Comment

Current regulations have no requirement for a "designated staff person" responsible for activities. Adding the requirement for a "designated" activity staff will create a financial hardship on providers, especially those centers located in rural areas.

The regulations are the minimum requirements for adult day services and for the regulations to change to a "designated" activities staff person are too restrictive from an educational as well as experiential perspective. The requirements will be difficult from a budgetary perspective, especially with government-supported programs reimbursement rate being substantially under the true cost of care. 

1. According to the Bureau of Labor Statistics, a therapeutic recreation specialist has annual wages of $45,890, an Occupational Therapist has annual wages of $80,150 and an Occupational Therapy Assistant has annual wages of $57,870. All are before fringe benefits. ADHC facilities who serve publicly funded programs will not be able to pay those wages and be sustainable when couple with the other staffing requirements. The current rate of reimbursement in the Medicaid waiver, Commonwealth Coordinated Care Plus (CCC+), is $57.04 for most of Virginia. The average cost of care across the state is over $100 per day.
2. The option to utilize a qualified activities professional is only expensive, but the training is difficult to obtain for employees in rural areas of the state. The activities professional course through the National Certification Council for Activity Professionals is a 40-hour training course for $695. This does not include the staff coverage that would be needed in the center and the extra cost the center would have to support. This training program may not be only offered through NCCAP in the future and this regulation does not allow enough variance to include future developments. 
3. The requirement for having at least an Associate's degree in "a discipline focusing on the provision of activities for adults" is vague.
4. The requirement for 1-year experience in an activities program in an adult care setting would be difficult for those in rural areas where the ADHC is only in the area. 

Recommendation:

The proposed regulation 22VAC40-61-330 Activities, Part D should either be eliminted in its entirety or changed to include other therapies like music and art therapy professionals.

The proposed regulation should either be eliminated or revised to be a minimal standard that does not create a financial hardship, especially for small centers or those in rural areas. 

The proposed regulation should either be eliminated or revised to include any current or future training program offered through National Certification Council for Activity Professionals. 

The proposed regulation should either be eliminated or revised to include 1-year experience in an adult day setting or long-term care setting.