I am submitting this comment in strong opposition to the proposed 56-hour weekly "soft cap" on personal assistance services within the Community Living (CL) and Family and Individual Support (FIS) Developmental Disability (DD) Waivers.

As a Virginia resident and friend of family caregivers, I urge DMAS to protect individualized, needs-based care and reject a uniform 56-hour benchmark. My concerns align with the critical issues raised by disability advocates across the Commonwealth:

• DD Needs Are Distinct From CCC+ Nursing Care: Forcing DD waiver recipients into the CCC+ exception framework is inappropriate. CCC+ exception criteria prioritize physical dependence and skilled medical needs. Individuals with developmental and intellectual disabilities frequently require intensive, continuous prompting, behavioral de-escalation, mobility assistance, and safety supervision to live safely. Inability to complete a task independently or safely must be treated with the same weight as physical inability.

• Assess Cumulative, 24/7 Impact: The arbitrary benchmark of 56 hours (8 hours a day) fails to reflect unpredictable needs, elopement risks, sleep disturbances, and multi-hour behavioral interventions that occur around the clock. Assessments must evaluate the cumulative intensity of care required across day and night.

• Protect Existing Authorizations: Individuals with established, authorized service plans exceeding 56 hours per week must be grandfathered and protected from automatic reductions.

• Do Not Assume Family Availability: Family caregiving cannot be treated as a free substitute for authorized paid support hours. Presuming informal care is readily available risks severe caregiver burnout and involuntary institutional placement.

• Accessible and Transparent Exceptions: If any cap remains, the reconsideration and appeal process must be transparent, timely, and accessible, rather than an administrative hurdle intended to cut necessary services.

Individualized care is the foundational promise of Virginia's DD waivers. Please preserve authorizations based on actual, comprehensive assessed need rather than an arbitrary weekly cap.