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Board of Medical Assistance Services
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11/4/21  10:56 pm
Commenter: Karen Tefelski

COMMENTS - DD Waiver Manual - Chap 2

CHAPTER 2 - DD Waiver Manual - 30-Day Public Comment - vaACCSES

General Comments:

  1. Manual needs to clearly delineate the responsibilities and requirements for Support Coordinators to perform from service providers. It is confusing throughout the Manual with the mixing of lists of responsibilities. Would be helpful to list separately or specifically reference who is responsible for what requirement.
  2. Although Service Facilitation is listed at the beginning of this chapter as a DD Waiver service, it seems to be the only service excluded from having its own section in Chapter 2.

Page 3 - Participating Provider - Bullet 2 - Include licensing regulation citation. Are we now requiring criminal history checks for non-licensed providers? What type of criminal history check for barrier crimes is required of non-licensed service providers? Do they have access to the required licensing service if not a DBHDS licensed provider? Why is the last sentence in the paragraph underlined?

Page 3 - Participating Provider - Bullet 2 - DBHDS Licensing Regulations require the VDSS Child Protective Services Central Registry for all providers even if they do not provide services to children. Is this bullet intended that this be required only for providers serving minor children?

Page 4 - Sub-Bullet 1 - This is new and not included in the DD Waiver regulations.

Page 4 - Sub-Bullet 4 - Bullet is repeat of the last sentence in Sub-Bullet 3.

Page 5 - Bullet 4 - States "Accept training on Crisis Education and Prevention Plans....".

Comment:  Is this a new additional training requirement?  When is it required to be done? How often will it be provided? Required before seeing clients? Why is it underlined?

Page 5 - Bullets 5-6 - Why are bullets underlined?


Page 6 - Bullet 4 - States “Accept Assignment of Medicare benefits for eligible Medicaid Individuals.” 

Comment:  Please clarify and provide additional information. This line does not appear in the regulations. Additional requirement is more prescriptive.


Page 7 - Bullet 1 -
Recommend language change to “Support activities and support instructions that are inclusive of skill-building when required for the specific service provided and that are designed to assist in achieving the individual’s desired outcomes.”
Comment: Skill building is not required for PCA, Respite and Companion services under the CD model.  This needs to be clarified.


Page 7 - Bullet 3 - Sub-Bullet 1 -
The manual should match the regs, and it should read, “Providers shall prepare and maintain unique person-centered written documentation in the form of progress notes or supports checklist as defined by the service.”


Page 7 - Last Sub-Section - Bullet 3 -
Comment: Define staff in "Notes that are not signed and dated by staff who deliver the service, with the date services were rendered".  Clarification regarding how this applies to the PCA or the SF?


Page 8 - 2nd Bullet - States “Document and maintain written semi-annual supervision notes for each Direct Support Professional (DSP) that are signed by the supervisor…”

Comment: For clarity - define frequency as “every 180 days” versus semi-annual.


Page 10 - First Paragraph Continued from Page 9:

Comment:  It should be noted and clarified


Page 10 - Bullet 3:-
Comment:  Further explanation and clarification is needed regarding medication administration.  Further clarify who can and can’t administer medications.  PCA's under CD cannot administer meds. 


Page 11 - Individual Rights/Responsibilities

Comment:  Where did this list come from?  Recommend including Office of Human Rights and HCBS Rights.


Core Competency Requirements

Page 21 - ADD/INSERT New Paragraph 2 under Core Competency Requirements - . Recommend adding definition of DSP included in the DD Waiver regulations (12VAC30-122-20) for clarity and transparency.

Page 21 - ADD for clarification that this section does not apply to CD services.


Page 21 - Agency Types and Services:
:  Although included in the DD Waiver Regulations, and thus, in the Waiver Manual - there is no authority to require ISE and GSE to adhere to these competency requirements. Since 2019, the Appropriations Act includes language that exempts ISE and GSE from DBHDS staff competencies when staff are Certified Employment Support Professionals (CESP) or have ACRE certifications, or they work for a SE provider that holds a national CARF accreditation. The Appropriations Act authority supersedes regulations and manual language.

Page 22 - Training, Testing and Assurances Requirements - 2nd to Last Paragraph
  The DSP orientation exam will have new supplemental materials in addition to the 2016 material that is required of those onboarded 11/15/21 and after. This will need to be updated in Manual.

Page 23 - 3rd Paragraph - The assurance documents at the link have incorrect form numbers.

Page 24 - First Sentence -  Recommend using the Waiver Regulation language here. According to the new Waiver Regs 12VAC30-122-180 - Orientation testing; Professional Competency requirements, advanced competency requirement. B.4.4. Providers shall ensure that supervisors of DSPs complete the competencies checklist (DMAS Form P241a) for each DSP they supervise withi 180 days of the DSP hire date and complete annual updates thereafter.  For sponsored residential services, the date of hire can be the date that the sponsor begins providing service in the sponsored home setting.

CommentID: 116675