Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-500 - Services facilitation service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Individuals enrolled
				in the FIS or CL waivers may select the consumer-directed model of service
				delivery for certain services, absent any of the specified conditions that
				preclude such a choice, and may also receive support from a services
				facilitator. Services facilitation service shall be a separate waiver service
				and shall be used only in conjunction with consumer-directed personal
				assistance service, respite service, or companion service.
B. Criteria and allowable activities.
1. Services facilitators shall train
				individuals enrolled in the waiver, or the individual's employer of record
				(EOR), as appropriate, to direct, such as select, hire, train, supervise, and
				authorize timesheets of their own assistants who are rendering personal
				assistance services, respite services, and companion services.
2. The services facilitator shall also make
				an initial comprehensive home visit to collaborate with the individual and the
				individual's family/caregiver, as appropriate, (i) to identify the individual's
				needs for a requested consumer-directed service; (ii) to assist in the
				development of the plan for supports with the individual and the individual's
				family/caregiver, as appropriate; (iii) provide employer management training to
				the individual or EOR, as appropriate, on his responsibilities as an employer;
				and (iv) to provide ongoing support of the consumer-directed model of service.
				The services facilitator shall provide employer management training to the EOR
				within seven days of the initial visit.
a.
				The initial comprehensive home visit shall be completed only once upon the
				individual's entry into the consumer-directed model of service regardless of
				the number or type of consumer-directed services that an individual is approved
				to receive.
b. If an individual
				changes services facilitators, the new services facilitator shall complete a
				reassessment visit in lieu of a comprehensive visit.
c. The employer management training shall be
				completed before the individual or EOR may hire an assistant who is to be
				reimbursed by DMAS.
d. After the
				initial visit, the services facilitator shall continue to monitor the
				individual's plan for supports quarterly (i.e., every 90 days) and more often
				as needed. If consumer-directed respite service is provided, the services
				facilitator shall review the utilization of consumer-directed respite service
				either every six months or upon the use of 240 respite service hours, whichever
				comes first.
3. An
				in-person meeting shall occur between the services facilitator and the
				individual at least every six months to reassess the individual's needs and to
				ensure appropriateness of any consumer-directed service received by the
				individual. During these visits with the individual, the services facilitator
				shall observe, evaluate, and consult with the individual, EOR, and the
				individual's family/caregiver, as appropriate, for the purpose of assessing the
				adequacy and appropriateness of consumer-directed service with regard to the
				individual's current functioning, medical needs, and social needs. The services
				facilitator's written summary of the visit shall include:
a. Discussion with the individual and EOR or
				individual's family/caregiver, as appropriate, whether the particular
				consumer-directed service is adequate to meet the individual's needs;
b. Any suspected abuse, neglect, or
				exploitation and to whom it was reported;
c. Any special tasks performed by the
				assistant or companion and the assistant's or companion's qualifications to
				perform these tasks;
d. The
				individual's and EOR's or individual's family/caregiver's, as appropriate,
				satisfaction with the assistant's or companion's service;
e. Any hospitalization or change in medical
				condition, functioning, or cognitive status;
f. The presence or absence of the assistant
				or companion in the home during the services facilitator's visit; and
g. Any other service received and the
				amount.
4. The services
				facilitator, during routine quarterly visits, shall also review and verify time
				worked as needed to ensure that the number of hours approved in the plan for
				supports is not exceeded. If discrepancies are identified, the services
				facilitator shall discuss these with the individual or EOR to resolve
				discrepancies and shall notify the fiscal/employer agent as defined in
				12VAC30-122-170. If an individual is consistently identified as having
				discrepancies in his timesheets, the services facilitator shall contact the
				support coordinator. Failure to review and verify timesheets and maintain
				documentation of such reviews shall subject the provider to recovery of
				payments made by DMAS in accordance with
				12VAC30-80-130.
5. The services facilitator shall be
				available during standard business hours to the individual or EOR by
				telephone.
6. The consumer-directed
				services facilitator shall assist the individual or EOR with employer issues as
				requested by either the individual or EOR.
7. The services facilitator shall also
				complete the assessments, reassessments, and supporting documentation necessary
				for consumer-directed service.
8.
				Service facilitation service shall be provided on an as-needed basis as
				mutually agreed to by the individual, EOR, and services facilitator but at a
				minimum quarterly routine visits shall take place. Services facilitator service
				shall be documented in the supporting documentation for consumer-directed
				service, and the service facilitation provider shall bill consistent with the
				supporting documentation. Claims that are not adequately supported by this
				supporting documentation may be subject to a DMAS recovery of
				expenditures.
9. If an EOR is
				consistently unable to hire and retain an assistant to provide
				consumer-directed services, the services facilitator shall contact the support
				coordinator and DBHDS to transfer the individual, at the choice of the
				individual, to a provider that provides Medicaid-funded agency-directed
				companion service, personal assistance service, or respite care service, as may
				be appropriate.
10. If an
				individual enrolled in consumer-directed service has a lapse in
				consumer-directed service for more than 60 consecutive calendar days, the
				services facilitator, or the individual or family/caregiver functioning as the
				services facilitator, shall notify the support coordinator so that
				consumer-directed service may be discontinued, and the option afforded to the
				individual to change to agency-directed service as long as the individual still
				qualifies for the service.