12VAC 30-50-440  page 1 A Target Group

This section relates to individuals with an ID diagnosis and states that services must “include at least one face to face contact with the individual every 90 days”   This wording is not consistent with Pg 4 Targeted Group – individuals with a DD diagnosis stating a “face to face contact …occurs every three months”.  This section should state every 90 days with a 10 day grace period.

12VAC30-50-490 page 4 Target Group 1.

Face to face contacts should state every 90 days with a 10 day grace period.

12VAC30-50-490 page 4 Target Group 2.

States that when someone applies for the DD Waiver and there is not slot available he/she will be placed on the waiting list.  There should be a comment that if found eligible or once eligibility is established, will be placed on the waiting list

12VAC30-122-30  page 19 B

Waiver populations; single waiver enrollment; waiver termination upon loss of eligibility.

“An individual who has a diagnosis of DD may be on the waiting list for one of the DD Waivers (FIS, CL, or BI) while simultaneously being enrolled in the Elderly or Disabled with Consumer Direction (EDCD)….”  This is confusing due to the new name being the CCC+ Waiver; the name of the EDCD Waiver should be changed to be consistent to what its current title. 

12VAC30-122-50  For all those Seeking DD Waiver:  A2 Individuals Qualifying for DD Waiver... shall meet level of care provided in an ICF/IID and shall demonstrate this need at least annually….

Please clarify if this if for only individuals who have received a DD Waiver or if it includes those on the DD Wait List.  It would be very labor intensive to complete a VIDES annually for all individuals on the wait list.  The VIDES should only be completed for those receiving the waiver services to demonstrate that he/she meets the level of care of an ICF/IID.  For those on the wait list, the VIDES should be completed for eligibility/qualification but then completed again prior to enrolling into the DD Waiver.

12VAC30-122-50 For all those Seeking DD Waiver: 4. Shall meet financial eligibility

This can be interpreted as saying that one must meet Medicaid eligibility to be on the wait list- this should be clarified to say “once granted a waiver slot, one must meet financial eligibility….”. 

12VAC30-122-70 Choice between institutional care and waiver services

Please clarify how often and individual completes this.  Currently one must complete this annually while on the wait list, but not once he/she is enrolled in waiver. This question comes up often.

12VAC30-122-80  page 24 C1 Waiver approval process; authorizing and accessing services.

“The individual and the individual's family/caregiver, as appropriate, shall meet with the support coordinator within 30 calendar days of the waiver enrollment date…” Please clarify if this is the Projected Enrollment Date or the Active Enrollment Date. 

12VAC30-122-80 page 24 C4 –Initiating services in 30 days

There is a shortage in providers for many of the waiver services and we are finding that once a provider is secured, it can take months to get a staff hired to provide the service.  Giving 30 days doesn’t appear to be realistic, 60-90 days would be better. 

12VAC30-122-90 DD Waiting List

Has the criteria that to be on the waiver waiting list one must indicate that he/she would use a waiver if offered within 30 days still a requirement? I did not see this in these proposed regs. 

12VAC30-122-100  page 29 3F Modifications to or Termination of Services

In nonemergency situations, I would like to see that providers are required to give at least 30 day notice if they decide to discontinue services.  This would decrease the possibility that an individual may go without needed supports which may impact health and safety. This gives the individual and his support team time to transition to another provider without a lapse of services. 

12VAC30-122-100. Page 29 3F Modifications to or termination of service

“ The support coordinator shall have the responsibility to identify those individuals who no longer meet the level of functioning criteria or….” Please update this to say “…no longer meet the VIDES criteria….”

12VAC30-122-120. Page 30 A 4 Provider requirements.

“Accept referrals for services only when staff is available to initiate services within 30 calendar days of the referral and perform such services on an ongoing basis.” There are several individuals currently waiting for over 30 days for staff to be hired after a provider accepts the referral. There needs to be a rate change or incentives given to providers that can be passed on to potential staff.  The rates that DSPs make is way too low for the quality of care we are asking.  DBHDS, DMAS and Licensure needs to hold providers accountable in actively looking for staff as well as provide assistance to providers in recruiting and securing staff.

12VAC30-122-150  E Support Coordinators can act as Service Facilitators

A Support Coordinator who provides Service Facilitation Services can not guarantee conflict free case management services. I would like to see this not be an option for Support Coordination.

12VAC30-122-190  A6 – Support coordinators shall conduct and document a minimum of quarterly visits to all other individuals with at least one visit annually occurring in the home.

Quarterly visits should be clarified to state “a minimum of face to face visits every 90 days with a 10 day grace period”  This statement should further describe visits as being in a variety of settings with every other visit being in the home to be consistent with the Enhanced Case Management Criteria set for by the DOJ Settlement.  

12VAC30-122-190 B2a- The reassessment shall be signed and dated by the support coordinator and shall include an update of the level of care….

Please clarify that the “level of care” is actually the VIDES..

12VAC30-122-200  A1 Support Intensity Scale - DBHDS shall use the SIS® Adult for individuals who are 16 to 72 years of age

Please list the assessment that will be used for individuals over the age of 72. 

12VAC30-122-240

Please consider adding Personal Care and Companion Service to the BI Waiver. This is a much needed service that many individuals on the BI waiver could use and may provide the necessary supports someone who only needs personal care services in his/her own home could use along with the other services under this waiver to access the community.

Additional Comment: DD vs ID

Due to the merge of the DD and ID Waivers, there should not be any difference with the two targeted population groups.

           There should be the same reimbursement for screening individuals to be placed on the waiver wait list,  regardless of diagnosis.

            Individuals who are awarded a waiver slot should be given a choice between CSB Support Coordination or a private Supports Coordination entity the CSB contracts with, regardless of diagnosis.

Please update in these new regulations the true merge of individuals being supported under this one DD Waiver. 

Additional Comment: Residential Services

Please add to the regs that if an individual has a residential provider and that provider is aware of medical changes such as medication changes, appointments with a physician or specialist that isn’t a routine appointment; then the provider must inform the support coordinator of the results of the appointment or change in medication/change in status within 5 days. Several providers do not inform support coordinators of medical/physical changes until the quarterly. This results in the support coordinator not being aware of potential health and safety issues for possibly 2-3 months and therefore being unable to monitor these changes.  When this concern has been  brought up to providers they state that because it is not required that they do so in the regs, they will continue to only inform us in the quarterly.  This has been an issue for many years with some providers.