DD Waiver Final Regulations – April 2019

General Comments

• Support the consistent use of “progress notes” as defined in the DD Waiver regulations versus the use of “daily note” references.  We support the definition of “progress notes” as defined in 12VAC30-122-20 “Definitions” for consistency.  “Progress notes” means individual-specific written documentation that (i) contains unique differences specific to the individual’s circumstances and the supports provided, and the individual’s responses to such supports; (ii) is signed and dated by the person who rendered the supports; and (iii) is written and signed and dated as soon as is practicable but no longer than one week after the referenced service.”

• Semi-Annual Supervisory Notes for DSPs including “individual’s satisfaction with service provision”. Requirement should be eliminated.

  • Community Coaching (122-310.E.2), Community Engagement (122-320.E.2), Group Day (122-380.D.5.), Group Residential (122-390.D.5), Crisis Support Services (122-350.E.2) and Center-Based Crisis Support Services (122-300.E.2) all have additional burdensome requirements under Service Documentation or Provider requirements that state that there must be written supervision notes for each DSP, signed by the supervisor and included semi-annual documentation of individual’s satisfaction by the supervisor. Semi-Annual supervisory documentation of an individual’s “Satisfaction with service provision” or “observation of satisfaction” is also required.  This is duplicative of the initial and annual thereafter required documentation of proficiency of staff competencies included under 122-180.

12VAC30-122-20. Definitions.

General: 

• 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.

12VAC30-122-80. Waiver approval process; authorizing and accessing services.

• C.4.- Following initiated within change “30 days” to “90 days,” Taking into account the existing workforce recruitment timeframes, training requirements, etc., services may not realistically be initiated in only 30 days.

12VAC30-122-120. Provider requirements.

• A.4.- Change “30 calendar days” to “90 calendar days”
• A.10.d- Strike “Such documentation shall be written on the date of service delivery.”

12VAC30-122-180. Orientation testing; professional competency requirements; advanced competency requirements.

• D.2- Change sentence to “Completed documentation from the online certificate shall be maintained in the Personnel File.”
• E.7- Add “only” before specific to the needs; and following specific to the needs strike “and level”

• E.8- add “only” before “specific to the needs”; strike “and service levels” [These changes clarify the intent have the advanced competencies applicable as the needs of the individual requires.]

   

12VAC30-122-200. Supports Intensity Scale® requirements; Virginia Supplemental Questions; levels of support; supports packages.

• A.1- Delete “to 72” and add “or older” after “years of age.”If the SIS is only validated to age 72 then language should be added to automatically assign all individuals age 72 or older to Level 5, Tier 4. Level 5 is the highest level denoting significant need in general but not specifying it to medical or behavioral.Tier 4 is mid-range denoting significant need, which is appropriate for an aging population.However, there should be a statement that these individuals shall not be excluded from consideration of an individualize rate because of medical or behavioral needs.

• A.2.a - Change “three” to “four” to stay consistent with the CL application

• Add a new subsection – “Requires that the results of the SIS be provided within 10 days of scoring in an understandable format and that the service coordinated be required to explain the results and implications of the SIS score and avenues of appeal.”

12VAC30-122-390 - Group Home Residential Service.

• E.1.c- Change “at least a daily note” to “a Progress Note”.

12VAC30-122-410 - In-Home Support Service.

• Recommend that In-Home Services hours be authorized quarterly, semi-annually or annually – a “pool” of hours that would include and accommodate “periodic support hours”. Current regulations do not limit adding an average number of “periodic support hours”.However, in practice, this is an ongoing implementation issue with additional flexible hours not being approved.A longer period of authorization would help allow flexibility when an individual must stay home from group day or employment, community engagement. it supports choice.