I suggest rewording the proposed definition of supported living on page 58.  The proposed service description states that Supported living takes place in an apartment setting operated by a DBHDS-licensed provider.

 

This specificity of taking place ONLY in an apartment is restrictive and in fact conflicts with both the Licensing definition and the Waiver Manual definition.  It may mislead Support Coordinators to not consider supported living options offered by providers in a licensed residential setting such as a condominium, an attached townhouse or detached house, since the Support Coordinators may not realize that services in these settings CAN in fact be authorized as supported living services.

 

Licensing regulations state that Supervised living residential service means the provision of significant direct supervision and community support services to individuals living in apartments or other residential settings. These services differ from supportive in-home service because the provider assumes responsibility for management of the physical environment of the residence, and staff supervision and monitoring are daily and available on a 24-hour basis. 

The Waiver regulation 12VAC30-122-540 states that Supported living residential service shall take place in a residential setting operated by a DBHDS-licensed provider of supervised living residential service or supportive in- home service

I suggest guiding Support Coordinators on the distinction between group home (24 hour) and supported living is the scope and amount of services and to note that both services require the provider to include the physical residential setting while supportive services are distinguished because the individual provides their own housing and therefore the housing is not connected to the support services.

Within Chapter 12: Employment, Post- Secondary Opportunities, and Integrated Community Involvement> Employment Services under Waiver (page 124). The handbook indicates the following:

Ordinarily, DARS would be a first option for referral for employment services for people who use Waiver services. However, this may be bypassed when DARS has a waitlist. Acceptable documentation for this would be: 1) Written documentation from DARS or the school system, OR 2) Progress note that records the content of a communication that includes a name, date, and person contacted, documented either in the individual's file maintained by the SC on the ISP or 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. 

The text needs clarification on the following:

1. What constitutes as a DARS waitlist?
   
   1. Is a waitlist communicated only after a job seeker as been determined eligible to receive DARS services or does a waitlist also include the 60 day period DARS has to determine someone's eligibility to receive services?
2. Where can Support Coordinators locate information on whether there is a waitlist?
   1. Does DARS share this information on a case by case basis or is the expectation that DARS provides this information through formal communication, such as a memorandum?
   2. What is the Support Coordinator's responsibility on maintaining verification that there is a waitlist to justify utilizing Waiver for Supported Employment services?

As a provider, we want to ensure we continue to work with our Support Coordinators in properly utilizing the employment resources that are available to the individuals we support. Having clarity on what defines a DARS waitlist and where to access this information will ensure that Support Coordinators and providers understand expectations and help communicate informed choices to job seekers. 

 

We, the Public Policy Committee of the Virginia Association for Behavior Analysis, have the following comments on the DBHDS DD Support Coordination (Case Management) Handbook. 

On page 49, crisis prevention services staff should not revise the behavior plan as drafted. They should revise the CEPP, if indicated. Only the Behaviorist, who authored the behavior plan, should revise the plan.

On pages 97-98, consider inserting “Licensed Behavior Analyst and Licensed Assistant Behavior Analyst” under “Who else can help?” for Constipation, Dehydration, UTI, Change in Mental Status, and Elopement/Wandering.

On page 109, consider adding our association as a resource under Community Resources – www.virginiaaba.org.

We thank you for the opportunity to comment and welcome your continued partnership.

Current wording: Though it is not the responsibility of the SC to ensure that providers adhere to the additional requirements, it is important that SCs familiarize themselves with these requirements as they may need to discuss the settings with regulations with providers." 

This is helpful but it stops short of conveying what is the "responsibility" of the SC for the HCBS. For example, what is the SC' responsibility for non-compliance outside of addressing with the provider. 

Suggest: "Though it is not the responsibility of the SC to (enforce) provider's adherence to the additional requirements, it is within their responsibility to be familiar with the settings requirements as they may need to discuss the regulations with individuals they support and their families, as well as with providers. Support Coordinators should consult with the Community Resource Consultant for ongoing or repeated issues of non-compliance around the settings regulations."

      

"The Diagnostic Eligibility Review Form can be used to ensure that collected documentation substantiates a diagnosis that confirms eligibility for SC services." 

Can the Department include a hyperlink to this form on this page/paragraph?

Comment #1: Chapter 2 (Support Coordination Overview) – The manual uses a definition for ID as defined by the American Association of Intellectual and Developmental Disabilities (AAIDD), for which I have no objection. However, I assume all of the CSBs/RBHAs define ID according to the code of Virginia and this is not mentioned in the section on ID Support Coordination. An important difference: it’s not sufficient to just know the individual’s IQ (as suggested by the AAIDD definition), but this needs to be based on a qualifying standardize measure for intellectual functioning (as conveyed in the state’s definition). Simply put, our eligibility determinations are based on the Code’s definition and not AAIDD, so I don’t follow why this section (on ID SC) doesn’t mention the Code’s definition for ID. The wording suggests that the AAIDD definition should outweigh what the Code defines (and how it defines ID). BTW, Page 18/section on “Support Coordination for people with DD begins” defines DD according to the Code of Virginia. Comment #2: Page 20 (top) The four (4) bullet points repeatedly refer to the individual as “recipient” and this is no more a person-centered term than client or consumer. Would suggest some re-wording of this section so that it is more person-centered: For example: • Instead of “A person who is a recipient of the DD Waiver” use “A person that has a DD Waiver.” • Instead of “A person with ID on the waiting list for the DD waiver who is eligible for Medicaid (in this instance the person may or may not be a recipient of one of the Waivers”) Use “A person with . . . (in this instance the person may or may not have one of the waivers). • Instead of: A person with a DD (diagnosis) on the waiting list . . . . (in this instance the person may or may not be a recipient of one of the Waivers) | Use “A person with . . . (in this instance the person may or may not have one of the waivers). • Ditto above: (in this instance the person may or may not be a recipient of one of the Waivers) | Use “A person with . . . (in this instance the person may or may not have one of the waivers). Comment #3: Same section (top of page 20 4th bullet point) – These bullet points are about eligibility for TCM (State plan option). Bullet point #2 is about someone with ID on the waiting list and bullet point #3 is about someone with Dd on the waiting list. (Bullet 1 is someone with a DD Waiver). Bullet #4 is about someone with “ID” that is “not” on the waiting list and is eligible for Targeted Case Management. Question: What about someone with “DD” (other than ID) that is “not on the waiting list. Comment #4: Page 20 (middle of page/Post Move Monitoring) – Since there’s just one Training Center remaining, could they simply refer to Southeastern Virginia Training Center (throughout the document) than wording that suggests multiple or more than one TC? Comment #5: Page 23 – continued SDM/ADMA(agreements) – this section uses the terms supportive and substitute interchangeable. Would suggest using Supportive and if use of the term “Substitute” is used intentionally (for example, in reference to a legal guardian, specifically) then perhaps this can be more clearly written. Comment #6: Virginia’s continuum of Decision-Making Supports |It’s helpful that the document defines each of these areas ((e.g., SDMA, Advance Directives, POAs, Authorized Reps, Temp guardianship and limited guardianship, and full guardianship). Consider examples of when to consider or suggest one versus the other.(e.g., an individual with multiple exception medical needs may do better with a guardian that has either limited or full authority versus a SDM.) Comment #7: Page 24 second paragraph from the bottom. Suggest using “individual” instead of “loved one.” Comment #8: Page 24 (bottom / 2nd bullet point) This line reads, “The LG ultimately makes all decisions that are made regarding the care of the “incapacitated person.” Actually, I think this should read, “The LG makes decisions that are pursuant to the guardianship court order for the “incapacitated person.” Comment #9: Page 25 / Appeals Rights (second paragraph). A SC may need to assist a person to request an eligibility appeal in writing within 30 days of receipt of the notice about the action. The person may write a letter or complete an Appeal Request Form that would include: . . .” Clarification: Is “The Person” here considered the SC or the individual? (we have, for example, permitted SCs to assist with this, as needed; however, we caution against them actually writing such letters just in case something is done wrong (I don’t want to risk an appeal being accepted or denied because of something in or not in the letter.)

"For children through age 21 years of age, physicals must be completed according to the EPSDT frequency." Is there a chart for this frequency that can be hyperlinked here?

Page 39 (I think (page number is missing):

Should this section address the role of the CSB/SC when this form (Documentation of Individual Choice Between Institutional Care and HCBS) is either not returned to DBHDS or otherwise uploaded by the individual/family member into WaMS?