VACSB Comments on Proposed 1915(c) Home and Community-Based Services Waiver Amendments

The Virginia Association of Community Services Boards (VACSB) appreciates the opportunity to comment on the proposed amendments to the Community Living (CL), Family and Individual Supports (FIS), and Commonwealth Coordinated Care Plus (CCC+) waivers. We request revisions that preserve individualized services, meaningful choice, and continuity of care while addressing the practical impact on individuals, families, and CSBs.

Personal assistance soft cap

VACSB shares dLCV’s concerns about the proposed 56-hour weekly soft cap under the CL and FIS waivers. Authorizations should reflect each individual’s assessed needs. A new threshold could create unnecessary barriers to services already determined necessary through person-centered planning.

VACSB requests that DMAS retain individualized authorizations without the proposed cap. If DMAS proceeds, exceptions must account for cognitive, behavioral, functional, and disability-related safety needs. DMAS should prevent automatic reductions solely to conform to the cap, publish clear exception criteria and decision timelines, and protect service continuity while timely requests are reviewed. Individuals and families must receive clear notice and information about appeal rights.

Services facilitation and CSB support coordination

VACSB has significant concerns about eliminating standalone services facilitation. CSB staff have emphasized that services facilitators provide essential assistance with employer responsibilities, attendant enrollment, authorizations, and problem resolution. Their established relationships with individuals, families, and CSBs help prevent disruptions in consumer-directed services.

VACSB requests that DMAS preserve independent services facilitation and meaningful provider choice. To the extent the transition is required by enacted budget language, DMAS should identify options to preserve existing relationships and qualified local providers, including clear subcontracting and reimbursement arrangements.

The transition must not shift unmet services facilitation responsibilities to CSB support coordinators who lack the training and capacity to absorb them. DMAS and DBHDS should clearly define each entity’s responsibilities and establish direct escalation procedures. Any additional responsibilities assigned to CSBs must include appropriate resources, training, and reimbursement.

Transition readiness and continuity

Before each regional transition, DMAS should verify adequate broker staffing, transfer of necessary records, and continuity of authorizations and attendant payments. Individuals and families should receive advance notice, a named contact, accessible guidance, and a clear process for resolving concerns or requesting a different broker.

DMAS should involve individuals, families, services facilitators, and CSBs in readiness planning and adjust timelines when necessary to prevent service interruptions.

Eligibility review and quality oversight

VACSB supports retaining the higher-level DMAS nurse review following a CCC+ determination that an individual no longer meets level-of-care criteria. This safeguard helps identify errors before essential services are lost and reduces the burden on families to correct those errors through appeals.

DMAS should also identify who will assume service-plan review responsibilities when MCOs are removed from the quality measures and explain how oversight and corrective action will be maintained.

Employer responsibilities and technical corrections

DMAS should provide plain-language guidance on delegated employer-of-record duties, responsibility for each function, and the implications of assigning an Employer Identification Number to the individual receiving services.

VACSB supports correcting outdated paid-family-caregiver requirements without creating additional barriers. DMAS should also confirm that removing the identified Medicaid Works eligibility and transportation-provider provisions, described as never implemented, will not disrupt current participants’ coverage or services.

VACSB urges DMAS to ensure these amendments preserve access to necessary supports and do not transfer additional administrative burdens to individuals, families, or an already strained community service system.