometimes that is Not feasible for every situation. If you take away Consumer Direct Services because we cannot get a back up plan, this violates our ADA rights to choose in the least restrictive environment possible. This could lead into disabled people being forced to live in nursing homes, which would also violate persons with disabilities ADA rights to live in the community.

Comments on the EOR Draft Handbook Chapter Five-: Hiring an Attendant

Here is the sample "Want Ad" for finding attendant services to keep people living in the community 

and not living in an institution.  You should include this in Chapter Five for the benefit of the EORs.

Hiring: A job featuring:  

• no health benefits, 
• no vacation pay,
• no sick time,
• no disability,
• no workers’ compensation, 
• no retirement or 401K plan,
• GPS monitored time logging that tracks you which you must download on your phone, use your own data plan and minutes to support,
• The hourly amount is below minimum wage and set by the General Assembly and there is no negotiation.  (Never mind you can go to Walmart or McDonald's and get a job for more money with benefits.) and
• Supported individuals must be taken out into the community and no reimbursement for your gas or transportation expenses you spend.

Additionally, you need compassion and expect to be mentally and physically exhausted all for less than minimum wage.

This is the job for you!! Job requirements: Suitable Candidate must enjoy:

• Working in an environment with a general sense of mistrust and being treated as guilty until EVV (a broken and unreliable system) proves you innocent?

• Being overseen by indifferent, abusive and over-loaded caseworkers that let services expire dropping the ball on paperwork and don’t answer the phone or email? (Seriously, you can’t get anyone on the phone.)
• Working in an environment that when there a problem- the overlords will fix the "glitch" in their software, (we hope) within 60 days.  
• Working hard and knowing that you can't be sure when you will be paid or even if you will be paid or that the amount will be correct.
• Knowing that your employer will be a stressed-out family who is overwhelmed and under threats by the government to claw back funds the overlords deem invalidly paid.
• Being required to follow guidelines that are contained in multiple regulations without any clear instructions on how to interpret regulations.

• Last summer Fredericksburg VA last summer, we were told the Time4care app would work anywhere, even out of state, because attendants all have unique passwords to log in. However we discovered this weekend that this information was FALSE. While attending to my son in TN Nov7-12, the attendant was NOT able to even log in to the app. She had to manually enter all hours once we returned home. The EVV requirements, therefore, seem like it is restricting community integration. This trip was for my son to participate in a relay race and visit extended family afterwords.  All of these manually entered hours apparently will be red-flagged. This is unfair to the waiver recipient as DMAS has stated that too many red flags could result in a loss of services. This does not seem to be in compliance with the Olmstead Act. And why was this misinformation put out there in the first.place? 3000 words.

I don’t see where the draft mentions evv.  I have read numerous articles where cdpa, the low wages that come with the job and the total lack of benefits, sick leave, retirement, workmen’s comp... are throw backs to slavery according to many of the articles since most of the workers are women of color.. how in home health workers are allowed to be exempt from these benefits and expected to work for basically nothing; drive a client around for no additional reimbursement and now tracked like a criminal via evv... not only are the attendants now tracked but the clients are tracked as well throughout their entire day.. this is going to make it impossible to hire staff... Virginia could exempt live in providers and help ease this burden. They could have also requested an additional one year exemption for everyone... it is a shame.. this isn’t stopping fraud; this is making it impossible for people to utilize the lowest cost service and treating the staff like slaves and criminals.   What if we were tracking all the Muslims with gps locators and cutting their pay the 2-3 min a day that it takes to log in and out each day???  

i don’t have a smart phone and at my clients home there isn’t a landline. We had to purchase a device for $80 and take it to a public WiFi site every other week then get back online somewhere to check time entries.   My client is likely to end up either with a higher cost service plan or in a high cost group home cause evv is very time consuming and messes up everyone’s time and pay... it is sad Virginia didn’t take a stand and support care providers and people with disabilities. If you want to catch real fraud you should see what group homes and public school bill for services never provided.   I don’t know why Virginia wants to shut down the lowest cost services. 

I don’t see where the draft mentions evv.  I wish Virginia had advocates that would have let consumers know about open comment period for evv. Evv makes it really hard to hire people now. I might end up in another state facility because of evv. Every time I have been in state placements I have been beaten up and heavily medicated and abused in every way. I don’t want to live a life like that .. it isn’t living ... please exempt live in providers at least :( ... 

I live in King George where the pay is much lower than in the surrounding counties of Spotsylvania and Stafford. As a result, there are no caregivers to hire in King George. Anybody who lives here and is in that line of work,drives  twenty minutes north where the pay is $2 or more per hour. And yet it is illegal to tip, supplement, or pay for gas to get anybody to drive . out here. The system punishes the rural counties by making it impossible to find help. 

I hear that live in caregivers can be exempt under the CURES Act. However, Virginia chose not to exempt. Let me explain two situations SO FAR to help you better understand WHY live ins should have been exempted. First, meal preparation gets interrupted twice daily to clock in or out. On several occasions, it has taken a long time to get clocked in: stiff fingers on the keyboard, an app update needing to be installed before a log-in is even possible,  trying to find a place in the house where there is internet,  or the app not working after several attempts. So many meals have been ruined because of the time away from the stove just to to clock in or out. The second situation involves travel. I've had to pull off the interstate and highway 301 to clock out. Ridiculous. 

"Person centered planning requires really listening to the person" DMAS stated this and yet they are not listening to the person about EVV!  

Do not say persons are not being tracked when they are providing location at least twice a day.  A minimum of two clock ins and outs a day over a period of time produces documentation of habits.  No one wants their daily lives and their habits tracked.  No one.  To have live-ins do this, is essentially having their lives tracked.  It is an invasion of privacy.  

Live ins were found exempt by CMS.  Virginia chose to include live-ins. However, many agencies in Virginia are still stating that live-ins are part of the Federal Mandate.  That spreading of disinformation must stop. 

The Cures Act states EVV is for "visits".  The name is titled Electronic Visit Verification.  Live-ins do not visit.  Their job is 24 hours a day and yet they are given a set of arbitrary hours to clock in and out to.  It is nearly impossible to clock in and out at set times when a person is providing 24 hour care.  The clock becomes more important than the person cared for in a situation like this.  The last thing a good caregiver wants to do is let down the person they care for, but the state is making a live-in's job so difficult, that they may be forced to quit.  Institutionalization will be the ONLY option at that point. 

With the majority of live-ins receiving two in-home visits per month and countless ongoing evaluations, how much oversight is enough? 

EVV has created unnecessary burdens and additional bureacracy just to CLOCK IN AND OUT.  This is not a simple clock in and out procedure. There is always some difficulty with EVV which can be attested to simply by using a search engine and reading complaints readily available online.  Letters have been written to many state officials as well concerning this cumbersome, burdensome process.   

The waiver program was put into place to allow independence and community access to persons with disabilities.  EVV is a grand hinderance to partaking and enjoying community access.  Do not say they can go anywhere with the app and clock in and out!  When folks are stuck home dealing with the app, the bureacracy, and fallout EVV causes, they are NOT in the community!  Crippling the disabled by making it more difficult to maneuver their daily lives is not an option.  

This is the lowest cost care available to the state and it is being eroded by EVV.  

 Virginia said in their agency statement https://townhall.virginia.gov/L/GetFile.cfm?File=64\5039\8364\AgencyStatement_DMAS_8364_v3.pdf on the that Va wouldn’t apply any more stringent  guidelines then cms required... cms said community locations and live in providers didn’t have to be evv. Please allow live in providers to be exempt. My brother will end up in a group home and due earlier and cost the state more if you don’t exempt live in providers 

evv Is going to contribute to the shortage of health care providers. Please exempt live in providers so my grandson doesn’t end up in a group home to suffer a miserable existence until he passes away at a young age

Parents of children and adults with multiple disabilities are operating under extreme pressure to provide the most beneficial and loving care for our loved ones, under the most burdensome of circumstances now without the addition of EVV.

It's a complicated, error ridden application, with an impossible clock in/clock out requirement for a 24/7 responsibility. To be readily available at a moments notice for falls, driving, incontinence, daily emergencies, seizures, gtube feeds, 7 times a day medication administration, all ADL assistance, possible elopement, hands on assistance for mobility cleaning, and a miriad of predicable and unpredictable situations during the day and night and be burdened with the EVV complications, clock/in clock out on the exact minute requirement, with no EOR on site to discuss and fix issues is going to be extremely stressful, if not impossible. 

It's very difficult to hire and maintain qualified caregivers and nurses due to low pay rates, no benefits whatsoever, and now add a complicated, burdensome app for them to navigate, much less the live in caregiver, who is on 24/7 without payment for all the hours over the allotment. The calls, paperwork, meetings, deadlines we do without any payment. We do it because we love our children! 

I am hearing about paycheck problems for work done by many attendents and great numbers of mistakes with the Celltrak App. Phone calls not being answered by fiscal agent or DMAS  to help with App issues ir pay issues and tracking people and our children, the consumers. This isn't right. Tracking is and invasion of my child's civil rights. I expect the powers that be to take a step back and research these issues and correct them. You are making a stressful situation worse. You can start by exempting live in attendents, and postponeing roll out on EVV for a time when everything is fixed. Raise the rates! Rates were about $12 an hour over 10 years ago in NOVA. That isn't a living wage for the great responsibility of a very physical, mental and emotional job. Give benefits, every other jib does!  There is a crisis in this state for caregivers and therefore puts our loved ones in extreme jeopardy for placement!  Thank you!

Nursing agencies -

Are you aware that the larger nursing agencies are no longer taking Medicaid Waiver cases. I was told by Maxim and Continuum they no longer staff waiver cases due to low reimbursement rates and frequent Medicaid rules changes, and they do not staff our Culpeper area at all. Smaller agencies have to pick up cases. Our area is extremely difficult to staff for homecare as most nurses are employed and live near I95 in the Woodbridge area which is a great distance from Culpeper, Fauquier areas and it's difficult to staff with these small agencies. Please look into this. Thank you.

This system traps my son to the hours the aid has to clock in and out.  The aid works 8am to 4pm.  So he can not leave the house before 8am and has to be home by 4pm.  He travels to Richmond ( a trip that takes 1.5 hours of travel) for OT, PT and speech and therapies have to be scheduled to allow for the travel time. This means that instead of scheduling all three in one day he has to travel 4 days a week.  This costs a lot of money in gas and it means that he can not do the homework the therapists want him to do.  

I live in Orange County and the pay for aides are less than NoVa.  The pay for aides are way too low.  The take home pay aides make either agency or Consumer Directed should be a minimum of $15 per hour.   At home aides are still more cost effective for the state than a group/nursing home even at a higher pay rate.

Live in aides and parents should be exempt from this.  This system is designed for an aide who comes and goes - meaning that during clock in/out there is 2 adults in the home to help the disabled person.  A live in/parent is/can be the only adult in the home.  The disabled person has needs that do not happen on a clock and must come before the nuisance of making a call to clock in/out.  

How can you threaten a disabled person's medicaid status because of an arbitrary system of red flags?  How can you put the health and safety of a disabled person in jeopardy so an aide can clock in/out so they don't get a "red flag"?  This system is severely flawed and punishes a disabled person for being disabled and needing help.  Instead of encouraging and removing barriers so the disabled can thrive this system is trapping them in home, tracking their movements and threatening their health and safety.  

I voluntarily decided to care for my friend's daughter with disabilities when her family's circumstances changed.  I already have a large family, what is one more?  Well, it has been a challenge, but through many trials, we have made it work for a decade.  Now, comes EVV.  It has literally turned mine and my family's life upside down.  I thought the most trouble I had would come from handling a disability!  Now, I am considering letting this person go to an institution! To think I must even consider this decision is horrendous and heart wrenching! This will be on the hands of the state, since live-ins are not federally mandated!  How is Virginia being person centered when IGNORING the federal exemption and the PERSON all at the same time??!

At first I thought EVV system was not a bad idea, until we started using it.  One of my daughter’s attendants logged out at the end of the shift but it kept running after he left.  Next morning he was able to notice what happened and wrote a note with correct shift time.  However, I can see this as a problem in the future.  This was a system error.  We also went on vacation with an attendant but had no WiFi and though we were able to enter time manually later, we were told too many manual entries could cause to lose services.  What else can we do if there is no WiFi?The fact that you can only have the EVV on one device per attendant is a problem. The attendant’s phone broke and, therefore, he could not use the EVV for a few days. Also, the APP burns the phone battery quickly and it is also harder to keep track of the hours to make sure you do not go over.  After all, the attendant has it on her/his phone.   I really think the EVV system will in the end cause more problems than logging in the portal. It definitely is complicating things for people with disabilities.  Hope to get some answers.

your eor draft left out evv. Evv is making the job undoable ... as a cna I can get paid more and my whole projected income without having my location tracked and having to pay a cell phone bill to clock in. Lots of people can’t get the Medicaid phone. My brother will likely end up in a group home. That will cost dmas lots more. It is sad you are doing this to disabled people. Virginia should exempt live in providers. 

it is sad you are doing this to live on providers... please exempt live in providers ... your draft doesn’t mention evv 

I’ve called both DMAS and CDCN about problems clocking in/out for my sons attendants. I was also emailing both entities- so much do that I have a specific name and number of a person at DMAS. This system is intrusive to the disabled person. Asking if the attendant was at the persons residence is non if your business. Expecting location services to be active ON THEIR PERSONAL phone is intrusive. How dare you want to know the whereabouts?  Court decided I’m good enough to be the guardian and make decisions so who are you to question what we do?  Paper or online timesheets served their purpose and were not intrusive. Our disabled people deserve the same respect non disabled people get. 

numerous people are saying because of evv their attendants aren’t getting paid ...   CDCN and celltrak seem to be the main culprits ... Virginia should exempt live in providers and request a good faith one year exemption for everyone else to sort out this mess... we are loosing good attendants and our loved ones will end up in crowded higher cost to the state facilities... please don’t let this happen ... somebody really let the governor know what it really going on... 

Concerned citizens are sending letters to those in office addressing several issues with EVV.  They have been rebuffed by a generic "one-pager" (nothing more than a definition of EVV) response handed to them by those in office.  From a letter directly from DMAS, those concerned citizens have learned that DMAS purposefully handed those in office these "one-pagers" as DMAS refers to them to hand out in response to legitimate concerns!  This is directly instructing those in office of how to respond to concerned citizens!  So, DMAS is in the business of telling those in office to purposefully IGNORE stakeholders by handing them a "one-pager" response crafted by DMAS??!  I am seriously concerned about what country DMAS thinks they are living in and they certainly are not following their own "person-centered" principles of "listening to the person"!  I am not even sure if DMAS telling those in office how to do their jobs AND IGNORE THEIR CITIZENRY is LEGAL!

NCIL (National Council on Independent Living) has statistics stating that the fraud level in the Consumer Directed program is very, very low.  Check out their numbers!  DMAS has yet to produce any statistics showing that fraud is rampant in the consumer directed program especially among live-ins.  In one of the Roanoke EVV meetings, there were investigators there and when asked how much fraud there was, their unprofessional answer was, "a lot".  As DMAS is well aware, the majority of live-ins are working more hours than they are allotted.  The majority of live-ins are parents of loved ones caring for a disabled family member.  The majority in VA are making $9 per hour with no benefits.  How does keeping track of their hours and whereabouts with EVV show anything?  With just two punches (many are required to do more) on EVV GPS system per day, their whereabouts are being tracked and recorded more than any American citizen would want to be tracked! Felons are treated better!  It is quite one thing to track a nurse VISITING/EXITING a home versus tracking THE LIVES of a family and their disabled son/daughter or loved one!  Yes, just two clock ins/out per day(some have to do more) IS tracking a citizen.  EVV is nothing more than a WITCH HUNT that costs taxpayers a considerable amount in additional record keeping, bureaucracy, software, hardware, staffing, cell phones/devices, etc.... and all the taxpayer is going to find out is that these live-ins need more hours and pay!  There are bad people in the world, so does that mean we track all law abiding persons because of a few bad?  No, that is an expensive witch hunt and nothing more! 

How dare DMAS suggest that EOR's use their phones to install the intrusive EVV app!  EOR's volunteer ALL their hours and their social security numbers, so that the state does not have to be financially responsible for attendants as employees! Many EOR's are not even related to the consumer with disabilities!  The majority of EOR's have one or two jobs or businesses to run.  How else could they volunteer? Now, the state is asking EOR's to use their personal phones to add a VERY INTRUSIVE app to it!?  EVV has already put a strain on EOR's to the point where some may be lost because of EVV!  DMAS is taking advantage of kind hearted people who have already given of their time and their valued socials and asking for MORE yet DMAS shows no compassion or kind heartedness themselves! 

numerous people are recommending people switch ccc+ mcos to ones that don’t use celltrak due to all the issues ...  apparently numerous people aren’t getting paid with cdcn . That might be an issue for dmas ... 

While there is not a CCC Plus Recipient Manual, I am left to rely on the Provider manual. The following are concerns that I have, as a Employer of Record and my daughter as the Recipient of the CCC Plus Waiver that are not addressed in the Provider Manual:

1. As a recipient, I would like to receive Explanations of Benefits, (EOB’s). If Medicaid fraud is a concern to DMAS, a good checks and balance system would include EOB’s so recipients can see what they are being billed for and what is being covered. An article that ran on the front page of The Virginian Pilot on 11/9/2019 reported that a local OB-GYN was being investigated by the Feds for health care fraud for performing surgeries on female patients without their consent. Many of his patients had Medicaid therefore did not ever receive an EOB. One particular patient tried for years to have children and eventually sought fertility treatment. Through the fertility specialist visit, she learned that her doctor had tied her tubes without her consent, nor even her knowledge. I wonder if all of the women that he performed unnecessary and life-altering surgeries on had received EOB’s, if he would have been caught sooner.
2. As a recipient, I am grateful that $5000 is granted annually for Environmental Modifications. However, I would like to suggest this be revisited as it is next to useless for me as a paraplegic recipient.  For me to be more independent in my home, I need larger-scale contract work done. For example, in my 2 story home, my bathroom is upstairs and to pull out the tub and put in a wheelchair accessible shower, that fee is over and above the annual $5000. There is a half bathroom downstairs, but to add in a wheelchair accessible shower, would be above and beyond the currently allowed $5000. Additionally, I would benefit from a minor kitchen renovation including a kitchen counter that I could roll up to and safely access a stove. Currently, I cannot cook as I cannot reach the stove top knobs nor can I see from my wheelchair what would be inside of a pot. Such a renovation in my kitchen is over and above the current annual $5000 allowance.  I would like to suggest that an either\or option be included with EM. Perhaps every 5 years, recipients can be eligible for a $25,000 EM.  That way, I could pool they annual allowance and eventually be able to make modifications to my home to make it safer and more accessible for me. Currently, with the annual $5000, there isn’t much that I can do. This year, I was only able to widen a door. While I am grateful for the annual amount, as it is better than nothing, however, it really isn’t a drop in the bucket for what my environmental needs are.
3. We are on the HIPP program therefore we are exempt from the MCO. Because we do not have a case manager, I feel like I am left floundering in many instances. For example, when I needed some Adaptive Technology, I did not know how to navigate the process. I asked my Service Facilitator however they stated their job only encompasses the Consumer-Directed portion of the CCC Plus Waiver. So I was left to my own. I contacted a few of my doctors and while they did the best they could in suggesting routes to try, there wasn’t a definite policy and procedure manual for us to follow. Additionally, when I knew that I wanted a contractor to look at my bathroom for a possible environmental modification, there wasn’t anything in print for me, the recipient, on how to access the appropriate people who could assist me in getting that ball rolling. A CCC Plus Waiver Manual would have been helpful.  This would also put all recipients on a level playing field, whether they have a case manager with an MCO or not.
4. As far as the Environmental Modifications and the Assistive Tech as mentioned above, after a few months of fumbling and bumbling and hitting many dead ends, we happened upon Ability Unlimited. They seemed like the answer to all of what we needed, and they boasted that they could do it within a matter of a few weeks. That was in the spring of 2018. They have dragged their feet, we have followed up time and time again however to date, we still do not have in place what they said would take “a few weeks”…it has been 18 months! So while we may have an annual $5000 limit for various benefits, that’s not a reality when the vendors drag their feet and take over a year to process and get all of the paperwork and resources in order. If a CCC Plus Waiver Manual existed, with specific policies and procedures printed and in place for each of the advertised benefits, a recipient would be able to advocate better for themselves. I would have liked to “fire” Ability Unlimited however not knowing any other vendors who had the qualifications that DMAS required, I felt stuck and locked into this one vendor. Still, after 18 months of waiting, I still do not know who else to approach.

RE: CCC CD EOR Manual, July 2019 DRAFT:

Pg 4: “CD services are available in the following VA Medicaid waivers and benefits:

CCC Plus waiver

CL Waiver

FIS waiver

EPSDT Benefit

Are recipient manuals available for each of the above waivers and benefits?

Pg 4: Terms to Know (Services Facilitator)

1. I would like to see more specifics on what the SF are and are not permitted to discuss and the frequency that they may visit. We have had 2 different Service Facilitating Agencies in the past 10 years that my daughter as been on a Waiver. The first agency visited once every 60 days, and stayed in my home for about 10 minutes, asking questions specifically about my attendants, timesheets, etc.

The second agency we worked with currently visits once every month and asks numerous questions, varying from each and every one of my daughter’s medical appointments, to her behavior, changes in my health, my daughter’s sleep patterns, her socialization, her IEP at school, my work hours, my husband’s work hours, and our involvement in the community. These are very personal questions and I find them intrusive. The current SF visits every month and stays for upwards of 30 minutes. I am not sure whether these questions they ask are within their bounds or not but if there were a CCC Plus Waiver Recipient Manual, I would know for sure what is permissible and could better advocate for my daughter and my family’s privacy.

If the SF job is strictly to assist with hiring and firing attendants, then if a recipient has a stable attendant without any issues, then there is no need for such frequent visits with detailed/intrusive questions. And if the SF job is to facilitate all aspects of the CCC Plus Waiver, then the definition of Services Facilitator on page 4 needs to be revisited, and the SF agencies need to be properly trained.

Pg 4: Terms to Know:

Need to add and define EVV

Pg 5: Benefits of consumer-direction…

Reading that list sounds so heavenly however, the negatives that we have faced for the past 12 months seem to overshadow the supposed benefits.

I’d argue that rather than the proposed draft “increased flexibility,” is grossly incorrect as working relations with CDCN after they won the bid over PPL, combined with the mass confusion related to EVV and CellTrak, there is INCREASED FRUSTRATION and INCREASED RIGIDITY.

I would argue that “accommodates individual needs and preferences” in the proposed draft should rather read, “caters to the bureaucracy rather than the individual needs.”

And on the last bullet point, while I agree that the consumer has the opportunity of choice who provides services, the reality is that finding a new attendant is next to impossible with the hoops they must jump through and adhere to (EVV) for a measly single digit dollar per hour.

Pg 5: Back Up Support Plan:

“Individuals who do not have a backup plan are not eligible for CD services.” This seems backwards to me, I think the government has this wrong.  As an American citizen with honesty, integrity, and justice composing my character, I happen to have a daughter with disability.  Leaning on my support system, I see my primary support system as being my family, friends, and neighbors.  It is the government Waiver that is my back-up plan. It seems completely asinine for the government to require me to have a backup plan, for the backup plan.

STOP evv. Isn't it enough on people that are DISABLED and the attendants caring for them without having extra burdens placed on them such as this restrictive socialistic evv. It is DAMAGING to the DISABLED COMMUNITY.What kind of law is this attacking the DISABLED as if they are CRIMINALS. As my DISABLED daughter would say WHAT'S NEXT THE MEN IN BLACK,ATTENDANTS FOR ATTENDANTS, OR perhaps DRONES. This is not HELPING the DISABLED COMMUNITY but CREATING more kaos than anything.  99% of the DISABLED COMMUNITY is NOT happy about this invasion of privacy. Again WE ARE NOT CRIMINALS.

evv is very time consuming. It makes it difficult for me to hire attendants. I never want to live in a nursing home. 

Most of the country, including Texas, New York, and California requested an additional year to hold off EVV so advocates can continue to get it removed from federal regulations.  Why is Virginia not looking out for its citizens who are disabled and are using a service to keep them out of nursing homes and other costly facilities? You are making that service obsolete by imposing EVV which adds costs to a job it is already near impossible to staff.  Please DMAS put in for the good faith effort waiver. CMS says you still can.  Also PLEASE exempt live in providers.

Many persons want to speak out against EVV, but are in fear of retribution from DMAS and DBHDS.  Then there are those that are dealing with a disability and for one reason or another cannot speak out and are at a grave disadvantage.  So, for every person posting on here, please know that there are twice to three times as many wanting to speak out against EVV and the difficulty it has caused everyone. 

about requiring everyone in cl and fis waiver to now have to jump through the hoops with the ccc+ mco to access cdpa services .... cause you know the disabled need 3 sets of social workers telling them how to run their lives to stay out of state facilities :( 

Not everyone is qualifying for the free phones.  The free phones often do not work especially in rural locations.  How is asking someone to drive to wifi to download their times/locations two times a month not asking the consumer to pay for secondary services to receive their home care?  Tax write off for mileage is currently .58 cents per mile.  That is the general cost of wear/tear and gas to get around these days.  A trip to wifi could easily cost $20 to $30 round trip.  Twice a month is $40 to $60.  Yes, everyone runs errands, but these errands will rarely coincide with the direction the consumer is going or the consumer's time frame, so it will end up being a purposed trip just for EVV.  How is asking someone to download an app. onto their personal phones not asking the consumer to have to pay for secondary services? How is asking the consumer to buy and use a tablet, phone,  or other device to comply with EVV not asking the consumer to pay for secondary services? 

i actually think it is wonderful dmas is trying to make a smother transition from

ccc+ waiver to the dd waivers 

the reason some clients can’t get it is because they don’t have a credit history and the companies won’t give them out without that.   Also I know it is hard for some to believe but many attendants don’t know how to use a smart device. 

Please exempt live ins.  The app. is too hard to work with.  There were enough problems with the portal as it was.  It is too hard to handle a disability along with trying to manage EVV. 

It is very hard for someone working at DMAS making over $150,000 a year, government salaried (typically 40 hours), with all benefits to understand that requiring a person to clock in and out at specific times in their residence is not easy.  That is why everyone should have been involved in the decision making regarding EVV including those required to use it, not just those with comfortable salaries and healthy, able bodied loved ones.  The majority of persons being required to use it did not find out about it until fall 2019. There were no stakeholder meetings involving the very persons who are subjected to having to use EVV. 

We are only "able-bodied" temporarily.  Disability happens to all. 

Would those making a comfortable 150K plus per year want these live-in conditions for themselves if their loved one became disabled? :  $9/hour, no job security, no benefits, no paid sick days, no paid holidays,  no career track, pay for all transportation into the community with that $9/hour, beg a loved one or friend to be an EOR voluntarily, ask the EOR to submit their socials voluntarily,  24 hours on-call, remembering medical routines, worry constantly that the EOR will quit, worry incessantly about getting sick and not being there, have two government funded home visits a month subjecting their home to scrutiny, etc...? 

Now add to all that being tied to a timed device because of EVV every single day of their lives.  This isn't a situation where you are coming or "visiting" a job and you can clock in coming and clock out going - this isn't McDonald's.  You live there.  You must constantly watch the clock, so that you can clock in and out even though you are on call 24 hours a day and you work more than the set of hours given as a live-in.  Your home should be your sanctuary, not an office or a space where you are subject to constant worry about the clock.  You worry you will forgot and there will be no pay, wrong pay, loss of services,  etc....  You worry you will spend your whole day straightening out payroll issues as a result of EVV.  You worry your power will go out.  You worry your device will be lost.  You worry the device will break.  You worry about being tracked at a minimum of twice a day.  You worry about where all this information about you and your location/habits is going. 

To think all the trouble of EVV for live-ins could be exempted and is exempted at the Federal level, and the state chose to include live-ins is unbelievable. To know that decision was made without consulting all stakeholders by those making salaries that are within the top 5% of the nation's government salaries is unconscionable.

Ask for the good faith exemption.  Exempt Live-ins. 

Seventy percent of the states have applied for the good faith exemption for EVV.  There are several issues, bugs, and problems with the whole program that are displayed on this townhall, many have written Va state reps with their concerns, and a simple internet search can bring up many reservations regarding EVV.  Virginia, apply for the good faith exemption.

Chapter TWO

Pg. 8 Delete last bullet under Duties of the EOR, as the system for signing, submitting timesheets has been eliminated with the introduction of EVV.

Pg. 8 Role of the SF:

1st check mark- what services is this referring to? Just CD Services? or ALL Waiver benefits? Verbage needs to be more specific.

"Submit Requests..."- Does this include Environmental Modifications and Assistive Tech? Before I got connected with Ability Unlimited, I asked my SF if they could submit to KEYPRO and they said, "no, that is out of my scope...that comes from the contractor, or a case manager. As a Waiver participant without a MCO, I need to know who needs to submit my EM and AT requests.

And "service authorizations" is very broad...Physical Therapy authorizations? Wheelchair repair authorizations? A Speech Eval Authorization? Surgery authorization? If this is to be a State Manual, it needs to say what it means and mean what it says, leaving no room for uncertainly or question, be very specific.

"Document services as required by DMAS"- again, what specific services are required? Is there a specific form or web-based service report template? Be very specific.

Lastly in this section- "Assist EOR with filling out paperwork for the FEA." I remember a time when my SF could check in the PPL system and see the status of my new hire. And when the switch to CDCN occurred, my SF, was not able to gain access to the CDCN web-based system. As I understand, to this day, my SF does not have access to that system.

pg.9- How frequent and what does a reassessment visit consist of? What is being reassessed? Is there a specific form?

Need much more detail on “conduct annual level of care review process.” What does that process entail? When it is due? Ultimately, who receives a copy of the review? What is that “process?”

Re: The F/EA is responsible for…

“Management of enrollment packets”- here are my thoughts:

I have hired six employees with CDCN as my F/EA. Their enrollment packet management system is inexcusable. Not a single one of my 6 new hires within the past 6 months have EVER gotten things taken care of in a timely manner. One of my latest hires went from completing her packet the first week of September until the beginning of November working without receiving a pay check. In that time, I called, emailed, left messages for CDCN requesting a status check. My employee told me that she could not continue working without a paycheck.

Early on in January 2019, I hired 2 employees at the same time. I USPS Certified Mailed BOTH of the Child Protective Services notarized forms, to this day, CDCN nor the USPS has confirmed that they were ever received. According to my tracking receipt, they are in a sorting facility in Richmond. Due to this mishap, and CPS requiring that original form, this creates a lengthy delay in an employee’s ability to work as they need that “good to pay” status. Is there a way to expedite that CPS background check, perhaps eliminating the need for CDCN to need to ORIGINAL form? Is there a reason why the Criminal Background can be scanned/faxed/emailed and the CPS needs to be mailed?

With CDCN, the EOR and the Attendant have to be registered on the Portal. And all 6 of my hires within the past year have done so, as have I, the EOR. Eventually, my Attendants receive “Good to Pay” emails. However, there appears to be a glitch at this point as they can log on to the timesheet area but they can NOT see the Recipient listed. And I can long into my Portal and I can see that they are NOT listed as caregivers. So we have to email/call/leave a message asking them to link the 2 accounts. This should be automatic if CDCN is sending a “good to pay” status update. CDCN should not be permitted to send a “good to pay” status update until the 2 accounts are linked.

Sometimes CDCN will send my Attendant an email stating they are “Good to Pay” and can begin work. Sometimes CDCN will send me, the EOR an email. There does not appear to be a standard procedure on notifying both Attendant and EOR, of which there should be.

Lastly on pg. 9 “Answer all questions that the EOR and attendants….” Without any hesitation, this needs to be edited to include a time limit. CDCN has been delinquent in responding to my attempts to contact them as well as my Attendants attempts. As attendants and EOR work round the clock, it would behoove CDCN to increase the evening and weekend hours, as the questions and issues have been prevalent and receiving a timely answer to enrollment, payroll, EVV, timesheets, hours has been frustrating.

Pg.10 Last 4 lines...I believe this procedure outdated? I don't recall my SF ever contacting the F/EA to request an enrollment packet. I have always accessed the enrollment packets myself via the website of the F/EA.

Pg.11

Employer Management Training- It seems to me that the majority of the job description of the SF is to train the EOR on how to be an employer including hiring, supervising, training, and firing attendants. That appears to take place withitn the first 7 days of the initial comp. visit. So if this is the crux of their job description, and it has to be done within the first 7 days, then what are the monthly visits for? I’ve had this waiver for well over 10 years and that once a month visit is burdensome. I can certainly understand a once per quarter visit, or an “as needed” visit, but if they are only there as a coach to help the EOR for the management aspect, after a while, those visits are so redundant and pointless. However, if their job encompasses more, then those job roles need to be spelled out and there should be more detail on what services the SF are providing.

RE: IMPORTANT, midway down the page:  In light of that paragraph, may I ask is it the EOR responsibility to also pay the attendant out of pocket when the attendant has been in “good to pay” status for several consecutive pay cycles however CDCN can’t get their act together and link the Consumer and Attandant’s web portals? My current Attendant went 8 weeks working without pay as CDCN couldn’t get their act together. She told me, “I can’t work for free anymore.” And she has not been the first attendant that this has happened to.

RE: TIMESHEETS- This section needs to be updated to reflect the current EVV policy

Re: SF FOLLOW-UP VISITS- I feel that my SF hands are tied. The SF has no authority over CDCN and as far as I understand, CDCN has not allowed SF to access their system in order to check on the status of a new hire.

Pg. 12 “The SF must visit the individual once every 30 to 90 days if personal care services are being provided or as needed and/or requested by the individual.”

This is clear as mud. Does this mean that if the individual does not request, nor do they feel the need a visit from the SF that it doesn’t need to occur? Or does it mean that it has to happen once between every 30 and 90 days, and more frequently if needed?

I have utilized CD Services for the past 10 years and the monthly home visits have become so redundant and it’s just another visit to schedule and arrange to be home for. I’d suggest quarterly or every other month visits.

I have hired 2 people since the transition to cdcn from ppl and both were able to work within 3-4 days ... I am however not dealing wit cps forms.  I think cdcn did a much better job. We can email on the forms and everyos fine in days... with ppl it took then 2 1/2 months onetime to process the hire paperwork 

Chapter Three

Pg. 13

RE: “service plan identifies the following: tasks that the attendant will perform on a daily basis, or as needed.”

Based on DMAS-487, I don’t see where “as needed” is able to be notated. Either that needs to be added to the 487 OR the “as needed” needs to be deleted from the EOR Manual, page 13.

I would like to comment on something that would only apply to teenagers on the waiver. As I understand, there are certain ADL’s and IADL’s that individuals under the age of 18 are unable to include on their Service Plan/Plan of Care and on the DMAS 7A, specifically Meal Preparation, Grocery Shopping, and Transportation.

My daughter is eligible for Department of Aging and Rehabilitative Services (DARS) services at the age of 14. The public school system also begins to work with students at 14 years of age as they begin to shift the focus to transitioning to adult life. For teens ages 14-18, there are many of those transition skills that the Attendant could help with would be beneficial and helpful as it will make the recipient all the more independent. However, we cannot utilize the Attendant for such as we’ve been told that anyone under 18 cannot have those sections as part of their plan. These ADL's are indeed an important part of our daughter’s Plan of Care she is able to learn how to create a healthy lunch, make a shopping list, and go grocery shopping. These are skills that will inevitably keep her out of a facility and perhaps independently living on her own.

While Transportation is N/A to my daughter right now, and while she may never drive, I guarantee that learning the local public transportation system will be part of her plan of Care before she is 18. And that means that I send her and her Attendant out to navigate the local public transportation routes for them to get to the Library or the Mall. Again, I feel this needs to be revisited and looked at as an exception for those working towards transitioning to independence.

Additionally, another area that individuals under the age of 18 are unable to include on their Service Plan/Plan of Care and on the DMAS 7A, is Clean Areas Used by the Recipient. We are teaching our teenage daughter independent living skills. She has a service dog that assists her with picking things up that she has dropped, turning lights on and off, carrying things for her, and pulling objects such as laundry baskets. Our daughter has to be a responsible pet owner and clean up after her pet, which involves sweeping. Her chore is to sweep the dog hair, and therefore, it is the PCA's job to oversee that she is keeping her area clear of pet hair by utilizing a broom from her wheelchair and learning to manipulate a hand held vacuum on the stairs.

I would like to suggest that this be an exception for recipients who are actively pursuing Transition Services with DARS, or who have specific independent living skills listed in the service plan. Specifically Cleaning Areas Used by the Recipient, Grocery Shopping, and Meal Preparation as the IADL categories.

Additionally, the Service Plan needs to be more considerate of the timeframes when care is required/needed. It is unrealistic to put specific hours on the service plan and not to deviate from those hours. With all of the various factors that affect the schedule of a special needs family  (doctor’s appointments, illnesses, therapies, summer schedules, Spring Break Schedules, family appointments, school, community activities, etc…) it is difficult to pin point specific times that the Attendant is needed in the Plan of Care. For our family, we have a rough idea listed in the Service Plan however, this can change week by week and sometimes day by day, depending on what is going on. I would like for the Recipient and EOR to be able to have flexibility with the Plan of Care hours and altering them as their schedule needs. I don’t like that I’m told that I can only have my attendant clock in and out during the hours designated on my Plan of Care. If my POC states 12-5 but I need to take my daughter to a DR appointment at 1pm, and could benefit from the Attendant working 3-8, I want to have that flexibility. I’d like to be able to schedule based on the current need vs what the POC dictated 6 months ago when it was written.

Chapter FOUR

Pg. 15

Re: Documentation- I assume that w/ EVV all timesheet documentation is kept by the Fiscal Agent, and is the CellTrak Ap and CDCN Web Portal sufficient enough for this documentation responsibility. IF this is the case, this needs to be updated as the EOR more than likely does not have anything on paper such as timesheets.

DMAS Reviews- It would be beneficial for DMAS to put in the manual exactly what “documentation” they would be requesting for audit purposes. I try to keep organized, but a checklist of what they would be looking for would be most beneficial.

RE: Enrollment Packets- this has taken a painfully long and inexplicably amount of time with CDCN. I submitted via scanned and uploaded, the employee Packet on October …. minus the Child Services Form as that needed to be mailed via USPS.

On October 7, 2019, I received a “Good to Pay” notice for this attendant. (Even though I had yet to mail the Child Protective Services Central Registry Authorization). On October 14^th I mailed the Child Services Background Check form as CDCN requires the original signed form. Today is November 20^th and today I received an email from CDCN requesting the original DSS form. They also stated that this Attendant’s account is now on hold until this can be resolved. So I have thought for the past 5 weeks that all was good, come to find out, apparently CDCN never received it.  For this particular attendant, she now has to fill out the form AGAIN, take it to be NOTARIZED AGAIN, and use good ole USPS to snail mail it to CDCN who then sends it to DSS.

RE: Criminal Background Checks/Child Protective Services Central Registry

CDCN permits the Criminal Background check to be scanned/emailed/faxed. CDCN requests the ORIGINAL signature for the CPS Central Registry. This has caused much frustration with the new attendants I have hired within the past year. I scan and upload the entire employee packet and I USPS snail mail the CPS Central Registry notarized form to CDCN in Richmond. They do not notify me when they receive it, nor when they have completed the check.

Early on in January 2019, I hired 2 employees at the same time. I USPS Certified Mailed BOTH of the Child Protective Services notarized forms, to this day, CDCN nor the USPS has confirmed that they were ever received. According to my tracking receipt, they are in a sorting facility in Richmond. Due to this mishap, and CPS requiring that original form, this creates a lengthy delay in an employee’s ability to work as they need that “good to pay” status. Is there a way to expedite that CPS background check, perhaps eliminating the need for CDCN to need to ORIGINAL form? Is there a reason why the Criminal Background can be scanned/faxed/emailed and the CPS needs to be mailed?

Of the 6 employees that I have hired in the past 12 months, we have had to RE-NOTARIZE and USPS snail mail 50%- 3 of those CPS forms. One of those employees said, “Forget it. I need to get paid now, I can’t sit around waiting.” And I lost that employee. In fact, she was on “good to pay” status and even submitted 2 timesheets…that is one month without pay, with working!  However, because CDCN did not communicate that they were still lacking the Central Registry for this Attendant, they have placed this Attendant’s account on hold. I doubt she will ever see her paycheck.

Due to this consistent mishap, and CPS requiring that original form, this creates a lengthy delay in an employee’s ability to work as they need that “good to pay” status. Finding an attendant who will put up with the wait is next to impossible. Having hired six employees in the past 12 months is evidence that the Attendants are not putting up with the frustration and red tape that CDCN creates. They are gaining work elsewhere, and they are GOOD people! It takes a Lot for me, the EOR to find someone who will perform their job tasks with integrity. So when I find one, I really would like to keep them. However, when they don’t get a paycheck for 5, 6, 8 weeks, I really don’t blame them!

Is there a way that that DSS Central Registry Form can be expedited via scanned copy?

Pg. 16

Re: Scheduling- I would like to suggest the two words “within reason” to the 2^nd sentence. Service Plan needs to be more considerate of the timeframes when care is required/needed. It is unrealistic to put specific hours on the service plan and not to deviate from those hours. With all of the various factors that affect the schedule of a special needs family  (doctor’s appointments, illnesses, therapies, summer schedules, Spring Break Schedules, family appointments, school, community activities, etc…) it is difficult to pin point specific times that the Attendant is needed in the Plan of Care. For our family, we have a rough idea listed in the Service Plan however, this can change week by week and sometimes day by day, depending on what is going on. I would like for the Recipient and EOR to be able to have flexibility with the Plan of Care hours and altering them as their schedule needs. I don’t like that I’m told that I can only have my attendant clock in and out during the hours designated on my Plan of Care. If my POC states 12-5 but I need to take my daughter to a DR appointment at 1pm, and could benefit from the Attendant working 3-8, I want to have that flexibility. I’d like to be able to schedule based on the current need vs what the POC dictated 6 months ago when it was written.

RE: Timesheets-

This section needs to be updated to reflect the current EVV mandate.

The process of how the SF, DMAS, Fiscal Agent, and in some cases, the MCO all remain on the same page as far as number of approved hours and the hours for Attendant Care in the Plan of Care needs to be published in the Manual.  If a recipient is approved for 30 hours per week from DMAS but the fiscal agent is saying that they only see 25, what is the proper chain to follow in order for that situation to be rectified?

Pg.17

RE: Medicaid Payment in Full- “The pay rate is determined by the VA General Assembly and is not negotiable. Attendants may not be paid any extra above this rate.”

How is this enforced?

Pg.18

Re: Important Information

Please reconsider some of those circumstances when the recipient is a minor. When the minor is in the hospital, and if the parent must be at work or attending to other children, it would benefit the recipient to have someone with them of whom they know and trust.

EVV is outrageous to even believe is going on.  Our lives are so difficult as it is.  The bureaucracy of living with a disability is a never ending paperwork nightmare.  Year after year.  Constantly proving a disability that is obviously never going to improve, only progress!  Hiring attendants constantly.  How many others will not be able to cope with the additional burden of EVV.  Virginia has driven the consumer and their families to the point of giving up all hope of any semblance of a life that is even OK. 

Evv is horrible! We clock in and out 6 times a day.  Everyday revolves around alarm clocks going off, so that we don't miss times.  Makes me sick that my child will be subjected this the rest of their life just to get daily assistance!

Virginia Premier said they were not going to be getting the "bugs" out any time soon in the EVV system.  We are not guinea pigs for the software engineers.  This is too stressful. Ask for the good faith exemption, please.

What a way to help caregivers by making their jobs twice as hard with EVV.

today celltrak kicked everyone or numerous people out of the system ... celltrak is blaming cdcn ... 

We cannot registered back in until cdcn unblocks us all... (imagine how difficult this is for someone who isn’t tech savvy like the typical person who is willing to work for $9.40 an hour with absolutely NO BENEFITS) 

please Virginia get the good faith exemption for the year and exempt live ins 

in Virginia stakeholders were not given the opportunity to participate in the process as required by cms.   No one knew what dmas was going to do to us. We have no one else to complain to. Some stakeholders feel dmas intentionally attempted to shut down advocates when the one page evv summary was sent to Virginia law makers to give to constituents who went to the law makers to ask for relief in this restrictive process.  70% of states have asked for the good faith one year waiver. Virginia could exempt live ins.