| Action | Three Waivers (ID, DD, DS) Redesign |
| Stage | Proposed |
| Comment Period | Ended on 4/5/2019 |
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General
Many individuals on the FIS waiver, living independently of their families, are often dependent on "natural supports" (often their parents) to handle tasks such as:
When parents age or die and no other natural supports are avilable to handle such tasks, what will happen? Will the only option be for these individuals to be transferred to the CL waiver so that they can receive such supports from a Group Home or SR provider? Or would a more economical option be to create a category of service to address this need so that a person on the FIS waiver could remain in his current living situation?
Benefits Planning, Community Guide, Non-medical Transportation/Employment & Community Transportation Services, Peer Support Services are not included in the proposed regulations but are current available waiver services. All waiver services should be included for the purposes of public review and comment.
12VAC30-122-20.Definitions
Definitions for benefits planning, community guide, non-medical transportation/employment and community transportation services should be added to the definition section.
Add a definition for Independent Living.
12VAC30-122-60. Financial eligibility standards for individuals.
• B.3.a.(1) and B.3.b.(1) Delete following employed “at least 8 hours but”. Individuals who work fewer than eight hours per week are unnecessarily disadvantaged by the limitation. Many individuals may work less than 8 hours per week because of medical or other reasons. Without this disregard, there is no incentive for them to work because their income would go to patient pay.
• Recommend Spend-down for all Long-Term Care waiver categories. This language is already in the CCC+ waiver. This language should be moved to all categories.
B.3. Recommend that Patient Pay be considered an Income Related Work Expense (IRWE). IRWEs are already considered when countable earned income is considered. Reasoning - without waiver services, an individual would not be earning at the level they are earning. But, earning at a higher level is forcing them to incur a Patient Pay. This is a disincentive to earn wages at a higher level.
• Recommend Special Group Category Consideration – SSI/SSDI waiver recipients increasingly have retired, disabled or deceased parents and the waiver recipient’s income increases because their parent’s FICA account is opened and a portion of this account is received by the waiver recipient. This amount (now SSDI) often puts the waiver recipient over the 300% gross income limit. The first thing the individual does is quit work if working. These individuals should be put in a “protected category” which will disregard the amount of the new income (SSDI) that will cause them to become ineligible for waiver services. This protection is considered when looking at continued Medicaid eligibility. (https://secure.ssa.gov/poms.nsf/Inx/0501715015)
• Recommend Subsidies and Special Conditions as deduction for wages earned (per SSA definitions). If the individual is not fully earning his or her wages because the work is performed under special conditions (e.g. close and continuous supervision, on the job coaching, etc), then we should deduct that part of his or her wages that are not “earned” by the individual from his/her average gross wages. This is true whether or not the employer or someone else provides the special on-the-job conditions.
12VAC30-122-90. Waiting list; criteria; slot assignment; emergency access; reserve slots.
• C.1.a. – Following care for the individual add “a primary care giver who is 70 years of age or greater”. While I recognize that the age criterion was removed during the “redesign,” I feel that the impact has been significant on older families. It also limits the family’s ability to assist their adult children to make life decisions before it is an emergency.
C.1.d- Following IDEA services and strike “is transitioning to independent living” and add “has expressed a desire to live independently”
E.3- Strike “A regional WSAC session will then be held for the remainder of available slots, reviewing those individuals meeting criteria for the Priority Two and then Priority Three.” I feel strongly that all slots should be for the Priority 1 list – if the service array in the BI Waiver is not attractive to those on Priority 1 then either the slots should be re-purposed or the service array should be changed.
12VAC30-122-240. Services covered in the Building Independence Waiver.
• Add Agency and CD Companion and Personal Assistance, and Individual & Caregiver Training to the BI waiver. With the addition of these services, there may be more interest in utilizing this lower cost waiver by persons on the Priority 1 waiting list.
12VAC30-122-250. Services covered in the Community Living Waiver.
• Add Family and Caregiver Training. This service is applicable to all individuals and families and should not be limited to the FIS waiver.
12VAC30-122-260 – Services covered: Family and Individual Support Waiver.
• Add Independent Living Services to the FIS waiver. This service can assist individuals living on their own or wishing to live on their own.
12VAC30-122-340 - Companion service.
• C.1- Strike second sentence and limiting the service to eight hours per 24-hour day. While the occasions might be rare, this service can support those who can otherwise function reasonably independently at a modest cost – the 8 hour per day limitation can interfere with that. The waivers already allow a combination of various services to flexibly accommodate an individual’s needs. Companion services are inexpensive and there may be times when an individual requires more than eight hours of this service in a given day. The authorization should be an annual amount or hours that can be used as the individual needs them. Eight hours per day is an arbitrary cap.
12VAC30-122-420 - Independent Living Support Service.
• A – Add following receiving this service “lives, or is preparing to live, alone . . .”; strike “typically”. This service should be available to those planning to transition to more independent living and not just those already living independently.
• A- Add “or FIS waiver” at the end of the last sentence. There are individuals that wish to live independently in the FIS waiver who wish to live independently, particularly transition age you who could benefit from this service. It should not be limited to those already in an independent living setting.
12VAC30-122-430 - Individual and Family/Caregiver Training Service.
• A- Strike “FIS waiver” Add “in all of the DD waivers”. There is no reason that it is only included in the FIS waiver. Individuals and their families can benefit from this service.