As you all are aware, Centers for Medicaid/Medicare Services (CMS), which is the federal overseer of Medicaid Waivers, has given the Department of Medical Assistance Services (DMAS) approval to officially allow parents of minors and spouses of those getting services to continue to be paid attendants. 

In theory this was great news for many of you! However, as we have all recently learned, the expectations and deadlines are unrealistic. The “guardrails” explained in the DMAS trainings earlier this month, and the timeline to implement those guardrails, we now know is inevitably going to cause a disruption of services for thousands of consumers in this position! 

Let's review the challenges with the practicality of getting these guardrails in place by 11/11/2023... that is only 13 business days from now!

• Employee (Attendant) and Employer (EOR) cannot both be Legally Responsible Individuals (LRIs) for the same Consumer (the child). So..
• Example: If Mom is the attendant and Dad (or Stepdad) is the EOR, one of those things must change by 11/11/23. 
• In order for Mom (in the example above to continue to be the attendant, the following two things must happen:
• A new EOR must be identified, and they must:
• Live within a 50 mile radius of the child receiving services
• Your Service Facilitator will need to complete a DMAS-95B form on the new EOR
• Receive EOR training 
• Complete an Extraordinary Care Questionnaire, then Service Facilitator and Authorizing Entity must sign off on it.
• The attendant will need to fill out a new LRI packet, which has yet to be released by all of the fiscal agents.
• Fiscal Agents will begin to receive an inordinate amount of change of EOR requests and LRI packets and will become backlogged.

• Since the LRI (mom in the example above) has to be the attendant of last resort, the EOR will have to fill out an Extraordinary Care Form and prove that there are no other options outside of the home to hire an attendant. Proof of the attempts made in the last 6 weeks leading up to 11/11 may include:
• Copies of ads placed
• Notes from interviews of other attendants (besides the LRI)
• A documented history of other attendants that didn't work out, high turnover
• Medical/Behavioral Specialist documentation supporting special medical or behavioral needs, also documented in the plan of care.
• Documentation indicating that language is a factor in service delivery, meaning there are not others around that speak the child's language (or ASL) that could be the paid attendant.

This sounds like a lot to get done in 13 business days right? That’s because it is. 

One of DMAS's possible solutions to these challenges is to allow aides to be back paid for services if they are finally approved as the aide through 12/31/23. This means families would go without pay from 11/11/23 until potentially 12/31/23. At which time they could collect back pay when they are processed.

We know from our experience working with attendants who are paid the low wages that attendants are paid... going for almost two months without pay is not really a solution or option for you.

DMAS has the ability to request approval from CMS to allow for a non-enforcement period, where they temporarily do not enforce some rules (as they did in the beginning of the pandemic under Appendix K).

The only real solution to these coming hardships is a

PERIOD of NON-ENFORCEMENT.

Without a PERIOD of NON-ENFORCEMENT from DMAS, all of these new rules will be going into effect November 11, 2023.

This is your last chance to TAKE ACTION!

Who: Contact DMAS, your Legislators and the Governor’s Office.

• DMAS
• DMAS Customer Service - 800-643-2273
• cccpluswaiver@dmas.virginia.gov
• ddwaiver@dmas.virginia.gov
• CDLRI@dmas.virginia.gov 
• Your State Delegate and Senator (based on where you live): 
• Find your legislators here
• Contact the Governor’s Secretary of Health and Human Services
• john.littel@governor.virginia.gov
• 804-786-7765
• Governor of Virginia on Facebook
• Governor of Virginia on Twitter

Urge them to SHOW they care for the consumers they are here to serve by taking action to Protect your Continuity of Care!

Why and How:

• Why: Tell them about the hardships these new “guardrails” are causing your family. Tell them that you fear your care will be interrupted by this 11/11/23 deadline. Be specific about your families situation and how you are being impacted. All MCO's and Fiscal Agents have not had time to release and disperse to providers and clients their plans or the documents needed for a successful transition.
• How: DMAS should Request and Implement a non-enforcement period of 6 months beyond 11/11/23 while they train providers and families, while families work to make changes to accommodate the new rules, and while the fiscal agents prepare for this transition. Without this period of non-enforcement, the proposed solution is that the fiscal agents will cut off the pay of the LRI on 11/10 and the fiscal agents have until 12/31 to process LRI packets. (Packets that most fiscal agents have not released to date.)

Please find a sample letter here created by a family who has been advocating for a period of non-enforcement. You are welcome to copy it and fill in the areas to make it unique with your families story.

Moms In Motion and At Home Your Way will continue to do their best to help you navigate these new DMAS changes while we also advocate alongside with our clients for DMAS to make changes. We understand that change is hard. We are so thankful for the kindness and patience that our clients continue to show to our Service Facilitators as our team is navigating these changes at the same time you are, and we may not have all of the answers you need. We ask that you continue to focus every frustration into advocating for change alongside us by reaching out to the people and agencies that can still do something about this; DMAS, your legislators, the Governor's office, your MCO's, and Fiscal Agents. Let's take a stand to make a change... we are in this together!