Appendix C: Participant Services, C-2: General Service Specifications (3 of 3), d. Provision of Personal Care or Similar Services by Legally Responsible Individuals, pages 175-176
Per The budget passed by the Virginia General Assembly in 2022 requires that DMAS must allow parents of minor-aged children and spouses (legally responsible individuals) to be paid caregivers of their minor-aged children or spouse. The draft Application recognizes this stipulation.
DMAS proposes to require that legally responsible individuals (LRIs) work for a personal care agency. DMAS proposes to not allow the consumer-directed model for personal assistance services provided by LRIs. This is likely due to related CMS requirements to ensure proper safeguards against abuse of the service are in place and enforceable.
RECOMMENDATION: DMAS should continue to allow LRIs to be employed through the consumer-directed model and personal care agencies. The individual or the EOR should be the entity that decides whether to use agency-directed, consumer-directed and/or a combination of consumer-directed and agency directed personal assistance services. Specifically state that these rules/ safeguards used for LRIs should not also be applied to any household or family member of an adult individual who is their own guardian.
To address issues raised by CMS regarding LRIs providing paid support, the following provisions could be part of the Application:
The Virginia Informed Choice form is adequate for this purpose. A separate form should be developed by DMAS to be completed by the case manager/support coordinator when an LRI provides agency-directed or consumer-directed personal assistance services.
Case manager/support coordinators and services facilitators must receive a DMAS-developed training about consumer-directed services, including the provision of LRIs providing personal assistance services.
A case manager/support who refuses to submit or delays beyond 14 days to submit documentation to allow an LRI to provide personal assistance services must provide appeal rights to the individual and the EOR.