Chapter 4 - Nursing:  The requirement to have the plans renew ever 6 months is a heavy burden not only on the providers but also on the medical community.  We have a difficult time locating good medical partners for our individuals with complex needs.  We are at their mercy in getting signatures.  It's a time consuming struggle for a  provider to have to constantly check back with them.  Please continue the nursing plan to coincide with the person's annual ISP. 

The reduction in the allowed hours of skilled nursing services from 42 to 21 hours a week is detrimental for many of those we support.  Many have been forced to change from skilled to private duty nursing.  Some of these individuals had 24 hour nursing while at NVTC.  Their needs have not decreased.