The Choice Group: DD Waiver Manual Public Comment

Chapter 6:

Bullet 1, 3rd sentence -
Comment:  What is considered to be "the individual's record"?  Add specific reference to what record.  Is it enough to document these things in a provider’s system?  Also, what is classified as "any substantial change"?  And what specific "documentation of such change" is required? Please add specificity.

Chapter 4:                                       

1. Chart with “Corresponding Regulations” and BI, FI and CL columns are a helpful visual and provide clarity regarding regulation reference at the beginning of each service.  We recommend that a chart be used for all services in Chapter 4. (See page 78 as example).
2. There is an overall need to clearly delineate the responsibilities and requirements for support coordinator actions versus service provider actions.  Ideally, support coordination would either have a companion Manual or minimally, within the Waiver manual, have clear sections within chapters and/or services. Possibly, even a separate chapter with ONLY the Support Coordination requirements and responsibilities. The lack of separation and specificity are confusing regarding responsibility and requirements of “providers” throughout the Manual.  The question asked often throughout is “which provider is responsible

Table of Contents & Service Option Charts:
Corrections Needed:

• Individual & Family/Caregiver Training is incorrectly marked as included in the BI waiver - should be FIS Waiver
• Workplace Assistance Services is incorrectly marked as only being included in the FIS Waiver - it is also included in the CL Waiver.

60 Day Assessment Service Authorization Requests

Page 22:

Comment:  Would prefer that the language used provide additional clarity than the 60-day assessment is an option (“may”) - but not required. Recommend - “Provider has the option to request a 60-day assessment prior to initiating plan for supports.”

Page 23:  Provider Discontinuation of Services.

Comment: Regarding 10 business days advanced notice in writing. This is not always possible. Individual Supported Employment (ISE) services, for example, will end when an individual quits or is terminated from a position and DARS categories are open. Would prefer language that better reflects that this is best practice when possible but not required. Additionally, it indicates that in a situation in which health/safety concerns are the reason for discharge, DBHDS must be notified – who at DBHDS is to be notified?

Individual and Family Caregiver Training

Page 70:
Indicates that contact notes, monthly notes, and quarterly reports must be completed. This is more than the regulations require.  Is also duplicative. It is also more information than is required for other services.  Other services require a quarterly review. Clarification is needed if monthly summaries are needed when there is a quarterly review being completed.

Benefits Planning
Page 90: Criteria/Allowable Activities
1^st Paragraph
Comment:  DELETE “or” before “employment status” and ADD “or need for work incentives”.

Page 94:
Paragraph 1:  Indicates that this service requires face to face contact.
Comment:  Regulations do not specify that this be a face-to-face contact.  Alternative options must be available including telehealth and virtual options. Overly prescriptive and not included in regulations.

Page 95: Mid-page - Bullet 1 -
Comment:  ADD “or is not available” after “have been explored and exhausted”.  Also, please clarify what documentation is needed to fulfill the requirement of “explored or exhausted”.

Page 95: Mid-page - Bullet 2 - Indicates there should be documentation of “All correspondence to the individual and the individual's family/caregiver, as appropriate, the support coordinator, DMAS, and DBHDS”
Comment:  Should also include “DSS and SSA as appropriate” for this particular service.

Supported Employment Services

Page 119: Criteria/Allowable Activities
Comment: 

• Recommend that bullets be entirely realigned AND be delineated between Individual SE and Group SE.
• The first sentence indicates that there is one element that is limited to ISE only. However, there are seven elements listed and are provided in GSE services. The “this element is limited…” should be at the end of the previous bullet.  It should state - “Individual job development, with or without the individual present that produces an appropriate job match for the individual and the employer to include job analysis or determining job tasks, or both. This element is limited to ISE only and is not permitted for GSE”
• Allowable activities should allow for reimbursement for collateral contacts, including Workplace Assistance if the service is provided. 
• Staff provision of transportation – need criteria for what is considered “unavailable or inaccessible” and how this is to be documented. 

• States - “For DMAS reimbursement to occur, the individual must be present, unless otherwise noted, when these activities occur:  Vocational or job-related discovery or assessment,

Supports to ensure the individual's health and safety during the hours of work”
Comment: We recommend that the above allowable activities be noted that these activities can be conducted without the individual being present.  In fact, many discovery and assessment documents are reviewed in the absence of the individual.  Furthermore, the coordination and logistics of arranging health and safety supports, such as coordination with the employment site or family members, would precede the implementation and therefore occur without the individual being present.

Page 120: Customized Employment
Comment:  There is nothing indicated in the manual regarding who may provide this service. Under DARS funded CE only ACRE Customized Employment certified specialists may provide this service – is this the expectation for DBHDS or can any ISE employment specialist provide it?

Page 120 - Job Search Planning
Comment:  the following “conduct an analysis of benefits which may be accessed through Benefits Planning” is unclear. Benefits planning is a separate service.  What is the “analysis of benefits” that is being referred to? While most employment specialists can identify when an individual would need that service, it is the role of the support coordinator to refer for the service and coordinate services.  

Page 122: Documentation of the Individual’s Ineligibility for SE Services
5^th Bullet:  States “Documentation of the individual’s ineligibility for supported employment service through DARS or IDEA, as applicable. If the individual is ineligible to receive service through IDEA, documentation is required only for lack of DARS funding. Acceptable documentation for the lack of DARS or IDEA funding would include a letter from either DARS or the local school system or a record of a telephone call, including name, date, and person contacted, documented either in the individual's file maintained by the support coordinator, on the ISP, or on the supported employment provider's supporting documentation. Unless the individual's circumstances change, for example, the individual is seeking a new job, the original verification may be forwarded into the current record or repeated on the supporting documentation on an annual basis”
Comment: We recommend that the responsibility for documenting Waiver ineligibility based on DARS or IDEA eligibility should be the responsibility of the Support Coordinator and should be indicated as a Support Coordinator responsibility instead of a provider responsibility.

Workplace Assistance

Page 124: Criteria/Allowable Activities
Comment:  ADD “This service is designed to support individuals in competitive, integrated positions for whom all options for independence in regards to appropriate job match, reasonable accommodations, and the utilization of natural supports in the workplace have been explored, exhausted and documented. This service is supplementary to individual supported employment in order to maintain stability in the workplace.”

Page 124 - Paragraph 1
Comment:  Includes a typo. Should read “has learned the basic skills…”

Additionally, there should be information under criteria indicating that natural supports and accommodations are not available for the identified support needs.

Chapter 2:

Page 8:

“Document and maintain written semi-annual supervision notes for each Direct Support Professional (DSP) that are signed by the supervisor. Additionally, o For DBHDS-licensed entities, the provider must provide ongoing supervision of all companions and/or DSP staff consistent with the requirements of 12VAC35-105. o For providers who are licensed by VDH or have accreditation from a CMS[1]recognized organization to be a personal care or respite care provider, they must provide ongoing supervision of companion or DSP staff consistent with those regulatory requirements.”

Comment: Please specify what is considered semi-annual(i.e. twice a year, every 6 months, more often), as well as where these notes are to be kept and what is required to be included. While there is information for DBHDS licensed entities, there is not information regarding non-licensed providers. Please also clarify who is considered a supervisor for this requirement.