Virginia Regulatory Town Hall
Agency
Department of Social Services
 
Board
State Board of Social Services
 
chapter
Auxiliary Grants Program - As of 2013, a regulation of the Department of Aging & Rehabilitative Services [22 VAC 40 ‑ 25]
Action Amend Auxiliary Grant Program
Stage Proposed
Comment Period Ended on 4/16/2010
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21 comments

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2/15/10  7:31 pm
Commenter: Frankie Minor/Chestnut Grove Assisted Living/Southwest Assisted Living

90 day residency requirment in this amendment.
 

  I am located in extreme Southwest Virginia.I am the last county in the state .Lee County .We border Tn.and Ky .We are a large facility in a rural area.This amendment is being made to preserve the beds for the Virginia people who need them .I have never turned away a Virginia resident ,who seemd suitable for my facility .Our facility is an asset to have in our county.I depend on keeping my census to the max in order to attempt to keep my facility running and to keep work for 35 employee's.Even at the current rate ,it takes all and more to provide a half way decent service for the resident's.The current Auxuliary Grant is a maximum $17.00 per day .I have seen the rate at .25 cents a day .All this depends on the residents income.But  the resident's income comes with the resident from out of state to help supply jobs.The 90 day residency could have a adverse effect on me and could cause me to close my doors .

   This is a critical program to serve the population it serves.It is also the most underfunded program in the state.The J.L.A.R.C.study performed in 2006 referred to special circumstances as the only way a facility could survive at the auxiliary grant rate.The special circumstances requires the operator working at the facility many long hours doing many different task for less than minimum wage.A lot of  operators continue to do this and are satisfied and do a good job.On the other hand this should not be a requirment  to make ends meet for the operators who accept auxiliary grant.

     I hope everyone can participate in this public comment session and hopefully get the 90 day residency requirment amended to be taken out.   Thank You

CommentID: 11283
 

2/16/10  8:35 am
Commenter: Laverne Canter - Fort Shelby Manor ALF

Auxillary Grant Proposal
 

In regards to the change in the qualification for receiving Auxillary Grants, I understand that this is not a requirement in nursing homes, so why should it be in alfs.  My facility is located in Bristol, Va. just steps away from the Tennessee line.  The closest hospital to my facility is Wellmont Hospital where my residents go for medical care, and many of my referals come from the discharge planners at this hospital.  Will many folks see this move as discrimination?  I thought that once you move to any state and establish your address that you are then a resident of that state, not 30, 60 or 90 days later.  Please do not pass this as it would be very determintal to my business.  My facility is probably 90 to 95 percent auxillary grant residents anyway, and we are already struggling with meeting all of the new regulations that have been imposed on us.  I understand that the AG rate for Virginia is one of , if not the lowest in the country already.   With this change, you will be adding to the already pitiful burdens that are put on our elderly for their care.  Thank you for considering my comments on this very important subject.

CommentID: 11284
 

2/16/10  11:11 am
Commenter: Vicki Hay - Green Spring Rest Home, Inc.

Auxiliary Grant Proposals
 

I would like to make my concerns known concerning the 90 day residency period proposed in the Auxiliary Grant Program.  I own and operate a small 25 bed facility in Abingdon which is apporximately 5 miles from the Tennessee line.  We have been in business now for nearly 30 years and in the course of that 30 year period we have received many residents from Tenn. who wished to move to Virginia.  I was always taught in school that the Constitution granted everyone the right to reside where ever they wished.  In my opinion this proposal seems to negate that fact and makes moving to Virginia a very undesirable decision.  The proposed 90 day waiting period for public assistance will not only tarnish people's view of the state of Virginia but will also add additional burden on the ALF's who depend on that money to remain in business.  As we all know the A. G. rate in  Virginia is seriously underfunded as is, and homes will greatly suffer should they have to wait 90 days for assistance with caring for individuals who choose to live in the great state of Virginia.  I sincerely hope that you reconsider this decision and act accordingly.  Thank you.

CommentID: 11286
 

2/17/10  12:52 pm
Commenter: Sandra Minton, Abingdon Manor

Auxiliary Grant Proposals
 

I do not believe anyone has acknowledged the impact this proposal will have on the assisted living facilities in Southwest Virginia.  We get referrals from our neighboring states including TN, NC,and Kentucky. Not only do these residents help us to stay in business but when their families visit they also are spending money and paying Virginia taxes which also helps the economy.  So its a win- win situation.  However, if we have to wait the 90 day gross period before they can become a "resident" of Virginia we cannot afford to accept them.  Our AG rates are embarrassly low as it is, and most homes in the Southwest are struggling to stay open.  We are not funded for the regulations we have to abide by now, and to add more regulations is like pouring salt into an open wound.  We were promised, years ago, that all regulations would be funded, and each year or so, we get new regulations and NO funding for them. Not only do we provide a home, and care for residents, but we also provide jobs for Virginia citizens.  To continue to add burdens to our Assisted Living Facilities will only cost the State of Virginia, so I ask that this regulation not to pass, and for all to think of the long term effects that closing our home will have on our State.

We have state employees, a license inspector,  which lives in another state.  Should she be penalized  because of the state she lives in?

CommentID: 11294
 

2/17/10  8:55 pm
Commenter: Mike Williams, Virginia Long Term Care Network

Response to AG Program Changes
 

While we understand many of the changes being made to this program, we also oppose ANY change that makes it harder for AG receiving ALF's in VA to operate.  The residency change does just this.

Obviously, Virginia is trying to take more individuals off the AG program (by restricting border state acceptance).  This should not be a priority, as the budget for the AG Program continues to run under (due to lower numbers).  However, Virginia is attacking the "public pay" ALF segment that can weather it the least.

All ALF's in Virginia are dealing with increasing costs.  From utilities and food, to unfunded regulations, ALF's are paying more.  "Public pay" ALF's only survive by operating at 98-100% occupancy.  Accepting $1,112/month is already $800/month below the current cost of monthly care for ALF's in Virginia (JLARC). These ALF's can not afford anymore negative forces.  Restricting any residents (or making it harder to accept them) will do just this to these ALF's.  We CAN NOT do this to them.

We regularly see no respect given to "public pay" ALF's in Virginia, but where will these residents go if they close?  Will "private pay" ALF's be forced to accept the AG rate?  We already saw this Bill attempted 3 years ago.  They can no more afford it than those already doing so.  Will these residents end up on the street?  Not taking medications?

One thing is for sure.... Virginia does NOT have a plan for closings of AG ALF"s.  The "portability of the AG Rate" program is a joke and Insitutional Care will cost VA millions.....

Mike Williams, Executive Director

Virginia Long Term Care Network

888-776-7971

www.vaLTCnetwork.com

CommentID: 11296
 

2/18/10  9:11 am
Commenter: Bob Williams

New AG Regs
 

It seems that these changes target the facilities that can least afford more regulations. The number of ALF's that will accept AG residents has decreased dramatically because the rate is currently too low. More regs will lower that number even more. That will send many residents back to state MH hospitals where the cost of care is $500.00 PER DAY!! IT does not take a financial genius to see what that will do to the state budget. I implore you to see what a great bargain that the AG program is for the state of Va. and help those homes and not try to impose penalties on them. Thank you for your time.

Bob Williams

CommentID: 11297
 

2/23/10  10:25 am
Commenter: Randy Scott, St. Mary's Woods

AG regs
 

clarification for ALF providers regarding procedures surrounding resident discharges from facilities-

currently there is confusion depending on which county or city the resident is from. 

If a resident is in the hospital who decides they loose the grant in 14 or 45 days. 

can the family pay the difference in the grant and keep the room

when the grant stops there is no grace period paid for to allow the family to get the furniture out.  

 i agree with the residency requirement

CommentID: 12469
 

2/24/10  10:13 am
Commenter: Mary Jane Hay, R.N.

Auxiliary Grant Proposals
 

 I would like to comment on the proposed 90 day waiting period for qualified individuals who move into Virginia from other states.  I find this proposal unfair to all persons wishing to live in Virginia as well as all the homes who depend on this income to care for the indigent elderly.  The A.G. rate is sorely underfunded as is and the homes who care for these individuals are already dealing with unfunded and overly burdensome regulations.  This will be one more major hit to an already beaten and bruised acommunity of homes who care for the poorest of the poor.  Please reconsider this proposal and stop this action before homes in this area suffer even more.

CommentID: 13079
 

2/25/10  1:27 pm
Commenter: Barbara Gregory, Gregory's Rest Home

comment
 

I was born and raised in TN, I do get residents from TN and it would be unfair to them and to me for them to have to wait 90 days to get any help. 

This is suppose to be a free county and anyone should not be denied to live where they want and to call home due to some regulations.  we should not have any more regulations we have enough.

CommentID: 13200
 

2/26/10  7:22 pm
Commenter: James Hay

AG Proposal
 

This proposal needs to be reconsidered for several reasons. To name just a few:

1.  The AG rate is already  underfunded

2.  The excessive regulations that the State has place on ALF's will only add to the financial crisis these facilities are already facing

3.  This proposal will continue to over burdent the small business struggling to stay open in this present economic crisis

4.  This proposal is unfair to anyone who wishes to move to the state or to return to their birth state

Presently, Assisted Living Facilities's have to meet greater regulations there ever in the history of our business. While regulations aren't necessarily a bad thing, but imposing regulations without funding them is just plain wrong and punitive to small business.    This proposal needs to be stopped ASAP.

CommentID: 13247
 

2/28/10  8:50 pm
Commenter: Jamie Minor

Comments about impact of amendments
 

Small business are the backbone of America.A lot of government  incentives are given to start a small business in a state ,county or other specific locations.This amendment seems like it wants small business  of assisted livings that except a.g.out of Virginia.This would be a misfortune not to have assisted living's to serve the auxiliary grant,regardless of where residents are from .These residents who qualify for a.g. are funded from their federal check and a.g.money.This is similiar to a waiver program where the state match the money from federal.A person needing nursing home care can cross the state line without any issues,sometimes it is because a service is not available in that state.At any point it is still a person with money coming supply local and state jobs .I have seen a.g.checks for providing care for people for as little as $4.00 per month. The reasoning behind this was said, to save that a.g.bed for a virginia resident.I can't help believe this came from mental health in efforts to prevent any alf from accepting any out of state residents because sometimes the person would require lengthy hospitilizatoin in a state hospital within a week.I understand their concerns.But some operators realized that was an issue and the screening process and acceptance process has improved.If national healthcare is approved and Va.participates,from what I have heard the states are open from state to state to share medicaid and welfare programs would this apply?Also if healthcare is passed it will require require employers to provide healthcare for employees or pay a fee.To many bad things happening to a.l.f.s to survive. 5 years a.g.rates were 60% below the market. That wa before min.wage increase of 36%.Everyone ignores the cost of care.20 years of lenthy cost reports for nothing.Just a incredible huge file to look at .To bad we can't just send this business to China where they don't have to go by the law of the land and cheap labor.This amendment should be withdrawn and some empathy and more funding needs to be given to these a.g.home.Thank you

CommentID: 13304
 

3/1/10  3:55 pm
Commenter: Lisa Neice, Administrator Greendale Home

Auxilary Grant Proposal
 

As  an ALF operator, I am very concerned about the proposal concerning the auxilary grant program. Why is this program being discriminated against? According to the Department of Social Services, anyone seeking assistance ( Medicaid, TANF, SNAP foodstamps ) in Virginia must only have proof of residency. There is no time frame, in fact some programs provide eligibility as soon as the next day after moving to this state! I see this proposal as another step toward the shutting down of some very good facilities in the Commonwealth. The maximum amount that VA pays (through AG), for the care of the elderly and disabled is a measly $17.00 per day! This is a disgrace to everyone living in the Commonwealth of Virginia, and especially those needing the service.If cuts must be made in the state budget, how about cutting in areas that are making a profit, and leave the indigent alone!

CommentID: 13323
 

3/1/10  9:49 pm
Commenter: James Wilson Hay , Green Springs Rest Home

Auxilliary Grant Proposal
 

Please do not support the proposal concerning the Auxilliary Grant that is currently being considered. It isn't fair to punish certain residents of the state if  you are not going to require the same standards for all new residents in regards to all programs. If there is a 90 day waiting period for all assistance offered by the state, then the propasal could be considered fair.  However, if you are only going to address only one type of assistance then the proposal becomes punitive to new residents.  There are so many other areas where cuts could be made that would really save the state money, but this isn't one of them.

 

CommentID: 13327
 

3/18/10  5:38 pm
Commenter: Debbie Cooper ,Administrator,D.O.N

What will they do when a.g.home are gone
 

It is unbelievable more regulations toward a.g.Now a 90 day resident requirment for the poorer individuals before a.g. will qualify for them .Who did we make mad?Just shut us down suddenly and get it over with .We get no support or empathy.A resident can can from another state and qualify for medicaid the first day.This includes  hospitalization ,nursing homes ,food or whatever.Why do all continue to beat a dead horse.This is a very worthwhile meaningful program for the people in need regardless where they are from.Our location is extreme southwest ,who are we to serve?Their maybe a lot of private pay  in need for assisted living that can fill the gap, if the state does not pass  a amendment or law to prevent anyone from driving through the state.  Most people do not accept a.g.because of the neglect to fund it. The state is reluctant to find another way to help fund poor people in need for assisted living.That is why they rank 47th in the nation total medicaid expendentures per capita.This means 46 states are better at getting medicaid money ,which is funded throug federal government than Virginia is .A lot of studies have been done.A lot more cost occuring regulations ,but the funding continues to be ignored and neglected. This seems to be an infrengment of a person's civil.rights.How many of you have been in a a.g.home ?How and why did this come about?If this is imposed the state may save a few pennies and close a few homes.But if imposed it will do a lot more harm than good.Lot of other groomed and proud programs waste millions.Everyone has beat the hide the dead horse ,just keep beating until the bone and guts are gone.

CommentID: 13514
 

3/21/10  6:53 pm
Commenter: tanya anders medication aide

90 day residence requirement
 

I think that the ninety day residence requirement needs to be thought through a little more. The residents in an assisted living are human beings with feelings just like the people in the community.If someone moves to virginia from another state and need public assistance are they made ot wait ninety days before getting any help?

CommentID: 13550
 

3/24/10  10:00 am
Commenter: Scott Rittenhouse, Campbell Insurance

Auxiliary grant Proposal
 

In my travels around the state, working in Insurance Sales, I must comment on the proposed Legislation that would decrease the amount of reimbursement to our Assisted Living Owners. This would have a catastrophic impact on the Owner & Operators of these communities.  I also work in NC and the state of North Carolina has a significantly higher AG rate than that of VA.  I know that our State is in a financial crisis, however these Owners & Operators have already been stretched to the limit with the increased requirments that have been placed on them over the past two years, with no increase in the AG Rate.  Also, requiring a wait time for residents from out of state to qualify would also have a catastrophic impact on the business operations of Assisted Living Facilities on or near the State Line.  Unless the State wants to start taking care of these Alf residents, Legislators should listen to the voices of our Assisted Living Owner/Operators.

CommentID: 13584
 

3/24/10  3:40 pm
Commenter: Wanda Lawson, Office manager for assisted living

amendment for the 90 day residency
 

I work in an assisted living facility in extreme southwest Virginia.  This assisted living borders the states of Kentucky and Tennessee. We are about an hour drive away from each of the two states.   We are closer in distance to the capitols of these two states than we are to the capitol of Virginia.  This facility serves the population from certain areas  for all three states. Why should assisted living residents be treated any different "discriminated against" when the 90 day rule does not apply to nursing home placements from out of state?  Our facility is probably 85% auxilary grant funded.  To pass this could be the straw that broke the camel's back.  Please do not let this pass!  If this home has no choice but to close, 92 residents would lose their home.  Forty employees would lose their jobs.  I would lose a job that I love and have had for 29 years. PLEASE CONSIDER ALL FACTS INVOLVED!!!!!! 

CommentID: 13588
 

4/13/10  11:31 am
Commenter: Frankie Minor 20 years administrator

General comments about this amendment,contents,purpose its harm and what its all about.
 

I realize the cost of funding the auxiliary grant is a burden on the state,because it comes from the general funds.We are trying to get better programs in place to help fund assisted living for the poor.Until that time it is very important for the a.g. homes to survive.Allowing the 90 day residency requirement to become a standard or law would hurt and would be another issue facing the a.g.home in it's ability to survive ,because of it low reimbursement rate.If the money needs to be controlled for this fund ,why not consider a certificate of need for new assisted livings.I find the reasoning for this ,saving the bed for a Virginia resident hard to believe.I have never turned down a appropriate Virginia resident for care in my facility regardless of pay ,in fact I have taken many Virginia residents with no income,placed at my facility by local d.s.s.,many homeless or inability to survive in the community.We can always reserve 2 or 3 bed for Virginia residents ,if we ever got to that point.At any rate I would like to see some documentation of any virginia resident being turned away for acceptance to an alf because no bed were available,because they were taken up by people from out of state.So therefore if you cannot show me documentation ,I would consider this statement to be inaccurate and just another way to impose harm or punishment to the a.g. home .We have taken care of many difficult residents for many years and continue to do so from our own state.We have in the past accepted and tried to care for some difficult residents from other states as well.We did not know any better.This was before any new regs.were passed that required pre- screening and a possible fine for $10,000 on a facility who brings in a potential dangerous resident to your facility,regardless of where their from.So facilities do everything possible to make a safe and livable suitable environment ,and not having the risk of being fined a large amount ,possible putting the a.g.home out of business.This was probable all brought on by mental health ,because some of the more difficult residence from other states were admitted to alf's and almost immediately or later required long term hospitalization in a state facility,therefore placing a financial burden on the state and taking up a bed intended to be more for a Virginia  resident.I have heard this from my local mental health facility and have met with them and shared concerns about this and understood and have virtually eliminated this issue.It seems a little overkill on this issue ,but as you can tell no one speaks for a.g.alfs and what good services they have provided and the money they have saved the state ,as a major downsizing of mental health institutes from the 80's.This was a very difficult job that most people would not consider.We are better facilities with improved regs.We do not need the 90 day resident requirement to be approved.If the above is the issue ,it has been taken care of.Look at ways to help us and our fellow man in need not hurt us .The pros far outweigh the cons,of not allowing 90 day residency requirement.Most people making these rules and regulations have never been in a home and have no empathy with low income and high care residents involved Its time for the tide to turn.

CommentID: 13984
 

4/14/10  3:22 pm
Commenter: tommy L. Cassteel

Residency Requirements
 

The issues of a residency requirement are complex. Assisted living facilities are a critical part of our community's continum of care. They provide good and needed services. They are also  an important aspect of the local economy and provide jobs for many of our clients. It is unfortunate however that the State of Tennessee does not provide the kind of support for their citizens in need of assisted living care that Virginia does. Consquently , the tax payers of  the Commonwealth have to bear the cost of the many Tennessee residents who are placed in Virginia. There are often other service related costs to these placements as well, that are paid by the State and local governments. I would support any reasonable efforts to support the viability of assisted living facilities, however, our agency supports the residency requirements because of the additional costs associated with the Tennessee residents.

CommentID: 13992
 

4/14/10  11:37 pm
Commenter: Frankie Minor 20 years administrator

Response to Tommy Cassteel comment
 

Any person can move to any state and almost immediately qualify for any assistance if they are eligible.

Why single out assisted living?

What if you had a family members that was in need of Assisted Living in another state and could not get it because they were poor.

One of the  reason's this amendment is proposed is to require a citizen to live in Virginia for 90 days before they qualify for the Auxiliary Grant .

The reason documented in this amendment is to save the a.g bed for the Virginia resident.Most assisted livings do not even accept a.g.rate.

If I were waiting for a Virginia resident to come and fill my bed I would have been out of business a long time ago.

Our larger closest town's are in other in another state.

Most of these people are very appreciative of our service and are nice well suitable residents.

The a.g grant can be as little as 25 cent s a day to as much as $17.00 a day.The persons income comes with them.

This is a little price to pay to help a Virginia business ,taxes ,job,and most of all providing care for individuals in need ,regardless of where they are from,if they are currently a resident of Virginia.

Office of the civil rights of D.S.S. prohibits discrimination based on disability or because all or part of an individual's income is derived  from a public assistance.

The VDSS Office for civil rights works to assure these rights are upheld.

Thanks for this opportunity to be heard,I sincerely appreciate it.

I hope you will find enough evidence  not to allow the 90 day residency requirement to become a standard.

Their are many other ways to control money or save beds other than allowing this.

 

 

CommentID: 13995
 

4/16/10  9:24 pm
Commenter: C.H. Logwood

Auxiliary grant changes
 

The puzzling aspect of this change is that there is no information about the actual breadth of the problem statewide. It appears to be a problem in part of one area of the state, or less than 5% of he localities in the state, not including the unknown "Bristol County". There is no mention of AG recipients  from NC, WVA, or MD "taking" AG beds in VA, so the necessity of taking any action outside of these localities seems unclear. After all, localities in northern Virginia receive a higher rate of payment, so exceptions can be made to overall regulation. 

That said, the change will likely not accomplish the reduction in funding "out of state" residents as the six month with relatives provision will defeat the 90 day residency provision. There will be a way devised to increase family relations and the "out of state" flow will continue.  There is no information on how many VA residents were denied AG placement in these areas. Just because beds will not be filled by out of state residents doesn't mean there will be VA residents who qualify to be in the ALFs. Nor does it guarantee there will be a demand from  VA residents and localities to fill these beds. That the market will somehow result in a reduction in what ALFs charge makes no sense. A possible outcome could be a reduction in the number of ALFs, as operators will not accept residents for whom they will not receive payment for 90 days, if the resident qualifies for AG or if they stay 90 days.  

If there is an unmet demand for AG beds in this area perhaps the Governor should consider incentives to develop unused buildings in the Southwest MH facility. A likely outcome of fewer  AG beds could be increased homelessness, demands on adult and social services, demands on the mental health agencies and hospitals. As proposed, this should not be adopted.  
More study and information are needed. 

ore study a

  

CommentID: 14002