To our Moms In Motion Families:

We know that all of you have questions about what is going to happen in November when supposedly Parents of minors and Spouses (P&Ss) will no longer be able to be paid attendants without “guardrails”. We know you are frustrated. We are too. It may seem like we have not done much to prepare you, but we are working tirelessly to get answers and prepare. We have been advocating to DMAS and asking them for direction on this for months, with no clear answers. Unfortunately, when you’re swimming in mud, nothing is clear.

What we do now know:

1. The ability for Parents of minors & Spouses (P&Ss) to be paid attendants was originally set to end Nov. 11, 2023.
2. DMAS has submitted applications to CMS (Centers for Medicare & Medicaid Services, DMAS’s overseer) to amend our 3 waivers to allow P&Ss to remain paid Consumer and Agency Directed attendants with some “guardrails” for Consumer-Directed.
3. CMS has recently issued official correspondence to the States that

a. Appendix K flexibilities will be automatically extended by CMS until the approval and effective date of the State’s amendment applications.

b. CMS is doing this because they are becoming backlogged with amendments and cannot process all of these by Nov. 11, 2023. And in their words: in the name of minimizing disruption to beneficiaries, providers and states.

What does this mean:

• You can remain paid attendants as you are per the CMS guidance until CMS approves the DMAS submitted amendments.

a. No one knows when that will be. CMS anticipates a backlog.

b. According to CMS guidelines P&Ss as paid attendants should be allowed without additional “guardrails” for Consumer Directed services until CMS approves the amendments.

• But - MCOs, CSBs and DMAS have been setting consumer’s approvals to end on Nov. 11, 2023 in order to require the “guardrails” to be in place by Nov 11, 2023.

a. That is no longer a valid reason.

What we are doing to prepare for approval of the amendments:

• The “guardrails” are going to make Consumer Direction an undesirable option for some of you.
• For example, one of the guardrails is that when one parent is the paid attendant, the other cannot be the EOR. Finding a new EOR may prove to be difficult.
• To help our families avoid that challenge we are starting an Agency. 
• We are ready to begin offering this option. We will be starting with our DD Waiver families who want to choose Agency-Directed services. That will be followed by the same option for our families on the CCC+ waiver that are interested in moving.
• For those interested in learning more about our new agency, please click the link below to get added to our newsletter and contact list: https://forms.gle/LNRGc87StmMWmWtf6

What we all need to do immediately:

1. Moms In Motion's CEO and COO will continue advocating with DMAS.
2. You, Your Community, the families we serve, need to advocate to DMAS, their CSBs, MCOs, State Senators and State Delegates and Governor that: Ask for these three things:

1. As CMS is doing, DMAS, CSBs and MCOs need to extend their authorizations for 6 months in the name of minimizing disruption to beneficiaries, providers and states.

2. DMAS needs to enact a period of non-enforcement of any new requirements (the “guardrails”) for a period of 6 months after the amendments are approved to allow for a smooth transition to their “guardrails”.

3. Give Service Facilitators a livable and competitive wage. Increase Service Facilitation Rates to the Burns and Associates 2021 Report 50%tile rates.

3. Links/Contacts

i. DMAS -

1. Managed Care Helpline - 804-786-6145
2. DMAS Customer Service - 800-643-2273
3. cccpluswaiver@dmas.virginia.gov
4. ddwaiver@dmas.virginia.gov
5. https://www.dmas.virginia.gov/about-us/contact/contact-us/

ii. CSBs - tell them to contact their Support Coordinator

iii. MCOs - https://app.getguru.com/card/TBBpXXMc/FISCAL-AGENT-MCO-CONTACT-INFO-AND-NPI

iv. Who’s your legislator - https://whosmy.virginiageneralassembly.gov/

v. Governor’s Office -

1. 804-786-2211
2. https://www.facebook.com/GovernorVA73
3. https://twitter.com/governorva

Things we still do not know:

1. We do not know when/if CMS will approve the amendments that were submitted by DMAS.
2. We do not know DMAS’s plan for communication of any of this to providers, families, MCO’s, or Fiscal Agents.
3. We do not know how each fiscal agent will handle the transition for those with the EOR/Paid Attendant combination. 

Please Keep In Mind

• Our Service Facilitators have experienced tremendous upheaval since the new year and being required to conduct visits in the home vs. remotely.
• Service Facilitation and Aides are reimbursed differently.
• Aides have gotten increases over the years in their payments and are now scheduled to get another 5% increase on 1/1/2024.
• That's 55% soon to be 60% in increases over the last 18 years for aides.
• Service Facilitation has not gotten an increase in the rates we are paid by the state for our services since 2005 (except the 12.5% Covid era correction which equates to less than 1% year over year for the least 18 years).
• That's 12.5% in increase over the last 18 years for SFs!
• (not to mention SF's education and experience requirements increased during this time as well)
• Many of you have been on the Waivers for a long time and can appreciate how although rates have not gone up for Service Facilitation, the complexity of providing that service has increased tremendously.

Moms In Motion is doing the best we can in the current environment.

• Our individual Service Facilitators and the people who answer our phones, and our Division Mangers, all of our team is doing the best they can in the current environment. 
• Please provide us as an organization and our Team as individuals as much understanding and grace as you possibly can. 
• Be nice to them, these circumstances are not their fault. Taking frustration out on them puts us all in a downward spiral.
• If we work together and are kind to each other, we will all be better for it.

In summary, we know you are frustrated with the lack of communication. We are not providing answers because we do not have them. Use your frustrations to ask those in charge (DMAS, the MCOs, the CSBs, your legislators, Governor Youngkin) as fuel. Ask them to:

1. Extend their, MCOs and CSBs authorizations for 6 months in the name of minimizing disruption to beneficiaries, providers and states.
2. DMAS should enact a period of non-enforcement of any new requirements for Consumer Directed services (the “guardrails”) for a period of 6 months after the amendments are approved to allow for a smoother transition to their “guardrails”.
3. Increase Service Facilitation Rates to allow for proper support of these services. - We humbly ask this. We know you have a lot on your plate and your main concern should be yourselves and your family's well being. These rates would allow us to do our job of supporting you at the level that you deserve and were used to. We've asked and asked the powers that be ourselves. We now ask for you help with our fight as well.

Your advocacy did result in the State changing their approach to continuing Parents of minors and Spouses as paid attendants. Before you mobilized, the State was not going to allow P&Ss to continue under consumer direction at all in their amendment applications. Because of your voice, Delegate Don Scott, House Minority Leader, sent a letter to the Hon. John Littel, Secretary of Health and Human Resources asking for a reversal of this decision. It worked!

We need you to do it again! Advocate for yourselves (and we would love it if you would put in a word for us if you could:) ).