Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
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3/29/23  9:35 pm
Commenter: Karen Tefelski, VaACCSES

Individual Supported Employment - Personal Care

Appendix C: Participant Services, C-1/C-3: Services Specification, Individual Supported Employment, Service Definition, 2nd paragraph, last sentence, page 73

The inability to use the restroom, receive assistance to eat and drink, and to remove outdoor garments are significant ongoing, pervasive barriers to the employment of people with DD who have a physical disability. Assistance with these functions is difficult to schedule, the functions are typically brief, and are not always performed at specific times during the day. The draft Application states, “Personal assistance is not part of individual supported employment.” If an individual only needs assistance with these items and is stable in their employment, personal care assistance cannot be the sole purpose of Workplace Assistance as described on page 170, paragraph three. These service limitations leave an individual with DD one option for assistance, FIS Waiver personal care services. However, these needed supports are difficult to schedule and need to be performed when needed, such as when the individual needs to use the restroom. Individuals with DD are not able to predetermine exactly when they will need to use the restroom, not any more than an individual who is not disabled. Limiting their ability to use the restroom to a predetermined schedule is impractical, cruel, and shortsighted. Prohibiting Individual Supported Employment staff from providing this needed assistance when the staff are already present on the job site is a poor use of resources. The distinct FIS Waiver service of personal assistance services may be appropriate for the workplace, depending on the frequency, length of time and nature of the assistance. Each individual’s needs and circumstances are unique. However, an outright prohibition of these supports by Individual Supported Employment providers is inappropriate.

RECOMMENDATION: Individual Supported Employment should include assistance with personal assistance support, when needed, if the Individual Supported Employment staff are present when the assistance is needed. Personal assistance support should not be a significant percentage of time included in the individual’s plan for Individual Supported Employment. However, it should be permitted as one model to meet the personal assistance needs of individuals with DD.

CommentID: 215053