(2 of 2) General Comments Continued.

12VAC30-122-20. Definitions.
General:
• Definitions for benefits planning, community guide, non-medical transportation/employment and community transportation services should be added to section.
• Assistive Technology- add following environment “, actively participate in other waiver services which are part of their plan.”; delete “in which they live”. The current definition does not account for all of the new and possible future expansive use of technology in all available waiver services. Expanding the definition will enable waiver services to adapt to the fast pace of changing technology in all walks of life.
• Community Coaching – add following participating “or to support an individual when there is an ongoing barrier to participation . . .” [This is an issue of access to the Community Engagement
service; individuals with chronic medical, sensory or mobility issues, challenging behavioral issues or a condition which is progressively more debilitating will be barred from Community Engagement as 1:1 staff exceeds the parameters of the service.]
• Community engagement – delete “one staff person to” or change the last sentence to “Community Engagement Services shall be provided in groups no larger than 3 individuals with a minimum of one staff”. Basically, delete the reference to “staff” in the definition. The goal is to limit the size of the group.
• Independent Living – Add a definition. The term is used throughout the proposed regulations with no definition. Proposed 12VAC30-122-90 defines the eligibility criteria for the Priority One waiting list to include young adults who are no longer eligible for IDEA services and who are transitioning to “independent living.” The regulations describe the individuals whom the Building Independence Waiver is designed to support as “individuals who reside in an integrated, independent living arrangement....” (proposed 12VAC30-122-240). Additionally, the Independent living support service described in proposed 12VAC30-122-420 is available to adults 18 years of age and older to provide the skill building and supports “necessary to secure and reside in an independent living situation.” Nowhere in the regulations, however, is the phrase “independent living” as used in these sections defined.
• Positive Behavior Supports – use the definition of the American Association for Positive Behavior Supports and delete the language provided. This will bring the service in line with the national standard.
• Progress Note – We support this definition as written and object to the variations contained in the Provider Requirement sections of the several service descriptions. See our “General Comments” above.
• QDDP – add a reference to all sections in this regulation which permit “QDDP” for the purposes of developing service plans and/or the supervision of staff to be defined in accordance with 12VAC35-105; while it is not necessary for the purposes of the definition, it will add clarity to the regulations.
• Face-to-face visit- add following support coordinator “or shared living administrative provider” [Face-to-face is the term used for the periodic meetings required in that service]
• Independent Living – Add a definition
• Service Authorizations- Strike the word “medically”. DD waiver services are all Medicaid-funded services. However, not all services authorized or funded under the waiver are medical in nature. (e.g. supported employment, community engagement, etc). While we understand the Medicaid standard of “medical necessity” for payment, it implies that services must have a physician’s order and not be developed by the Person-Centered planning process.
• Supported living residential- delete following a service “taking place in an apartment setting”; add following operated by a DBHDS-licensed provider. Change to “taking place in an individual’s own home”. There is no operational reason to limit the choice of the type of living arrangement.
12VAC30-122-40. Waiver services; when not authorized.
• B. Clarify that transition services can be provided to individuals who are inpatients at the listed facilities when they are preparing for discharge. The subsection states that waiver services shall not be furnished to individuals who are inpatients of a hospital, nursing facilities, ICF/IID, or inpatient rehabilitation facility. It goes on to state that waiver services shall not be provided until the individual has exited the institution and has been enrolled in the waiver. However, some of the costs covered by transition services would have to be incurred prior to the individual exiting the
institution, in order for the individual to have an alternative place to live. Such expenses include security deposits, set-up fees, or deposits for utilities, etc.