12 VAC 30-120-1020     COVERED SERVICES; LIMITS ON COVERED SERVICES

1020 A.4.(b) (health, safety and welfare guarantee)

Recommendation

Replace the following sentence: “The health, safety, or welfare of the waiver individual cannot be guaranteed or a back up emergency plan cannot be developed” with the following: “A back up emergency plan cannot be developed.”

Rationale

Health, safety and welfare cannot be “guaranteed” for anyone and requiring this is impractical. If this term must remain in the final regulations, this “guarantee” should be required for all services.

1020 B.2. (year for assistive technology)

Recommendation

Continue to authorize assistive technology by the plan year. Do not change the year to a calendar year.

Rationale

The proposed regulation would have individuals receiving services via three different cycles: plan year for most services, calendar year for assistive technology and environmental modifications, and state fiscal year for respite. These different year definitions will be confusing and cumbersome. Currently, requests for assistive technology and environmental modifications are spread throughout the year based on plan year dates.  If these services were put on a calendar year cycle, assessors, case managers and providers will be overwhelmed during the last quarter of the year with requests for these services. Services authorizations should all be by plan year to avoid this possibility and to reduce confusion and additional cumbersome processes.

1020 B.2.a. (assistive technology limit)

Recommendation

Correct the annual limit to $5,000.

1020 C.1. (companion services)

Recommendation

Add the word routine to the last sentence in the following manner: The provision of companion services shall not entail routine hands-on care.

Rationale

Companion services should allow for unforeseen or occasional assistance with hands-on care. For example, an individual who typically would not need assistance in the bathroom, may need assistance if they develop an unforeseen illness, such as the flu. Another individual who typically does not need assistance with dressing may need assistance with a piece of clothing such as a coat if they become frustrated with the task.

1020 E. (institutionalization standard for assistive technology)

Recommendation

Remove the following language from the first sentence in the service description: “and without which the individual would require institutionalization.”

Rationale

All waiver services meet this standard – if the service is not needed, it should not be provided. All waiver services are provided to prevent institutionalization.

1020 F.2.b. (environmental modifications limit)

Recommendation

Correct the annual limit to $5,000.

1020 F.2.b. (case management required)

Recommendation

Remove “in addition to MR/ID targeted case management pursuant to 12VAC30-50-450.”

Rationale

This statement is not unique to environmental modifications. People who use ID Waiver services must also receive State Plan ID targeted case management.

1020 F.2.b. (year for environmental modifications)

Recommendation

Continue to authorize environmental modifications by the plan year. Do not change the year to a calendar year.

Rationale

The proposed regulation would have individuals receiving services via three different cycles: plan year for most services, calendar year for assistive technology and environmental modifications, and state fiscal year for respite. Currently, requests for assistive technology and environmental modifications are spread throughout the year based on plan year dates.  If these services were put on a calendar year cycle, assessors, case managers and providers will be overwhelmed during the last quarter of the year with requests for these services. Services authorizations should all be by plan year to avoid this possibility and to reduce confusion and additional cumbersome processes. 

1020 F.2.f. (Fair Housing Amendments Act)

Recommendation

Add “modifications required by an entity to comply with the Fair Housing Amendments Act” to the list of excluded modifications.

1020 F.4.c. (upkeep and maintenance of environmental modifications)

Recommendation

Allow the upkeep and maintenance of an item not purchased under the ID Waiver to be covered as an environmental modification service.

Rationale

It may be more cost effective and otherwise preferable to maintain an item than to purchase a new item, regardless of how the item was initially funded (payment source).