The 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 is great news.

In practice the expectations and deadlines are unrealistic.

The “guardrails” included with this allowance and the timeline to implement those guardrails will lead to a disruption of services for thousands of consumers in this position! 

Here are the challenges with the practicality of getting these guardrails in place by 11/11/2023 (Just 26 business days from now).

• Employee (Aide) and Employer (EOR) cannot both be Legally Responsible Individuals (LRIs) for the same Consumer (the child). So..
• For children waiver recipients w/parents as aides, to continue using Consumer-Directed (CD) services, the aide and EOR cannot both be legally responsible individuals (LRIs) for the consumer (the child). For 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
• Receive EOR training 
• Complete an Extraordinary Care Questionnaire, then Service Facilitator and Authorizing Entity must sign off on it.
• Your Service Facilitator will need to complete a DMAS-95B form on the new EOR
• The attendant will need to fill out a new LRI packet, which has yet to be developed by the fiscal agents.
• Fiscal Agents will begin to receive an inordinate amount of change of EOR requests and LRI packets and will become backlogged.

• The EOR must meet certain requirements to prove that Mom (in the example above) should be approved as the attendants. One way to do this is by showing that Mom is the only available person to provide this service via Written Objective Documentation (WOD) Requirements
• EOR will be required to prove that in the last 6 weeks leading up to 11/11/23, they have made valid attempts to hire someone that does not live in the home with the person receiving services before the parent/spouse will be approved to provide those services and before authorizations will be reauthorized. This means providing the Service Facilitator with copies of ads placed, interview notes taken, a history of failed attempts to hire externally, etc. (ie. The LRI (Mom) must be the attendant of last resort.)

This sounds like a lot to get done in 26 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 be allowed to go without pay from 11/11/23 until 12/31/23. At which time they could collect back pay when they are processed.

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

Call to 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
• 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
• 73rd Governor of Virginia on Facebook
• 73rd 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.
• 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.

Next Steps:

If you are one of our Moms In Motion families with a minor child receiving services and one LRI (parent) is the paid attendant and the other is the EOR:

• Begin the process of changing your EOR.
• It often takes up to 8 weeks to make this change happen, so don’t wait!
• You can start that process by filling out our secure form with all of the information of the new EOR here.
• Having the LRI as the paid attendant must be the last resort. To prove that it is, begin your advertising for an outside attendant. 
• Post on social media
• Place an ad in a local newspaper
• Use Care.com
• Fill out the Extraordinary Care form and submit it to your Service Facilitator: Click here
• Please note that an LRI must be approved by the authorizing agency (MCO, DMAS, DBHDS) and approval is not guaranteed.

Attend the DMAS training on LRI either tomorrow or Wednesday. Register here.

Agency-Directed Services:

Moms In Motion is starting an Agency (At Home Your Way (“AHYW”)) to provide Agency Directed services. We will begin transitioning our DD Waiver (Community Living or Family & Independent Supports) families to this model, if desired. For the families facing these guardrails on the Consumer Directed side, this is a great option. At Home Your Way can hire your attendant and that person can continue to work with their loved one*. 

• AHYW will provide to eligible employees
• Reimbursement for up to 40 hours for live in or legally responsible adults (as authorized by your MCO, CSB or DMAS) (no overtime)*
• Employees will be eligible to earn sick leave in this Agency Directed company at the same rate as aides do under Consumer Direction.
• Medical, Dental and Vision Care Insurance
• A 401K program
• Due to the differences in Agency Rates provided by DMAS in NOVA and ROS and that AHYW will provide the above noted benefits to eligible employees the following will be the pay rates for aides each area:
• NOVA - $15.12/hour
• ROS - $12.70/hour
• If DMAS increases rates in Jan 2024 by 5% as allowed by the recently passed budget, those rates will increase accordingly to:
• NOVA - $15.88/hour
• ROS - $13.33/hour
• To indicate your desire to move from Consumer Directed to Agency Directed services with At Home Your Way, please fill out this form.
• At this time, to better serve families through this transition, At Home Your Way is only taking on clients that have an attendant of their choice that is ready to start employment through our agency to care for you or your loved one.*
• Your attendant can begin this process by reading the DD Direct Service Professional (DSP = Attendant) Orientation manual here.

Moms In Motion and At Home Your Way will do our best to help you navigate these new DMAS changes. We understand that change is hard. Please be patient and kind to your Service Facilitators as we are navigating these changes at the same time you are and we may not have all of the answers you need.  

If you have specific questions about the new rules and how they apply to you, DMAS has provided the following contact information: CDLRI@dmas.virginia.gov