The Arc of Virginia’s Comments on DD Waiver DRAFT Manual  Nov. 11.4.2021 

The Arc of Virginia is offering the following comments on the Draft DD Waiver Manual - Chapter 4.

We appreciate the format that includes the Table of Contents for the manual, chart of services by waiver type and identification of incompatible services.

The manuals contain valuable information for those who use waiver services. If the manuals are placed on the Member Page of the DMAS website then they will be much more accessible for the users of DD Waiver.

Waiting List Priority Status and Criteria 

Priority One designates four criteria including:

“The individual is a young adult who is no longer eligible for IDEA services and has expressed a desire to live independently.  After individuals attain 27 years of age, this criterion shall no longer apply.”.

Comment:

DBHDS has added additional requirements for a person to meet this criteria. If a person meets the criteria (above) in the manual but it does not specify that there are additional requirements to meet Priority Level Onem it is misleading.

Peer Mentor  

“The peer mentor has face-to-face contact with the individual to discuss his/her specific interests/desired outcomes related to realizing greater independence and the barriers to achieving them;  The peer mentor explains community services and programs and suggests strategies to the individual to achieve his/her desired outcomes, particularly related to living more independently, engaging in paid employment and expanding social opportunities in order to ultimately reduce the need for supports from family members or paid staff;  The peer mentor provides information from his/her experiences to help the individual in problem solving, decision making, developing supportive community relationships and exploring specific community resources that promote increased independence and community integration;  The peer mentor assists the individual in developing a personal plan for accessing the identified integrated community activities, supports, services, and/or resources. 

Contacts between the Peer Mentor and the individual who is receiving the waiver may be in the form of face-to-face or remote technology that allows the Peer Mentor to view the individual and converse with him.” 

Comment: For clarity and consistency add “or remote technology” after “face to face” in this statement  ““The peer mentor has face-to-face contact with the individual to discuss his/her specific interests/desired outcomes related to realizing greater independence and the barriers to achieving them; 

We strongly support The VA Board for People with Disabilities’ comment below:

Personal Assistance: Agency-Directed and Consumer-Directed Services, page 189

Page 189 of the draft manual describes Exemption of Nurse Delegation Requirements in the CD Model.

For CD services, the Code of Virginia § 54.1-3001(12) states: “any person performing state or federally funded health care tasks directed by the consumer which are typically self-performed for an individual who lives in a private residence and who, by reason of disability is unable to perform such tasks but who is capable of directing the appropriate performance of such tasks” is exempted from the Nurse Practice Act and nurse delegation requirements.

Key requirements for the exemption from nurse delegation requirements, which must be performed in accordance with 18VAC90-19-240 through 18VAC90-19-280

· Applies to consumer-directed services only,

· Applies to tasks that are “typically” self-performed,

· The individual receiving service must be capable of directing the attendant in the appropriate performance of the task,

· The individual must live in a private residence,

· The individual must be unable to perform the tasks due to a disability.

Comment: The VBPD recommends that DMAS follow the key requirements for the exemption of nurse delegation and allow a provider of CD personal assistance services to support the prescribed use of medication, including assistance with medication administration,  in cases where the medication would normally be self-administered by the individual but for their disability (for example, placing pill-form medicine on an individual’s tongue, support with the use of a metered-dose inhaler).  

Some states, such as Louisiana, refer to such support as “Self-Guided administration of medications” and describe it as follows: The client may not physically be able to self-administer medications or perform other health care tasks for themselves but can accurately guide the worker through the process to do it for them. The role of the worker in client guided care is limited to performing the physical aspects of health care tasks such as administration of medication under the guidance of the client for whom the tasks are being done.

The Nurse Practice Act explicitly exempts this type of support, and it is allowable under the key requirements detailed in the manual. If an individual receiving CD personal assistance services is capable of directing the attendant in the appropriate performance of self-guided administration of medications, they should be able to do so as part of the personal assistance service. Not allowing such support effectively excludes many people from CD services who are otherwise capable of directing their health care tasks as described in the NPA. It is a barrier to full participation in community life, achieving greater independence, and self-determination.” 

The Arc of Virginia appreciates the opportunity for all  stakeholders to offer comments for consideration on the Draft Manuals.