WDAC Feedback on Service Definitions
Service Definition / Notes/Comments / Action / Potential Modifications Based on Feedback
#1: Shared Living Within Supports Waiver:
The payment for the portion of the total cost of rent and food that can be reasonably attributed to a family memberor unrelatedlive-in person who resides in the same household as the individual. Payment is intended for the provision of general fellowship, protection, and support activities, without the expectation of responsibility for habilitative care or medical related services. /
- Follow upregarding application to FLSA rule change
- Will service be limited to participants who choose to and are capable of self-directing their service or open to agency-directed service plans as well?
- Clarify the self-directed service options available under the replacement waiver programs as well as the scope of participant-direction (e.g. Employer Authority, Budget Authority or both) for waiver application
- How will we enable the wide range of rent costs across the state – Fairfax to Bristol? Will there be a cap?
- Fed reg. §440.182 State Plan home and community-based services currently require caregiver to be unrelated
- Self direction issues proposed for committee discussion
The payment for the portion of the total cost of rent and food that can be reasonably attributed to an family memberor unrelatedlive-inperson caregiver who resides in the same household as the individual, but not if the recipient is living in the home of the caregiver or in a residence that is owned or leased by the caregiver. Payment is intended for the provision of general fellowship, protection, and support activities, without the expectation of responsibility for habilitative care or medical related services.
#2: Non-Medical Transportation
Service offered in order to enable individuals to gain access to waiver and other community services or events, activities and resources, inclusive of transportation to employment or volunteer sites, homes of family or friends, civic organizations or social clubs, public meetings or other civic activities, and spiritual activities or events as specified by the service plan and when no other means of access is available. This service is offered in addition to medical transportation required under 42 CFR §431.53 and transportation services under the State plan, defined at 42 CFR §440.170(a) (if applicable), and does not replace them.
Transportation services under the waiver are offered in accordance with the individual’s service plan and shall include a consumer-directed option which would allow family, neighbors, friends, or community agencies to provide this service whenever possible. This service may include vouchers for public transportation. All providers must be 18 years of age or older with a valid Social Security Numberand must possess and maintain at a minimum a: (1) valid driver’s license, (2) proof of general liability insurance coverage in compliance with federal and/or state statutory requirements, (3) satisfactory driving record, (4) clean criminal record. /
- Will mileage reimbursement for personal attendant care be added to service? Need to avoid double billing of Medicaid.
- Use the term “participant direction” throughout since CMS abandoned the term “consumer direction” in favor of “participant direction”
- Is service restricted to Virginia?
- More specificity needed to define satisfactory criminal record, background check, and driving record. What is necessary to not rule out family members and friends as CD providers:
- felony or misdemeanor
- years since conviction?
- relation to driving, etc questions was asked below as well but not
- How willcriminal or background record checks be conducted with out of stateresidency (ex. TN borders VA, NC also borders the Danville/Martinsville area)?
- Substituted the term “participant” for “consumer(NOTE: conflict with DMAS terminology)
- Details regarding criminal history/background investigation requirements, can be addressed in regulations, manual, or other departmental guidance
- Other issues proposed for committee discussion
Service offered in order to enable individuals to gain access to waiver and other community services or events, activities and resources, inclusive of transportation to employment or volunteer sites, homes of family or friends, civic organizations or social clubs, public meetings or other civic activities, and spiritual activities or events as specified by the service plan and when no other means of access is available. This service is offered in addition to medical transportation required under 42 CFR §431.53 and transportation services under the State plan, defined at 42 CFR §440.170(a) (if applicable), and does not replace them.
Transportation services under the waiver are offered in accordance with the individual’s service plan and shall include a consumer-participant directed option which would allow family, neighbors, friends, or community agencies to provide this service whenever possible. This service may include vouchers for public transportation. All providers must be 18 years of age or older with a valid Social Security Numberand must possess and maintain at a minimum a: (1) valid driver’s license, (2) proof of general liability insurance coverage in compliance with federal and/or state statutory requirements, (3) satisfactory driving record, (4) clean criminal record.
#3: Private Duty Nursing
Individual and continuous care (in contrast to part-time or intermittent care) provided by licensed nurses within the scope of state law. These services are provided to an individual at their place of residence. Home. / No comments
#4: Goods and Services Smart Goods and Services
Individual DirectedSmart Goods and Services are purchases of electronic devices, software, services, equipment, and supplies not otherwise provided through this waiver or through the State Plan, that would allow individuals with intellectual and developmental disabilities to access technology that can be used in the individual’s residence to support greater independence and self-determination.
The service would support the selection, acquisition, and training in the use of these goods and services to address an identified need in the individual’sState-approved person-centered service plan (including improving and maintaining the individual’s opportunities for full membership in the community) and meet the following requirements: the item or service would decrease the need for other Medicaid services; AND/OR promote inclusion in the community; AND/OR increase the individual’s safety in the home environment; AND, the individual does not have the funds to purchase the item or service or the item or service is not available through another source.
Individual Directed Smart Goods and Services are purchased for the individual. The individual’s person-centered plan will include a needs assessment conducted by a technology specialist to help determine the best type and use of technology and the overall cost effectiveness of various options. This service includes ongoing Electronic Monitoring, which is the provision of oversight and monitoring within the home of adult individuals through off-site electronic surveillance which includes live video feed; live audio feed; motion sensing system; radio frequency identification (RFID); web-based monitoring system; or other devices approved by DBHDS/DMAS. The system shall include devices to engage in live, two-way communication with the individual being monitored. Also included is the provision of stand-by intervention staff prepared for prompt engagement with the individual and/or immediate deployment to the residential setting in critical situations. /
- Is the SMART terminology copyrighted? Should the title be changed to Electronic Based Home Support, e.g.?
- How will such assessments be conducted?(Does DBHDS plan to issue manual instructions on the parameters of the assessment and avoiding conflicts of interest. i.e., vendors, etc.)
- Changed service name as per recommendation.
- Added copyright symbol as placeholder
- Instructions on personnel issues and conduct of assessments can be addressed in regulations, manual, or other departmental guidance
Individual DirectedElectronic Based Home Supports
are Ggoods and Sservices based on Smart Home© technology. This includes arepurchases of electronic devices, software, services, equipment, and supplies not otherwise provided through this waiver or through the State Plan, that would allow individuals with intellectual and developmental disabilities to access technology that can be used in the individual’s residence to support greater independence and self-determination.
The service would support the selection, acquisition, and training in the use of these goods and services to address an identified need in the individual’sState-approved person-centered service plan (including improving and maintaining the individual’s opportunities for full membership in the community) and meet the following requirements: the item or service would decrease the need for other Medicaid services; AND/OR promote inclusion in the community; AND/OR increase the individual’s safety in the home environment; AND, the individual does not have the funds to purchase the item or service or the item or service is not available through another source.
Individual Directed Smart Goods and Services are purchased for the individual. The individual’s person-centered plan will include a needs assessment conducted by a technology specialist to help determine the best type and use of technology and the overall cost effectiveness of various options. This service includes ongoing Electronic Monitoring, which is the provision of oversight and monitoring within the home of adult individuals through off-site electronic surveillance which includes live video feed; live audio feed; motion sensing system; radio frequency identification (RFID); web-based monitoring system; or other devices approved by DBHDS/DMAS. The system shall include devices to engage in live, two-way communication with the individual being monitored. Also included is the provision of stand-by intervention staff prepared for prompt engagement with the individual and/or immediate deployment to the residential setting in critical situations.
#5: Therapy/Dental Services
The scope and nature of these services do not otherwise differ from services furnished under the State plan. The provider qualifications specified in the State plan apply. The additional amount of services that may be provided through the waiver must be justified in the Plan for Supports. Services to be covered include: • Physical therapy • Occupational therapy • Speech and language therapy • Dental Services for adults, up to a maximum of $1,000 per person per year, for two routine oral examinations and cleanings for the purpose of maintaining and/or preserving oral health. /
- “Person-centered plan,” “individual supports plan” and “plan of care” are used interchangeably through the definitions. Review to ensure consistent plan references are used throughout.
- Struck “ISP” and “Plan for Supports” and inserted “individual’s person-centered plan” for more consistency
The scope and nature of these services do not otherwise differ from services furnished under the State plan. The provider qualifications specified in the State plan apply. The additional amount of services that may be provided through the waiver must be justified in the Plan for Supportsindividual’sState-approved person-centered plan. Services to be covered include: • Physical therapy • Occupational therapy • Speech and language therapy • Dental Services for adults, up to a maximum of $1,000 per person per year, for two routine oral examinations and cleanings for the purpose of maintaining and/or preserving oral health.
#6: Residential Service
These services shall consist of skill-building, routine supports, general supports, and safety supports, provided primarily in an individual's home or in a licensed or approved residence, that enable an individual to acquire, retain, or improve the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings.
All home and community-based residential settings meet certain qualifications. These include:
• The setting is integrated in and supports full access to the greater community;
• Is selected by the individual from among setting options;
• Ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint;
• Optimizes autonomy and independence in making life choices; and
• Facilitates choice regarding services and who provides them.
- Includes general support and supervision of individuals during the day and night with staffing levels that provide for the individual’s health and safety needs documented on the ISP
• Group residential (taking place in a license group home or approved Adult Foster Care home),
• sponsored residential (taking place in a licensed sponsored residential home),
• supported living (taking place in the individual’s own home or apartment), and
• in-home supports (taking place in the individual’s family home and supplemental to the primary care provided by the individual, family or other unpaid caregiver).
Residential support services shall be authorized for Medicaid reimbursement in the Plan for Supports only when the individual requires these services and when such needs exceed the services included in the individual's room and board arrangements with the service provider, or if these services exceed supports provided by the family/caregiver. Only in exceptional instances shall residential support services be routinely reimbursed up to a 24-hour period. /
- Address integration targets re CMS Final Rule
- Shifting the focus to promoting independence and integration means that more time and attention needs to be devoted to activities other than general support and supervision.
- “Person-centered plan,” “individual supports plan” and “plan of care” are used interchangeably through the definitions. Review to ensure consistent plan references are used throughout
- Add Shared Living
- Integration targets can be addressed in manual, regulations, or other departmental guidance
- Skill building is included in service in addition to supports and supervision
- Struck “ISP” and “Plan for Supports” and inserted “individual’s person-centered plan” for more consistency
- Shared living is already added as a new proposed waiver service representing a roommate arrangement without habilitative expectations.
These services shall consist of skill-building, routine supports, general supports, and safety supports, provided primarily in an individual's home or in a licensed or approved residence, that enable an individual to acquire, retain, or improve the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings.
All home and community-based residential settings meet certain qualifications. These include:
• The setting is integrated in and supports full access to the greater community;
• Is selected by the individual from among setting options;
• Ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint;
• Optimizes autonomy and independence in making life choices; and
• Facilitates choice regarding services and who provides them.
- Includes general support and supervision of individuals during the day and night with staffing levels that provide for the individual’s health and safety needs documented on the ISP individual’s person-centered plan
• Group residential (taking place in a license group home or approved Adult Foster Care home),
• sponsored residential (taking place in a licensed sponsored residential home),
• supported living (taking place in the individual’s own home or apartment), and
• in-home supports (taking place in the individual’s family home and supplemental to the primary care provided by the individual, family or other unpaid caregiver).
Residential support services shall be authorized for Medicaid reimbursement in the Plan for Supportsperson-centered plan only when the individual requires these services and when such needs exceed the services included in the individual's room and board arrangements with the service provider, or if these services exceed supports provided by the family/caregiver. Only in exceptional instances shall residential support services be routinely reimbursed up to a 24-hour period.
#7: Crisis Service Description
Crisis supports are services that provide intensive supports by appropriately trained staff to an individual experiencing a behavioral or medical crisis either within the individual’s current residence or in an alternate community setting. (a) Crisis supports in the individual’s residence: These services provide crisis response staff to assist in supporting and stabilizing individual while also training and mentoring staff or family members, who normally support the individual, in order to remediate the crisis and minimize or prevent recurrence. (b) Crisis supports in an alternate community setting: These services can be provided in a day setting or an alternative residential setting and provide crisis response staff to support the individual in that setting, to stabilize and prepare the individual to maintain their current place of residence, return home or to move into another permanent location. In addition, staff will arrange to train and mentor staff or family members who will support the individual long term once the crisis has stabilized, in order to minimize or prevent recurrence of the crisis. Crisis support staff will deliver such support in a way that maintains the individual's typical routine to the maximum extent possible. This includes support during attendance at employment or customized community supports services, which may be billed on the same dates and times of service as crisis /
- Clarify when the party responding to the crisis is: (a) a licensed provider of crisis services; (b) the local CSB; and a Reach team. The goal should be to build local capacity, rather than shifting response role to REACH teams. DBHDS should be weighing the appropriate metrics for capacity building in this area so progress in localizing the response system can be measured and the results can be acted upon
- It would be helpful to have a single section on crisis prevention, stabilization and supports and then include all of the components of the crisis system in one place.
- Will waiver pay for prevention strategies?
- Need sample language for crisis intervention and stabilization piece
- Added language incorporating crisis prevention strategies as part of an integrated crisis management waiver service
- Struck inclusion of medical crisis in definition
- Recommendation for integrated comprehensive “waiver crisis system service” proposed for committee discussion.