ASSISTIVE TECHNOLOGY:  We appreciate the clarification of AT in this waiver and think it more effectively describes AT that will benefit individuals in the DD Waiver.

SCREENING, ELIGIBILITY AND EMERGENCY WAIVER SLOTS:

We had a family in our community who had great difficulty getting their family member screened because of the interpretation of the following:  see "9.  Home and community-based waiver services shall not be provided to any individual who resides in a nursing facility ...." (p. 22 of 125) - This statement was interpreted by our screening entity (and confirmed by DMAS) to mean THEY ARE NOT ABLE TO SCREEN AN INDIVIDUAL FOR DD WAIVER ELIGIBILITY IF THEY ARE IN AN INSTITUTIONAL SETTING.  Adding clarification on services such as "while they are still residing in an institutional setting" or a distinction between screening and providing services would be helpful.

     No screening means no eligibility and no ability to apply for an emergency waiver slot.  An emergency waiver slot could be the "viable discharge plan"   It would be very helpful for DMAS to identify DD Waiver eligible individuals in nursing homes and other institutional settings and do outreach to see which individuals would like to live in the community with waiver services.

PERSONAL CARE SERVICE PROVIDERS:  We would like to see MORE THAN one additional individual living in the same residence be able to receive personal care services from the same provider.

Thank you for this opportunity to comment on the IFDDS Waiver Changes and other concerns.

Eleanor Voldish, Executive Director

The Arc of Loudoun

General comment regarding the term Developmental Disability

The proposed regulations refer to people with related conditions.  This term should be changed back to people with developmental disabilities.

12 VAC 30-50-490     CASE MANAGEMENT

Return to the original terms of support coordination and support coordinator.

Clarify the plan of care will not be effective or approved for people on the DD waiver waiting lists.  The Regulation needs to clarify what is intended by “in effect.”

Clarify that individuals who are on a DD Waiver waiting list do not need to have face-to-face contact every 90 days.

Eliminate language that limits support coordination for individuals residing in facilities.

Modify this item to allow parents, spouses, or any person living with the individual to be employed by a company that provides support coordination for their child, spouse or individual with whom they live.

12 VAC 30-120-700     DEFINITIONS

APPROVED

Add a definition of approved as follows: Means that DMAS has determined that the individual is eligible for services, an adequate Consumer Services Plan has been developed and that funding is available for the individual=s services.

COMPANION SERVICES

Omit the language “The provision of companion services does not entail hands-on care”.  Companion services should include assistance ADLs if the assistance is not the primary purpose of the companion service.

CONSENT

Add a definition of consent as follows:

Means -

1.  The individual has been fully informed of all information relevant to the activity for which consent is sought in the individual=s native language or other mode of communication;

2. The individual understands and agrees, in writing or verbally on a recording for individuals who do not write or read, to the carrying out of the activity for which consent is sought and the consent describes that activity for which consent is sought;

3.  The individual understands that the granting of consent is voluntary on the part of the individual and may be revoked at any time.

DAYS

Add a definition of days as follows: Means calendar days.

ELIGIBLE

Add a definition of eligible as follows: Means that the individual has been screened and meets the non-financial eligibility requirements for the DD Waiver.

HOME

Change “two” to four when stating how many individuals who receive services can live together.

INSTRUMENTAL ACTIVTIES OF DAILY LIVING

Clarify that the tasks listed in the definition are examples and not the only tasks included in this definition.

PEND

Clarify the term “authorization” in this item and throughout the Regulation.

PERSON-CENTERED PLANNING

Reorganize the definition so that “the individual” comes before “the family.”  Omit “with long term care needs.”  The sentence would be “...directed by the individual or their family, when appropriate.”

PERSONAL EMERGENCY RESPONSE SYSTEM

Omit “at high risk of institutionalization.”

PLAN OF CARE

Retitle this to Consumer Services Plan.

RELATED CONDITIONS

Use the term developmental disabilities, not related conditions.

Amend the language “mentally retarded persons” to “people with mental retardation.”

RESPITE CARE

Omit “residing with the individual.”

RESPITE CARE PROVIDER

Omit “living in the home.”

SKILLED NURSING SERVICES

Modify the last sentence of this definition to clarify that skilled nursing services are not limited to the four items in that sentence.

12 VAC 30-120-710     GENERAL COVERAGE AND REQUIREMENTS

710 B.2.

Omit Aand medically necessary.@

710 C.2.a.

Omit “or the individual’s care manager.”

710 C.2.c.

Omit the last sentence “A waiting list of emergency cases will not be kept.”

12 VAC 30-120-720 RECIPIENT QUALIFICATION AND ELIGIBILITY REQUIREMENTS, INTAKE PROCESS

720 A.2.

The Regulation should reflect the personal maintenance increase.

720 B.2.

Reorganize this section to appropriately reflect the process an individual uses to request screening and the date used for placement on the waiting list.

720 B.7.

Clarify that the individual cannot be charged a fee, including the cost of assessment, as part of the eligibility/screening process.

720 B.8.

Modify the first sentence of this section by adding “if appropriate” after “family/caregiver.”

720 B.11.

Clarify that the MR case manager is responsible to notify entities when the transfer occurs.

720 D.1.

In the first sentence of this section replace “DMAS” with “the individual or their representative.”

Clarify that the Screening Team has 45 days to notify the individual they are eligible.

720 D.3.

Add “, place on a waiting list” between “Medicaid coverage” and “or deny for Medicaid coverage.”

720 D.5.c.

Omit this item.

720 D.7 and 8

Terminology is inconsistent in these sections and should be revised.

720 F.1.a.

Modify the first sentence of this section by adding “if appropriate” after “family/caregiver.”

720 F.1.d.

Add “DMAS shall provide their decision regarding services to the support coordinator within 14 days of receiving the request for review of the plan.”

12 VAC 30-120-750     IN-HOME RESIDENTIAL SUPPORT SERVICES

750 A.2.

Clarify that other services, not just the three listed in this item, can be used simultaneously with in-home residential support services.

12 VAC 30-120-752     DAY SUPPORT SERVICES

752 B.2.

The new description of Levels of day support@ is confusing.  Clarify the difference between Aprimarily at one location/building@ and Aprimarily in community settings.@

12 VAC 30-120-754     SUPPORTED EMPLOYMENT SERVICES

754 D.2.

The second sentence should read as follows: AIf the individual is eligible to receive services through the Individuals with Disabilities Education Act .....@

12 VAC 30-120-756     THERAPEUTIC CONSULTATION

Comment

Since this service does not include direct therapy, it is important to clarify which services can be used as positive behavioral support and applied behavioral analysis as outlined in the June 26, 2006 DMAS Medicaid Memo to providers.

12 VAC 30-120-758     ENVIRONMENTAL MODIFICATIONS

758 A.

Amend the current restriction on “primary home” and “primary vehicle” to allow two homes and two vehicles to be made accessible with environmental modifications.

758 A. and C.

Comport these two sections so that the term “prior authorized” is used consistently.

12 VAC 30-120-762     ASSISTIVE TECHNOLOGY

762 C.

Amend the service description to clarify that the service includes training on the use of assistive technology.

12 VAC 30-120-766     PERSONAL CARE AND RESPITE CARE SERVICES

766 A.

The last sentence of this section, add the Virginians with Disabilities Act.

766 B.2.

Omit “living in the home.”

766 C.6.

Replace “one other individual” with “three other individuals.”

12 VAC 30-120-770     CONSUMER-DIRECTED SERVICES

770 A.2.

In the second sentence, replace “a family caregiver” with another appropriate person.”

770 A.5.

In the last sentence of this section replace “service facilitation” with “consumer directed.”

770 B.5.

Replace “The CD services facilitator” with “The CD fiscal contractor.”

12 VAC 30-120-776     COMPANION SERVICES

776 A.

Add the following: AAssistance with activities of daily living may be an incidental part of CD companion services.@

776 B.1.

Modify the criteria so that the service can be used by individuals regardless of whether or not they can be left alone.  The criteria should focus on the fact that people need this service to assist with or support the individual with IADLs and socialization.

776 D.6.

In the second sentence of this section, add “potential” before “consumer-directed employees.”

Add a new section titled Procedural Safeguards.  The following items should be organized into this new section include appeal rights; choice of providers; complaints; consent; discharge; participation in meetings; informed choice; procedural safeguards statement; records and written notice.