Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
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3/29/23  10:41 pm
Commenter: Karen Tefelski, VaACCSES

Employment & Day

Appendix C: Participant Services, C-1/C-3: Service Specification, Workplace Assistance, Service Definition, page 170

Refer to comment 18 above regarding the difficulty individuals have becoming or remaining employed due to the inability to access assistance for basic life functions such as eating, drinking and using the restroom. Four services can be used in an employment situation:

1. Individual Supported Employment that prohibits support with personal assistance.

2. Group Supported Employment that allows, “Personal care activities are not typically provided, but may be included.”

3. Personal assistant services reimbursed at a low provider rate virtually ensuring that no provider will commit to providing services in one-hour increments, leaving the work site, and returning later in the day for a one-hour service again. An individual could ask a co-worker to perform the personal care services, and then the co-worker take leave of their regular work duties to assist their co-worker with personal assistance. It is not typical in a professional working relationship for one employee to assist another with personal assistance such as using the restroom. This can become problematic for both co-workers.

4. Workplace Assistance is severely limited as an option for individuals who needs personal assistance due to restrictions in the draft Application including: “…nor may Workplace Assistance services be provided solely for the purpose of provision of assistance with ADLs.” The focus of Workplace Assistance is to “maintain stabilization” in employment. Workplace Assistance is one of the highest per hourly provider rate service. The assumption is that the service is not billed throughout the entire work day of the individual, but only when needed during certain parts of the day. The provider rate addresses the fact that this is an in-and-out service.

RECOMMENDATION:  A service is needed that can reasonably be expected to be available when needed so that an individual who needs assistance with ADLs can be competitively employed without being limited to group support employment.


Appendix C: Participant Services, C-1/C-3: Service Specification, Skilled Nursing, Service Delivery Method, page 154

This item is inconsistent. The draft Application does not check boxes related to this service indicating that a relative or legal guardian can provide this service. Later in this section under Provider Specifications for this Service, there is language that would permit relatives and legal guardians to provide this service.

RECOMMENDATION:  Clarify that a relative or legal guardian can provide skilled nursing services by checking the corresponding boxes in the item that specifies who can provide the service.


Appendix C: Participant Services, C-1/C-3: Service Specification, Companion, limits on the amount, frequency or duration of this service, 2nd paragraph, page 115

Companion services provide informal support that are vital to individuals who may not want or need ongoing skill development. Limiting companion services to eight hours a day restricts the natural daily flow of life and may not be adequate for the needs of an individual, especially if they are not using significant daily hours of residential services. The limitation results in individuals missing opportunities to participate in integrated social group activities with people who are not disabled and to enjoy activities such as visiting amusement parks.

RECOMMENDATION:  Increase the amount of companion hours to 12 hours per day.


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.


Appendix C: Participant Services, C-1/C-3: Services Specification, Individual Supported Employment, limits on the amount, frequency or duration of this service, 2nd paragraph, page 74

Individual Supported Employment is to be denied if the individual is “eligible for or receiving supported employment” funded by the Rehabilitation Act or the Individuals with Disabilities Education Act. There are individuals with DD who may be eligible for supported employment through the Rehabilitation Act. These same individuals who are eligible, may be wait listed due to an order of selection process established by the Virginia Department for Aging and Rehabilitative Services (DARS) due to federal and/or state funding shortages.

RECOMMENDATION:  FIS Waiver supported employment services should be provided to individuals with DD, if they are eligible for DARS supported employment services, but unable to access these services through DARS due to the lack of DARS funding.


Appendix C: Participant Services, C-1/C-3: Services Specification, Group Day Services, Service Definition, page 65

A back-up plan is not stated as a requirement Group Day Services. Individuals using the FIS Waiver could be living in their own home and required daily intensive supports. If a Group Day Services are closed due to weather or other unforeseen circumstances or the individual does not go to Group Day Services on a scheduled day or time, the individual may need to have a back-up plan in place to ensure they receive needed supports.

RECOMMENDATION:  Clarify that a plan for Group Day Services should include a back-up plan.


CommentID: 215090