Compliance Analysis Overview

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VIRGINIA DEPARTMENT FOR THE AGING

COST SHARING / FEE FOR SERVICE POLICY

Overview The 1995 session of the Virginia General Assembly created the legislative intent that any new State General Fund revenues be used to implement sliding fees for services. In 2000 the Older Americans Act reauthorization permitted states to

implement cost sharing. These methods are referred to as both cost sharing and fee for service.

Cost sharing / fee for service is permitted for all services funded by Federal Older Americans Act funds except information and referral\assistance, outreach, benefits counseling, care coordination, ombudsman, elder abuse prevention, legal assistance or other consumer protection services and congregate and home delivered meals.1

The Area Agency on Aging (AAA) must: (A) protect the privacy and confidentiality of each older individual with respect to the declaration or non-declaration of individual income and to any share of costs paid or unpaid by an individual; (B) establish appropriate procedures to safeguard and account for cost share payments; (C) use each collected cost share payment to expand the service for which such payment was given;

(D) not consider assets, savings, or other property owned by an older individual to determine cost share; (E) not deny any service for which funds are received under the Older Americans Act for an older individual due to the income of such individual or such individual's failure to make a cost sharing payment; (F) determine the eligibility of older individuals to cost share solely by a confidential declaration of income and with no requirement for verification; (G) widely distribute State created written materials in languages reflecting the reading abilities of older individuals that describe the criteria for cost sharing, the State's sliding fee scale, and the mandate described under subparagraph (E);2 (H) conduct public hearings on the Area Plan, that shall solicit the views of older individuals, providers, and other stakeholders on implementation of cost sharing in the service area;3 (I) develop a plan to ensure that the participation of low-income older individuals (with particular attention to low-income older individuals,

including low-income minority older individuals, older individuals with limited

1 Older Americans Act of 1965, as amended, Section 315(a)(2) 2 Older Americans Act of 1965, as amended, Section 315(a)(5) 3 Older Americans Act of 1965, as amended, Section 315(c)(1)

Revised 05/29/2007

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VIRGINIA DEPARTMENT FOR THE AGING COST SHARING / FEE FOR SERVICE POLICY Page 2 of 4

English proficiency, and older individuals residing in rural areas) receiving services will not decrease with the implementation of the cost sharing;4 (J) use fees as they are collected. If fees are earned near the end of the fiscal year and the agency is unable to spend this income by then, it shall at least be spent before the expenditure of any Federal or State General Funds in the beginning of the next fiscal year;5 and

(K) adopt written policies and procedures, approved by the governing board, for cost sharing / fee for service.

Waiver An AAA may request a waiver to the State's cost sharing / fee for service policies on Older Americans Act funds. The State shall approve such a waiver if the AAA can adequately demonstrate that--(A) a significant proportion of persons receiving services under this Act, subject to cost sharing in the planning and service area, have incomes below the threshold established in State policy; or (B) cost sharing would be an unreasonable administrative or financial burden upon the area agency on aging.6

It is the intent of the Virginia General Assembly that new State General Funds awarded for fiscal year 1996 and later be spent in a cost sharing / fee for service program. Therefore the Department for the Aging (Department) can not waive the requirement for cost sharing / fee for service of these State General Funds.

Cost sharing / fee for service conditions or fee scales prohibited by the Older Americans Act AAAs may implement conditions or fee scales on State General Funds that are prohibited by the Older Americans Act provided the State General Funds are not used as match for Federal Older Americans Act dollars. AAAs that impose additional conditions or an alternative fee scale, must complete appropriate waiver in the Area Plan for approval by the Department. If an AAA wishes to implement additional conditions they must be listed in the AAA’s policies and procedures on cost sharing / fee for service. Additional conditions may include: (1) a minimum payment (2) a flat fee (3) means testing (4) denial of services based on income (5) denial of services for non-payment (6) others

4 Older Americans Act of 1965, as amended, Section 315(c)(2) 5 22VAC5-20-390, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 6 Older Americans Act of 1965, as amended, Section 315(a)(6)

Revised 05/29/2007

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VIRGINIA DEPARTMENT FOR THE AGING COST SHARING / FEE FOR SERVICE POLICY Page 3 of 4

Charge or Fee The AAA shall develop and distribute a schedule of fees for services. Programs should establish a reasonable maximum fee based on the cost of the service delivered. The schedule shall clearly show the amount to be charged.

Charges shall be reasonably based on the cost of the service, recognizing that

programs may need to estimate the costs of service delivery or round off fees to simplify their pricing strategy. Charges should be established to fully cover the cost of the service being provided. All costs, including administration and overhead, must be distributed fairly and equitably among programs. In-kind should be considered as a part of the cost of the service.

Sliding Fee Scale / Schedule The “VDA Sliding Fee Scale”, revised annually, is the scale to be used as the basis for assessing fees. This scale is based on the most recent published Federal Poverty Guidelines. The Northern Virginia AAAs in Planning and Service Area 8 are to follow the “Northern Virginia VDA Sliding Fee Scale”.7 An AAA may request an alternative to the “VDA Sliding Fee Scale” for Older Americans Act funding by completing the appropriate waiver in the Area Plan.

The client’s family income is based on the “Number in Family” and the “Annual Gross Income.” The definition of family is the same as the one in the User’s Manual: Virginia Uniform Assessment Instrument (UAI), as revised. For

example, an elderly person(s) are considered a separate family unit even when they live in the home of their adult children or a relative.

A signed agreement, readily understood by the client, shall be required unless payment is collected at the time of service delivery. A service may be delivered on an infrequent or short-term basis such as transportation, which may be paid at the time of service delivery, so a written agreement is unnecessary. A copy of the fee schedule shall be attached to the written agreement whenever a client is to receive a bill or prepay for services in order to avoid misunderstandings.

Income The AAA may adjust total income to take into account the expense of: (1) medical/dental services, including durable medical equipment and/or consumable medical supplies, which are prescribed by the patient’s physician and received by the patient but which are not covered by Medicaid, Medicare or other insurance,

(2) modifications to the home for medical reasons, (3) medical insurance premiums, and

7 The VDA Sliding Fee Scale is based on the income levels for charges promulgated in the Virginia Department of Health’s Regulations Governing Eligibility Standards and Charges for Health Care Services to Individuals, 12VAC5-200-110.

Revised 05/29/2007

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VIRGINIA DEPARTMENT FOR THE AGING COST SHARING / FEE FOR SERVICE POLICY Page 4 of 4

(4) the cost of home/community based services identified as a need according to the UAI and not available without cost to the client.

Additionally, AAAs may exclude excessive health care costs that are out-of-pocket expenses to the client for the following home and community based services. These costs shall be used to adjust gross income when the service is

essential to keeping the client in the home: (1) adult day care, (2) companion/chore/homemaker services, (3) emergency alert systems, (4) home delivered meals, (5) personal care services, (6) respite services, (7) transportation to medical appointments and/or adult day care, and (8) non-medical home repairs essential for the health and safety of the client.

Adjustments to or exclusions from income are permitted provided they are clearly identified in the AAA’s polices and procedures for cost sharing / fee for service.

Recertification At least once a year or when the AAA becomes aware of a change in a client’s income; the AAA shall review the client’s income.

Client Statements When a service is provided on an infrequent or short-term basis, such as transportation, which may be paid at the time of service delivery, a statement is unnecessary. Otherwise, clients should be given a statement of the fees for which they are responsible along with instructions on how to pay their share of the cost. The written statement shall contain at a minimum, balance forward, amount paid, value of service provided since last bill (if any), and balance due.

Collection A reasonable effort shall be made to collect fees from clients or others who may choose to pay on the client’s behalf. A reasonable effort shall include billing the client for fees on a regular basis, indicating their outstanding balance.

If a client does not pay their fees, the AAA may not discontinue Older Americans Act services. However, the AAA shall ensure that each service provider will provide an opportunity to voluntarily contribute to the cost of the service.8

8 Older Americans Act of 1965, as amended, Section 315(b)(4)(A)

Revised 05/29/2007

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VIRGINIA DEPARTMENT FOR THE AGING

COST SHARING / FEE FOR SERVICE POLICY

The 1995 Virginia General Assembly intended that new State General Fund revenues fund sliding fees for services. In 2000, the Older Americans Act reauthorization allowed states to

implement cost sharing, also called fee for service.

Cost sharing/fee for service is allowed for all federally funded Older Americans Act services except information/referral, outreach, benefits counseling, care coordination, ombudsman, elder abuse prevention, legal aid, and congregate/home-delivered meals.1

The AAA must: (A) protect older individuals' privacy regarding income declarations and cost shares; (B) establish procedures to safeguard and account for cost share payments; (C) use each collected payment to expand the related service;

(D) not consider assets, savings, or other property owned by an older individual to determine cost share; (E) not deny any service for which funds are received under the Older Americans Act for an older individual due to the income of such individual or such individual's failure to make a cost sharing payment; (F) determine the eligibility of older individuals to cost share solely by a confidential declaration of income and with no requirement for verification; (G) widely distribute State created written materials in languages reflecting the reading abilities of older individuals that describe the criteria for cost sharing, the State's sliding fee scale, and the mandate described under subparagraph (E);2 (H) conduct public hearings on the Area Plan, that shall solicit the views of older individuals, providers, and other stakeholders on implementation of cost sharing in the service area;3 (I) develop a plan to ensure that the participation of low-income older individuals (with particular attention to low-income older individuals,

including low-income minority older individuals, older individuals with limited

1 Older Americans Act of 1965, as amended, Sec. 315(a)(2); 2 Sec. 315(a)(5); 3 Sec. 315(c)(1)

Revised 05/29/2007

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VIRGINIA DEPARTMENT FOR THE AGING COST SHARING / FEE FOR SERVICE POLICY Page 2 of 4

English proficiency, and older individuals residing in rural areas) receiving services will not decrease with the implementation of the cost sharing;4 (J) use fees as they are collected. If fees are earned near the end of the fiscal year and the agency is unable to spend this income by then, it shall at least be spent before the expenditure of any Federal or State General Funds in the beginning of the next fiscal year;5 and

(K) adopt written policies and procedures, approved by the governing board, for cost sharing / fee for service.

Waiver An AAA may request a waiver to the State's cost sharing / fee for service policies on Older Americans Act funds. The State shall approve such a waiver if the AAA can adequately demonstrate that--(A) a significant proportion of persons receiving services under this Act, subject to cost sharing in the planning and service area, have incomes below the threshold established in State policy; or (B) cost sharing would be an unreasonable administrative or financial burden upon the area agency on aging.6

It is the intent of the Virginia General Assembly that new State General Funds awarded for fiscal year 1996 and later be spent in a cost sharing / fee for service program. Therefore the Department for the Aging (Department) can not waive the requirement for cost sharing / fee for service of these State General Funds.

Cost sharing / fee for service conditions or fee scales prohibited by the Older Americans Act AAAs may implement conditions or fee scales on State General Funds that are prohibited by the Older Americans Act provided the State General Funds are not used as match for Federal Older Americans Act dollars. AAAs that impose additional conditions or an alternative fee scale, must complete appropriate waiver in the Area Plan for approval by the Department. If an AAA wishes to implement additional conditions they must be listed in the AAA’s policies and procedures on cost sharing / fee for service. Additional conditions may include: (1) a minimum payment (2) a flat fee (3) means testing (4) denial of services based on income (5) denial of services for non-payment (6) others

4 Older Americans Act of 1965, as amended, Section 315(c)(2) 5 22VAC5-20-390, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 6 Older Americans Act of 1965, as amended, Section 315(a)(6)

Revised 05/29/2007

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VIRGINIA DEPARTMENT FOR THE AGING COST SHARING / FEE FOR SERVICE POLICY Page 3 of 4

Charge or Fee The AAA shall develop and distribute a fee schedule with a reasonable maximum based on service costs, clearly indicating the amount charged.

Charges shall reasonably reflect the service cost, recognizing that

Programs may estimate or round fees to simplify pricing. Charges must fully cover costs, including admin and overhead, and in-kind contributions should be included.

The “VDA Sliding Fee Scale”, revised annually and based on Federal Poverty Guidelines, is used for fee assessment. Northern Virginia AAAs follow the “Northern Virginia VDA Scale”. AAAs may request alternatives via waiver in the Area Plan.

Family income is based on “Number in Family” and “Annual Gross Income,” defined as in the Virginia UAI Manual. For

For example, elderly individuals are considered separate family units even if living with relatives.

A signed, understandable agreement is required unless payment is made at service. For infrequent or short-term services like transportation, no written agreement is needed. Attach fee schedule to agreements for billed or prepaid services to prevent misunderstandings.

Income The AAA may adjust total income for expenses such as: (1) medical/dental services, including prescribed durable medical equipment and supplies not covered by Medicaid, Medicare, or insurance,

(2) home modifications for medical reasons; (3) medical insurance premiums; and

7 The VDA Sliding Fee Scale is based on income levels in Virginia Department of Health Regulations 12VAC5-200-110.

Revised 05/29/2007

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VIRGINIA DEPARTMENT FOR THE AGING COST SHARING / FEE FOR SERVICE POLICY Page 4 of 4

(4) costs of home/community services identified as needed by UAI and not free to the client.

AAAs may exclude excessive out-of-pocket healthcare costs for the following services, used to adjust gross income when the service is

essential services include: (1) adult day care; (2) companion/chore/homemaker services; (3) emergency alert systems; (4) home-delivered meals; (5) personal care; (6) respite; (7) transportation; (8) essential non-medical home repairs.

Adjustments or exclusions from income are allowed if clearly identified in the AAA’s policies and procedures for cost sharing / fee for service.

Recertify at least annually or upon notice of income change; the AAA shall review the client’s income.

Client statements are unnecessary for infrequent or short-term services like transportation paid at delivery. Otherwise, clients must receive a statement with fees, instructions, and details: balance forward, paid amount, service value since last bill, and balance due.

A reasonable effort shall be made to collect fees from clients or others paying on their behalf, including regular billing and indicating outstanding balances.

If a client does not pay fees, the AAA may not discontinue Older Americans Act services but must ensure providers offer voluntary contribution opportunities.8

8 Older Americans Act of 1965, as amended, Section 315(b)(4)(A)

Revised 05/29/2007

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GUIDANCE FOR THE PROVISION OF

THERAPEUTIC BEHAVIORAL SERVICES 01/2017 Service Item Code: H2019 - Therapeutic Behavioral Services

I. Policy

Challenging behaviors may adversely affect an individual’s ability to gain and/or maintain employment. It is the policy of the Virginia Department for Aging and Rehabilitative Services (DARS) to provide Therapeutic Behavioral Services (TBS) to individuals with challenging behaviors who require these services to establish eligibility, assess rehabilitation and career needs, or achieve an employment goal. Services are provided by Field Rehabilitation Services staff through approved community-based providers, depending upon the person’s

needs and desires as well as upon the availability of qualified providers in a consumer’s home community. Therapeutic Behavioral Services may also be purchased by other DARS staff through the Community Rehabilitation Case Management Services (CRCMS) Program, or through the DARS Brain Injury Direct Services (BIDS) Fund.

II. Definitions

Therapeutic Behavioral Services are defined as comprehensive, specialized supports provided in community settings to address challenging behaviors that affect an individual’s ability to gain or maintain employment, and to live independently and successfully in their community of choice. Services are provided by agency-approved vendors of Positive Behavior Support (PBS) or Applied Behavior Analysis (ABA), both of which are clinically validated

approaches to reducing or eliminating behaviors that interfere with employment and independent living. The overall goal of Therapeutic Behavioral Services (TBS) is to improve an individual’s quality of life and ability to function successfully in the workplace and other community settings.

A. Positive Behavior Support (PBS) is a comprehensive, research-based approach to behavior change that combines principles and practices from

Applied Behavior Analysis (ABA) and the inclusion and self-determination

[TABLE 1-1]

GUIDANCE FOR THE PROVISION OF THERAPEUTIC BEHAVIORAL SERVICES 01/2017 Service Item Code: H2019 - Therapeutic Behavioral Services

[/TABLE]

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movements. PBS places a heavy emphasis on incorporating person-centered planning and values. The PBS approach can be used as an individualized intervention, as well as a systems-change intervention (e.g., within a school system). PBS interventions are empirically documented and can be used by a wide range of support providers. PBS provides structured support to an individual in order to reduce behavioral challenges, increase independence,

and ensure the development of constructive positive behaviors to meet life goals in the areas of social relationships, employment, academic achievement, functional life-skills, self-determination, health, and safety. Use of PBS decreases the need for more intrusive or aversive interventions (i.e., punishment or suspension) and can lead to both systemic as well as individualized change. The competent and skilled use of PBS (i.e., focusing

on strategies that are compassionate, constructive, and educationally oriented) can help individuals make meaningful progress toward their goals.

The overall purpose of PBS is to improve an individual’s quality of life. [For more information, visit The Association for Positive Behavior Support (APBS) at http://www.apbs.org.]

B. Applied Behavioral Analysis (ABA) is a well-established and respected

discipline among the helping professions, with a mature body of scientific knowledge, established standards for evidence-based practice, distinct methods of service, recognized experience and educational requirements for practice, and identified sources of requisite education in universities. The field of Behavior Analysis grew out of the scientific study of principles of learning and behavior. It has two main branches: experimental and applied behavior analysis. Literature from the field of experimental analysis of

behavior (EAB) provides the scientific foundation for applied behavior analysis (ABA), which is both an applied science that develops methods of changing behavior and a profession that provides services to meet diverse behavioral needs. Professionals in Applied Behavior Analysis engage in the specific and comprehensive use of principles of learning, including operant and respondent learning, in order to address behavioral needs of widely varying individuals in diverse settings. Examples of these applications

include: building the skills and achievements of children in school settings; enhancing the development, abilities, and choices of children and adults with different kinds of disabilities; and augmenting the performance and satisfaction of employees in organizations and businesses. (Behavior Analyst Certification Board®, Inc. (BACB®) http://www.bacb.com.

III. Qualified Providers

C. The Board Certified Behavior Analyst (BCBA) is an independent practitioner who also may work as an employee or independent contractor for an

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organization. The BCBA conducts descriptive and systematic (e.g., analogue) behavioral assessments, including functional analyses, and provides behavior analytic interpretations of the results. The BCBA designs and supervises behavior analytic interventions. The BCBA is able to effectively develop and implement appropriate assessment and intervention methods for use in unfamiliar situations and for a range of cases. The BCBA seeks the

consultation of more experienced practitioners when necessary. The BCBA teaches others to carry out ethical and effective behavior analytic interventions based on published research and designs and delivers instruction in behavior analysis. BCBAs supervise the work of Board Certified Assistant Behavior Analysts and others who implement behavior analytic interventions. Individuals who hold the BCBA credential should be

considered as having met and exceeded standards for the BCaBA and RBT credentials.

B. The Board Certified Assistant Behavior Analysis (BCaBA) conducts descriptive behavioral assessments and is able to interpret the results and design ethical and effective behavior analytic interventions for clients. The BCaBA may assist a BCBA with the design and delivery of introductory level

instruction in behavior analysis. It is mandatory that each BCaBA practice under the supervision of a BCBA. Governmental entities, third-party insurance plans, and others utilizing BCaBAs must require this. Individuals who hold the BCaBA credential should be considered as having met and exceeded standards for the RBT credential.

C. The Registered Behavior Technician (RBT®) is a paraprofessional who

practices under the close, ongoing supervision of a BCBA, BCaBA, or FL-CBA. The RBT is primarily responsible for the direct implementation of behavior-analytic services. The RBT does not design intervention or assessment plans. It is the responsibility of the RBT supervisor to determine which tasks an RBT may perform as a function of his or her training, experience, and competence. The BACB certificant supervising the RBT is responsible for the work performed by the RBT on the cases they are

overseeing.

D. The Positive Behavior Support (PBS) Facilitator is an independent practitioner who may also work as an employee or independent contractor for an organization. The PBS Facilitator develops a support team and works the individual receiving services and the team members to teach new skills

that promote successful living in community settings. Using a person-centered planning process, the PBS Facilitator works with support teams how to complete a Functional Behavior Assessment and develop a Positive Behavior Support Plan. This also includes learning how to analyze

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behavioral data and implement positive behavior interventions. The PBS Facilitator also provides leadership in reviewing, evaluating, and revising PBS Plans. In Virginia, endorsement of PBS Facilitators is done through The Partnership for People with Disabilities located at Virginia Commonwealth University.

IV. Service Provision

A. Service Eligibility: The provision of Therapeutic Behavioral Services (TBS) is not limited to any specific disability group. Individuals are considered eligible for TBS if they meet the following criteria: medically stable; services are needed to establish eligibility for Vocational Rehabilitation Services, assess rehabilitation and career needs, or achieve and maintain employment;

and behaviors are of such intensity, frequency, or complexity that they cannot be successfully managed otherwise.

B. Crisis Intervention: Therapeutic Behavior Services (TBS) are not designed to replace crisis or other critically needed mental health services. If an individual expresses thoughts of harming self or others, the individual should be guided to seek help from the nearest hospital emergency services

department. If a person is in immediate crisis (presents a clear risk of harm to self or others), the vendor should determine whether it is appropriate to call Adult Protective Services (APS) or “911” or both. The vendor and the Support Team (see IV.C. below) should assist the individual to contact the treating psychologist/psychiatrist (if there is one) and should work with local crisis and hospital professionals to meet the person’s immediate safety needs.

C. Support Team: A Support Team is crucial to ensuring consistent and sustainable behavior support across environments. The vendor of Therapeutic Behavior Services (TBS) is responsible for facilitating the Support Team which assists in developing and implementing the Behavior Support Plan. The Support Team consists of the individual and the vendor of Therapeutic Behavior Services (TBS), and may include any of the following:

vocational rehabilitation counselor, Community Services Board case manager, job coach, coworkers, family members, legal guardian or authorized representative, friends, etc. The TBS vendor serves as the leader of the Support Team and regularly convenes the team for the ongoing work of supporting the individual and assuring that the Behavior Support Plan (see IV.D. below) is implemented.

D. Behavior Support Plan: A Positive Behavior Support (PBS) Facilitator or a Board Certified Behavior Analyst (BCBA) is responsible for completing a Functional Behavior Assessment and developing a Behavior Support Plan.

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The Assessment and the Plan are completed by conducting the following activities:  Interviewing the individual, Support Team members, as well as any agency or system that provide relevant services and supports;  Observing the individual in a variety of environments and settings

(e.g., home, work, and community);  Assessing the need for modification/adjustment across various environments;  Developing mechanisms for collecting baseline and ongoing data to measure progress toward goals;  Training Support Team members and relevant service providers (e.g.,

job coach, coworkers, family members, friends) about general behavioral intervention services, and specific goals / objectives in the individuals Behavior Support Plan; and  Reviewing, evaluating, and revising Behavior Support Plan as needed.

The Behavior Support Plan should include:  Statement of the proposed function(s) of an individual’s challenging

behavior (s);  Statement that lists environmental influences on the challenging behavior;  Identification of the most effective support techniques and methodologies;

 “Reactive Strategies” to use when challenging behavior is displayed, as well as identification of replacement skills and behaviors, and strategies to teach them to the individual; and  Review of the applicability of the Plan across all environments, including school, home, and community settings.

E. Quality Characteristics: DARS expects vendors of Therapeutic Behavioral

Services (TBS) to provide the services using the following quality characteristics: services and supports are person-centered and person-directed (i.e., the goals and objectives in the Plan are identified and/or agreed upon by the individual); are provided in community-based settings where the person works, lives, and spends time; and are natural, non-intrusive, and non-stigmatizing.

V. Role of the Vocational Rehabilitation Counselor (or Purchaser of Service).

A. To review a list of agency-approved providers of TBS, VR Counselors can search the DARS AWARE system using Service Item Code H2019. Vendors who have requested approval with a specialty designation for serving

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persons with autism spectrum disorder (ASD) or brain injury (BI) will be noted in AWARE.

B. The Vocational Rehabilitation Counselor (or other “purchaser”) should initially authorize up to thirty (30) hours for a Functional Behavior Assessment and development of a Behavior Support Plan. The vendor should conduct an

intake assessment to determine, prior to instituting a Functional Behavior Assessment, the service needs of an individual and the feasibility of using Therapeutic Behavioral Services. The vendor must submit the results of the Functional Behavior Assessment, along with the written Behavior Support Plan, when submitting the initial invoice for payment. The Behavior Support Plan should include the number of hours requested for authorization of services as

well as a schedule of service delivery (i.e., frequency and duration of intervention hours). Authorization of hours of Therapeutic Behavioral Services (beyond the initial 30 hours) will be provided based on approval of the Behavior Support Plan, not to exceed 100 hours. Requests for more than 100 units of service should be approved by a DARS Supervisor.

C. The vendor must submit the results of the Functional Behavior Assessment,

along with the written Behavior Support Plan, when submitting the initial invoice for payment. The Behavior Support Plan should include the goals/objectives to be addressed, outcome measurements, the number of hours requested for authorization of services, as well as a schedule of service delivery (i.e., frequency and duration of intervention hours). Subsequent invoices should be submitted using the TBS Monthly Invoice / Reporting Form provided by DARS.

VI. Termination of Services The services of the PBS Facilitator or the BCBA are terminated if the goals contained in the individual service plan have been met; the Vocational Rehabilitation Counselor or the service provider determine that the individual is unable to meet the intermediate and long-term goals in the Plan and this is documented fully; or, health and safety issues contraindicate the individual’s

continued participation.

VII. Payment The agency has established that vendors of Therapeutic Behavioral Services (H2019) will be reimbursed at the rate of $73 per unit (H2019), and a Northern Virginia rate of $86 per unit (H2019N) for the City of Alexandria and the counties of Arlington and Fairfax only.

Vendors are required to submit a request for reimbursement for payment on a monthly basis, using the DARS Monthly Invoice / Report Form. Vendors must

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provide a written progress / summary report, including the number of hours expended, services rendered, and hours requested for the following month (total number of hours not to exceed 130 without DARS supervisory approval).

January 2017 

Contact Patricia Goodall, Manager of Brain Injury Services Coordination Unit, at patti.goodall@dars.virginia.gov or 800/552-5019 if you have questions.

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GUIDANCE FOR THE PROVISION OF

THERAPEUTIC BEHAVIORAL SERVICES 01/2017 Service Item Code: H2019 - Therapeutic Behavioral Services

I. Policy

Challenging behaviors may impair employment. DARS policy is to provide TBS to individuals needing these services to establish eligibility, assess needs, or reach employment goals. Services are delivered by Field Rehabilitation Services staff through approved community providers, depending on the person’s

needs and provider availability in the consumer’s community. TBS may also be purchased by other DARS staff via CRCMS or BIDS Fund.

II. Definitions

Therapeutic Behavioral Services are comprehensive supports in community settings addressing challenging behaviors affecting employment and independence. Services are provided by approved PBS or ABA vendors, both clinically validated

approaches to reduce behaviors interfering with employment and independence. TBS aims to improve quality of life and functioning in work and community settings.

A. Positive Behavior Support (PBS) is a comprehensive, research-based approach to behavior change that combines principles and practices from

Applied Behavior Analysis (ABA) and the inclusion and self-determination

[TABLE 1-1]

GUIDANCE FOR THE PROVISION OF THERAPEUTIC BEHAVIORAL SERVICES 01/2017 Service Item Code: H2019 - Therapeutic Behavioral Services

[/TABLE]

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movements. PBS emphasizes person-centered planning and values. It can serve as individualized or systems-change intervention (e.g., in schools). PBS is empirically supported and used by various providers to reduce challenges, increase independence,

and promote positive behaviors to meet goals in social, employment, academic, life skills, self-determination, health, and safety. PBS reduces need for intrusive interventions and fosters systemic and individual change. Skilled use of PBS (i.e., focusing

on compassionate, constructive, and educational strategies that help individuals progress toward goals.

The purpose of PBS is to improve quality of life. [For more, visit APBS at http://www.apbs.org.]

B. Applied Behavioral Analysis (ABA) is a well-established and respected

discipline with a mature scientific body, standards for evidence-based practice, distinct methods, recognized educational requirements, and university sources. Behavior Analysis originated from the scientific study of learning and behavior, with two main branches: experimental and applied. Literature from experimental analysis of

behavior (EAB) underpins ABA, an applied science developing behavior change methods and a profession providing services for diverse needs. ABA professionals use principles of learning, including operant and respondent, to address varied behavioral needs across settings. Examples include:

include building skills of children in schools; enhancing abilities and choices of children and adults with disabilities; and improving employee performance and satisfaction in organizations. (BACB® http://www.bacb.com.)

III. Qualified Providers

C. The Board Certified Behavior Analyst (BCBA) is an independent practitioner who also may work as an employee or independent contractor for an

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organization. The BCBA conducts behavioral assessments, including functional analyses, and interprets results. The BCBA designs and supervises interventions, developing and implementing methods for various situations. The BCBA seeks the

consults with experienced practitioners when needed. BCBAs teach and supervise others in ethical, research-based interventions. Those with BCBA credentials are considered to have exceeded standards for BCaBA and RBT.

considered to have met and exceeded standards for BCaBA and RBT.

B. The BCaBA conducts behavioral assessments, interprets results, and designs ethical interventions. The BCaBA may assist a BCBA with designing and delivering introductory-level

instruction in behavior analysis. BCaBAs must practice under a BCBA’s supervision. Entities using BCaBAs must require this. BCaBAs are considered to meet standards exceeding RBT requirements.

C. The Registered Behavior Technician (RBT®) is a paraprofessional who

works under close supervision of a BCBA, BCaBA, or FL-CBA. The RBT directly implements services but does not design plans. Supervisors determine tasks based on training and competence. Supervisors are responsible for RBT work on cases they oversee.

overseeing.

D. The PBS Facilitator is an independent practitioner or contractor who develops support teams and collaborates with individuals and team members to teach new skills

that promote successful community living. Using a person-centered process, the PBS Facilitator collaborates with support teams to complete a Functional Behavior Assessment and develop a Positive Behavior Support Plan, including analysis.

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analyze behavioral data and implement positive interventions. The PBS Facilitator leads review, evaluation, and revision of PBS Plans. In Virginia, endorsement is through The Partnership for People with Disabilities at Virginia Commonwealth University.

IV. Service Provision

A. Service Eligibility: TBS is not limited to specific disabilities. Individuals are eligible if they are medically stable, need services to establish Vocational Rehabilitation eligibility, assess needs, or achieve/maintain employment;

and behaviors are of such intensity, frequency, or complexity that they cannot be successfully managed otherwise.

B. Crisis Intervention: TBS is not a substitute for crisis or critical mental health services. If an individual expresses self- or other-harm, they should seek help from emergency services.

If in immediate crisis with risk of harm, the vendor should determine whether to call APS, 911, or both. They and the Support Team should assist contact with mental health professionals and coordinate with crisis/hospital staff for safety.

C. Support Team: Essential for consistent behavior support. The TBS vendor facilitates the team, which includes the individual, vendor, and may include vocational rehab counselor, case manager, job coach, family, guardian, friends, etc. The vendor leads and convenes the team for plan implementation.

vocational rehabilitation counselor, Community Services Board case manager, job coach, coworkers, family members, legal guardian or authorized representative, friends, etc. The TBS vendor serves as the leader of the Support Team and regularly convenes the team for the ongoing work of supporting the individual and assuring that the Behavior Support Plan (see IV.D. below) is implemented.

D. Behavior Support Plan: A PBS Facilitator or BCBA completes a Functional Behavior Assessment and develops a Behavior Support Plan.

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The Assessment and Plan are completed by interviewing the individual, Support Team, and relevant agencies; observing the individual in various environments;

e.g., home, work, community); assessing needs for modifications; developing data collection methods; training Support Team and providers (e.g.,

job coach, coworkers, family, friends) on behavioral interventions and plan goals; reviewing and revising the Behavior Support Plan as needed.

The Behavior Support Plan should include:  Statement of the proposed function(s) of an individual’s challenging

behavior (s);  Statement that lists environmental influences on the challenging behavior;  Identification of the most effective support techniques and methodologies;

 “Reactive Strategies” to use when challenging behavior is displayed, as well as identification of replacement skills and behaviors, and strategies to teach them to the individual; and  Review of the applicability of the Plan across all environments, including school, home, and community settings.

E. Quality Characteristics: DARS expects vendors of Therapeutic Behavioral

Services (TBS) to provide the services using the following quality characteristics: services and supports are person-centered and person-directed (i.e., the goals and objectives in the Plan are identified and/or agreed upon by the individual); are provided in community-based settings where the person works, lives, and spends time; and are natural, non-intrusive, and non-stigmatizing.

V. Role of the Vocational Rehabilitation Counselor (or Purchaser of Service).

A. To review approved TBS providers, VR Counselors can search the DARS AWARE system using Service Item Code H2019. Vendors with specialty designations for ASD or BI are noted.

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persons with autism spectrum disorder (ASD) or brain injury (BI) will be noted in AWARE.

B. The Vocational Rehabilitation Counselor (or other “purchaser”) should initially authorize up to thirty (30) hours for a Functional Behavior Assessment and development of a Behavior Support Plan. The vendor should conduct an

intake assessment to determine, prior to instituting a Functional Behavior Assessment, the service needs of an individual and the feasibility of using Therapeutic Behavioral Services. The vendor must submit the results of the Functional Behavior Assessment, along with the written Behavior Support Plan, when submitting the initial invoice for payment. The Behavior Support Plan should include the number of hours requested for authorization of services as

well as a schedule of service delivery (i.e., frequency and duration of intervention hours). Authorization of hours of Therapeutic Behavioral Services (beyond the initial 30 hours) will be provided based on approval of the Behavior Support Plan, not to exceed 100 hours. Requests for more than 100 units of service should be approved by a DARS Supervisor.

C. The vendor must submit the results of the Functional Behavior Assessment,

along with the written Behavior Support Plan, when submitting the initial invoice for payment. The Behavior Support Plan should include the goals/objectives to be addressed, outcome measurements, the number of hours requested for authorization of services, as well as a schedule of service delivery (i.e., frequency and duration of intervention hours). Subsequent invoices should be submitted using the TBS Monthly Invoice / Reporting Form provided by DARS.

VI. Termination of Services: Services end when goals are met; the VR Counselor or provider determine the individual cannot meet goals, with full documentation; or health and safety issues contraindicate continued service.

continued participation.

VII. Payment The agency will reimburse vendors of Therapeutic Behavioral Services (H2019) at $73 per unit (H2019) and $86 per unit (H2019N) for Alexandria, Arlington, and Fairfax.

Vendors must submit monthly reimbursement requests using the DARS Monthly Invoice / Report Form.

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Provide a written progress report with hours expended, services rendered, and hours requested for the next month (not exceeding 130 hours without DARS approval).

January 2017 

Contact Patricia Goodall, Manager of Brain Injury Services, at patti.goodall@dars.virginia.gov or 800/552-5019 for questions.

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Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

16

ALF RELOCATION PLAN

TABLE OF CONTENTS

16.1 Introduction 16.2 Notification of ALF closure

16.3 ALF relocation team 16.4 Funding for relocation 16.5 Information to be gathered

16.6 Notifications to be made 16.7 The relocation process

16.8 ALF Responsibilities 16.9 Suggested agency responsibilities

16.9.1 DSS, Division of Licensing Programs 16.9.2 DARS APS Division staff

16.9.3 LDSS (Adult Services (AS) and Eligibility Workers) 16.9.4 Community Services Board/Behavioral Health Authority 16.9.5 Area Agency on Aging (AAA) and Long Term Care Ombudsman

16.10 Information needed by team 16.11 Additional considerations for an adverse closure

16.12 Role of law enforcement and other authorities

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16

ALF RELOCATION PLAN

16.1 Introduction

This document is intended to be used as a resource during a voluntary or involuntary closure of an assisted living facility (ALF) in Virginia. Local departments of social services (LDSS) and other local, regional, or state entities and organizations may find the information helpful, particularly if the ALF closure is complex.

These guidelines apply to ALF closures where there is adequate time to assess residents and ensure that they are transferred to an appropriate location. However, in the event of emergency closings (e.g., fire, natural disaster), each locality is encouraged to develop

an emergency protocol when the closure is anticipated to occur within 72 hours or less or if there is an adverse closure. An adverse closure is when conditions such as licensing revocation, owner disengagement, legal action, financial disclosure, action by local Code Enforcement or general funding issues are the results of the facility’s closure. This document contains some information which may be helpful in addressing an adverse closure though the locality is strongly encouraged to plan with all agencies in its jurisdiction that could assist with implementing emergency procedures (e.g., county administrator, police, shelter facilities, transportation, emergency medical services, etc.).

When families and residents are notified of pending closure, there may be some resistance to participate in the relocation process as they may assume that the situation will be resolved, and facility closure avoided. In addition, there may be strong feelings of attachment to the facility as it has been the residents’ home, and staff should be sensitive to those feelings.

16.2 Notification of ALF closure

When a decision is made that an ALF will close, the facility is required by the Standards

for Licensed Assisted Living Facilities (22 VAC 40-73-40 D) to notify the Department of

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Social Services (DSS), Division of Licensing Programs (DOLP), no less than 60 days prior to the planned closure or sale date of the intent to close.

When the decision to close is based on a DSS DOLP denial or revocation of the facility’s license, the notice of this action will be posted at the facility identifying contacts for relocation questions. A sample notice is available on the DSS intranet and can be modified to designate whomever the ALF Relocation Team (Team) feels may serve as the most appropriate contact source.

The DOLP staff will immediately notify the appropriate LDSS Director and/or Adult Protective Services (APS) Supervisor and the appropriate Department for Aging and Rehabilitative Services (DARS) APS Division staff of the impending closure decision

made by a facility or notices of intent to deny or revoke a license.

An ALF, in coordination with residents and or families/representatives, has the primary responsibility for relocating individuals and planning for the closing. The ALF is required, pursuant to 22 VAC 40-73-40 D, to notify the residents and their legal representatives and designated contact persons 60 days prior to the planned closure date or as soon as the intent to close is known. If the ALF fails to notify these parties or if this is an emergency relocation, the Team will establish and implement a notification process. The notifications should be given both verbally and in writing. An optional letter, “Sample Notification Letter to Family” is available on the DSS intranet.

Some ALFs may not have the financial ability to operate for 60 days. This situation should be identified as quickly as possible and incorporated into the planning process. There are no specific governmental funds reserved for ALF supplies (e.g. food), staff salaries or essential operating expenses during the facility closure process. Facilities closing under negative or adverse circumstances can be complex in terms of maintaining resident care, business operations and developing safe discharge plans for all residents.

16.3 ALF relocation team

If the ALF does not provide notification and relocation assistance, the Team may be convened to ensure that residents are transferred to an appropriate alternate setting safely. Some Team members may meet in-person while other members may participate virtually.

Representatives from the following agencies may be included on the Team:

• ALF staff.

• DSS, DOLP (State and Regional Office).

• DARS APS Division.

• LDSS.

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• State and/or local Long-Term Care Ombudsman.

• Community Services Board (CSB)/behavioral health authority (BHA).

• Area Agency on Aging (AAA).

• Local Health Department (LHD).

Note: In an adverse action, the Team may need to consult local code enforcement, local government officials, utilities providers, law enforcement, medical facilities and staff, Disability Determination Services (DDS), Department of Medical Assistance Services (DMAS), and other service providers.

When it is known that individuals residing in an ALF need to be relocated, and the ALF is not taking responsibility for the relocations, the Team will begin work as soon as

practicable. The Team will review circumstances and assess needs related to the ALF closing and to clarify roles. A Team Coordinator should be identified. The Team Coordinator will delegate tasks to appropriate team members. The Team may assist until all residents are safely relocated. In an adverse closure, it is imperative to contact stakeholders as soon as possible to designate a lead agency/team coordinator, establish communication practices, define roles and responsibilities and a method and timeframe for regular updates. If the ALF owner is not engaged, then a community partner agency will need to assume lead responsibility. The lead agency/ team coordinator should remain engaged until all residents are safely relocated and the doors of the facility are permanently closed.

If the resident has a CSB/BHA case manager, that case manager shall take the lead locating an appropriate new placement for that resident.

Consideration should be given to the resident’s and his or her representative’s choice of placement to the extent possible. In an emergency relocation, resident safety and well-being is the priority. In this case, if the resident is not moved to his or her first choice of placement, arrangements can be made later for a transfer to an alternate preferred setting.

The Team’s involvement in the relocation will vary based upon identified local needs, requests for assistance, size of the facility, whether the closing is an emergency, and local resource availability. The primary responsibility of the Team is to ensure that every

resident who needs to be relocated is relocated in the most efficient manner and in a way that ensures that his or her safety, choice, and well-being are considered. In some relocations, the Team may have very little involvement; in others, the Team may be more involved. The Team may also ensure that the appropriate records are available and transferred with the resident at the time of the relocation and that the new location is documented and shared with the appropriate LDSS so that Auxiliary Grant (AG) payments follow the resident, and the AG resident receives his or her personal allowance.

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The “Checklist for ALF Relocation Team” located on the DSS intranet, may be used to ensure each step of the relocation process is completed, as well as serving as documentation of actions.

16.4 Funding for relocation

The Team may have to identify appropriate funding sources for such tasks as

transportation and assisting with guardianship petitions (if needed). Though the LDSS is required to prorate the AG that follows the resident into a new facility, there may not be funds available to pay another ALF for a partial month or to provide the funds from a personal allowance account.

LDSS may use APS funds, Budget Line (BL) 895, to assist with a resident’s relocation and to address any risk of maltreatment. Proper procedures to document the opening of an APS case in PeerPlace must be followed. If the LDSS needs additional 895 funding, the LDSS should contact the APS Division to determine if additional funding is available. If funding is available, the LDSS may submit a budget request. The AAA and CSB/BHA may also be considered as funding sources for relocation of residents.

In an adverse ALF closure, the Team may not have access to the facility’s financial information. If this happens, DSS DOLP should be consulted about the possibility of an emergency injunction. An injunction will ensure access to the ALF accounts to keep the facility running during the closure process. The Team should collaborate with local city, or or county attorneys, or the Commonwealth’s Attorney as appropriate.

If there are not enough funds to operate for 60 days, the Team will need to consider options such as:

• Shortening the period for the facility to close.

• Economizing the facility operations, such as shutting down portions of the facility in phases as residents relocate, thereby reducing non-essential expenses.

• Contacting the local government administrator for assistance with a plan to

address the facility’s utility cut-off notices.

• Consult with area food banks or other crisis response providers to address food

shortages.

16.5 Information to be gathered

When an ALF plans to close, the ALF has the primary responsibility of gathering the following information. If an ALF is uncooperative, then the Team may have to intervene to gather the information.

• Total number and names of individuals residing in the ALF.

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Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

• Number and names of residents receiving AG (arranged by locality and FIPS).

• Family members/legal representatives and their contact information.

• Physicians and other service providers and their contact information.

• Number and names of residents receiving CSB/BHA case management services.

• Numbers and names of residents paying privately to reside in the ALF.

• Date last Uniform Assessment Instrument (UAI) was conducted.

• Names of representative payees for residents’ Social Security benefits

• Facility operational expenses if facility is under adverse action for financial reasons. See the DSS intranet for the document ALF Operating Funds Checklist.

The optional form ALF Discharge Summary Checklist located on the DSS intranet may

be used for each resident needing to relocate to ensure that appropriate information is collected and provided to the new placement.

The ALF staff shall ensure that the records of each resident contain a current UAI;

Individualized Service Plan (ISP); mental health screening information/treatment plans, if applicable; physician’s orders for medication and/or treatment; payment source information; and information about the resident’s family and legal representative. Every record should be complete and up to date to the extent possible so that the receiving facility will have as much information on the resident being transferred. The Team should assist in the process if the ALF is unable to carry out this responsibility.

A Team member may be appointed to keep the Resident Tracking Document updated throughout the relocation. This document is located on the DSS intranet and serves as documentation of where each resident was relocated.

16.6 Notifications to be made

ALF staff should contact the following entities that need to know that a resident is being relocated. The Team may assist as necessary.

• All physicians (as well as other health professionals) who follow residents. A Sample Physician Notification Letter is located on the DSS intrant.

• LDSS Eligibility staff via the Eligibility Communication Document located on the

DSS intranet.

• The Social Security Administration (SSA) if any residents receive a Supplemental

Security Income (SSI) payment, a Social Security Disability Insurance (SSDI)

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payment or a Social Security retirement payment. The Team may request that an SSA representative be assigned to assist with changes in representative payees if needed.

• The local health department, if the resident needs a Medicaid Long-Term Service and Supports (LTSS) Screening.

• The LDSS’s attorney if there is a need for guardian/conservator petitions or other legal actions.

• Depending on the nature of the closing, appropriate legislators and local elected

and public officials.

• As appropriate, provider organizations.

16.7 The relocation process

In some cases, family members or resident representatives will take the lead in finding a new ALF or other placement for the individual. The Team may determine which ALFs may be able to admit individuals who need to relocate; Licensing Program staff may assist with identifying such facilities that may be able to take residents. The Team will provide as much choice and as many alternatives as possible to each resident who needs to relocate. The resident’s most recent UAI determines the resident’s level of care.

ALF staff, family members and legal representatives should assist the resident with packing his or her belongings, including necessary records, medications, personal account funds, and with transportation to the new ALF or other placement. The Team will may arrange for and assist with packing and transportation as needed.

If a resident relocates outside of a qualified assessor’s jurisdiction (whether it be the LDSS, the AAA, the CSB/BHA, etc.), the current assessor must refer the resident’s information to a qualified assessor in the new jurisdiction. If the resident has a CSB/BHA case manager, the case manager shall notify the person in that position, in the new locality

of residence, and provide them the resident’s information. The LDSS in the new locality of residence is the assessor of last resort and should be provided the residents’ information and new location.

16.8 ALF Responsibilities

In accordance with 22 VAC 40-73-430 D, the ALF shall assist the resident and his legal representative, if any, in the discharge or transfer process. The facility shall:

• Help the resident prepare for relocation, including discussing the resident's destination.

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• May conduct a meeting for individuals residing in the facility, as well as their family members, to provide an explanation of why the facility is closing, alternative placements, resident rights, and answers to any questions.

• Ensure compliance with licensing standards; ensure the health and safety of all residents; and ensure that all resident care needs are met.

• Prepare a list of all individuals residing in the facility and provide the list to the Team that includes the information in Section 16.5, as well as any additional

information that may be needed.

• Identify each resident’s medical condition and service needs and determine the

level of services required to safely accommodate them in an alternative facility or setting.

• Explain the situation to each resident and assure that the resident and his or her responsible party are permitted to exercise an informed choice about where he or she wishes to move.

• Provide each resident with information on alternative care arrangements and a listing of long-term care facilities appropriate to his or her service needs.

• Contact the resident’s responsible party, next of kin and/or other personal representatives to notify him or her of the facility’s planned closing date and to determine who will take primary responsibility for relocating the individual. (Residents should not be referred to APS for placement purposes unless and until diligent efforts have been made by the ALF and resident’s personal representatives and/or other agency staff to find placements).

• Share the resident’s information, including the UAI, with the new facility or other placement to ensure continuity of care and services.

• Orient all staff to minimize any trauma associated with the relocation.

• Assist the resident or his or her legal representative in making transportation

arrangement on the day of relocation.

• Ensure that belongings are packed and arrange for transfer of the belongings.

• Reconcile all personal fund accounts that the ALF managed on behalf of residents.

Ensure funds are returned to each resident or his or her personal representative.

• Assure that all responsible parties and necessary agencies are notified of the new location and address of the location for each resident who has relocated.

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Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

16.9 Suggested agency responsibilities

Recommended roles for agencies participating on the Team are based on past experiences with ALF closings. Relocation efforts will vary among localities. It is suggested that localities tailor this plan according to local needs and resources.

16.9.1 DSS, Division of Licensing Programs

DSS Licensing Staff may act as a liaison between the Team and the staff at the ALF.

Licensing staff may provide guidance to the facility with regard to their duties and responsibilities during a closure. Other responsibilities may include implementing and monitoring the closure plan, keeping Team members apprised of any concerns, making a list of ALFs available to individuals needing to relocate, residents’ family members, and other agency staff, and assisting with licensing issues and resident and family questions.

16.9.2 DARS APS Division staff

APS Division staff will serve in an advisory capacity to the Team. The APS Division staff will coordinate all requests for financial assistance associated with the relocation efforts via BL 895. APS Division staff may serve as the point of contact with the State Long-Term Care Ombudsman and the Department of Medical Assistance Services, as needed.

16.9.3 LDSS (Adult Services (AS) and Eligibility Workers)

LDSS staff will take the lead in assisting residents who are not receiving CSB/BHA services. Assistance from other LDSS may be arranged by APS Division staff depending on the circumstances of the relocation. If the resident receives AG, the appropriate LDSS worker will notify the individual’s LDSS eligibility worker of the relocation to another ALF or other placement. Prompt notification of the eligibility worker is critical to ensure AG payments can be suspended or held until the relocation is completed. The LDSS worker is also responsible for notifying the individual’s guardian if the individual moves from the current jurisdiction to another jurisdiction.

If the ALF is unwilling to do so, LDSS eligibility workers will contact SSA and inform that agency of the changes in addresses for each resident who receives SSI/SSA

payments. The receiving facility and LDSS must be notified of each resident who has SSA changes and follow-up to ensure that SSI/SSA and AG checks are properly received at the new address.

If the resident relocates to an ALF in a different locality, the LDSS worker in the locality of the new placement shall be notified in writing of the placement date to leave adequate time to schedule the required annual reassessments.

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Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

16.9.4 Community Services Board/Behavioral Health Authority

The CSB/BHA will assume primary responsibility for relocating residents who receive services from the CSB/BHA. If the resident relocates from the jurisdiction of one CSB/BHA to the jurisdiction of another, the original CSB/BHA should ensure all services and supports at the receiving CSB/BHA are in place.

16.9.5 Area Agency on Aging (AAA) and Long-Term Care Ombudsman

AAA support may be made available, including the assistance of the local long-term care ombudsman. Local long-term care ombudsmen focus on residents’ rights and serve as liaisons between the families and service providers.

16.10 Information needed by team

The following information should be available during the closure. The Team Coordinator will determine which members of the team can provide this information.

• List of local ALFs with addresses and telephone numbers.

• Statewide directory of ALFs.

• Telephone numbers of relocation team members including home numbers where possible.

• Eligibility Worker Communication Document.

• List of local transportation providers, including the local agency’s own transportation system.

• ALF’s discharge policy/relocation plan.

16.11 Additional considerations for an adverse closure

The Team may consider obtaining the following information from the owner/administrator or other sources as needed:

• Why is the facility closing? Are there immediate safety concerns? (Helpful Hint:

Safety concerns are to be addressed immediately. If emergency evacuation is required, contact local emergency responders, Red Cross, and local city or county administrators to engage a shelter plan).

• Will the owner remain engaged until all residents are safely relocated as required?

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Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

• Which residents are receiving Social Security benefits? Where are Social Security benefits being deposited? (Helpful Hint: If the checks are being deposited in the facility’s/owner’s account, the funds will need to be redirected).

• Provide US Postal Service change of address forms for the owner to sign for each resident.

• How are resident funds being managed? Remind the owner that resident personal funds accounts belong to the resident and must be relinquished.

• Is the resident’s supply of medication sufficient for the closure period and transition

to the new facility? Ask whether leftover medications can be returned to the closing facility’s pharmacy.

16.12 Role of law enforcement and other authorities

Alleged financial exploitation and theft committed by ALF staff including the owner or administrator should be reported to APS, Social Security, and local law enforcement for review and possible investigation.

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Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

16

ALF RELOCATION PLAN

TABLE OF CONTENTS

16.1 Introduction 16.2 Notification of ALF closure

16.3 ALF relocation team 16.4 Funding for relocation 16.5 Information to be gathered

16.6 Notifications to be made 16.7 The relocation process

16.8 ALF Responsibilities 16.9 Suggested agency responsibilities

16.9.1 DSS, Division of Licensing Programs 16.9.2 DARS APS Division staff

16.9.3 LDSS (Adult Services (AS) and Eligibility Workers) 16.9.4 CSB/BHA 16.9.5 Area Agency on Aging (AAA) and Long Term Care Ombudsman

16.10 Information needed by team 16.11 Additional considerations for an adverse closure

16.12 Role of law enforcement and other authorities

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16

ALF RELOCATION PLAN

16.1 Introduction

This document serves as a resource during voluntary or involuntary ALF closures in Virginia. LDSS and other entities may find it helpful, especially for complex closures.

These guidelines apply when there is sufficient time to assess residents and transfer them appropriately. For emergencies (e.g., fire, disaster), localities should develop

Localities should develop emergency protocols for closures within 72 hours or adverse closures, such as licensing revocation, owner disengagement, legal or funding issues. Planning with all relevant agencies is encouraged.

Families and residents may resist relocation, expecting the closure to be avoided, and may feel attached to the facility. Staff should be sensitive to these feelings.

16.2 Notification of ALF closure

When an ALF decision to close is made, the facility must comply with the Standards

for Licensed Assisted Living Facilities (22 VAC 40-73-40 D) to notify the Department of

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Social Services (DSS), Division of Licensing Programs (DOLP), no less than 60 days prior to the planned closure or sale date of the intent to close.

If closure results from DSS DOLP license denial or revocation, a notice will be posted at the facility with contact info. A sample notice is available on the DSS intranet.

DOLP staff will promptly notify the LDSS Director, APS Supervisor, and DARS APS staff of the impending closure.

made by a facility or notices of license denial or revocation.

The ALF, with residents and families, is responsible for relocation planning and must notify residents and legal reps 60 days before closure or as soon as known. If not, the Team will establish notification procedures, verbally and in writing. A sample letter is available on the DSS intranet.

Some ALFs may lack funds for 60 days; this should be identified early. No specific government funds are reserved for supplies, staff, or operations during closure. Closing under adverse circumstances is complex, requiring careful planning.

16.3 ALF relocation team

If the ALF fails to notify or assist, the Team may be convened to ensure safe resident transfer. Members may meet in person or virtually.

Representatives from these agencies may be on the Team:

• ALF staff.

• DSS, DOLP (State and Regional Office).

• DARS APS Division.

• LDSS.

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Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

• State and/or local Long-Term Care Ombudsman.

• Community Services Board (CSB)/BHA.

• Area Agency on Aging (AAA).

• Local Health Department (LHD).

In adverse actions, the Team may consult code enforcement, officials, utilities, law enforcement, medical staff, DDS, DMAS, and other providers.

When residents in an ALF need relocation and the ALF is not responsible, the Team will begin work as soon as

The Team will review circumstances, assess needs, identify a Coordinator to delegate tasks, assist until residents are relocated, and in adverse closures, contact stakeholders promptly to designate a lead agency, establish communication, define roles, and set update schedules. If the owner is unengaged, a community partner will assume lead responsibility until all residents are safely relocated and the facility closes.

If a resident has a CSB/BHA case manager, they shall lead in finding a new placement.

Resident and representative placement preferences should be considered. In emergencies, safety is priority; if not placed in first choice, transfers to preferred settings can be arranged later.

Team involvement varies based on local needs, assistance requests, facility size, emergency status, and resources. The primary responsibility is to ensure that every

The Team must ensure each resident is relocated efficiently, safely, and with their preferences considered. The Team may have varying involvement, ensure records transfer, and document the new location for AG payments and allowances.

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The DSS intranet Checklist for ALF Relocation Team may be used to ensure completion of each step and document actions.

16.4 Funding for relocation

The Team may have to identify appropriate funding sources for such tasks as

transportation and guardianship assistance. While LDSS must prorate AG following the resident, funds may be unavailable for partial months or personal allowances.

LDSS may use APS funds (BL 895) for relocation and maltreatment risks, following PeerPlace procedures. Additional funding requests can be made to the APS Division. AAA and CSB/BHA may also fund relocations.

If the Team lacks access to financial info during adverse closure, DSS DOLP should be consulted for an emergency injunction to access accounts and keep the facility operational. Collaborate with local attorneys or the Commonwealth’s Attorney as needed.

If funds are insufficient for 60 days, the Team must consider options such as:

• Shortening the facility’s closing period.

• Economize operations by phasing shutdowns as residents relocate to reduce non-essential expenses.

• Contacting the local government administrator for assistance with a plan to

address utility cut-off notices.

• Consult with local food banks or crisis providers to address food

shortages.

16.5 Information to be gathered

When an ALF plans to close, it must gather specified information. If uncooperative, the Team may intervene.

• Number and names of residents in the ALF.

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• Residents receiving AG, listed by locality and FIPS.

• Family members/legal representatives and their contact information.

• Physicians and service providers with contacts.

• Residents receiving CSB/BHA case management, listed by name.

• Residents paying privately, listed by name.

• Date of last UAI.

• Names of residents’ Social Security payees.

• Facility expenses if under adverse action; see DSS intranet for ALF Operating Funds Checklist.

The optional ALF Discharge Summary Checklist on the DSS intranet may

be used for each resident to ensure information collection and transfer to new placement.

ALF staff shall ensure each resident’s records contain a current UAI;

Records must include ISP, mental health info, physician orders, payment sources, and family/legal info, complete and current. The Team may assist if needed.

A Team member may update the Resident Tracking Document on the DSS intranet, documenting each resident’s relocation site.

16.6 Notifications to be made

ALF staff should notify entities about resident relocations; the Team may assist as needed.

• All physicians and health professionals following residents; sample letter on DSS intranet.

• LDSS Eligibility staff via the Eligibility Communication Document located on the

DSS intranet.

• SSA if residents receive a Supplemental

SSI, SSDI, or Social Security retirement payments.

ALF Relocation Plan Page 6 of 11

• Page 7 ---

Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

payment or a Social Security retirement payment. The Team may request that an SSA representative be assigned to assist with changes in representative payees if needed.

• Local health department if resident needs Medicaid LTSS screening.

• LDSS attorney if guardian/conservator petitions or legal actions are needed.

• Depending on closing, notify appropriate legislators and local officials.

and public officials.

• As appropriate, provider organizations.

16.7 The relocation process

Family members or resident representatives may lead in finding new ALFs or placements. The Team may identify facilities able to admit residents. The Team offers choices and alternatives. The resident’s latest UAI determines their level of care.

ALF staff, family, and legal representatives should assist with packing belongings, records, medications, funds, and transportation. The Team may arrange and assist as needed.

If a resident relocates outside a qualified assessor’s jurisdiction (LDSS, AAA, CSB/BHA), the current assessor must refer the resident’s info to a qualified assessor in the new jurisdiction. If the resident has a CSB/BHA case manager, they shall notify the new locality’s case manager.

The new locality’s LDSS is the last resort assessor and must receive the resident’s info and new location.

16.8 ALF Responsibilities

Under 22 VAC 40-73-430 D, the ALF shall assist residents and their legal representatives in discharge or transfer. The facility shall:

• Assist residents in preparing for relocation, including discussing destination.

ALF Relocation Plan Page 7 of 11

• Page 8 ---

Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

• Hold a meeting with residents and families to explain closure, alternatives, rights, and answer questions.

• Ensure licensing compliance, resident health and safety, and care needs are met.

• Prepare and provide a list of residents, including info from Section 16.5 and additional data.

information that may be needed.

• Identify residents’ medical conditions and service needs.

level of services needed to safely accommodate them in an alternative setting.

• Explain the situation to residents and ensure they and their responsible parties can make informed choices about relocation.

• Provide residents with info on alternative care and suitable long-term facilities.

• Notify responsible parties of closure date and identify primary relocation contact; do not refer residents to APS until diligent placement efforts are made.

• Share resident info, including UAI, with new facility to ensure care continuity.

• Orient staff to minimize trauma during relocation.

• Assist the resident or their legal representative with transportation

arrangement on the day of relocation.

• Ensure belongings are packed and arrange transfer.

• Reconcile all resident personal fund accounts managed by the ALF.

Ensure funds are returned to each resident or their personal representative.

• Notify responsible parties and agencies of each resident’s new location and address.

ALF Relocation Plan Page 8 of 11

• Page 9 ---

Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

16.9 Suggested agency responsibilities

Agency roles are based on past ALF closings. Relocation efforts vary; localities should tailor this plan to local needs and resources.

16.9.1 DSS, Division of Licensing Programs

DSS Licensing Staff may liaise between the Team and ALF staff.

Licensing staff may guide the facility on duties during closure, monitor the plan, inform the Team of concerns, list available ALFs, and assist with licensing and questions.

16.9.2 DARS APS Division staff

APS staff will advise the Team, coordinate financial assistance requests via BL 895, and may contact the Long-Term Care Ombudsman and Medicaid Services as needed.

16.9.3 LDSS (Adult Services (AS) and Eligibility Workers)

LDSS staff will lead in assisting residents not receiving CSB/BHA services. APS may arrange additional assistance. If the resident receives AG, the LDSS worker must notify the eligibility worker promptly to suspend or hold payments and inform guardians of jurisdiction changes.

If the ALF refuses, LDSS eligibility workers will notify SSA of address changes for residents receiving SSI/SSA.

Payments: the facility and LDSS must be notified of SSA changes and ensure checks are received at the new address.

When a resident moves to an ALF in a new locality, the new LDSS must be notified in writing of the placement date to schedule reassessments.

ALF Relocation Plan Page 9 of 11

• Page 10 ---

Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

16.9.4 Community Services Board/Behavioral Health Authority

The CSB/BHA will assume primary responsibility for relocating residents who receive services from the CSB/BHA. If the resident relocates from the jurisdiction of one CSB/BHA to the jurisdiction of another, the original CSB/BHA should ensure all services and supports at the receiving CSB/BHA are in place.

16.9.5 AAA and Ombudsman

AAA support may include the local long-term care ombudsman, who focuses on residents’ rights and acts as a liaison between families and providers.

16.10 Information needed by team

During closure, this information should be available; the Team Coordinator will identify which team members can provide it.

• List of local ALFs with addresses and telephone numbers.

• Statewide directory of ALFs.

• Telephone numbers of relocation team members including home numbers where possible.

• Eligibility Worker Communication Document.

• List local transportation providers, including the agency’s system.

• ALF’s discharge policy/relocation plan.

16.11 Additional considerations for an adverse closure

The Team may obtain this information from the owner/administrator or other sources as needed:

• Why is the facility closing? Are there immediate safety concerns? (Helpful Hint:

Address safety concerns immediately; if evacuation is needed, contact emergency responders, Red Cross, and local officials to activate a shelter plan.

• Will the owner stay engaged until all residents are safely relocated?

ALF Relocation Plan Page 10 of 11

• Page 11 ---

Virginia Department for Aging and Rehabilitative Services December 2023 Adult Protective Services Division ALF Relocation Plan

• Which residents receive Social Security? Where are benefits deposited? (If in the facility’s/owner’s account, funds must be redirected).

• Provide USPS change of address forms for owner to sign for each resident.

• How are resident funds managed? Remind owner that personal accounts belong to residents and must be relinquished.

• Is the resident’s medication supply sufficient for closure and transition?

to the new facility? Ask whether leftover medications can be returned to the closing facility’s pharmacy.

16.12 Role of law enforcement and other authorities

Report alleged financial exploitation and theft by ALF staff, owner, or administrator to APS, Social Security, and law enforcement for review and investigation.

ALF Relocation Plan Page 11 of 11

• Page 1 ---

National Assistive Technology Act Data System State Plan - Full Report

The Virginia Assistive Technology System (VATS) 2024

General Information

Statewide AT Program (Information to be listed in national State AT Program Directory)

State AT Program Title The Virginia Assistive Technology System

State AT Program URL www.vats.virginia.gov

Mailing Address 2001 Maywill Street, Suite 202

City Richmond

State Va

Zip Code 23230

Program Email barclay.shepard@dars.virginia.gov

Phone 8046629990

TTY 8004649950

Lead Agency

Agency Name Virginia Department for Aging and Rehabilitative Services

Mailing Address 8004 Franklin Farms Drive

City Richmond

State Va

Zip Code 23229

Program URL https//www.dars.virginia.gov

Implementing Entity

Does your Lead Agency contract with an Implementing Entity to carry out the Statewide AT Program on its behalf? N/A

Name of Implementing Agency

Mailing Address

[TABLE 1-1] State AT Program Title | The Virginia Assistive Technology System State AT Program URL | www.vats.virginia.gov Mailing Address | 2001 Maywill Street, Suite 202 City | Richmond State | Va Zip Code | 23230 Program Email | barclay.shepard@dars.virginia.gov Phone | 8046629990

TTY | 8004649950

[/TABLE]

[TABLE 1-2] Agency Name | Virginia Department for Aging and Rehabilitative Services Mailing Address | 8004 Franklin Farms Drive City | Richmond State | Va Zip Code | 23229 Program URL | https//www.dars.virginia.gov

[/TABLE]

[TABLE 1-3] Does your Lead Agency contract with an Implementing Entity to carry out the Statewide AT Program on its behalf? N/A | Name of Implementing Agency | Mailing Address |

[/TABLE]

• Page 2 ---

City

State

Zip Code

Program URL

[TABLE 2-1] City | State | Zip Code | Program URL |

[/TABLE]

• Page 3 ---

General Information (Continued...)

Program Director and Other Contacts

Program Director for State AT Program Shepard, Barclay (last, first) Title Manager

Phone 8046629990

E-mail barclay.shepard@dars.virginia.gov

Program Director at Lead Agency (last, Shepard, Barclay first) Title Manager Phone 8046629990

E-mail barclay.shepard@dars.virginia.gov Primary Contact at Implementing Agency (last, first) - If applicable

Title

Phone

E-mail

Person Responsible for completing this form if other than Program Director

Name (last, first)

Title

Phone

E-mail

Certifying Representative

Name (last, first) Hayfield, Kathryn

Title DARS Commissioner

Phone 8046627010

E-mail kathryn.hayfield@dars.virginia.gov

[TABLE 3-1] Program Director for State AT Program (last, first) | Shepard, Barclay Title | Manager Phone | 8046629990 E-mail | barclay.shepard@dars.virginia.gov Program Director at Lead Agency (last, first) | Shepard, Barclay Title | Manager Phone | 8046629990 E-mail | barclay.shepard@dars.virginia.gov Primary Contact at Implementing Agency (last, first) - If applicable | Title | Phone | E-mail |

[/TABLE]

[TABLE 3-2] Name (last, first) | Title | Phone | E-mail |

[/TABLE]

[TABLE 3-3] Name (last, first) | Hayfield, Kathryn Title | DARS Commissioner Phone | 8046627010 E-mail | kathryn.hayfield@dars.virginia.gov

[/TABLE]

• Page 4 ---

Module A: Change in Lead Agency or Implementing Entity

Does your Lead Agency contract with an Implementing Entity to carry out the Statewide AT Program on its behalf (From No General Information)?

1. Is the Lead Agency named in this State Plan a new or different Lead Agency from the one designated by the Governor in No your previous State Plan?
2. Is the Implementing Entity named in this State Plan a new or different Implementing Entity from the one designated by No the Governor in the previous State Plan?

• Page 5 ---

Module B: Advisory Council

1. How many representatives of the designated State agency for Vocational Rehabilitation are members of the advisory 1 council?
2. How many representatives of the designated State agency for Vocational Rehabilitation for individuals who are blind are 1 members of the advisory council (when there is such a separate VR agency for individuals who are blind)?
3. How many representatives of a state Center for Independent Living are members of the advisory council?. 1
4. How many representatives of the State workforce development board established under the Workforce Innovation and 1 Opportunity Act are members of the advisory council?
5. How many representatives of the State educational agency are members of the advisory council? 1
6. Do you have an alternative financing program (AFP) for assistive technology in your state/territory that is separate from Yes the State AT Program and is operated by a non-profit entity?
7. 1. If yes, how many representatives of an alternative financing program (AFP) are members of the advisory 1 council?
8. How many representatives of the following agencies and/or organizations are members of the advisory council? 1 (At least one is required by the AT Act.) Medicaid state agency 1 State agency administering Developmental 0 Disabilities Act State agency administering or organization funded 0 under Older Americans Act Organization representing veterans 0 University Center for Excellence in Developmental 0 Disabilities (UCEDD) State Protection and Advocacy System 0 State Council on Developmental Disabilities 0
9. How many additional representatives of other agencies and/or organizations are members of the advisory council? 1 Early Intervention/Child Services state agency0 State Deaf/Hard of Hearing 0 Commission/Office State Insurance agency 0 State Library/Secretary of State/Talking 0 Books agency State ADA Office/Disability 0 Commission/Advocacy Office State Legislators 0 State Parent Training Information Center 0 (IDEA funded) Other (description required in text box below)1 Describe Other Agency At Large Members do not represent organizations
10. How many individuals with disabilities who use assistive technology or their family members or guardians are members of 9 the advisory council?

Advisory Council Calculation Description Number

Individuals with disabilities that use AT or their family members or guardians on the advisory council 9 Total number of individuals on the advisory council 17 Percentage 52.94%

10. In accordance with section 4(c)(2) of the AT Act of 1998, as amended our state has a consumer-majority advisory council Yes that provides consumer-responsive, consumer-driven advice to the state for planning of, implementation of, and evaluation of the activities carried out through the grant, including setting measurable goals. This advisory council is geographically representative of the State and reflects the diversity of the State with respect to race, ethnicity, and types of disabilities across the age span, and users of types of services that an individual with a disability may receive. 11. Procedures are in place to ensure that the Advisory Council members are geographically representative of the

[TABLE 5-1] Description | Number Individuals with disabilities that use AT or their family members or guardians on the advisory council | 9 Total number of individuals on the advisory council | 17 Percentage | 52.94%

[/TABLE]

• Page 6 ---

State and reflects the diversity of the State with respect to race, ethnicity, age, and types of disabilities, and users of types of services that an individual with a disability may receive, including home and community-based services (as defined in section 9817 (a)(2) of the American Rescue Plan Act of 2021 (42 U.S.C. 1396d not)), vocational rehabilitation services (as defined in section 7 of the Rehabilitation Act of 1973 (29 U.S.C. 705)) and services through the Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.) Yes

• Page 7 ---

Module C: Actual Expenditures and Budgeted Allocations

1. Actual Expenditures Carryover Year Close-out

In the following table provide the actual expenditure data for the closed-out carryover fiscal year AT grant award (liquidated the previous December 31). Please note, this data is for a specific year AT Act grant award amount, NOT any specific 12 month period of time as funds from a grant award can be obligated over more than that initial 12 month period.

For the State Plan submitted in 2024, you will report the closed-out grant award for FY21. The grant began 10/1/2020 with the first year ending on 9/30/2021, the first carryover year ended on 9/30/2022 and the second carryover year ended on 9/30/2023 with the 3 month liquidation period ending 12/31/2023.

Actual Expenditures for Closed-out Final Percentage Requirements Carryover Year Award Expenditures The AT Act required state level expenditures to be at a. All State Level Activities $481,492.00 84.63% least 60% of grant award.

If flexibility is claimed, at least 70% is required. b. All State Leadership Activities $87,434.00 15.37% c. Total Expenditures $568,926.00

d. Total Award $568,926.00

e. Lapsed Amount $0.00 0.00%

f. Transition Training & Technical The AT Act requires at least 5% of state leadership $15,046.00 17.21% Assistance Set Aside expenditures to be spent on transition activities.

[TABLE 7-1] Actual Expenditures for Closed-out Carryover Year Award | Final Expenditures | Percentage | Requirements a. All State Level Activities | $481,492.00 | 84.63% | The AT Act required state level expenditures to be at least 60% of grant award.

If flexibility is claimed, at least 70% is required. b. All State Leadership Activities | $87,434.00 | 15.37% | c. Total Expenditures | $568,926.00 | | d. Total Award | $568,926.00 | | e. Lapsed Amount | $0.00 | 0.00% | f. Transition Training & Technical Assistance Set Aside | $15,046.00 | 17.21% | The AT Act requires at least 5% of state leadership expenditures to be spent on transition activities.

[/TABLE]

• Page 8 ---

Module C: Actual Expenditures and Budgeted Allocations (Continued...)

1. Actual YTD Expenditures and Budgeted Allocations for Preceding Year Award

In the following table provide year-to-date (YTD) obligated and liquidated expenditure data for the preceding fiscal year AT grant award along with planned budget allocations for the unobligated remainder of that award. Please note, this data is for a specific year AT Act grant award amount, NOT any specific 12 month period of time as funds from a grant award can be obligated over a 24 month period.

For the State Plan submitted in 2024, you will report year to date FY22 grant award expenditures. This grant began 10/1/2021 with the initial award year ending on 9/30/2022 and the carryover year ended on 9/30/2023. Many programs received a no cost extension which extended the obligation date to 9/30/2024

The total grant award for was $590,637.00

Actual & Planned Immediate Planned not yet YTD Obligated not YTD Liquidated Preceding Year Award Obligated Total Liquidated Expenditures Expenditures Expenditures Expenditures All State Level Activities $0.00 $494,541.00 $0.00 $494,541.00 All State Leadership Activities $0.00 $96,096.00 $0.00 $96,096.00 Total $0.00 $590,637.00 $0.00 $590,637.00

Transition Training & Technical $0.00 $12,358.00 $0.00 $12,358.00 Assistance

[TABLE 8-1] Actual & Planned Immediate Preceding Year Award Expenditures | YTD Obligated not Liquidated Expenditures | YTD Liquidated Expenditures | Planned not yet Obligated Expenditures | Total All State Level Activities | $0.00 | $494,541.00 | $0.00 | $494,541.00 All State Leadership Activities | $0.00 | $96,096.00 | $0.00 | $96,096.00 Total | $0.00 | $590,637.00 | $0.00 | $590,637.00 Transition Training & Technical Assistance | $0.00 | $12,358.00 | $0.00 | $12,358.00

[/TABLE]

• Page 9 ---

Module D: State Level Activity Summary

1. Which State Financing Activities do you conduct?

None

Please indicate if flexibility or comparability is claimed for State Financing activities.

Flexability

1. Which Reutilization Activities do you conduct?

• Device Reassignment or Open Ended Loan

1. Do you conduct Short-term Device Loans?

Yes

1. Do you conduct Device Demonstrations?

Yes

• Page 14 ---

Module I: Device Refurbish and Reassignment and/or Open-ended Loan

1. Select the one option that best describes who conducts this activity.

Other entities e.g. contractors (Others)

1. Select the one option that best describes from where this activity is conducted.

Regional sites (Regional)

1. Do you charge a fee for this activity?

No

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Page 15 ---

Module I: Device Refurbish and Reassignment and/or Open-ended Loan (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

• Have written agreement with this entity
• Provide financial support to this entity

Other (select any/all)

1. Select the option(s) that describe how a reutilized device is provided to a recipient. (select all that apply)

• Device ownership is transferred to the recipient

1. Describe the activity.

VATS contracts with two non-profit organizations (one adult and one children's reuse services) to provide full service and satellite/loan closet locations which house gently used durable medical equipment for medical mobility, independence and personal safety. These sites partner will local healthcare, community service organizations, and or foundations/grants and are located throughout Virginia based on consumer demand, community need and business viability/sustainability.

1. The online page for this specific activity https://www.vats.virginia.gov/ATrecycling.htm; https://www.free-foundation.org/; can be found at: https://atdevicesforkids.org/

• Page 16 ---

Module J: Device Loan

1. Select the one option that best describes who conducts this activity.

Both the Statewide AT Program and other entities/contractors (Both)

1. Select the one option that best describes from where this activity is conducted.

A combination of a central location and regional sites (Combination)

1. Do you charge a fee for this activity?

No

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Have written agreement with this entity

• Page 17 ---

Module J: Device Loan (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Select the option that describes how the majority of devices loaned are delivered to and returned from a borrower. (select one) The majority of devices are delivered or picked up in-person

1. Describe the activity.

VATS has an extensive library in Fairfax, Virginia that is open to any Virginian with a disability, their family members, and any service provider who works with individuals with disabilities. This library is a free resource. Anyone can make an appointment to visit the library to have a hands-on demonstration of a specific device or software. If you are unable to travel to the library, an assistive technology specialist can arrange to meet you at a more central location. Individuals or organizations can borrow equipment in the library on a short-term basis (generally 1-4 weeks) based on need and availability. We recommend that an individual participate in a short demonstration or training of an assistive technology device prior to or at the same time as the loan. Some equipment is housed at partner organizations throughout the state in order to make equipment available to constituents. In addition to the main AT library, VATS maintains partnerships with several disability service organizations to provide statewide access to equipment for training, demonstration and/or loan.

1. The online page for this specific activity https://www.vats.virginia.gov/progserv.htm can be found at:

• Page 18 ---

Module K: Device Demonstration

1. Select the one option that best describes who conducts this activity.

Both the Statewide AT Program and other entities/contractors (Both)

1. Select the one option that best describes from where this activity is conducted.

A combination of a central location and regional sites (Combination)

1. Do you charge a fee for this activity?

No

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Have written agreement with this entity

• Page 19 ---

Module K: Device Demonstration (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Describe the activity.

VATS has an extensive library in Fairfax, Virginia that is open to any Virginian with a disability, their family members, and any service provider who works with individuals with disabilities. This library is a free resource. Anyone can make an appointment to visit the library to have a hands-on demonstration of a specific device or software. If you are unable to travel to the library, an assistive technology specialist can arrange to meet you at a more central location. Individuals or organizations can borrow equipment in the library on a short-term basis (generally 1-4 weeks) based on need and availability. We recommend that an individual participate in a short demonstration or training of an assistive technology device prior to or at the same time as the loan. Some equipment is housed at partner organizations throughout the state in order to make equipment available to constituents. In addition to the main AT library, VATS maintains partnerships with several disability service organizations to provide statewide access to equipment for training, demonstration and/or loan.

1. The online page for this specific activity https://www.vats.virginia.gov/progserv.htm can be found at:

• Page 20 ---

Module L: Training/Educational Activities

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

State Units on Aging (select any/all)

Area Agencies on Aging (select any/all)

State Departments of Education (select any/all)

Local School Districts (select any/all)

Institutions of Higher Education (select any/all)

Hospitals and Health Care Systems (select any/all)

Early Intervention Programs (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Page 21 ---

Module L: Training (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Provide a short description of at least one and no more than three planned training activities. One of the activities described must be planned Information and Communication Technology (ICT) accessibility training that will provide the required ICT Training performance measures. If the Statewide AT Program is meeting the transition requirements of the AT Act through training, please describe that planned activity. If the Statewide AT Program sponsors or co-sponsors a statewide conference please include that event as one you describe.

Planned ICT Accessibility Training (required) VATS is collaborating with Apple Government to provide a series of handheld accessibility trainings for vocational rehabilitation staff and VATS Assistive Technology Advisory Council on accessibility features built into Apple devices.

Planned Transition Training or Other Training Activity (optional)

Planned Statewide Conference or Other Training Activity (optional)

1. The online page for this specific activity https://www.vats.virginia.gov/progserv.htm can be found at:

• Page 22 ---

Module M: Technical Assistance

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Page 23 ---

Module M: Technical Assistance (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Provide a short description of at least one and no more than two planned technical assistance activities. If the Statewide AT Program is meeting the transition requirements of the AT Act through technical assistance, please describe that planned activity.

Planned Transition Technical Assistance or Other Technical Assistance Activity (required) VATS meets regularly with Virginia No Wrong Door to improve the No Wrong Door system's capacity to improve access to and acquisition of assistive technology devices and services Planned Other Technical Assistance Activity (optional)

• Page 24 ---

Module N: Public Awareness

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Page 25 ---

Module N: Public Awareness (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Provide a short description of at least one and no more than two planned major public awareness activities. If the Statewide AT Program conducts a major ongoing public awareness activity such as an annual AT awareness day with a Governor’s Proclamation, please include that activity.

Major Annual Planned or Other Public Awareness Activity (required) VATS collaborates with the state's vocational rehabilitation program annually to promote National AT Awareness Day through internal correspondence and social media. This public awareness activity helps Virginians learn about and connect to assistive technology resources available in the Commonwealth.

Planned Other Public Awareness Activity (optional)

• Page 26 ---

Module O: Information and Assistance

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Have written agreement with this entity

• Page 27 ---

Module O: Information and Assistance (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Describe the activity By contacting VATS via phone or website, Virginians can access the entire array of services to include Information & Assistance, Training, Technical Assistance and Public Awareness. Callers can access specific information on assistive technology products, funding options, and resources. VATS connects callers with a professional who can answer inquiries and guide you to the best assistive technology resources in your community! VATS is a Virginia No Wrong Door partner and connects with No Wrong Door partner agencies and constituents to connect Virginians with valuable assistive technology reources.

• Page 28 ---

Assurances and Measurable Goals Section 4(d) of the AT Act prescribes the duties of the Lead Agency receiving a grant under section 4 of the AT Act and requires the State to provide a number of assurances in its application for funds. 34 CFR part 76 also requires that any State Plan include certain assurances. The Statewide AT Program certifying representative will attest to these assurances and other requirements below and by submitting the State Plan, will affirm that to the best of his or her knowledge and belief all information provided in the State Plan is true and correct and the State Plan fully discloses all known weaknesses concerning the accuracy, reliability, and completeness of the information.

Assurances

As the Certifying Representative of the Lead Agency for the State of , I hereby assure the following:

1. The Lead Agency prepared and submitted this State Plan on behalf of the State of Va.
2. The Lead Agency submitting this plan is the State agency that is eligible to submit this plan and if an Implementing Entity is identified it is designated to implement the required AT Act activities.
3. The State agency has authority under State law to perform the functions of the State under this program.
4. The State legally may carry out each provision of this plan.
5. All provisions of this plan are consistent with State law.
6. A State officer, specified by title in this certification, has authority under State law to receive, hold, and disburse Federal funds made available under the plan.
7. The State officer who submits this plan, specified by title in this certification, has authority to submit this plan.
8. The agency that submits this plan has adopted or otherwise formally approved this plan.
9. The plan is the basis for State operation and administration of the program. 10. The Lead Agency will maintain and evaluate the program under this State Plan. 11. The State will annually collect data related to the required activities implemented by the State under this section in order to prepare the progress reports required under subsection 4(f) of the Act. 12. The Lead Agency will submit the annual progress report on behalf of the State. 13. The State will prepare reports to the Secretary in such form and containing such information as the Secretary may require to carry out the Secretary's functions under this Act and keep such records and allow access to such records as the Secretary may require to ensure the correctness and verification of information provided to the Secretary. 14. The Lead Agency will control and administer the funds received through the grant. 15. The Lead Agency will make programmatic and resource allocation decisions necessary to implement the State Plan. 16. Funds received through the grant will be expended in accordance with Section 4 of the Act, and will be used to supplement, and not supplant, funds available from other sources for technology-related assistance, including the provision of assistive technology devices and assistive technology services. 17. The Lead Agency will ensure conformance with all applicable Federal and State accounting requirements. 18. The State will adopt such fiscal control and accounting procedures as may be necessary to ensure proper disbursement of and accounting for the funds received through the grant. 19. Funds made available through a grant to a State under this Act will not be used for direct payment for an assistive technology device for an individual with a disability. 20. A public agency or an individual with a disability holds title to any property purchased with funds received under the grant and administers that property. 21. The physical facility of the Lead Agency and Implementing Entity, if any, meets the requirements of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) regarding accessibility for individuals with disabilities. Section 4(d)(6)(E) 22. Activities carried out in the State that are authorized under this Act, and supported by Federal funds received under this Act, will comply with the standards established by the Architectural and Transportation Barriers Compliance Board under section 508 of the Rehabilitation Act of 1973 (20 U.S.C. 794d). Section 4(d)(6)(G) 23. The Lead Agency will coordinate the activities of the State Plan among public and private entities, including coordinating efforts related to entering into interagency agreements. 24. The Lead Agency will coordinate efforts related to the active, timely, and meaningful participation by individuals with disabilities and their family members, guardians, advocates, or authorized representatives, and other appropriate individuals, with respect to activities carried out through the grant. 25. The Lead Agency or Implementing Entity will conduct outreach to and as appropriate, collaborate with other State agencies that receive Federal funding for assistive technology including – a. The State educational agency receiving assistance under the Individuals with Disabilities Education Act (20 U.S.C.1400 et seq.); b. The State vocational rehabilitation agency receiving assistance under title I of the Rehabilitation Act of 1973 (29 U.S.C. 720 et seq.); c. The agency responsible for administering the State Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.); The State agency receiving assistance under the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.); and d. Any other agency in a State that funds assistive technology.

• Page 1 ---

National Assistive Technology Act Data System State Plan - Full Report

The Virginia Assistive Technology System (VATS) 2024

General Information

Statewide AT Program (Information to be listed in national State AT Program Directory)

State AT Program Title The Virginia Assistive Technology System

State AT Program URL www.vats.virginia.gov

Mailing Address 2001 Maywill Street, Suite 202

City Richmond

State Va

Zip Code 23230

Program Email barclay.shepard@dars.virginia.gov

Phone 8046629990

TTY 8004649950

Lead Agency

Agency Name Virginia Department for Aging and Rehabilitative Services

Mailing Address 8004 Franklin Farms Drive

City Richmond

State Va

Zip Code 23229

Program URL https//www.dars.virginia.gov

Implementing Entity

Does your Lead Agency contract with an Implementing Entity to carry out the Statewide AT Program? N/A

Name of Implementing Agency

Mailing Address

[TABLE 1-1] State AT Program Title | The Virginia Assistive Technology System State AT Program URL | www.vats.virginia.gov Mailing Address | 2001 Maywill Street, Suite 202 City | Richmond State | Va Zip Code | 23230 Program Email | barclay.shepard@dars.virginia.gov Phone | 8046629990

TTY | 8004649950

[/TABLE]

[TABLE 1-2] Agency Name | Virginia Department for Aging and Rehabilitative Services Mailing Address | 8004 Franklin Farms Drive City | Richmond State | Va Zip Code | 23229 Program URL | https//www.dars.virginia.gov

[/TABLE]

[TABLE 1-3] Contract with Implementing Entity? N/A | Name | Mailing Address |

[/TABLE]

• Page 2 ---

City

State

Zip Code

Program URL

[TABLE 2-1] City | State | Zip | URL |

[/TABLE]

• Page 3 ---

General Information (Continued...)

Program Director and Other Contacts

Program Director for State AT Program Shepard, Barclay (last, first) Title Manager

Phone 8046629990

E-mail barclay.shepard@dars.virginia.gov

Program Director at Lead Agency (last, Shepard, Barclay first) Title Manager Phone 8046629990

E-mail barclay.shepard@dars.virginia.gov Primary Contact at Implementing Agency (last, first) - If applicable

Title

Phone

E-mail

Person Responsible for completing this form if other than Program Director

Name (last, first)

Title

Phone

E-mail

Certifying Representative

Name (last, first) Hayfield, Kathryn

Title DARS Commissioner

Phone 8046627010

E-mail kathryn.hayfield@dars.virginia.gov

[TABLE 3-1] Program Director for State AT Program (last, first) | Shepard, Barclay | Manager | 8046629990 | barclay.shepard@dars.virginia.gov; Lead Agency Program Director (last, first) | Shepard, Barclay | Manager | 8046629990 | barclay.shepard@dars.virginia.gov; Primary Contact at Implementing Agency (if applicable) | Title | Phone | E-mail |

[/TABLE]

[TABLE 3-2] Name (last, first) | Title | Phone | E-mail |

[/TABLE]

[TABLE 3-3] Name (last, first) | Hayfield, Kathryn Title | DARS Commissioner Phone | 8046627010 E-mail | kathryn.hayfield@dars.virginia.gov

[/TABLE]

• Page 4 ---

Module A: Change in Lead Agency or Implementing Entity

Does your Lead Agency contract with an Implementing Entity to carry out the Statewide AT Program (From No General Information)?

1. Is the Lead Agency in this State Plan new or different from the one designated by the Governor in your previous State Plan?
2. Is the Implementing Entity in this State Plan new or different from the one designated by the Governor in the previous State Plan?

• Page 5 ---

Module B: Advisory Council

1. How many representatives of the State agency for Vocational Rehabilitation are members of the advisory council?
2. How many representatives of the State agency for Vocational Rehabilitation for individuals who are blind are members of the advisory council?
3. How many representatives of a state Center for Independent Living are members of the advisory council?. 1
4. How many representatives of the State workforce development board under the Workforce Innovation and Opportunity Act are members of the advisory council?
5. How many representatives of the State educational agency are members of the advisory council? 1
6. Do you have an AFP for assistive technology separate from the State AT Program operated by a non-profit?
7. If yes, how many AFP representatives are members of the advisory council?
8. How many representatives of the following agencies and/or organizations are members of the advisory council? 1 (At least one is required by the AT Act.) Medicaid state agency 1 State agency administering Developmental 0 Disabilities Act State agency administering or organization funded 0 under Older Americans Act Organization representing veterans 0 University Center for Excellence in Developmental 0 Disabilities (UCEDD) State Protection and Advocacy System 0 State Council on Developmental Disabilities 0
9. How many additional representatives of other agencies and/or organizations are members of the advisory council? 1 Early Intervention/Child Services state agency0 State Deaf/Hard of Hearing 0 Commission/Office State Insurance agency 0 State Library/Secretary of State/Talking 0 Books agency State ADA Office/Disability 0 Commission/Advocacy Office State Legislators 0 State Parent Training Information Center 0 (IDEA funded) Other (description required in text box below)1 Describe Other Agency At Large Members do not represent organizations
10. How many individuals with disabilities using assistive technology or their families/guardians are on the advisory council?

Advisory Council Calculation Description Number

Individuals with disabilities that use AT or their family members or guardians on the advisory council 9 Total number of individuals on the advisory council 17 Percentage 52.94%

In accordance with section 4(c)(2) of the AT Act of 1998, our state has a consumer-majority advisory council providing consumer-driven advice for planning, implementation, and evaluation, including setting goals. It is geographically representative and reflects diversity in race, ethnicity, disabilities, age, and service types. Procedures ensure geographic representation.

[TABLE 5-1] Description | Individuals with disabilities using AT or their families/guardians | Number | 9 | Total | 17 | Percentage | 52.94%

[/TABLE]

• Page 6 ---

The council reflects state diversity in race, ethnicity, age, disabilities, and services including home/community-based, vocational rehab, and IDEA services. Yes.

• Page 7 ---

Module C: Expenditures and Budget

1. Actual Expenditures Carryover Year Close-out

Provide actual expenditure data for the closed-out FY AT grant (liquidated by December 31). Data covers the award year, not a 12-month period, as funds may be obligated over more time.

For the 2024 State Plan, report FY21's closed-out grant. It started 10/1/2020, ending 9/30/2021; carryovers ended 9/30/2022 and 2023, with liquidation ending 12/31/2023.

Actual Expenditures for Closed-out Final Percentage Requirements Carryover Year Award Expenditures The AT Act required state level expenditures to be at a. All State Level Activities $481,492.00 84.63% least 60% of grant award.

If flexibility is claimed, at least 70% is required. b. All State Leadership Activities $87,434.00 15.37% c. Total Expenditures $568,926.00

d. Total Award $568,926.00

e. Lapsed Amount $0.00 0.00%

f. Transition Training & Technical The AT Act requires at least 5% of state leadership $15,046.00 17.21% Assistance Set Aside expenditures to be spent on transition activities.

[TABLE 7-1] Actual Expenditures for Closed-out Carryover Year Award | Final Expenditures | Percentage | Requirements a. All State Level Activities | $481,492.00 | 84.63% | The AT Act required state level expenditures to be at least 60%.

If flexibility is claimed, at least 70% is required. b. All State Leadership Activities | $87,434.00 | 15.37% | c. Total Expenditures | $568,926.00 | | d. Total Award | $568,926.00 | | e. Lapsed Amount | $0.00 | 0.00% | f. Transition Training & Technical Assistance Set Aside | $15,046.00 | 17.21% | The AT Act requires at least 5% of state leadership expenditures to be spent on transition activities.

[/TABLE]

• Page 8 ---

Module C: Actual Expenditures and Budgeted Allocations (Continued...)

1. Actual YTD Expenditures and Budgeted Allocations for Preceding Year Award

Provide YTD obligated and liquidated expenditure data for the previous fiscal year's AT grant, along with planned allocations for the unobligated remainder. Data is for the entire award period, not a specific 12 months.

For the 2024 State Plan, report FY22 YTD expenditures. The grant started 10/1/2021, ending 9/30/2022, with carryover until 9/30/2023, extended to 9/30/2024 for some programs.

The total grant award for was $590,637.00

Actual & Planned Immediate Planned not yet YTD Obligated not YTD Liquidated Preceding Year Award Obligated Total Liquidated Expenditures Expenditures Expenditures Expenditures All State Level Activities $0.00 $494,541.00 $0.00 $494,541.00 All State Leadership Activities $0.00 $96,096.00 $0.00 $96,096.00 Total $0.00 $590,637.00 $0.00 $590,637.00

Transition Training & Technical $0.00 $12,358.00 $0.00 $12,358.00 Assistance

[TABLE 8-1] Actual & Planned Immediate Preceding Year Award Expenditures | YTD Obligated not Liquidated Expenditures | YTD Liquidated Expenditures | Planned not yet Obligated Expenditures | Total All State Level Activities | $0.00 | $494,541.00 | $0.00 | $494,541.00 All State Leadership Activities | $0.00 | $96,096.00 | $0.00 | $96,096.00 Total | $0.00 | $590,637.00 | $0.00 | $590,637.00 Transition Training & Technical Assistance | $0.00 | $12,358.00 | $0.00 | $12,358.00

[/TABLE]

• Page 9 ---

Module D: State Level Activity Summary

1. Which State Financing Activities do you conduct?

None

Please indicate if flexibility or comparability is claimed for State Financing activities.

Flexability

1. Which Reutilization Activities do you conduct?

• Device Reassignment or Open Ended Loan

1. Do you conduct Short-term Device Loans?

Yes

1. Do you conduct Device Demonstrations?

Yes

• Page 14 ---

Module I: Device Refurbish and Reassignment and/or Open-ended Loan

1. Select the one option that best describes who conducts this activity.

Other entities e.g. contractors (Others)

1. Select the option that best describes where this activity is conducted.

Regional sites (Regional)

1. Do you charge a fee for this activity?

No

1. Identify your collaboration types for this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Page 15 ---

Module I: Device Refurbish and Reassignment and/or Open-ended Loan (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

• Have written agreement with this entity
• Provide financial support to this entity

Other (select any/all)

1. Select option(s) describing how a reutilized device is provided to a recipient. (select all that apply)

• Device ownership is transferred to the recipient

1. Describe the activity.

VATS contracts with two non-profits (adult and children’s reuse services) to provide full service and satellite/loan closet locations housing gently used durable medical equipment for mobility, independence, and safety. These sites partner with local healthcare, community organizations, and foundations/grants, located throughout Virginia based on demand, need, and viability.

1. The online page for this specific activity https://www.vats.virginia.gov/ATrecycling.htm; https://www.free-foundation.org/; can be found at: https://atdevicesforkids.org/

• Page 16 ---

Module J: Device Loan

1. Select the one option that best describes who conducts this activity.

The Statewide AT Program and other entities/contractors

1. Select the one option that best describes from where this activity is conducted.

A central location and regional sites

1. Do you charge a fee for this activity?

No

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Have written agreement with this entity

• Page 17 ---

Module J: Device Loan (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Select how most devices are delivered and returned: in-person pickup or delivery.

1. Describe the activity.

VATS’s Fairfax library is open to Virginians with disabilities, their families, and service providers. It’s free. Appointments for device demos are available; specialists can meet at central locations if needed. Equipment can be borrowed short-term (1-4 weeks). Participants are encouraged to train before or during loan. Some equipment is at partner sites statewide. VATS partners with disability organizations for statewide access to training, demos, and loans.

1. Online page for this activity: https://www.vats.virginia.gov/progserv.htm

• Page 18 ---

Module K: Device Demonstration

1. Select the one option that best describes who conducts this activity.

Both the Statewide AT Program and other entities/contractors (Both)

1. Select the one option that best describes from where this activity is conducted.

A combination of a central location and regional sites (Combination)

1. Do you charge a fee for this activity?

No

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Have written agreement with this entity

• Page 19 ---

Module K: Device Demonstration (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Describe the activity.

VATS has an extensive library in Fairfax, Virginia that is open to any Virginian with a disability, their family members, and any service provider who works with individuals with disabilities. This library is a free resource. Anyone can make an appointment to visit the library to have a hands-on demonstration of a specific device or software. If you are unable to travel to the library, an assistive technology specialist can arrange to meet you at a more central location. Individuals or organizations can borrow equipment in the library on a short-term basis (generally 1-4 weeks) based on need and availability. We recommend that an individual participate in a short demonstration or training of an assistive technology device prior to or at the same time as the loan. Some equipment is housed at partner organizations throughout the state in order to make equipment available to constituents. In addition to the main AT library, VATS maintains partnerships with several disability service organizations to provide statewide access to equipment for training, demonstration and/or loan.

1. The online page for this specific activity https://www.vats.virginia.gov/progserv.htm can be found at:

• Page 20 ---

Module L: Training/Educational Activities

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

State Units on Aging (select any/all)

Area Agencies on Aging (select any/all)

State Departments of Education (select any/all)

Local School Districts (select any/all)

Institutions of Higher Education (select any/all)

Hospitals and Health Care Systems (select any/all)

Early Intervention Programs (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Page 21 ---

Module L: Training (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Describe 1-3 planned training activities, including ICT accessibility training meeting performance measures. Include transition activities or sponsored conferences.

Planned ICT Accessibility Training (required) VATS is collaborating with Apple Government to provide handheld accessibility training for vocational rehab staff and VATS Assistive Technology Advisory Council on Apple device features.

Planned Transition Training or Other Training Activity (optional)

Planned Statewide Conference or Other Training Activity (optional)

1. The online page for this specific activity https://www.vats.virginia.gov/progserv.htm can be found at:

• Page 22 ---

Module M: Technical Assistance

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Page 23 ---

Module M: Technical Assistance (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Describe 1-2 planned technical assistance activities, including transition activities if applicable.

Planned Transition or Other Technical Assistance (required) VATS regularly collaborates with Virginia No Wrong Door to enhance access to assistive technology devices and services. Other activities are optional.

• Page 24 ---

Module N: Public Awareness

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Page 25 ---

Module N: Public Awareness (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Describe at least one or two major public awareness activities, including ongoing activities like an annual AT awareness day with a Governor’s Proclamation.

Major annual public awareness activity (required): VATS partners with the state's vocational rehab annually to promote National AT Awareness Day via internal communications and social media, raising awareness of assistive tech resources.

Planned Other Public Awareness Activity (optional)

• Page 26 ---

Module O: Information and Assistance

1. Identify the types of collaborations you have in place to conduct this activity.

Banks/Financial Institution (select any/all)

Independent Living Center (select any/all)

Easter Seals (select any/all)

Disability/Assistive Technology Organizations (select any/all)

Federal Entities/Agencies (select any/all)

State Entities/Agencies (select any/all)

• Have written agreement with this entity

• Page 27 ---

Module O: Information and Assistance (Continued...)

Local/Community Entities (select any/all)

Private Entities (select any/all)

Other (select any/all)

1. Describe the activity By contacting VATS via phone or website, Virginians can access the entire array of services to include Information & Assistance, Training, Technical Assistance and Public Awareness. Callers can access specific information on assistive technology products, funding options, and resources. VATS connects callers with a professional who can answer inquiries and guide you to the best assistive technology resources in your community! VATS is a Virginia No Wrong Door partner and connects with No Wrong Door partner agencies and constituents to connect Virginians with valuable assistive technology reources.

• Page 28 ---

Section 4(d) of the AT Act outlines the Lead Agency's duties and required assurances in the application. The certifying representative affirms the truthfulness and completeness of the State Plan, including known weaknesses.

Assurances

As the Lead Agency Certifying Representative for the State of , I assure the following:

1. The Lead Agency prepared and submitted this State Plan for Virginia.
2. The Lead Agency is the eligible State agency submitting this plan and, if identified, the Implementing Entity responsible for AT Act activities.
3. The State agency has legal authority under State law to perform this program's functions.
4. The State legally may carry out each provision of this plan.
5. All provisions comply with State law.
6. A State officer, named in this certification, has authority under State law to manage Federal funds under the plan.
7. The State officer submitting this plan, named in this certification, has authority to do so.
8. The submitting agency has formally adopted or approved this plan.
9. This plan forms the basis for State operations. The Lead Agency will maintain, evaluate, and annually report on the program, manage funds, ensure compliance, and coordinate activities among public and private entities, including federal agencies supporting assistive technology.

• Page 1 ---

POLICIES AND PROCEDURES FOR THE PROTECTION OF HUMAN

SUBJECTS FOR

Policy, Legislative Affairs and Analytics Division 8004 Franklin Farms Drive

Richmond, Virginia 23229 Effective: November 2024

FWA Number: 00008936

Initial Approval: August 15, 2005 Expires: January 25, 2026

Approved by

Kathryn A. Hayfield, Commissioner November 2024

• Page 2 ---

TABLE OF CONTENTS

BACKGROUND 5

I. OVERVIEW 5

II. STATEMENT OF PRINCIPLES 6

III. LEGAL AUTHORITY 7

IV. HRRC MISSION AND PURPOSE 7

V. DEFINITIONS 7

THE HUMAN RESEARCH REVIEW COMMITTEE (HRRC) MEMBERSHIP 9

I. APPOINTMENTS 9

II. COMPOSITION 9

J. PRIMARY MEMBERS 9

B. ALTERNATE MEMBERS 9

C. AD HOC REVIEWERS 10

III. MEMBER RESPONSIBILITIES 10

IV. OFFICERS 10

V. CONFLICTS OF INTEREST 10

HRRC OPERATIONS 11

I. FULL COMMITTEE MEETINGS 11

II. ELECTRONIC MEETINGS 11

III. MEETING AGENDAS 12

IV. CONDUCT OF BUSINESS 12

J. ORDER/QUORUM 12

B. ATTENDEES AND GUESTS 12

C. VOTING AND ACTIONS 13

D. MEETING MINUTES 14

V. HRRC RECORD RETENTION 14

W. VIRGINIA FREEDOM OF INFORMATION ACT AND INSTITUTIONAL REVIEW BOARDS 14

HRRC REVIEWS AND DECISION MAKING PROCESS 15

I. BACKGROUND 15

II. APPLICATIONS AND SUBMISSION MATERIALS 15

III. KEY DETERMINATIONS FOR REVIEW OF HUMAN SUBJECTS RESEARCH 16

J. IS THE PROJECT CONSIDERED RESEARCH 16

B. DOES THE PROJECT INVOLVE HUMAN SUBJECTS? 17

C. DOES THE PROJECT QUALIFY FOR EXEMPT REVIEW? 17

2

• Page 3 ---

D. DOES THE PROJECT QUALIFY FOR EXPEDITED OR LIMITED REVIEW? 20

E. MINIMAL RISK 20

F. ADDITIONAL PROTECTIONS AND SPECIAL CONSIDERATIONS 21

G. INFORMED CONSENT 21

H. RESEARCHER CONFLICTS OF INTEREST 23

I. RECRUITMENT MATERIALS 23

IV. TYPES OF REVIEWS 24

J. EXEMPT REVIEW 24

B. EXPEDITED AND LIMITED REVIEWS 24

C. FULL HRRC REVIEW 27

D. COPPERATIVE RESEARCH (45 CFR § 46.1144) 27

V. HRRC APPROVAL TIMELINES 29

VI. MODIFICATIONS TO RESEARCH PROJECTS 29

VII. CONTINUING REVIEWS, STATUS UPDATES AND PROJECT CLOSURES 30

VIII. RESEARCH PROJECT NON-COMPLIANCE 31

APPENDIX A: LIST OF ALL HRRC FORMS (REQUIRED AND OPTIONAL) 32

3

• Page 4 ---

ACKNOWLEDGMENTS

This edition incorporates both the federal regulations as well as state regulations governing the protection of human subjects participating in federally funded or sponsored research to include the changes to the “Common Rule” implemented in January 2019.

Please submit Human Research Review Committee (HRRC) applications to:

Devin Bowers HRRC Co-Chair and Administrator Policy, Legislative Affairs and Analytics Virginia Department for Aging and Rehabilitative Services 8004 Franklin Farms Drive Richmond, Virginia 23229

(804) 662-7010 Email: devin.bowers@dars.virginia.gov

or

Catherine Harrison HRRC Chair Policy, Legislative Affairs and Analytics Director

Virginia Department for Aging and Rehabilitative Services 8004 Franklin Farms Drive Richmond, Virginia 23229 Phone: (804) 662-9968 Email: catherine.harrison@dars.virginia.gov Toll Free: 1-800-552-5019 TTY Toll Free: 800-464-9950

FAX (804) 662-7663

For questions or comments about this manual or compliance concerns please contact:

Catherine Harrison HRRC Chair Policy, Legislative Affairs and Analytics Director Virginia Department for Aging and Rehabilitative Services 8004 Franklin Farms Drive

Richmond, Virginia 23229 Phone: (804) 662-9968 Email: catherine.harrison@dars.virginia.gov Toll Free: 1-800-552-5019 TTY Toll Free: 800-464-9950

FAX (804) 662-7663

4

• Page 5 ---

DARS HUMAN RESEARCH AND REVIEW COMMITTEE

POLICIES, PROCEDURES AND GUIDANCE MANUAL

Background

I. Overview

Title 45 Part 46 of the US Code of Federal Regulations (CFR) – Protection of Human Subjects establishes the application of Belmont Report principles and provides the process necessary to protect the rights of human subjects involved in research. Federal funds may not be expended for research involving human subjects unless the requirements of Title 45 Part 46 have been satisfied (§46.122). To eliminate confusion and promote uniformity, a number of federal

departments and agencies have adopted as regulation a common Federal Policy for the Protection of Human Research Subjects (Common Rule).

One of the programs the Virginia Department of Aging and Rehabilitative Services (DARS) operates is the vocational rehabilitation (VR) program that receives funding and oversight from the Rehabilitation Services Administration, Office of Special Education and Rehabilitative Services, US Department of Education (DOE). DOE has codified the same requirements found in the Common Rule (Federal Policy for the Protection of Human Research Subjects) at 34 CFR Part

97. Several other DARS programs are administered under the federal Administration for Community Living (ACL), which is in the US Department of Health and Human Services Secretariat (DHHS) and fall under the auspices of the Common Rule.

The DHHS regulations incorporate the Common Rule as Subpart A of 45 CFR 46. Additionally, DOE has adopted Subpart D of 45 CFR 46, Protections for Children Who Are Subjects in Research. Therefore, all federally funded or sponsored human subjects research involving minors must comply with both Subpart A and Subpart D of 45 CFR Part 46.

For the purposes of this document, the term "“covered entity” includes all DARS’ divisions, programs, and offices (except for the Division of Disability Determination Services); Centers for Independent Living; sheltered workshops (i.e., employment services organizations with contracts or vendor arrangements with DARS), Area Agencies on Aging; and the Wilson Workforce and Rehabilitation Center (WWRC). DDS is fully funded by the US Social Security Administration (SSA). Any research involving DDS employees, clients and/or personally

identifiable data, must be approved by SSA.

Research approved by the Human Research Review Committee (HRRC) may be subject to further appropriate review and approval or disapproval by the DARS Commissioner. However, the Commissioner shall not approve the research if it has not been approved by the HRRC (45

CFR § 46.112).

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Covered entities shall comply with pertinent federal and state laws and regulations which provide additional protections for human subjects (45 CFR § 46.101(e)). In the case of discrepancies between state laws or regulations, DARS policies and procedures and current federal regulations and policies for the conduct of human subject research, the federal requirements always takes precedence.

This document fulfills the terms of DARS’s Federal Wide Assurance (FWA) on file with the DHHS

to have written procedures for the conduct of human subject research.

The FWA is a binding written agreement between DARS and DHHS, which states that DARS is guided by the ethical principles of the Belmont Report and will comply with federal regulations (45 CFR Part 46) for federally funded human subject’s research.

Non-federally funded research activities conducted by covered entities shall be conducted in

compliance with Sections 32.1-162.16 et seq. and 51.5-132 of the Code of Virginia, which is the basis for DARS regulations (22VAC30-40-10 et seq.), and this policy and procedures document.

Non-therapeutic research is prohibited unless the HRRC determines that such research will not present greater than minimal risk to the subject (§ 32.1-162.19 of the Code of Virginia and

22VAC30-40-40 C).

This document is intended to be an electronic resource. Please refer to the electronic version of

this document to ensure you are using the most updated version. The signature copy of this document is maintained by the DARS Policy, Legislative Affairs and Analytics Division. An electronic copy of this document can be obtained from the HRRC webpage.

To report possible areas or incidences of research non-compliance with federal or state laws and regulations which involve covered entities, please contact the DARS HHRC Chair in Policy, Legislative Affairs and Analytics.

II. Statement of Principles

In accordance with § 51.5-132 of the Code of Virginia and ensuing regulations, DARS is responsible for safeguarding the rights and welfare of human subjects who volunteer to participate in human subject research conducted by covered entities. As such, DARS assures that no human subject research will be conducted or authorized by covered entities unless the DARS HRRC has reviewed and approved such research.

The National Research Act of 1974 established the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. In 1979, the Commission published its report, Ethical Principles and Guidelines for the Protection of Human Subjects of Research, commonly called the Belmont Report. Today's federal regulations for the protection of human subjects are based on the ethical principles of the Belmont Report. The Belmont Report

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identifies three basic principles as particularly relevant to the ethics of research involving human subjects:

(1) Respect for Persons, (2) Beneficence, and (3) Justice.

DARS assures that all human subjects’ research will comply with the terms of its Federal-wide Assurance (FWA).

III. Legal Authority

The DARS HRRC is authorized to review and approve proposed research conducted or authorized by covered entities as directed by:

i. 45 CFR Part 46 Protection of Human Subjects;

II. 34 CFR Part 97, as applicable;

III. Code of Virginia §§ 32.1-162.16 et seq. and 51.5-132;

IV. 22 VAC 30-40-10 et seq. Protections of Participants in Human Research; and v. This document, the Policies and Procedures for the Protection of Human Subjects.

IV. HRRC Mission and Purpose

The purpose of the HRRC is to ensure human research involving covered entities maintains an individual’s rights to privacy and protection from harm or risk. The HRRC reviews research proposals and requests to determine how federal and state, human research subject, laws and regulations apply to proposed research activities. The HRRC conducts competent, complete, and professional reviews of human research activities conducted or authorized by covered entities to ensure the privacy and protection of human subject participants is maintained.

V. Definitions

The following terms have the following meanings:

"Covered entity" means the Department for Aging and Rehabilitative Services, the Wilson Workforce and Rehabilitation Center, area agencies on aging, sheltered workshops, and independent living centers.

“Human subject” means “a living individual about whom an investigator (whether professional or student) conducting research obtains:

i. data through intervention or interaction with the individual, or II. identifiable private information.”

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For the purposes of this document, the term “subject” means any and all subjects and/or participants involved in the research project.

"Identifiable private information" means private information for which the identity of the subject is or may readily be ascertained by the investigator or associated with the information.

"Informed consent" means a process by which the investigator fully explains the research activities and ensures the prospective subject has sufficient opportunity to ask questions and has sufficient time to make a decision whether or not to participate in the research prior to signing the HRRC-approved written consent document. Informed consent shall be prospectively obtained without coercion and in accordance with 22VAC30-40-100.

“Intervention” includes both physical procedures by which data are gathered (for example,

venipuncture) and manipulations of the subject or the subject’s environment that are performed for research purposes.

“Interaction” includes communication or interpersonal contact between investigator and subject.

"Minimal risk" means the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or

during the performance of routine physical or psychological examinations or tests.

"Nontherapeutic research" means human subject research in which there is no reasonable expectation of direct benefit to the physical or mental condition of the subject.

“Private information” includes information about behavior that occurs in a context in which an individual can reasonably expect that no observation or recording is taking place, and information which has been provided for specific purposes by an individual and which the

individual can reasonably expect will not be made public (for example, a medical record).

Private information must be individually identifiable (i.e., the identity of the subject is or may readily be ascertained by the investigator or associated with the information) to constitute research involving human subjects.

“Research” means “a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge.”

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The Human Research Review Committee (HRRC) Membership

I. Appointments

The DARS Commissioner shall be responsible for appointing members to the HRRC. Term of

membership commences with the date of the appointment letter and may be unlimited. To review the current committee membership please visit the HRRC webpage.

II. Composition

J. Primary Members

As set forth in 45 CFR §46.107, the HRRC shall have at least five members. Members shall have

varying backgrounds to promote the complete and adequate review of research activities commonly conducted by the institution. The HRRC shall be sufficiently qualified through the experience and expertise of its members, and the diversity of the members, including consideration of race, gender, cultural backgrounds and sensitivity to such issues as community attitudes, to promote respect for its advice and counsel in safeguarding the rights and welfare of human subjects. In addition to possessing the professional competence necessary to review specific research activities, the HRRC shall be able to ascertain the acceptability of proposed research in terms of institutional commitments and regulations, applicable law, and standards

of professional conduct and practice. The HRRC shall, therefore, include persons knowledgeable in these areas.

Since this HRRC regularly reviews research that involves a vulnerable category (45 CFR §46.107) of subjects, such as children, prisoners, individuals with impaired decision-making capacity, or economically or educationally disadvantaged persons, consideration shall be given to the inclusion of one or more individuals who are knowledgeable about and experienced in working with these subjects.

At least two members of the HRRC must be individuals whose primary concerns are in non-scientific or ethical areas (e.g., members of the clergy, lawyers).

B. Alternate Members

To maintain the HRRC size, alternate members may be appointed to review a project where a member has a conflicting interest or when a primary member cannot attend the meeting.

Alternate members are subject to the same requirements as members, including the conflict of interest and confidentially requirements. Alternate members may attend the HRRC, count towards a meeting quorum, and vote in place of any absent primary voting member.

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C. Ad Hoc Reviewers

The HRRC may invite individuals with special expertise (“ad hoc reviewers”) to assist in the review of research protocols. They may be from within a covered entity or external to a covered entity/entities. Ad hoc reviewers are subject to the conflict of interest and confidentially requirements for all proposal reviews. Ad hoc reviewers cannot vote on the

HRRC.

III. Member Responsibilities

Members are expected to:

• Attend the required initial education program.
• Maintain confidentiality of all HRRC-related activities and refrain from discussing them

outside the context of these duties.

• Conduct competent, complete and professional reviews of research protocols in a timely manner.
• Attend and contribute to the HRRC review and discussion of protocols during full committee meetings.
• Attend any required continuing education for HRRC members.

• Adhere to the conflict of interest policy.

IV. Officers

Officer positions shall include the Chair and the Co-Chair/HRRC Administrator. The Chair shall be the Director of the DARS Policy, Legislative Affairs and Analytics Division. The Co-Chair/Administrator shall be designated by the Chair, and shall be an employee of DARS.

V. Conflicts of Interest

No member of the HRRC shall be directly involved in the proposed human research project or have administrative approval authority over the proposed research, except in connection with her/his responsibilities as a member of the HRRC. No member shall participate in an initial or continuing review of any project in which they have a conflicting interest. The HRRC is responsible for determining whether a member has a conflict of interest.

Members must complete and sign the Conflict of Interest HRRC Member Statement (Form A) to acknowledge receipt of the conflict of interest policy. The HRRC Administrator shall keep the signed Conflict of Interest HRRC Member Statement (Form A) on file.

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HRRC Operations

For review by the HRRC, a covered entity’s research project or activity must meet both of the definitions for “research” and “human subject.” If it does not, then the covered entity does not need to submit it to the HRRC. Questions as to whether or not activities constitute human

subjects research may be directed to the Chair or the Co-Chair/Administrator of the HRRC.

Please refer to appendices for additional information regarding the steps to determine whether activities constitute human subjects research.

I. Full Committee Meetings

The HRRC Committee will convene at least once annually for research requiring continuing

review and will convene more often as needed. Individual meetings may be scheduled if an application requiring Full Committee review is necessitated.

Meetings may be cancelled by the Chair due to: (a) insufficient applications requiring Full Committee review, (b) inability to secure a quorum for attendance, or (c) other reasons (e.g., inclement weather) that make a scheduled meeting unnecessary.

The HRRC Co-Chair/Administrative will distribute information on the time and place of all HRRC

meetings and study materials for HRRC member review prior to all meetings.

II. Electronic Meetings

The Federal Office for Human Research Protections (OHRP) in the DHHS recognizes HRRC meetings that are conducted electronically provided that:

1. Each participating member has received all pertinent materials prior to the meeting, and

can actively and equally participate in the discussion of all research projects;

1. Minutes of such meetings clearly document that these conditions have been satisfied in addition to the usual HRRC meeting documentation requirements;
2. The HRRC follows its written procedures; and
3. Except when an Exempt, Expedited or Limited Review, or Cooperative Research procedure is used, review of proposed research must be done during convened Full Committee meetings at which a majority of the members of the HRRC are in attendance.

When appropriate, all virtual meetings must be conducted in a secure manner.

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III. Meeting Agendas

Agendas must include each research project by HRRC control number, Principal Investigator name, and title of research project. Agendas must be included in the official record to assist with the specifics of an item or submission.

A copy of the final agenda may be placed with the minutes to assist in the location of items

within the minutes. The agenda is not considered a required document as per regulation, but rather a tool for organizing meetings and preparation of minutes.

IV. Conduct of Business

Prior to convening an HRRC meeting or review of a research project, HRRC members, including alternates, must have the following forms signed and on file with the Co-Chair/HRRC

Administrator:

• Conflict of Interest HRRC Member Statement (Form A)
• HRRC Confidentiality Agreement (Form B)

A. Order/Quorum

The HRRC meeting is called to order by the Chair when a quorum of members is in attendance.

The meeting ends or is suspended whenever a quorum of members is no longer present for deliberations. A quorum is required to review research and vote.

A quorum requires a majority of the voting members. For project review purposes, a quorum will consist of a simple majority of the HRRC members, including at least one HRRC member whose primary expertise is nonscientific in nature.

With approval from the Chair, designated alternate members may serve in the place of regular members, count toward a quorum, and vote if materials were presented to them in advance of the meeting.

B. Attendees and Guests

At the discretion of the Chair and/or primary reviewer, the Principal Investigator (PI) may be invited to attend the meeting for the purpose of additional clarification or discussion. A Guest

Attendance Certification (Form C) must be completed by the attendee, and signed by both the attendee and a witness. Investigator(s) is (are) required to leave the meeting for subsequent discussion and voting.

Persons may be permitted to observe HRRC meetings as guests under the following conditions:

1. Guest attendance is at the discretion of the Chair;

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1. Guests may be asked to leave at any time;
2. Guests must not be in attendance during the review of research in which they serve as PI or Co-Investigator;
3. Guests may be asked to sign a HRRC Confidentiality Agreement (Form B);
4. Guests must sign a Conflict of Interest Disclosure Statement (Form D) and reveal any conflicts of interest prior to attendance, and/or must excuse themselves if a potential conflict reveals itself; and

a. If applicable, Form D will need to be accompanied by Listing of Co-Investigators (Form E).

1. Guests must sign in and may be asked to document the purpose of their visit.

C. Voting and Actions

Only members and alternate members may vote. Votes by proxy are not allowed. At the discretion of the Chair, voting may be by written ballot or show of hands.

A vote regarding a project must follow a motion proposed by a voting member of the HRRC. A second member of the HRRC must second the motion. The Chair will call for a vote if no further discussion is raised. For research to be approved by the HRRC, it must receive the approval of a majority of those members present at a meeting in which a quorum exists.

No member may vote who has a conflict of interest with respect to the research under consideration.

During a convened meeting of the HRRC, any member may make a motion using one of the following procedures:

1. Approved: Defined as approved as is, with no further action requested or required.
2. Approved on condition: Defined as approved on condition that scripted changes are made to documents and returned for verification via expedited review, not returned to the Full Committee. This action cannot be used at the time of continuing review.

1. Tabled: Defined as the requirement that additional information must be provided and/or more than scripted changes to documents must be made and returned to the Full Committee for further review. This action cannot be used at the time of continuing review.
2. Disapproved: Defined as not approved by the HRRC for reasons specified in a Letter of Disapproval.
3. Suspended: Defined as the suspension of approval of the research project for any reason the HRRC deems appropriate.

1. Termination: Defined as the termination of approval of the research project for any reason the HRRC deems appropriate.
2. Approved/Short Term-A: This may only be used for continuing reviews. This action allows for continuing review to proceed to approval where scripted changes have been requested by the HRRC, a delay in implementing the changes will not place subjects at

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increased risk of harm, and the HRRC will not have time to approve the changes before HRRC approval expires. All scripted changes to documents must be made and returned for verification via expedited review as detailed in the approval letter. Under this motion to approve, expiration of approval is on the last day of the second month from the HRRC meeting (e.g. HRRC meeting date is June 1, 2019 and approval will expire August 31, 2019). Once the supplemental information/modifications (scripted only) have been made and are verified by expedited review, the continuing review cycle will be reset

(not to exceed one year from full committee continuing review). The HRRC is using this process at the time of continuing review to ensure that scripted changes requested by HRRC members are given valid and thorough consideration, and not overlooked simply due to concerns about the impact of an interruption in HRRC approval.

1. Approved/Short Term-B: This may only be used for continuing reviews. This action allows continuing review to proceed to approval where supplemental information or non-scripted changes have been requested by the HRRC, a delay in reviewing the

information or implementing the changes will not place subjects at increased risk of harm, and the HRRC will not have time to approve the changes before HRRC approval expires. The HRRC is using this process at the time of continuing review to ensure that supplemental information or non-scripted changes requested by HRRC members are given valid and thorough consideration, and not overlooked.

D. Meeting Minutes

The official meeting minutes shall include a record, without individual identification, of the number of votes to approve, disapprove, table, or abstain regarding all actions. In the event a member of the HRRC elects to abstain, the minutes should record the abstention and the identity of the individual who did not vote.

V. HRRC Record Retention

The Co-Chair/Administrator maintains all required records for individual studies until at least

three years past the end date of the study, or longer if required by regulations.

The Co-Chair/Administrator also maintains all records of HRRC meetings in accordance with records laws and federal regulations.

The Co-Chair/Administrator maintains and updates the HRRC website as needed, creates and updates the policy manual and forms, and publishes and disseminates important communications to the HRRC and Principal Investigators with approved and pending research

projects.

W. Virginia Freedom of Information Act and Institutional Review Boards

An opinion published by the Virginia Office of the Attorney General indicates Institutional Review Boards (IRB) are exempt from the Freedom of Information Act (FOIA). The opinion

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states that IRB are not public bodies; therefore, they are not subject to the provisions of FOIA.

Records are not subject to the inspection or copying of any citizen.

HRRC Reviews and Decision Making Process

I. Background

The HRRC (or designated reviewers, in the case of exempt and expedited or limited reviews) is required by state regulations to review all requests within 45 calendar days after submission of a complete application.

The HRRC shall review and have authority to approve and require modifications in (to secure approval) or disapprove all research activities covered by this policy (45 CFR § 46.109). All

requirements in this process must be fulfilled.

No human research shall be conducted or authorized by a covered entity unless the DARS HRRC, or designated reviewer as appropriate, has reviewed and approved the proposed human research project.

II. Applications and Submission Materials

The HRRC Chair or Co-Chair/Administrator will screen all applications for completeness. When an application is submitted but is not complete, the HRRC Chair or Co-Chair/Administrator shall make reasonable attempts to obtain the missing information. Only complete applications will be advanced for review and approval by the HRRC.

Upon receipt of a new research project submission, the HRRC Chair or Co-Chair/Administrator conducts an initial review, called a “pre-review” using the Pre-Review Checklist (Form F). The HRRC Chair or Co-Chair/Administrator determines the review level required (Exempt, Expedited

or Limited, Full HRRC, Cooperative Research, or Not Human Subjects Research). Depending on the review level and completeness of the submission, HRRC Chair or Co-Chair/Administrator may either request revisions or process the submission to the next stage of review.

Research records must be kept for a minimum of three years after completion of the study.

Each Principal Investigator must retain records of all correspondence relating to the use of human subjects in research, as required by the HRRC and federal regulations. As applicable, this includes:

1. All HRRC application materials (initial, amendment, continuing review, etc.);
2. All approval letters and important correspondence (initial, continuing review, and amendment approval letters; reportable event memos, etc.);
3. All versions of approved informed consent forms;
4. Training records for research team members; and
5. Research data, which must be stored according to the HRRC approved protocol.

15

[TABLE 15-1] Research records must be kept for a minimum of three years after completion of the study. | Each Principal Investigator must retain records of all correspondence relating to the use of | human subjects in research, as required by the HRRC and federal regulations. As applicable, this | includes: | | 1. All HRRC application materials (initial, amendment, continuing review, etc.); | 2. All approval letters and important correspondence (initial, continuing review, and | amendment approval letters; reportable event memos, etc.); | 3. All versions of approved informed consent forms; | 4. Training records for research team members; and | 5. Research data, which must be stored according to the HRRC approved protocol.

[/TABLE]

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III. Key Determinations for Review of Human Subjects Research

To approve a new research protocol involving human subjects, the HRRC must determine that all of the criteria from 45 CFR § 46.111 are satisfactorily met.

To approve a research protocol, the HRRC must consider and approve all criteria below:

1. The proposed research design is scientifically sound and will not unnecessarily expose subjects to risk;
2. Risks to subjects are reasonable in relation to anticipated benefits, if any, to subjects, and the importance of knowledge that may reasonably be expected to result;
3. Subject selection is equitable;
4. Additional safeguards required for subjects likely to be vulnerable to coercion or undue influence;

1. Informed consent is obtained from research subjects or their legally authorized representative(s);
2. Risks to subjects are minimized; and
3. Subject privacy and confidentiality are maximized.

To assist with understanding the research review requirements and the HRRC approval process, please review the Decision Process Flowcharts found here.

A. Is the Project Considered Research?

Research means "a systematic investigation, including research development, testing and evaluation, designed to develop or contribute to general knowledge. Activities which meet this definition constitute research, whether or not they are conducted or supported under a program which is considered research for other purposes. For example, some demonstration and service programs may include research activities" [45 CFR 46.102(d) & 22 VAC 30-40-10].

Systematic means "characterized by order and planning; not haphazard; a series of orderly actions."

General knowledge is synonymous with generalizable knowledge which means that the intent of collecting the information is to learn and apply what is discovered to a wider group of individuals than those included in the study and to publish the results in an outside publication such as a journal, trade magazine, conference proceedings, or periodical.

The Quality Improvement Determination Worksheet (Form G) may be useful in considering this question.

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B. Does the Project Involve Human Subjects?

Human research means "any systematic investigation which utilizes human participants who may be exposed to physical or psychological injury as a consequence of participation, and which departs from the application of established and accepted therapeutic methods appropriate to meet the participant's needs."

Human participant means "a living individual about whom an investigator (whether professional or student) conducting research obtains (i) data through intervention or interaction with the individual or (ii) identifiable private information. Intervention includes both physical procedures by which data are gathered (for example, venipuncture) and manipulations of the participant or participant's environment that are performed for research purposes."

C. Does the Project Qualify for Exempt Review?

Unless they are covered by some other provision, the following kinds of research are exempt from full HRRC review:

Category 1. Research conducted in established or commonly accepted educational settings, involving normal educational practices that are not likely to impact adversely student opportunity to learn required educational content or the assessment of educators who provide instruction, such as:

a. Research on regular and special education instructional strategies; or b. Research on the effectiveness of or the comparison among instructional techniques, curriculum, or classroom management methods.

Category 2. Research involving the use of educational tests (cognitive, diagnostic, aptitude, or achievement), survey procedures, interview procedures, or observation of public behavior (including visual or auditory recording), unless:

c. The information obtained is recorded in such a manner that human subjects can be identified, directly or through identifiers linked to the subjects and the HRRC conducts a limited review to make the determination required by 22VAC30-40-70 J 7; or b. Any disclosure of the human subjects' responses outside the research could reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects' financial standing, employability, educational advancement, or

reputation.

Category 3. Research involving benign behavioral interventions.

c. Research involving benign behavioral interventions in conjunction with the collection of information from an adult subject through verbal or written

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responses, including data entry, or audiovisual recording if the subject prospectively agrees to the intervention and information collection and at least one of the following criteria is met: i. The information obtained is recorded by the investigator in such a manner that the identity of the human subjects cannot readily be ascertained, directly or through identifiers linked to the subjects;

II. Any disclosure of the human subjects' responses outside the research

would not reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects' financial standing, employability, educational advancement, or reputation; or III. The information obtained is recorded by the investigator in such a manner that the identity of the human subjects can readily be ascertained, directly or through identifiers linked to the subjects, and the HRRC conducts a limited review to make the determination required

by 22VAC30-40-70 J 7. b. For this subsection, benign behavioral interventions are brief in duration, harmless, painless, not physically invasive, and not likely to have a significant adverse lasting impact on the subjects, and the investigator has no reason to think the subjects will find the interventions offensive or embarrassing. Provided all these criteria are met, examples of benign behavioral interventions include having the subjects play an online game, having them solve puzzles under various noise conditions, or having them decide how to allocate a nominal amount of received cash between themselves and someone

else. c. If the research involves deceiving the subjects regarding the nature or purposes of the research, this exemption is not applicable unless a subject authorizes the deception through a prospective agreement to participate in research in circumstances in which a subject is informed that he will be unaware of or misled regarding the nature or purposes of the research.

Category 4. Secondary research for which consent is not required: Secondary research using

identifiable private information, if at least one of the following criteria is met:

d. The research involves the collection or study of existing data, documents, records, pathological specimens, or diagnostic specimens, if these sources are publicly available; b. The information is recorded by the investigator in a manner that subjects (i) cannot be identified, directly or through identifiers linked to the subjects; (ii) the investigator does not contact the subjects; and (iii) the investigator will not re-identify the subject; c. The research involves only information collection and analysis involving the

investigator's use of identifiable health information when that use is regulated under 45 CFR Part 160, General Administrative Requirements, and Part 164, Security and Privacy, Subparts A and E, for the purposes of "health care operations'' or "research'' as those terms are defined at 45 CFR 164.501 or for "public health activities and purposes'' as described under 45 CFR 164.512(b); or

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d. The research is conducted by, or on behalf of, the department using department-generated or department-collected information obtained for nonresearch activities if the research generates identifiable private information that is or will be maintained on information technology that is subject to and in compliance with § 208(b) of the E-Government Act of 2002, 44 USC § 3501 note; if all of the identifiable private information collected, used, or generated as part of the activity will be maintained in systems of records subject to the Privacy Act of 1974, 5 USC § 552a; and if applicable,

the information used in the research was collected subject to the Paperwork Reduction Act of 1995, 44 USC § 3501 et seq.

Category 5. Research and demonstration projects conducted by or subject to the approval of the commissioner, which are designed to study, evaluate, or otherwise examine:

e. Public benefit or service programs;

b. Procedures for obtaining benefits or services under those programs; d. Possible changes in or alternatives to those programs or procedures; or e. Possible changes in methods or levels of payment for benefits or services under those programs.

Category 6. Taste and food quality evaluation and consumer acceptance studies:

f. If wholesome foods without additives are consumed; or

b. If a food is consumed that contains a food ingredient at or below the level and for a use found to be safe, or agricultural chemical or environmental contaminant at or below the level found to be safe, by the Food and Drug Administration or approved by the Environmental Protection Agency or the Food Safety and Inspection Service of the US Department of Agriculture.

Category 7. Storage or maintenance for secondary research for which broad consent is required. Storage or maintenance of identifiable private information for potential secondary

research use if the HRRC conducts a limited review and makes the determinations required by 22VAC30-40-70 J 8.

Category 8. Secondary research for which broad consent is required: Research involving the use of identifiable private information, if it meets the following criteria:

c. Broad consent for the storage, maintenance, and secondary research use of the identifiable private information is obtained in accordance with 22VAC30-40-100 A and D;

b. Documentation of informed consent or waiver of documentation of consent is obtained in accordance with 22VAC30-40-100 L; c. The HRRC conducts a limited review and makes the determination required by 22VAC30-40-70 J 7 and makes the determination that the research to be conducted is within the scope of the broad consent referenced in subdivision 1 of this subsection; and

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d. The investigator does not include returning individual research results to subjects as part of the study plan. The investigator shall not be prevented from abiding by any legal requirements to return individual research results.

For more information on exempt review, please refer to IV. Types of Reviews, A. Exempt Reviews.

D. Does the Project Qualify for Expedited or Limited Review?

Expedited or limited review procedures may apply for certain kinds of research involving no more than minimal risk, and for minor changes in approved research.

The HRRC may use the expedited or limited procedure for categories of research that are listed in 63 FR 60364-60367 where one or more of the following apply:

1. Some or all the research appearing on the list and found by the reviewer to involve no more than minimal risk.
2. Minor changes in previously approved research during the period of one year or less for which approval is authorized; or
3. Research for which limited review is a condition of exemption under 22VAC30-40-80 2 c, 22VAC30-40-80 3a (1), and 22VAC30-40-80 7 and 8.

For more information on expedited review, please see IV. Types of Reviews, B. Expedited and

Limited Reviews.

E. Minimal Risk

The regulations state that “minimal risk” means “the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests” (45 CFR 46.102(i)).

Examples of minimal risk are:

1. Study poses no more risk than expected in daily life (e.g., blood draw, physical exam, routine psychological testing);
2. Non-interventional studies (e.g., observational studies of behavior or nutrition);
3. Survey/Questionnaire studies of a non-sensitive nature;
4. Electrophysiological studies in healthy subjects or clinical populations (surface

recordings such as EEG, ERP, MEG);

1. Genomic studies;
2. Non-invasive imaging (e.g., MRI and fMRI) in healthy subjects or clinical populations to investigate basic mechanisms of brain function;

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1. Research involving materials (data, documents, records—including medical records—or biological specimens) that have been collected or will be collected solely for research purposes;
2. Survey/interview research where disclosure of the information would not place the subjects at risk or be damaging to them or their reputation in any way.

Examples of greater than minimal risk are:

1. Studies involving identification of the subjects and/or their responses which would reasonably place them at risk of criminal or civil liability or be damaging to the subjects financial standing, employability, insurability, reputation, or be stigmatizing, unless reasonable and appropriate protections will be implemented so that risks related to invasion of privacy and breach of confidentiality are no greater than minimal risk;
2. Studies involving deception; and

1. Manipulation of subjects’ emotions.

Research involving minimal risk that fits into one or more exempt or expedited or limited review categories may be reviewed by a designated HRRC Chair, Co-Chair/Administrator or other designated reviewer rather than by the full HRRC.

F. Additional Protections and Special Considerations

The HRRC considers certain groups of human subjects to be particularly vulnerable in a research setting. The HRRC considers additional protections for research activities involving children, prisoners, individuals with impaired decision-making capacity, or economically or educationally disadvantaged persons.

In reviewing these research projects, the HRRC ascertains that the inclusion of the vulnerable population is adequately justified and that additional safeguards are implemented to minimize risks unique to each population. The HRRC considers for approval, research projects involving

vulnerable populations if one of the following conditions is met:

1. The research does not involve more than minimal risk to the subject;
2. the research is likely to benefit the subject directly, even if the risks are considered more than minimal; or
3. the research involves greater than minimal risk with no prospect of direct benefit to individual subjects but is likely to yield generalizable knowledge about the subject's disorder or condition.

G. Informed Consent

The HRRC shall require documentation of informed consent or may waive documentation in accordance with this section.

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Depending on the type of review and the research project, the HRRC may require additional elements of informed consent, waive or alter elements of the informed consent, or allow for broad consent when in the HRRC's judgment, the information would meaningfully add to the protection of the rights and welfare of subjects. For those projects requesting to waive informed consent, principal investigators should complete the Waiver of Informed Consent Request (Form H).

Requirements for informed consent for research projects are governed by 45 CFR 46.116 and

22VAC30-40-100.

In seeking informed consent, the following basic elements shall be provided to each prospective human subject or prospective human subject's legally authorized representative:

1. A statement that the project involves research, an explanation of the purposes of the

research and the expected duration of the human subject's participation, a description of the procedures to be followed, and identification of any procedures that are experimental;

1. A description of any reasonably foreseeable risks or discomforts to the human subject;
2. A description of any benefits to the human subject or to others that may reasonably be expected from the research;
3. A disclosure of appropriate alternative procedures or courses of treatment, if any, that may be advantageous to the human subject;

1. A statement describing the extent, if any, to which confidentiality of records identifying the human subject will be maintained;
2. For research involving more than minimal risk, an explanation as to whether any compensation and an explanation as to whether any medical treatments are available if injury occurs and, if so, what they consist of, or where further information may be obtained;
3. An explanation of who to contact for answers to pertinent questions about the research and the human subject's rights, and who to contact in the event of a research-related

injury to the subject;

1. A statement that participation is voluntary, refusal to participate will involve no penalty or loss of benefits to which the human subject is otherwise entitled, and the human subject may discontinue participation at any time without penalty or loss of benefits to which the subject is otherwise entitled; and
2. One of the following statements about research that involves the collection of identifiable private information: a. A statement that identifiers may be removed from the identifiable private

information and that, after such removal, the information could be used for future research studies or distributed to another investigator for future research studies without additional informed consent from the human subject or the human subject's legally authorized representative, if this may be a possibility; or

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b. A statement that the human subject's information collected as part of the research, even if identifiers are removed, shall not be used or distributed for future research studies.

Notwithstanding consent by a legally authorized representative, no person shall be forced to participate in any human subject research. Further, no legally authorized representative may consent to nontherapeutic research unless the HRRC determines that such nontherapeutic

research will present no more than a minor increase in overall risk to the prospective subject.

No nontherapeutic research shall be performed without the consent of the human subject.

The HRRC has the authority to observe or have a third party observe the consent process and research at any time.

H. Researcher Conflicts of Interest

The HRRC is responsible for ensuring these potential conflicts of interest do not negatively impact the rights or welfare of participants, or the fair and unbiased review of research proposals.

In each research project review, the HRRC notes any potential conflict of interest that could impact the rights or welfare of participants and may require additional safeguards to minimize this impact.

For research involving entities for which the Principal Investigator has a financial conflict of interest disclosed to the HRRC, the Principal Investigator must have a conflict management plan that is submitted to the HRRC for review.

For each project, the principal investigator is required to complete and submit the Conflict of Interest Disclosure Statement (Form D) to the HRRC.

I. Recruitment Materials

Recruitment requires HRRC oversight.

Materials developed for recruiting human participants for research activities must be reviewed and approved by the HRRC. It is recommended that the materials used in recruitment include the HRRC research project number and HRRC approval date.

The materials should be submitted with all formatting, pictures, etc. included. The HRRC evaluates not only the written content, but the overall presentation for appropriateness and to ensure the recruitment material does not unduly promote compensation or promise benefit.

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IV. Types of Reviews

There are four types of reviews:

• Exempt,
• Expedited or Limited,

• Full HRRC, and
• Cooperative Research.

The DARS Commissioner may restrict, suspend, terminate, or choose not to authorize the HRRC's use of the exempt and expedited or limited review procedures.

A. Exempt Review

Certain types of research projects may be eligible for review under exempt review procedures.

The research must involve no more than minimal risk and fit one or more of the categories for exempt research as outlined in 45 CFR § 46.104(d) and 22VAC30-40-80.

The Chair or Co-Chair/Administrator will review the research project and may assign an HRRC member as an additional reviewer, if needed. The Chair or Co-Chair/Administrator will review the exempt research application and all supporting materials to determine whether the

research meets the criteria of one or more of the eligible categories.

The Co-Chair/Administrator will notify the Principal Investigator of the outcome of the review in writing. All HRRC decisions regarding approval, disapproval, or request for revisions will be communicated to the Principal Investigator in writing within 15 business days following receipt of a completed submission. The reviewer’s determination is documented in Review Criteria Checklist (Form I).

For a complete listing of the required documents for an application for exempt review, please review the Exempt Review Application Checklist (Form J).

B. Expedited and Limited Reviews

1. Expedited Review:

Certain types of research protocols may be eligible for review under expedited review

procedures as governed by 45 CFR § 46.110 and 22VAC30-40-90. The research must involve no more than minimal risk and fit one or more of the categories for expedited review procedures as specified in the Federal Register.

The Co-Chair/Administrator completes an initial review of the study submission and will assign one or more reviewers from among the HRRC members, in consultation with the Chair when

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needed. HRRC members are assigned to review research protocols based on the nature of the research and the expertise of the HRRC member.

The Co-Chair/Administrator may act as the sole reviewer if they feel they have adequate expertise to complete the review without input from additional reviewers. Examples: research involving only records review, or where study procedures involve extremely low or no risk.

Assigned HRRC members will review the research application and all supporting materials to determine whether the research:

1. Meets the definition of minimal risk,
2. Meets the criteria of one or more of the eligible categories, and
3. Fulfills the regulatory criteria for approval.

HRRC members reviewing a study may:

1. Ask questions about the research,
2. Require modifications to the protocol and other study materials,
3. Recommend approval,
4. Request additional HRRC members to review the protocol, or
5. Request that the study be reviewed by the full board.

2. Limited Review:

Limited review is a process required only for certain exemptions and does not require an HRRC to consider all of the HRRC approval criteria in 45 CFR § 46.111. In a limited review, the HRRC must determine that certain conditions, which are specified in 45 CFR Part 46, are met.

Limited review may be done via the Expedited Review mechanism, that is, by the Chair or an experienced HRRC member designated by the Chair, however, it may also be conducted by the

full HRRC.

The purpose of limited review is to ensure privacy and confidentiality protections are in place with exempt research that involves the collection or use of sensitive, identifiable data and when “broad consent” was obtained and (if appropriate) documented according to an approved protocol. There are four Exemptions that may require limited review:

1. Research that only includes interactions involving educational tests, survey or interview

procedures, or observation of public behavior if at least one of the three provisions included in this exemption is met. Limited review is required only if the third provision of the exemption is being used—that the information obtained is recorded by the investigator such that the identity of the subjects can readily be ascertained either directly or through identifiers. For this exemption, the limited review serves to

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determine that adequate provisions are in place to protect the privacy of subjects and maintain confidentiality of the data.

1. Research involving benign behavioral interventions in conjunction with specified data collection methods if the criteria listed in one of three possible provisions are met.

Limited review is required only if the third provision of the exemption is being used— that the information obtained is recorded by the investigator such that the identity of the subject can readily be ascertained either directly or through identifiers. For this

exemption, the limited review serves to determine that adequate provisions are in place to protect the privacy of subjects and maintain confidentiality of the data.

1. Storage and maintenance of identifiable private information for potential secondary research use, for which broad consent is required. This exemption requires limited review to determine that the requirements for broad consent are met; that broad consent is appropriately documented or documentation of broad consent is appropriately waived; and that there are adequate provisions in place to protect the

privacy of subjects and maintain confidentiality of the data, if there will be a change made for research purposes in the way the identifiable private information are stored or maintained.

1. Secondary research involving identifiable private information for which broad consent is required. This exemption requires the HRRC to determine through limited review that there are adequate provisions in place to protect the privacy of subjects and maintain confidentiality of the data, and that the research to be conducted is within the scope of the obtained broad consent.

3. Expedited and Limited Review Requests:

For a complete listing of the required documents for an application for expedited or limited HRRC review, please review the Expedited or Limited Application Checklist (Form M).

The Co-Chair/Administrator will notify the Principal Investigator of the outcome (approval or request for revisions) of the expedited or limited review in writing within 20 business days

following submission of a completed submission.

The determination is documented in Review Criteria Checklist (Form I). If instructed by the HRRC member(s) that reviewed the study, the Co-Chair/Administrator may review submitted revisions.

Reviewers may not disapprove a study via expedited procedures; disapproval may only occur by a majority vote at a convened HRRC meeting. If the reviewer recommends disapproval, the

study must be referred to the full HRRC for review.

If there are multiple expedited reviewers and their determinations conflict, the Co-Chair/Administrator communicates with the members to determine whether concordance can be reached. If not, the Chair reviews the research project and may either make the final decision or refer the matter to the full HRRC for review.

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When an expedited review procedure is used, the HRRC Chair or Co-Chair/Administrator shall advise members during the next meeting of the Full Committee meeting of research projects that have been approved since the last convened meeting of the Full Committee.

C. Full HRRC Review

The HRRC Co-Chair/Administrator completes an initial review and may either:

• Request clarifications or additional documents, or
• Place the study on the next available meeting agenda.

The HRRC Co-Chair/Administrator assigns one or more HRRC members as primary reviewers, based on the nature of the research and the expertise of the HRRC member. Primary reviewers

are encouraged to contact the Principal Investigator to ask questions or seek clarification about the research prior to the full committee meeting.

Each HRRC member receives the research project and all supporting documents prior to the meeting.

Investigators are invited to attend the meeting at which their research project will be reviewed.

If present, a researcher will be asked to describe the research project, and the HRRC will ask

any questions or request clarifications about the study.

After sufficient discussion, the HRRC members vote on each research protocol and the votes are recorded in the meeting minutes. See C. Voting and Actions on possible actions to be taken during a meeting. The determination is documented in Review Criteria Checklist (Form I).

All HRRC decisions regarding approval, disapproval or requests for revisions will be made by the

HRRC within 30 business days and subsequently communicated to the Principal Investigator in writing within seven business days of the HRRC meeting where the submission is reviewed. If the HRRC decides to disapprove a research activity, it shall include in its written notification a statement of the reasons for its decision and give the Principal Investigator an opportunity to respond in person or in writing.

For a complete listing of the required documents for an application for full HRRC review, please review the Full Review Application Checklist (Form P).

D. Cooperative Research (45 CFR § 46.1144)

Cooperative research projects are those projects covered by this document which involve a covered entity and another institution or institutions. In the conduct of cooperative research projects, each covered entity and institution is responsible for safeguarding the rights and welfare of human subjects. With the approval of the appropriate director(s) of the covered

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entity or entities, a covered entity participating in a cooperative research project may enter into a joint review arrangement, rely upon the review of another qualified IRB (‘IRB of Record’), or make similar arrangements for avoiding duplication of effort.

For covered entities with research projects that are subject to the DARS HRRC, the DARS Commissioner is the only person who can approve a request for the HRRC to ‘Defer’ to an external IRB to serve as the ‘IRB of Record’ for the research project.

When the HRRC relies on an external IRB to serve as the ‘IRB of Record,’ the external IRB will be evaluated by the HRRC Chair or Co-Chair/Administrator to determine if it meets specific criteria for the protection of human research subjects and, if so, execute written agreements outlining specific responsibilities of each party.

There must be a formal written authorization agreement between the HRRC and the external

IRB delineating the roles and responsibilities of each party. The agreement must include a commitment that the external IRB will adhere to the requirements of the external IRB’s FWA.

The HRRC has a standard form that may be used for this purpose, or the parties involved may develop their own agreement. This agreement must be kept on file with the HRRC and the external IRB, and made available to OHRP or any US federal department or agency conducting or supporting research covered by the FWA upon request.

To start this process, the Principal Investigator must submit the information identified in the

Checklist and Instructions for Cooperative Research Projects (Form R).

The DARS Commissioner should make determinations to approve or disapprove cooperative research requests within 15 business days. If the DARS Commissioner approves a request for the DARS HRRC to ‘Defer’ to an external IRB to serve as the ‘IRB of Record’, the Co-Chair/Administrator will work with the external IRB to execute an “IRB Authorization Agreement” (Form S).

Once the research project has been reviewed and approved by the external IRB, the Principal Investigator must provide the DARS HRRC a copy of the external IRB approval.

If a joint review arrangement cannot be reached, the covered entity may submit the research application prepared for the other institution to the HRRC. The HRRC Chair or Co-Chair/Administrator will conduct an initial review of the application to ensure all required information is included. Follow-up to obtain additional information will occur with the covered entity, as needed. The HRRC Chair or Co-Chair/Administrator will follow the applicable review

protocol as outlined under A. Exempt Review, B. Expedited and Limited Reviews, or C. Full HRRC Review.

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V. HRRC Approval Timelines

When projects are federally funded, the Principal Investigator is responsible for sending a copy of the approval letter to the Grants and Contracts Office and/or the funding agency, as needed.

The following approval timelines shall apply:

1. Exempt Review: Projects receive a three-year approval, beginning the date HRRC Co-Chair/Administrator issues the approval letter.
2. Expedited or Limited Review: Projects receive a one-year approval, beginning on the date HRRC Co-Chair/Administrator determines that any conditions for approval have been met and issues the approval letter.
3. Full Committee Review: The approval period begins the date of the convened meeting at which the HRRC voted to approve the study or approve with conditions. The default

approval period is one year, but the HRRC may determine that a shorter review period is appropriate.

VI. Modifications to Research Projects

The Principal Investigator must conduct the research in accordance with the specific methods described in the application that was approved by the HRRC.

Whenever an ongoing project acquires a new Principal Investigator, or whenever there are changes (e.g., changes in consent procedures, addition of potentially sensitive items to research instruments, changes in treatment procedures) in the protocol or the subject population, a modification must be filed.

No changes in approved research may be initiated without HRRC review and approval, except when necessary to eliminate apparent immediate hazards to research subjects.

If a Principal Investigator wishes to make changes to a previously approved research project, these changes must first be submitted via the Modification Request (Form T) and approved by the HRRC.

The HRRC reviews modifications to previously approved research in accordance with the level of risk of the study as a whole and proposed changes. Modifications may be reviewed at a full HRRC meeting or via expedited procedures. Specifically:

1. Exempt reviews: Modifications are reviewed by HRRC Co-Chair/Administrator only, unless the changes are significant enough that the study no longer qualifies for exempt status. In this case, the amendment would receive either expedited or full HRRC review, in accordance with the level of risk of the changes.
2. Expedited reviews: Modifications receive expedited review, unless the changes raise the study to the level of more than minimal risk and full HRRC review is required. Expedited

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reviews may be conducted by the HRRC Co-Chair/Administrator only, or one or more additional reviewers may be assigned.

1. Full HRRC reviews: Minor modifications may receive expedited review by HRRC Co-Chair/Administrator and/or one or more reviewers. Significant modifications must receive full HRRC review. HRRC Co-Chair/Administrator, primary reviewer(s), and/or the Chair determine whether a change is “minor” vs. “significant”. If there is not consensus, the modification is sent to the full HRRC.

VII. Continuing Reviews, Status Updates and Project Closures

The HRRC shall conduct continuing review of research requiring ongoing review at intervals appropriate to the degree of risk, but not less than once per year for those requiring continuing review and shall have authority to observe or have a third party observe the informed consent process and the research.

Depending on the degree of risk, the HRRC may conduct continuing review at a fully convened meeting, may conduct continuing review under expedited review procedures, or may not require continuing review.

Research classified as exempt will not require further review after the initial approval.

However, Principal Investigators should submit the Research Project Status Report (Form U) every three years. For research projects classified as exempt, principal investigators should

send notification by email to the HRRC Co-Chair/Administrator within 30 calendar days after a research project closure. A Research Project Closure Report (Form X) is not required.

Research classified as expedited will not require further review after the initial approval.

However, Principal Investigators should provide an annual status update using the Research Project Status Report (Form U) and complete a Research Project Closure Report (Form X) within 30 calendar days after a research project closure.

For research projects classified as cooperative research using external IRB to serve as ‘IRB of Record,’ Principal Investigators should send notification by email to the HRRC Co-Chair/Administrator within 30 calendar days after a research project closure. A Research Project Closure Report (Form X) is not required.

Projects requiring continuing review should use the Continuing Review and Adverse Event Report (Form Y) and submit it to the HHRC Co-Chair/Administrator. Continuing Review reports, when required, are to be at least annually for all approved research projects, to ensure

conformity with the approved proposal. The frequency of such reports shall be determined by the HRRC and shall be consistent with the nature and degree of risk of each research project. In addition, the Principal Investigator should complete a Research Project Closure Report (Form X) within 30 calendar days after a research project closure.

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During the course of a research project, Principal Investigators should submit the Continuing Review and Adverse Event Report (Form Y) if unanticipated problem(s), safety issue(s), or other serious, unexpected adverse effect(s) or event(s) that are related or possibly related to your project arise.

During the course of a research project, Principal Investigators should submit the Research Inquiries, Comments or Concerns Report (Form V), when appropriate, to report to the HRRC

any inquiries, comments and/or concerns from human research subjects, the community, and others.

If the Principal Investigator does not submit a Research Project Status Report (Form U) or Continuing Review and Adverse Event Report (Form Y) as required by the established deadline, the HRRC will close the research project.

For more information, please refer to sections 45 CFR § 46.104(d)(2)(iii), 46.104(d)(3)(i)(C), 46.104(d)(7), and 46.104(d)(8)(iii) of the revised Common Rule.

VIII. Research Project Non-Compliance

Principal Investigators must not start any aspect of research involving human subjects (e.g., recruitment, screening, etc.) until they have received written notification of HRRC approval.

The Principal Investigator is responsible for compliance with other laws and institutional rules (such as compliance with HIPAA, FERPA, biosafety regulations, etc.) and must provide documentation of any other reviews to the HRRC upon request.

Principal investigators shall report non-compliance with the approved research proposal to the

HRRC.

If the HRRC determines that the research project fails to comply with the approved proposal or

violates law or regulation, the HRRC or the DARS Commission may restrict or terminate further research, prohibit the Principal Investigator from presenting or publishing the research project results, and/or bar the Principal Investigator from conducting future studies that come before the HRRC.

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Appendix A: List of All HRRC Forms (Required and Optional)

Form Name Alphabetical Identifier Conflict of Interest HRRC Member Statement: This form is used by A HRRC members and Ad-Hoc Reviewers prior to conducting any HRRC

reviews or participating in an HRRC meeting.

HRRC Confidentiality Agreement: This form is used by HRRC B members and ad-Hoc reviewers prior to conducting any HRRC reviews or participating in an HRRC meeting and for any guests who are present during an HRRC meeting.

Guest Attendance Certification: Use this form to document each C guest who attends at full HRRC meeting as well as their

understanding of the guest responsibilities.

Conflict of Interest Disclosure Statement: The Principal Investigator D uses this form to disclose or deny any financial interest(s) in the research project on behalf of the Principal Investigator, Co-Investigator(s), and Project Coordinator(s), as appropriate.

Listing of Co-Investigators: Use this form to identify any Co- E Investigators on the research project.

HRRC Pre-Review Checklist: HRRC Chair or Co-Chair/Administrator F use this form to document a completed pre-review of an application.

Quality Improvement Determination Worksheet: This form helps G researchers and the HRRC determine if a project is Quality Improvement (QI)/Quality Assurance (QA) or Human Subjects Research. This is not a required form.

Waiver of Informed Consent Request: Use this form to request H

waivers of the informed consent requirements.

Review Criteria Checklist: HRRC Chair or Co-Chair/Administrator use I this form to document a completed review of an application and that it satisfies the requirements of the HRRC.

Exempt Review Application Checklist: Use this form to ensure you J have compiled and submitted all the required materials for an Exempt Review.

Request for Exempt Review: Use this form to request an Exempt K Review. The form identifies the exempt review qualifying category.

Exempt Review Application: Use this form to submit an Initial L Application for Exempt Review view and clearance of human subject research.

Expedited or Limited Review Application Checklist: Use this form to M ensure you have compiled and submitted all the required materials

for an Expedited or Limited Review.

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[TABLE 32-1] | Form Name | | | Alphabetical Identifier | Conflict of Interest HRRC Member Statement: This form is used by HRRC members and Ad-Hoc Reviewers prior to conducting any HRRC reviews or participating in an HRRC meeting. | | | A | | HRRC Confidentiality Agreement: This form is used by HRRC members and ad-Hoc reviewers prior to conducting any HRRC reviews or participating in an HRRC meeting and for any guests who are present during an HRRC meeting. | | | B | | Guest Attendance Certification: Use this form to document each guest who attends at full HRRC meeting as well as their understanding of the guest responsibilities. | | | C | | Conflict of Interest Disclosure Statement: The Principal Investigator uses this form to disclose or deny any financial interest(s) in the research project on behalf of the Principal Investigator, Co-Investigator(s), and Project Coordinator(s), as appropriate. | | | D | | Listing of Co-Investigators: Use this form to identify any Co-Investigators on the research project. | | | E | | HRRC Pre-Review Checklist: HRRC Chair or Co-Chair/Administrator use this form to document a completed pre-review of an application. | | | F | | Quality Improvement Determination Worksheet: This form helps researchers and the HRRC determine if a project is Quality Improvement (QI)/Quality Assurance (QA) or Human Subjects Research. This is not a required form. | | | G | | Waiver of Informed Consent Request: Use this form to request waivers of the informed consent requirements. | | | H | | Review Criteria Checklist: HRRC Chair or Co-Chair/Administrator use this form to document a completed review of an application and that it satisfies the requirements of the HRRC. | | | I | | Exempt Review Application Checklist: Use this form to ensure you have compiled and submitted all the required materials for an Exempt Review. | | | J | | Request for Exempt Review: Use this form to request an Exempt Review. The form identifies the exempt review qualifying category. | | | K | | Exempt Review Application: Use this form to submit an Initial Application for Exempt Review view and clearance of human subject research. | | | L | | Expedited or Limited Review Application Checklist: Use this form to ensure you have compiled and submitted all the required materials for an Expedited or Limited Review. | | | M | |

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Request for Expedited or Limited Review: Use this form to request N Expedited or Limited Review. The form identifies the expedited or limited review qualifying category.

Expedited or Limited Review Application: Use this form to submit an O Initial Application for Expedited or Limited Review and clearance of human subjects’ research.

Full Review Application Checklist: Use this form to ensure you have P compiled and submitted all the required materials for a Full HRRC Review.

Full Review Application: Use this form to submit an Initial Q Application for Full HRRC Review and clearance of human subjects’ research.

Checklist and Instructions for Cooperative Research Projects: This R

form is used by an applicant to pursue cooperative research and use an external IRB as the IRB of Record for a research project. This form is a template; a principal investigator may submit a written and signed letter if it has the required elements.

IRB Authorization Agreement: This form is used by the HRRC to S establish an agreement with an external IRB to serve as ‘IRB of Record’ for a research project. This form is a template; another form or document may be used if it has the required elements.

Modification Request: Use this form to request a modification to a T previously approved research project protocol.

Research Project Status Report: Use this form to provide an update U on previously approved, exempt, expedited or limited review research projects.

Research Inquiries, Comments or Concerns Report: Use this form to V report inquiries, comments and/or concerns from human research

subjects, the community, and others.

Research Project Closure Report: Use this form to notify the HRRC X when your research project is completed.

Continuing Review and Adverse Event Report: Use this form to Y provide information for the HRRC, or designated reviewer, for regular updates of a previously approved project subject to the HRRC’s continuing review requirement, or to report unanticipated

problem(s), safety issue(s), or other serious, unexpected adverse effect(s) or event(s) that are related or possibly related to your project.

33

[TABLE 33-1] Request for Expedited or Limited Review: Use this form to request Expedited or Limited Review. The form identifies the expedited or limited review qualifying category. | N Expedited or Limited Review Application: Use this form to submit an Initial Application for Expedited or Limited Review and clearance of human subjects’ research. | O Full Review Application Checklist: Use this form to ensure you have compiled and submitted all the required materials for a Full HRRC Review. | P Full Review Application: Use this form to submit an Initial Application for Full HRRC Review and clearance of human subjects’ research. | Q Checklist and Instructions for Cooperative Research Projects: This form is used by an applicant to pursue cooperative research and use an external IRB as the IRB of Record for a research project. This form is a template; a principal investigator may submit a written and signed letter if it has the required elements. | R IRB Authorization Agreement: This form is used by the HRRC to establish an agreement with an external IRB to serve as ‘IRB of Record’ for a research project. This form is a template; another form or document may be used if it has the required elements. | S Modification Request: Use this form to request a modification to a previously approved research project protocol. | T Research Project Status Report: Use this form to provide an update on previously approved, exempt, expedited or limited review research projects. | U Research Inquiries, Comments or Concerns Report: Use this form to report inquiries, comments and/or concerns from human research subjects, the community, and others. | V Research Project Closure Report: Use this form to notify the HRRC when your research project is completed. | X Continuing Review and Adverse Event Report: Use this form to provide information for the HRRC, or designated reviewer, for regular updates of a previously approved project subject to the HRRC’s continuing review requirement, or to report unanticipated problem(s), safety issue(s), or other serious, unexpected adverse effect(s) or event(s) that are related or possibly related to your project. | Y

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• Page 1 ---

POLICIES AND PROCEDURES FOR THE PROTECTION OF HUMAN

SUBJECTS FOR

Policy, Legislative Affairs and Analytics Division 8004 Franklin Farms Drive

Richmond, Virginia 23229 Effective: November 2024

FWA Number: 00008936

Initial Approval: August 15, 2005 Expires: January 25, 2026

Approved by

Kathryn A. Hayfield, Commissioner November 2024

• Page 2 ---

TABLE OF CONTENTS

BACKGROUND 5

I. OVERVIEW 5

II. STATEMENT OF PRINCIPLES 6

III. LEGAL AUTHORITY 7

IV. HRRC MISSION AND PURPOSE 7

V. DEFINITIONS 7

THE HUMAN RESEARCH REVIEW COMMITTEE (HRRC) MEMBERSHIP 9

I. APPOINTMENTS 9

II. COMPOSITION 9

J. PRIMARY MEMBERS 9

B. ALTERNATE MEMBERS 9

C. AD HOC REVIEWERS 10

III. MEMBER RESPONSIBILITIES 10

IV. OFFICERS 10

V. CONFLICTS OF INTEREST 10

HRRC OPERATIONS 11

I. FULL COMMITTEE MEETINGS 11

II. ELECTRONIC MEETINGS 11

III. MEETING AGENDAS 12

IV. CONDUCT OF BUSINESS 12

J. ORDER/QUORUM 12

B. ATTENDEES AND GUESTS 12

C. VOTING AND ACTIONS 13

D. MEETING MINUTES 14

V. HRRC RECORD RETENTION 14

W. VIRGINIA FREEDOM OF INFORMATION ACT AND INSTITUTIONAL REVIEW BOARDS 14

HRRC REVIEWS AND DECISION MAKING PROCESS 15

I. BACKGROUND 15

II. APPLICATIONS AND SUBMISSION MATERIALS 15

III. KEY DETERMINATIONS FOR REVIEW OF HUMAN SUBJECTS RESEARCH 16

J. IS THE PROJECT CONSIDERED RESEARCH 16

B. DOES THE PROJECT INVOLVE HUMAN SUBJECTS? 17

C. DOES THE PROJECT QUALIFY FOR EXEMPT REVIEW? 17

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D. DOES THE PROJECT QUALIFY FOR EXPEDITED OR LIMITED REVIEW? 20

E. MINIMAL RISK 20

F. ADDITIONAL PROTECTIONS AND SPECIAL CONSIDERATIONS 21

G. INFORMED CONSENT 21

H. RESEARCHER CONFLICTS OF INTEREST 23

I. RECRUITMENT MATERIALS 23

IV. TYPES OF REVIEWS 24

J. EXEMPT REVIEW 24

B. EXPEDITED AND LIMITED REVIEWS 24

C. FULL HRRC REVIEW 27

D. COPPERATIVE RESEARCH (45 CFR § 46.1144) 27

V. HRRC APPROVAL TIMELINES 29

VI. MODIFICATIONS TO RESEARCH PROJECTS 29

VII. CONTINUING REVIEWS, STATUS UPDATES AND PROJECT CLOSURES 30

VIII. RESEARCH PROJECT NON-COMPLIANCE 31

APPENDIX A: LIST OF ALL HRRC FORMS (REQUIRED AND OPTIONAL) 32

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ACKNOWLEDGMENTS

This edition incorporates federal and state regulations on human subjects in federally funded research, including the January 2019 “Common Rule” changes.

Please submit HRRC applications to:

Devin Bowers HRRC Co-Chair and Administrator Policy, Legislative Affairs and Analytics Virginia Department for Aging and Rehabilitative Services 8004 Franklin Farms Drive Richmond, Virginia 23229

(804) 662-7010 Email: devin.bowers@dars.virginia.gov

or

Catherine Harrison HRRC Chair Policy, Legislative Affairs and Analytics Director

Virginia Department for Aging and Rehabilitative Services 8004 Franklin Farms Drive Richmond, Virginia 23229 Phone: (804) 662-9968 Email: catherine.harrison@dars.virginia.gov Toll Free: 1-800-552-5019 TTY Toll Free: 800-464-9950

FAX (804) 662-7663

For questions or comments about this manual or compliance, contact:

Catherine Harrison HRRC Chair Policy, Legislative Affairs and Analytics Director Virginia Department for Aging and Rehabilitative Services 8004 Franklin Farms Drive

Richmond, Virginia 23229 Phone: (804) 662-9968 Email: catherine.harrison@dars.virginia.gov Toll Free: 1-800-552-5019 TTY Toll Free: 800-464-9950

FAX (804) 662-7663

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DARS HUMAN RESEARCH AND REVIEW COMMITTEE

POLICIES, PROCEDURES AND GUIDANCE MANUAL

Background

I. Overview

Title 45 Part 46 of CFR—Protection of Human Subjects—applies Belmont Report principles and mandates compliance for federally funded research involving human subjects (§46.122). Federal funds cannot be used unless requirements are met. To promote uniformity, many federal

departments and agencies have adopted the common Federal Policy for the Protection of Human Research Subjects (Common Rule).

DARS operates the vocational rehabilitation (VR) program funded and overseen by the Rehabilitation Services Administration, US Department of Education (DOE), which codifies the same requirements as the Common Rule at 34 CFR Part

Several other DARS programs, under the federal Administration for Community Living (ACL) in DHHS, also fall under the Common Rule.

DHHS regulations incorporate the Common Rule as Subpart A of 45 CFR 46, and DOE adopts Subpart D for protections of child subjects; all federally funded research involving minors must comply with both.

For the purposes of this document, the term "“covered entity” includes all DARS’ divisions, programs, and offices (except for the Division of Disability Determination Services); Centers for Independent Living; sheltered workshops (i.e., employment services organizations with contracts or vendor arrangements with DARS), Area Agencies on Aging; and the Wilson Workforce and Rehabilitation Center (WWRC). DDS is fully funded by the US Social Security Administration (SSA). Any research involving DDS employees, clients and/or personally

identifiable data, must be approved by SSA.

Research approved by the HRRC may require further review and approval by the DARS Commissioner, who cannot approve research not approved by the HRRC (45

CFR § 46.112).

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Covered entities must comply with federal and state laws providing additional protections (45 CFR §46.101(e)). In case of discrepancies, federal requirements take precedence over state laws and DARS policies.

This document fulfills DARS’s Federal Wide Assurance (FWA) with DHHS.

to have written procedures for conducting human subject research.

The FWA is a binding agreement between DARS and DHHS, affirming DARS's adherence to Belmont Report principles and compliance with 45 CFR Part 46 for federally funded human subject research.

Non-federally funded activities by covered entities shall be conducted in

compliance with Virginia Code §§ 32.1-162.16 et seq. and 51.5-132, DARS regulations (22VAC30-40-10 et seq.), and this policy.

Non-therapeutic research is prohibited unless HRRC determines it poses no more than minimal risk (§ 32.1-162.19).

22VAC30-40-40 C).

This document is an electronic resource. Refer to the electronic version of

this document to ensure use of the latest version. The signature copy is maintained by DARS Policy, Legislative Affairs and Analytics Division. An electronic copy is available on the HRRC webpage.

To report research non-compliance with federal or state laws involving covered entities, contact the DARS HHRC Chair in Policy, Legislative Affairs and Analytics.

II. Statement of Principles

Per Virginia § 51.5-132 and regulations, DARS safeguards human subjects' rights and welfare. No research by covered entities proceeds without HRRC review and approval.

The National Research Act of 1974 established the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. In 1979, the Commission published its report, Ethical Principles and Guidelines for the Protection of Human Subjects of Research, commonly called the Belmont Report. Today's federal regulations for the protection of human subjects are based on the ethical principles of the Belmont Report. The Belmont Report

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identifies three core principles relevant to research ethics:

(1) Respect for Persons, (2) Beneficence, and (3) Justice.

DARS ensures all human subjects research complies with its FWA.

III. Legal Authority

DARS HRRC is authorized to review and approve research by covered entities as directed by:

i. 45 CFR Part 46 Protection of Human Subjects;

II. 34 CFR Part 97, as applicable;

III. Code of Virginia §§ 32.1-162.16 et seq. and 51.5-132;

iv. 22VAC30-40-10 et seq. on protections; v. This policy and procedures document.

IV. HRRC Mission and Purpose

HRRC ensures research by covered entities respects privacy and minimizes harm. It reviews proposals to ensure compliance with laws and protects human subjects.

V. Definitions

The following terms mean:

"Covered entity" means the Department for Aging and Rehabilitative Services, the Wilson Workforce and Rehabilitation Center, area agencies on aging, sheltered workshops, and independent living centers.

“Human subject” means “a living individual about whom an investigator (whether professional or student) conducting research obtains:

i. data via intervention or interaction; ii. identifiable private info.

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In this document, “subject” includes all research participants.

"Identifiable private information" means private information for which the identity of the subject is or may readily be ascertained by the investigator or associated with the information.

""Informed consent" means a process where the investigator explains research, allows questions, and gives time for decision before signing HRRC-approved consent. It must be obtained without coercion per 22VAC30-40-100.

“Intervention” includes physical procedures for data collection (e.g.,

venipuncture) and manipulations of the subject or environment for research.

“Interaction” includes communication or interpersonal contact between investigator and subject.

"Minimal risk" means the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or

routine physical or psychological exams or tests.

"Nontherapeutic research" means human subject research in which there is no reasonable expectation of direct benefit to the physical or mental condition of the subject.

“Private information” includes behavior in contexts where observation is not expected and info provided for specific purposes.

individual can reasonably expect will not be made public (e.g., medical record).

Private information must be identifiable (identity ascertainable or associated) to involve human subjects research.

“Research” is a systematic investigation aimed at developing or contributing to generalizable knowledge.

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HRRC Membership

I. Appointments

The DARS Commissioner appoints HRRC members. Term of

membership begins with appointment date and may be unlimited. Review current members at HRRC webpage.

II. Composition

J. Primary Members

Per 45 CFR §46.107, HRRC shall have at least five members. Members shall have

Members shall have diverse backgrounds, experience, and expertise to review research, considering race, gender, culture, community attitudes, institutional commitments, regulations, law, and standards.

The HRRC shall include persons knowledgeable in these areas.

For research involving vulnerable subjects (per 45 CFR §46.107), include individuals experienced with these populations.

At least two HRRC members must have non-scientific or ethical concerns (e.g., clergy, lawyers).

B. Alternate Members

Alternate members may review projects with conflicts or when primary members cannot attend.

Alternate members must meet same requirements, may attend, count for quorum, and vote for absent primary members.

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C. Ad Hoc Reviewers

The HRRC may invite experts (“ad hoc reviewers”) from within or outside the entity to assist. They must meet conflict and confidentiality requirements and cannot vote on the

HRRC.

III. Member Responsibilities

Members are expected to:

• Attend the required initial education program.
• Maintain confidentiality of all HRRC-related activities and refrain from discussing them

outside the context of these duties.

• Conduct competent, complete, and professional reviews of research protocols promptly.
• Attend and contribute to HRRC review and discussion of protocols during full meetings.
• Attend any required continuing education for HRRC members.

• Adhere to the conflict of interest policy.

IV. Officers

Officer positions include the Chair and Co-Chair/Administrator. The Chair is the Director of DARS Policy, Legislative Affairs and Analytics. The Co-Chair/Administrator is designated by the Chair and is a DARS employee.

V. Conflicts of Interest

No HRRC member shall be directly involved in or have approval authority over proposed research, except as an HRRC member. Members cannot review projects where they have a conflict. HRRC determines conflicts.

Members must sign and complete the Conflict of Interest HRRC Member Statement (Form A) to acknowledge receipt. The HRRC Administrator keeps the signed form on file.

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HRRC Operations

For HRRC review, a project must meet both “research” and “human subject” definitions. If not, submission is unnecessary. Questions about human subjects research may be directed to the Chair or Co-Chair/Administrator.

subjects research may be directed to the Chair or the Co-Chair/Administrator of the HRRC.

Refer to appendices for steps to determine if activities constitute human subjects research.

I. Full Committee Meetings

The HRRC will convene at least once annually for continuing research

review and may meet more often as needed. Individual meetings may be scheduled for full review applications.

The Chair may cancel meetings due to: (a) insufficient applications, (b) lack of quorum, or (c) other reasons like weather.

The HRRC Co-Chair/Administrator will distribute meeting time, place, and study materials.

for review prior to meetings.

II. Electronic Meetings

OHRP in DHHS recognizes electronic HRRC meetings if:

1. Each member has received all pertinent materials before the meeting, and

participants can actively and equally discuss all projects;

1. Minutes of meetings must document conditions met alongside usual HRRC documentation;
2. The HRRC follows its written procedures; and
3. Unless using Exempt, Expedited, Limited Review, or Cooperative Research, review must occur during convened Full Committee meetings with a majority of HRRC members present.

All virtual meetings must be secure when appropriate.

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III. Meeting Agendas

Agendas must list each project by HRRC control number, PI name, and title. They should be included in the official record for reference.

A copy of the final agenda may be placed with the minutes to assist in the location of items

within the minutes. The agenda is not considered a required document as per regulation, but rather a tool for organizing meetings and preparation of minutes.

IV. Conduct of Business

Before HRRC meetings or reviews, members and alternates must have signed forms on file with the Co-Chair/HRRC.

Administrator:

• Conflict of Interest HRRC Member Statement (Form A)
• HRRC Confidentiality Agreement (Form B)

A. Order/Quorum

The Chair calls the HRRC meeting to order when a quorum is present.

The meeting ends or is suspended whenever a quorum of members is no longer present for deliberations. A quorum is required to review research and vote.

A quorum requires a majority of voting members, including at least one nonscientific expert, for project review purposes.

With Chair approval, designated alternates may serve, count toward quorum, and vote if materials were provided beforehand.

B. Attendees and Guests

At the Chair's or primary reviewer's discretion, the PI may be invited for clarification or discussion. A Guest

Attendance Certification (Form C) must be completed and signed by attendee and witness. Investigators must leave for discussion and voting.

Persons may observe HRRC meetings as guests under conditions:

1. Guest attendance is at the Chair's discretion;

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1. Guests may be asked to leave anytime;
2. Guests must not attend during review of research where they serve as PI or Co-Investigator;
3. Guests may be asked to sign a HRRC Confidentiality Agreement (Form B);
4. Guests must sign Conflict of Interest Disclosure (Form D), disclose conflicts before attendance, and excuse themselves if conflicts arise;

If applicable, Form D must be accompanied by Listing of Co-Investigators (Form E).

1. Guests must sign in and may document visit purpose;

C. Voting and Actions

Only members and alternates may vote; proxies are not allowed. Chair may choose written ballot or show of hands.

A project vote requires a motion and second by HRRC members. The Chair calls for a vote if no discussion. Approval needs a majority of quorum-present members.

Members with conflicts of interest may not vote.

Any HRRC member may make a motion during a meeting:

1. Approved: Defined as approved as is, with no further action required;
2. Approved on condition: Approved if scripted changes are made and verified via expedited review; cannot be used at continuing review;

1. Tabled: Requires additional info or more than scripted changes, returned to Full Committee; cannot be used at continuing review;
2. Disapproved: Not approved by HRRC for reasons in a Letter of Disapproval;
3. Suspended: Approval of research is suspended for any reason HRRC deems appropriate;

1. Termination: Approval of research is terminated for any reason HRRC deems appropriate;
2. Approved/Short Term-A: Used only for continuing reviews, allowing approval where scripted changes are requested, and delays won't endanger subjects;

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increased risk of harm, and the HRRC will not have time to approve the changes before HRRC approval expires. All scripted changes to documents must be made and returned for verification via expedited review as detailed in the approval letter. Under this motion to approve, expiration of approval is on the last day of the second month from the HRRC meeting (e.g. HRRC meeting date is June 1, 2019 and approval will expire August 31, 2019). Once the supplemental information/modifications (scripted only) have been made and are verified by expedited review, the continuing review cycle will be reset

(not to exceed one year from full committee continuing review). The HRRC is using this process at the time of continuing review to ensure that scripted changes requested by HRRC members are given valid and thorough consideration, and not overlooked simply due to concerns about the impact of an interruption in HRRC approval.

1. Approved/Short Term-B: Used only for continuing reviews, allowing approval where supplemental or non-scripted changes are requested, and delays in review;

If changes do not increase subject risk and cannot be approved before expiration, this process ensures thorough review of supplemental or non-scripted changes.

D. Meeting Minutes

Minutes must record vote counts without individual IDs; abstentions and abstaining members' identities must be noted.

V. HRRC Record Retention

The Co-Chair/Administrator maintains records for individual studies until at least

three years after study end date, or longer if required by regulations.

The Co-Chair/Administrator maintains HRRC meeting records per laws and regulations.

The Co-Chair/Administrator maintains and updates the HRRC website as needed, creates and updates the policy manual and forms, and publishes and disseminates important communications to the HRRC and Principal Investigators with approved and pending research

projects.

W. Virginia Freedom of Information Act and Institutional Review Boards

Virginia Attorney General's opinion states IRBs are exempt from FOIA. The opinion

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IRBs are not public bodies and are not subject to FOIA.

Records are not subject to inspection or copying by citizens.

HRRC Reviews and Decision Making Process

I. Background

HRRC (or designated reviewers for exempt, expedited, or limited reviews) must review all requests within 45 days of a complete application.

HRRC has authority to approve, modify, or disapprove all research covered by this policy (45 CFR § 46.109).

All requirements must be fulfilled.

No human research may be conducted or authorized unless reviewed and approved by the DARS HRRC or designated reviewer.

II. Applications and Submission Materials

The HRRC Chair or Co-Chair/Administrator will screen applications for completeness and seek missing info. Only complete applications proceed for review.

Upon receipt, the HRRC Chair or Co-Chair/Administrator conducts a pre-review using Form F and determines the review level (Exempt, Expedited

or Limited, Full HRRC, Cooperative, or Not Human Subjects Research). Based on review level and completeness, revisions may be requested or the submission advanced.

Research records must be retained for at least three years after study completion.

Principal Investigators must retain all correspondence related to human subjects research, as required by HRRC and federal regulations, including:

1. All HRRC application materials (initial, amendment, continuing review, etc.);
2. All approval letters and key correspondence (initial, continuing review, amendments, reportable event memos);
3. All versions of approved informed consent forms;
4. Training records for research team members; and
5. Research data must be stored per HRRC approved protocol;

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[TABLE 15-1] Research records must be kept for a minimum of three years after completion of the study. | Each Principal Investigator must retain records of all correspondence relating to the use of | human subjects in research, as required by the HRRC and federal regulations. As applicable, this | includes: | | 1. All HRRC application materials (initial, amendment, continuing review, etc.); | 2. All approval letters and important correspondence (initial, continuing review, and | amendment approval letters; reportable event memos, etc.); | 3. All versions of approved informed consent forms; | 4. Training records for research team members; and | 5. Research data must be stored per HRRC approved protocol;

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III. Key Determinations for Review of Human Subjects Research

HRRC must determine all criteria from 45 CFR § 46.111 are met to approve a new human subjects protocol.

To approve a protocol, HRRC must consider and approve all criteria below:

1. The proposed research design is scientifically sound and will not unnecessarily expose subjects to risk;
2. Risks to subjects are reasonable relative to anticipated benefits and the importance of knowledge expected to result;
3. Subject selection is equitable;
4. Additional safeguards are required for vulnerable subjects to coercion or undue influence;

1. Informed consent is obtained from subjects or their legal representatives;
2. Risks to subjects are minimized; and
3. Subject privacy and confidentiality are maximized.

Review the Decision Process Flowcharts here to understand review requirements and HRRC approval.

A. Is the Project Considered Research?

Research is a systematic investigation to develop or contribute to general knowledge, including activities in demonstration and service programs [45 CFR 46.102, 22 VAC 30-40-10].

Systematic means "orderly and planned; not haphazard."

Generalizable knowledge aims to learn, apply, and publish results to a wider group beyond the study participants.

The Quality Improvement Worksheet (Form G) may assist in this determination.

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B. Does the Project Involve Human Subjects?

Human research is systematic investigation involving participants who may face physical or psychological injury, departing from established therapeutic methods.

A human participant is a living individual from whom data is obtained via intervention, interaction, or identifiable private info, including physical procedures and environmental manipulations.

C. Does the Project Qualify for Exempt Review?

Research exempt from full HRRC review unless covered by other provisions:

Category 1: Research in established educational settings involving normal practices unlikely to adversely affect student learning or educator assessment:

a. Research on instructional strategies; b. Research on effectiveness or comparison of techniques, curriculum, or management methods.

Category 2. Research involving educational tests (cognitive, diagnostic, aptitude, or achievement), survey procedures, interview procedures, or observation of public behavior (including visual or auditory recording), unless:

c. The information obtained is recorded in such a manner that human subjects can be identified, directly or through identifiers linked to the subjects and the HRRC conducts a limited review to make the determination required by 22VAC30-40-70 J 7; or b. Any disclosure of the human subjects' responses outside the research could reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects' financial standing, employability, educational advancement, or

reputation.

Category 3. Research involving benign behavioral interventions.

c. Research involving benign behavioral interventions with information collection from an adult subject through verbal or written

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responses, including data entry or audiovisual recording, if the subject prospectively agrees and at least one of the following: i. The information is recorded so the identity cannot be readily ascertained, directly or through identifiers;

II. Any disclosure of the human subjects' responses outside the research

would not reasonably place the subjects at risk of criminal or civil liability or be damaging to the subjects' financial standing, employability, educational advancement, or reputation; or III. The information obtained is recorded by the investigator in such a manner that the identity of the human subjects can readily be ascertained, directly or through identifiers linked to the subjects, and the HRRC conducts a limited review to make the determination required

by 22VAC30-40-70 J 7. b. Benign behavioral interventions are brief, harmless, painless, non-invasive, unlikely to have lasting adverse effects, and not offensive or embarrassing. Examples include online games, puzzles under noise, or deciding how to allocate a nominal cash amount.

else. c. If the research involves deception, this exemption does not apply unless the subject authorizes deception via prospective agreement, being informed they will be unaware or misled about the research's nature or purposes.

Category 4. Secondary research for which consent is not required: Secondary research using

identifiable private information, if at least one of the following criteria is met:

d. The research involves studying existing data, documents, records, or specimens if publicly available; b. The information is recorded so subjects cannot be identified, the investigator does not contact or re-identify them; c. The research involves only information collection and analysis involving the

investigator's use of identifiable health information when that use is regulated under 45 CFR Part 160, General Administrative Requirements, and Part 164, Security and Privacy, Subparts A and E, for the purposes of "health care operations'' or "research'' as those terms are defined at 45 CFR 164.501 or for "public health activities and purposes'' as described under 45 CFR 164.512(b); or

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d. The research is conducted by or for the department using department-generated or collected info for nonresearch activities if it produces identifiable private info maintained on IT systems compliant with § 208, E-Government Act, and Privacy Act, as applicable.

the information used in the research was collected subject to the Paperwork Reduction Act of 1995, 44 USC § 3501 et seq.

Category 5. Research and demonstration projects conducted or approved by the commissioner, designed to study, evaluate, or examine:

e. Public benefit or service programs;

b. Procedures for benefits or services; d. Changes or alternatives to programs or procedures; or e. Changes in payment methods or levels for benefits or services.

Category 6. Taste, food quality, and consumer acceptance studies:

f. If wholesome foods without additives are consumed; or

b. If a food contains an ingredient or contaminant at or below levels deemed safe by FDA, EPA, or USDA.

Category 7. Storage or maintenance for secondary research requiring broad consent of identifiable private information.

research use if the HRRC conducts a limited review and makes the determinations required by 22VAC30-40-70 J 8.

Category 8. Secondary research requiring broad consent: Research using identifiable private information if it meets the following criteria:

c. Broad consent for storage, maintenance, and secondary use of identifiable private info is obtained per 22VAC30-40-100 A and D;

b. Informed consent or waiver is obtained per 22VAC30-40-100 L; c. HRRC conducts a limited review and determines the research fits the broad consent scope per 22VAC30-40-70 J 7.

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d. The investigator does not include returning individual results in the study plan but must comply with legal requirements to do so.

For more on exempt review, see IV. Types of Reviews, A. Exempt Reviews.

D. Does the Project Qualify for Expedited or Limited Review?

Expedited or limited review may apply for research with minimal risk or minor changes in approved research.

The HRRC may use expedited or limited procedures for research categories listed in 63 FR 60364-60367 where applicable:

1. Research on the list found by reviewers to involve no more than minimal risk.
2. Minor changes in approved research within one year of approval; or
3. Research for which limited review is a condition of exemption under 22VAC30-40-80 2 c, 22VAC30-40-80 3a (1), and 22VAC30-40-80 7 and 8.

For more information on expedited review, please see IV. Types of Reviews, B. Expedited and

Limited Reviews.

E. Minimal Risk

“Minimal risk” means harm or discomfort not greater than daily life or routine exams (45 CFR 46.102(i)).

Examples of minimal risk are:

1. Study poses no more risk than routine daily activities (e.g., blood draw, exam, psychological testing);
2. Non-interventional studies (e.g., observational behavior or nutrition);
3. Survey/Questionnaire studies of a non-sensitive nature;
4. Electrophysiological studies in healthy subjects or clinical populations (surface

recordings such as EEG, ERP, MEG);

1. Genomic studies;
2. Non-invasive imaging (e.g., MRI, fMRI) in healthy or clinical subjects to study brain mechanisms;

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1. Research involving materials (data, documents, records, medical records, biological specimens) collected solely for research;
2. Survey/interview research where disclosure poses no risk or harm to subjects or reputation.

Examples of greater than minimal risk are:

1. Studies identifying subjects/responses that could risk liability, damage finances, employment, insurability, reputation, or stigmatization unless protections ensure risks are minimal.
2. Studies involving deception; and

1. Manipulation of subjects’ emotions.

Minimal risk research fitting exempt, expedited, or limited categories may be reviewed by a designated HRRC Chair, Co-Chair, or reviewer instead of the full HRRC.

F. Additional Protections and Special Considerations

The HRRC considers children, prisoners, individuals with impaired decision-making, or disadvantaged persons as vulnerable and requires additional protections.

The HRRC ensures vulnerable populations are justified and safeguarded; considers approval of such research projects.

vulnerable populations if one of the following conditions is met:

1. Research involves no more than minimal risk to subjects;
2. Research likely to benefit subjects directly, even if risks exceed minimal;
3. the research involves greater than minimal risk with no prospect of direct benefit to individual subjects but is likely to yield generalizable knowledge about the subject's disorder or condition.

G. Informed Consent

The HRRC shall require or may waive informed consent documentation per this section.

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Depending on the type of review and the research project, the HRRC may require additional elements of informed consent, waive or alter elements of the informed consent, or allow for broad consent when in the HRRC's judgment, the information would meaningfully add to the protection of the rights and welfare of subjects. For those projects requesting to waive informed consent, principal investigators should complete the Waiver of Informed Consent Request (Form H).

Informed consent requirements follow 45 CFR 46.116 and

22VAC30-40-100.

In seeking informed consent, the following basic elements shall be provided to each prospective human subject or prospective human subject's legally authorized representative:

1. Statement that the project involves research and its purposes;

research and the expected duration of the human subject's participation, a description of the procedures to be followed, and identification of any procedures that are experimental;

1. Description of foreseeable risks or discomforts to the human subject;
2. Description of benefits to the human subject or others reasonably expected from the research;
3. Disclosure of appropriate alternative procedures or treatments, if any, advantageous to the human subject;

1. Statement describing extent to which confidentiality of records identifying the human subject will be maintained;
2. For research with more than minimal risk, explain if compensation or medical treatments are available for injury, or where to get more info;
3. Explain who to contact for questions about the research, rights, or research-related issues;

injury to the subject;

1. Statement that participation is voluntary, refusal involves no penalty or loss of benefits, and subjects may discontinue at any time without penalty;
2. Statement about research collecting identifiable private information: a. Identifiers may be removed from identifiable private data;

information and that, after such removal, the information could be used for future research studies or distributed to another investigator for future research studies without additional informed consent from the human subject or the human subject's legally authorized representative, if this may be a possibility; or

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b. A statement that the human subject's information collected as part of the research, even if identifiers are removed, shall not be used or distributed for future research studies.

No one shall be forced to participate, and representatives may only consent to nontherapeutic research if HRRC approves that it presents no more than minor risk.

research poses no more than minor risk.

Nontherapeutic research requires subject consent.

HRRC or third party may observe consent and research anytime.

H. Researcher Conflicts of Interest

HRRC ensures conflicts don't harm participant rights, welfare, or review fairness.

In each research review, HRRC notes potential conflicts of interest that could affect participant rights or welfare and may require safeguards.

For research with entities where the PI has a disclosed financial conflict, the PI must submit a conflict management plan to HRRC.

The PI must complete and submit the Conflict of Interest Disclosure Statement (Form D) for each project.

I. Recruitment Materials

Recruitment requires HRRC oversight.

Recruitment materials must be reviewed and approved by HRRC and should include the project number and approval date.

Materials must include all formatting and images; HRRC evaluates content and presentation to ensure appropriateness and no undue promotion of compensation or benefits.

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IV. Types of Reviews

Four review types exist:

• Exempt,
• Expedited or Limited,

• Full HRRC, and
• Cooperative Research.

The DARS Commissioner may restrict, suspend, terminate, or deny HRRC's use of exempt, expedited, or limited reviews.

A. Exempt Review

Some research projects may qualify for exempt review procedures.

Research must involve minimal risk and meet categories in 45 CFR § 46.104(d) and 22VAC30-40-80.

The Chair or Co-Chair/Administrator reviews the project and may assign additional reviewers as needed to determine if the

research meets one or more eligible categories.

The Co-Chair/Administrator will notify the PI of review outcomes in writing within 15 business days, with decisions documented in Review Criteria Checklist (Form I).

See the Exempt Review Application Checklist (Form J) for required documents.

B. Expedited and Limited Reviews

1. Expedited Review:

Some research protocols may qualify for expedited review

Per 45 CFR § 46.110 and 22VAC30-40-90, research must involve minimal risk and meet categories for expedited review in the Federal Register.

The Co-Chair/Administrator reviews the submission and assigns HRRC reviewers, consulting with the Chair as needed.

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needed. HRRC members are assigned to review research protocols based on the nature of the research and the expertise of the HRRC member.

The Co-Chair/Administrator may serve as sole reviewer if sufficiently expert, e.g., record review or minimal/no risk studies.

Assigned HRRC members review applications and supporting materials to determine whether the

1. Meets the definition of minimal risk,
2. Meets criteria of one or more eligible categories, and
3. Fulfills the regulatory criteria for approval.

HRRC members reviewing a study may:

1. Ask questions about the research,
2. Require modifications to protocol and study materials,
3. Recommend approval,
4. Request additional HRRC members review protocol, or
5. Request full board review of the study.

2. Limited Review:

Limited review applies only to specific exemptions and does not require full HRRC criteria; it verifies conditions in 45 CFR Part 46.

Limited review may be via Expedited Review by the Chair or designated HRRC member, or conducted by the

full HRRC.

Limited review ensures privacy and confidentiality for exempt research involving sensitive, identifiable data, with broad consent documented per protocol. Four exemptions may require limited review:

1. Research involving only educational tests, surveys, or interviews;

Procedures or public behavior observation require limited review if the third exemption provision is used—when data recorded allows subject identity to be readily ascertained, and the review ensures that

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determine that adequate provisions are in place to protect subjects' privacy and maintain data confidentiality.

1. Research involving benign behavioral interventions with specified data collection if criteria in one of three provisions are met;

Limited review is required only if the third exemption provision is used— the information recorded by the investigator identifies the subject directly or via identifiers. For this

For this exemption, the limited review ensures provisions protect subjects' privacy and data confidentiality.

1. Storage and maintenance of identifiable private info for secondary research with broad consent; requires limited review to verify consent, documentation, waiver, and protections;

privacy of subjects and data confidentiality if changes are made to how identifiable private information is stored or maintained.

1. Secondary research with identifiable private info requiring broad consent; HRRC must verify protections, confidentiality, and scope within broad consent;

3. Expedited and Limited Review Requests:

For a complete listing of the required documents for expedited or limited HRRC review, see the Expedited or Limited Application Checklist (Form M).

The Co-Chair/Administrator will notify the Principal Investigator of review outcome (approval or revisions) in writing within 20 business days

after a complete submission.

The determination is documented in Review Criteria Checklist (Form I). The Co-Chair/Administrator may review revisions if instructed by the HRRC reviewer(s).

Reviewers cannot disapprove via expedited procedures; disapproval requires a majority vote at a convened HRRC meeting. If disapproval is recommended, the

study must be referred to the full HRRC for review.

If multiple expedited reviewers conflict, the Co-Chair/Administrator seeks consensus. If unresolved, the Chair reviews the project and may decide or refer to the full HRRC.

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When using expedited review, the HRRC Chair or Co-Chair/Administrator will inform members at the next Full Committee meeting of projects approved since the last meeting.

C. Full HRRC Review

The HRRC Co-Chair/Administrator completes an initial review and may either:

• Request clarifications or additional documents, or
• Place the study on the next available meeting agenda.

The HRRC Co-Chair/Administrator assigns primary reviewers based on research nature and expertise. Primary reviewers

are encouraged to contact the Principal Investigator for questions or clarification before the full committee meeting.

Each HRRC member receives the project and supporting documents before the meeting.

Investigators are invited to attend their research review meeting.

If present, a researcher will describe the project, and the HRRC will ask

any questions or request clarifications about the study.

After discussion, HRRC members vote, and votes are recorded in minutes. The decision is documented in Review Criteria Checklist (Form I).

All HRRC decisions on approval, disapproval, or revisions will be made by the

HRRC will decide within 30 business days and notify the Principal Investigator in writing within 7 days. Disapproval notices will include reasons and allow response.

For full HRRC review, see the Full Review Application Checklist (Form P).

D. Cooperative Research (45 CFR § 46.1144)

Cooperative research involves a covered entity and other institutions, each responsible for safeguarding human subjects' rights and welfare. With director approval, the

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entity or entities, a covered entity participating in a cooperative research project may enter into a joint review arrangement, rely upon the review of another qualified IRB (‘IRB of Record’), or make similar arrangements for avoiding duplication of effort.

For projects under DARS HRRC, only the DARS Commissioner can approve deferring to an external IRB as the ‘IRB of Record’.

When HRRC relies on an external IRB as the ‘IRB of Record,’ the HRRC Chair or Co-Chair/Administrator will evaluate if it meets criteria for human research protection and, if so, execute written responsibility agreements.

There must be a formal written authorization agreement between the HRRC and the external

The agreement must specify roles and responsibilities, including a commitment that the external IRB will follow its FWA requirements.

The HRRC has a standard form or parties may develop their own; the agreement must be filed with the HRRC and external IRB and made available to OHRP or relevant US agencies upon request.

To initiate, the Principal Investigator must submit the information in the

Checklist and Instructions for Cooperative Research Projects (Form R).

The DARS Commissioner will decide on cooperative research requests within 15 business days. If approved for ‘Defer,’ the Co-Chair/Administrator will work with the external IRB to execute an “IRB Authorization Agreement” (Form S).

After external IRB approval, the Principal Investigator must submit a copy to the DARS HRRC.

If joint review fails, the covered entity may submit the application to the HRRC, which will conduct an initial review for completeness and request additional info as needed.

protocol as outlined under A. Exempt Review, B. Expedited and Limited Reviews, or C. Full HRRC Review.

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V. HRRC Approval Timelines

For federally funded projects, the Principal Investigator must send a copy of the approval letter to the Grants and Contracts Office and/or funding agency, as needed.

The following approval timelines shall apply:

1. Exempt Review: Projects receive a three-year approval, beginning the date HRRC Co-Chair/Administrator issues the approval letter.
2. Expedited or Limited Review: Projects receive a one-year approval starting when HRRC Co-Chair/Administrator determines conditions are met and issues the approval letter.
3. Full Committee Review: The approval begins on the date of the convened HRRC meeting where the study was approved or approved with conditions. The default

The approval period is one year, but HRRC may set a shorter review period.

VI. Modifications to Research Projects

The Principal Investigator must conduct research per the methods in the HRRC-approved application.

When a new Principal Investigator is appointed or there are protocol or subject population changes (e.g., consent, sensitive items, treatment), a modification must be filed.

No changes to approved research may start without HRRC review and approval, except to eliminate immediate hazards.

Changes to approved research must be submitted via Modification Request (Form T) and approved by HRRC.

HRRC reviews modifications based on risk level, either at full meetings or via expedited procedures.

1. Exempt reviews: Modifications are reviewed by HRRC Co-Chair/Administrator unless changes disqualify the study from exempt status, then they receive expedited or full HRRC review based on risk.
2. Expedited reviews: Modifications are reviewed expeditiously unless they involve more than minimal risk, requiring full HRRC review. Expedited

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Reviews may be conducted by the HRRC Co-Chair/Administrator alone or with additional reviewers.

1. Full HRRC reviews: Minor modifications may be expedited by HRRC Co-Chair/Administrator and reviewers; significant ones require full HRRC review. The Co-Chair/Administrator, reviewers, or Chair decide if changes are minor or significant; if no consensus, sent to full HRRC.

VII. Continuing Reviews, Status Updates and Project Closures

HRRC shall conduct ongoing reviews at risk-appropriate intervals, at least annually, and may observe consent and research processes.

Based on risk, HRRC may conduct full, expedited, or no continuing review.

Exempt research requires no further review after initial approval.

Principal Investigators must submit the Research Project Status Report (Form U) every three years; exempt projects require no further action.

Notify HRRC Co-Chair/Administrator by email within 30 days of closure; no Closure Report (Form X) needed.

Expedited research requires no further review after initial approval.

Principal Investigators must submit annual status updates (Form U) and a Closure Report (Form X) within 30 days after project closure.

For cooperative research using external IRB as ‘IRB of Record,’ Principal Investigators must email HRRC Co-Chair/Administrator within 30 days of project closure. No Research Project Closure Report (Form X) is needed.

Projects needing continuing review must submit the Continuing Review and Adverse Event Report (Form Y) to the HHRC Co-Chair/Administrator. These reports are required at least annually for all approved projects to ensure

conformity with the approved proposal. HRRC will determine report frequency based on project risk. Principal Investigators must complete a Research Project Closure Report (Form X) within 30 days after project closure.

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Principal Investigators must submit the Continuing Review and Adverse Event Report (Form Y) if unanticipated problems, safety issues, or serious, unexpected adverse effects related or possibly related to the project occur.

Principal Investigators should submit the Research Inquiries, Comments, or Concerns Report (Form V), when appropriate, to HRRC.

any inquiries, comments, or concerns from research subjects, community, or others.

If the Principal Investigator fails to submit a Research Project Status Report (Form U) or Continuing Review and Adverse Event Report (Form Y) by the deadline, HRRC will close the project.

For more info, see sections 45 CFR § 46.104(d)(2)(iii), 46.104(d)(3)(i)(C), 46.104(d)(7), and 46.104(d)(8)(iii) of the revised Common Rule.

VIII. Research Project Non-Compliance

Principal Investigators must not begin any human subjects research (e.g., recruitment, screening) until receiving written HRRC approval.

Principal Investigators are responsible for complying with laws and institutional rules (e.g., HIPAA, FERPA, biosafety) and must provide review documentation to HRRC upon request.

Principal investigators shall report non-compliance with the approved research proposal to the

HRRC.

If HRRC finds non-compliance with the approved proposal or

violates law or regulation, HRRC or DARS may restrict or terminate research, prohibit presentation or publication, or bar the Principal Investigator from future studies before HRRC.

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Appendix A: All HRRC Forms (Required and Optional)

Form Name Alphabetical Identifier Conflict of Interest HRRC Member Statement: This form is used by A HRRC members and Ad-Hoc Reviewers prior to conducting any HRRC

reviews or participating in an HRRC meeting.

HRRC Confidentiality Agreement: Used by HRRC B members, ad-Hoc reviewers, and guests before HRRC reviews or meetings.

Guest Attendance Certification: Used to document each guest attending full HRRC meetings and their

understanding of the guest responsibilities.

Conflict of Interest Disclosure Statement: Used by Principal Investigator D to disclose or deny financial interests for PI, Co-Investigators, and Coordinators.

Listing of Co-Investigators: Used to identify Co-Investigators on the research project.

HRRC Pre-Review Checklist: Used by HRRC Chair or Co-Chair/Administrator F to document pre-review completion.

Quality Improvement Determination Worksheet: Helps G researchers and HRRC determine if a project is QI/QA or Human Subjects Research. Not required.

Waiver of Informed Consent Request: Used to request H

waivers of the informed consent requirements.

Review Criteria Checklist: Used by HRRC Chair or Co-Chair/Administrator I to document review and compliance with HRRC requirements.

Exempt Review Application Checklist: Used to ensure all required materials for Exempt Review are compiled and submitted.

Use this form to request an Exempt K Review; it identifies the qualifying category.

Use this form to submit an Initial L Application for Exempt Review and clearance of human subject research.

Use this form to ensure all required materials are compiled and submitted for Expedited or Limited Review.

for an Expedited or Limited Review.

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[TABLE 32-1] | Form Name | | | Alphabetical Identifier | Conflict of Interest HRRC Member Statement: This form is used by HRRC members and Ad-Hoc Reviewers prior to conducting any HRRC reviews or participating in an HRRC meeting. | | | A | | HRRC Confidentiality Agreement: This form is used by HRRC members and ad-Hoc reviewers prior to conducting any HRRC reviews or participating in an HRRC meeting and for any guests who are present during an HRRC meeting. | | | B | | Guest Attendance Certification: Use this form to document each guest who attends at full HRRC meeting as well as their understanding of the guest responsibilities. | | | C | | Conflict of Interest Disclosure Statement: The Principal Investigator uses this form to disclose or deny any financial interest(s) in the research project on behalf of the Principal Investigator, Co-Investigator(s), and Project Coordinator(s), as appropriate. | | | D | | Listing of Co-Investigators: Use this form to identify any Co-Investigators on the research project. | | | E | | HRRC Pre-Review Checklist: HRRC Chair or Co-Chair/Administrator use this form to document a completed pre-review of an application. | | | F | | Quality Improvement Determination Worksheet: This form helps researchers and the HRRC determine if a project is Quality Improvement (QI)/Quality Assurance (QA) or Human Subjects Research. This is not a required form. | | | G | | Waiver of Informed Consent Request: Use this form to request waivers of the informed consent requirements. | | | H | | Review Criteria Checklist: HRRC Chair or Co-Chair/Administrator use this form to document a completed review of an application and that it satisfies the requirements of the HRRC. | | | I | | Exempt Review Application Checklist: Use this form to ensure you have compiled and submitted all the required materials for an Exempt Review. | | | J | | Request for Exempt Review: Use this form to request an Exempt Review. The form identifies the exempt review qualifying category. | | | K | | Exempt Review Application: Use this form to submit an Initial Application for Exempt Review view and clearance of human subject research. | | | L | | Expedited or Limited Review Application Checklist: Use this form to ensure you have compiled and submitted all the required materials for an Expedited or Limited Review. | | | M | |

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Use this form to request N Expedited or Limited Review; it identifies the qualifying category.

Use this form to submit an O Initial Application for Expedited or Limited Review and clearance of human research.

Use this form to ensure all required materials are compiled and submitted for Full HRRC Review.

Use this form to submit an initial Q Application for Full HRRC review and clearance of human research.

Checklist and Instructions for Cooperative Research Projects: This R

form is used by an applicant to pursue cooperative research and use an external IRB as the IRB of Record for a research project. This form is a template; a principal investigator may submit a written and signed letter if it has the required elements.

Use this form to establish an agreement with an external IRB as ‘IRB of Record’; other forms may be used if they contain required elements.

Use this form to request modifications to a previously approved research protocol.

Use this form to update on previously approved, exempt, expedited, or limited review research projects.

Research Inquiries, Comments or Concerns Report: Use this form to V report inquiries, comments and/or concerns from human research

subjects, the community, and others.

Use this form to notify HRRC when your research project is completed.

Continuing Review and Adverse Event Report: Use this form to Y provide information for the HRRC, or designated reviewer, for regular updates of a previously approved project subject to the HRRC’s continuing review requirement, or to report unanticipated

problem(s), safety issue(s), or other serious, unexpected adverse effect(s) or event(s) that are related or possibly related to your project.

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[TABLE 33-1] | Forms for review requests, applications, checklists, agreements, modifications, updates, inquiries, closure, and adverse events, with categories and templates as specified.

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BEHAVIORAL HEALTH SERVICES 10/2013

Individuals approved as vendors of licensed behavioral health services for DARS customers must submit an application for approval to Patricia Goodall, Ed.S., DARS Central Office (application materials are in the DARS Forms Cabinet under “Publications” on the left side of DARS’ home page at www.vadars.org and then under “Forms & Files”). If an applicant meets state and agency requirements, the vendorship request will be approved. Vendors are asked periodically to submit specific information or updated applications to DARS for monitoring purposes.

Eligible providers of Behavioral Health Services for DARS include the

following licensed professionals: Clinical Psychologists, Psychiatrists and other Physicians; and Allied Behavioral Health Clinicians (i.e., licensed school psychologists, licensed professional counselors, licensed clinical social workers, licensed physicians assistants, and licensed nurse practitioners). Therapeutic Behavior Services are provided by licensed Board Certified Behavior Analysts, Board Certified Assistant Behavior Analysts, and endorsed Positive Behavior Support Facilitators.

• Prior to authorization of services, agency staff should assure an individual’s Virginia licensure is current and that s/he is in good standing with the respective regulatory board(s) of the Department of Health Professionals (DHP). Information on current licensure, probationary status, etc. is on the DHP website at http://www.dhp.virginia.gov under “License Lookup” on left. To check on the endorsement status of a Positive Behavior Support Facilitator (PBSF), contact Patti Goodall at 800/552-5019 or Patti.Goodall@dars.virginia.gov.

A vendor providing licensed behavioral health services for DARS customers

must adhere to the agency’s standards for such providers (as described in the vendorship application materials) and must agree to accept the agency’s established fees for services. Fees are based on CPT codes with a unit cost: in most cases, a unit is equal to one hour of direct service to an individual.

The fees listed indicate the maximum allowable reimbursement, with any exceptions noted; actual reimbursement amounts depend on the number of units of service authorized and provided.

 Note that “Northern Virginia rates” have been established and should be used when services are provided in the City of Alexandria and the counties of Arlington and Fairfax only. When authorizing services to these vendors,

use the five-digit CPT code followed by an “N” (e.g., CPT 90791N, Diagnostic Evaluation), as included in this section.

Fees will be paid to vendors as indicated below upon receipt of an invoice.

Invoices should generally be submitted monthly, accompanied by an evaluation / assessment report, treatment plan, and/or brief therapy progress notes (outlining individual’s attendance, goals, and progress).

NOTE: “Add-on codes” are always performed in addition to the primary service or procedure and are never reported as a “stand alone code.”

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CPT CODES, PROCEDURES, UNITS, AND FEES

CPT Code 90791, Diagnostic Evaluation (formerly 90801, Diagnostic Interview) AWARE Service Category: Medical/ Mental Health Treatment AWARE Procedure Category: Specialist Examinations

Description: Diagnostic Evaluation is an integrated biopsychosocial assessment, including history, mental status, and recommendations. The evaluation may include communication with family or other sources and review and ordering of diagnostic studies. Used for diagnostic assessment(s) or reassessment(s), if required, and do not include psychotherapeutic services. Typically, the Diagnostic Evaluation report should include diagnosis, limitations, and prognosis; the report may also include recommendations for further assessment and/or treatment or rehabilitation needs.

If complicating factors exist (e.g., an interpreter is needed), the diagnostic evaluation may include interactive complexity services; in that situation, use the “add-on” code 90785, Interactive complexity (see below) in conjunction with 90791. Psychotherapy services, including for crisis, may not be reported on the same day as a Diagnostic Evaluation.

Fees: 90791 Clinical Psychologists and Psychiatrists $149 per unit (90791N, $166);

Allied Behavioral Health Clinicians $124 per unit (90791N, $138).

A follow-up session may be authorized for review of findings with the rehabilitation counselor, consumer, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

CPT Code 90785 Diagnostic Evaluation, interactive complexity (formerly 90802, Diagnostic Interview, interactive complexity) AWARE Service Category: Medical/ Mental Health Treatment AWARE Procedure Category: Specialist Examinations  ADD-ON CODE! (This is designated an “add-on code”- it should only be used in conjunction with CPT 90791 – it is never used as a “stand alone code.”)

Description: Diagnostic Evaluation with Interactive Complexity refers to specific communication factors that complicate the delivery of the Diagnostic Evaluation.

Common factors include more difficult communication with young and verbally undeveloped or impaired individuals. These are often individuals who have third parties involved such as parents / guardians / other family members, interpreters, language translators, agencies, court officers, or schools. The clinician may use play equipment, physical devices, language / speech interpreter, or other mechanisms of communication. This code may be used when providing services for a person who is deaf, hard of hearing, deafblind, or requires a language interpreter.

Fees: 90785 One Unit of Service: Clinical Psychologists and Psychiatrists $5; Other Allied Behavioral Health Clinicians $5.

CPT code 96101 Psychological Testing, per hour of the clinician’s time CPT code 96102 Psychological Testing, per hour of the technician’s time

[TABLE 2-1] CPT Code 90791, Diagnostic Evaluation (formerly 90801, Diagnostic Interview) AWARE Service Category: Medical/ Mental Health Treatment AWARE Procedure Category: Specialist Examinations Description: Diagnostic Evaluation is an integrated biopsychosocial assessment, including history, mental status, and recommendations. The evaluation may include communication with family or other sources and review and ordering of diagnostic studies. Used for diagnostic assessment(s) or reassessment(s), if required, and do not include psychotherapeutic services. Typically, the Diagnostic Evaluation report should include diagnosis, limitations, and prognosis; the report may also include recommendations for further assessment and/or treatment or rehabilitation needs.

If complicating factors exist (e.g., an interpreter is needed), the diagnostic evaluation may include interactive complexity services; in that situation, use the “add-on” code 90785, Interactive complexity (see below) in conjunction with 90791. Psychotherapy services, including for crisis, may not be reported on the same day as a Diagnostic Evaluation.

Fees: 90791 Clinical Psychologists and Psychiatrists $149 per unit (90791N, $166);

Allied Behavioral Health Clinicians $124 per unit (90791N, $138).

A follow-up session may be authorized for review of findings with the rehabilitation counselor, consumer, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

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[TABLE 2-2] CPT Code 90785 Diagnostic Evaluation, interactive complexity (formerly 90802, Diagnostic Interview, interactive complexity) AWARE Service Category: Medical/ Mental Health Treatment AWARE Procedure Category: Specialist Examinations  ADD-ON CODE! (This is designated an “add-on code”- it should only be used in conjunction with CPT 90791 – it is never used as a “stand alone code.”) Description: Diagnostic Evaluation with Interactive Complexity refers to specific communication factors that complicate the delivery of the Diagnostic Evaluation.

Common factors include more difficult communication with young and verbally undeveloped or impaired individuals. These are often individuals who have third parties involved such as parents / guardians / other family members, interpreters, language translators, agencies, court officers, or schools. The clinician may use play equipment, physical devices, language / speech interpreter, or other mechanisms of communication. This code may be used when providing services for a person who is deaf, hard of hearing, deafblind, or requires a language interpreter.

Fees: 90785 One Unit of Service: Clinical Psychologists and Psychiatrists $5; Other Allied Behavioral Health Clinicians $5.

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Description: Psychological Testing involves psychodiagnostic assessment of emotionality, intellectual abilities, personality, and psychopathology.

Psychological testing may be administered face-to-face by a technician as long as a qualified health care professional interprets the test results and prepares the written report. The licensed health care professional must conduct a face-to-face clinical interview and determine the appropriate test(s) to be used in an evaluation. The total number of units of testing typically does not exceed five (5); additional units must be approved by a supervisor.

Fees: 96101 Psychological Testing: Clinical Psychologists $82 per unit (96101N, $89);

Allied Behavioral Health Clinicians $62 per unit (96101N, $67) 96102 Psychological Testing: Technician $85 per unit (96102N, $101)

A follow-up session may be authorized for review of findings with the rehabilitation counselor, consumer, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

CPT code 96116: Neurobehavioral Status Exam

Description: Neurobehavioral Status Exam is the clinical screening / assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem-solving, and visual spatial abilities. The per unit rate includes the psychologist’s time, both face-to-face time with the consumer and time interpreting test results and preparing the report. This service is used for screening of neurocognitive deficits or when comprehensive testing is not indicated. The Neurobehavioral Status Exam is appropriate for the assessment of individuals who have had a recent comprehensive evaluation, a history of mild brain injury, and/or reports of subjective cognitive complaints.

The report should include diagnosis, limitations, prognosis, and treatment/rehabilitation needs.

Includes a Diagnostic Evaluation (90791) with one unit of Neuropsychological Status Exam (96116).

Fees: 96116 Neurobehavioral Status Exam: Licensed Clinical Psychologists: $88 per unit

(96116N, $97).

A follow-up session may be authorized for review of findings with rehabilitation counselor, consumer, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

CPT Code 96118: Neuropsychological Testing: Licensed Clinician (formerly Neuropsychological Assessment Battery: Licensed Clinician) CPT Code 96119: Neuropsychological Testing: Technician (formerly Neuropsychological Assessment Battery: Technician)

Description: Neuropsychological Testing is used with individuals who have a history of acquired brain injury, disorder, or disease and there is no recent evaluation on record. This service involves a comprehensive assessment of attention, sensory perception, language, memory, intelligence, and deductive reasoning. This code should not be used for suspected learning disability or attention deficit issues. Neuropsychological Testing is used to determine diagnosis, limitations, prognosis, and treatment/rehabilitation needs.

[TABLE 3-1] CPT code 96116: Neurobehavioral Status Exam Description: Neurobehavioral Status Exam is the clinical screening / assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem-solving, and visual spatial abilities. The per unit rate includes the psychologist’s time, both face-to-face time with the consumer and time interpreting test results and preparing the report. This service is used for screening of neurocognitive deficits or when comprehensive testing is not indicated. The Neurobehavioral Status Exam is appropriate for the assessment of individuals who have had a recent comprehensive evaluation, a history of mild brain injury, and/or reports of subjective cognitive complaints.

The report should include diagnosis, limitations, prognosis, and treatment/rehabilitation needs.

Includes a Diagnostic Evaluation (90791) with one unit of Neuropsychological Status Exam (96116).

Fees: 96116 Neurobehavioral Status Exam: Licensed Clinical Psychologists: $88 per unit

(96116N, $97).

A follow-up session may be authorized for review of findings with rehabilitation counselor, consumer, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

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Neuropsychological testing may be administered face-to-face by a technician as long as a qualified health care professional interprets the test results and prepares the written report. The licensed health care professional must conduct a face-to-face clinical interview and determine the appropriate test to be used in the evaluation.

Includes a Diagnostic Evaluation (90791) with up to seven (7) units of Neuropsychological Testing (96118, 96119).

A follow-up session may be authorized for review of findings with the rehabilitation counselor, consumers, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

Fees: 96118 Licensed Clinical Psychologists $91 per unit (96118N, $100); 96119 Technicians $73 per unit (96119N, $86).

CPT Code 90832: Individual Psychotherapy / Clinical Counseling, 30 minutes (formerly 90804, Individual Psychotherapy / Clinical Counseling) CPT Code 90834: Individual Psychotherapy / Clinical Counseling, 45 minutes (formerly 90806, Individual Psychotherapy / Clinical Counseling) CPT Code 90837: Individual Psychotherapy / Clinical Counseling, 60 minutes (formerly 90808, Individual Psychotherapy / Clinical Counseling) AWARE Service Category: Medical/ Mental Health Treatment AWARE Procedure Category: Psychological Services

Description: Individual Psychotherapy/Clinical Counseling may be authorized for individuals who are experiencing emotional or interpersonal problems that affect employability or independent functioning. Individual Psychotherapy / Clinical Counseling refers to the provision of insight oriented, behavior modifying and supportive psychotherapy/clinical counseling. This service includes ongoing assessment and adjustment of psychotherapeutic interventions, and may include involvement of family members or other support persons, but does not include group psychotherapy or support groups.

May authorize up to twenty-seven (27) units of services. Clinician must submit a treatment plan to the DARS rehabilitation counselor following the first ten (10) sessions before an additional seventeen (17) sessions may be authorized.

Authorization for more than twenty-seven (27) sessions must be approved by the supervisor. Consultation is available from the agency’s Director of Psychology Services or designee.

A Diagnostic Evaluation (90791) should be completed by the clinician prior to starting therapy. This procedure code may also be used to conduct a follow-up session for review of diagnostic and assessment results with the rehabilitation counselor, consumer, and other significant parties.

Fees: 90832, 30 minutes Licensed Clinical Psychologists $62 (90832N, $69); Allied Behavioral Health Clinicians: $49 (90832N, $55). 90834, 45 minutes Licensed Clinical Psychologists $80 (90834N, $87); Allied Behavioral Health Clinicians: $63 (90834N, $69). 90837, 60 minutes Licensed Clinical Psychologists $117 (90837N, $127); Allied Behavioral Health Clinicians: $92 (90837N, $100).

CPT 90833, Individual Psychotherapy / Clinical Counseling (with medical evaluation and management service), 30 minutes

[TABLE 4-1] CPT Code 90832: Individual Psychotherapy / Clinical Counseling, 30 minutes (formerly 90804, Individual Psychotherapy / Clinical Counseling) CPT Code 90834: Individual Psychotherapy / Clinical Counseling, 45 minutes (formerly 90806, Individual Psychotherapy / Clinical Counseling) CPT Code 90837: Individual Psychotherapy / Clinical Counseling, 60 minutes (formerly 90808, Individual Psychotherapy / Clinical Counseling) AWARE Service Category: Medical/ Mental Health Treatment AWARE Procedure Category: Psychological Services Description: Individual Psychotherapy/Clinical Counseling may be authorized for individuals who are experiencing emotional or interpersonal problems that affect employability or independent functioning. Individual Psychotherapy / Clinical Counseling refers to the provision of insight oriented, behavior modifying and supportive psychotherapy/clinical counseling. This service includes ongoing assessment and adjustment of psychotherapeutic interventions, and may include involvement of family members or other support persons, but does not include group psychotherapy or support groups.

May authorize up to twenty-seven (27) units of services. Clinician must submit a treatment plan to the DARS rehabilitation counselor following the first ten (10) sessions before an additional seventeen (17) sessions may be authorized.

Authorization for more than twenty-seven (27) sessions must be approved by the supervisor. Consultation is available from the agency’s Director of Psychology Services or designee.

A Diagnostic Evaluation (90791) should be completed by the clinician prior to starting therapy. This procedure code may also be used to conduct a follow-up session for review of diagnostic and assessment results with the rehabilitation counselor, consumer, and other significant parties.

Fees: 90832, 30 minutes Licensed Clinical Psychologists $62 (90832N, $69); Allied Behavioral Health Clinicians: $49 (90832N, $55). 90834, 45 minutes Licensed Clinical Psychologists $80 (90834N, $87); Allied Behavioral Health Clinicians: $63 (90834N, $69). 90837, 60 minutes Licensed Clinical Psychologists $117 (90837N, $127); Allied Behavioral Health Clinicians: $92 (90837N, $100).

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CPT 90836, Individual Psychotherapy / Clinical Counseling (with medical evaluation and management service), 45 minutes CPT 90838, Individual Psychotherapy / Clinical Counseling (with medical evaluation and management service), 60 minutes AWARE Service Category: Medical/ Mental Health Treatment AWARE Procedure Category: Psychological Services  ADD-ON CODE! (This is designated as an “add-on code” – it should be used only in conjunction with existing CPT Codes 99201-99204; 99211-99214: Medical Evaluation and Management (see the General and Specialty Medical Services section of the DARS Services Reference Manual).

Description: Some individuals receive psychotherapy only (90832, 90834, 90837, above); others receive psychotherapy and medical evaluation and management (E/M) services (90833, 90836, 90838) on the same day by the same physician or other qualified health care professional. To report both E/M and psychotherapy on the same day, the two services must be significant and separately identifiable. These services are reported by using specific psychotherapy codes (90832, 90834, 90837, above), as well as the specific “add-on codes” for psychotherapy when performed on the same day with medical evaluation and management services (90833, 90836, 90838). [For example, an individual might see a psychiatrist who provides both individual psychotherapy / clinical counseling and a medical evaluation and management service on the same day. In that case, two codes should be reported: 90833 for a 30-minute psychotherapy session ($41) and 99201 for a ten minute evaluation/management session ($43), for a total cost of $84.] Fees: 90833, 30 minutes Psychiatrists / Clinical Psychologists $41 (90833N, $45); Allied Behavioral Health Clinicians $32 (90833N, $36) 90836, 45 minutes Psychiatrists / Clinical Psychologists $67 (90836N, $72); Allied Behavioral Health Clinicians $53 (90833N, $57) 90838, 60 minutes Psychiatrists / Clinical Psychologists $108 (90838N, $117);

Allied Behavioral Health Clinicians $85 (90833N, $92)

CPT code 90853: Group Psychotherapy/Group Clinical Counseling

Description: Group Psychotherapy/Group Clinical Counseling services are provided to individuals experiencing emotional or interpersonal problems that affect employability or independent functioning. Group Psychotherapy/Group Clinical Counseling should not be used if an individual is receiving individual or family therapy, unless approved by the supervisor. Consultation regarding the appropriateness of this service for an individual is available from the agency’s Director of Psychology Services or designee. (Note that this does not include participation in a peer-run support group.)

The treating clinician must submit a treatment plan to the DARS rehabilitation counselor following the first ten (10) sessions before additional sessions will be approved. Authorization for a total of more than twenty-seven (27) sessions must be approved by the supervisor. Consultation is available from the agency’s Director of Psychology Services or designee.

Includes a Diagnostic Evaluation (90791) with up to twenty-seven (27) units of Group Psychotherapy/Group Clinical Counseling (90853).

Fees: 90853 Group Psychotherapy/Group Clinical Counseling: Clinical Psychologists $24 per unit (90853N, $26); Allied Behavioral Health Clinicians $19 per unit (90853N, $21)

[TABLE 5-1] CPT code 90853: Group Psychotherapy/Group Clinical Counseling Description: Group Psychotherapy/Group Clinical Counseling services are provided to individuals experiencing emotional or interpersonal problems that affect employability or independent functioning. Group Psychotherapy/Group Clinical Counseling should not be used if an individual is receiving individual or family therapy, unless approved by the supervisor. Consultation regarding the appropriateness of this service for an individual is available from the agency’s Director of Psychology Services or designee. (Note that this does not include participation in a peer-run support group.) The treating clinician must submit a treatment plan to the DARS rehabilitation counselor following the first ten (10) sessions before additional sessions will be approved. Authorization for a total of more than twenty-seven (27) sessions must be approved by the supervisor. Consultation is available from the agency’s Director of Psychology Services or designee.

Includes a Diagnostic Evaluation (90791) with up to twenty-seven (27) units of Group Psychotherapy/Group Clinical Counseling (90853).

Fees: 90853 Group Psychotherapy/Group Clinical Counseling: Clinical Psychologists $24 per unit (90853N, $26); Allied Behavioral Health Clinicians $19 per unit (90853N, $21)

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CPT Code 90785 Diagnostic Evaluation, interactive complexity (formerly 90802, Diagnostic Interview, interactive complexity) AWARE Service Category: Medical/ Mental Health Treatment AWARE Procedure Category: Specialist Examinations  ADD-ON CODE! (This is designated an “add-on code”- it should only be used in conjunction with CPT 90853 – it is never used as a “stand alone code.”)

Description: Diagnostic Evaluation with Interactive Complexity refers to specific communication factors that complicate the delivery of the Diagnostic Evaluation.

Common factors include more difficult communication with young and verbally undeveloped or impaired individuals. These are often individuals who have third parties involved such as parents / guardians / other family members, interpreters, language translators, agencies, court officers, or schools. The clinician may use play equipment, physical devices, language / speech interpreter, or other mechanisms of communication. This code may be used when providing services for a person who is deaf, hard of hearing, deafblind, or requires a language interpreter.

Fees: 90785 Clinical Psychologists and Psychiatrists $5 per unit; Other Allied Behavioral Health Clinicians $5 per unit.

CPT Code 90885: Evaluation of Records or Reports

Description: Evaluation of Records or Reports involves a review of an individual’s mental health records, psychiatric reports, psychological assessments, and other accumulated data for behavioral and mental health diagnostic and rehabilitation planning purposes. The vendor is expected to provide a brief consultative report as part of this service. Counselors who purchase this service should assure that a vendor is qualified to interpret the specific reports, assessments, and other data contained in a record (i.e., the vendor has the appropriate credentials and training).

Fees: 90885 Licensed Clinical Psychologists, Psychiatrists, and Physicians $29 per unit (90885N, $32); Allied Behavioral Health Clinicians $23 per unit (90885N, $25). (Note that for this code, one unit is equal to 15 minutes.)

HCPCS Code H2019: Therapeutic Behavioral Services.

Description: Therapeutic Behavioral Services refers to behavioral treatment and intervention, specifically Applied Behavior Analysis (ABA) and/or Positive Behavior Support (PBS), provided in community settings for individuals who need comprehensive, specialized supports to address challenging behaviors. ABA and PBS are clinically proven approaches to reducing or eliminating behaviors which interfere with employment and independent living. The overall goal of Therapeutic Behavioral Services is to improve an individual’s quality of life and ability to function successfully in the workplace and other community settings. For additional information and guidance on the appropriate use of this Procedure Code, including Standards of Conduct, please go to the DARS Forms Cabinet and look under Behavioral Health / Psychological Services.

Therapeutic Behavioral Services typically include the following:  Intake Assessment to determine service needs as well as the feasibility of using either Applied Behavior Analysis or Positive Behavior Support.

[TABLE 6-1] CPT Code 90785 Diagnostic Evaluation, interactive complexity (formerly 90802, Diagnostic Interview, interactive complexity) AWARE Service Category: Medical/ Mental Health Treatment AWARE Procedure Category: Specialist Examinations  ADD-ON CODE! (This is designated an “add-on code”- it should only be used in conjunction with CPT 90853 – it is never used as a “stand alone code.”) Description: Diagnostic Evaluation with Interactive Complexity refers to specific communication factors that complicate the delivery of the Diagnostic Evaluation.

Common factors include more difficult communication with young and verbally undeveloped or impaired individuals. These are often individuals who have third parties involved such as parents / guardians / other family members, interpreters, language translators, agencies, court officers, or schools. The clinician may use play equipment, physical devices, language / speech interpreter, or other mechanisms of communication. This code may be used when providing services for a person who is deaf, hard of hearing, deafblind, or requires a language interpreter.

Fees: 90785 Clinical Psychologists and Psychiatrists $5 per unit; Other Allied Behavioral Health Clinicians $5 per unit.

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[TABLE 6-2] HCPCS Code H2019: Therapeutic Behavioral Services.

Description: Therapeutic Behavioral Services refers to behavioral treatment and intervention, specifically Applied Behavior Analysis (ABA) and/or Positive Behavior Support (PBS), provided in community settings for individuals who need comprehensive, specialized supports to address challenging behaviors. ABA and PBS are clinically proven approaches to reducing or eliminating behaviors which interfere with employment and independent living. The overall goal of Therapeutic Behavioral Services is to improve an individual’s quality of life and ability to function successfully in the workplace and other community settings. For additional information and guidance on the appropriate use of this Procedure Code, including Standards of Conduct, please go to the DARS Forms Cabinet and look under Behavioral Health / Psychological Services.

Therapeutic Behavioral Services typically include the following:  Intake Assessment to determine service needs as well as the feasibility of using either Applied Behavior Analysis or Positive Behavior Support.

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 Comprehensive Functional Behavior Assessment to identify target behaviors and assess the need for modifications and adjustments in an individual’s community environments (home, work, recreation, etc.).  Written Behavior Support Plan, with ongoing evaluation and revisions.  Development and facilitation of a Behavior Support Team, as appropriate and if a team is not already in place.  Training for the individual, support team members, and relevant service providers in behavioral approaches that increase positive/adaptive behaviors and enhance an individual’s ability to function independently and successfully in community settings.

The agency will initially authorize up to 30 hours for a Functional Behavior Assessment and development of a Behavior Support Plan. The vendor should conduct an intake assessment to determine, prior to instituting a Functional Behavioral Assessment, the service needs of an individual and the feasibility of using an Applied Behavior Analysis or Positive Behavior Support approach. The vendor must submit the results of the Functional Behavior Assessment, along with the written Behavior Support Plan, when submitting an invoice for payment. The Behavior Support Plan should include the number of hours requested for authorization of services as well as a schedule of service delivery (i.e., frequency and duration of intervention hours). Authorization of hours of Therapeutic Behavioral Services (beyond the initial 30 hours) will be provided based on approval of the Behavior Support Plan, not to exceed 100 hours. Requests for more than 100 units of service should be approved by the supervisor.

Qualified Providers: A list of approved vendors of this service is available on the DARS website, in the Forms Cabinet under Behavioral Health / Psychological Services. Individuals who have the following qualifications and whose vendorship applications have been approved are authorized providers of Therapeutic Behavioral Services for DARS:

 Board Certified Behavior Analyst® (BCBA®): The Board Certified Behavior Analyst (BCBA) is an independent practitioner who also may work as an employee or independent contractor for an organization. The BCBA conducts descriptive and systematic (e.g., analogue) behavioral assessments, including functional analyses, and provides behavior analytic interpretations of the results. The BCBA designs and supervises behavior analytic interventions. BCBAs supervise the work of Board Certified Assistant Behavior Analysts and others who implement behavior analytic interventions.

 Board Certified Assistant Behavior Analyst® (BCaBA®): The Board Certified Assistant Behavior Analysis (BCaBA) conducts descriptive behavioral assessments and is able to interpret the results and design ethical and effective behavior analytic interventions for clients. The BCaBA may assist a BCBA with the design and delivery of introductory level instruction in behavior analysis. It is mandatory that each BCaBA practice under the supervision of a BCBA. Governmental entities, third-party insurance plans, and others utilizing BCaBAs must require this.

 Endorsement as a Positive Behavior Support (PBS) Facilitator: A Positive Behavior Support (PBS) Facilitator is an independent practitioner who may also work as an employee or independent contractor for an organization. In Virginia, endorsement of PBS Facilitators is done through The Partnership for People with Disabilities located at Virginia Commonwealth University.

[TABLE 7-1]  Comprehensive Functional Behavior Assessment to identify target behaviors and | assess the need for modifications and adjustments in an individual’s community | environments (home, work, recreation, etc.). |  Written Behavior Support Plan, with ongoing evaluation and revisions. |  Development and facilitation of a Behavior Support Team, as appropriate and | if a team is not already in place. |  Training for the individual, support team members, and relevant service | providers in behavioral approaches that increase positive/adaptive behaviors | and enhance an individual’s ability to function independently and successfully | in community settings. | The agency will initially authorize up to 30 hours for a Functional Behavior | Assessment and development of a Behavior Support Plan. The vendor should conduct | an intake assessment to determine, prior to instituting a Functional Behavioral | Assessment, the service needs of an individual and the feasibility of using an | Applied Behavior Analysis or Positive Behavior Support approach. The vendor must | submit the results of the Functional Behavior Assessment, along with the written | Behavior Support Plan, when submitting an invoice for payment. The Behavior | Support Plan should include the number of hours requested for authorization of | services as well as a schedule of service delivery (i.e., frequency and duration | of intervention hours). Authorization of hours of Therapeutic Behavioral Services | (beyond the initial 30 hours) will be provided based on approval of the Behavior | Support Plan, not to exceed 100 hours. Requests for more than 100 units of service | should be approved by the supervisor. | Qualified Providers: | A list of approved vendors of this service is available on the DARS website, in | the Forms Cabinet under Behavioral Health / Psychological Services. Individuals | who have the following qualifications and whose vendorship applications have been | approved are authorized providers of Therapeutic Behavioral Services for DARS: | |  Board Certified Behavior Analyst® (BCBA®): The Board Certified Behavior | Analyst (BCBA) is an independent practitioner who also may work as an | employee or independent contractor for an organization. The BCBA conducts | descriptive and systematic (e.g., analogue) behavioral assessments, | including functional analyses, and provides behavior analytic | interpretations of the results. The BCBA designs and supervises behavior | analytic interventions. BCBAs supervise the work of Board Certified | Assistant Behavior Analysts and others who implement behavior analytic | interventions. |  Board Certified Assistant Behavior Analyst® (BCaBA®): The Board Certified | Assistant Behavior Analysis (BCaBA) conducts descriptive behavioral | assessments and is able to interpret the results and design ethical and | effective behavior analytic interventions for clients. The BCaBA may assist | a BCBA with the design and delivery of introductory level instruction in | behavior analysis. It is mandatory that each BCaBA practice under the | supervision of a BCBA. Governmental entities, third-party insurance plans, | and others utilizing BCaBAs must require this. |  Endorsement as a Positive Behavior Support (PBS) Facilitator: A Positive | Behavior Support (PBS) Facilitator is an independent practitioner who may | also work as an employee or independent contractor for an organization. In | Virginia, endorsement of PBS Facilitators is done through The Partnership | for People with Disabilities located at Virginia Commonwealth University.

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Fees: H2019 Therapeutic Behavioral Services $73 per unit (H2019N, $86)

Requests for additional information should be directed to Patricia Goodall, Ed.S., at Patti.Goodall@dars.virginia.gov or 800/552-5019.

HCPCS Code H2020: Job Coach-Enabled Positive Behavioral Supports

Description: Job Coach-Enabled Positive Behavioral Supports refers to on-site behavioral support provided by a DARS approved Job Coach under the recommendation and guidance of a Positive Behavior Support Facilitator (PBSF) or a Board Certified Behavior Analyst (BCBA). The purpose of Job Coach-Enabled Positive Behavioral Supports is to implement face-to-face on-site interventions in the workplace to reduce or eliminate client behaviors which interfere with employment. Services provided under Job Coach-Enabled Positive Behavioral Supports typically include the following:

 Training for the individual, co-workers, and supervisors in behavioral approaches that increase positive/adaptive behaviors and enhance an individual’s ability to function independently and successfully in the workplace;  Data collection to track impact of proposed interventions;  Report writing; and  Participation in team meetings with behavior specialist and other members.

The services to be provided through Job Coach-Enabled Positive Behavioral Supports must be included as part of an individual’s written behavior support plan. The plan must describe the nature of the support provided by the job coach, estimated hours per month needed, and the role of the behavior specialist (i.e., PBSF or BCBA) in monitoring progress. Subsequent requests must include a report from the behavior specialist with an update on monthly activities, description of consumer progress and challenges to be addressed; number of hours used to date; and requests for additional hours (requests for more than 25 hours of support must be approved by a supervisor).

 This procedure code is approved only for ESO vendors (i.e., Choice Group Inc., Didlake, PRS Inc., and VCU) participating in the VCU Autism Spectrum Disorders (ASD) Career Links Grant and the WWRC Autism Speaks Grant.

Fees: H2020 Job Coach-Enabled Positive Behavioral Supports: o VCU $48.87 per unit o The Choice Group Inc. Central Rate $62.57 per unit o The Choice Group Inc. NOVA rate $65.97per unit o Didlake Inc. NOVA rate $69.44 per unit o PRS Inc. NOVA rate $74.36 per unit

X1150: Broken Appointment Description: Broken Appointment is a missed appointment or cancellation of an appointment less than 24 hours before the scheduled time. Vendors should make an effort to confirm appointments with DARS customers at least a day in advance.

Fee: X1150 Broken Appointment $30

[TABLE 8-1] Fees: H2019 Therapeutic Behavioral Services $73 per unit (H2019N, $86) Requests for additional information should be directed to Patricia Goodall, Ed.S., at Patti.Goodall@dars.virginia.gov or 800/552-5019.

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[TABLE 8-2] X1150: Broken Appointment Description: Broken Appointment is a missed appointment or cancellation of an appointment less than 24 hours before the scheduled time. Vendors should make an effort to confirm appointments with DARS customers at least a day in advance.

Fee: X1150 Broken Appointment $30

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BEHAVIORAL HEALTH SERVICES 10/2013

Individuals approved as vendors of licensed behavioral health services for DARS customers must submit an application for approval to Patricia Goodall, Ed.S., DARS Central Office (application materials are in the DARS Forms Cabinet under “Publications” on the left side of DARS’ home page at www.vadars.org and then under “Forms & Files”). If an applicant meets state and agency requirements, the vendorship request will be approved. Vendors are asked periodically to submit specific information or updated applications to DARS for monitoring purposes.

Eligible DARS Behavioral Health providers include the

following licensed professionals: Clinical Psychologists, Psychiatrists and other Physicians; and Allied Behavioral Health Clinicians (i.e., licensed school psychologists, licensed professional counselors, licensed clinical social workers, licensed physicians assistants, and licensed nurse practitioners). Therapeutic Behavior Services are provided by licensed Board Certified Behavior Analysts, Board Certified Assistant Behavior Analysts, and endorsed Positive Behavior Support Facilitators.

• Prior to authorization of services, agency staff should assure an individual’s Virginia licensure is current and that s/he is in good standing with the respective regulatory board(s) of the Department of Health Professionals (DHP). Information on current licensure, probationary status, etc. is on the DHP website at http://www.dhp.virginia.gov under “License Lookup” on left. To check on the endorsement status of a Positive Behavior Support Facilitator (PBSF), contact Patti Goodall at 800/552-5019 or Patti.Goodall@dars.virginia.gov.

A vendor providing licensed behavioral health services for DARS customers

must follow agency standards (per vendorship application) and accept established fees. Fees are based on CPT codes, with a unit typically equal to one hour of direct service.

Fees indicate maximum reimbursement; actual amounts depend on authorized and provided units.

Northern Virginia rates apply when services are in Alexandria, Arlington, and Fairfax. When authorizing services to these vendors,

use the five-digit CPT code plus “N” (e.g., CPT 90791N, Diagnostic Evaluation).

Fees are paid upon invoice receipt.

Invoices should be submitted monthly with evaluation, assessment report, treatment plan, or progress notes (attendance, goals, progress).

NOTE: “Add-on codes” are always performed in addition to the primary service or procedure and are never reported as a “stand alone code.”

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CPT CODES, PROCEDURES, UNITS, AND FEES

CPT 90791, Diagnostic Evaluation (formerly 90801), AWARE Service: Medical/Mental Health; Procedure: Specialist Examinations

Diagnostic Evaluation is a biopsychosocial assessment, including history, mental status, and recommendations. It may involve communication with sources and review of studies. It does not include psychotherapy. Reports should include diagnosis, limitations, prognosis, and recommendations for further assessment or treatment.

If complicating factors exist (e.g., interpreter), include interactive complexity services using add-on code 90785 with 90791. Psychotherapy services, including crisis, cannot be reported on the same day as a Diagnostic Evaluation.

Fees: 90791 Clinical Psychologists and Psychiatrists $149 per unit (90791N, $166);

Allied Behavioral Health Clinicians $124 per unit (90791N, $138).

Follow-up sessions for review of findings with counselor, consumer, and others may be authorized under Individual Psychotherapy (90832, 90834, 90837).

CPT 90785, Diagnostic Evaluation with Interactive Complexity (formerly 90802), AWARE: Medical/Mental Health; Procedure: Specialist Examinations. ADD-ON CODE! Used only with CPT 90791, never alone.

Diagnostic Evaluation with Interactive Complexity involves communication factors complicating delivery.

Factors include difficult communication with young, impaired, or non-verbal individuals, often involving third parties (parents, interpreters, agencies). Used for deaf, hard of hearing, deafblind, or language interpreter services.

Fees: 90785, one unit: Psychologists and Psychiatrists $5; Other Allied Clinicians $5.

CPT 96101: Psychological Testing per hour (clinician); 96102: per hour (technician).

TABLE 2-1: CPT 90791, Diagnostic Evaluation (formerly 90801), AWARE: Medical/Mental Health; Procedure: Specialist Examinations. An integrated biopsychosocial assessment including history, mental status, and recommendations. May involve communication with sources and review of studies. Used for diagnostic or reassessment, excluding psychotherapy. Reports should include diagnosis, limitations, prognosis, and recommendations.

If complicating factors exist (e.g., an interpreter is needed), the diagnostic evaluation may include interactive complexity services; in that situation, use the “add-on” code 90785, Interactive complexity (see below) in conjunction with 90791. Psychotherapy services, including for crisis, may not be reported on the same day as a Diagnostic Evaluation.

Fees: 90791 Clinical Psychologists and Psychiatrists $149 per unit (90791N, $166);

Allied Behavioral Health Clinicians $124 per unit (90791N, $138).

A follow-up session may be authorized for review of findings with the rehabilitation counselor, consumer, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

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TABLE 2-2: CPT 90785, Diagnostic Evaluation with Interactive Complexity (formerly 90802), AWARE: Medical/Mental Health; Procedure: Specialist Examinations. ADD-ON CODE! Used only with CPT 90791. Involves communication factors complicating evaluation.

Common factors include more difficult communication with young and verbally undeveloped or impaired individuals. These are often individuals who have third parties involved such as parents / guardians / other family members, interpreters, language translators, agencies, court officers, or schools. The clinician may use play equipment, physical devices, language / speech interpreter, or other mechanisms of communication. This code may be used when providing services for a person who is deaf, hard of hearing, deafblind, or requires a language interpreter.

Fees: 90785 One Unit of Service: Clinical Psychologists and Psychiatrists $5; Other Allied Behavioral Health Clinicians $5.

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Description: Psychological Testing involves psychodiagnostic assessment of emotionality, intellectual abilities, personality, and psychopathology.

Psychological testing can be administered face-to-face by a technician if a qualified professional interprets results and prepares the report. The professional must conduct a clinical interview and select tests. Typically, up to five units; more require supervisor approval.

Fees: 96101 Psychological Testing: Psychologists $82/unit (96101N, $89);

Allied Clinicians $62/unit (96101N, $67); Technician $85/unit (96102N, $101).

A follow-up session may be authorized for review of findings with the rehabilitation counselor, consumer, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

CPT code 96116: Neurobehavioral Status Exam

Neurobehavioral Status Exam screens thinking, reasoning, judgment, knowledge, attention, language, memory, planning, problem-solving, and visual-spatial skills. The per-unit rate covers psychologist’s time, including face-to-face and report preparation. Used for neurocognitive screening or when comprehensive testing isn't needed, suitable for recent evaluations, mild brain injury, or cognitive complaints.

The report should include diagnosis, limitations, prognosis, and treatment/rehabilitation needs.

Includes a Diagnostic Evaluation (90791) with one unit of Neuropsychological Status Exam (96116).

Fees: 96116 Neurobehavioral Status Exam: Licensed Clinical Psychologists: $88 per unit

(96116N, $97).

A follow-up session may be authorized for review of findings with rehabilitation counselor, consumer, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

CPT Code 96118: Neuropsychological Testing: Licensed Clinician; CPT Code 96119: Testing: Technician.

Neuropsychological Testing assesses individuals with brain injury, disorder, or disease without recent eval, covering attention, perception, language, memory, intelligence, reasoning; not for learning disabilities or ADHD; used to determine diagnosis, limitations, prognosis, and treatment needs.

[TABLE 3-1] CPT 96116: Neurobehavioral Status Exam assesses thinking, reasoning, judgment, knowledge, attention, language, memory, planning, problem-solving, and visual-spatial skills. The unit rate covers psychologist’s time, including face-to-face and report prep. Used for screening neurocognitive deficits or when comprehensive testing isn't needed, suitable for recent eval, mild brain injury, or subjective complaints.

The report should include diagnosis, limitations, prognosis, and treatment/rehabilitation needs.

Includes a Diagnostic Evaluation (90791) with one unit of Neuropsychological Status Exam (96116).

Fees: 96116 Neurobehavioral Status Exam: Licensed Clinical Psychologists: $88 per unit

(96116N, $97).

A follow-up session may be authorized for review of findings with rehabilitation counselor, consumer, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

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Neuropsychological testing can be administered face-to-face by a technician if a qualified health professional interprets results and prepares the report, conducting a clinical interview to select tests.

Includes a Diagnostic Evaluation (90791) with up to seven (7) units of Neuropsychological Testing (96118, 96119).

A follow-up session may be authorized for review of findings with the rehabilitation counselor, consumers, and other significant parties under Individual Psychotherapy / Clinical Counseling (90832, 90834, 90837).

Fees: 96118 Licensed Psychologists $91/unit (96118N, $100); 96119 Technicians $73/unit (96119N, $86).

CPT 90832: Psychotherapy 30 min; 90834: 45 min; 90837: 60 min. AWARE: Medical/Mental Health Treatment; Psychological Services.

Psychotherapy/Clinical Counseling may be authorized for individuals with emotional or interpersonal issues affecting employability or independence. It involves insight, behavior modification, support, ongoing assessment, and may involve family, but excludes group therapy.

Up to 27 units may be authorized; a treatment plan must be submitted after 10 sessions before 17 more can be approved.

Authorization for over 27 sessions requires supervisor approval; consultation is available from the Director of Psychology Services or designee.

A Diagnostic Evaluation (90791) must be completed before therapy; it can also be used for follow-up review of diagnostic and assessment results.

Fees: 90832 (30 min): Psychologists $62 ($69); Clinicians $49 ($55). 90834 (45 min): Psychologists $80 ($87); Clinicians $63 ($69). 90837 (60 min): Psychologists $117 ($127); Clinicians $92 ($100).

CPT 90833: Psychotherapy/Clinical Counseling with medical evaluation, 30 min.

[TABLE 4-1] CPT 90832: Psychotherapy 30 min; 90834: 45 min; 90837: 60 min. AWARE: Medical/Mental Health Treatment; Psychological Services. Psychotherapy/Clinical Counseling is for emotional/interpersonal issues affecting employability or independence, involving insight, behavior, support, ongoing assessment, excluding group therapy.

May authorize up to twenty-seven (27) units of services. Clinician must submit a treatment plan to the DARS rehabilitation counselor following the first ten (10) sessions before an additional seventeen (17) sessions may be authorized.

Authorization for more than twenty-seven (27) sessions must be approved by the supervisor. Consultation is available from the agency’s Director of Psychology Services or designee.

A Diagnostic Evaluation (90791) should be completed by the clinician prior to starting therapy. This procedure code may also be used to conduct a follow-up session for review of diagnostic and assessment results with the rehabilitation counselor, consumer, and other significant parties.

Fees: 90832, 30 minutes Licensed Clinical Psychologists $62 (90832N, $69); Allied Behavioral Health Clinicians: $49 (90832N, $55). 90834, 45 minutes Licensed Clinical Psychologists $80 (90834N, $87); Allied Behavioral Health Clinicians: $63 (90834N, $69). 90837, 60 minutes Licensed Clinical Psychologists $117 (90837N, $127); Allied Behavioral Health Clinicians: $92 (90837N, $100).

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CPT 90836: Psychotherapy/Clinical Counseling 45 min; 90838: 60 min. Add-on codes for services with medical evaluation and management (codes 99201-99204, 99211-99214).

Some individuals receive psychotherapy only (90832, 90834, 90837); others receive psychotherapy plus medical evaluation (90833, 90836, 90838) on the same day by the same provider. Both services must be significant and separately identifiable, reported with respective codes. Example: psychotherapy (90833) plus evaluation (99201). Fees: 90833: Psychiatrists/psychologists $41 ($45); Clinicians $32 ($36). 90836: Psychiatrists/psychologists $67 ($72); Clinicians $53 ($57). 90838: Psychiatrists/psychologists $108.

Allied Clinicians $85 (90833N, $92).

CPT 90853: Group Psychotherapy/Group Counseling.

Group Psychotherapy/Group Counseling is for individuals with emotional or interpersonal issues affecting employability or independence. Not for those in individual or family therapy unless approved; excludes peer support groups.

A treatment plan must be submitted after 10 sessions before additional sessions are approved; over 27 sessions require supervisor approval; consultation is available.

Includes a Diagnostic Evaluation (90791) with up to 27 units of Group Psychotherapy/Group Counseling (90853).

Fees: 90853 Group Psychotherapy: Psychologists $24/unit ($26); Clinicians $19 ($21).

[TABLE 5-1] CPT 90853: Group Psychotherapy/Group Counseling for emotional/interpersonal issues affecting employability or independence. Not for individual or family therapy unless approved. Submit a treatment plan after 10 sessions; over 27 sessions need supervisor approval; consultation available.

Includes a Diagnostic Evaluation (90791) with up to twenty-seven (27) units of Group Psychotherapy/Group Clinical Counseling (90853).

Fees: 90853 Group Psychotherapy/Group Clinical Counseling: Clinical Psychologists $24 per unit (90853N, $26); Allied Behavioral Health Clinicians $19 per unit (90853N, $21)

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CPT 90785: Diagnostic Evaluation, interactive complexity. Add-on code for use only with CPT 90853; category: Medical/Mental Health Treatment; Specialist Examinations.

Description: Diagnostic Evaluation with Interactive Complexity refers to specific communication factors that complicate the delivery of the Diagnostic Evaluation.

Common factors include more difficult communication with young and verbally undeveloped or impaired individuals. These are often individuals who have third parties involved such as parents / guardians / other family members, interpreters, language translators, agencies, court officers, or schools. The clinician may use play equipment, physical devices, language / speech interpreter, or other mechanisms of communication. This code may be used when providing services for a person who is deaf, hard of hearing, deafblind, or requires a language interpreter.

Fees: 90785: Psychologists/Psychiatrists $5/unit; Other clinicians $5/unit.

CPT Code 90885: Evaluation of Records or Reports

Evaluation of Records or Reports reviews mental health records, psychiatric reports, assessments, and data for diagnostic and rehabilitation planning. Vendors must provide a brief consultative report and be qualified to interpret reports, assessments, and data.

Fees: 90885 Licensed Psychologists, Psychiatrists, Physicians $29/unit (90885N, $32); Allied Clinicians $23/unit (90885N, $25). One unit equals 15 minutes.

HCPCS Code H2019: Therapeutic Behavioral Services.

Therapeutic Behavioral Services involve ABA and PBS interventions in community settings to address challenging behaviors, aiming to improve quality of life and functioning. For guidance, see DARS Forms Cabinet under Behavioral Health / Psychological Services.

Therapeutic Behavioral Services include:  Intake assessment to determine needs and feasibility of ABA or PBS.

[TABLE 6-1] CPT 90785: Diagnostic Evaluation with Interactive Complexity, an add-on code used only with CPT 90853, involves communication factors complicating evaluation.

Common factors include more difficult communication with young and verbally undeveloped or impaired individuals. These are often individuals who have third parties involved such as parents / guardians / other family members, interpreters, language translators, agencies, court officers, or schools. The clinician may use play equipment, physical devices, language / speech interpreter, or other mechanisms of communication. This code may be used when providing services for a person who is deaf, hard of hearing, deafblind, or requires a language interpreter.

Fees: 90785 Clinical Psychologists and Psychiatrists $5 per unit; Other Allied Behavioral Health Clinicians $5 per unit.

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[TABLE 6-2] HCPCS Code H2019: Therapeutic Behavioral Services.

Description: Therapeutic Behavioral Services refers to behavioral treatment and intervention, specifically Applied Behavior Analysis (ABA) and/or Positive Behavior Support (PBS), provided in community settings for individuals who need comprehensive, specialized supports to address challenging behaviors. ABA and PBS are clinically proven approaches to reducing or eliminating behaviors which interfere with employment and independent living. The overall goal of Therapeutic Behavioral Services is to improve an individual’s quality of life and ability to function successfully in the workplace and other community settings. For additional information and guidance on the appropriate use of this Procedure Code, including Standards of Conduct, please go to the DARS Forms Cabinet and look under Behavioral Health / Psychological Services.

Therapeutic Behavioral Services typically include the following:  Intake Assessment to determine service needs as well as the feasibility of using either Applied Behavior Analysis or Positive Behavior Support.

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 Functional Behavior Assessment to identify target behaviors and needed modifications.  Written Behavior Support Plan with ongoing updates.  Development and facilitation of a Behavior Support Team if needed.  Training for individual, support team, and providers in behavioral approaches to promote independence.

Initial authorization is up to 30 hours for FBA and Behavior Support Plan. The vendor must submit assessment results and plan with invoice. Additional hours up to 100 require approval; over 100 hours need supervisor approval.

Qualified Providers: Approved vendors are listed on the DARS website under Behavioral Health / Psychological Services. Only those with approved applications are authorized providers.

 Board Certified Behavior Analyst® (BCBA®): The Board Certified Behavior Analyst (BCBA) is an independent practitioner who also may work as an employee or independent contractor for an organization. The BCBA conducts descriptive and systematic (e.g., analogue) behavioral assessments, including functional analyses, and provides behavior analytic interpretations of the results. The BCBA designs and supervises behavior analytic interventions. BCBAs supervise the work of Board Certified Assistant Behavior Analysts and others who implement behavior analytic interventions.

 Board Certified Assistant Behavior Analyst® (BCaBA®): The Board Certified Assistant Behavior Analysis (BCaBA) conducts descriptive behavioral assessments and is able to interpret the results and design ethical and effective behavior analytic interventions for clients. The BCaBA may assist a BCBA with the design and delivery of introductory level instruction in behavior analysis. It is mandatory that each BCaBA practice under the supervision of a BCBA. Governmental entities, third-party insurance plans, and others utilizing BCaBAs must require this.

 Endorsement as a Positive Behavior Support (PBS) Facilitator: A Positive Behavior Support (PBS) Facilitator is an independent practitioner who may also work as an employee or independent contractor for an organization. In Virginia, endorsement of PBS Facilitators is done through The Partnership for People with Disabilities located at Virginia Commonwealth University.

 Functional Behavior Assessment to identify target behaviors and needed modifications.  Written Behavior Support Plan with updates.  Development and facilitation of a Behavior Support Team if needed.  Training for individual, support team, and providers in behavioral approaches to promote independence. Initial authorization is up to 30 hours; submit assessment results and plan with invoice. Additional hours up to 100 require approval; over 100 need supervisor approval. Qualified providers are listed on the DARS website and include BCBA®, BCaBA®, and endorsed PBS Facilitators, all under supervision and approved applications.

[/TABLE]

• Page 8 ---

Fees: H2019 Therapeutic Behavioral Services $73/unit (H2019N, $86)

Requests for info: Patricia Goodall, Ed.S., Patti.Goodall@dars.virginia.gov, 800/552-5019.

HCPCS Code H2020: Job Coach-Enabled Positive Behavioral Supports

Job Coach-Enabled Positive Behavioral Supports involve on-site behavioral support by a DARS-approved Job Coach, guided by a PBSF or BCBA, to implement face-to-face workplace interventions reducing interfering behaviors.

 Training for the individual, co-workers, and supervisors in behavioral approaches that increase positive/adaptive behaviors and enhance an individual’s ability to function independently and successfully in the workplace;  Data collection to track impact of proposed interventions;  Report writing; and  Participation in team meetings with behavior specialist and other members.

Support services must be in the individual’s behavior support plan, detailing support nature, estimated monthly hours, and behavior specialist role. Subsequent requests require a report, progress update, and supervisor approval for over 25 hours.

 This code is approved only for ESO vendors (Choice Group Inc., Didlake, PRS Inc., VCU) participating in VCU ASD Career Links and WWRC Autism Speaks Grants.

Fees: H2020 Job Coach Supports: VCU $48.87/unit; Choice Group Inc. Central $62.57; NOVA $65.97; Didlake $69.44; PRS $74.36.

X1150: Broken Appointment is a missed or less than 24-hour canceled appointment. Vendors should confirm at least a day in advance.

Fee: X1150 Broken Appointment $30

[TABLE 8-1] Fees: H2019 Therapeutic Behavioral Services $73/unit (H2019N, $86). For info, contact Patricia Goodall, Ed.S., Patti.Goodall@dars.virginia.gov, 800/552-5019.

[/TABLE]

[TABLE 8-2] X1150: Broken Appointment is a missed or less than 24-hour canceled appointment. Confirm at least a day in advance.

Fee: X1150 Broken Appointment $30

[/TABLE]

• Page 1 ---

THE CONSUMER’S GUIDE to

SELF-EMPLOYMENT

A Guide to the Consumers of

Virginia Department for Aging and Rehabilitative Services

Division of Rehabilitative Services

SEE-001 (rev. 7/1/12)

• Page 2 ---

Table of Contents

Program Overview 3

A Glance at Relevant Policy 4

Self Assessment Questionnaire 5

Your Personal Budget 5

The Roles and Responsibilities of Those Involved 5

The DRS Self-Employment Enterprise Proposal The Business Plan Outline 8

A list of Your Investments 8 A list of Your Request for Support 9

The Financial Projections 9 Supporting Attachments 10

The Evaluation Process The Self-Employment Enterprise Committee 10

The Business Assessment Scale 11

Resources 12

Attachments Sample Business Plan

Sample Cash Flow Projection & Blank Template Business Plan Checklist

Budget Template Self-Assessment Questionnaire

2

• Page 3 ---

Program Overview

The Virginia Department for Aging and Rehabilitative Services (DARS), Division of Rehabilitative Services (DRS), Vocational Rehabilitation (VR) Program offers a self-

employment enterprise option for consumers seeking alternatives to traditional forms of

employment. This program is limited in scope and requires considerable investment on the part of consumers, in both time and financial resources. For highly motivated individuals,

however, it can be a viable and rewarding alternative.

It is important to realize that, as a vocational rehabilitation agency, DRS attempts to support consumers in their efforts to re-enter the workforce as productive members of society. The

Self-Employment Enterprise (SEE) Program is focused upon the individual and your efforts to

create a job for yourself through small business. Consequently, the program has a micro-

enterprise orientation, meaning the vast majority of participants are home-based sole proprietorships (self-employment rather than entrepreneurship).

That is not to say that more capital intensive business concepts can not or will not be supported, for all proposals seeking DRS funding are considered on a case by case basis.

Rather, it is to say that the greater the complexity and associated cost to facilitate a business,

the more speculative it becomes, and the longer it will take to achieve breakeven. It is

likewise true that the larger the capital investment required to accomplish a start-up, the less relative importance DRS financial investment becomes, since having access to working capital

means there are fewer disability related barriers to entry into the marketplace. The DRS SEE

Program therefore, seeks a balance between the needs and the capacity of the consumer.

You’re not alone in this however, as your VR counselor will assist you with understanding

and progressing through DRS requirements for self-employment. This document is one of

the tools to assist you in understanding what would be required of you in planning your business, and in approaching DRS for potential funding to help you get started.

3

• Page 4 ---

In short, you’ll be expected to compile a competent business plan in writing for the agency to review. To assist in the agency’s review, you will have researched it appropriately and will

ultimately make a presentation before DRS management to discuss your request for financial

assistance in getting it started. This guide contains a business plan outline to help you, as well as a cash flow projection template addressing start-up and routine monthly income and

expenses for the first twelve months. Included in this guide is a worksheet for determining

your personal budget, which must also be taken into consideration.

DRS goes a step further and provides individualized technical assistance in small business

through the SEE coordinator. Your VR counselor will ask that you complete the assessment

questionnaire and prepare a personal budget before meeting with the SEE coordinator. The SEE coordinator can meet with you as often as you may need to, provided you continue to

progress toward completing and presenting your SEE proposal.

Best wishes to you in your efforts and congratulations on your decision to pursue self-employment. It’s not for everyone and certainly not for the timid or faint of heart, but with

competent planning, purposeful effort and adequate resources, it may offer the hope of a

better future.

A Glance at Relevant Policy for Self-Employment Enterprises

Consistent with DRS self-employment enterprise policy, you, the consumer, must:

• Be the primary funding source for the self-employment enterprise (meaning the DRS

amount shall not equal or exceed the sum from all the other funding sources and

consumer investments). The DRS amount shall be determined case-by-case based on the

amount obtained from other funding sources, as well as the consumer’s in-kind contributions to the business. The consumer shall seek principal funding from other

4

• Page 5 ---

private or public sources, including contributions from yourself and family, bank loans,

Plan to Achieve Self-Sufficiency (PASS), etc.

• Purchase any vehicles that must be licensed to operate, if needed for the business.

• Assume financial responsibility for any lease or purchase any permanent building or land,

if necessary to the business concept.

• Address improvements or permanent additions or modifications to any business property

except to the extent necessary to make property accessible to the consumer.

• Fund routine operating costs on a continuing basis.

• Comply with all relevant state, federal and local laws and regulations, including the Americans with Disabilities Act.

• Be organized as a for-profit business.

• Address existing debt yourself.

• Operate a business that does not violate community morality.

Self-Assessment Questionnaire

Attached is a brief self-assessment questionnaire to be completed by you prior to meeting with the SEE coordinator, if possible. This will assist in the agency’s evaluation of your

experience and preparedness in operating a small business.

Your Personal Budget

It’s important to have a working understanding of your personal expenses each month. DRS

support of an SEE, among other things, is contingent upon the ability of the business venture to be sustainable, both of itself and of you. This means you must be able to support your

personal expenses each month, and the business may need to address a portion, if not all of

those needs.

5

• Page 6 ---

The budget will also assist in developing the financial projections, as your personal financial

needs must be reflected in your compensation. If need be, the SEE coordinator can assist you in preparing the budget, but at this stage it is important that you complete the template and

enter into this section, the total anticipated monthly expenses you have.

Total personal expenses each month $________

How much of these personal expenses do you anticipate your

business income will need to support each month? $_________

The Roles and Responsibilities of Those Involved

The DRS VR Counselor:

• Serves as the initial point of contact for self-employment.

• Provides the consumer with support and self-assessment materials to facilitate initial

evaluations.

• Assesses the consumer’s physical, emotional and psychological readiness for self-

employment.

• Makes referrals to the SEE coordinator for technical assistance and support, when

appropriate.

• Oversees the SEE process to ensure adequate delivery of services.
• Takes an active role as a member of the SEE Committee.

• Participates in Business Assessment Scale scorings.

• Develops the IPE and incorporates milestones and progress measures.

• If approved, conducts procurements on behalf of the consumer (unless others in the office

are tasked with those particular responsibilities).

• Conducts follow-up reviews on performance, if approved and funded, with the assistance

of the SEE coordinator.

• Determines case closure.

6

• Page 7 ---

The Consumer:

• Determines and expresses the intent to pursue self-employment.

• Determines the concept or concepts for business they wish to investigate and ultimately develop into a formal proposal for DRS review.

• Assumes responsibility for writing, completing and presenting the SEE proposal, which

will include, a competent business plan; an itemized list of the consumer’s investments in

the business to date with associated costs; an itemized list of the requested assistance sought through DRS with associated costs; a detailed cash flow projection incorporating

start-up and routine operating costs, and which demonstrates the ability of the business to

support their personal obligations.

• Completes and submits requested assessment materials to the VR counselor.

• Participates in meetings and technical assistance sessions to facilitate the proposal’s

development.

• Complies with requests made by the VR counselor and / or the SEE coordinator as required.

• Provides the VR counselor and SEE coordinator with follow-up financial information to

evaluate the performance of the business prior to close-out of the case.

• Complies with all local, state and federal laws and requirements of small businesses.

The DRS SEE Coordinator:

• Guides the consumer through the business planning process.

• Assists consumers as necessary with development of cash flow projections.

• Assists consumers as necessary with development of personal budgeting.

• Does not write the plan, but offers technical assistance with its completion.
• Provides technical assistance in generating and analyzing competent market analysis

information.

• Provides technical assistance in developing viable marketing strategies.

7

• Page 8 ---

• Recommends potential training and funding alternatives in the area.

• Recommends cost effective marketing strategies.
• Conducts preliminary and formal Business Assessment Scale scorings with consumers,

counselors, SEE Committee members, etc.

• Makes recommendations to the VR counselor and SEE Committee members as needed, for

their determination.

• Conducts follow-up meetings to evaluate the progress and status of funded cases.

• Makes additional recommendations as necessary, to assist with evaluating financial

performance, post-funding.

The SEE Committee:

• Listens to, evaluates, and makes recommendations on the consumer’s SEE Proposal.
• Participates in the formal Business Assessment Scale scoring of SEE proposals.

• Makes additional or exceptional recommendations to counselors and management as

necessary.

The DRS Self-Employment Enterprise Proposal

Your proposal to DRS will include a competent business plan; an itemized list of your

investments in the business; an itemized list of your request for DRS assistance; and detailed

financial projections for cash flow. You may also have supporting attachments and each of

these areas is discussed briefly in this section.

The Business Plan Outline: All business plans contain primarily the same categories of information, although there are a

number of different ways to present it. The attached outline provides a general

understanding of what those categories are and more traditional groupings for them.

8

• Page 9 ---

For the benefit of those evaluating your business plan, be concise. Communicate what is necessary to support your conclusions and projections, but be careful not to pad the plan.

Also, understand that you may not be present to defend the plan to someone evaluating it. It

must stand-alone and clearly communicate your concept as a viable business, worthy of their support.

The attached outline will assist you in gathering and organizing your information and the

SEE coordinator is available by appointment to assist you in developing a competent plan in written form.

9

• Page 10 ---

Business Plan Table of Contents:

• Purpose
• Executive Summary
• Company Description
• Products and Services
• Management and Operations

• Market Analysis
• Marketing and Sales Strategy
• Financial Data
• Appendices and Supporting Information

Elements of the Typical Business Plan: See attached.

A List of Your Investments – You must incorporate into your proposal an itemized list of your investments in the business,

which the SEE coordinator will qualify. Loans or other cash contributions count, including if

they are provided by immediate family members, provided they are not allowed to exert any management control as a result of their investment, and have no ownership rights or

percentage of ownership rights in the business.

In addition to loans or other capital injections, consumers may document ‘in-kind’ contributions of tools, equipment, vehicles, etc. that will be used in the conduct of business,

minus any percentage of personal use. These must be current market values (depreciated

values) unless the items were purchased within the last twelve months. DRS has a depreciation schedule outlining typical useful lifetimes for various equipment.

Examples include office furniture and equipment, vehicles, materials or inventory in stock,

computers and related equipment, etc. Again, current values less the percentage of personal use are considered. More specifically, if a consumer wished to have a vehicle considered as

part of their investments since it will be used in support of legitimate business activities, DRS

would qualify the current value of the vehicle (blue book), minus the value of the vehicle

10

• Page 11 ---

related to personal use. For example, if the consumer owns a vehicle currently valued at

$5,000.00 and 65% of its usage is anticipated to be for personal use, $1,750.00 would be qualified investment in the business (35% of $5,000).

Consumer investment is critical to determining the potential level of DRS financial support since DRS policy requires consumers to be the majority investor in the business. Understand

that the majority investor rule does not typically translate into a 51% / 49% sharing of

expenses. On average, DRS has supported approximately 30% of start-up costs per case over

the most recent cases funded. This is due in part to some consumers having more investment than was necessary through DRS investment to facilitate a successful start-up. In some cases,

the limitations of the Virginia Public Procurement Act restrict the types of procurements and

assistance that can be provided (for example, DRS funds cannot be placed into a consumer’s hands for discretionary spending purposes, no vehicles are allowed, no real property, etc.).

A List of Your Request for DRS Financial Support –

You must also incorporate an itemized list of your request for DRS financial support, with

associated costs. It is your responsibility to investigate those items needed by the business, their relative costs and to identify at least two (preferably three) sources for the procurement.

This information is to be shared with the VR counselor or other designated professional

tasked with conducting procurements, if funding is approved.

The Financial Projections – Templates facilitating the completion of detail financial projections are attached. They require

the capacity to use Excel spreadsheet software if completed electronically, but can be done by

hand, if need be. These will be attached to your proposal.

11

• Page 12 ---

Supporting Attachments –

You may attach letters of recommendation, your resume’, market survey information, or any

other information you feel is pertinent to supporting your conclusions or proposal. Don’t feel you need to pad the plan or make it any longer than is necessary to convey or support valid

conclusions.

The Evaluation Process

Self-Employment Enterprise Committee

When appropriate, the VR counselor shall convene a SEE Committee to review the SEE

proposal. The committee consists of the VR counselor, the counselor’s Office Manager, the

SEE coordinator, an appropriate member of the business community (i.e., SBDC, SCORE) if warranted, and other individuals whom the counselor determines may be necessary to the

review process. The counselor may include members with knowledge specific to the

proposed enterprise, the geographic and market areas, and/or general small business operations.

The SEE coordinator will serve as the facilitator for the committee. The SEE Committee will

evaluate the proposal and the presentation made in person, by the consumer. Committee members will review the proposal and conduct an informal question and answer session with

the consumer.

Following the presentation and all questions, the SEE Committee will excuse the consumer and conduct discussions of the proposal and request for DRS funding. Following all relevant

discussions, the SEE Committee members will participate in a formal scoring of the Business

Assessment Scale, conducted by the SEE coordinator. The SEE coordinator shall be responsible for compiling the BAS scoring and incorporating the results into the written

12

• Page 13 ---

recommendation to the VR counselor and members of the SEE Committee for subsequent

review and determination of the proposal request.

In its evaluation, the SEE Committee shall review all documentation and consider the ability

of the consumer to successfully implement the business plan. The Committee may choose to inspect the proposed site and to request further information or action be taken before

reaching its decision. The Committee may also establish conditions to be met prior to funding,

or may implement demonstration phases in incremental steps (both in procurement and

execution).

The SEE coordinator will provide the written recommendation summarizing the SEE

Committee’s intent, to the VR counselor and will copy the other members of the SEE Committee. The VR counselor is not bound by the recommendation, but will make and

forward their determination through the chain of command dictated by appropriate

procurement authorization levels. As a practical matter, all SEE requests made for DRS

financial assistance exceeding $5,000.00 are ultimately sent to the Department for Aging and Rehabilitative Services Commissioner for his review and determination.

If the SEE Committee recommends disapproval, the consumer may undertake amendments to the plan and submit a modified SEE proposal to the SEE Committee; abandon the enterprise;

or request an administrative appeal.

The Business Assessment Scale

The Business Assessment Scale (BAS) is an evaluation tool addressing five areas pertinent to

business;

• Management Expertise / Skill

• Commitment / Desire / Persistence

13

• Page 14 ---

• Technical Skill / Work Experience

• Market Demand
• Personal Credit / Financial Solvency

The SEE coordinator will conduct the preliminary scoring with the involvement of the

consumer and the VR counselor in the initial stages of developing the self-employment proposal. This will allow the consumer to understand how they will be formally evaluated at

the conclusion of the process during the SEE Committee meeting. It should also demonstrate

areas of weakness that may be addressed in the planning phase to improve the consumer’s formal scoring. A low score may indicate a need for small business training, more detailed

market analysis, or more targeted work experience, for example.

Each of the five areas is scored individually and then entered into a matrix where relative

weights are applied, giving greater emphasis to certain areas. The resulting scores are added to compile one overall score. If the score falls below 60, it is an indication that at least

additional training in small business would be beneficial. In some cases, it’s clear that self-

employment is not a practical option for the consumer.

For BAS scores at 60 or above, the counselor should consider that the consumer has met the minimum score for further consideration, although it may still be beneficial for some

consumers to pursue additional training or work experience. A number of factors can

influence this decision and should be determined on a case by case basis by the VR counselor

and SEE coordinator.

There are typically only two times the BAS is applied. The initial scoring is simply an

overview and informal assessment to assist all parties in understanding the consumer’s

business management skills and experience. The second scoring is applied formally

following the SEE Committee presentation by the consumer and discussion by the Committee members. Further consideration following the formal scoring means a written

14

• Page 15 ---

recommendation is prepared for the VR counselor and the other members of the SEE

Committee. The SEE coordinator prepares the written recommendation

Resources

The following is a short list of available on-line resources to assist you in researching and

preparing your business proposal for DRS review:

¤ www.irs.gov – the U.S. Internal Revenue Service is an excellent resource for technical information, forms and publications related to applicable taxes.

¤ www.sba.gov – the U.S. Small Business Administration is another excellent resource on a broad range of topics impacting small business. SBA also offers loan guarantee programs to support small businesses seeking to access capital for start-up and expansion needs. SBA works closely with preferred commercial lenders to provide a

financial bridge for small business owners. ¤ www.doc.gov – the U.S. Department of Commerce offers significant resource information and programs to foster domestic and international trade. DOC is the home agency for the U.S. Census Bureau, through which it is possible to develop

considerable demographic information on your target markets. This includes population clocks, median incomes, ethnic and gender based information as well as age, children, households, etc.

¤ www.vdba.virginia.gov - The Virginia Department of Business Assistance

¤ www.vdba.virginia.gov/vsbfa.shtml - The Virginia Small Business Finance Authority ¤ www.virginiasbdc.org - The Virginia Small Business Development Center Network

¤ www.vamicro.org - The Virginia Micro-enterprise Network

¤ www.vadars.org - The Virginia Department of Aging & Rehabilitative Services ¤ www.vdbvi.org - The Virginia Department for the Blind and Vision Impaired

¤ www.vddhh.org - The Virginia Department for the Deaf and Hard of Hearing

¤ www.atlfa.org - The New Well Fund (formerly The Virginia Assistive Technology Loan Fund Authority) The U.S. Chamber of Commerce / The Virginia Chamber of Commerce ¤ The Virginia Retail Merchant’s Association ¤ The Virginia Community College System ¤

15

• Page 1 ---

THE CONSUMER’S GUIDE to

SELF-EMPLOYMENT

A Guide to the Consumers of

Virginia Department for Aging and Rehabilitative Services

Division of Rehabilitative Services

SEE-001 (rev. 7/1/12)

• Page 2 ---

Table of Contents

Program Overview 3

A Glance at Relevant Policy 4

Self Assessment Questionnaire 5

Your Personal Budget 5

The Roles and Responsibilities of Those Involved 5

The DRS Self-Employment Enterprise Proposal The Business Plan Outline 8

A list of Your Investments 8 A list of Your Request for Support 9

The Financial Projections 9 Supporting Attachments 10

The Evaluation Process The Self-Employment Enterprise Committee 10

The Business Assessment Scale 11

Resources 12

Attachments Sample Business Plan

Sample Cash Flow Projection & Blank Template Business Plan Checklist

Budget Template Self-Assessment Questionnaire

2

• Page 3 ---

Program Overview

The Virginia Department for Aging and Rehabilitative Services (DARS), Division of Rehabilitative Services (DRS), Vocational Rehabilitation (VR) Program offers a self-

employment enterprise option for consumers seeking alternatives to traditional forms of

employment. This program is limited and requires significant investment of time and money from consumers. For highly motivated individuals,

however, it can be a viable and rewarding alternative.

It is important to realize that, as a vocational rehabilitation agency, DRS supports consumers in re-entering the workforce as productive members of society. The

Self-Employment Enterprise (SEE) Program is focused upon the individual and your efforts to

create a job for yourself through small business. Consequently, the program has a micro-

enterprise orientation, meaning most participants are home-based sole proprietors (self-employment, not entrepreneurship).

This does not mean more capital-intensive business concepts cannot be supported; all proposals seeking DRS funding are considered case by case.

It means that greater complexity and costs to facilitate a business

becomes more speculative, and breakeven takes longer. It is

also true that larger start-up capital reduces DRS financial importance, as access to working capital

means fewer disability-related barriers to marketplace entry. The DRS SEE

Program seeks a balance between consumer needs and capacity.

You’re not alone; your VR counselor will assist with understanding

and progressing through DRS self-employment requirements. This document is

tools to help you understand business planning and approaching DRS for funding.

3

• Page 4 ---

You must compile a competent business plan for review; you will research it appropriately to assist.

ultimately present to DRS management to discuss your financial request.

assistance in getting it started. This guide contains a business plan outline to help you, as well as a cash flow projection template addressing start-up and routine monthly income and

expenses for the first 12 months. This guide includes a worksheet for determining

your personal budget, which must also be considered.

DRS provides individualized technical assistance in small business

through the SEE coordinator. Your VR counselor will ask that you complete the assessment

questionnaire and prepare a personal budget before meeting the SEE coordinator. The coordinator can meet as often as needed, provided you continue to

progress toward completing and presenting your SEE proposal.

Best wishes on pursuing self-employment. It’s not for everyone, especially the timid, but with

competent planning, effort, and resources, it may offer hope for a

better future.

A Glance at Relevant Policy for Self-Employment Enterprises

Consistent with DRS self-employment enterprise policy, you, the consumer, must:

• Be the primary funding source for the self-employment enterprise (meaning the DRS

amount shall not equal or exceed the sum from all the other funding sources and

consumer investments). The DRS amount is determined case-by-case based on

amount from other sources and the consumer’s in-kind contributions. The consumer shall seek principal funding from other

4

• Page 5 ---

private or public sources, including contributions from yourself and family, bank loans,

Plan to Achieve Self-Sufficiency (PASS), etc.

• Purchase any vehicles that must be licensed to operate, if needed for the business.

• Assume financial responsibility for any lease or purchase any permanent building or land,

if necessary to the business concept.

• Address improvements or modifications to any business property

except to the extent necessary to make property accessible to the consumer.

• Fund routine ongoing operating costs.

• Comply with all applicable state, federal, local laws, including the Americans with Disabilities Act.

• Be organized as a for-profit business.

• Address existing debt yourself.

• Operate a business compliant with community morality.

Self-Assessment Questionnaire

Attached is a brief self-assessment questionnaire to be completed before meeting with the SEE coordinator, if possible. This will assist in the agency’s evaluation of your

experience and preparedness in operating a small business.

Your Personal Budget

It’s important to understand your monthly personal expenses. DRS

support of an SEE depends on the business’s and your sustainability, meaning you must support your

personal expenses each month, and the business may need to cover some or all of

those needs.

5

• Page 6 ---

The budget also helps develop financial projections, as your personal financial

needs must be reflected in your compensation. The SEE coordinator can assist in preparing the budget, but you must complete the template and

enter this section with your total anticipated monthly expenses.

Total personal expenses each month $________

How much of these personal expenses do you anticipate your

business income will need to support each month? $_________

The Roles and Responsibilities of Those Involved

The DRS VR Counselor:

• Serves as the initial contact for self-employment.

• Provides support and self-assessment materials to facilitate initial

evaluations.

• Assesses the consumer’s physical, emotional and psychological readiness for self-

employment.

• Makes referrals to the SEE coordinator for technical assistance and support, when

appropriate.

• Oversees the SEE process to ensure service delivery.
• Participates actively as a SEE Committee member.

• Participates in Business Assessment Scale scorings.

• Develops the IPE and incorporates milestones and progress measures.

• If approved, conducts procurements on behalf of the consumer (unless others in the office

are tasked with those particular responsibilities).

• Conducts follow-up reviews on performance, if approved and funded, with the assistance

of the SEE coordinator.

• Determines case closure.

6

• Page 7 ---

The Consumer:

• Determines and expresses the intent to pursue self-employment.

• Determines concepts for business they wish to investigate and develop into a formal proposal for DRS review.

• Assumes responsibility for writing, completing and presenting the SEE proposal, which

will include, a competent business plan; an itemized list of the consumer’s investments in

the business to date with costs; an itemized list of requested assistance through DRS with costs; a detailed cash flow projection including

start-up and routine operating costs, demonstrating the business’s ability to

support their personal obligations.

• Completes and submits requested assessment materials to the VR counselor.

• Participates in meetings and technical assistance sessions to facilitate the proposal’s

development.

• Complies with requests by the VR counselor and/or SEE coordinator as required.

• Provides the VR counselor and SEE coordinator with follow-up financial information to

evaluate business performance before case closure.

• Complies with all local, state and federal laws and requirements of small businesses.

The DRS SEE Coordinator:

• Guides the consumer through business planning.

• Assists consumers with development of cash flow projections.

• Assists consumers with development of personal budgeting.

• Does not write the plan, but offers technical assistance with its completion.
• Provides technical assistance in generating and analyzing competent market analysis

information.

• Provides technical assistance in developing viable marketing strategies.

7

• Page 8 ---

• Recommends potential training and funding alternatives in the area.

• Recommends cost effective marketing strategies.
• Conducts preliminary and formal Business Assessment Scale scorings with consumers,

counselors, SEE Committee members, etc.

• Makes recommendations to the VR counselor and SEE Committee members as needed, for

their determination.

• Conducts follow-up meetings to evaluate the progress and status of funded cases.

• Makes additional recommendations as necessary, to assist with evaluating financial

performance, post-funding.

The SEE Committee:

• Listens to, evaluates, and makes recommendations on the consumer’s SEE Proposal.
• Participates in the formal Business Assessment Scale scoring of SEE proposals.

• Makes additional or exceptional recommendations to counselors and management as

necessary.

The DRS Self-Employment Enterprise Proposal

Your proposal to DRS will include a competent business plan; an itemized list of your

investments in the business; an itemized list of your request for DRS assistance; and detailed

financial projections for cash flow. Supporting attachments and each of

these areas is discussed briefly in this section.

The Business Plan Outline: All business plans contain primarily the same categories of information, although there are a

number of different ways to present it. The attached outline provides a general

understanding of those categories and traditional groupings.

8

• Page 9 ---

For the benefit of those evaluating your business plan, be concise. Communicate what is necessary to support your conclusions and projections, but be careful not to pad the plan.

Also, you may not be present to defend the plan to evaluators. It

must stand alone and clearly communicate your viable business concept for support.

The attached outline will assist you in gathering and organizing your information and the

SEE coordinator is available by appointment to assist in developing a written, competent plan.

9

• Page 10 ---

Business Plan Table of Contents:

• Purpose
• Executive Summary
• Company Description
• Products and Services
• Management and Operations

• Market Analysis
• Marketing and Sales Strategy
• Financial Data
• Appendices and Supporting Information

Elements of the Typical Business Plan: See attached.

A List of Your Investments – You must include an itemized list of your investments in the business,

which the SEE coordinator will qualify. Loans or other cash contributions count, including if

they are provided by immediate family members, provided they exert no management control and have no ownership rights or

ownership rights in the business.

In addition to loans or capital, consumers may document ‘in-kind’ contributions of tools, equipment, vehicles, etc., used in business,

minus any personal use percentage. Values must be current market (depreciated)

values) unless purchased within 12 months. DRS has a depreciation schedule for equipment lifetimes.

Examples include office furniture, equipment, vehicles, materials, or inventory,

computers and related equipment, etc. Again, current values less the percentage of personal use are considered. More specifically, if a consumer wished to have a vehicle considered as

part of their investments used to support legitimate business activities, DRS

would qualify the current vehicle value (blue book) minus the vehicle's value

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related to personal use; e.g., if the consumer owns a vehicle valued at

If valued at $5,000 and 65% is personal use, then $1,750 (35%) is qualified investment.

Consumer investment determines DRS support; policy requires consumers to be the majority investor. Understand

that the majority investor rule does not usually mean a 51%/49% share of

expenses. On average, DRS has supported approximately 30% of start-up costs per case over

the most recent funded cases. Some consumers had more DRS investment than needed for a successful start-up. In some cases,

Virginia Public Procurement Act limits procurement types and

assistance; DRS funds cannot be given for discretionary spending, no vehicles, no real property, etc.

Your DRS Financial Support Request List –

Include an itemized list of your DRS support request, with

associated costs. You must investigate needed items, their costs, and identify at least two (preferably three) sources.

Share this info with the VR counselor or designated professional

tasked with conducting procurements, if funding is approved.

Financial Projections – Templates for detailed financial projections are attached. They require

the ability to use Excel if completed electronically, but can be done by

hand, if need be. These will be attached to your proposal.

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Supporting Attachments –

Attach letters of recommendation, your resume, market surveys, or any

other info supporting your conclusions or proposal. Avoid padding or lengthening unnecessarily.

conclusions.

The Evaluation Process

Self-Employment Enterprise Committee

When appropriate, the VR counselor shall convene a SEE Committee to review the SEE

proposal. The committee includes the VR counselor, Office Manager,

SEE coordinator, a business community member (e.g., SBDC, SCORE) if warranted, and others the counselor deems necessary to the

review process. The counselor may include members with knowledge specific to the

proposed enterprise, the geographic and market areas, and/or general small business operations.

The SEE coordinator will facilitate the committee. The SEE Committee will

evaluate the proposal and in-person presentation by the consumer. Committee members will review and conduct an informal Q&A with

the consumer.

After the presentation and questions, the SEE Committee will excuse the consumer and discuss the proposal and DRS funding request. After all relevant

discussions, the SEE Committee will formally score the Business

Assessment Scale, conducted by the SEE coordinator. The coordinator will compile BAS scores and include results in the written

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recommendation to the VR counselor and SEE Committee members for subsequent

review and determination of the proposal request.

In its evaluation, the SEE Committee shall review all documentation and consider the ability

of the consumer to implement the business plan. The Committee may inspect the site and request further information or action before

reaching its decision. The Committee may also establish conditions to be met prior to funding,

or may implement demonstration phases in incremental steps (both in procurement and

execution).

The SEE coordinator will provide the written recommendation summarizing the SEE

Committee’s intent, to the VR counselor and will copy other SEE Committee members. The VR counselor is not bound by the recommendation but will make and

forward their determination through the chain of command dictated by appropriate

procurement authorization levels. Practically, all SEE requests for DRS

financial assistance exceeding $5,000.00 are ultimately sent to the Department for Aging and Rehabilitative Services Commissioner for his review and determination.

If the SEE Committee disapproves, the consumer may amend and resubmit the SEE proposal, abandon the enterprise;

or request an administrative appeal.

The Business Assessment Scale

The Business Assessment Scale (BAS) evaluates five areas relevant to

business;

• Management Expertise / Skill

• Commitment / Desire / Persistence

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• Technical Skill / Work Experience

• Market Demand
• Personal Credit / Financial Solvency

The SEE coordinator will conduct the preliminary scoring with the involvement of the

consumer and VR counselor during initial stages of developing the self-employment proposal. This helps the consumer understand how they will be evaluated at

the conclusion of the process during the SEE Committee meeting. It should also demonstrate

areas of weakness to address in planning to improve the consumer’s score. A low score may indicate a need for small business training, more detailed

market analysis, or more targeted work experience, for example.

Each of the five areas is scored individually and entered into a matrix where

weights are applied, emphasizing certain areas. Scores are combined into one overall score. If below 60, it indicates at least

additional small business training may be beneficial. In some cases, self-

employment is not a practical option for the consumer.

For BAS scores ≥60, the counselor should consider that the consumer meets the minimum score for further consideration, though additional training or experience may still benefit some

consumers to pursue additional training or experience. Several factors can

influence this decision and should be determined case-by-case by the VR counselor

and SEE coordinator.

BAS is typically applied twice. The initial scoring is simply an

overview and informal assessment to assist all parties in understanding the consumer’s

business management skills and experience. The second scoring is applied formally

after the SEE Committee presentation and discussion. Further consideration after formal scoring involves a written

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recommendation is prepared for the VR counselor and SEE members

Committee. The SEE coordinator prepares the written recommendation

Resources

Below is a list of online resources to assist in researching and

preparing your business proposal for DRS review:

¤ www.irs.gov – the U.S. Internal Revenue Service is an excellent resource for technical information, forms and publications related to applicable taxes.

¤ www.sba.gov – the U.S. Small Business Administration is another excellent resource on a broad range of topics impacting small business. SBA also offers loan guarantee programs to support small businesses seeking to access capital for start-up and expansion needs. SBA works closely with preferred commercial lenders to provide a

financial bridge for small business owners. ¤ www.doc.gov – the U.S. Department of Commerce offers significant resource information and programs to foster domestic and international trade. DOC is the home agency for the U.S. Census Bureau, through which it is possible to develop

demographic info on target markets, including population clocks, median incomes, ethnicity, gender, age, children, households, etc.

¤ www.vdba.virginia.gov - The Virginia Department of Business Assistance

¤ www.vdba.virginia.gov/vsbfa.shtml - The Virginia Small Business Finance Authority ¤ www.virginiasbdc.org - The Virginia Small Business Development Center Network

¤ www.vamicro.org - The Virginia Micro-enterprise Network

¤ www.vadars.org - The Virginia Department of Aging & Rehabilitative Services ¤ www.vdbvi.org - The Virginia Department for the Blind and Vision Impaired

¤ www.vddhh.org - The Virginia Department for the Deaf and Hard of Hearing

¤ www.atlfa.org - The New Well Fund (formerly The Virginia Assistive Technology Loan Fund Authority) The U.S. Chamber of Commerce / The Virginia Chamber of Commerce ¤ The Virginia Retail Merchant’s Association ¤ The Virginia Community College System ¤

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PREFACE

Background SE Providers Forums

The Virginia Division of Rehabilitative Services (DRS) has a Regional provider forums are being held for Supported long history of providing rehabilitative services to citizens of Employment practitioners to receive information, to network, the Commonwealth with disabilities. Over time, progress in and to develop skills in improving services. These forums medical and assistive technology has challenged vocational allow practitioners access to training needs on best practices, rehabilitation professionals to redefine existing boundaries in DRS procedures, and methods of monitoring consumer determining eligibility for services. Rehabilitation progress. practitioners continually seek innovative resources and Guide Purpose programs that offer the possibility of increasing consumer productivity, earnings, integration, and independence.

The purpose of the Guide to Supported Employment and Job Supported Employment (SE) services represent a valuable Coach Training Services is to provide practical and specific array of contemporary rehabilitation options. The goal is to information to supplement the Virginia DRS Policy and maximize employment opportunities for persons with the most Procedure Manual. Where possible, the Guide seeks to severe disabilities who require support in order to work in illustrate evolving best practices gleaned from case examples integrated, competitive employment. Unlike “evaluate-train- and data gathered in Virginia. Specifically, the Guide is place” models of rehabilitation services, Supported intended to provide supported employment practitioners with Employment assesses, then places and trains consumers. An guidance in: array of service options is needed for persons with disabilities.  Achieving a customer-oriented environment that This Guide focuses on the array of options within SE promotes consumer choice and participation, individual programs. For the purposes of this Guide, the term responsibility, practitioner excellence and sensitive “supported employment services” shall be used to refer delivery of quality services; collectively to the following:  Enhancing understanding of operational procedures and

1. The federally defined program of Supported Employment, the need for cooperation, collaboration, and coordination; and  Clarifying and expanding on the roles, responsibilities, and expectations among supported employment
2. Job Coach Training Services in Virginia. practitioners; and The statewide system of Supported Employment services in  Planning, implementing, monitoring, and evaluating Virginia was initially developed through a five-year grant supported employment programs from the Office of Special Education and Rehabilitative Services (OSERS). Service providers include the Division of Rehabilitative Services, local Community Services Boards, and Employment Services Organizations. Current efforts to strengthen the system focus on the following:  Refining the skills of practitioners who provide supported employment services in Virginia;  Improving linkages to ensure coordinated and effective services to individuals receiving Supported Employment services; and  Promoting consumer choice, participation and responsibility.

Provision of Supported Employment services requires the participation of many agencies and individuals, each providing funding or direct consumer services from their own perspective. For the purposes of this Guide, the term “practitioner” shall be used to collectively refer to rehabilitation counselors, employment specialists, provider organizations, community mental health agencies, and other qualified individuals who are providers of Supported Employment services. The cooperation, collaboration and coordination of each of these practitioners is imperative to successfully serve persons through supported employment programs.

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Guide Preparation/Updates Guide Content and Organization

The original Guide, published in February of 1994, was the The sections that follow serve collectively as a guide to result of cooperative efforts of representatives from a variety Supported Employment services from the perspective of the of programs and agencies substantially involved in the Supported Employment practitioner’s needed information. provision of supported employment services to persons with Part I is an overview of Supported Employment as defined by severe disabilities. The Office of Employment Services and federal legislation, and as implemented in Virginia. The Special Programs of the Division of Rehabilitative Services characteristics and advantages of various models are presented prepared the Guide with input from a variety of resources. to assist practitioners in determining, with the consumer, Recommendations and comments were received from, among which placement best fits the individual’s needs. others, administrative and direct services staff of DRS, the Department for the Blind and Vision Impaired (DBVI), the Part II provides the reader with an overview of the DRS VCU-RRTC, and SE providers. Supported Employment process and emphasizes the various practitioner roles and responsibilities.

Every effort has been made to ensure content consistency between this Guide, DRS manuals, provider agreements, and Part III highlights a number of best practices in consumer commonly used definitions. assessment, program planning, case management, monitoring and quality assurance to guide the rehabilitation counselor in The Field Rehabilitative Services – Support Team always the effective planning and delivery of Supported Employment welcomes input and feedback on this Guide and other services. resources developed and distributed by DRS for Supported Employment. Part IV provides “nuts and bolts” information on authorizing, agency fund codes, invoicing, and extended services funding Please note that the guide uses certain terms interchangeably. alternatives.

A “job coach” and “employment specialist” is, for the purposes of the Guide, the same. Likewise, a consumer of Part V defines and illustrates various Social Security Work supported employment services may be referred to as a Incentive programs. “supported employee” or a “consumer.”

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PART I

AN INTRODUCTION TO

SUPPORTED EMPLOYMENT SERVICES

Supported Employment Description once job development by the employment specialist has occurred, intensive job skill training to learn the required In the individual placement model, a single employee is skills. In addition, he would need intermittent intervention to placed in an integrated work setting in the community. The help him develop appropriate behavior responses, and individual is employed by the business. Ongoing support ongoing counseling and guidance to help him overcome work services are provided by an employment specialist who is fears. After discussing with Jim, the counselor and employed by an approved provider of supported employment employment specialist selected behavior-modeling techniques, services. The employment specialist typically provides the which included multiple demonstrations, tactile intervention, individual with initial job skill training on an intensive one-to-and positive reinforcement. one basis for the entire workday. The employment specialist gradually decreases supports, as the individual becomes more The rehabilitation counselor planned and coordinated proficient. Optimally, a system of “natural supports” is extended support services in the IPE that Jim would need developed within the workplace and community, which throughout his employment. The plan also identified the local facilitates success with extensive supports that are already Community Services Board as the source of support services occurring in the individual’s community. and as the source of funding beyond DRS case closure. The employment specialist would provide job coaching as needed Case Example as well as extensive long term supports at the work site.

The following case example illustrates the characteristics of a Jim secured a job as a key grip at a local television station. supported employment program: His job is to make sure that the television cameras do not run over the connecting cables during filming of shows. Jim is also responsible for assisting a janitor in cleaning the Jim is 27 years of age with no television station. previous history of competitive The employment specialist provided Jim with intensive job employment. Until age 22, Jim was skill training on a daily basis for the first few months of enrolled in a secondary-level day employment. In addition, the employment specialist helped activity program for persons with Jim learn to use the public transportation system to get to and moderate to severe intellectual from work. The janitor helps Jim select the appropriate disability. Since that time, he has participated in a center-based adult cleaning supplies and monitors the quality of his work. As Jim has progressed, the employment specialist has gradually development program. Jim is reduced the amount and frequency of assistance provided to generally cooperative and his attendance record is very good.

Jim at the work site.

Jim’s primary functional limitations are his difficulty acquiring new skills, his slow work speed, and his Jim has now been employed for five months. He appears to be distractibility. a willing worker and is generally liked and accepted by his supervisors and the other employees. The rehabilitation After discussing Jim’s needs and determining his eligibility for counselor continues to evaluate Jim’s progress and assist Jim DRS services, Jim’s rehabilitation counselor helped him and the employment specialist with problem solving. Jim’s develop his goals into an Individualized Plan for Employment case will be closed by DRS once he is stabilized in (IPE). The plan was based on Jim’s interests, his prior employment. However, the employment specialist will successes at the adult development program, and other continue to provide the needed supports for as long as Jim is available information. In developing the plan, the counselor employed. felt that he needed more information regarding Jim’s job site preferences, as well as the specific supports that would be __________________________________________________ needed. Jim and his counselor met with an employment specialist who scheduled a situational assessment. Federal Definition The 2001 amended federal regulations for the State Supported During the situational assessments, Jim performed several Employment Services Program, reauthorized in the types of jobs in the community. This experience provided Jim, the counselor and the employment specialist with data on Rehabilitation Act Amendments of 1998, define supported employment as: work performance and preferences. The situational assessment helped identify his vocational goal as well as “Competitive work in integrated work settings or employment identifying barriers to Jim’s employment in the community, in integrated work settings in which individuals are working and the support services he would need to become toward competitive work, consistent with the strengths, competitively employed in an integrated work setting. resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals, for individuals with For example, everyone agreed that Jim would initially need, the most significant disabilities: DRS Guide to Supported Employment and Job Coach Training Services Page 3

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1. For whom competitive employment has not traditionally disability. occurred (or for whom competitive employment has been Ongoing support services are regarded by RSA to be interrupted or intermittent as a result of a significant time-limited services. The maximum time limit for VR disability), and sponsorship of ongoing supports is 18 months following
2. Who because of the nature and severity of their disability, placement, unless the IPE indicates that more than 18 need intensive supported employment services from DRS months are needed for the employee to achieve job and long-term follow-along services (also called extended stability. The time need not be consecutive days worked. services) after transition from supported employment That is, for the supported employee placed more than services.“ once, the 18-month period begins anew.

The amended federal regulations expand the definition of Key Concepts ongoing supports beyond job skill training as the only type of ongoing support. Instead, ongoing services may The federal definition includes several key concepts that include a variety of supports needed for the supported warrant discussion: employee to achieve and maintain job stability. The  Competitive Work - Supported employment must regulations further allow for ongoing support services to provide full-time or part-time work. Weekly goals for be provided by skilled job trainers, co-workers of the hours of employment are to be determined on an supported employee, or other qualified individuals. individual basis. Competitive employment requires the Dependent upon the type of support(s) being provided, a payment of a minimum wage. Wage compensation must qualified individual may be a family member, a be made in accordance with the Fair Labor Standards Act. supervisor, or other person.

The person with a disability in supported employment must be paid wages on a basis consistent with wages paid  Long-term Follow Along/Extended Services - Usually to non-disabled workers with similar job functions. referred to as long-term follow along, extended services are services provided once the time-limited services The amended federal regulations establish the setting of sponsored by the state VR agency are completed and an individualized weekly work requirement as a consist of specific services needed to maintain the component of the Individualized Plan for Employment supported employment placement. The source of (IPE). The transition from time-limited services, extended services must be documented in the sponsored by the state vocational rehabilitation (VR) Individualized Plan for Employment (IPE). If extended agency, to extended services, funded by a source other services are not immediately available prior to the than Federal “110” funds, should not occur until the initiation of the IPE, but the counselor has a reasonable supported employee is stable in employment. In addition expectation that extended services will be available when to fair wage compensation, the supported employee the consumer is stabilized in the job, the plan can be should receive the same benefit package provided to all initiated. Extended services are to be paid for with funds eligible employees. from sources other than the Titles I, VI, IIIC, or IIID of  Integrated Work Setting - The employment must the Federal Rehabilitation Act. provide daily contact in the immediate work setting with Based on guidance from RSA, Virginia DRS has adopted other employees and/or the general public. There is no the following definition of long-term follow limit on the number of individuals with disabilities who along/extended services: can be clustered together in the work setting. However, Individual Competitive Employment is the preferred option.

Criteria in this area of the federal regulations have not changed. Work in integrated settings for persons with most severe disabilities is one of the founding principles of supported employment. This principle is consistent with the concept of least restricted environment established in the Individuals with Disabilities Education Act (IDEA). Integration in the work place is inextricably tied to social inclusion in the larger community as a whole.  Ongoing Support Services - The individual can be provided supports such as job site training, transportation, family support, or any service necessary to achieve and maintain the supported placement throughout the term of employment. Ongoing supports must include, at a minimum, twice monthly monitoring at the work site until the DRS case is closed with the supported employee to assess job stability. In some cases, off site monitoring may be necessary due to the nature of the consumer’s DRS Guide to Supported Employment and Job Coach Training Services Page 4

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living accommodations Long-term follow along/Extended services means ongoing  Long-term case management coordination support services provided by an approved provider that are  Ongoing or intermittent assistance from mental health day sufficient to maintain a person with a most significant or residential programs disability in employment after DRS case closure. These  Supported Living services may consist of but are not limited to:  Family support in order to provide disability-related  direct face to face contact and intervention with the assistance to the individual consumer and/or employer on a regular basis  phone or other communication with the consumer or Target Population employer on a regular basis Supported employment extends services to persons with most  development and maintenance of natural workplace significant disabilities that previously might not have been supports. considered as having the potential for employment and not found eligible for state VR services. While SE had its national With the agreement of the consumer, DRS counselor and ESO beginnings in serving persons with an intellectual disability, job coach either bimonthly or quarterly contacts with the services in Virginia can be appropriate for persons with other consumer would be acceptable to DRS provided that: most significant disabilities who have the desire to work in  the consumer and family understand the frequency, competitive employment in integrated settings. Supported  the consumer is given access to follow along supports if employment is not a disability-specific service option. needed sooner than the next scheduled contact, and  the ongoing supports being provided are adequate to meet Models of Supported Employment the client’s needs with respect to maintaining This section describes four models of supported employment employment. The type of contact may be either face to currently in use in Virginia. The specific characteristics of face or by other means. Otherwise, the frequency and each model are presented in terms of the work setting, type of contact must be provided on a sufficient basis, supervision, job duties, and similar considerations. The based on consumer need, in order to ensure that the individual placement and group models of supported consumer is maintained in employment. employment each offer some inherent advantages.

The provision of extended services by a Practitioners should consider the advantages of the various provider and funding source beyond VR models, as well as the suitability of the model to the case closure ensures continuity of individual, when selecting the most appropriate model. ongoing support. The provision of extended services differentiates Individual Placement Model supported employment from the The case examples given earlier featuring Jim and Mike traditional rehabilitation model of job illustrate the individual placement model of supported placement, short-term (90-day) follow- employment. An employment specialist places one person at up, and termination of VR services. However, in contrast to a job site, provides support, and then gradually reduces time discrete post employment services provided after case closure, and assistance at the work site. extended services are long-term (for as long as the individual As described in the beginning of the section, in the individual needs them to maintain employment), multifaceted supports. placement model, a single supported employee is placed in an SE will serve persons having the most significant integrated work setting in the community. The individual is disabilities.DRS considers individuals with “most significant an employee of the business. An employment specialist, who disabilities” when they meet the following criteria: (1) Is an is employed by an approved provider of supported individual with a significant disability (2) has a physical or employment services, provides ongoing support services. The mental impairment that seriously limits three or more employment specialist typically provides the individual with functional capacities (including, but not limited to, mobility, initial job skill training on an intensive one-to-one basis for communication, self-care, self-direction, interpersonal skills, the entire workday or based on the needs of the individual. work skills or work tolerance) in terms of an employment The employment specialist gradually decreases supports, as outcome; and (3) whose vocational rehabilitation which can be the individual becomes more proficient. Optimally, a system expected to require multiple (more than one) core vocational of “natural supports”, that is support by the employer, rehabilitation services for six months or more. coworkers, family and friends is developed within the workplace and community.

Individuals who have a most significant disability include, but are not limited to, those who need one or more of the The individual placement model is the most prevalent and following types of disability related assistance to enhance their widely utilized by rehabilitation counselors in Virginia. The employment opportunities and independent functioning: individual placement model offers the following advantages:  Supported Employment as the appropriate employment  Flexibility in tailoring ongoing support services to the placement specific needs of the supported employee and the  Personal assistance and intervention accessing such employer; services  Maximum integration of the supported employee in the  Frequent or extensive assistance from rehabilitation work setting and community with employees and other professionals to acquire employment or independent individuals without disabilities;

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 Facilitation in the development of a system of natural facility. They are physically integrated into the larger work supports in the workplace and community; environment with employees without disabilities and enjoy the  Ease in determining the point of transfer of programmatic same benefits as others who work there. The employment and financial responsibility from initial DRS sponsorship specialist stays with them and does not reduce his presence to long-term service provider support; and completely (fading), as it is expected that they will require  Gradual reduction in support costs, and increased intensive ongoing supports for as long as they are employed. employee earnings (based on state and national data Mobile Work Crew Model gathered by VCU-RRTC).

In the Mobile Work Crew Model, a small group of supported Group Placements employees travel together to one or more integrated work settings in the community where they perform contract work Definition of Group Models such as custodial, grounds-keeping and similar functions. The The Code of Federal regulations define an SE group as having provider employs the individuals on the work crew. A full-more than one consumer on site. Most enclaves/mobile crews time supervisor who is also employed by the provider provides have at least three consumers with a supervisor and trainer as ongoing support services. needed.

A mobile work crew in Southwest Virginia illustrates this By definition, an enclave or mobile crew is integrated as both model. A work crew of eight supported employees performs are in the community. A person working in an SE group custodial duties at several different itinerant stops each day. setting is considered successfully employed by DRS and Supported employees on the work crew clean and dust, therefore would be considered a successful DRS closure even vacuum, strip, wax and buff floors, empty trash and do light if the consumer is making less than minimum wage. maintenance work. They receive daily supervision and Enclaves/mobile crews pay may be based on productivity as training from the employment specialist who functions as the allowed under the Fair Labor Standards Act. Organizations crew leader. The provider usually purchases the equipment must follow the Federal Wage and Hour guidelines when and provides transportation services to and from the various determining wages. A consumer may be paid minimum wage work sites. or below as long as federal guidelines are met. Some groups Who should be employed in an enclave or mobile work crew SE sites pay more than minimum wage such as those in NISH instead of SE individual placement? sites.

In all cases, selection into one of these settings should be Group models of supported employment offer the following adapted to meet the need of the consumer. A consumer advantages: capable of entering competitive employment with hourly  An established mechanism for provision of ongoing follow along services does not require the more restricted and support services for those persons who require a greater supervised enclave or mobile crew model. Enclave and degree of (supervised) structured support in order to be mobile work crews are predominantly for consumers that need successful in competitive employment; more work supports than a supported employment individual  Ease in coordination and delivery of services to multiple placement. Though one may eventually work in an individual supported employees; placement after experience in a group, enclaves and mobile crews are generally not interim training programs but long  Consolidation of supported employment services term employment programs. contracts among a few service providers and employers, GUIDANCE FOR GROUP SITUATIONAL ASSESSMENTS and,

1. The rehabilitation team can recommend that an individual  An additional option for the consumer to move offsite is assessed by an employment specialist other than the from a sheltered setting, increase wages, and development one supervising the group because of the consumer’s of more interdependence in the community. functional limitations as a result of the consumer’s Enclave Model disability. The team should consist, at a minimum, of the In the enclave model, a small group of supported employees is DRS counselor, the employment specialist and the placed at a job site in the community where they work consumer. together or are dispersed within an integrated setting. The 2. The assessment must be prescriptive in nature and individuals in the enclave may be employed either by the individualized for the person. While DRS requires that, at employer or by the provider of supported employment a minimum, the Situational Assessment Form (SE Form services. An employment specialist functioning as a full-time 1) be completed as it meets CARF requirements, other enclave supervisor provides ongoing support services. The additional information, that is prescriptive in nature such enclave supervisor may be employed either by the employer or as behavioral and learning issues, should be acquired and by the provider. documented by the employment specialist.
2. The situational assessment should address specific In Richmond, an enclave that illustrates the elements of this vocational rehabilitation issues needed for program and model has been developed. A group of four supported vocational planning that cannot be obtained in any other employees arrives at the site of the employer, a major book circumstances or available records including those from and magazine publisher, by van or on their own. The schools, CSBs, or other Agencies. individuals in the enclave work side-by-side, processing subscription orders at individual workstations in the business DRS Guide to Supported Employment and Job Coach Training Services Page 6

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1. The assessment must have a formalized protocol that having less overt support?) includes task analysis of the specific job duties required in  What model represents the least restrictive setting that is the enclave or mobile work crew. feasible and appropriate?
2. Some of the results obtained from the assessment must  What model will allow the consumer to be most include an overview of the knowledge, skills and abilities independent and productive and is consistent with that could be transferred to other jobs. knowledge, skills and abilities?
3. The hours requested and authorized must be based on  What model is the consumer most comfortable with? individual consumer needs, not requested as a matter of course.  What is the quality of the services available in each
4. If the situational assessment is performed as a “tryout” for model? the enclave or mobile work crew where the assessment Job Coach Training Services (JCTS) takes place, the assessment is authorized at the approved daily rate. An assessment or” try out” should only be Some individuals may require intensive initial support, but completed if there is an opportunity for immediate will not require extended supports on a long-term basis. DRS placement in the general area being assessed or tried. developed a flexible model of Job Coach Training Services to
5. Usually the above defined hourly assessment is the meet the needs of those consumers. exception rather than norm. When completed, the Case Example transferability of findings should preclude the need for The following case example illustrates Job Coach Training further hourly assessments.

Services in Virginia: There should not be any job development hours billed as the Shelly is a 22 year-old woman who has a severe hearing enclave/mobile crew has already been established with impairment and is mentally challenged. She was referred to different jobs already defined.

DRS by her mother because of repeated difficulty getting or Entrepreneurial Model keeping a job. The longest period Shelly had worked, when she did get employment, was only two days.

A small furniture refinishing company was developed in the Richmond area. Eight supported employees work in the The counselor arranged to meet with Shelly and an business in a small industrial and office park. The employees interpreter. Shelly indicated through the interpreter that she performed all activities associated with furniture refinishing. was frustrated because employers said she was “too slow.” They worked under the supervision of a business manager and After diagnostic testing, Shelly’s eligibility for services was several other employees without disabilities, who were trained established. She and her counselor scheduled a vocational in intervention and natural support techniques. The supported evaluation to explore her job interests, aptitudes and skills. employees interacted with customers and other non-disabled individuals in the vicinity of the business. During vocational evaluation, Shelly demonstrated excellent In the Entrepreneurial Model, a small group of supported general worker traits and aptitudes for assembly and machine employees produces goods or services either on a sub-contract operation. However, she did have difficulty learning new basis or as a prime manufacturer. The individuals in the group, tasks, responding appropriately to change, and getting along with the managers and other employees actually oriented to her work environment. Shelly gave many comprise the business. Support services are provided by indications of being sociable, yet she tended not to associate managers and other employees without disabilities who are with others during evaluation. employed by the business. Supported employees interact with Shelly and her counselor agreed that she needed intensive the general public and other employees initial training at the job site, more intensive than an on-the-job-training (OJT) program would provide. Her counselor Selection of SE Models felt this would probably be too time-consuming for many Establishment of the various models of supported employment employers to provide. Yet, they both agreed that once in Virginia has largely occurred over the past 20 years. acclimated and trained in her new environment, Shelly would Recent developments have necessitated increasingly not need these or other support services beyond the first few sophisticated marketing techniques, job development months. activities, and support services. During this time, best practices have emerged, which guide practitioners in selecting An employment specialist who specialized in job site a particular model with an individual. accommodations participated in a problem-solving session to discuss intensive training strategies, orientation, and In all cases, selection and application of the models of integration issues. Everyone felt that Shelly’s training would supported employment should be adapted to meet the need of be effective if the job site were safe and accessible, and early the consumer. In determining the suitability of a model for a communication techniques with her co-workers and particular individual, the practitioner should consider the supervisor were developed. following: Shelly was interviewed with an interpreter present, and  What model will provide the consumer with the best subsequently hired by a major optical corporation as an opportunity for successful integration, reduction in Assembler and Machine Operator. The employment specialist, supports, and career advancement over time? (I.e., will with the assistance of the interpreter, provided one-on-one the individual demonstrate progress and “mature” from training to enable Shelly to develop speed and quality highly structured and visible support models to a model DRS Guide to Supported Employment and Job Coach Training Services Page 7

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production skills. The employment specialist also made illness may require developmental supports on a long-term adjustments to Shelly’s work environment to make it safer and basis. more efficient for her. Most importantly, the employment SUPPORTED EMPLOYMENT AS AN specialist helped Shelly to develop good work relationships and effective communications with other persons at the EVIDENCE BASED PRACTICE corporation.

Programs providing employment supports are a valuable Shelly no longer requires any support services. The resource for people with severe mental illness seeking rehabilitation counselor has successfully closed her case. competitive employment. Employment is a key component of Today, Shelly continues to have positive work relationships recovery. Individuals with severe mental illness who hold and competent production skills. competitive jobs for an extended period of time frequently experience a number of benefits, including improvements in Key Concepts their self-esteem and symptom control.

Job Coach Training Services include job development, job Effective employment programs targeting individuals with placement, job skill training, transportation training, and other severe mental illness emphasize encouraging interest and time-limited support services sponsored by DRS. Extended building confidence in working, getting a job consistent with support services are not provided on a long-term basis. The individual work goals, and retaining employment.

DRS counselor can authorize JCTS only when the consumer Employment services that follow seven evidenced-based does not require ongoing support services on an extended practices have proven successful in assisting people with basis beyond DRS case closure. severe mental illness in achieving and sustaining employment Therefore, this program does not meet the criteria of the outcomes. The following information summarizes these seven federal regulations for supported employment. The consumer key practices and provides additional resources on effective may be regarded as either “most significantly disabled” or employment supports for all individuals who need supported “significantly disabled” if the agency sponsors this service for employment, not just those experiencing severe mental illness. the consumer.

1. Participation in the employment program is Target Population based on consumer choice.

Studies and direct experience have shown that more True consumer choice requires access to the information cognitively and behaviorally impaired individuals require necessary to make an informed choice. Practices that more ongoing support services on an extended basis. For encourage informed consumer choice about employment example, a consumer who has multiple severe disabilities, no include: prior work experience, and little or no family support may be  Creating an atmosphere where anyone who chooses to an appropriate candidate for supported employment. By work can work. contrast, a consumer who is most severely disabled and needs  Asking consumers if they want to work as soon as they intensive initial training to learn a complex job or to increase enter the employment program. productivity, but who does not require extended services,  Promoting employment consistently and regularly as a could be provided with Job Coach Training Services or other positive, achievable outcome. appropriate services.  Encouraging consumers to talk about their fears and Counselor judgment, along with input from those most concerns about work and providing the assistance needed familiar with the consumer’s functional skills and needs, to address these concerns. should be utilized in determining the appropriateness of JCTS,  Building confidence by giving attention to each regardless of specific disability. Key questions to be asked in individual’s strengths and motivations. selecting this service option are: Programs that successfully promote informed consumer  What is the functional level of the consumer and choice take a systematic approach incorporating these anticipated need for supports? practices. These programs recognize that for individuals with  Is there a lengthy or consistent history of successful severe mental illness, consumer characteristics do not predict competitive employment? success in competitive employment. Gender, ethnicity,  What is the complexity of the consumer’s desired job diagnosis, hospitalization history, cognitive functioning, placement? education, or substance abuse history are not predictors of  What family, employer or other support systems already employment success. Instead, employment programs are most exist or could be developed? successful when they operate on the principle of “zero exclusion.” Anyone who expresses a desire to work and Persons with severe physical disabilities such as spinal cord makes an informed choice to participate in an employment injuries, cerebral palsy, or hearing impairments can often program is eligible. obtain and maintain employment without extended services.

For these individuals, rehabilitation engineering and JCTS For a variety of reasons, programs that use the zero exclusion may be more efficient and effective. approach do not assess consumers for work readiness using traditional methods, such as standardized aptitude tests. These Some persons with serious mental illness may require only assessment methods have in the past screened out consumers intermittent intervention and JCTS, as opposed to ongoing with mental illness at a high rate, including many who could extended services. Other individuals with serious mental successfully work, and take resources away from services that DRS Guide to Supported Employment and Job Coach Training Services Page 8

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could be better directed to helping people find jobs. Also, finding competitive jobs. From the moment a consumer most standardized assessment approaches do not actually begins the program, communicate a clear message that an predict which individuals will work. And finally, these integrated competitive employment outcome is the goal and assessments typically do not give information about what focus all employment services and supports on directly interventions to offer as a way to help consumers work meeting that goal. Avoid volunteer approaches or paid successfully. employment options that are not drawn from the competitive employment job market.

1. Employment supports are integrated with mental health treatment. 4. A rapid job search approach is used.

It is critically important for consumers with severe mental A rapid job search approach means that contact will be made illness that employment supports be integrated with any with employers within the first month after a consumer enters mental health treatment. Employment efforts are unlikely to the employment program. Most consumers with mental health be effective if the person is not receiving adequate clinical support needs prefer to work towards an employment outcome case management. Practices that encourage integration of instead of going through transitional preparatory activities. In employment services and supports with mental health fact, work readiness or other preparatory activities that delay treatment include: competitive work can actually reduce prospects for community employment. Practices focusing on a rapid job  Employment support team members are in close and search include: frequent contact with the mental health case managers.  Treatment plans and employment plans are coordinated  Providing direct assistance in job finding through job and mutually supportive. leads and active job development.  Treatment team meetings include the employment staff  Emphasizing on-the-job training with supports at the job and consideration of employment plans and issues. site.  Obtaining rapid approval from funding agencies for For integration of employment and mental health services to employment plans. be effective, there must be genuine collaboration and mutual problem solving. For example, medication or housing A rapid job search will not take place when there is limited changes should always be coordinated with employment coordination between the funding entity and the employment changes. If they aren’t, responsibility for follow-up becomes agency. Schedule regular staffing or case conferences to be unclear, and employment staff may be caught up doing crisis sure information is shared as necessary. The job search intervention, a role more appropriately fulfilled by case process will vary in strategy and timing from person to person. managers. However, established collaborative practices among key stakeholders in the job search process will help support a rapid Integration of employment and mental health services movement to employment. contributes to lower employment program dropout rates, because case managers are involved in keeping consumers 5. Job finding is individualized with attention to engaged. Clinicians and employment specialists report better consumer preferences. communication. Clinicians become involved and excited Job finding is a collaborative process between the consumer about employment, and the close working relationship and the employment support team. This process emphasizes between the clinicians and the employment team results in use of a consumer’s preferences, strengths, and prior work clinical information being a part of the vocational plan. experiences. Practices that focus on consumer preferences

1. Services are focused on competitive include: employment as the goal.  Working closely with consumers’ personal interests.

Individuals with severe mental illness have historically  Seeking jobs and workplace environments that match received services in day treatment or sheltered programs that individual preferences. focus on an array of rehabilitation activities, protected job  Helping individuals make informed choices about options, or short-term work experiences. However, disclosing the presence of a disability to employers. prevocational preparation, extended career counseling, or  Working closely with the consumer and employer on other work readiness activities do not effectively promote identifying and negotiating needed workplace competitive employment outcomes. In comparison, practices accommodations. that focus on competitive employment as the goal include: The collaborative process between the consumer and the  Targeting attention and resources on work as a goal from employment support team emphasizes job selection that takes the moment the individual enters the program. into account job duties, location, hours of employment, work  Stating the benefits of work and encouraging success. environment, and other factors related to satisfaction and  Avoiding spending time and resources on work readiness success in working. Job matching can include arranging experiences or extended periods of assessment. customized employment opportunities with employers through  Assuring that assessments occur rapidly and build on the job carving, negotiating job descriptions, or creating job desire and motivation of the consumer to seek work. descriptions. Consumers are much less likely to quit their In providing employment services and supports, it’s essential jobs if these initial positions are consistent with their preferences. In addition, consumers working in fields to devote resources and energy to assisting consumers with DRS Guide to Supported Employment and Job Coach Training Services Page 9

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consistent with their preferences have higher job satisfaction.

1. Supports are ongoing.

Placing arbitrary time limits on supports after a person is employed is very detrimental to employment success.

Practices that emphasize the continued availability of ongoing supports include:  Assisting individuals in discovering their true job interests by working in competitive employment.  Maintaining direct supports to consumers and employers (where appropriate to an employment plan) after obtaining work.  Assisting people with moving into new jobs as long-term job interests are clarified.

1. Benefits counseling is used to educate consumers on the effect of earnings on benefits.

Some individuals with significant disabilities receive disability benefits such as Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Many also receive benefits related to health care, housing and/or food assistance.

Benefits planning services are an important employment support. Practices that focus on benefits planning include:  Assuring that consumers have access to professional benefits counselors and understand the interaction between work earnings and disability-related benefits.  Addressing fully the many concerns individuals have about the potential loss of benefits after employment, fears that are frequently based on rumors and misconceptions.  Assuring that job plans (in terms of hours of employment, pay and benefits) are coordinated with benefit plans developed during benefits counseling.

The Social Security Administration has implemented a program called, Ticket to Work, to assist individuals with disabilities who receive SSDI and/or SSI. These services provide information and direct assistance on how benefit programs and work incentives interface with earnings from employment and self-employment. There is a list under the "Find Help" link on www.chooseworkttw.net.

Conclusion These seven principles establish a core framework for building an effective program of employment supports for individuals with severe mental illness. The principles have direct implications for employment service providers, agencies that purchase employment services, and consumers of these services.

Employment programs that follow these evidence-based practices will be more likely to effectively and successfully assist consumers with severe mental illness in meeting their employment goals. (The section on evidence based practices is from the April 2005 issue of T-TAP used with permission and published by Virginia Commonwealth University and the Institute for Community Inclusion University of Massachusetts, Boston).

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PART II

ROLES AND RESPONSIBILITIES IN THE INTERAGENCY SUPPORTED

EMPLOYMENT PROCESS

Roles and Responsibilities responsibility for communication, quality assurance and coordination throughout the SE implementation process.

The Rehabilitation Counselor Job Development The examples of individuals receiving supported employment services in Part I illustrate the important and various roles of During the job development process (usually in the “Service” the vocational rehabilitation counselor throughout the status, formerly Status 18), the rehabilitation counselor can interagency supported employment process. The counselor assist in many areas. Counselor involvement in the stage prior assists the consumer with setting goals, monitors their to placement (program planning from application to service) implementation by the consumer and provider/provider, will impact favorably on the efficiency and economy of the assesses consumer progress, and provides input to the provider job development process. It is very important that the job to insure quality services for the consumer. The counselor has match be developed for the particular employee. Factors to lead responsibility for planning and coordinating SE services consider in the process of matching jobs to prospective to ensure quality and successful consumer outcomes. consumers include the following: This counseling and coordination role continues after the job  Availability and type of supervision and supports placement phase as the counselor works in collaboration with available at the job; the provider providing services. The rehabilitation counselor  Transportation requirements and resources for the continues to play a monitoring role after case closure, consumer to utilize in meeting the work schedule; interacting with the provider of extended services.  Job responsibilities, production requirements, and degree General responsibilities of the rehabilitation counselor in the of independence in the position; and supported employment process include:  Hours of employment, work environment and work schedule.  Using informed choice as a way to assist consumers in choosing the most appropriate provider for services  Collaboration with consumers, family, community programs and service providers in the development and implementation of a supported employment rehabilitation plan;  Advocacy for the development and/or expansion of services and providers to meet the support needs of DRS consumers.

The counselor’s responsibility for coordinating SE services necessitates fundamental knowledge and skills. The counselor should draw upon his/her knowledge of the interagency process and resources. Examples of some of these areas include:  Knowledge of supported employment philosophy, regulations, and emerging service delivery techniques;  Skill in developing interagency collaboration and techniques for consensus building;  Skill in planning, delivering, and assessing services to consumers with most severe and/or multiple disabilities, including consumers with low-incidence disabilities (such as deaf-blindness), and those with newly recognized disabilities (such as traumatic brain injury);  Knowledge of state and local resources to aid in developing systems of natural supports in the work place and community for consumers and families; and  An assessment of the need for assistive technology.

Counselor Best Practices in Delivery of Supported Employment Services The DRS Counselor has the lead responsibility in choosing appropriate services, monitoring the quality of services and coordinating the “players” involved in the supported employment process. In monitoring service delivery and consumer progress, the rehabilitation counselor has lead DRS Guide to Supported Employment and Job Coach Training Services Page 11

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 Individual SE or JCTS cases. Changing to “Employed” Specific responsibilities of the rehabilitation counselor in the status (formerly status 22) after 60 days of stability for job development process include: cases served in an SE group model.  Providing sufficient funding of needed services;  Remaining an active part of the rehabilitation process  Assisting employment specialist with placement leads; including visiting the consumer on the job to ensure that  Providing guidance on appropriateness of potential leads the consumer and employer are satisfied as well as whether developed by consumer, employment specialist ensuring that appropriate services are being provided by or others; the job coach.  Providing specific direction, and coordinating and  Collaborating with the SE Provider in reference to Long-monitoring job development efforts of employment Term Follow-Along source. Approving Long-Term specialist; Employment Support Services (LTESS) applications  Problem-solving and planning workable strategies with before they are submitted by the ESO. Providing the employment specialist. expertise and input in utilization of LTESS dollars for long term follow-along.

Counselor responsibilities in promoting consumer readiness for employment include: Post-Employment Services  Providing the consumer counseling and guidance on In many instances consumers may need to be retrained, or appropriate interviewing and work behaviors; trained in a new job duty once long-term follow along services  Assisting the consumer and family in learning about begin. LTESS funds do not support training or retraining supported employment expectations; services, only services that provide job maintenance. If the  Assisting the consumer and family in understanding DRS case is closed the counselor may wish to consider Social Security Work Incentives (SSWI) and arranging funding the necessary training through post-employment and keeping appointments with the Social Security services. LTESS funds will continue to support the follow Administration, when applicable; along services while training services are funded by DRS. The  Communicating by phone and reviewing monthly written steps necessary to provide this service are outlined in the FRS reports to provide additional guidance and to request Policy and Procedures Manual. relevant information.

Employment Service Organizations Job Placement Providers of supported employment services include Specific counselor responsibilities in job placement (“Service” rehabilitation facilities; Community Services Board operated Status, formerly Status 18) include: programs, and both private non-profit and for-profit  Completing Work Opportunities Tax Credit (WOTC) organizations. In order to become a DRS approved provider, forms when applicable; the organization must submit for approval program  Arranging to visit the consumer on the job site with the manuals/curriculum guidelines among other required employment specialist; documentation for the service intended to be provided.  Arranging for staffing meetings to problem-solve as Applications also require written support of the local DRS necessary and communicating regularly with the job supervisor of the office that will be the purchaser of those coach and consumer; services. In addition, the provider must submit a Purchase of  Monitoring and providing information and assistance Service Application in order to determine the initial rates by regarding: wage and hour requirements, appropriateness the Field Rehabilitative Services – Support Team (FRS-ST). of placement, integration, number of hours worked, need Specific guidance may be obtained from the appropriate staff for adaptations, and offsite supports, e.g. transportation, member of FRS-ST. Forms may be found on the Virginia recreation/leisure services etc. DRS website, www.vadrs.org. Providers of employment services must also become a CARF accredited organization Job Training/Stabilization within a year of approval.

Specific responsibilities of the rehabilitation counselor during It is an absolute requirement for provider approval that the job training and stabilization include: applicant organization’s capacity and commitment to provide  Providing sufficient funding of needed services; ongoing support services be documented in writing.  Providing troubleshooting suggestions and monitoring The Rehabilitation Counselor and Employment consumer progress on vocational and related goals;  Remaining in close communication with job coach, Specialist: Working Together to Provide Quality employment specialist, consumer, and family, as Services appropriate;

One of the most important aspects of the rehabilitation process  Reviewing monthly written reports, maintaining is the relationship between the DRS counselor and the telephone contacts, amending the IPE as necessary employment specialist. The parties need to build a relationship built on trust and regular communication in order  Accurately recording status changes from “Service” to ensure that appropriate services are planned and provided to (formerly status 18) to “Employed” (formerly status 22) their mutual consumers. upon first day of starting paid employment.

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The employment specialist functions in the following roles: The employment specialist/provider will also provide billing, progress reports, and other data gathering instruments as  Assists consumer in job interviewing and job site outlined in the Appendix D of the provider agreement. Since orientation as needed. Assures with the counselor, that all LTESS applications must be approved by a DRS counselor, the following criteria are addressed: appropriateness of the employment specialist should obtain this approval and placement, community integration, number of hours of document it in the case file before the application is submitted. work as identified in the IPE, job site accommodations, off-site support services (e.g., transportation, family support, etc.). Arranges for DRS counselor to visit the consumer at the job site as appropriate; shares information on consumer progress.  Provides the consumer with job skill training and/or other support services as necessary and in a manner consistent with the IPE. Informs DRS counselor as to consumer progress, stabilization of consumer on job, and need for related services through monthly written reports and phone contacts.  Ensures consumer stability and satisfaction in job with provision of needed supports. Ensures satisfaction of employer with consumer performance. Jointly facilitate transition meeting with counselor to transfer consumer to extended services (long-term support). Informs DRS counselor as to consumer progress and provision of extended services.  Provides consumer with extended support services in collaboration with CSB case manager, DRS Counselor, other service providers, and family, as necessary to maintain job stability. Assists consumer in retraining for job upgrading or assists in continuing job stabilization.

The employment specialist has the following specific responsibilities in his/her role as the primary direct service provider of ongoing supports:  Implements systematic data collection and follow-along procedures to monitor consumer performance and progress;  Makes decisions regarding the need for skill or production training, compensatory strategies, behavior management programs, travel training, job site modification, and/or assistive devices;  Communicates with consumer, the rehabilitation counselor, family members or residential staff, and the funding representative;  Addresses concerns of the employer and co-workers;  Advocates on behalf of the supported employee and develops natural support systems within the workplace;  Coordinates schedules to respond to follow-along needs of the supported employee; and  Assists with job mobility and re-placement services.

The amount and frequency of supports provided by employment specialist are reduced following the initial training phase (fading). It is therefore critical that the employment specialist devises a method of ongoing assessment of consumer performance and employer satisfaction that utilizes input from a variety of sources.

Methods of evaluating consumer progress and determining intervention strategies include: periodic employee evaluations, progress reports, parent/guardian/caregiver feedback, onsite visits, and telephone contacts with employers and family members or other residential staff.

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PART III

USEFUL PRACTICES IN SUPPORTED EMPLOYMENT

The following section highlights a number of practices in information about the individual’s ability to function in an on-consumer assessment, program planning, case management, site job training program leading to supported employment; monitoring and quality assurance that can guide the need for on-going support services in order to perform rehabilitation counselor in the effective planning and delivery competitive work; and ability to work in an integrated of supported employment services. employment setting at the time of placement. Situational assessment for supported employment is distinctly different Assessment in Supported Employment from facility or center-based assessments and traditional As stated in the federal regulations, determination of eligibility vocational evaluation because it: for VR services must take into consideration the individual’s  Utilizes competitive work settings in the community to potential to benefit from supported employment services. The gauge consumer strengths and needs; counselor can often determine an individual’s eligibility for  Produces performance results consistent with the work VR services, including potential for supported employment, environment for which projections are being made; based on existing information. Such information would  Utilizes standard supported employment training include the consumer’s personal history, training and procedures on selected job factors. employment experiences, and other relevant information Observation of a consumer’s work performance in a contained in diagnostic and general evaluation reports. competitive work environment, particularly where multiple However, after gathering existing information, the counselor job sites are used to assess different vocational interests and might still have significant questions regarding the nature and objectives, can address key questions the counselor might scope of services needed and the best model for providing have about a consumer’s work characteristics, interests, skills, those services. abilities, and training needs. These key questions include: Using Vocational Evaluation Information  Does the individual seem to show a preference across job Vocational evaluation has traditionally provided the counselor types? with information regarding the individual’s eligibility for DRS  Does the individual work more effectively at specific services and feasibility for supported employment based upon times of the day? the “evaluate-place-train” model. Persons with most severe or  How long can the individual work without stopping for a multiple disabilities who were assessed using traditional break? normative or comparative work samples were sometimes  Does the individual respond positively or negatively to found infeasible for supported employment (and therefore, factors in the environment (noise, movement, objects, ineligible for DRS services) because of the severity of their people, and amount of space, etc.)? and limitations. Much progress has been made in the field of  To what types and frequency of prompts does the vocational evaluation in terms of considering an individual’s individual respond best? employment potential if provided with assistive technology If necessary, the counselor should identify additional areas of and other necessary support services. information needed about the individual consumer that can be A thorough vocational evaluation can yield valuable, addressed during the situational assessment, such as: transferable information that can be reported to the counselor a. Strength and endurance; and generalized to the community. The information can be b. Challenging behaviors; utilized in such a way that the consumer’s needs for supports, c. Mobility (e.g., transfer safety to autos) transportation, behavioral intervention, etc. can be identified, d. Transportation needs/skills (e.g., move about in the home especially if the counselor requests this specific information of and at the work site safely), training/assistance require; the evaluator. Integration of vocational evaluation, within the e. Functional application of academic skills (e.g., reading, supported employment process adds to the continuum of money use, telling time); services and can potentially decrease providered costs. f. Expressive and receptive communication skills.

Situational assessment is another tool that is available to the counselor in determining whether an individual with a most The counselor can purchase situational assessment from any severe disability can benefit from supported employment Employment Service Organization approved to provide the services. service.

Situational Assessment The Evaluation/Assessment Report In situational assessment, the individual completes work tasks Following the completion of the situational assessment, the in one or more competitive employment environments in the counselor will receive a detailed, informative report prepared community. A key question for deciding on a situational by the vocational evaluator or employment specialist (see assessment might be: “What impediments and strengths Situational Assessment report in Appendix D of Provider impact on the consumer’s success in the community?” Agreement and in back of this manual). SE providers are Situational assessment helps counselors and employment required to complete the SE Form 1 (Situational Assessment specialists to determine consumer preferences for particular Report) for situational assessments of DRS consumers. The job sites, as well as the specific types and level of supports information needed to be addressed on the form includes necessary. The situational assessment must provide assessment information required by CARF. The range and DRS Guide to Supported Employment and Job Coach Training Services Page 14

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scope of the written report, whether it is a vocational employment specialist; evaluation or situational assessment report, should be  Planned or projected date (or number of months) for sufficiently comprehensive to provide information concerning reaching employment goal; the following:  Description of ancillary services/support needed that will  Recommendations for a vocational goal; assist the consumer in obtaining and maintaining  Type and level of supports needed at the job site; employment (rehabilitation engineering services, Personal  Individualized training needed to acquire and maintain Assistance Services, clothing, medication, psychotherapy, acceptable production skills; physical restoration services, etc.);  Anticipated level of interventions that will be required by  Anticipated need for Post-Employment Services for the employment specialist; Supported Employment; and  Type of integrated work environment in which the  Review of possible need for Rehabilitation Technology or supported worker can potentially succeed; PAS services in conjunction with SE services.  Other information needed to develop an appropriate Supported Employment and Job Coach Training Services individualized employment plan, including the supported (JCTS) draw much of their effectiveness from the employee’s interest in doing the job, transportation to and individualized approach of their program options and funding from work, family support, and financial issues (i.e., wage that reflect the needs of the individual. Funding should always impact on Social Security benefits). be individualized to a consumer’s specific need and Supplemental Information demonstrated progress while receiving services.

The rehabilitation counselor should expand on the information Factors that impact program selection, length, being gathered by the evaluator or employment specialist and design are: through the situational assessment process by obtaining the following information:  Type and severity of consumer disability;  Residential setting involvement and implications for  Motivation and job skills of consumer; programming requirements;  Nature of service area (urban/rural) and employment  Family/caregiver support; market;  Disincentives to working in the community;  Viability of the vocational goal;  Effects of medication on functioning;  Experience and knowledge of counselor and employment  Need for Psychosocial supports; and/or specialist;  Consumer attitudes and preferences regarding work.  Effectiveness of interagency communication and cooperation;

IPE Requirements for Supported  Effectiveness of selection and planning committee in Employment monitoring progress and problem solving.

Counselors should develop intermediate IPE objectives based The rehabilitation counselor develops an Individualized Plan on their projection of the extent to which these factors impact for Employment (Appendix B) with consumer involvement on individual consumer progress. The counselor should and in accordance with the policies and procedures specified anticipate that the consumer’s rate of progression through the in the Virginia DRS Policy and Procedure Manual. Certain different phases of job development, job placement, training, specific information needs to be documented on the IPE etc. may differ according to the consumer’s disability. For developed for supported employment. Information that must example, data collected by DRS and VCU-RRTC on different be included on the initial IPE and/or subsequent amendments disability groups often generalize in the following ways: includes:  Description of the training program and the related  Persons with most severe physical disabilities and serious supports needed, including where, how, and when these mental illness may have more diverse vocational interests supports will be provided; and aptitudes, and therefore spend longer time in job  Identify the following: development than someone who has had little exposure to

1. The extended services that are required after DRS competitive work; terminates funding,  Persons with serious mental illness tend to have the
2. Why these services are needed, and lowest rate of job retention; although they obtain higher
3. Who will provide and fund the extended services wages in a wider range of types of employment, and (long term follow along); require the shortest duration of DRS sponsorship;  If the counselor cannot identify the provider of long term  For persons in supported employment who have serious follow along services at the time the IPE is developed, the mental illness, the type, timing and location of IPE must include a statement explaining the basis for interventions may differ from the types of support concluding there is a reasonable expectation that a source provided in supported employment to persons with other of extended services will be available. For example, disabilities. For example, current research indicates that “CSB funding is available in the individual’s community persons having serious mental illness can significantly to support long term follow along services;” reduce anxiety if supports are intensified 72 hours before  Specific vocational goal that has been agreed upon they enter employment; and between the consumer, rehabilitation counselor and  Persons with traumatic brain injury and dual diagnoses DRS Guide to Supported Employment and Job Coach Training Services Page 15

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require significantly higher on-site intensive must be based on the individual student’s needs, taking intervention by the job coach or DRS employment into account the student’s preferences and interests, and specialist than other populations. must include instruction, community experiences, the development of employment and other post-school adult Still, a caution may be important here: the individual’s living objectives, and, if appropriate, acquisition of daily characteristics and functional abilities must always be the living skills and functional vocational evaluation. determinant for goals, objectives and progress. Functional Transition services must promote or facilitate the abilities may be more predictive than the diagnosis. achievement of the employment goal identified in the In critically assessing SE services and invoicing, as well as student’s DRS Employment Plan. (2001 federal deciding to extend authorized hours on a particular case, the regulation 34 CFR § 361.5 (b)(55)). following is helpful to counselors: Student with a disability means those students with  The training supports and behavioral techniques used by disabilities who are receiving special education services the employment specialist should decrease the consumer’s and students with disabilities who are not receiving dependency on the employment specialist; special education services.  Supported employment services are designed to b. Unless otherwise noted, procedures for coordinating, significantly increase earnings, work-related benefits, providing, or paying for transition services shall be community integration, job security and mobility. These consistent regardless of whether the individual is components, and goals specified in the IPE, should be served by a local education agency, state operated utilized to gauge the success of the outcomes; and program, or through the Comprehensive Services  While the percentage of intervention time (and therefore Act. hours requested) may initially be high, counselors should c. Appropriate referrals, DRS policies and procedures see this intervention time decline as a measure of regarding application and eligibility shall apply. progress. (Approximately 50 percent of all interventions are provided during the first four weeks of employment; Planning for supported employment services with 66 percent during the first 12 weeks of employment; and secondary students should begin at least three years prior 90 percent in the first six months of employment.) The to the student exiting school, and should be consistent graph below illustrates this decline over time. with the educational programming for the student.

However, each consumer’s case should be reviewed for Related services including rehabilitation counseling services must be identified on the transitioning components of the IEP individual consumer needs. Services may be provided with as well as in the IPE. proper authorization and approval in compliance with the Virginia DRS Policy and Procedure Manual. Federal The student’s/consumer’s long-range goal or desired outcome regulations specify that the maximum length of time for which on the transition component of the IEP should be supported SE services may be authorized is 18 months from the time of employment. If a student needs a particular related service in job placement, unless the IPE is amended based on the order to benefit from special education services, the related consumer needs. The length of actual time for authorizing SE service professional should be involved in developing the IEP. services should be based on the individual needs and progress The professional may be invited by the school or parent to join of the consumer. Exceptions to the 18-month limit require the IEP team as a person “with knowledge or special signatory approval from the Regional Director. expertise” about the child. __________________________________________________ Additional guidance on transitioning services for school Additional IPE and IEP Requirements for students is found in Chapter 8 of the Virginia DRS Policy and Secondary Students Procedure Manual.

DRS recommends that students and their families begin to __________________________________________________ make transition plans at least three years prior to exiting school. Additional IPE Requirements for Evidence Based Supported Employment for persons with Chapter 8 of the Virginia DRS Policy and Procedure Manual states: Serious Mental Illness  Eligibility for Transition Services The most effective method in arranging support services for persons with serious mental illness is a team approach. DRS a. Definitions. sponsors vocationally oriented services to eligible consumers Transition services mean a coordinated set of activities for to seek, secure, and maintain employment. The consumer a student with a disability designed within an outcome- may, in addition, need therapeutic, residential, financial, and oriented process that promotes movement from school to social supports like those provided concurrently by the post-school activities, including post-secondary clubhouse and the CSB. education, vocational training, integrated employment  Evidence Based Supported Employment and support (including supported employment), continuing and adult services that are jointly planned and provided to persons education, adult services, independent living, or with serious mental illness by DRS, the CSB, and community participation. The coordinated set of activities clubhouse should be documented on the IPE; and DRS Guide to Supported Employment and Job Coach Training Services Page 16

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 The IPE should specify responsibility for services funding must be completed and approved by the provided both at the job site and off-site, as needed. counselor before case closure.

Criteria for Assessing Job Stability and For persons in group models, “stability” is defined as the completion of a 60 day period in which intervention is Closure directed at maintaining a level of production and not at major barriers to successful integration into the job site. In other As the monthly progress reports and other measures of the words, the job coach/trainer is devoting the majority of time consumer’s progress indicate a reduction of intervention by addressing training issues rather than behavioral issues. The the employment specialist (fading), the DRS counselor should consumer is meeting a level of production that is acceptable to monitor closely for indications of job stability. Services should the employer (either the business or ESO itself). In addition, then be geared toward maintaining production. “Stability” in since an enclave/mobile crew supervisor is on-site at all times, employment is determined by the counselor, consumer and job intervention, (for the purpose of reporting on the SE coach once the following conditions are met.

Placement and Training form), is calculated at 100%. Once Indicators of job stability are: the placement and training services are no longer being provided, the case may be successfully closed once they have  Funding for extended employment has been secured. been employed for 90 days. (LTFA Services have begun) __________________________________________________  Job coaching and related interventions have decreased to a level necessary to maintain the client Specific Counselor Responsibilities in Delivery of SE in employment. Intervention has reached a plateau or Services leveled out. In some cases, the amount of Monitoring consumer progress towards job stabilization intervention (i.e., time) onsite may not have involves active participation by the counselor in obtaining decreased but the nature of the intervention has information necessary to understand changes in the evolved to primarily maintenance. intervention schedule. The fading process is at times  Client is emotionally or behaviorally stable. interrupted by more training and/or problem-solving that  Client performs expected job duties. requires a more intensive intervention at the work site by the  Supervisor reports satisfaction with client’s job employment specialist. In such an event, the counselor should performance. arrange for a staffing with the employment specialist and  Client is satisfied with the job and work environment. consumer if the consumer’s progress seems questionable. The  Necessary modifications and accommodations have purpose of the staffing would be to problem-solve (and further been made at the worksite. determine whether continuation in this employment position is  Client has reliable transportation to and from work. appropriate). Studies have shown that the greater the amount  Client is compensated at or above minimum wage but of communication between counselor and consumer, the not less than the customary wage paid by the greater chance the consumer has in succeeding on the job. In employer for the same or similar work performed by addition, the counselor should make every effort in visiting the people who do not have disabilities. consumer on the job to ensure that services are appropriate  For persons in the individual placement model, the and that the consumer and employer are satisfied. average intervention time by the job coach has reached a The rehabilitation counselor concludes funding of supported maintenance level of support. The client/employee’s employment services when the consumer is stable in needs have leveled off. employment. It is important that the consumer be given the  In the individual model, once the consumer has been opportunity to demonstrate a clear pattern of “leveling” of job placed in employment, the DRS counselor moves the case coach intervention. Again, in the individual model, while this from “Service” status to “employed” status based on the may be less than 20 percent of the weekly hours in start date of the job. After 90 more days of employment, employment for at least 30 days prior to the movement of the the case is eligible for closure and can then be case to DRS status “working”, in specific cases, the successfully closed, if stability has been reached and all percentage of time may be more. This may be the case after 30 requirements are met for “Closed-Rehab” criteria. days or may be extended longer, as needed, dependent on the  Once the case reaches stability, long term follow along individual consumer and job performance. The counselor funding begins. At this point, the DRS counselor should should have firm documentation that the consumer is stable in not fund any placement and training services unless more employment prior to DRS closure and initiation of funding for services are needed for job training. Employment extended services. maintenance services should be supported by long term follow along funds at this point, not DRS case service Long-Term Follow Along/Extended Support funds. Services  Because the case must be in “employed” status at least 90 days before closure, long term follow along funding may Extended support services, often referred to as long-term or may not begin before case closure depending on the follow-along, commence upon stabilization in employment. length of time the consumer needs placement and training For all populations these services consist mainly of ongoing services before reaching “stability”. However, the job based support provided throughout the term of application for long term follow along such as LTESS employment to enable the individual to maintain employment.

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The DRS counselor has a responsibility for participating in the planning and delivery of extended support services. It is important that the DRS counselor remain informed during the delivery of extended support services for the purposes of documentation, and evaluation of services In terms of best practices, this includes remaining informed of the consumer’s progress and job status following case closure.

While the DRS case is still open, the counselor should maintain direct contact with the consumer at and away from the job site and also receive the Ongoing Services Form (SE FORM 4) from the beginning of long term follow along until case closure from the employment specialist describing employer satisfaction and services being delivered.

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PART IV

AUTHORIZING THROUGH USE OF SERVICE ITEM NUMBERS,

IMPLEMENTING EXPENDITURE THRESHOLDS AND AGENCY FUND

CODES

Service Item Codes Authorization of Services

This section describes how the counselor authorizes services This section covers provider reporting expectations and using appropriate computerized coding information authorizing guidance for counselors. This information is and funding criteria. Various Service Item Numbers are consistent with Appendix D, the evaluative and reporting available to counselors when authorizing services sections of all supported employment provider agreements. within approved programs of SE, JCTS, and TEP. Applicable These agreements are renewed annually. The information is Service Items, which are listed in the Virginia DRS Policy also consistent with the Virginia DRS Policy and Procedure and Procedure Manual, are identified and described below: Service Item Numbers Service Item Codes A5132 JCTS Job Development Services A5101 SE Job Development Services A5134 Individual JCTS Placement and Training

A5103 Individual SE Placement and Training Manual. Please refer to the Appendices at the end of the Guide for examples of reports.

A5105 SE Group Placement and Training A5117 Entrepreneurial SE Placement and Training Counselors should reference the DRS Training and Facilities Manual or the Employment Services Organization Directory Supported Employment Services on the DRS website to determine: Definition: These services are for persons who (a) have  Approved providers for supported employment; most severe/significant disabilities and who have three or  Specific, detailed program descriptions; and more significant functional limitations; (b) who need multiple services over an extended period of time (c) will require post-  Provider rates. closure follow-along support and funding in order to maintain employment; and (d) will be employed in job sites that meet Situational Assessment the federal criteria for integrated settings.

Past statewide data indicate that an average supported Situational Assessment employment assessment is 16 hours. Included in this averaging of hours is face-to-face contact with the consumer, Definition: A service that utilizes competitive work settings, writing reports, and time transporting the consumer to the job and not a facility-based setting, to gauge the strengths, sites. This is an average and should not limit consumers deficits, and support needs of persons being considered for receiving services that require more than 16 hours of supported employment. This service produces an assessment assessment time. of performance consistent with the environment for which authorization projections are made. Following the completion of situational assessment the counselor will receive a detailed, informative report prepared Service Item Number by the vocational evaluator or employment specialist.

Components of the assessment which give rise to the data used A6320 Situational Assessment — Individual in the written report include: number and type of work sites, A6322 Situational Assessment – Group – Daily Rate types of jobs performed, number of hours per work site, and types and extent of training prompts utilized. The range and (Daily rate for enclaves and mobile work crews) scope of the written report, whether it is a vocational A6321 Situational Assessment- Group Hourly Rate evaluation or situational assessment report, should be sufficiently comprehensive to provide information concerning Job Coach Training Services (JCTS) the following:  Type and level of supports needed at the job site;

Definition: Services for persons who have severe disabilities and who need short-term, intensive on-site training  Individualized training needed to acquire and maintain by a job coach. These services do not constitute supported acceptable production skills; employment for coding purposes and should not be coded as  Anticipated level of interventions that will be required such on DRS closure forms because (a) the individual is not by the employment specialist; targeted for extended services after DRS case closure or (b) the job site does not meet the federal criteria for supported  Integrated work environment in which the supported employment. worker can potentially succeed; and DRS Guide to Supported Employment and Job Coach Training Services Page 19 [TABLE 19-1] Service Item Numbers A5132 JCTS Job Development Services A5134 Individual JCTS Placement and Training

[/TABLE]

[TABLE 19-2] Service Item Codes A5101 SE Job Development Services A5103 Individual SE Placement and Training A5105 SE Group Placement and Training A5117 Entrepreneurial SE Placement and Training

[/TABLE]

[TABLE 19-3] Service Item Number A6320 Situational Assessment — Individual A6322 Situational Assessment – Group – Daily Rate (Daily rate for enclaves and mobile work crews) A6321 Situational Assessment- Group Hourly Rate

[/TABLE]

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 Other information needed to develop an appropriate  Type and level of training; individualized employment plan, including the supported  Adaptations for employment site; employee’s interest in doing the job, transportation to and from work, family support, and financial issues (i.e., wage  Strengths/Concerns/Proposed Solutions; impact on Social Security benefits).  Intervention hours utilized (current month);

The ESO is responsible for developing sites for situational  Intervention hours requested (next month); and assessments. Generally, the DRS counselor does not pay for the time spent in developing a site. However, for consumers  Degree of job stabilization achieved to date. that may require a site with narrow specifications that is not Service Authorization easily found in the community, the DRS counselor may negotiate with the employment specialist the hours needed to Currently for job development and placement and training develop such a site. This should only occur rarely and on an services, DRS counselors use a “zero balance” method in individual basis. In addition, the ESO is required to have authorizing and tracking services. In other words, based on sufficient liability insurance for covering the consumer on the negotiations with the employment specialist, the counselor SA site. authorizes a specific numbers of hours for services each month. If the hours are not used, the remainder is canceled Job Development and reauthorized for the following month. If more hours are need than originally authorized, additional hours are The length and the cost of pre-placement authorizations are authorized by the counselor after negotiations with the job dictated by specific consumer goals as stated in the IPE, and coach. the planned strategies developed by the counselor, consumer, _________________________________________________ and employment specialist. The number of hours needed to Expectations Governing Billing and Reporting develop a supported employment placement will vary. The counselor should request and obtain progress information Employment specialists provide brief monthly written monthly from the employment specialist during the job progress reports on each consumer. These reports, available development process through written reports containing the on the DRS website, should accompany monthly invoice following: sheets. Counselors may ask to review intervention sheets or  Name, number and type of employers contacted; case notes. Situational Assessments requires the use of SE Form 1. Job development requires the use of SE Form 2.  Job development strategies applied; Placement and Training requires the use of SE Form 3.

Ongoing Services require the use of SE Form 4. General  Job development hours utilized; billing activities can be divided into four categories:  Potential placement possibilities or outcomes expected;  Work site activities - includes travel, training and and intervention with consumer, employer, and employees at  Additional job development hours requested for the work site. In certain situations billable travel following month. time may be negotiated between the DRS counselor and the ESO. An example is: in some Placement and Training parts of Virginia traffic results in higher travel Counselors should review each consumer’s needs and times. This may be a time when billable travel authorize services accordingly. However, federal regulations time is negotiated. prohibit counselors from authorizing these services for longer  Job development activities - includes consumer than 18 months from the time of job placement, unless the IPE specific job development with employers, supervisors, is amended based on consumer needs. It should also be noted and other personnel for purposes directly related to that the approval by the Regional Director is needed to extend employment. services beyond 18 months. It is important that the counselor closely monitor consumer progress.  Off-site activities - includes training in transportation, money handling, and advocacy for persons not directly During the period of DRS authorized services, the affiliated with the work site. employment specialist must submit monthly reports of consumer progress to the rehabilitation counselor along with  Assessment/Report Writing - includes provision of invoices for services provided. The reports needed for situational assessment services and all task analysis, Situational Assessment, Job Development, Placement and training and progress report writing.

Training and Ongoing Services are all found on the DRS DRS pays only for the actual time spent providing services. website. The counselor should document the need for For example, phone calls to consumers are not to be billed at reauthorizing additional services based on counselor an artificial minimum time but for the actual time talking to observation and the monthly reports containing the following the consumer. Likewise, services are to be prorated when information: appropriate. For example, if an employment specialist visits  Original employment objectives; an employer and discusses four consumers, then the cost of that visit is divided by four and the appropriate portion is  Job description and worker responsibilities;

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reflected in each consumer service billing. employment. Job training or retraining are not considered job maintenance services so these services are not to be billed to Non Billable Services LTESS funds. Likewise, case management, independent DRS consider administrative functions of the employment living or other services that are not vocational in nature should specialists and ESO management as non-billable since time not be billed to LTESS funds. Per the Code of Virginia, spent in these functions are factored into the ESO’s hourly LTESS funds are not appropriated by the General Assembly to rates. Examples of administrative functions are as follows: fund those services.  Time spent by ESO management supervising employment __________________________________________________ Job Loss and Job Upgrade after DRS Case specialists, consulting with them about cases and performing internal case reviews.

Closure  Time spent completing and sending a request for service When a consumer loses a job (especially when it is not their hours. fault, for example, due to layoff), the rehabilitation counselor should take a new referral if substantial vocational  Time spent in preparing a bill (not a report) for services. rehabilitation services are required. Supported employment  Time spent in marketing ESO services. services can be re-initiated for a former consumer in instances of job destabilization or potential upgrade. A consumer need Explanation of Fund Codes not lose their job before receiving additional intervention or job development services.

Various Agency Fund Codes are applicable to authorizing SE, JCTS and TEP services. Primary Agency Fund Codes and Availability of Long-Term Follow-Along Services their appropriate use are as follows: This section describes traditional and innovative methods of

1. SE Funds: Use this Federal Title VI-B supported securing funding for long term follow along services. employment funds to purchase direct and ancillary services for persons who meet all of the criteria for Utilization of SE by DRS counselors occurs primarily through supported employment. fee-for-service agreements with provider agencies such as rehabilitation facilities; Community Service Board operated
2. Basic VR Funds: Use this code only after all SE Fund programs, agencies specializing in supported employment, job codes are fully encumbered or otherwise unavailable. coach training services and transitional employment programs.

The counselor should use Basic VR Funds in authorizing Job Agreements with provider organizations involve the following Coach Training Services when there is a need for short term funding arrangements: intensive on-site training and the consumer will not require

1. DRS purchases job placement and intensive job site post-closure follow-along. training and support (commonly referred to as DRS time LTESS (Long-term Employment Support limited services) until the supported employee is stable in employment; and Services) Funds
2. An agency other than DRS purchases or provides support In 1994, members of VA ACCSES approached the General services designed to maintain the worker in employment Assembly requesting funds for long-term follow-along after completion of DRS funding. services. The organization cited specific numbers of consumers across the state of Virginia in need of support for Some funding sources for long term follow along services in both long-term follow-along in Supported Employment and supported employment are disability specific. For persons long- term follow-along for Extended Sheltered Employment with serious mental illness and mental intellectual disabilities, Services. LTESS funds are not disability specific in that it services may be funded or provided directly by the local CSB. may support long-term follow along services for any Practitioners of supported employment services nationwide consumer that is regarded as having a most significant are utilizing increasingly diversified funding sources to disability by DRS. Funds have been appropriated annually provide monetary support for extended services. As noted since that time. Employment Service Organizations approved above, in Virginia the primary sources of funding for extended for SE and EES (facility based) services were given equal services are the CSB converted day activity funds. Some portions of the total appropriated to be used for long-term examples of other potential funding sources being developed support. Reallocations in subsequent years have been and utilized in Virginia and/or nationally are listed below: determined in a variety of fashions, including based on utilization in previous years. The Division of Rehabilitative Services was identified by the General Assembly as the  Social Security Incentives: Plan to Achieve Self Support administrative agent. By policy, all LTESS applications (PASS) and Impairment Related Work Expense (IRWE); should be approved by a DRS counselor and the approval Ticket to Work (TTW) documented in the consumer’s file prior to submission to the DRS Office of Employment Services and Special Programs.  SSA Ticket to Work LTESS funds support ongoing vocational support services that  Employer, consumer, family contributions; are necessary and sufficient for consumers to maintain DRS Guide to Supported Employment and Job Coach Training Services Page 21

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 Provider/facility (ex: production or donated goods are also demonstrating cost reduction. This cost reduction revenues); increases the longer the person remains employed.  Local public funds; Natural supports occur when individuals other than the job coach (for example, co-workers, supervisors, parents, bus  Private Insurance carrier reimbursement; drivers, or significant others) provide needed and appropriate supports. The employment specialist often interacts in more  General State revenues; of a consultant role by teaching others appropriate and  Charitable/Foundation funds (i.e., United Way). sensitive intervention, support functions, and monitoring those supports.

Natural supports are a rapidly developing strategy for increasing consumer involvement and inclusion. Pilot studies

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PART V

SOCIAL SECURITY WORK INCENTIVES AND

SUPPORTED EMPLOYMENT

Program Description (For 2015) resource tests. Earned income, however, may go above the initial eligibility level and the individual For the purpose of this information, it will be assumed may continue eligibility. that the reader has the basic knowledge of the Social  Medicare is associated with SSDI and is administered Security Administration (SSA) disability benefit by SSA. programs and their respective eligibility and continuing eligibility requirements. For a more complete description  Medicaid is associated with SSI and, in Virginia, is of SSA eligibility requirements, see the SSA publications: administered by Social Services.

Understanding SSI, A Guide to SSI for Groups and  The SSDI benefit amount is determined by the extent Organizations, Disability and the Red Book on and frequency of past earned income on which Social Employment Support. Also, information may be Security taxes were paid, sometimes referred to as obtained at “the work site” at www.ssa.gov/work and the FICA tax. The more one earns (or was earned by the Red Book site at www.ssa.gov by looking under person through whom a person qualifies), the higher “Disability” then “Publications.” Please review the the monthly benefit amount. information contained in the Red Book regarding Subsidy, Impairment Related Work Expenses, Earned  The maximum SSI amount for which an individual or Income and General Income Exclusions, 1619 (a), 1619 couple qualifies is called the Federal Benefit Rate (b), and PASS procedures for complete and thorough (FBR). The maximum FBR depends on the explanations of those incentives. This chapter is meant to individual’s marital status and living arrangements. serve as a guide, not as definitive explanations. The SSI benefit check amount is based on the Earning a wage will impact beneficiaries of the Title II individual/couple FBR which is reduced by the Programs: Social Security Disability Insurance (SSDI) or amount of his/her countable income. and Childhood Disability Benefits (CDB) and recipients Work Incentives of the Title XVI Program-Supplemental Security Income (SSI) - differently. It is suggested that any person wishing People currently receiving Social Security Disability to assist themselves or others be familiar with the basic Insurance (SSDI) and/or Supplemental Security Income effects and rules of earned and/or unearned income on the (SSI) have various work incentives that are designed to benefits of these programs and how these programs assist them in obtaining or returning to gainful overlap for individuals who are, or can become, eligible employment. These work incentives are complex and can for both. It is also suggested that you work with the overlap, depending on the individual, their needs, and/or individual’s Social Security Employment Support their occupational goal.

Representative or a claims representative whenever rendering advice on SSA regulations to validate that The following outlines the utilization of work incentives advice. The following are definitions of the Social for those individuals who choose to work and earn Security disability programs. income. Again, the practitioner must have a thorough understanding of the effects of work on SSDI and SSI,  SSDI/CDB are entitlement programs for individuals and of the continuing eligibility criteria for each of these who have either worked for enough time paying programs. This information must be validated through Social Security taxes or who receive a benefit from the individual’s SSDI/SSI Employment Support or claims their parent/legal guardian who paid Social Security representative(s) and fully communicated to the taxes. individual and family members prior to placement and prior to using the work incentives.  CDB is a benefit received by an individual who became disabled before age 22 and who has a All information given is assuming that the individual parent/step-parent who earned SSA benefits who is receiving SSDI and/or SSI has not medically recovered now deceased, retired, or disabled. Individuals must and would meet and continue to meet all eligibility meet earned income and disability tests for eligibility guidelines for the program under which that work and continuing eligibility. SSDI and CDB will be incentive falls (SSDI/SSI). referred to as SSDI in this text.

Social Security Disability Insurance  SSI is a program based on financial need and disability. Individuals must meet disability, earned If an individual who has received only Social Security and unearned income and resource tests for Disability Insurance (SSDI) for more than one year goes eligibility. For continuing eligibility individuals must to work the following applies. continue to meet disability, unearned income and DRS Guide to Supported Employment and Job Coach Training Services Page 23

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Trial Work Period (SSDI) months under SGA and not receive it for the months over.

The end of the EPE is determined by the individual’s When the individual becomes SSDI eligible the earned income and use of work incentives and may last beneficiary begins a Trial Work Period (TWP). longer than the minimum of 36 months (this is a brief Technically this is not of concern until the individual explanation). If an individual has had an SGA cessation begins paid work. This period consists of nine months and is earning over SGA the 36th month, then he/she (not necessarily consecutive) during which there is no would be terminated from SSDI eligibility the 37th month limit on the amount of earned income and therefore if earning over SGA. Medicare continues through EPE benefits continue. periods. Medicare coverage will last at least 93 months For every month earned income exceeds $780 (for the after the Trial Work Period ends. year 2015) or you work more than 80 self-employed Subsidy (SSDI) hours in a month, a TWP month is counted. You continue counting these TWP months until the individual has A work incentive, which has direct ties to supported worked for nine months earning over $780/month (within employment, is subsidy. Additional training, support, or a 60-month period of time). For example, you locate a supervision supplied to an individual by the job coach, a position for an individual entering data onto a computer. volunteer, or employer that is above and beyond that He works five months earning $800 per month (this supplied to an employee in a similar position without a amount is more than $780 and therefore each month is disability is a subsidy. counted as a TWP month). For the next three months contract work is low, hours for new workers are reduced, A subsidy is calculated by the additional time in hours per and he earns $195 per month (these are not TWP months). month these “extras” are given multiplied by the wage of the supported employee. This amount is not counted in The workload increases and for the next four months he the SGA determination. A subsidy may enable an earns $900 per month (these are TWP months). He has individual to become eligible for SSDI (not working or completed his TWP with nine months of earned income working but earning less than SGA). over $780/month within any 60-month period of time. He received his SSDI check for the entire 12 months he was Many supported employees have unnecessarily lost their in the TWP. Work incentives are not applicable during SSDI benefits because subsidy was not claimed or the trial work period. verified by the job coach or employer.

Grace Period There are other subsidies where employers may incur additional expenses in supporting an individual on a job The grace period begins upon completion of the TWP in through providing supervision or services, allowing a the first month where an individual earns more than slower rate of speed or fewer duties, and/or purchasing substantial gainful activity. The grace period is completed items to accommodate the individual. when a person earns more than gainful activity for three Impairment Related Work Expenses (IRWE) months (not necessarily consecutive) following the TWP.

The individual is entitled to their SSDI for these three for the SSDI Beneficiary additional months following the TWP regardless of Like subsidy, Impairment Related Work Expenses earnings. (IRWE) can be used in the SGA determination that may Extended Period of Eligibility (SSDI) enable an individual to remain in the EPE and avoid a premature SSDI eligibility termination. Impairment After an individual has used his TWP, the next month he Related Work Expenses are expenses incurred by the enters the Extended Period of Eligibility (EPE). The EPE individual with a listed disability that enable him to work. lasts for a minimum of 36 months. During this time an They must be paid by the individual in a month in which individual may have a benefit cessation which is based on he is working and not be reimbursed by any other source. a minimum of three months of earned income averaging IRWEs are frequently used when an individual needs to over Substantial Gainful Activity (SGA), in 2015 usually purchase SE extended services. over $1,090 per month for individuals with disabilities other than blind. (SGA for SSDI beneficiaries who are For the SSDI beneficiary, paying for some of his own SE blind is $1,820.) services out of his earnings may enable him to continue to receive his benefit. His SSDI benefit amount does not Once a benefit cessation has occurred during the EPE, an change; he either receives it all or does not receive any. individual will qualify to receive SSDI benefits only in months where earned income is below SGA. Reporting Reporting and documentation for proof of IRWE payment earnings and applying work incentives is mandatory to must be provided to SSA in writing with a record kept of avoid over/under payments during this time and this the report being sent. Agencies need to establish policies reporting should be in writing with copies kept. for cost-sharing or other methods to fund services and billing/collection procedures to enable individuals to have When reported earnings fluctuate between over and under a stake in ownership of services SGA the individual should receive the benefit for the DRS Guide to Supported Employment and Job Coach Training Services Page 24

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Additional IRWE examples frequently used are payments 1619(b) is an important link to the SSI system. If your SSI for special transportation for individuals who cannot drive cash benefits were to stop due to your earned income or use public transportation; medications required to (wages) or a combination of earned and unearned income, control or alleviate a disabling condition; or payments for you will still be considered an SSI recipient as long as assistive technology devices. The SSA publication Red you would otherwise be eligible for benefits if not for Book on Work Incentives contains an extensive section your income. Usually, SSI benefit eligibility will on various items and services that are/are not deductible terminate if you do not receive a cash payment within a as IRWEs. twelve (12 ) month period. Because you would be otherwise eligible for benefits if not for your income, your Supplemental Security Income (SSI) cash benefits can be reinstated without a new application Work Incentives if your income falls below SSI levels. In addition, 1619(b) will protect your Medicaid eligibility even if you are not Unlike the SSDI Program (where the working individual eligible for a cash benefit. You must meet the following receives all or none of the SSDI benefit amount criteria to qualify for 1619(b). depending on earned income), in the Supplemental

1. Still have a disability Security Income (SSI) Program, the SSI benefit amount is calculated on a formula through which a person’s SSI is 2) Need the coverage to pay expenses that allow you to (usually) gradually reduced or increased in accordance work with decreases and increases in other income.
2. Accumulate no more than $2000 in resources Each year the Federal Benefit Rate (FBR) is established
3. Earn less than $34,543 gross per calendar year (2015 January 1, which is the maximum amount the figure). Some people can still qualify using an individual/eligible couple may receive in their benefit. individualized threshold if they have high medical The maximum SSI amount is determined by the expenses individual’s marital status and living arrangements. To remain eligible for any work incentive program, the 5) Have been eligible for SSI cash benefits for at least individual must remain eligible in all ways for the SSA one month program under which those work incentives fall. SSI Eligibility for 1619(b) must be screened and approved by individuals who later qualify for CDB or SSDI may lose the Social Security Administration (SSA) and the SSI eligibility entirely if they qualify for this and/or Department of Social Services (DSS). another unearned income benefit which is at an amount too high for eligibility. (SSI recipients with a parent (or a Subsidy (SSI) second parent) approaching retirement or who become disabled or deceased, need to be aware of this.) The Subsidy applies to the SSI program only in assisting in following applies: establishing initial eligibility- working but earning less than Substantial Gainful Activity (SGA) for individuals Earned Income and General Exclusions (SSI) with disabilities other than blind. (SGA does not apply to SSI individuals who are blind.) Subsidy is determined for For individuals with no unearned income, the first SSI in assisting with eligibility in the same manner as for $85/month of earned income does not reduce their SSI SSDI. benefit amount. If an individual has unearned income such as SSDI, the first $20 of unearned income is excluded and the first $65 of the earned income is excluded. The earned income remaining after the earned income exclusion is subtracted is divided by two, thus for every $2 earned by the SSI recipient, the benefit amount is reduced by $1.

The balance of the countable earned income and/or unearned income after exclusion(s) is then subtracted from the individual’s FBR to determine the SSI benefit amount. An individual’s SSI benefit amount may fluctuate from zero up to the Federal Benefit Rate for which they qualify. Reporting of earned and unearned income to the SSI claims representative is necessary to avoid over or under payments. (For persons who also have SSDI, a report must also be made to that claims representative.) 1619(b) (SSI) DRS Guide to Supported Employment and Job Coach Training Services Page 25

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Impairment Related Work Expenses (IRWE) It is important to remember that once the occupational for SSI Recipients goal is achieved then the PASS is terminated. Therefore, it is always important to include a goal of anticipated The definition of Impairment Related Work Expenses achievement/independence to be reached prior to the (IRWE) for SSI is the same as for SSDI. The difference is conclusion of the PASS. The PASS is time limited and in the effect its use has on the SSI benefit amount because must be related to helping the individual achieve a of the manner in which the SSI benefit is calculated. The specific occupational goal. amount of the IRWE is excluded from earned income In the SSI calculation, an SSI pre-approved PASS amount only, after the exclusion(s) are subtracted and before the of earned and/or unearned income is excluded when balance of earned income is divided by half. determining the SSI benefit amount. (Resource amounts In effect, the individual’s SSI benefit amount can be to be included are a separate calculation for SSI increased by up to 50 percent of the cost of the IRWE — eligibility, however, are written into the PASS formal up to the individual’s FBR — the net effect of an up to 50 plan as planned expenditures.) A PASS can be set up to percent reimbursement of these costs by SSI. save or use money monthly to purchase something outright, and to make monthly installment payments, IRWE expenses must be reported and documentation of and/or to pay off a loan. payment must be provided to SSA. IRWEs are not time-limited and may be used as long as required by the PASS plans are very flexible and can pay for almost individual because of his/her disability to maintain anything related to an occupational goal. Remember: employment.

1. A PASS candidate must have resources or source(s) Plan for Achieving Self Support (PASS) (SSI) of income other than SSI. He cannot use SSI money in a PASS.

The Plan for Achieving Self Support (PASS) (or more self-support) is a work incentive that is exclusively 2. A PASS candidate must receive or be eligible to associated with SSI. Individuals must be eligible for SSI receive SSI [Unearned income or resources used in a (excluding the resources and income to be put in the PASS or IRWE expenses (included in the working PASS). However, an individual that receives SSDI may individual’s PASS and/or excluded from earned become eligible for SSI through the use of a PASS. The income) or Subsidies may enable the recipient to recipient should discuss this with their SSA Employment become eligible for SSI].

Support Representative. Subsidies and IRWEs may assist

1. A PASS (unless also meeting the definition of an in meeting the earned income eligibility requirements for IRWE) does not change SGA earned income SSI. The PASS is a way for an SSI recipient to achieve an guidelines associated with SSDI for persons on occupational goal that requires money for services or SSI/SSDI. items. PASS plans must be written and formally submitted to and approved by SSA before they can be 4. A PASS does not change income and resource used. SSA’s goal for a PASS is to encourage the recipient guidelines associated with SSI, other than excluding to become less dependent on SSI benefits. money designated for the PASS, only during the term of the PASS. (If unearned income is too high at the An individual may write a PASS for a vocational end of the PASS or if resources designated are not evaluation or situational assessment to determine a used during the PASS so that the person is above the feasible occupational goal. They may be written to pay for resource limit at the conclusion of the PASS then the educational expenses, occupational behavioral person will no longer be eligible for SSI/Medicaid.) intervention training, training of independent living skills required in the work environment, uniforms, items, and/or 5. A PASS can only be used to achieve a specific equipment required to meet an occupational goal. PASS occupational goal that must be realistic and clearly plans can also now be written, in some cases, to assist an stated in measurable terms that determine when the individual in maintaining employment where their goal is met. Payment for more than one item or position would be in jeopardy without this assistance. service can be written into a PASS.

Some examples of occupational goals for PASS to pay for

1. A PASS is a time-limited work incentive and must Supported Employment would be: be written for a specific time frame. It must be  To become a computer data entry operator achieving approved by the SSA and will be periodically a speed of 60 WPM with 100 percent accuracy; monitored.  To become a kitchen utility worker to a level of 7. Receipts or proof of payment will need to be independence which requires no more than five hours available to the individual’s SSI claims of SE support per month; or representative(s) as required. Work incentives must be monitored. SSA strongly recommends that,  To become the owner/operator of a small business in especially in cases where amounts are saved toward country crafts to the level of $1,000 profit per month. an occupational goal, PASS monies be maintained in DRS Guide to Supported Employment and Job Coach Training Services Page 26

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a separate bank account that is used only for PASS of a PASS or IRWE for method of payment for extended savings and withdrawals for PASS payments. services. In the Individual’s Plan for Employment, the rehabilitation counselor would document the PASS and/or PASS and IRWE IRWE amount as the resource for services, delineate the PASS and IRWE are not necessarily mutually exclusive. services, and name the provider of those services and As denoted in the PASS example, some expenditures monitoring provisions to be used to account for progress could be considered under both programs, i.e., paying for and achievement of the occupational objective. The an employment specialist toward achieving an rehabilitation counselor would then be able to provide the occupational goal. In the PASS example, the expense was initial funding of SE services. used as an IRWE for the SSDI-SGA test and in the SSI PASS and IRWEs may also be used in a variety of ways calculation as a PASS, for full reimbursement of in conjunction with supported employment to provide expenses. In paying for SE to achieve an occupational related services or access related needs. Both work goal, a PASS could be used for a specific time frame. At incentives may be utilized to pay for services such as co-the conclusion of the PASS the expense of SE could be payment or full payment of extended SE services, special used as an IRWE in the SSI calculation in some cases (a transportation, assistive technology required on the job or person with SSDI above the unearned income break-even in getting ready for work, personal care services required point will not remain SSI eligible at the end of the PASS). on the job or in getting ready for work, and etc.

Other expenses would only qualify for a PASS or an Someone with SSDI above the unearned income break-IRWE. The purchase of a car to use in transportation to even point can develop a PASS plan to pay for a achieve the goal of: “To become a Kitchen Utility Worker vocational evaluation and/or situational assessment to at the level of performance of 100 percent of all essential determine an occupational goal and later develop another job functions” would only qualify as a PASS because it is PASS to achieve an occupational goal through SE not “impairment related.” The car modification expenses services. The PASS could exclude SSDI, making the of installing hand controls for an individual who is an recipient eligible for SSI during the term of the PASS. accountant and because of injury is now unable to use his The second PASS could also exclude earned income, legs would only qualify as an IRWE because the making the recipient eligible for a higher SSI benefit up to individual has already achieved his occupational goal: their Federal Benefit Rate during the term of the PASS. accountant. When either PASS or IRWE could be used The cost of SE services is used to bring earnings below for SSI recipients, it is usually in the individual’s financial SGA for continued SSDI benefits (costs of vocational interest to use the PASS time limit first, followed by the evaluation and situational assessments are not IRWEs as IRWE. the individual is not working during the assessments).

PASS, IRWE, and Supported Employment Once working, an individual may earn money exceeding SGA, if this occurs before the PASS has ended, the An individual may be found ineligible for rehabilitation individual may lose their SSDI benefit. This may allow services due to not requiring or being able to benefit from him/her to maintain SSI eligibility at the end of the PASS services. If the individual or family members feel that (if earnings exceed SGA after the extended services costs he/she should be eligible for rehabilitation services and and subsidies are subtracted from the gross earned supported employment then a PASS may be used for a income). With SSI eligibility maintained at the end of the supplemental vocational evaluation. It could include second PASS, the individual may be eligible for 1619(b) situational assessments, and/or assistive technology extended Medicaid coverage if earnings reach the earned assessments toward establishing a feasible occupational income break-even point. This is often desirable because goal. These assessments may provide evidence of of the SSI program flexibility for the individual to achieve vocational potential, thus qualifying the individual for higher earned income up to the state threshold amount rehabilitation services. enabling him/her to maintain SSI and Medicaid.

Using State or Federal dollars for SE services requires Using the same example, but with the individual using an that before Rehabilitation SE services can be initiated, IRWE to pay for his own extended services is another available extended services must be identified. An creative solution. However this will only work after the individual may be found eligible for rehabilitation individual has lost his SSDI benefit. An IRWE would not services, however, may be informed that these services enable an individual with an SSDI benefit higher than the cannot be initiated because an extended service provider unearned income break-even point to maintain SSI. The cannot be identified.

IRWE can be used for SSI purposes when the PASS is The rehabilitation counselor will then work to determine complete. Monies spent on paying for the IRWE, an extended service provider. However the individual extended services could be excluded from the earned may not qualify for community or other service provision income in the SSI calculation. or may be eligible for community or other services, which Remember that PASS can exclude earned or unearned have a waiting list for SE service provision. The income; whereas IRWE can only be used to exclude individual/SSA named payee may elect to identify the use DRS Guide to Supported Employment and Job Coach Training Services Page 27

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earned income. Thus, as IRWE only effects earned Student Earned Income Exclusion income, and it cannot enable an individual with SSDI The student earned income exclusion is for students who higher than the unearned income break-even point to are on SSI that are working. Under the SEIE, Social maintain SSI eligibility.

Security will not count up to $1,780 per month of the Careful consideration should be used when planning the student’s wages up to a maximum of $7,180 per year. To utilization of PASS and/or IRWE work incentives. There qualify, the student must be under age 22, in college for are many situations that can adversely affect the at least eight hours a week, in grades 7-12 for 12 hours a individual receiving SSI and/or SSDI disability benefits. week, or in a job training program for 15 hours a week.

The general rule of thumb mandates that you consult with Medicaid Works your local SSA office to determine applicability and feasibility, on a case by case basis. SSA will determine Medicaid works is a Medicaid program administered by whether an item or service is an IRWE for that individual the local Departments of Social Services that allows and will review and approve/disapprove/modify PASS individuals with disabilities to get or retain Medicaid plans for that individual. With knowledge and adequate coverage despite having higher income and resources than record keeping/documentation, SSA work incentives can allowed under the “traditional” Medicaid program. In be an invaluable resource to individuals with disabilities order to qualify for Medicaid works, the applicant must be and service providers. disabled, working (or can prove when work will begin) and be between the ages of 16 and 65. For initial It is imperative that the employer be notified that the SE eligibility, a person cannot have an income higher than service provider must be contacted when he/she receives a $785 per month. Resources cannot exceed $2,000 if single questionnaire from SSA as their supports need to be or $3,000 per couple. Once eligibility in Medicaid works included on that report. It is also important that the job is approved, income limits increase to $75,000 per year. coach assist the employer in identifying the modifications Resources increase to $34,543. or accommodations that he/she provides to the individual.

A simple statement by the employer such as, “It takes Earned Income Tax Credit Robert eight hours to perform the job that I could do in six.” denotes an employer subsidy that he/she may never The Earned Income Tax Credit (EITC), can reduce the tax think to write on the earned income and/or work activity liability for the year for certain low-income individuals. questionnaire. The amount of money an individual can earn and still claim the credit varies depending on filing status and Note: This is an in-brief explanation. For more specifics number of dependents. The number of dependents also and clarifications, please see your local Social Security determines the amount of the credit. The greater the Administration Employment Support or Claims number of dependents, the higher the credit is.

Representative regarding each individual case that you deem may be a possibility for a work incentive. Individual Development Accounts (IDA’s) Adequate ability to report and keep records of An IDA is a matched savings account that allows low-expenditures for services/items purchased and income individuals to put earned income aside into a earned/unearned income and ability to adequately respond special account to save for the purchase of items that to and keep records of SSA correspondence/inquires and need. These could include starting a business, buying a documentation of your responses is mandatory. home, and paying for education to name a few. For Thousands of individuals in supported employment individuals who receive SSI, earned income put into the unnecessarily or prematurely lose their benefits and/or are IDA will not count against their SSI. Because the IDA charged with overpayments and/or are underpaid. This is reduces the amount of money that Social Security counts, often due to lack of knowledge of the SSA disability recipients of SSI will see their benefits increase. Money benefit programs and work incentives to include that is set aside into an IDA also does not count as subsidies, IRWEs and PASS and/or lack of reporting and resources for programs such as food stamps and documentation.

Medicaid.

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[TABLE 28-1] $1,780 | | $7,180

[/TABLE]

[TABLE 28-2] Careful consideration should be used when planning the utilization of PASS and/or IRWE work incentives. There are many situations that can adversely affect the individual receiving SSI and/or SSDI disability benefits.

[/TABLE]

[TABLE 28-3] Note: This is an in-brief explanation. For more specifics and clarifications, please see your local Social Security Administration Employment Support or Claims Representative regarding each individual case that you deem may be a possibility for a work incentive.

[/TABLE]

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PREFACE

Background SE Providers Forums

The Virginia DRS regional provider forums support practitioners in receiving information, networking, and improving services, focusing on best practices, monitoring, and innovative resources to enhance consumer productivity, earnings, integration, and independence.

The purpose of the Guide to Supported Employment and Job Supported Employment (SE) services represent a valuable Coach Training Services is to provide practical and specific array of contemporary rehabilitation options. The goal is to information to supplement the Virginia DRS Policy and maximize employment opportunities for persons with the most Procedure Manual. Where possible, the Guide seeks to severe disabilities who require support in order to work in illustrate evolving best practices gleaned from case examples integrated, competitive employment. Unlike “evaluate-train- and data gathered in Virginia. Specifically, the Guide is place” models of rehabilitation services, Supported intended to provide supported employment practitioners with Employment assesses, then places and trains consumers. An guidance in: array of service options is needed for persons with disabilities.  Achieving a customer-oriented environment that This Guide focuses on the array of options within SE promotes consumer choice and participation, individual programs. For the purposes of this Guide, the term responsibility, practitioner excellence and sensitive “supported employment services” shall be used to refer delivery of quality services; collectively to the following:  Enhancing understanding of operational procedures and

1. The federally defined program of Supported Employment, the need for cooperation, collaboration, and coordination; and  Clarifying and expanding on the roles, responsibilities, and expectations among supported employment
2. Job Coach Training Services in Virginia. practitioners; and The statewide system of Supported Employment services in  Planning, implementing, monitoring, and evaluating Virginia was initially developed through a five-year grant supported employment programs from the Office of Special Education and Rehabilitative Services (OSERS). Service providers include the Division of Rehabilitative Services, local Community Services Boards, and Employment Services Organizations. Current efforts to strengthen the system focus on the following:  Refining the skills of practitioners who provide supported employment services in Virginia;  Improving linkages to ensure coordinated and effective services to individuals receiving Supported Employment services; and  Promoting consumer choice, participation and responsibility.

Supported employment requires collaboration among agencies and practitioners—including counselors, specialists, organizations, and mental health agencies—to effectively serve consumers.

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Guide Preparation/Updates Guide Content and Organization

The original Guide, published in February of 1994, was the The sections that follow serve collectively as a guide to result of cooperative efforts of representatives from a variety Supported Employment services from the perspective of the of programs and agencies substantially involved in the Supported Employment practitioner’s needed information. provision of supported employment services to persons with Part I is an overview of Supported Employment as defined by severe disabilities. The Office of Employment Services and federal legislation, and as implemented in Virginia. The Special Programs of the Division of Rehabilitative Services characteristics and advantages of various models are presented prepared the Guide with input from a variety of resources. to assist practitioners in determining, with the consumer, Recommendations and comments were received from, among which placement best fits the individual’s needs. others, administrative and direct services staff of DRS, the Department for the Blind and Vision Impaired (DBVI), the Part II provides the reader with an overview of the DRS VCU-RRTC, and SE providers. Supported Employment process and emphasizes the various practitioner roles and responsibilities.

Every effort has been made to ensure content consistency between this Guide, DRS manuals, provider agreements, and Part III highlights a number of best practices in consumer commonly used definitions. assessment, program planning, case management, monitoring and quality assurance to guide the rehabilitation counselor in The Field Rehabilitative Services – Support Team always the effective planning and delivery of Supported Employment welcomes input and feedback on this Guide and other services. resources developed and distributed by DRS for Supported Employment. Part IV provides “nuts and bolts” information on authorizing, agency fund codes, invoicing, and extended services funding Please note that the guide uses certain terms interchangeably. alternatives.

In the Guide, “job coach” and “employment specialist” are the same; supported employment consumers may be called “supported employees” or “consumers.”

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PART I

AN INTRODUCTION TO

SUPPORTED EMPLOYMENT SERVICES

Supported Employment Description once job development by the employment specialist has occurred, intensive job skill training to learn the required In the individual placement model, a single employee is skills. In addition, he would need intermittent intervention to placed in an integrated work setting in the community. The help him develop appropriate behavior responses, and individual is employed by the business. Ongoing support ongoing counseling and guidance to help him overcome work services are provided by an employment specialist who is fears. After discussing with Jim, the counselor and employed by an approved provider of supported employment employment specialist selected behavior-modeling techniques, services. The employment specialist typically provides the which included multiple demonstrations, tactile intervention, individual with initial job skill training on an intensive one-to-and positive reinforcement. one basis for the entire workday. The employment specialist gradually decreases supports, as the individual becomes more The rehabilitation counselor planned and coordinated proficient. Optimally, a system of “natural supports” is extended support services in the IPE that Jim would need developed within the workplace and community, which throughout his employment. The plan also identified the local facilitates success with extensive supports that are already Community Services Board as the source of support services occurring in the individual’s community. and as the source of funding beyond DRS case closure. The employment specialist would provide job coaching as needed Case Example as well as extensive long term supports at the work site.

The following case example illustrates the characteristics of a Jim secured a job as a key grip at a local television station. supported employment program: His job is to make sure that the television cameras do not run over the connecting cables during filming of shows. Jim is also responsible for assisting a janitor in cleaning the Jim is 27 years of age with no television station. previous history of competitive The employment specialist provided Jim with intensive job employment. Until age 22, Jim was skill training on a daily basis for the first few months of enrolled in a secondary-level day employment. In addition, the employment specialist helped activity program for persons with Jim learn to use the public transportation system to get to and moderate to severe intellectual from work. The janitor helps Jim select the appropriate disability. Since that time, he has participated in a center-based adult cleaning supplies and monitors the quality of his work. As Jim has progressed, the employment specialist has gradually development program. Jim is reduced the amount and frequency of assistance provided to generally cooperative and his attendance record is very good.

Jim at the work site.

Jim’s primary functional limitations are his difficulty acquiring new skills, his slow work speed, and his Jim has now been employed for five months. He appears to be distractibility. a willing worker and is generally liked and accepted by his supervisors and the other employees. The rehabilitation After discussing Jim’s needs and determining his eligibility for counselor continues to evaluate Jim’s progress and assist Jim DRS services, Jim’s rehabilitation counselor helped him and the employment specialist with problem solving. Jim’s develop his goals into an Individualized Plan for Employment case will be closed by DRS once he is stabilized in (IPE). The plan was based on Jim’s interests, his prior employment. However, the employment specialist will successes at the adult development program, and other continue to provide the needed supports for as long as Jim is available information. In developing the plan, the counselor employed. felt that he needed more information regarding Jim’s job site preferences, as well as the specific supports that would be __________________________________________________ needed. Jim and his counselor met with an employment specialist who scheduled a situational assessment. Federal Definition The 2001 amended federal regulations for the State Supported During the situational assessments, Jim performed several Employment Services Program, reauthorized in the types of jobs in the community. This experience provided Jim, the counselor and the employment specialist with data on Rehabilitation Act Amendments of 1998, define supported employment as: work performance and preferences. The situational assessment helped identify his vocational goal as well as “Competitive work in integrated work settings or employment identifying barriers to Jim’s employment in the community, in integrated work settings in which individuals are working and the support services he would need to become toward competitive work, consistent with the strengths, competitively employed in an integrated work setting. resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals, for individuals with For example, everyone agreed that Jim would initially need, the most significant disabilities: DRS Guide to Supported Employment and Job Coach Training Services Page 3

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1. For individuals for whom competitive employment has not traditionally occurred or ongoing support services are interrupted or intermittent due to a significant time-limited service, the maximum VR support period is 18 months.
2. Due to disability severity, placement requires, unless IPE states otherwise, intensive supported employment from DRS for over 18 months to achieve job stability and follow-along services. The period resets if placed more than once.

The amended federal regulations expand the definition of Key Concepts ongoing supports beyond job skill training as the only type of ongoing support. Instead, ongoing services may The federal definition includes several key concepts that include a variety of supports needed for the supported warrant discussion: employee to achieve and maintain job stability. The  Competitive Work - Supported employment must regulations further allow for ongoing support services to provide full-time or part-time work. Weekly goals for be provided by skilled job trainers, co-workers of the hours of employment are to be determined on an supported employee, or other qualified individuals. individual basis. Competitive employment requires the Dependent upon the type of support(s) being provided, a payment of a minimum wage. Wage compensation must qualified individual may be a family member, a be made in accordance with the Fair Labor Standards Act. supervisor, or other person.

The person with a disability in supported employment must be paid wages on a basis consistent with wages paid  Long-term Follow Along/Extended Services - Usually to non-disabled workers with similar job functions. referred to as long-term follow along, extended services are services provided once the time-limited services The amended federal regulations establish the setting of sponsored by the state VR agency are completed and an individualized weekly work requirement as a consist of specific services needed to maintain the component of the Individualized Plan for Employment supported employment placement. The source of (IPE). The transition from time-limited services, extended services must be documented in the sponsored by the state vocational rehabilitation (VR) Individualized Plan for Employment (IPE). If extended agency, to extended services, funded by a source other services are not immediately available prior to the than Federal “110” funds, should not occur until the initiation of the IPE, but the counselor has a reasonable supported employee is stable in employment. In addition expectation that extended services will be available when to fair wage compensation, the supported employee the consumer is stabilized in the job, the plan can be should receive the same benefit package provided to all initiated. Extended services are to be paid for with funds eligible employees. from sources other than the Titles I, VI, IIIC, or IIID of  Integrated Work Setting - The employment must the Federal Rehabilitation Act. provide daily contact in the immediate work setting with Based on guidance from RSA, Virginia DRS has adopted other employees and/or the general public. There is no the following definition of long-term follow limit on the number of individuals with disabilities who along/extended services: can be clustered together in the work setting. However, Individual Competitive Employment is the preferred option.

Criteria in this area of the federal regulations have not changed. Work in integrated settings for persons with most severe disabilities is one of the founding principles of supported employment. This principle is consistent with the concept of least restricted environment established in the Individuals with Disabilities Education Act (IDEA). Integration in the work place is inextricably tied to social inclusion in the larger community as a whole.  Ongoing Support Services - The individual can be provided supports such as job site training, transportation, family support, or any service necessary to achieve and maintain the supported placement throughout the term of employment. Ongoing supports must include, at a minimum, twice monthly monitoring at the work site until the DRS case is closed with the supported employee to assess job stability. In some cases, off site monitoring may be necessary due to the nature of the consumer’s DRS Guide to Supported Employment and Job Coach Training Services Page 4

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living accommodations Long-term follow along/Extended services means ongoing  Long-term case management coordination support services provided by an approved provider that are  Ongoing or intermittent assistance from mental health day sufficient to maintain a person with a most significant or residential programs disability in employment after DRS case closure. These  Supported Living services may consist of but are not limited to:  Family support in order to provide disability-related  direct face to face contact and intervention with the assistance to the individual consumer and/or employer on a regular basis  phone or other communication with the consumer or Target Population employer on a regular basis Supported employment extends services to persons with most  development and maintenance of natural workplace significant disabilities that previously might not have been supports. considered as having the potential for employment and not found eligible for state VR services. While SE had its national With the agreement of the consumer, DRS counselor and ESO beginnings in serving persons with an intellectual disability, job coach either bimonthly or quarterly contacts with the services in Virginia can be appropriate for persons with other consumer would be acceptable to DRS provided that: most significant disabilities who have the desire to work in  the consumer and family understand the frequency, competitive employment in integrated settings. Supported  the consumer is given access to follow along supports if employment is not a disability-specific service option. needed sooner than the next scheduled contact, and  the ongoing supports being provided are adequate to meet Models of Supported Employment the client’s needs with respect to maintaining This section describes four models of supported employment employment. The type of contact may be either face to currently in use in Virginia. The specific characteristics of face or by other means. Otherwise, the frequency and each model are presented in terms of the work setting, type of contact must be provided on a sufficient basis, supervision, job duties, and similar considerations. The based on consumer need, in order to ensure that the individual placement and group models of supported consumer is maintained in employment. employment each offer some inherent advantages.

The provision of extended services by a Practitioners should consider the advantages of the various provider and funding source beyond VR models, as well as the suitability of the model to the case closure ensures continuity of individual, when selecting the most appropriate model. ongoing support. The provision of extended services differentiates Individual Placement Model supported employment from the The case examples given earlier featuring Jim and Mike traditional rehabilitation model of job illustrate the individual placement model of supported placement, short-term (90-day) follow- employment. An employment specialist places one person at up, and termination of VR services. However, in contrast to a job site, provides support, and then gradually reduces time discrete post employment services provided after case closure, and assistance at the work site. extended services are long-term (for as long as the individual As described in the beginning of the section, in the individual needs them to maintain employment), multifaceted supports. placement model, a single supported employee is placed in an SE will serve persons having the most significant integrated work setting in the community. The individual is disabilities.DRS considers individuals with “most significant an employee of the business. An employment specialist, who disabilities” when they meet the following criteria: (1) Is an is employed by an approved provider of supported individual with a significant disability (2) has a physical or employment services, provides ongoing support services. The mental impairment that seriously limits three or more employment specialist typically provides the individual with functional capacities (including, but not limited to, mobility, initial job skill training on an intensive one-to-one basis for communication, self-care, self-direction, interpersonal skills, the entire workday or based on the needs of the individual. work skills or work tolerance) in terms of an employment The employment specialist gradually decreases supports, as outcome; and (3) whose vocational rehabilitation which can be the individual becomes more proficient. Optimally, a system expected to require multiple (more than one) core vocational of “natural supports”, that is support by the employer, rehabilitation services for six months or more. coworkers, family and friends is developed within the workplace and community.

Individuals who have a most significant disability include, but are not limited to, those who need one or more of the The individual placement model is the most prevalent and following types of disability related assistance to enhance their widely utilized by rehabilitation counselors in Virginia. The employment opportunities and independent functioning: individual placement model offers the following advantages:  Supported Employment as the appropriate employment  Flexibility in tailoring ongoing support services to the placement specific needs of the supported employee and the  Personal assistance and intervention accessing such employer; services  Maximum integration of the supported employee in the  Frequent or extensive assistance from rehabilitation work setting and community with employees and other professionals to acquire employment or independent individuals without disabilities;

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 Facilitation in the development of a system of natural facility. They are physically integrated into the larger work supports in the workplace and community; environment with employees without disabilities and enjoy the  Ease in determining the point of transfer of programmatic same benefits as others who work there. The employment and financial responsibility from initial DRS sponsorship specialist stays with them and does not reduce his presence to long-term service provider support; and completely (fading), as it is expected that they will require  Gradual reduction in support costs, and increased intensive ongoing supports for as long as they are employed. employee earnings (based on state and national data Mobile Work Crew Model gathered by VCU-RRTC).

In the Mobile Work Crew Model, a small group of supported Group Placements employees travel together to one or more integrated work settings in the community where they perform contract work Definition of Group Models such as custodial, grounds-keeping and similar functions. The The Code of Federal regulations define an SE group as having provider employs the individuals on the work crew. A full-more than one consumer on site. Most enclaves/mobile crews time supervisor who is also employed by the provider provides have at least three consumers with a supervisor and trainer as ongoing support services. needed.

A mobile work crew in Southwest Virginia illustrates this By definition, an enclave or mobile crew is integrated as both model. A work crew of eight supported employees performs are in the community. A person working in an SE group custodial duties at several different itinerant stops each day. setting is considered successfully employed by DRS and Supported employees on the work crew clean and dust, therefore would be considered a successful DRS closure even vacuum, strip, wax and buff floors, empty trash and do light if the consumer is making less than minimum wage. maintenance work. They receive daily supervision and Enclaves/mobile crews pay may be based on productivity as training from the employment specialist who functions as the allowed under the Fair Labor Standards Act. Organizations crew leader. The provider usually purchases the equipment must follow the Federal Wage and Hour guidelines when and provides transportation services to and from the various determining wages. A consumer may be paid minimum wage work sites. or below as long as federal guidelines are met. Some groups Who should be employed in an enclave or mobile work crew SE sites pay more than minimum wage such as those in NISH instead of SE individual placement? sites.

In all cases, selection into one of these settings should be Group models of supported employment offer the following adapted to meet the need of the consumer. A consumer advantages: capable of entering competitive employment with hourly  An established mechanism for provision of ongoing follow along services does not require the more restricted and support services for those persons who require a greater supervised enclave or mobile crew model. Enclave and degree of (supervised) structured support in order to be mobile work crews are predominantly for consumers that need successful in competitive employment; more work supports than a supported employment individual  Ease in coordination and delivery of services to multiple placement. Though one may eventually work in an individual supported employees; placement after experience in a group, enclaves and mobile crews are generally not interim training programs but long  Consolidation of supported employment services term employment programs. contracts among a few service providers and employers, GUIDANCE FOR GROUP SITUATIONAL ASSESSMENTS and,

1. The rehabilitation team can recommend that an individual  An additional option for the consumer to move offsite is assessed by an employment specialist other than the from a sheltered setting, increase wages, and development one supervising the group because of the consumer’s of more interdependence in the community. functional limitations as a result of the consumer’s Enclave Model disability. The team should consist, at a minimum, of the In the enclave model, a small group of supported employees is DRS counselor, the employment specialist and the placed at a job site in the community where they work consumer. together or are dispersed within an integrated setting. The 2. The assessment must be prescriptive in nature and individuals in the enclave may be employed either by the individualized for the person. While DRS requires that, at employer or by the provider of supported employment a minimum, the Situational Assessment Form (SE Form services. An employment specialist functioning as a full-time 1) be completed as it meets CARF requirements, other enclave supervisor provides ongoing support services. The additional information, that is prescriptive in nature such enclave supervisor may be employed either by the employer or as behavioral and learning issues, should be acquired and by the provider. documented by the employment specialist.
2. The situational assessment should address specific In Richmond, an enclave that illustrates the elements of this vocational rehabilitation issues needed for program and model has been developed. A group of four supported vocational planning that cannot be obtained in any other employees arrives at the site of the employer, a major book circumstances or available records including those from and magazine publisher, by van or on their own. The schools, CSBs, or other Agencies. individuals in the enclave work side-by-side, processing subscription orders at individual workstations in the business DRS Guide to Supported Employment and Job Coach Training Services Page 6

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1. The assessment must have a formalized protocol that having less overt support?) includes task analysis of the specific job duties required in  What model represents the least restrictive setting that is the enclave or mobile work crew. feasible and appropriate?
2. Assessment results must include an overview of transferable knowledge, skills, and abilities for independent, productive employment.
3. The hours requested and authorized must be based on  What model is the consumer most comfortable with? individual consumer needs, not requested as a matter of course.  What is the quality of the services available in each
4. If the assessment is a trial for the enclave or mobile crew, it’s authorized at the daily rate. It should only be completed if immediate placement is possible, as DRS offers flexible Job Coach Training models.
5. Usually the above defined hourly assessment is the meet the needs of those consumers. exception rather than norm. When completed, the Case Example transferability of findings should preclude the need for The following case example illustrates Job Coach Training further hourly assessments.

Services in Virginia: There should not be any job development hours billed as the Shelly is a 22 year-old woman who has a severe hearing enclave/mobile crew has already been established with impairment and is mentally challenged. She was referred to different jobs already defined.

DRS by her mother because of repeated difficulty getting or Entrepreneurial Model keeping a job. The longest period Shelly had worked, when she did get employment, was only two days.

A small furniture refinishing company was developed in the Richmond area. Eight supported employees work in the The counselor arranged to meet with Shelly and an business in a small industrial and office park. The employees interpreter. Shelly indicated through the interpreter that she performed all activities associated with furniture refinishing. was frustrated because employers said she was “too slow.” They worked under the supervision of a business manager and After diagnostic testing, Shelly’s eligibility for services was several other employees without disabilities, who were trained established. She and her counselor scheduled a vocational in intervention and natural support techniques. The supported evaluation to explore her job interests, aptitudes and skills. employees interacted with customers and other non-disabled individuals in the vicinity of the business. During vocational evaluation, Shelly demonstrated excellent In the Entrepreneurial Model, a small group of supported general worker traits and aptitudes for assembly and machine employees produces goods or services either on a sub-contract operation. However, she did have difficulty learning new basis or as a prime manufacturer. The individuals in the group, tasks, responding appropriately to change, and getting along with the managers and other employees actually oriented to her work environment. Shelly gave many comprise the business. Support services are provided by indications of being sociable, yet she tended not to associate managers and other employees without disabilities who are with others during evaluation. employed by the business. Supported employees interact with Shelly and her counselor agreed that she needed intensive the general public and other employees initial training at the job site, more intensive than an on-the-job-training (OJT) program would provide. Her counselor Selection of SE Models felt this would probably be too time-consuming for many Establishment of the various models of supported employment employers to provide. Yet, they both agreed that once in Virginia has largely occurred over the past 20 years. acclimated and trained in her new environment, Shelly would Recent developments have necessitated increasingly not need these or other support services beyond the first few sophisticated marketing techniques, job development months. activities, and support services. During this time, best practices have emerged, which guide practitioners in selecting An employment specialist who specialized in job site a particular model with an individual. accommodations participated in a problem-solving session to discuss intensive training strategies, orientation, and In all cases, selection and application of the models of integration issues. Everyone felt that Shelly’s training would supported employment should be adapted to meet the need of be effective if the job site were safe and accessible, and early the consumer. In determining the suitability of a model for a communication techniques with her co-workers and particular individual, the practitioner should consider the supervisor were developed. following: Shelly was interviewed with an interpreter present, and  What model will provide the consumer with the best subsequently hired by a major optical corporation as an opportunity for successful integration, reduction in Assembler and Machine Operator. The employment specialist, supports, and career advancement over time? (I.e., will with the assistance of the interpreter, provided one-on-one the individual demonstrate progress and “mature” from training to enable Shelly to develop speed and quality highly structured and visible support models to a model DRS Guide to Supported Employment and Job Coach Training Services Page 7

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production skills. The employment specialist also made illness may require developmental supports on a long-term adjustments to Shelly’s work environment to make it safer and basis. more efficient for her. Most importantly, the employment SUPPORTED EMPLOYMENT AS AN specialist helped Shelly to develop good work relationships and effective communications with other persons at the EVIDENCE BASED PRACTICE corporation.

Programs providing employment supports are a valuable Shelly no longer requires any support services. The resource for people with severe mental illness seeking rehabilitation counselor has successfully closed her case. competitive employment. Employment is a key component of Today, Shelly continues to have positive work relationships recovery. Individuals with severe mental illness who hold and competent production skills. competitive jobs for an extended period of time frequently experience a number of benefits, including improvements in Key Concepts their self-esteem and symptom control.

Job Coach Training Services include job development, job placement, skill training, transportation, and other support services sponsored by DRS. Long-term support is not provided; focus is on building confidence, achieving work goals, and retaining employment.

DRS counselor can authorize JCTS only when the consumer Employment services that follow seven evidenced-based does not require ongoing support services on an extended practices have proven successful in assisting people with basis beyond DRS case closure. severe mental illness in achieving and sustaining employment Therefore, this program does not meet the criteria of the outcomes. The following information summarizes these seven federal regulations for supported employment. The consumer key practices and provides additional resources on effective may be regarded as either “most significantly disabled” or employment supports for all individuals who need supported “significantly disabled” if the agency sponsors this service for employment, not just those experiencing severe mental illness. the consumer.

1. Participation in employment programs is based on consumer choice.

Studies and direct experience have shown that more True consumer choice requires access to the information cognitively and behaviorally impaired individuals require necessary to make an informed choice. Practices that more ongoing support services on an extended basis. For encourage informed consumer choice about employment example, a consumer who has multiple severe disabilities, no include: prior work experience, and little or no family support may be  Creating an atmosphere where anyone who chooses to an appropriate candidate for supported employment. By work can work. contrast, a consumer who is most severely disabled and needs  Asking consumers if they want to work as soon as they intensive initial training to learn a complex job or to increase enter the employment program. productivity, but who does not require extended services,  Promoting employment consistently and regularly as a could be provided with Job Coach Training Services or other positive, achievable outcome. appropriate services.  Encouraging consumers to talk about their fears and Counselor judgment, along with input from those most concerns about work and providing the assistance needed familiar with the consumer’s functional skills and needs, to address these concerns. should be utilized in determining the appropriateness of JCTS,  Building confidence by giving attention to each regardless of specific disability. Key questions to be asked in individual’s strengths and motivations. selecting this service option are: Programs that successfully promote informed consumer  What is the functional level of the consumer and choice take a systematic approach incorporating these anticipated need for supports? practices. These programs recognize that for individuals with  Is there a lengthy or consistent history of successful severe mental illness, consumer characteristics do not predict competitive employment? success in competitive employment. Gender, ethnicity,  What is the complexity of the consumer’s desired job diagnosis, hospitalization history, cognitive functioning, placement? education, or substance abuse history are not predictors of  What family, employer or other support systems already employment success. Instead, employment programs are most exist or could be developed? successful when they operate on the principle of “zero exclusion.” Anyone who expresses a desire to work and Persons with severe physical disabilities such as spinal cord makes an informed choice to participate in an employment injuries, cerebral palsy, or hearing impairments can often program is eligible. obtain and maintain employment without extended services.

For these individuals, rehabilitation engineering and JCTS For a variety of reasons, programs that use the zero exclusion may be more efficient and effective. approach do not assess consumers for work readiness using traditional methods, such as standardized aptitude tests. These Some persons with serious mental illness may require only assessment methods have in the past screened out consumers intermittent intervention and JCTS, as opposed to ongoing with mental illness at a high rate, including many who could extended services. Other individuals with serious mental successfully work, and take resources away from services that DRS Guide to Supported Employment and Job Coach Training Services Page 8

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could be better directed to helping people find jobs. Also, finding competitive jobs. From the moment a consumer most standardized assessment approaches do not actually begins the program, communicate a clear message that an predict which individuals will work. And finally, these integrated competitive employment outcome is the goal and assessments typically do not give information about what focus all employment services and supports on directly interventions to offer as a way to help consumers work meeting that goal. Avoid volunteer approaches or paid successfully. employment options that are not drawn from the competitive employment job market.

1. Employment supports are integrated with mental health treatment. 4. A rapid job search approach is used.

It is critically important for consumers with severe mental A rapid job search approach means that contact will be made illness that employment supports be integrated with any with employers within the first month after a consumer enters mental health treatment. Employment efforts are unlikely to the employment program. Most consumers with mental health be effective if the person is not receiving adequate clinical support needs prefer to work towards an employment outcome case management. Practices that encourage integration of instead of going through transitional preparatory activities. In employment services and supports with mental health fact, work readiness or other preparatory activities that delay treatment include: competitive work can actually reduce prospects for community employment. Practices focusing on a rapid job  Employment support team members are in close and search include: frequent contact with the mental health case managers.  Treatment plans and employment plans are coordinated  Providing direct assistance in job finding through job and mutually supportive. leads and active job development.  Treatment team meetings include the employment staff  Emphasizing on-the-job training with supports at the job and consideration of employment plans and issues. site.  Obtaining rapid approval from funding agencies for For integration of employment and mental health services to employment plans. be effective, there must be genuine collaboration and mutual problem solving. For example, medication or housing A rapid job search will not take place when there is limited changes should always be coordinated with employment coordination between the funding entity and the employment changes. If they aren’t, responsibility for follow-up becomes agency. Schedule regular staffing or case conferences to be unclear, and employment staff may be caught up doing crisis sure information is shared as necessary. The job search intervention, a role more appropriately fulfilled by case process will vary in strategy and timing from person to person. managers. However, established collaborative practices among key stakeholders in the job search process will help support a rapid Integration of employment and mental health services movement to employment. contributes to lower employment program dropout rates, because case managers are involved in keeping consumers 5. Job finding is individualized with attention to engaged. Clinicians and employment specialists report better consumer preferences. communication. Clinicians become involved and excited Job finding is a collaborative process between the consumer about employment, and the close working relationship and the employment support team. This process emphasizes between the clinicians and the employment team results in use of a consumer’s preferences, strengths, and prior work clinical information being a part of the vocational plan. experiences. Practices that focus on consumer preferences

1. Services are focused on competitive include: employment as the goal.  Working closely with consumers’ personal interests.

Individuals with severe mental illness have historically  Seeking jobs and workplace environments that match received services in day treatment or sheltered programs that individual preferences. focus on an array of rehabilitation activities, protected job  Helping individuals make informed choices about options, or short-term work experiences. However, disclosing the presence of a disability to employers. prevocational preparation, extended career counseling, or  Working closely with the consumer and employer on other work readiness activities do not effectively promote identifying and negotiating needed workplace competitive employment outcomes. In comparison, practices accommodations. that focus on competitive employment as the goal include: The collaborative process between the consumer and the  Targeting attention and resources on work as a goal from employment support team emphasizes job selection that takes the moment the individual enters the program. into account job duties, location, hours of employment, work  Stating the benefits of work and encouraging success. environment, and other factors related to satisfaction and  Avoiding spending time and resources on work readiness success in working. Job matching can include arranging experiences or extended periods of assessment. customized employment opportunities with employers through  Assuring that assessments occur rapidly and build on the job carving, negotiating job descriptions, or creating job desire and motivation of the consumer to seek work. descriptions. Consumers are much less likely to quit their In providing employment services and supports, it’s essential jobs if these initial positions are consistent with their preferences. In addition, consumers working in fields to devote resources and energy to assisting consumers with DRS Guide to Supported Employment and Job Coach Training Services Page 9

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Matching preferences increases job satisfaction.

1. Supports are ongoing.

Arbitrary time limits on supports harm employment success.

Ongoing supports include helping individuals identify true job interests, maintaining supports post-employment, and assisting with job transitions as long-term interests develop.

1. Benefits counseling educates consumers on earnings’ effects on benefits.

Many individuals with disabilities receive SSI, SSDI, and related benefits for health, housing, and food.

Benefits planning is vital, ensuring access to counselors, addressing concerns about benefit loss, and coordinating job plans with benefit strategies.

SSA’s Ticket to Work program offers info and assistance on benefits and work incentives for SSDI/SSI recipients. Details are at www.chooseworkttw.net.

These seven principles form a core framework for effective employment supports for individuals with severe mental illness, impacting providers, agencies, and consumers.

Programs following these evidence-based practices are more likely to help consumers with severe mental illness achieve employment goals. (Source: April 2005 T-TAP, Virginia Commonwealth University, and UMass Boston).

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PART II

ROLES AND RESPONSIBILITIES IN THE INTERAGENCY SUPPORTED

EMPLOYMENT PROCESS

Roles and Responsibilities responsibility for communication, quality assurance and coordination throughout the SE implementation process.

The Rehabilitation Counselor Job Development The examples of individuals receiving supported employment services in Part I illustrate the important and various roles of During the job development process (usually in the “Service” the vocational rehabilitation counselor throughout the status, formerly Status 18), the rehabilitation counselor can interagency supported employment process. The counselor assist in many areas. Counselor involvement in the stage prior assists the consumer with setting goals, monitors their to placement (program planning from application to service) implementation by the consumer and provider/provider, will impact favorably on the efficiency and economy of the assesses consumer progress, and provides input to the provider job development process. It is very important that the job to insure quality services for the consumer. The counselor has match be developed for the particular employee. Factors to lead responsibility for planning and coordinating SE services consider in the process of matching jobs to prospective to ensure quality and successful consumer outcomes. consumers include the following: This counseling and coordination role continues after the job  Availability and type of supervision and supports placement phase as the counselor works in collaboration with available at the job; the provider providing services. The rehabilitation counselor  Transportation requirements and resources for the continues to play a monitoring role after case closure, consumer to utilize in meeting the work schedule; interacting with the provider of extended services.  Job responsibilities, production requirements, and degree General responsibilities of the rehabilitation counselor in the of independence in the position; and supported employment process include:  Hours of employment, work environment and work schedule.  Using informed choice as a way to assist consumers in choosing the most appropriate provider for services  Collaboration with consumers, family, community programs and service providers in the development and implementation of a supported employment rehabilitation plan;  Advocacy for the development and/or expansion of services and providers to meet the support needs of DRS consumers.

Counselors need knowledge of supported employment, interagency collaboration, serving severe/multiple disabilities, local resources, and assistive technology assessment.

Counselors lead in selecting, monitoring, and coordinating supported employment services and stakeholders, ensuring quality and progress.

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 Individual SE or JCTS cases. Changing to “Employed” Specific responsibilities of the rehabilitation counselor in the status (formerly status 22) after 60 days of stability for job development process include: cases served in an SE group model.  Providing sufficient funding of needed services;  Remaining an active part of the rehabilitation process  Assisting employment specialist with placement leads; including visiting the consumer on the job to ensure that  Providing guidance on appropriateness of potential leads the consumer and employer are satisfied as well as whether developed by consumer, employment specialist ensuring that appropriate services are being provided by or others; the job coach.  Providing specific direction, and coordinating and  Collaborating with the SE Provider in reference to Long-monitoring job development efforts of employment Term Follow-Along source. Approving Long-Term specialist; Employment Support Services (LTESS) applications  Problem-solving and planning workable strategies with before they are submitted by the ESO. Providing the employment specialist. expertise and input in utilization of LTESS dollars for long term follow-along.

Counselor responsibilities in promoting consumer readiness for employment include: Post-Employment Services  Providing the consumer counseling and guidance on In many instances consumers may need to be retrained, or appropriate interviewing and work behaviors; trained in a new job duty once long-term follow along services  Assisting the consumer and family in learning about begin. LTESS funds do not support training or retraining supported employment expectations; services, only services that provide job maintenance. If the  Assisting the consumer and family in understanding DRS case is closed the counselor may wish to consider Social Security Work Incentives (SSWI) and arranging funding the necessary training through post-employment and keeping appointments with the Social Security services. LTESS funds will continue to support the follow Administration, when applicable; along services while training services are funded by DRS. The  Communicating by phone and reviewing monthly written steps necessary to provide this service are outlined in the FRS reports to provide additional guidance and to request Policy and Procedures Manual. relevant information.

Employment Service Organizations Job Placement Providers of supported employment services include Specific counselor responsibilities in job placement (“Service” rehabilitation facilities; Community Services Board operated Status, formerly Status 18) include: programs, and both private non-profit and for-profit  Completing Work Opportunities Tax Credit (WOTC) organizations. In order to become a DRS approved provider, forms when applicable; the organization must submit for approval program  Arranging to visit the consumer on the job site with the manuals/curriculum guidelines among other required employment specialist; documentation for the service intended to be provided.  Arranging for staffing meetings to problem-solve as Applications also require written support of the local DRS necessary and communicating regularly with the job supervisor of the office that will be the purchaser of those coach and consumer; services. In addition, the provider must submit a Purchase of  Monitoring and providing information and assistance Service Application in order to determine the initial rates by regarding: wage and hour requirements, appropriateness the Field Rehabilitative Services – Support Team (FRS-ST). of placement, integration, number of hours worked, need Specific guidance may be obtained from the appropriate staff for adaptations, and offsite supports, e.g. transportation, member of FRS-ST. Forms may be found on the Virginia recreation/leisure services etc. DRS website, www.vadrs.org. Providers of employment services must also become a CARF accredited organization Job Training/Stabilization within a year of approval.

Specific responsibilities of the rehabilitation counselor during It is an absolute requirement for provider approval that the job training and stabilization include: applicant organization’s capacity and commitment to provide  Providing sufficient funding of needed services; ongoing support services be documented in writing.  Providing troubleshooting suggestions and monitoring The Rehabilitation Counselor and Employment consumer progress on vocational and related goals;  Remaining in close communication with job coach, Specialist: Working Together to Provide Quality employment specialist, consumer, and family, as Services appropriate;

One of the most important aspects of the rehabilitation process  Reviewing monthly written reports, maintaining is the relationship between the DRS counselor and the telephone contacts, amending the IPE as necessary employment specialist. The parties need to build a relationship built on trust and regular communication in order  Accurately recording status changes from “Service” to ensure that appropriate services are planned and provided to (formerly status 18) to “Employed” (formerly status 22) their mutual consumers. upon first day of starting paid employment.

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The employment specialist assists with job placement, training, supports, and progress reporting, ensuring LTESS approval, stability, and long-term support in collaboration with counselors and providers.

The employment specialist monitors performance, makes training and support decisions, communicates with stakeholders, advocates, develops natural supports, coordinates follow-up, and assists with job mobility.

Support levels decrease after initial training; ongoing assessment of performance and satisfaction from multiple sources is essential.

Evaluation methods include employee reviews, reports, caregiver feedback, site visits, and contacts with employers and staff.

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PART III

USEFUL PRACTICES IN SUPPORTED EMPLOYMENT

The following section highlights a number of practices in information about the individual’s ability to function in an on-consumer assessment, program planning, case management, site job training program leading to supported employment; monitoring and quality assurance that can guide the need for on-going support services in order to perform rehabilitation counselor in the effective planning and delivery competitive work; and ability to work in an integrated of supported employment services. employment setting at the time of placement. Situational assessment for supported employment is distinctly different Assessment in Supported Employment from facility or center-based assessments and traditional As stated in the federal regulations, determination of eligibility vocational evaluation because it: for VR services must take into consideration the individual’s  Utilizes competitive work settings in the community to potential to benefit from supported employment services. The gauge consumer strengths and needs; counselor can often determine an individual’s eligibility for  Produces performance results consistent with the work VR services, including potential for supported employment, environment for which projections are being made; based on existing information. Such information would  Utilizes standard supported employment training include the consumer’s personal history, training and procedures on selected job factors. employment experiences, and other relevant information Observation of a consumer’s work performance in a contained in diagnostic and general evaluation reports. competitive work environment, particularly where multiple However, after gathering existing information, the counselor job sites are used to assess different vocational interests and might still have significant questions regarding the nature and objectives, can address key questions the counselor might scope of services needed and the best model for providing have about a consumer’s work characteristics, interests, skills, those services. abilities, and training needs. These key questions include: Using Vocational Evaluation Information  Does the individual seem to show a preference across job Vocational evaluation has traditionally provided the counselor types? with information regarding the individual’s eligibility for DRS  Does the individual work more effectively at specific services and feasibility for supported employment based upon times of the day? the “evaluate-place-train” model. Persons with most severe or  How long can the individual work without stopping for a multiple disabilities who were assessed using traditional break? normative or comparative work samples were sometimes  Does the individual respond positively or negatively to found infeasible for supported employment (and therefore, factors in the environment (noise, movement, objects, ineligible for DRS services) because of the severity of their people, and amount of space, etc.)? and limitations. Much progress has been made in the field of  To what types and frequency of prompts does the vocational evaluation in terms of considering an individual’s individual respond best? employment potential if provided with assistive technology If necessary, the counselor should identify additional areas of and other necessary support services. information needed about the individual consumer that can be A thorough vocational evaluation can yield valuable, addressed during the situational assessment, such as: transferable information that can be reported to the counselor a. Strength and endurance; and generalized to the community. The information can be b. Challenging behaviors; utilized in such a way that the consumer’s needs for supports, c. Mobility (e.g., transfer safety to autos) transportation, behavioral intervention, etc. can be identified, d. Transportation needs/skills (e.g., move about in the home especially if the counselor requests this specific information of and at the work site safely), training/assistance require; the evaluator. Integration of vocational evaluation, within the e. Functional application of academic skills (e.g., reading, supported employment process adds to the continuum of money use, telling time); services and can potentially decrease providered costs. f. Expressive and receptive communication skills.

Situational assessment is another tool that is available to the counselor in determining whether an individual with a most The counselor can purchase situational assessment from any severe disability can benefit from supported employment Employment Service Organization approved to provide the services. service.

Situational Assessment The Evaluation/Assessment Report In situational assessment, the individual performs work tasks in community settings. A detailed report from the evaluator or specialist is provided, including assessment info per CARF standards. SE Form 1 must be completed for DRS consumers to determine preferences, supports, and suitability.

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scope of the written report, whether it is a vocational employment specialist; evaluation or situational assessment report, should be  Planned or projected date (or number of months) for sufficiently comprehensive to provide information concerning reaching employment goal; the following:  Description of ancillary services/support needed that will  Recommendations for a vocational goal; assist the consumer in obtaining and maintaining  Type and level of supports needed at the job site; employment (rehabilitation engineering services, Personal  Individualized training needed to acquire and maintain Assistance Services, clothing, medication, psychotherapy, acceptable production skills; physical restoration services, etc.);  Anticipated level of interventions that will be required by  Anticipated need for Post-Employment Services for the employment specialist; Supported Employment; and  Type of integrated work environment in which the  Review of possible need for Rehabilitation Technology or supported worker can potentially succeed; PAS services in conjunction with SE services.  Other information needed to develop an appropriate Supported Employment and Job Coach Training Services individualized employment plan, including the supported (JCTS) draw much of their effectiveness from the employee’s interest in doing the job, transportation to and individualized approach of their program options and funding from work, family support, and financial issues (i.e., wage that reflect the needs of the individual. Funding should always impact on Social Security benefits). be individualized to a consumer’s specific need and Supplemental Information demonstrated progress while receiving services.

The rehabilitation counselor should expand on the information Factors that impact program selection, length, being gathered by the evaluator or employment specialist and design are: through the situational assessment process by obtaining the following information:  Type and severity of consumer disability;  Residential setting involvement and implications for  Motivation and job skills of consumer; programming requirements;  Nature of service area (urban/rural) and employment  Family/caregiver support; market;  Disincentives to working in the community;  Viability of the vocational goal;  Effects of medication on functioning;  Experience and knowledge of counselor and employment  Need for Psychosocial supports; and/or specialist;  Consumer attitudes and preferences regarding work.  Effectiveness of interagency communication and cooperation;

IPE Requirements for Supported  Effectiveness of selection and planning committee in Employment monitoring progress and problem solving.

Counselors should develop intermediate IPE objectives based The rehabilitation counselor develops an Individualized Plan on their projection of the extent to which these factors impact for Employment (Appendix B) with consumer involvement on individual consumer progress. The counselor should and in accordance with the policies and procedures specified anticipate that the consumer’s rate of progression through the in the Virginia DRS Policy and Procedure Manual. Certain different phases of job development, job placement, training, specific information needs to be documented on the IPE etc. may differ according to the consumer’s disability. For developed for supported employment. Information that must example, data collected by DRS and VCU-RRTC on different be included on the initial IPE and/or subsequent amendments disability groups often generalize in the following ways: includes:  Description of the training program and the related  Persons with most severe physical disabilities and serious supports needed, including where, how, and when these mental illness may have more diverse vocational interests supports will be provided; and aptitudes, and therefore spend longer time in job  Identify the following: development than someone who has had little exposure to

1. The extended services that are required after DRS competitive work; terminates funding,  Persons with serious mental illness tend to have the
2. Why these services are needed, and lowest rate of job retention; although they obtain higher
3. Who will provide and fund the extended services wages in a wider range of types of employment, and (long term follow along); require the shortest duration of DRS sponsorship;  If the counselor cannot identify the provider of long term  For persons in supported employment who have serious follow along services at the time the IPE is developed, the mental illness, the type, timing and location of IPE must include a statement explaining the basis for interventions may differ from the types of support concluding there is a reasonable expectation that a source provided in supported employment to persons with other of extended services will be available. For example, disabilities. For example, current research indicates that “CSB funding is available in the individual’s community persons having serious mental illness can significantly to support long term follow along services;” reduce anxiety if supports are intensified 72 hours before  Specific vocational goal that has been agreed upon they enter employment; and between the consumer, rehabilitation counselor and  Persons with traumatic brain injury and dual diagnoses DRS Guide to Supported Employment and Job Coach Training Services Page 15

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require significantly higher on-site intensive must be based on the individual student’s needs, taking intervention by the job coach or DRS employment into account the student’s preferences and interests, and specialist than other populations. must include instruction, community experiences, the development of employment and other post-school adult Still, a caution may be important here: the individual’s living objectives, and, if appropriate, acquisition of daily characteristics and functional abilities must always be the living skills and functional vocational evaluation. determinant for goals, objectives and progress. Functional Transition services must promote or facilitate the abilities may be more predictive than the diagnosis. achievement of the employment goal identified in the In critically assessing SE services and invoicing, as well as student’s DRS Employment Plan. (2001 federal deciding to extend authorized hours on a particular case, the regulation 34 CFR § 361.5 (b)(55)). following is helpful to counselors: Student with a disability means those students with  The training supports and behavioral techniques used by disabilities who are receiving special education services the employment specialist should decrease the consumer’s and students with disabilities who are not receiving dependency on the employment specialist; special education services.  Supported employment services are designed to b. Unless otherwise noted, procedures for coordinating, significantly increase earnings, work-related benefits, providing, or paying for transition services shall be community integration, job security and mobility. These consistent regardless of whether the individual is components, and goals specified in the IPE, should be served by a local education agency, state operated utilized to gauge the success of the outcomes; and program, or through the Comprehensive Services  While the percentage of intervention time (and therefore Act. hours requested) may initially be high, counselors should c. Appropriate referrals, DRS policies and procedures see this intervention time decline as a measure of regarding application and eligibility shall apply. progress. (Approximately 50 percent of all interventions are provided during the first four weeks of employment; Planning for supported employment services with 66 percent during the first 12 weeks of employment; and secondary students should begin at least three years prior 90 percent in the first six months of employment.) The to the student exiting school, and should be consistent graph below illustrates this decline over time. with the educational programming for the student.

However, each consumer’s case should be reviewed for Related services including rehabilitation counseling services must be identified on the transitioning components of the IEP individual consumer needs. Services may be provided with as well as in the IPE. proper authorization and approval in compliance with the Virginia DRS Policy and Procedure Manual. Federal The student’s/consumer’s long-range goal or desired outcome regulations specify that the maximum length of time for which on the transition component of the IEP should be supported SE services may be authorized is 18 months from the time of employment. If a student needs a particular related service in job placement, unless the IPE is amended based on the order to benefit from special education services, the related consumer needs. The length of actual time for authorizing SE service professional should be involved in developing the IEP. services should be based on the individual needs and progress The professional may be invited by the school or parent to join of the consumer. Exceptions to the 18-month limit require the IEP team as a person “with knowledge or special signatory approval from the Regional Director. expertise” about the child. __________________________________________________ Additional guidance on transitioning services for school Additional IPE and IEP Requirements for students is found in Chapter 8 of the Virginia DRS Policy and Secondary Students Procedure Manual.

DRS recommends that students and their families begin to __________________________________________________ make transition plans at least three years prior to exiting school. Additional IPE Requirements for Evidence Based Supported Employment for persons with Chapter 8 of the Virginia DRS Policy and Procedure Manual states: Serious Mental Illness  Eligibility for Transition Services The most effective method in arranging support services for persons with serious mental illness is a team approach. DRS a. Definitions. sponsors vocationally oriented services to eligible consumers Transition services mean a coordinated set of activities for to seek, secure, and maintain employment. The consumer a student with a disability designed within an outcome- may, in addition, need therapeutic, residential, financial, and oriented process that promotes movement from school to social supports like those provided concurrently by the post-school activities, including post-secondary clubhouse and the CSB. education, vocational training, integrated employment  Evidence Based Supported Employment and support (including supported employment), continuing and adult services that are jointly planned and provided to persons education, adult services, independent living, or with serious mental illness by DRS, the CSB, and community participation. The coordinated set of activities clubhouse should be documented on the IPE; and DRS Guide to Supported Employment and Job Coach Training Services Page 16

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 The IPE must specify funding responsibilities for on-site and off-site services, approved by the counselor before case closure.

Criteria for Assessing Job Stability and For persons in group models, “stability” is defined as the completion of a 60 day period in which intervention is Closure directed at maintaining a level of production and not at major barriers to successful integration into the job site. In other As the monthly progress reports and other measures of the words, the job coach/trainer is devoting the majority of time consumer’s progress indicate a reduction of intervention by addressing training issues rather than behavioral issues. The the employment specialist (fading), the DRS counselor should consumer is meeting a level of production that is acceptable to monitor closely for indications of job stability. Services should the employer (either the business or ESO itself). In addition, then be geared toward maintaining production. “Stability” in since an enclave/mobile crew supervisor is on-site at all times, employment is determined by the counselor, consumer and job intervention, (for the purpose of reporting on the SE coach once the following conditions are met.

Placement and Training form), is calculated at 100%. Once Indicators of job stability are: the placement and training services are no longer being provided, the case may be successfully closed once they have  Funding for extended employment has been secured. been employed for 90 days. (LTFA Services have begun) __________________________________________________  Job coaching and related interventions have decreased to a level necessary to maintain the client Specific Counselor Responsibilities in Delivery of SE in employment. Intervention has reached a plateau or Services leveled out. In some cases, the amount of Monitoring consumer progress towards job stabilization intervention (i.e., time) onsite may not have involves active participation by the counselor in obtaining decreased but the nature of the intervention has information necessary to understand changes in the evolved to primarily maintenance. intervention schedule. The fading process is at times  Client is emotionally or behaviorally stable. interrupted by more training and/or problem-solving that  Client performs expected job duties. requires a more intensive intervention at the work site by the  Supervisor reports satisfaction with client’s job employment specialist. In such an event, the counselor should performance. arrange for a staffing with the employment specialist and  Client is satisfied with the job and work environment. consumer if the consumer’s progress seems questionable. The  Necessary modifications and accommodations have purpose of the staffing would be to problem-solve (and further been made at the worksite. determine whether continuation in this employment position is  Client has reliable transportation to and from work. appropriate). Studies have shown that the greater the amount  Client is compensated at or above minimum wage but of communication between counselor and consumer, the not less than the customary wage paid by the greater chance the consumer has in succeeding on the job. In employer for the same or similar work performed by addition, the counselor should make every effort in visiting the people who do not have disabilities. consumer on the job to ensure that services are appropriate  For persons in the individual placement model, the and that the consumer and employer are satisfied. average intervention time by the job coach has reached a The rehabilitation counselor concludes funding of supported maintenance level of support. The client/employee’s employment services when the consumer is stable in needs have leveled off. employment. It is important that the consumer be given the  In the individual model, once the consumer has been opportunity to demonstrate a clear pattern of “leveling” of job placed in employment, the DRS counselor moves the case coach intervention. Again, in the individual model, while this from “Service” status to “employed” status based on the may be less than 20 percent of the weekly hours in start date of the job. After 90 more days of employment, employment for at least 30 days prior to the movement of the the case is eligible for closure and can then be case to DRS status “working”, in specific cases, the successfully closed, if stability has been reached and all percentage of time may be more. This may be the case after 30 requirements are met for “Closed-Rehab” criteria. days or may be extended longer, as needed, dependent on the  Once the case reaches stability, long term follow along individual consumer and job performance. The counselor funding begins. At this point, the DRS counselor should should have firm documentation that the consumer is stable in not fund any placement and training services unless more employment prior to DRS closure and initiation of funding for services are needed for job training. Employment extended services. maintenance services should be supported by long term follow along funds at this point, not DRS case service Long-Term Follow Along/Extended Support funds. Services  Because the case must be in “employed” status at least 90 days before closure, long term follow along funding may Extended support services, often referred to as long-term or may not begin before case closure depending on the follow-along, commence upon stabilization in employment. length of time the consumer needs placement and training For all populations these services consist mainly of ongoing services before reaching “stability”. However, the job based support provided throughout the term of application for long term follow along such as LTESS employment to enable the individual to maintain employment.

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The DRS counselor has a responsibility for participating in the planning and delivery of extended support services. It is important that the DRS counselor remain informed during the delivery of extended support services for the purposes of documentation, and evaluation of services In terms of best practices, this includes remaining informed of the consumer’s progress and job status following case closure.

While the DRS case is still open, the counselor should maintain direct contact with the consumer at and away from the job site and also receive the Ongoing Services Form (SE FORM 4) from the beginning of long term follow along until case closure from the employment specialist describing employer satisfaction and services being delivered.

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PART IV

AUTHORIZING THROUGH USE OF SERVICE ITEM NUMBERS,

IMPLEMENTING EXPENDITURE THRESHOLDS AND AGENCY FUND

CODES

Service Item Codes Authorization of Services

This section describes how the counselor authorizes services This section covers provider reporting expectations and using appropriate computerized coding information authorizing guidance for counselors. This information is and funding criteria. Various Service Item Numbers are consistent with Appendix D, the evaluative and reporting available to counselors when authorizing services sections of all supported employment provider agreements. within approved programs of SE, JCTS, and TEP. Applicable These agreements are renewed annually. The information is Service Items, which are listed in the Virginia DRS Policy also consistent with the Virginia DRS Policy and Procedure and Procedure Manual, are identified and described below: Service Item Numbers Service Item Codes A5132 JCTS Job Development Services A5101 SE Job Development Services A5134 Individual JCTS Placement and Training

A5103 Individual SE Placement and Training Manual. Please refer to the Appendices at the end of the Guide for examples of reports.

A5105 SE Group Placement and Training A5117 Entrepreneurial SE Placement and Training Counselors should reference the DRS Training and Facilities Manual or the Employment Services Organization Directory Supported Employment Services on the DRS website to determine: Definition: These services are for persons who (a) have  Approved providers for supported employment; most severe/significant disabilities and who have three or  Specific, detailed program descriptions; and more significant functional limitations; (b) who need multiple services over an extended period of time (c) will require post-  Provider rates. closure follow-along support and funding in order to maintain employment; and (d) will be employed in job sites that meet Situational Assessment the federal criteria for integrated settings.

Past statewide data indicate that an average supported Situational Assessment employment assessment is 16 hours. Included in this averaging of hours is face-to-face contact with the consumer, Definition: A service that utilizes competitive work settings, writing reports, and time transporting the consumer to the job and not a facility-based setting, to gauge the strengths, sites. This is an average and should not limit consumers deficits, and support needs of persons being considered for receiving services that require more than 16 hours of supported employment. This service produces an assessment assessment time. of performance consistent with the environment for which authorization projections are made. Following the completion of situational assessment the counselor will receive a detailed, informative report prepared Service Item Number by the vocational evaluator or employment specialist.

Components of the assessment which give rise to the data used A6320 Situational Assessment — Individual in the written report include: number and type of work sites, A6322 Situational Assessment – Group – Daily Rate types of jobs performed, number of hours per work site, and types and extent of training prompts utilized. The range and (Daily rate for enclaves and mobile work crews) scope of the written report, whether it is a vocational A6321 Situational Assessment- Group Hourly Rate evaluation or situational assessment report, should be sufficiently comprehensive to provide information concerning Job Coach Training Services (JCTS) the following:  Type and level of supports needed at the job site;

Definition: Services for persons who have severe disabilities and who need short-term, intensive on-site training  Individualized training needed to acquire and maintain by a job coach. These services do not constitute supported acceptable production skills; employment for coding purposes and should not be coded as  Anticipated level of interventions that will be required such on DRS closure forms because (a) the individual is not by the employment specialist; targeted for extended services after DRS case closure or (b) the job site does not meet the federal criteria for supported  Integrated work environment in which the supported employment. worker can potentially succeed; and DRS Guide to Supported Employment and Job Coach Training Services Page 19 [TABLE 19-1] Service Item Numbers A5132 JCTS Job Development Services A5134 Individual JCTS Placement and Training

[/TABLE]

[TABLE 19-2] Service Item Codes A5101 SE Job Development Services A5103 Individual SE Placement and Training A5105 SE Group Placement and Training A5117 Entrepreneurial SE Placement and Training

[/TABLE]

[TABLE 19-3] Service Item Number A6320 Situational Assessment — Individual A6322 Situational Assessment – Group – Daily Rate (Daily rate for enclaves and mobile work crews) A6321 Situational Assessment- Group Hourly Rate

[/TABLE]

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 Other information needed to develop an appropriate  Type and level of training; individualized employment plan, including the supported  Adaptations for employment site; employee’s interest in doing the job, transportation to and from work, family support, and financial issues (i.e., wage  Strengths/Concerns/Proposed Solutions; impact on Social Security benefits).  Intervention hours utilized (current month);

The ESO is responsible for developing sites for situational  Intervention hours requested (next month); and assessments. Generally, the DRS counselor does not pay for the time spent in developing a site. However, for consumers  Degree of job stabilization achieved to date. that may require a site with narrow specifications that is not Service Authorization easily found in the community, the DRS counselor may negotiate with the employment specialist the hours needed to Currently for job development and placement and training develop such a site. This should only occur rarely and on an services, DRS counselors use a “zero balance” method in individual basis. In addition, the ESO is required to have authorizing and tracking services. In other words, based on sufficient liability insurance for covering the consumer on the negotiations with the employment specialist, the counselor SA site. authorizes a specific numbers of hours for services each month. If the hours are not used, the remainder is canceled Job Development and reauthorized for the following month. If more hours are need than originally authorized, additional hours are The length and the cost of pre-placement authorizations are authorized by the counselor after negotiations with the job dictated by specific consumer goals as stated in the IPE, and coach. the planned strategies developed by the counselor, consumer, _________________________________________________ and employment specialist. The number of hours needed to Expectations Governing Billing and Reporting develop a supported employment placement will vary. The counselor should request and obtain progress information Employment specialists provide brief monthly written monthly from the employment specialist during the job progress reports on each consumer. These reports, available development process through written reports containing the on the DRS website, should accompany monthly invoice following: sheets. Counselors may ask to review intervention sheets or  Name, number and type of employers contacted; case notes. Situational Assessments requires the use of SE Form 1. Job development requires the use of SE Form 2.  Job development strategies applied; Placement and Training requires the use of SE Form 3.

Ongoing Services require the use of SE Form 4. General  Job development hours utilized; billing activities can be divided into four categories:  Potential placement possibilities or outcomes expected;  Work site activities - includes travel, training and and intervention with consumer, employer, and employees at  Additional job development hours requested for the work site. In certain situations billable travel following month. time may be negotiated between the DRS counselor and the ESO. An example is: in some Placement and Training parts of Virginia traffic results in higher travel Counselors should review each consumer’s needs and times. This may be a time when billable travel authorize services accordingly. However, federal regulations time is negotiated. prohibit counselors from authorizing these services for longer  Job development activities - includes consumer than 18 months from the time of job placement, unless the IPE specific job development with employers, supervisors, is amended based on consumer needs. It should also be noted and other personnel for purposes directly related to that the approval by the Regional Director is needed to extend employment. services beyond 18 months. It is important that the counselor closely monitor consumer progress.  Off-site activities - includes training in transportation, money handling, and advocacy for persons not directly During the period of DRS authorized services, the affiliated with the work site. employment specialist must submit monthly reports of consumer progress to the rehabilitation counselor along with  Assessment/Report Writing - includes provision of invoices for services provided. The reports needed for situational assessment services and all task analysis, Situational Assessment, Job Development, Placement and training and progress report writing.

Training and Ongoing Services are all found on the DRS DRS pays only for the actual time spent providing services. website. The counselor should document the need for For example, phone calls to consumers are not to be billed at reauthorizing additional services based on counselor an artificial minimum time but for the actual time talking to observation and the monthly reports containing the following the consumer. Likewise, services are to be prorated when information: appropriate. For example, if an employment specialist visits  Original employment objectives; an employer and discusses four consumers, then the cost of that visit is divided by four and the appropriate portion is  Job description and worker responsibilities;

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Reflected in billing. Job training or retraining are not job maintenance and not billable to LTESS funds. Case management, independent living, and non-vocational services are non-billable; their time is included in ESO’s hourly rates. Examples include supervising employment specialists, consulting, case reviews.  Time spent by ESO management supervising employment __________________________________________________ Job Loss and Job Upgrade after DRS Case specialists, consulting with them about cases and performing internal case reviews.

Closure  Time spent completing and sending a request for service When a consumer loses a job (especially when it is not their hours. fault, for example, due to layoff), the rehabilitation counselor should take a new referral if substantial vocational  Time spent in preparing a bill (not a report) for services. rehabilitation services are required. Supported employment  Time spent in marketing ESO services. services can be re-initiated for a former consumer in instances of job destabilization or potential upgrade. A consumer need Explanation of Fund Codes not lose their job before receiving additional intervention or job development services.

Various Agency Fund Codes are applicable to authorizing SE, JCTS and TEP services. Primary Agency Fund Codes and Availability of Long-Term Follow-Along Services their appropriate use are as follows: This section describes traditional and innovative methods of

1. SE Funds: Use this Federal Title VI-B supported securing funding for long term follow along services. employment funds to purchase direct and ancillary services for persons who meet all of the criteria for Utilization of SE by DRS counselors occurs primarily through supported employment. fee-for-service agreements with provider agencies such as rehabilitation facilities; Community Service Board operated
2. Use Basic VR Funds only after all SE programs, supported employment agencies, and job codes are fully encumbered or unavailable. coach training services and transitional employment programs.

The counselor should use Basic VR Funds in authorizing Job Agreements with provider organizations involve the following Coach Training Services when there is a need for short term funding arrangements: intensive on-site training and the consumer will not require

1. DRS purchases job placement and intensive job site post-closure follow-along. training and support (commonly referred to as DRS time LTESS (Long-term Employment Support limited services) until the supported employee is stable in employment; and Services) Funds
2. An agency other than DRS purchases or provides support In 1994, members of VA ACCSES approached the General services designed to maintain the worker in employment Assembly requesting funds for long-term follow-along after completion of DRS funding. services. The organization cited specific numbers of consumers across the state of Virginia in need of support for Some funding sources for long term follow along services in both long-term follow-along in Supported Employment and supported employment are disability specific. For persons long- term follow-along for Extended Sheltered Employment with serious mental illness and mental intellectual disabilities, Services. LTESS funds are not disability specific in that it services may be funded or provided directly by the local CSB. may support long-term follow along services for any Practitioners of supported employment services nationwide consumer that is regarded as having a most significant are utilizing increasingly diversified funding sources to disability by DRS. Funds have been appropriated annually provide monetary support for extended services. As noted since that time. Employment Service Organizations approved above, in Virginia the primary sources of funding for extended for SE and EES (facility based) services were given equal services are the CSB converted day activity funds. Some portions of the total appropriated to be used for long-term examples of other potential funding sources being developed support. Reallocations in subsequent years have been and utilized in Virginia and/or nationally are listed below: determined in a variety of fashions, including based on utilization in previous years. The Division of Rehabilitative Services was identified by the General Assembly as the  Social Security Incentives: Plan to Achieve Self Support administrative agent. By policy, all LTESS applications (PASS) and Impairment Related Work Expense (IRWE); should be approved by a DRS counselor and the approval Ticket to Work (TTW) documented in the consumer’s file prior to submission to the DRS Office of Employment Services and Special Programs.  SSA Ticket to Work LTESS funds support ongoing vocational support services that  Employer, consumer, family contributions; are necessary and sufficient for consumers to maintain DRS Guide to Supported Employment and Job Coach Training Services Page 21

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 Provider/facility (ex: production or donated goods are also demonstrating cost reduction. This cost reduction revenues); increases the longer the person remains employed.  Local public funds; Natural supports occur when individuals other than the job coach (for example, co-workers, supervisors, parents, bus  Private Insurance carrier reimbursement; drivers, or significant others) provide needed and appropriate supports. The employment specialist often interacts in more  General State revenues; of a consultant role by teaching others appropriate and  Charitable/Foundation funds (i.e., United Way). sensitive intervention, support functions, and monitoring those supports.

Natural supports are a rapidly developing strategy for increasing consumer involvement and inclusion. Pilot studies

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PART V

SOCIAL SECURITY WORK INCENTIVES AND

SUPPORTED EMPLOYMENT

Program Description (For 2015) resource tests. Earned income, however, may go above the initial eligibility level and the individual For the purpose of this information, it will be assumed may continue eligibility. that the reader has the basic knowledge of the Social  Medicare is associated with SSDI and is administered Security Administration (SSA) disability benefit by SSA. programs and their respective eligibility and continuing eligibility requirements. For a more complete description  Medicaid is associated with SSI and, in Virginia, is of SSA eligibility requirements, see the SSA publications: administered by Social Services.

Understanding SSI, A Guide to SSI for Groups and  The SSDI benefit amount is determined by the extent Organizations, Disability and the Red Book on and frequency of past earned income on which Social Employment Support. Also, information may be Security taxes were paid, sometimes referred to as obtained at “the work site” at www.ssa.gov/work and the FICA tax. The more one earns (or was earned by the Red Book site at www.ssa.gov by looking under person through whom a person qualifies), the higher “Disability” then “Publications.” Please review the the monthly benefit amount. information contained in the Red Book regarding Subsidy, Impairment Related Work Expenses, Earned  The maximum SSI amount for which an individual or Income and General Income Exclusions, 1619 (a), 1619 couple qualifies is called the Federal Benefit Rate (b), and PASS procedures for complete and thorough (FBR). The maximum FBR depends on the explanations of those incentives. This chapter is meant to individual’s marital status and living arrangements. serve as a guide, not as definitive explanations. The SSI benefit check amount is based on the Earning a wage will impact beneficiaries of the Title II individual/couple FBR which is reduced by the Programs: Social Security Disability Insurance (SSDI) or amount of his/her countable income. and Childhood Disability Benefits (CDB) and recipients Work Incentives of the Title XVI Program-Supplemental Security Income (SSI) - differently. It is suggested that any person wishing People currently receiving Social Security Disability to assist themselves or others be familiar with the basic Insurance (SSDI) and/or Supplemental Security Income effects and rules of earned and/or unearned income on the (SSI) have various work incentives that are designed to benefits of these programs and how these programs assist them in obtaining or returning to gainful overlap for individuals who are, or can become, eligible employment. These work incentives are complex and can for both. It is also suggested that you work with the overlap, depending on the individual, their needs, and/or individual’s Social Security Employment Support their occupational goal.

Representative or a claims representative whenever rendering advice on SSA regulations to validate that The following outlines the utilization of work incentives advice. The following are definitions of the Social for those individuals who choose to work and earn Security disability programs. income. Again, the practitioner must have a thorough understanding of the effects of work on SSDI and SSI,  SSDI/CDB are entitlement programs for individuals and of the continuing eligibility criteria for each of these who have either worked for enough time paying programs. This information must be validated through Social Security taxes or who receive a benefit from the individual’s SSDI/SSI Employment Support or claims their parent/legal guardian who paid Social Security representative(s) and fully communicated to the taxes. individual and family members prior to placement and prior to using the work incentives.  CDB is a benefit received by an individual who became disabled before age 22 and who has a All information given is assuming that the individual parent/step-parent who earned SSA benefits who is receiving SSDI and/or SSI has not medically recovered now deceased, retired, or disabled. Individuals must and would meet and continue to meet all eligibility meet earned income and disability tests for eligibility guidelines for the program under which that work and continuing eligibility. SSDI and CDB will be incentive falls (SSDI/SSI). referred to as SSDI in this text.

Social Security Disability Insurance  SSI is a program based on financial need and disability. Individuals must meet disability, earned If an individual who has received only Social Security and unearned income and resource tests for Disability Insurance (SSDI) for more than one year goes eligibility. For continuing eligibility individuals must to work the following applies. continue to meet disability, unearned income and DRS Guide to Supported Employment and Job Coach Training Services Page 23

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Trial Work Period (SSDI) months under SGA and not receive it for the months over.

The end of the EPE is determined by the individual’s When the individual becomes SSDI eligible the earned income and use of work incentives and may last beneficiary begins a Trial Work Period (TWP). longer than the minimum of 36 months (this is a brief Technically this is not of concern until the individual explanation). If an individual has had an SGA cessation begins paid work. This period consists of nine months and is earning over SGA the 36th month, then he/she (not necessarily consecutive) during which there is no would be terminated from SSDI eligibility the 37th month limit on the amount of earned income and therefore if earning over SGA. Medicare continues through EPE benefits continue. periods. Medicare coverage will last at least 93 months For every month earned income exceeds $780 (for the after the Trial Work Period ends. year 2015) or you work more than 80 self-employed Subsidy (SSDI) hours in a month, a TWP month is counted. You continue counting these TWP months until the individual has A work incentive, which has direct ties to supported worked for nine months earning over $780/month (within employment, is subsidy. Additional training, support, or a 60-month period of time). For example, you locate a supervision supplied to an individual by the job coach, a position for an individual entering data onto a computer. volunteer, or employer that is above and beyond that He works five months earning $800 per month (this supplied to an employee in a similar position without a amount is more than $780 and therefore each month is disability is a subsidy. counted as a TWP month). For the next three months contract work is low, hours for new workers are reduced, A subsidy is calculated by the additional time in hours per and he earns $195 per month (these are not TWP months). month these “extras” are given multiplied by the wage of the supported employee. This amount is not counted in The workload increases and for the next four months he the SGA determination. A subsidy may enable an earns $900 per month (these are TWP months). He has individual to become eligible for SSDI (not working or completed his TWP with nine months of earned income working but earning less than SGA). over $780/month within any 60-month period of time. He received his SSDI check for the entire 12 months he was Many supported employees have unnecessarily lost their in the TWP. Work incentives are not applicable during SSDI benefits because subsidy was not claimed or the trial work period. verified by the job coach or employer.

Grace Period There are other subsidies where employers may incur additional expenses in supporting an individual on a job The grace period begins upon completion of the TWP in through providing supervision or services, allowing a the first month where an individual earns more than slower rate of speed or fewer duties, and/or purchasing substantial gainful activity. The grace period is completed items to accommodate the individual. when a person earns more than gainful activity for three Impairment Related Work Expenses (IRWE) months (not necessarily consecutive) following the TWP.

The individual is entitled to their SSDI for these three for the SSDI Beneficiary additional months following the TWP regardless of Like subsidy, Impairment Related Work Expenses earnings. (IRWE) can be used in the SGA determination that may Extended Period of Eligibility (SSDI) enable an individual to remain in the EPE and avoid a premature SSDI eligibility termination. Impairment After an individual has used his TWP, the next month he Related Work Expenses are expenses incurred by the enters the Extended Period of Eligibility (EPE). The EPE individual with a listed disability that enable him to work. lasts for a minimum of 36 months. During this time an They must be paid by the individual in a month in which individual may have a benefit cessation which is based on he is working and not be reimbursed by any other source. a minimum of three months of earned income averaging IRWEs are frequently used when an individual needs to over Substantial Gainful Activity (SGA), in 2015 usually purchase SE extended services. over $1,090 per month for individuals with disabilities other than blind. (SGA for SSDI beneficiaries who are For the SSDI beneficiary, paying for some of his own SE blind is $1,820.) services out of his earnings may enable him to continue to receive his benefit. His SSDI benefit amount does not Once a benefit cessation has occurred during the EPE, an change; he either receives it all or does not receive any. individual will qualify to receive SSDI benefits only in months where earned income is below SGA. Reporting Reporting and documentation for proof of IRWE payment earnings and applying work incentives is mandatory to must be provided to SSA in writing with a record kept of avoid over/under payments during this time and this the report being sent. Agencies need to establish policies reporting should be in writing with copies kept. for cost-sharing or other methods to fund services and billing/collection procedures to enable individuals to have When reported earnings fluctuate between over and under a stake in ownership of services SGA the individual should receive the benefit for the DRS Guide to Supported Employment and Job Coach Training Services Page 24

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Additional IRWE examples frequently used are payments 1619(b) is an important link to the SSI system. If your SSI for special transportation for individuals who cannot drive cash benefits were to stop due to your earned income or use public transportation; medications required to (wages) or a combination of earned and unearned income, control or alleviate a disabling condition; or payments for you will still be considered an SSI recipient as long as assistive technology devices. The SSA publication Red you would otherwise be eligible for benefits if not for Book on Work Incentives contains an extensive section your income. Usually, SSI benefit eligibility will on various items and services that are/are not deductible terminate if you do not receive a cash payment within a as IRWEs. twelve (12 ) month period. Because you would be otherwise eligible for benefits if not for your income, your Supplemental Security Income (SSI) cash benefits can be reinstated without a new application Work Incentives if your income falls below SSI levels. In addition, 1619(b) will protect your Medicaid eligibility even if you are not Unlike the SSDI Program (where the working individual eligible for a cash benefit. You must meet the following receives all or none of the SSDI benefit amount criteria to qualify for 1619(b). depending on earned income), in the Supplemental

1. Still have a disability Security Income (SSI) Program, the SSI benefit amount is calculated on a formula through which a person’s SSI is 2) Need the coverage to pay expenses that allow you to (usually) gradually reduced or increased in accordance work with decreases and increases in other income.
2. Accumulate no more than $2000 in resources Each year the Federal Benefit Rate (FBR) is established
3. Earn less than $34,543 gross per calendar year (2015 January 1, which is the maximum amount the figure). Some people can still qualify using an individual/eligible couple may receive in their benefit. individualized threshold if they have high medical The maximum SSI amount is determined by the expenses individual’s marital status and living arrangements. To remain eligible for any work incentive program, the 5) Have been eligible for SSI cash benefits for at least individual must remain eligible in all ways for the SSA one month program under which those work incentives fall. SSI Eligibility for 1619(b) must be screened and approved by individuals who later qualify for CDB or SSDI may lose the Social Security Administration (SSA) and the SSI eligibility entirely if they qualify for this and/or Department of Social Services (DSS). another unearned income benefit which is at an amount too high for eligibility. (SSI recipients with a parent (or a Subsidy (SSI) second parent) approaching retirement or who become disabled or deceased, need to be aware of this.) The Subsidy applies to the SSI program only in assisting in following applies: establishing initial eligibility- working but earning less than Substantial Gainful Activity (SGA) for individuals Earned Income and General Exclusions (SSI) with disabilities other than blind. (SGA does not apply to SSI individuals who are blind.) Subsidy is determined for For individuals with no unearned income, the first SSI in assisting with eligibility in the same manner as for $85/month of earned income does not reduce their SSI SSDI. benefit amount. If an individual has unearned income such as SSDI, the first $20 of unearned income is excluded and the first $65 of the earned income is excluded. The earned income remaining after the earned income exclusion is subtracted is divided by two, thus for every $2 earned by the SSI recipient, the benefit amount is reduced by $1.

The balance of the countable earned income and/or unearned income after exclusion(s) is then subtracted from the individual’s FBR to determine the SSI benefit amount. An individual’s SSI benefit amount may fluctuate from zero up to the Federal Benefit Rate for which they qualify. Reporting of earned and unearned income to the SSI claims representative is necessary to avoid over or under payments. (For persons who also have SSDI, a report must also be made to that claims representative.) 1619(b) (SSI) DRS Guide to Supported Employment and Job Coach Training Services Page 25

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Impairment Related Work Expenses (IRWE) It is important to remember that once the occupational for SSI Recipients goal is achieved then the PASS is terminated. Therefore, it is always important to include a goal of anticipated The definition of Impairment Related Work Expenses achievement/independence to be reached prior to the (IRWE) for SSI is the same as for SSDI. The difference is conclusion of the PASS. The PASS is time limited and in the effect its use has on the SSI benefit amount because must be related to helping the individual achieve a of the manner in which the SSI benefit is calculated. The specific occupational goal. amount of the IRWE is excluded from earned income In the SSI calculation, an SSI pre-approved PASS amount only, after the exclusion(s) are subtracted and before the of earned and/or unearned income is excluded when balance of earned income is divided by half. determining the SSI benefit amount. (Resource amounts In effect, the individual’s SSI benefit amount can be to be included are a separate calculation for SSI increased by up to 50 percent of the cost of the IRWE — eligibility, however, are written into the PASS formal up to the individual’s FBR — the net effect of an up to 50 plan as planned expenditures.) A PASS can be set up to percent reimbursement of these costs by SSI. save or use money monthly to purchase something outright, and to make monthly installment payments, IRWE expenses must be reported and documentation of and/or to pay off a loan. payment must be provided to SSA. IRWEs are not time-limited and may be used as long as required by the PASS plans are very flexible and can pay for almost individual because of his/her disability to maintain anything related to an occupational goal. Remember: employment.

1. A PASS candidate must have resources or income sources other than SSI and cannot use SSI funds in a PASS.

The Plan for Achieving Self Support (PASS) (or more self-support) is a work incentive that is exclusively 2. A PASS candidate must receive or be eligible to associated with SSI. Individuals must be eligible for SSI receive SSI [Unearned income or resources used in a (excluding the resources and income to be put in the PASS or IRWE expenses (included in the working PASS). However, an individual that receives SSDI may individual’s PASS and/or excluded from earned become eligible for SSI through the use of a PASS. The income) or Subsidies may enable the recipient to recipient should discuss this with their SSA Employment become eligible for SSI].

Support Representative. Subsidies and IRWEs may assist

1. A PASS (unless also meeting the definition of an in meeting the earned income eligibility requirements for IRWE) does not change SGA earned income SSI. The PASS is a way for an SSI recipient to achieve an guidelines associated with SSDI for persons on occupational goal that requires money for services or SSI/SSDI. items. PASS plans must be written and formally submitted to and approved by SSA before they can be 4. A PASS does not change income and resource used. SSA’s goal for a PASS is to encourage the recipient guidelines associated with SSI, other than excluding to become less dependent on SSI benefits. money designated for the PASS, only during the term of the PASS. (If unearned income is too high at the An individual may write a PASS for a vocational end of the PASS or if resources designated are not evaluation or situational assessment to determine a used during the PASS so that the person is above the feasible occupational goal. They may be written to pay for resource limit at the conclusion of the PASS then the educational expenses, occupational behavioral person will no longer be eligible for SSI/Medicaid.) intervention training, training of independent living skills required in the work environment, uniforms, items, and/or 5. A PASS can only be used to achieve a specific equipment required to meet an occupational goal. PASS occupational goal that must be realistic and clearly plans can also now be written, in some cases, to assist an stated in measurable terms that determine when the individual in maintaining employment where their goal is met. Payment for more than one item or position would be in jeopardy without this assistance. service can be written into a PASS.

Some examples of occupational goals for PASS to pay for

1. A PASS is a time-limited work incentive and must Supported Employment would be: be written for a specific time frame. It must be  To become a computer data entry operator achieving approved by the SSA and will be periodically a speed of 60 WPM with 100 percent accuracy; monitored.  To become a kitchen utility worker to a level of 7. Receipts or proof of payment will need to be independence which requires no more than five hours available to the individual’s SSI claims of SE support per month; or representative(s) as required. Work incentives must be monitored. SSA strongly recommends that,  To become the owner/operator of a small business in especially in cases where amounts are saved toward country crafts to the level of $1,000 profit per month. an occupational goal, PASS monies be maintained in DRS Guide to Supported Employment and Job Coach Training Services Page 26

• Page 27 ---

a separate bank account that is used only for PASS of a PASS or IRWE for method of payment for extended savings and withdrawals for PASS payments. services. In the Individual’s Plan for Employment, the rehabilitation counselor would document the PASS and/or PASS and IRWE IRWE amount as the resource for services, delineate the PASS and IRWE are not necessarily mutually exclusive. services, and name the provider of those services and As denoted in the PASS example, some expenditures monitoring provisions to be used to account for progress could be considered under both programs, i.e., paying for and achievement of the occupational objective. The an employment specialist toward achieving an rehabilitation counselor would then be able to provide the occupational goal. In the PASS example, the expense was initial funding of SE services. used as an IRWE for the SSDI-SGA test and in the SSI PASS and IRWEs may also be used in a variety of ways calculation as a PASS, for full reimbursement of in conjunction with supported employment to provide expenses. In paying for SE to achieve an occupational related services or access related needs. Both work goal, a PASS could be used for a specific time frame. At incentives may be utilized to pay for services such as co-the conclusion of the PASS the expense of SE could be payment or full payment of extended SE services, special used as an IRWE in the SSI calculation in some cases (a transportation, assistive technology required on the job or person with SSDI above the unearned income break-even in getting ready for work, personal care services required point will not remain SSI eligible at the end of the PASS). on the job or in getting ready for work, and etc.

Other expenses would only qualify for a PASS or an Someone with SSDI above the unearned income break-IRWE. The purchase of a car to use in transportation to even point can develop a PASS plan to pay for a achieve the goal of: “To become a Kitchen Utility Worker vocational evaluation and/or situational assessment to at the level of performance of 100 percent of all essential determine an occupational goal and later develop another job functions” would only qualify as a PASS because it is PASS to achieve an occupational goal through SE not “impairment related.” The car modification expenses services. The PASS could exclude SSDI, making the of installing hand controls for an individual who is an recipient eligible for SSI during the term of the PASS. accountant and because of injury is now unable to use his The second PASS could also exclude earned income, legs would only qualify as an IRWE because the making the recipient eligible for a higher SSI benefit up to individual has already achieved his occupational goal: their Federal Benefit Rate during the term of the PASS. accountant. When either PASS or IRWE could be used The cost of SE services is used to bring earnings below for SSI recipients, it is usually in the individual’s financial SGA for continued SSDI benefits (costs of vocational interest to use the PASS time limit first, followed by the evaluation and situational assessments are not IRWEs as IRWE. the individual is not working during the assessments).

PASS, IRWE, and Supported Employment Once working, an individual may earn money exceeding SGA, if this occurs before the PASS has ended, the An individual may be found ineligible for rehabilitation individual may lose their SSDI benefit. This may allow services due to not requiring or being able to benefit from him/her to maintain SSI eligibility at the end of the PASS services. If the individual or family members feel that (if earnings exceed SGA after the extended services costs he/she should be eligible for rehabilitation services and and subsidies are subtracted from the gross earned supported employment then a PASS may be used for a income). With SSI eligibility maintained at the end of the supplemental vocational evaluation. It could include second PASS, the individual may be eligible for 1619(b) situational assessments, and/or assistive technology extended Medicaid coverage if earnings reach the earned assessments toward establishing a feasible occupational income break-even point. This is often desirable because goal. These assessments may provide evidence of of the SSI program flexibility for the individual to achieve vocational potential, thus qualifying the individual for higher earned income up to the state threshold amount rehabilitation services. enabling him/her to maintain SSI and Medicaid.

Using State or Federal dollars for SE services requires Using the same example, but with the individual using an that before Rehabilitation SE services can be initiated, IRWE to pay for his own extended services is another available extended services must be identified. An creative solution. However this will only work after the individual may be found eligible for rehabilitation individual has lost his SSDI benefit. An IRWE would not services, however, may be informed that these services enable an individual with an SSDI benefit higher than the cannot be initiated because an extended service provider unearned income break-even point to maintain SSI. The cannot be identified.

IRWE can be used for SSI purposes when the PASS is The rehabilitation counselor will then work to determine complete. Monies spent on paying for the IRWE, an extended service provider. However the individual extended services could be excluded from the earned may not qualify for community or other service provision income in the SSI calculation. or may be eligible for community or other services, which Remember that PASS can exclude earned or unearned have a waiting list for SE service provision. The income; whereas IRWE can only be used to exclude individual/SSA named payee may elect to identify the use DRS Guide to Supported Employment and Job Coach Training Services Page 27

• Page 28 ---

earned income. Thus, as IRWE only effects earned Student Earned Income Exclusion income, and it cannot enable an individual with SSDI The student earned income exclusion is for students who higher than the unearned income break-even point to are on SSI that are working. Under the SEIE, Social maintain SSI eligibility.

Security will not count up to $1,780 per month of the Careful consideration should be used when planning the student’s wages up to a maximum of $7,180 per year. To utilization of PASS and/or IRWE work incentives. There qualify, the student must be under age 22, in college for are many situations that can adversely affect the at least eight hours a week, in grades 7-12 for 12 hours a individual receiving SSI and/or SSDI disability benefits. week, or in a job training program for 15 hours a week.

The general rule of thumb mandates that you consult with Medicaid Works your local SSA office to determine applicability and feasibility, on a case by case basis. SSA will determine Medicaid works is a Medicaid program administered by whether an item or service is an IRWE for that individual the local Departments of Social Services that allows and will review and approve/disapprove/modify PASS individuals with disabilities to get or retain Medicaid plans for that individual. With knowledge and adequate coverage despite having higher income and resources than record keeping/documentation, SSA work incentives can allowed under the “traditional” Medicaid program. In be an invaluable resource to individuals with disabilities order to qualify for Medicaid works, the applicant must be and service providers. disabled, working (or can prove when work will begin) and be between the ages of 16 and 65. For initial It is imperative that the employer be notified that the SE eligibility, a person cannot have an income higher than service provider must be contacted when he/she receives a $785 per month. Resources cannot exceed $2,000 if single questionnaire from SSA as their supports need to be or $3,000 per couple. Once eligibility in Medicaid works included on that report. It is also important that the job is approved, income limits increase to $75,000 per year. coach assist the employer in identifying the modifications Resources increase to $34,543. or accommodations that he/she provides to the individual.

A simple statement by the employer such as, “It takes Earned Income Tax Credit Robert eight hours to perform the job that I could do in six.” denotes an employer subsidy that he/she may never The Earned Income Tax Credit (EITC), can reduce the tax think to write on the earned income and/or work activity liability for the year for certain low-income individuals. questionnaire. The amount of money an individual can earn and still claim the credit varies depending on filing status and Note: This is an in-brief explanation. For more specifics number of dependents. The number of dependents also and clarifications, please see your local Social Security determines the amount of the credit. The greater the Administration Employment Support or Claims number of dependents, the higher the credit is.

An IDA is a matched savings account allowing low-income individuals to save for purchases like starting a business, buying a home, or education. Income earned and unearned put into an IDA does not count against SSI benefits and does not affect other programs like food stamps. Proper reporting and record-keeping of SSA correspondence are mandatory to prevent benefit loss or overpayment.

Medicaid.

DRS Guide to Supported Employment and Job Coach Training Services Page 28

[TABLE 28-1] $1,780 | | $7,180

[/TABLE]

[TABLE 28-2] Careful planning of PASS and IRWE work incentives is essential, as many situations can negatively impact SSI and SSDI benefits.

[/TABLE]

[TABLE 28-3] For details, consult your SSA Employment Support or Claims Representative regarding potential work incentives.

[/TABLE]

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This page is intentionally left blank for notes.

DRS Guide to Supported Employment and Job Coach Training Services Page 29

Area Agency on Aging Service Standards Provided by the: Department for Aging and Rehabilitative Services (DARS) Office for Aging Services (OAS) 8004 Franklin Farms Drive Henrico, VA 23229-5019 Table of Contents Standard Page Adult Day Care 3 Care Coordination 8 Checking 16 Chore 20 Communication, Referral and Information and Assistance 26 Congregate Nutrition 32 Disease Prevention and Health Promotion 51 Elder Abuse Prevention 55 Emergency 57 Employment 62 Health Education & Screening 66 Home Delivered Nutrition 72 Homemaker 88 Identification Discount 94 Legal Assistance 97 Long-Term Care Coordinating Activities 104 Medication Management 106 Money Management 110 Nutrition Education 116 Options Counseling 122 Personal Care 132 Preparation and Administration of the Area Plan 139 Public Information and Education 142 Registered Dietitian Nutritionist Services 145 Residential Repair and Renovation 151 Senior Outreach to Services 155 Service Coordination Level One 160 Service Coordination Level Two 167 Gap Filling Services 174 Socialization and Recreation / Multipurpose Senior Center 178 Transportation 183 Volunteer 190 November 2021

ADULT DAY CARE

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Adult Day Care is the provision of personal care and supportive services for dependent adults in a supervised, protective, congregate setting during some portion of a twenty-four hour day.

Services offered in conjunction of adult day care typically include social and recreational activities, training, counseling, meals for adult day care and services such as rehabilitation, medications assistance and home health aide services for adult day health.1 The service may be provided for a fee by family caregivers for respite.

Eligible Population Adult Day Care programs are targeted to persons 60 years of age or older who are frail, have disabilities, or who are at risk of institutional placement. Priority shall be given to persons in the greatest economic or social need and/or living in rural or isolated areas, with particular attention to low-income minority individuals.2

Service Delivery Elements The area agency or service provider must perform all of the following components of adult day care services:

Licensure: Service providers of adult day care services must be licensed by the Virginia Department of Social Services and comply with the Virginia Department of Social Services’ Standards and Regulations for Licensed Adult Day Care Centers.3

Service-Specific Assessment: A service-specific assessment using the full Uniform Assessment Instrument (UAI) must be performed on each potential client that identifies:

• whether the person meets the criteria specified in Eligible Population;
• what the person’s service-specific needs are;
• what level of priority for service delivery the person meets.

Further, admission and assessment responsibilities must be in accordance with licensure standards.4

Care Plan: A written individualized care plan shall be developed, reviewed and revised with licensure standards and with involvement from the Participant or Authorized Representative or Family

1 National Aging Program Information System Reporting Requirements – State Program Report Definitions 2 Older Americans Act of 1965 as amended, Section 306(a)(4)(A)(i) 3 Code of Virginia, Section 63.2-1733 4 Standards and Regulations for Licensed Adult Day Care Centers, Department of Social Services, Commonwealth of Virginia, 22 VAC 40-60-560 through 564.

Page 1 of 4 Adult Day Care Effective 10/01/03, Revised 11/23/2004 Virginia Department for the Aging Member to the greatest extent possible.5 When “participant” is used throughout the standards, it can also mean authorized representative or family member, as deemed appropriate by the agency and/or the participant. The plan should consider the need for coordination of care for each participant, and if care is needed, and, if the participant is a client of another agency, the care plan shall reflect the services provided by the other agency.

The service provider will afford the participant the opportunity to participate in the implementation and evaluation of the plan.

Service Agreement: A service agreement shall be completed between the participant and the service provider and distributed in accordance with licensure standards.6 The agreement must also state that the participant has the opportunity to voluntarily contribute toward the cost of services paid for by Older American Act funds.7

An Area Agency is permitted to implement cost sharing for recipients of this service.8

The area agency or service provider must perform all activities in accordance with licensure standards, including but not limited to:

• Service Activities9
• Meal Provision10
• Service Records11
• Service Reassessments12

Administrative Elements The area agency or service provider must perform all of the following components of adult day care services, including but not limited to:

• Participants Rights13
• Emergency Procedures14
• Discharge Plan15
• Fee for Service

Consumer Contributions/Program Income The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program

5 Ibid., 22 VAC 40-60-570 6 Ibid., 22 VAC 40-60-580 7 Older Americans Act of 1965 as amended, Section 315(b) 8 Ibid., Section 315(a) 9 22 VAC 40-60-691 through 705, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 10 Ibid., 22 VAC 40-60-770 through 860 11 Ibid., 22 VAC 40-60-150 through 190 12 Ibid., 22 VAC 40-60-564 13 Ibid., 22 VAC 40-60-692 14 Ibid., 22 VAC 40-60-960 through 1020 15 Ibid., 22 VAC 40-60-660 through 690 Page 2 of 4 Adult Day Care Effective 10/01/03, Revised 11/23/2004 Virginia Department for the Aging income.16 There must be a written policy on handling Client Program Income (CPI) and other gratuities or donations.

• Cost Sharing/Fee for Service: An Area Agency is permitted to implement cost sharing/fee for service for this service using Title III funding.17

And/Or

• Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service provided the method of solicitation is non-coercive.18

Staff Qualifications: Provider agencies must meet or exceed all personnel requirements as set forth by licensure standards.19

Job Description: For each paid and volunteer position an Area Agency Aging or service provider shall maintain:

• A current and complete job description which shall cover the scope of each position-holder’s duties and responsibilities and which shall be updated as often as required, and

• A current description of the minimum entry-level standards of performance for each job.

Quality Assurance Staff Training: Provider agencies shall meet or exceed all training and quality assurance requirements as set forth by licensure standards.20

Supervision: Service providers shall regularly supervise their adult day care staff to ensure safe, effective, and appropriate care to each participant. The frequency and method of supervision is determined by agency policy. Supervision shall be documented regularly.21

Program Evaluation: Area agency on aging must have a written evaluation plan for systematic, periodic, objective evaluation of the effectiveness of adult day care services. The plan shall be implemented and a written report of findings produced. The report is to be used as a basis for planning and implementing changes in program goals, procedures, and aid resource utilization.

Service contractors must be monitored annually.

16 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 17 Older Americans Act of 1965, as amended, Section 315(a) 18 Older Americans Act of 1965, as amended, Section 315(b) 19 Ibid., 22 VAC 40-60-200 through 390 20 Ibid., 22 VAC 40-60-280 21 Ibid., 22 VAC 40-60-320 (3, 4) Page 3 of 4 Adult Day Care Effective 10/01/03, Revised 11/23/2004 Virginia Department for the Aging Client Records: Service providers are to maintain specific program and participant records that include:

• Full Uniform Assessment Instrument22
• Care plan23
• Service agreement24
• Service documentation 25
• Service reassessment26
• Discharge plan27
• Appeals process28
• Emergency procedures29
• Program evaluation
• Consent to Exchange Information

Units of Service: Units of service must be reported in AIM for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

• Hours (Spent in Day Care)
• Persons Served (Unduplicated)

Program Reports:

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the area agency on aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.
• AIM client level data transmitted to VDA by the last day of the following month.

22 Ibid., 22 VAC 40-60-564 23 Ibid., 22 VAC 40-60-570 24 Ibid., 22 VAC 40-60-580 25 Ibid., 22 VAC 40-60-590 26 Ibid., 22 VAC 40-60-564 27 Ibid., 22 VAC 40-60-680, 690 28 Ibid., 22 VAC 40-60-680 29 Ibid., 22 VAC 40-60-690 through 1020 Page 4 of 4 Adult Day Care Effective 10/01/03, Revised 11/23/2004 Virginia Department for the Aging Adult Day Care FAQ’s

1. What determines eligibility for this program?

A service specific assessment will be done utilizing the Full Uniform Assessment Instrument. Other admission and assessment procedures will be done in accordance with the Department of Social Services Standards and Regulations for Licensed Adult Day Care Centers.

1. Can a person receive personal care or home health and still attend day care?

Receiving one service does not preclude a client from receiving other services if needed. This, of course, depends on the availability of the service.

1. Is Medicaid or Medicare accepted for day care programs?

This would depend on the client’s eligibility for these programs and, if a certified provider is available offering this service.

1. Can this service be used for my parent while I work?

Service may be provided for purchase of respite for family caregivers.

1. Where can I find a copy of the Department of Social Services Standards and Regulations?

A copy is available on the VDA Web Site.

Page 1 of 1 FAQ Adult Day Care Revised 02/26/02 Virginia Department for the Aging CARE COORDINATION

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Care Coordination is assistance, either in the form of accessing needed services, benefits, and/or resources or, arranging, in circumstances where the older person and/or their caregivers are experiencing diminished functioning capacities, personal conditions or other characteristics, the needed services by providers.1 Care Coordination is a distinct and comprehensive service. It entails investigating a person’s needs and resources, linking the person to a full range of appropriate services, using all available funding sources and monitoring the care provided over an extended period of time.

Eligible Population Care Coordination shall be targeted to those older persons, age 60 years and over, who are frail, or have disabilities, or who are at risk of institutional placement. Priority shall be given to older persons who are in the greatest economic or social need and/or residing in rural and geographically isolated areas with particular attention to low-income minority individuals.2 Such persons shall also be unable to maintain independent living and self-sufficiency in their community due to the inability to define, locate, secure or retain the necessary resources and services of multiple providers on an on-going basis and shall be dependent in two (2) or more activities of daily living and significant unmet needs which result in substantive limitations in major life activities.

Unlike Medicaid elderly care coordination or Title III care coordination the state-funded Care Coordination for Elderly Virginians Program is not an entitlement program. Care coordination shall be available to the extent that state appropriations allow.

The care coordination team may decide to deny care coordination services if the team determines the client can be better served/more efficiently served in an institutional setting.

Service Delivery Elements

Care Coordination providers must perform all of the following: Outreach: Outreach is the proactive seeking of older persons who may be in need of care coordination. It involves defining and identifying a target population, and devising an outreach mechanism for educating this population about the program. Outreach makes the service known to other providers and helps assure proper referrals and coordination of care.

Intake/Screening: Intake/screening is an initial evaluation of a person’s needs for care coordination and/or another service. The purpose is to obtain enough information to determine the person’s

1 National Aging Program Information System Reporting Requirements – State Program Report Definitions 2 Older Americans Act of 1965 as amended, Section 306 (a)(4)(A)(i) Page 1 of 7 Care Coordination Effective 10/1/03, Revised 04/14/03 Virginia Department for the Aginglikelihood of needing care coordination or another service and whether a full assessment is needed. The information obtained includes the reason for the referral or for the individual seeking help, the informal and formal supports already available, and basic information such as age and income that relates to eligibility for services. Intake/Screening may be provided in the area agency on aging offices, at senior centers and other community facilities, in the older person’s residence or by telephone.

Assessment: The assessment, using the full Uniform Assessment Instrument (UAI), identifies the person’s care needs beyond the presenting problem in the areas of physical, cognitive, social and emotional functioning as well as financial and environmental needs. It also includes a detailed review of the person’s current support from family, friends and formal service providers. The assessment is conducted prior to provision of any further care coordination services. The assessment interview is conducted with the older person and, if applicable and with the person’s permission, his or her caregiver(s). It is conducted in the person’s residence. If the person is institutionalized or temporarily in another residence, a home visit is conducted after the person’s return to the residence. No longer than fifteen (15) working days shall pass between the time a client is referred for care coordination services and a full Uniform Assessment Instrument is completed.

• A nutritional screening shall be completed on each client.

• Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.

• Any fee for service charge to the client shall be determined by the applicable sliding fee scale. (Cost sharing is prohibited in Title III Care Coordination.)

Care Planning: The care plan is the link from the assessment to the delivery of services. Working with the person and the caregivers, the Care Coordinator develops a plan to address the problems and strengths identified in the assessment; the establishment of desired client-specific goals; the development of a complete list of services to achieve these goals, the responsibilities of the Care Coordinator, client, and informal and formal supports; and the payment sources for services. The client’s agreement with the care plan must be documented. The care plan must be developed within fifteen (15) working days of the completion of the full Uniform Assessment Instrument. Written notification of acceptance or denial into care coordination shall be mailed within five (5) working days of completion of the plan of care.

Arranging for Service Delivery: Service delivery is the process through which the Care Coordinator arranges and/or authorizes services to implement the care plan. This may involve arranging for services to be provided by outside agencies through collaboration, formal request, or the use of purchase-of-service agreements; coordinating help given by family, friends, and volunteers; and requesting services provided directly by the care coordination agency.

Page 2 of 7 Care Coordination Effective 10/1/03, Revised 04/14/03 Virginia Department for the Aging Monitoring: Monitoring is the maintenance of regular contact with the person, informal caregivers, and other providers of service. The purpose is to evaluate whether the services are appropriate, of high quality, and are meeting the individual’s current needs. Monitoring includes the function of verifying whether a service has been delivered and altering the care plan as the individual’s needs change. Contact must be made monthly with the client for purposes of monitoring the implementation of the care plan.

Reassessment: Reassessment is the formal review of the client’s status to determine whether the person’s situation and functioning have changed in relation to the goals established in the initial care plan. Again, service is reviewed for quality and appropriateness. If the person’s needs have changed, the care plan is adjusted. This review is done at least every six months or with any significant change in the person’s condition or services. The reassessment interview is conducted with the person in their home and, if applicable and with the person’s permission, his or her caregiver(s). Reassessments must be completed at least every six months. If a change is needed on the care plan prior to the six months reassessment, it can be facilitated with a phone call to the client. The change should be noted on the care plan and in the care coordination progress notes. The Care Coordinator should make two copies of the revised care plan, mailing one to the client and retaining the other in the client’s file.

• Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.
• Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Termination: Care Coordination services can be terminated at the discretion of the service provider.

Written notification of termination of care coordination services shall be mailed to the client 10 business days in advance of the date the action is to become effective.

Administrative Elements A qualified Care Coordinator must possess a combination of relevant work experience in human services or health care and relevant education that indicates the individual possesses the following knowledge, skills, and abilities at entry level. These must be documented on the Care Coordinator’s job application form or supporting documentation, or observable in the job or promotion interview.

Staff Qualifications:

• Knowledge: Care Coordinators should have a knowledge of aging and/or the impact of disabilities and illness on aging; conducting client assessments (including psychosocial, health and functional factors) and their uses in care planning; interviewing techniques; consumers’ rights; local human and health service delivery systems, including support services and public benefits eligibility requirements; the principles of human behavior and interpersonal relationships; effective oral, written, Page 3 of 7 Care Coordination Effective 10/1/03, Revised 04/14/03 Virginia Department for the Aging and interpersonal communication principles and techniques; general principles of file documentation, and service planning process and the major components of a service plan.

• Skills: Care Coordinators should have skills in negotiating with consumers and service providers; observing, filling and reporting behaviors; identifying and documenting a consumer’s needs for resources, services and other assistance; identifying services within the established services system to meet the consumer’s needs; coordinating the provision of services by diverse public and private providers; analyzing and planning for the service needs of elderly and/or disabled persons, and assessing individuals using the Uniform Assessment Instrument (UAI).

• Ability: Care Coordinators should have the ability to demonstrate a positive regard for consumers and their families; be persistent and remain objective; work as a team member, maintaining effective inter-and intra-agency working relationships; work independently, performing position duties under general supervision; communicate effectively, verbally and in writing; develop a rapport and to communicate with different types of persons from diverse cultural backgrounds, and interview.

It is required that an individual complete training on the UAI prior to performing care coordination.

Individuals meeting all the above qualifications shall be considered a qualified Care Coordinator; however, it is preferred that the Care Coordinator will possess a minimum of an undergraduate degree in a human service field, or be a licensed nurse. In addition it is preferable that the Care Coordinator will have two years of satisfactory experience in the human services field working with the aged or disabled.

Job Description: For each paid and volunteer position an Area Agency on Aging shall maintain:

• A current and complete job description which shall cover the scope of each position-holder’s duties and responsibilities and which shall be updated as often as required, and

• A current description of the minimum entry-level standards of performance for each job.

Units of Service: Units of service must be reported in AIM for each client receiving the service. Service Units can be reported on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

• Hours (All hours relating to care coordination services, including travel time for Care Coordination for Elderly Virginians Program clients Assessment time is included in hours, if this process leads to care coordination. An hour or part of an hour in 15 minute increments is a unit of service.)

Page 4 of 7 Care Coordination Effective 10/1/03, Revised 04/14/03 Virginia Department for the Aging • Persons served (unduplicated)

Program Reports:

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month.

If the area agency on aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.

• AIM client level data transmitted to VDA by the last day of the following month.

Organizational Structure: Care Coordination Services are separate and discreet services of an area agency on aging.

Care Coordinators must be organizationally separate from management of services provided by the agency and which the care coordination clients might receive.

Consumer Contributions/Program Income: The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.

• Cost Sharing/Fee for Service: Cost sharing/fee for service is prohibited in Title III Care Coordination.3

• Cost Sharing/Fee for Service: Cost sharing/fee for service is permitted for Care Coordination for Elderly Virginians Program Clients.

And/Or

• Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service provided that the method of solicitation in non-coercive.4

Quality Assurance: Criminal Background Checks:

• VDA strongly recommends that the agency and its contractors protect their vulnerable older clients by conducting criminal background checks for staff providing any service where they go to or into a client’s home.

Staff Training:

• All new staff must receive an in-depth orientation on policies and procedures; client’s rights’ characteristics and resources of the community; and techniques for conducting the assessment, care planning, service arrangement, and monitoring.

• Each staff person must participate in a ten (10) hour in-service training per year.

Content should be based on the Care Coordinator’s need for professional growth and upgrading of skills.

3 Older Americans Act of 1965 as amended, Section 315(a) 4 Older Americans Act of 1965 as amended, Section 315(b) Page 5 of 7 Care Coordination Effective 10/1/03, Revised 04/14/03 Virginia Department for the AgingCaseload Size: The ratio of clients to Care Coordinator must be reviewed annually and is dependent on the following:

• characteristics of the target population served (e.g., very frail, disoriented, without family support);
• complexity of the care plan;
• geographical size of the area covered, taking transportation difficulties into account;
• availability of community-based services; and the extent of responsibility and control over funds that is exercised by the Care Coordinator.

Supervision/Case Review: Consultation, supervision and case review shall be available to all staff providing the service.

Program Evaluation: The area agency on aging should conduct a regular systematic analysis of the persons served and the impact of the service. Service providers shall be monitored annually.

Complaint and Appeals: Care Coordination agencies shall have in place a written Complaint Procedures and Appeals Procedures.

Client Bill of Rights: Care Coordination agencies shall make a bill of rights available to all clients. This is a statement of the rights of the person receiving care coordination services and includes basic tenets that should be followed in providing the service. Clients should receive copies of the bill of rights on commencement of care coordination and, sign and date a copy to be kept in the client’s file.

Client Records: Records must be maintained for all recipients of services. Care Coordination for Elderly Virginians Program (CCEVP) participants must use forms recommended in the CCEVP Policies and Procedures Manual. Such records must contain the following:

• Intake instrument(s)
• Full Uniform Assessment Instrument
• Determine Your Nutritional Health Nutritional Checklist
• Federal Poverty documentation and Fee for Service calculations must be part of the client record. Federal Poverty/VDA Sliding Fee Scale form may be used. (Cost Sharing is prohibited in Title III Care Coordination.)
• Original Care Plan
• Monthly Progress Notes
• Case Coordination Fee Form
• Purchase of Gap-Filling Services Form

Page 6 of 7 Care Coordination Effective 10/1/03, Revised 04/14/03 Virginia Department for the Aging• Acceptance/Denial Notice

• Care Coordination Outcome Report
• Client Bill of Rights
• Consent to Exchange Information Form

Page 7 of 7 Care Coordination Effective 10/1/03, Revised 04/14/03 Virginia Department for the AgingCare Coordination FAQs

1. What care coordination programs operate in Virginia?

Area Agencies on Aging offer both Title III Care Coordination and the Care Coordination for Elderly Virginians Program sponsored by the Commonwealth of Virginia. Some agencies offer both programs. Consult the web page to see where these programs are located.

1. What is the Care Coordination for Elderly Virginians Program?

The Care Coordination for Elderly Virginians Program began as a pilot program in 1991 to effectively link elderly Virginians to appropriate long-term care services. Currently, 18 area agencies on aging participate in this program, enabling many elderly Virginians to maintain their independence instead of being institutionalized.

1. What is the job of the care coordinator?

The care coordinator seeks older persons who may need services in order to continue independent living. He/she evaluates a person’s need for services by using a full Uniform Assessment Instrument. If the client is dependent in two or more activities of daily living and has need of multiple services to maintain self-sufficiency in the community, the care coordinator will arrange and monitor services for the client.

1. How are hours determined for care coordination as reported in AIM and the

AMR?

Hours are determined per client and include all hours relating to care coordination including travel time for clients. (Assessment time is included if this process leads to care coordination.)

1. Where can one find the correct forms for the files of the Care Coordination for Elderly Virginians Program clients?

These forms can be located in the Care Coordination for Elderly Virginians Policies and Procedures Manual located on the VDA website.

Page 1 of 1 FAQ Care Coordination Revised 03/01/02 Virginia Department for the Aging

CHECKING

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Checking is the service of contacting older persons at their residence to make sure that they are well and safe. This activity may also serve to provide psychological reassurance to an older person who is alone and in need of personal contact from another individual.

Eligible Population Checking services are targeted to persons 60 years of age or older who are frail, have disabilities, or who are at risk of institutional placement. Priority shall be given to older persons who are in the greatest social and economic need and/or are residing in rural or geographically isolated areas, with particular attention to low-income minority individuals.1

Service Delivery Elements Service Specific Assessment: A service specific assessment using Virginia Service-Quick Form must be performed on each potential client to determine:

• Whether the person meets the criteria specified in eligible population;
• What the person’s service specific needs are;
• What level of priority for service delivery the person meets
• Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.
• Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Agencies providing Checking Services must perform the following: Telephone or visit an older person in order to provide comfort or help. May include “Lifeline” or other automated checking/reassurance services.

Administrative Elements Staff Qualifications:

• Knowledge: staff shall have an awareness of the biological, psychological, and social aspects of aging; community resources and public benefits eligibility requirements.
• Skills: staff should have skills in establishing and sustaining interpersonal relationships and problem solving.
• Ability: staff should have ability to communicate with persons with different socio-economic backgrounds and to work independently.

1 Older Americans Act of 1965 as amended, Section 306(a)(5)(A)(i) Page 1 of 3 Checking Effective 10/1/03, Revised 04/14/03 Virginia Department for the Aging Job Description: For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on Aging shall maintain:

• A current and complete job description which shall cover the scope of each position-holder’s duties and responsibilities and which shall be updated as often as required, and
• Current description of the minimum entry-level standard of performance for each job.

Units of Service: Units of service must be reported in AIM for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated summarized more than beyond one calendar month.

• Contacts (Telephone calls or visits to clients)
• Persons Served (Unduplicated)

Program Reports:

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month.

If the area agency on aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.

• AIM client level data transmitted by the last day of the following month.

Consumer Contributions/Program Income: There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations.

• Cost Sharing/Fee for Service: An Area Agency is permitted to implement cost sharing/fee for service for recipients of this service.2 And/Or
• Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service provided the method of solicitation is non-coercive.3

Quality Assurance Criminal Background Checks:

• VDA strongly recommends that the agency and its contractors protect their vulnerable older clients by conducting criminal background checks for staff providing any service where they go to or into a client’s home.

2 Ibid., Section 315(a) 3 Ibid., Section 315(b) Page 2 of 3 Checking Effective 10/1/03, Revised 04/14/03 Virginia Department for the AgingStaff Training:

• (Initial) In-depth orientation on agency policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.
• (Ongoing) At least annual in-service training, the content of which to be based on the need for professional growth and upgrading of knowledge, skills, and abilities.

Supervision/Case Review: Consultation, supervision, and caseload review shall be available to all staff providing the service.

Program Evaluation: The area agency on aging should conduct a regular systematic analysis of the persons served and the impact of the service. Service providers shall be monitored annually.

Client Records:

• Virginia Service – Quick Form (At a minimum, this form must be updated annually).
• Federal Poverty Documentation and Fee for Service calculation must be part of the client record. Federal Poverty/VDA Sliding Fee Scale form may be used.
• Service Documentation

Page 3 of 3 Checking Effective 10/1/03, Revised 04/14/03 Virginia Department for the AgingChecking FAQ’s

1. Does the checking service standard require that a client be visited in his home?

No, a client may be telephoned or participate in an automated checking/reassurance service.

Page 1 of 1 FAQ Checking Revised 02/25/02 Virginia Department for the Aging

CHORE

VIRGINIA DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES (DARS)

SERVICE STANDARD

Definition Chore services provide assistance to persons having difficulty with one or more of the following instrumental activities of daily living: heavy house work, yard work or sidewalk maintenance.1

Eligible Population Chore services are targeted to persons 60 years of age or older who are frail, have disabilities, or who live in isolated areas, with particular attention to low-income minority individuals and individuals with limited English proficiency.2

Service Delivery Elements The Area Agency on Aging must perform all of the following components of chore services:

Service Specific Assessment: A service specific assessment using the Part A of the Uniform Assessment Instrument shall be performed on each potential client to determine:  The person meets the criteria specified in eligible population  The person’s needs for supports/services  The level of priority for service delivery the person meets  The person’s Federal Poverty Level. The Federal Poverty/VDA form may be used for documentation.  Any fee for service charge determined by the applicable sliding fee scale

Service Plan: A written individualized service plan shall be developed which identifies the supports/services to be provided to the client in response to established need. The plan is to be developed prior to service commencement by the Area Agency on Aging with involvement from the client or authorized representative or family member to the greatest extent possible. When “client” is used throughout this service standard, it can also mean authorized representative or family member, as deemed appropriate by the Area Agency on Aging and/or the client. The client will be ensured the opportunity by the Area Agency on Aging to participate in the implementation and evaluation of the service plan. The plan may be modified to reflect any change in the client’s needs. Each plan shall include:  Identified service needs  Services to be delivered by the service provider and/or by other sources  Goal(s) and objective(s) of support(s)/service(s)  Service units to be provided 1 National Aging Program Information System Reporting Requirements – State Program Report Definitions 2 Older Americans Act as Amended 2006, Section 306 (a)(4)(A)(i) Page 1 of 5 Effective 10/1/03, Revised 10/1/13 Virginia Department for Aging and Rehabilitative Services Service Agreement: A service agreement will be completed between the Area Agency on Aging and the service provider with input from the client. If the Area Agency on Aging is the service provider, it will produce the service agreement. The client will receive a copy of the agreement. The agreement will include:  Services to be provided  Scheduled hours/days of service  Information regarding voluntary contributions/payment for service  Emergency contacts  Severe weather policy

Service Activities: Service activities provided by the service provider agency may include:  Window – washing  Floor cleaning (scrubbing and polishing)  Yard Maintenance  Painting – limited  Chopping and stacking wood  Carrying coal, wood and water  Removal of ice and snow  Minor repair work performed in the home on furniture and appliances  Minor repair work performed on the home (e.g. light carpentry work, hinge work, door knob repair, replace broken glass, etc.)  Heavy cleaning

Service Record: The client will sign a service record when the service is provided. Service records will be maintained at the Area Agency on Aging.

Service Reassessment: A review of the client’s need for services, the amount of services provided and the appropriateness of the care plan will be performed by the Area Agency on Aging when the client’s condition/situation changes, but at least annually.  Federal Poverty Level will be determined and documented. The Federal Poverty/VDA form may be used.  Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Service Termination Policy: The Area Agency on Aging must have a service termination policy that includes:  A service summary  Appropriate referrals to other community agencies, if needed  Follow-up services for the client, as appropriate Page 2 of 5 Effective 10/1/03, Revised 10/1/13 Virginia Department for Aging and Rehabilitative Services Chore services can be terminated at the discretion of the service provider, the Area Agency on Aging or the client. The Area Agency on Aging must mail notification of termination of chore services to the client 10 business days in advance of the date the action is to become effective if the service is ended by the service provider or the Area Agency on Aging.

Administrative Elements

Area Agency on Aging Staff Qualifications:  Knowledge: Area Agency on Aging staff shall have an awareness of the biological, psychological, and social aspects of aging; an awareness of the impact of disability and illness on aging; a general knowledge of minor home repair tasks and major household cleaning tasks; a knowledge of tools and equipment used in minor home repairs and heavy duty cleaning; and an awareness of community resources and consumer rights.  Skills: Area Agency on Aging staff shall have skills that enable them to establish and sustain personal relationships, work with service providers and solve problems.  Abilities: Area Agency on Aging staff shall be able to communicate effectively with persons of different socioeconomic backgrounds; to work independently and in groups, and to supervise contractors if necessary.

Job Description: For each paid position an Area Agency on Aging shall maintain:  A current and complete job description of the scope of each employee’s or volunteer’s duties and responsibilities. This description is updated as often as required.  A current description of the minimum entry-level standards of performance for each job.

Service Provider Staff Qualifications:  Knowledge: Service providers should have an awareness of, or sensitivity to the needs of older persons and individuals with disabilities. They will have the knowledge to ascertain the skills and equipment needed to perform the required chores to meet the specialized needs of older persons or individuals with disabilities.  Skills: Service providers must be able to perform minor home repairs and heavy duty household cleaning as needed by the client. Home repairs may require licensed contractors and the Area Agency on Aging may require a copy of the contractor’s license and proof of liability for their files. Volunteers should be supervised by individual(s) with skills in repairing or modifying the homes of older adults.

• Licensure of private contractors is required for any service above $1,200.00  Abilities: Service providers should be able to perform service activities as demonstrated through references from prior similar work experiences.

Units of Service: Units of service must be reported in the approved DARS electronic data system for each Page 3 of 5 Effective 10/1/03, Revised 10/1/13 Virginia Department for Aging and Rehabilitative Services client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.  Hours (All hours spent assessing the need for; and, arranging and delivering chore services)  Persons served (Unduplicated)

Program Reports:  Aging Monthly Report (AMR) to DARS by the twelfth (12th) of the following month.

This report must be updated and submitted even if no expenditure or units of service occurred.  AIM or PeerPlace client level data transmitted to DARS by the last day of the following month.  A completed and properly maintained Part A electronic/digital Uniform Assessment Instrument (UAI) is a mandatory requirement.  The question “Client in Federal Poverty?” (Answer yes or no) must be asked and recorded.  A written Policies and Procedures Manual must be maintained for the service.

Consumer Contributions/Program Income: The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income. There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations.

Cost-Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service.

Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited provided that the method of solicitation is non-coercive. Such contributions shall be encouraged for individuals whose self- declared income is at or above 185 percent of the Federal Poverty line, at contribution levels based on the actual cost of service.3

Quality Assurance

Criminal Background Checks: The Virginia Department for the Aging strongly recommends that the agency and its contractors protect their vulnerable older citizens by conducting criminal background checks for staff providing any service where they go to or into a client’s home.

Area Agency on Aging Staff Training: 3 Older Americans Act as Amended 2006. Section 315(b) Revised 1/6/2012 Page 4 of 5 Effective 10/1/03, Revised 10/1/13 Virginia Department for Aging and Rehabilitative Services  Initial – An in-depth orientation on agency policies and procedures, community characteristics and resources, and procedures for conducting the allowable activities under this service  Ongoing – A minimum of ten (10) hours per year of in-service training, the content of which is based on the need for professional growth and upgrading of knowledge, skills and abilities.

Supervision/Case Review: Consultation, supervision and case review shall be available to all staff providing the service.

The Case Monitor Section for this service must be completed in the approved DARS electronic data system.

Program Evaluation: The Area Agency on Aging shall conduct regular and systematic analysis of the persons served and the impact of the service.  Service providers must be monitored annually. A written copy of the monitoring report will be kept at the Area Agency on Aging.  Anonymous client surveys must be conducted annually. A file of these surveys with a summary of the survey results will be maintained by the agency.

Client Records: Area Agencies on Aging must maintain specific program records in the approved DARS electronic data system:  Part A of the Uniform Assessment Instrument  Federal Poverty Level  Service Plan  Service Reassessment, as needed  Progress Notes  Consent to Exchange Information Form  Caregiver Form, if this service is funded by OAA Title III E

The Area Agency on Aging will also maintain the following additional client records:  Service documentation, including any fee charged the client  Signed Client Bill of Rights/Appeals Process  Denial or Termination of Service Notice Page 5 of 5 Effective 10/1/03, Revised 10/1/13 Virginia Department for Aging and Rehabilitative Services Chore FAQ’s

1. How does the chore service differ from the homemaker service?

Chore service is the performing of heavy-duty household tasks such as window washing or floor cleaning. Homemaker service offers the performance of basic household tasks such as dusting, sweeping, laundry or shopping.

Page 1 of 1 FAQ Chore Revised 02/25/02 Virginia Department for the Aging

COMMUNICATION, REFERRAL AND INFORMATION AND ASSISTANCE

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definitions Communication—The process of offering general information to a client, caregiver, professional or other individual. [Ex. A caller asks for the number of the local DSS and the intake coordinator provides the number.]

Referral—The process of informing a client, caregiver, professional or other individual about appropriate choices and linking them with external entities providing opportunities, services, supports and/or resources to meet their needs. A referral does not involve direct services provided by the referring agency (AAA). [Ex. A caller inquires about how to apply for financial assistance. After asking several questions, the intake coordinator determines that the individual may be eligible for Medicaid and refers the caller to the local DSS office.]

Information and Assistance—The process of assessing a client or caregiver and transferring them to a service provided directly by the agency (AAA) or through a subcontractor and paid by the agency, or directly assisting them with obtaining needed services, supports and/or resources and, if necessary, advocating with entities on their behalf. [Ex. A caller inquires about financial assistance. The intake coordinator determines that the individual may be eligible for Medicaid, but is homebound and needs assistance with the application. The caller is assigned a care coordinator who will do a home visit to assess the individual, assist with the Medicaid application process, and determine if there are other services, such as home delivered meals, that could be beneficial.]

Follow-Up—A process of contacting individuals and the organizations to which they were referred to determine the outcome of the referral. Determining the quality and effectiveness of the referral and the service provided to the person referred. Additional assistance to the individual in locating or using needed services may be a part of the follow-up.

Planning and Evaluation—The process of aggregating and analyzing information collected through the provision of the service; collecting and reporting data on unmet needs for other services; and evaluating the overall effectiveness of the Communication, Referral, and Information and Assistance service.

Eligible Population Communication and Referral services are targeted to persons who are 60 years of age or older, persons with disabilities aged 18 and over, and their families and caregivers.

Individuals are eligible for Information and Assistance services if they are 60 years of age or older.

Priority shall be given to older individuals who are in the greatest economic and social need, and older individuals at risk for institutional placement, with preference given to low-income minority older individuals, older individuals with limited English proficiency, and older individuals residing in rural areas.1 Families and caregivers of older adults may also receive information and assistance for needed services. 1 Older Americans Act of 1965, as amended, Section 306(a)(4)(A)(i) Page 1 of 6 Communication, Referral and Information & Assistance Effective 07/01/2010, Revised 10/3/2011 Virginia Department for the Aging Service Delivery Elements If an agency provides Communication, no further action is required. The agency may opt to document communications in PeerPlace or some other format.

Agencies providing Referral services are required to complete the Virginia Service – Quick Form.

Agencies providing Information and Assistance services must perform all of the following components: Assessment: The process of identifying, analyzing, and prioritizing the needs of older persons, utilizing the required minimum assessment tool for the service to which the individual is being transferred, and any other client assessment documents as determined by the AAA. (Refer to the Information Systems Service Guide or applicable service standard.) Federal Poverty/VDA Sliding Fee Scale is required, unless all information needed to determine federal poverty is documented on the UAI (self-declaration only; no income verification is required).

See “Client Records” for the required documentation.

Administrative Elements Staff Qualifications: o Knowledge: Communication, Referral and Information and Assistance service staff should have an awareness of the biological, psychological, and social aspects of aging and caregiving; the impact of disabilities and illnesses on individuals; interviewing principles; community resources; and public benefits eligibility requirements. o Skills: Communication, Referral, and Information and Assistance service staff should have skills in establishing and sustaining interpersonal relationships; problem-solving; advocacy; and use of computer office software. o Ability: Communication, Referral, and Information and Assistance service staff should have the ability to: communicate with persons of different socio-economic backgrounds; conduct an effective interview; complete an assessment; arrange and negotiate service referrals; and work independently.

Job Descriptions: For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on Aging shall maintain: o A current and complete job description which shall cover the scope of duties and responsibilities of Communication, Referral, and Information and Assistance service staff; and o A current description of the minimum entry-level standards of performance for each job.2

Agency Data Requirements

Referral and Information and Assistance services will collect data to support community needs assessment and community planning activities.

2 22 VAC 5-20-250, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code Page 2 of 6 Communication, Referral and Information & Assistance Effective 07/01/2010, Revised 10/3/2011 Virginia Department for the Aging AIM System Agency Data Requirements for Recording Referrals and Information and Assistance

Units of Service: Units of service must be reported in AIM for each client receiving services. Service units can be reported for client on a daily basis, but not aggregated (summarized) more than beyond one calendar month. o Contacts: count the number of interactions with the client and with agencies, caregivers, professionals and others related to establishing services, and when a Quick Form or Part A of the UAI is completed. o Persons served (unduplicated): the individual who is receiving a direct service(s).

Optional Units (Not Entered into AIM but may be reported on AMR for AAA use) o Number of communication calls (i.e., tick marks or call log)

Program Reports: o Aging Monthly Report (AMR) is due to VDA by the twelfth (12 th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred. o AIM client level data must be transmitted to VDA by the last day of the following month.

NWD Tools / PeerPlace System Agency Data Requirements for Recording Referrals and Information and Assistance

Note: Each field described below must be asked of an individual for Referral and Information and Assistance services in order to properly coordinate their services and to meet NAPIS and other federal reporting requirements. These fields include all data elements from the Virginia Service – Quick Form, as well as some additional fields now needed to coordinate services across agencies.

• Virginia Service – Quick Form data elements have been noted by an asterisk.

Date: date service need established.

First Name:*

Last Name:*

Street Address: where individual resides*

City: where individual resides*

State: where individual resides*

Zip: where individual resides*

Phone Number: include area code* Page 3 of 6 Communication, Referral and Information & Assistance Effective 07/01/2010, Revised 10/3/2011 Virginia Department for the Aging Required Fields for ADRC Reporting:

DOB: Individual needing service.*

Contact Type: Received request for service information from o Consumer/Individual o Caregiver/Supporter o Professional o Other

Service Type: Service Requested.

Disability Type: Record disability category of the individual needing service as either: o Physical o MR/DD/ID o Mental Illness o Dementia Disorders (includes Alzheimer’s Disease) o Traumatic Brain Injury o Sensory Disabilities o Multiple Disabilities o Unspecified o No Disability

Federal Poverty: Answered as ‘Yes’, ‘No’, or ‘Refused to Answer’*

Federal Poverty/VDA Sliding Fee Scale Level A through G*

Assistance Type: Individual needing service was provided: o Options Counseling o Benefits Counseling (as part of options counseling) o Long Term Care Futures Planning (as part of options counseling)

Race:* o American Indian/Alaskan Native o Asian o Black / African American o Native Hawaiian or Other Pacific Islander o Other o White o 2 or More Races o Refused to Answer

Ethnicity* o Hispanic o Non Hispanic o Refused to Answer Page 4 of 6 Communication, Referral and Information & Assistance Effective 07/01/2010, Revised 10/3/2011 Virginia Department for the Aging Does the Individual Requesting Service Live Alone: ‘Yes’ or ‘No’*

Gender:* o Male o Female

Veteran: ‘Yes’ or ‘No’

FIPS Code:* (often referred to as county code) refers to Federal Information Processing Standards codes of jurisdiction of where the individual resides.

Referral Data Elements for the NWD Tools Application

Referral agency type: category or type of agency, including but not limited to: o CIL o CSB o DRS o DSS

Units of Service: Units of service must be reported in PeerPlace for each client receiving services. o Contacts: count the number of interactions with the client and with agencies, caregivers, professionals and others related to establishing services, and when the required fields in the IA record are completed. o Persons served (unduplicated): the individual who is establishing the need for service(s).

Contributions/Program Income The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.3 o Cost Sharing/Fee for Service: An Area Agency on Aging is not permitted to implement cost sharing/fee for service for recipients of communication, referral or information and assistance services.4 o Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited provided that the method of solicitation is non-coercive.5

Quality Assurance Staff Training: o Staff should receive orientation on agency policies and procedures, computer database (PeerPlace or AIM), client rights, client confidentiality, community characteristics and resources, and procedures for conducting the allowable activities under this service. o Staff should receive a minimum of eight (8) hours of in-service training per year based on the need for professional growth and upgrading of knowledge, skills, and abilities. 3 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 4 Older Americans Act of 1965, as amended, Section 315(a) 5 Older Americans Act of 1965, as amended, Section 315(b) Page 5 of 6 Communication, Referral and Information & Assistance Effective 07/01/2010, Revised 10/3/2011 Virginia Department for the Aging Follow-up: Follow-up is required in 10% of the referrals. Individuals and the organizations to which they were referred should be contacted to determine the quality and effectiveness of the referral and the service provided to the individual referred.

Supervision/Case Review: Consultation, supervision and case review shall be available to all staff providing the service.

Program Evaluation: The agency should conduct regular (at least annual) systematic analysis of the persons served and the impact of the service.

Client Records: Service providers must maintain specific program records that include the following information: o For referral purposes only, the Virginia Service - Quick Form is required. o For information and assistance, the required minimum assessment tool for the service to which the individual is being transferred must be completed for clients requiring direct services. (Refer to the Information Systems Service Guide or applicable service standard.) o Federal Poverty should be determined and documented. The Federal Poverty/VDA Sliding Fee Scale form should be used. (Self-declaration only; no income verification is required.) o Progress notes or contact logs to document case activity.

Page 6 of 6 Communication, Referral and Information & Assistance Effective 07/01/2010, Revised 10/3/2011 Virginia Department for the Aging CONGREGATE NUTRITION SERVICES (Title III – C1)

DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES-VIRGINIA

DIVISION FOR THE AGING SERVICE STANDARD Definition1 Provision, to an eligible client or other eligible participant at a nutrition site, senior center, or some other congregate setting, a meal which:  Complies with the most recent edition of the Dietary Guidelines for Americans, published by the Secretary of Health and Human Services and the Secretary of Agriculture,  Provides a minimum of 33 1/3 percent of the dietary reference intakes (DRI) as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences, if one meal is provided per day,  Provides a minimum of 66 2/3 percent of the DRI if two meals are provided per day,  Provides 100 percent of the DRI if three meals are provided per day,  To the maximum extent practicable, are adjusted to meet any special dietary needs of program participants,  Complies with applicable provisions of State or local laws regarding the safe and sanitary handling of food, equipment, and supplies used in the storage, preparation, service, and delivery of meals to an older individual.

The congregate nutrition site provides opportunities for socialization and recreation that may alleviate isolation and loneliness.

Eligible Population Congregate Nutrition Services are targeted to persons 60 years of age or older. Priority shall be given to older individuals with greatest economic and social need, with special emphasis on low-income minority individuals, older individuals with limited English proficiency, older persons residing in rural or geographically isolated areas, and older individuals at risk for institutional placement.2 In addition to meeting established eligibility, individuals must be mobile, not homebound, and physically, mentally, and medically able to attend a congregate meals program in accordance with written Area Agency on Aging (AAA) guidelines.

The AAA shall establish procedures for offering a meal on the same basis as meals are provided to participating older individuals, to other eligible individuals including the following3  The recipient’s spouse, regardless of age or disability  Individuals with disabilities who are not older individuals but who reside in housing facilities occupied primarily by older individuals at which congregate nutrition services are provided  At the discretion of the AAA, individuals with disabilities, regardless of age, who reside at home with and accompany older eligible individuals to the congregate site

1 Older Americans Act of 1965, as amended, Section 339 (2) (A) 2 Older Americans Act of 1965, as amended, Section 306(a)(4)(A)(i) 3 Older Americans Act of 1965, as amended, Section 339 (2) (H&I) Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 1 of 19  At the discretion of the AAA, individuals, regardless of age, providing volunteer services during the meal hours

There is no prohibition against providing services to persons under age 60 with funds from other sources.4

Service Delivery Elements The Area Agency on Aging or service provider must perform all of the following components of the congregate nutrition services:

Program Requirements Each nutrition services provider must provide at least one hot or other appropriate meal in a congregate setting each day the site is in operation. Additional meals meeting the requirements specified above under “Definitions” may be provided to each participant for days the site is not open.

AAAs must have at least one site operating each of 5 days a week, Monday through Friday, except in a rural area where such frequency is not feasible and a lesser frequency is approved by

DARS-VDA.

AAAs that do not have at least one meal site available somewhere within the PSA each day of the week (Monday through Friday, holidays and emergencies excepted) must submit to DARS-VDA for review and approval a plan documenting their rationale and detailing their policies and procedures to address the following issues:  Documentation of the factors that make it unfeasible to provide meals in at least one congregate meal site each day of the week Monday through Friday.  On the day(s) that there is no congregate meal site available within the PSA, describe provisions for congregate meal participants to receive meals at other facilities operated by the AAA or service provider such as an adult day health center, assisted living or nursing facility.

The Older Americans Act (OAA) requires that AAAs and nutrition service providers solicit the advice and expertise of (1) a dietitian or other individual with equivalent education and training in nutrition science, or if such an individual is not available, an individual with comparable expertise in the planning of nutrition services, (2) meal participants, and (3) other individuals knowledgeable about the needs of older individuals.5

DARS-VDA recommends that AAAs and nutrition service providers hire or contract with a registered dietitian (RD). Please see Guidance on Soliciting the Expertise of the RD.

Program participants and other individuals may be encouraged to actively participate in program planning and volunteer to perform tasks at the meal site to their ability and desire.

4 Older Americans Act of 1965, as amended 5 Older Americans Act of 1965, as amended, Section 339 (2) (G) Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 2 of 19 Nutrition services providers shall design meals that are appealing to program participants and shall enter into contracts that limit the amount of time meals must spend in transit before they are consumed.6 Additional Meals Definition: Meals sent home from the congregate meal site to be eaten at home when the meal site is not open, up to 5 days a week.

If an AAA wishes to provide additional take home meals to congregate nutrition participants, the agency shall develop an Additional Congregate Meal Policy that shall be approved by the agency’s governing board.

Requirements for additional meals:

1. The additional meals shall be provided at each visit for the client to carry home herself or himself. The meals shall not be delivered in bulk for the week or month. Clients not attending the site will not receive meals. The additional meals policy must state the maximum number of meals each client should receive, based on the days the congregate meal site is open. The policy should also take into account when the site is closed, such as for holidays, other functions, or repairs.
2. The additional meals policy shall state clients taking meals home must provide a signature indicating the number of meals received. Operationally, the client may indicate next to his or her signature on the sign-in sheet, the number of meals taken home. The signature form shall be included with the site’s monthly reporting process for documentation of meals provided for entry into the DARS-VDA approved client database.
3. All additional meals counted as eligible meal units shall meet nutrient content guidance as outlined in the DARS-VDA menu planning guidelines.

AAAs may consider partnering with local agencies such as food banks, food pantries, and other food assistance organizations which may provide or donate food for senior participants’ use at home. The food would not be counted as eligible service units, but nonetheless may significantly help senior participants. AAA’s may also consider facilitating SNAP or other food assistance enrollment for eligible congregate nutrition participants.

Emergency Meals Definition: There are two situations when emergency meals may be provided.

Anticipatory – Meals sent home from the congregate meal site at the beginning of the winter and/or summer storm season, in anticipation of inclement weather. Participants are instructed to store the meals until needed in case of congregate meal site closure for inclement weather or other emergencies.

Actual emergency meals – Meals sent in response to an actual weather or emergency event which necessitates closure of the congregate meal site for more than one week.

Requirements:

1. No more than 5 meals may be provided at one time in anticipation of seasonal weather emergencies. If known emergency events and site closures have caused participants to eat their emergency meals, subsequent replacements may be provided in 5 meal allotments. 6 Older Americans Act of 1965, as amended, Section 339 (2) (B&C) Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 3 of 19

1. In the event of an actual weather or other emergency, the number of meals provided shall be based on the amount of time the congregate site is closed. Up to 10 meals may be provided at one time, if the congregate meal site will be closed for more than one week.
2. Documentation shall show the number of meals and client names receiving emergency meals. Signatures are preferred, but at a minimum, the client name and number of eligible meals per client shall be reported for entry in the DARS-VDA approved client database.
3. In order to be counted as eligible meals, the emergency meals shall meet nutrient content guidance as outlined in the DARS-VDA menu planning guidelines.

Breakfast Meals Please see the DARS-VDA Menu Planning Guidelines.

Assessment  A service-specific assessment using the Virginia Service Quick Form and the Determine Your Nutritional Health screening checklist shall be performed on each potential client or other eligible individual (not a volunteer). Client assessment data shall be documented in the DARS-VDA-approved electronic client database.  The AAA may develop and use a form (in place of the Virginia Service Quick Form) to be completed by the senior, when appropriate, as long as all information is collected and documented in the DARS-VDA-approved electronic client database.  Federal Poverty should be determined and documented. The answer to the question “Is the Client in Federal Poverty?” (answer Yes or No) must be asked and recorded in the DARS-VDA-approved electronic client database. The Federal Poverty/DARS-VDA form may be used.  Cost sharing does not apply to this service.  For an individual of any age, who provides volunteer services during the meal hours (not a site participant) and receives a congregate meal, an assessment is not required.

However, a Virginia Service Quick Form shall be requested. At a minimum, the full legal name and service units (collected at least on a monthly basis) must be entered into the DARS-VDA-approved client database. If there is continual service, an update to the volunteer’s Virginia Service Quick Form must be requested at least annually. The updated volunteer data must be recorded in the DARS-VDA-approved client electronic database.  Emergency contact information.

Nutrition Screening The “Determine Your Nutritional Health” Nutrition Screening checklist developed and distributed by the Nutrition Screening Initiative must be completed during assessment. The AAA or service provider will develop a written plan specifying how the agency will use the screening results.

At a minimum, the screening results may be used in the following ways:  Referral to appropriate services such as (1) dental professionals for those with tooth or mouth problems, (2) the food stamp program, food bank, or other social programs if they indicate they don’t have enough money to buy food, (3) their doctor or a dietitian if they have a chronic condition requiring a special diet, for example.

Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 4 of 19  Planning nutrition education programs. For example, educating participants how to increase fruit and vegetable intake or to shop for and prepare nutritious meals, depending on what the screening form shows.  As a criterion in prioritizing client needs for nutrition service especially when program funding is limited.

Care Plan The Care Plan is optional and may be completed by another department within the Area Agency on Aging. If used, the Care Plan may include nutritional and social needs that can be met through congregate nutrition services. Before the service is delivered, a written individualized care plan may be developed that identifies the service components to be provided to meet the client’s assessed need. The plan should be developed with involvement from the client. “Client” may include the individual’s authorized representative or family member. The client should be given the opportunity to provide input for the implementation and evaluation of the plan. The plan may be modified to reflect any change in the client’s needs. Each plan may include:  Identified service needs  Services to be delivered by the service provider or other sources  Goals and objectives of service to be provided  Quantity of service units to be provided

Service Confirmation A service confirmation, which may be in the form of a letter, packet, or handbook shall be provided to the client to explain the service arrangement. The client shall receive a copy that includes:  Service to be provided  Scheduled days of service  Information regarding voluntary contributions  Description of procedures to be followed if a participant becomes ill or injured  Service interruption due to severe/inclement weather or other conditions  Explanation of the Service Termination Policy  Other policies deemed informative and appropriate by the service provider

If service is denied or the client is placed on a waiting list, written notice shall be provided to the client within 10 business days of the denial decision or placement on the waiting list. The agency’s process on filing an appeal shall be provided with the denial.

Service Termination Policy Service will be terminated at the discretion of the provider. Written notification of service termination shall be mailed 10 business days prior to the date the action is to become effective.

The agency’s process on filing an appeal shall be provided with the termination notice.

Reassessment  A review of the participant’s need for services, the amount of services provided and the appropriateness of the care plan (if completed) shall be performed when the participant’s condition or situation changes, but at least annually.  The Virginia Service Quick Form, and “Determine Your Nutritional Health” Nutrition Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 5 of 19 Screening shall be updated at the same time. Client reassessment data shall be documented in the DARS-VDA-approved electronic client database.  Federal Poverty should be determined and documented. The answer to the question “Is Client in Federal Poverty?” (answer Yes or No ) must be asked and recorded in the DARS-VDA-approved electronic client database. The Federal Poverty/DARS-VDA form may be used.  Cost sharing does not apply to this service.  Update of emergency contact information.

Site Location Congregate nutrition sites shall be as close as possible to the majority of eligible older individuals’ residences. Where feasible, sites shall be located that encourage joint arrangements with schools and other facilities serving meals to children in order to promote intergenerational meal programs.7 The AAA or provider shall develop written agreements with each agency or organization where a congregate nutrition site is located. The agreement shall include responsibilities and obligations of each party including, but not limited to:  Sanitation of restrooms and common areas; cleaning, care and maintenance of facility and grounds; pest control; snow removal; obtaining Health Department Permits; fire inspection; insurance coverage of items owned by the congregate program; liability insurance; compliance with all applicable federal, state and local laws  Staffing interrelationships and roles, including responsibility and authority  Cost or payments to be incurred by either party  Days and hours the congregate sites will operate in the facility  Provision for termination of the agreement by either party

Physical Facilities, Accessibility and Equipment Each nutrition site shall meet minimum requirements related to the physical facility and equipment, including, but not limited to:  Meet Americans with Disabilities Act requirements, and if necessary, have a written plan to accommodate seniors with disabilities  Access to a kitchen or approved work area, for the set-up and dispensing of meals. This includes all equipment necessary to maintain proper food temperatures. If used for the nutrition program, there shall be operating thermometers in the refrigerator and freezer.

Approval of the area by the local health department may be requested, but is not required, for sites where food is served but not prepared.  Separate sinks for hand washing and food service  Equipment, including tables and chairs for meals and other programs, which are sturdy and appropriate for older persons. The site shall have adequate space to accommodate persons with canes, walkers, wheelchairs, and other assistive devices.  Door exit signs  Occupancy limit signs, if required by locality 7 Older Americans Act of 1965, as amended, Section 339 (2) (E) Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 6 of 19  Telephone accessible to staff  Fire extinguisher(s) in good working order  Readily accessible first aid kit

Nutrition Education, Nutrition Counseling, and other Nutrition Services AAAs and nutrition service providers will provide nutrition education, nutrition counseling, and other nutrition services, as appropriate, based on the needs of meal participants.8 The nutrition services and programs offered by AAAs will be described in the Area Plan and comply with the following definitions:

Nutrition Education (1 session per participant) -- A program to promote better health by providing accurate and culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition) information and instruction to participants, caregivers, or participants and caregivers in a group or individual setting overseen by a dietitian or individual of comparable expertise.9

Information for nutrition education will be obtained from a reputable source or provided by a registered dietitian or other qualified individual. The participant shall be provided with information on a continuing basis, but at least quarterly. Scheduled programs shall be documented as having taken place including dates, tracking of participant attendance for the DARS-VDA-approved client database, and the source and/or presenter of the information.

Food Safety: At least once a year, Nutrition Education on food safety, such as food handling, reheating, and storage, shall be provided and may include a review of how meals are safely handled at the meal site as well as information for home food safety practices.

Nutrition Counseling (1 session per participant) -- Provision of individualized guidance to individuals who are at nutritional risk because of their health or nutrition history, dietary intake, chronic illnesses, or medications use, or to caregivers. Counseling is provided one-to-one by a registered dietitian, and addresses the options and methods for improving nutrition status.10

Disease Prevention and Health Promotion: When the Administration for Community Living (ACL) mandates that Title III-D funds shall only be used for highest tier evidence-based programs, AAAs shall be expected to comply. See DP/HP Service Standard for current requirements and definitions.

Lower tier activities may be offered in the congregate nutrition site through the use of community volunteers and in-kind contributions of local health organizations, as long as no Title III-D funding is used to support them, when highest tier evidence-based activities are mandated by the ACL. Lower tiered activities might be, for example, nutrition education provided in-kind 8 Older Americans Act of 1965, as amended, Section 331(3). 9 Administration on Aging, Title III and Title VII, State Program Report Data Elements at http://www.agid.acl.gov/Resources/DataSources/DataFiles/StateProgramReportForm053110.pdf , page 23, accessed on July 28, 2014. 10 Administration on Aging, Title III and Title VII, State Program Report Data Elements at http://www.agid.acl.gov/Resources/DataSources/DataFiles/StateProgramReportForm053110.pdf , page 23, accessed on July 28, 2014.

Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 7 of 19 by Cooperative Extension program assistants, or health screenings provided by volunteer nurses, physicians, and other credentialed and trained health professionals. DP/HP information may be provided to the participant on a continuing basis, but at least monthly. Scheduled programs shall be documented as having taken place including dates, tracking of participant attendance, and the source and/or presenter of the information.

Physical Activity and Exercise Voluntary participant-appropriate physical activities may be offered on a continuing basis, with the goal of at least weekly. Daily participant-appropriate physical activity will be provided as feasible and may include yoga, exercise, and tai chi classes taught by volunteer instructors.

Participants will be advised to discuss participation in the physical activity program with their physician or health care professional. If Title III-D funding is used to support such activities as yoga, exercise, tai chi, etc. these must be structured highest criteria programs, when highest tier evidence-based activities are mandated by ACL that have undergone research study and have been published in peer-reviewed literature.

Community Services and Public Benefits Congregate Nutrition Services shall provide a link to other available community services such as health screening, counseling, consumer education, senior employment, preventive health services, food stamps and other public benefits, etc.

Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program The AAA or service provider must assist clients in taking advantage of benefits available under the SNAP EBT (Electronic Benefit Transfer) Card and may do so by assisting clients to apply for and use benefits. The AAA or service provider may, but is not required to, accept food stamps from eligible clients as their meal contribution. The AAA or service provider may encourage the seniors to use the food stamps to purchase nutritious food to consume at home. AAAs or service providers that wish to accept food stamps must apply for authorization through their local USDA-FNS field office and assure that all federal, state, and local agency provisions relating to their use and handling are met.

Emergency Situations The AAA or service provider shall have written procedures to follow in the event of weather-related emergencies or other situations that may interrupt service or the transportation of participants or supplies to the nutrition site.

A written plan that describes procedures to be followed if a participant becomes ill or injured, shall be explained to staff, volunteers, and participants and shall be visibly posted (or otherwise readily available) at each congregate site. “911” posted near a telephone, along with the center’s address, is recommended. Site staff shall keep emergency contact information on hand for each participant. Emergency contact information shall be kept up-to-date.

Fire Safety Fire drills shall be conducted at least quarterly, in accordance with local fire marshal recommendations; documentation is required. During the fire drill, fire exit routes shall be designated and reviewed. Staff shall be knowledgeable about the location and operation of all Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 8 of 19 fire extinguishers at the site.

Removal of Food Items The AAA or service provider shall establish and post a policy about food items that participants may, or may not, take home. The sign and printing shall be large enough to be seen and read and shall be reviewed as frequently as necessary with participants. The AAA or service provider may elect to disallow removal of any food items or may allow removal of nonperishable foods such as bread, crackers, pieces of fresh fruit, etc.

Drinking Water To encourage participants to maintain hydration, drinking water shall be available and located near participants. When feasible, water shall be available at each table.

Menu Planning Meals shall meet the requirements specified above under “Definitions.” In order to facilitate menu planning, DARS-VDA has developed Meal Planning Guidelines that nutrition program providers must use to ensure that meals meet the nutrient requirements. See DARS-VDA Menu Planning Guidelines.

Sweets Guidelines See DARS-VDA Guidelines For Sweets Served At The Congregate Nutrition Site.

Donated Foods The AAA or service provider may establish policies and procedures regarding use or distribution of foods donated by local vendors and retailers. All donated food prepared or served in the program shall meet quality standards. The AAA or service provider may determine which foods are acceptable, healthful, and/or nutritious for distribution or use during the operation of the meal site.

Meals Brought in by Participants The AAA or service provider may establish policies and procedures to allow or disallow meals brought in by participants. The policies and procedures may address such situations as participants who attend site activities and either do not eat the meal or bring their own meal, pot luck meals, and sharing of ethnic cuisines. In any case, only the meals provided by the program funds and that meet meal definitions and standards shall be counted as eligible service units.

Meal Preparation Congregate meals may be provided on site, by a central kitchen, or contracted through other organizations. Congregate meal sites, central kitchens, and subcontractors are required to follow all applicable regulations and standards of the Virginia Department of Health, Food Regulations and the DARS-VDA Menu Planning Guidelines. Whether the food service operation is provided by the AAA or contracted out, the final responsibility for overall food service operation shall rest with the AAA.

Procurement When contracting for meal preparation, delivery of meals, and site operations, all procurement Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 9 of 19 transactions shall be conducted in a manner to provide open and free competition. Specifications for bids, and the terms and conditions of the resulting contracts, shall comply with service standards and guidelines as established by DARS General Services Division.

Food Service Operation Compliance with applicable provisions of State or local codes and regulations regarding the safe and sanitary handling of food, equipment, and supplies used in the storage, preparation, service, and delivery of meals to an older individual is required.11 This includes, but is not limited to health, fire and safety codes and regulations; building codes; purchasing regulations; licensure requirements; and any other requirements applicable to each meal preparation site and food service vendor used for the nutrition program.

If applicable, the current food permit and/or inspection report, issued by the Health Department shall be posted or be on file. When the local Health Department is able to comply, inspection of the meal site by the local Environmental Health Specialist is recommended, but not required.

The Nutrition Director shall maintain copies of all current inspection reports according to AAA record retention policy, but not less than one year.

Food must be prepared, plated and transported with the least possible manual contact, with suitable utensils and on surfaces that, prior to use, have been cleaned, rinsed and sanitized to prevent cross contamination. Effective procedures for cleaning (removing visible dirt and stains) and sanitizing (reducing the number of micro-organisms by using hot water at 171 degrees (77 degrees C) or above, or a chemical sanitizing solution) dishes, equipment, food contact surfaces, work areas, serving and dining areas shall be written, posted or readily available, and followed consistently.

Material Safety Data Sheets (MSDS) must be readily available on any chemicals. Employees must be informed about potentially dangerous chemicals used in the workplace and how to safely use them. Toxic materials, such as cleaners and sanitizers, shall be maintained in the original container, or transferred to a clearly labeled appropriate container.

Health and Hygiene of Food Servers The AAA or service provider shall have policies and procedures regarding health and hygiene for all individuals who prepare and/or serve food that includes:  Infectious illness such as diarrhea, vomiting, fever, sore throat, etc.  Open sores on hands or arms  Gloves worn over nail polish and artificial fingernails for individuals serving food  Central kitchens will abide by Virginia Department of Health Food Regulations

Food Safety & Potentially Hazardous Food Items "Potentially hazardous food" is any food or food ingredient, natural or synthetic, which requires temperature control because it is in a form capable of supporting:  The rapid and progressive growth of infectious or toxigenic microorganisms;  The growth and toxin production of Clostridium botulinum; or 11 Older Americans Act of 1965, as amended, Section 339 (2) (F) Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 10 of 19  In raw shell eggs, the growth of Salmonella enteritidis.12 Potentially hazardous food includes:  An animal food (a food of animal origin) that is raw or heat-treated;  A food of plant origin that is heat-treated or consists of raw seed sprouts;  Cut melons; and  Garlic-in-oil mixtures that are not acidified or otherwise modified at a food processing plant in a way that results in mixtures that do not support growth as specified above in this definition.13 In addition, any food that consists in whole or in part of:  Milk or milk products;  Shell eggs;  Beef, poultry, pork, lamb, fish, and shellfish;  Tofu;  Soy protein foods; and  Cooked rice, beans, potatoes (baked or boiled), or other heat-treated plant foods.14

In order to retain maximum nutritional value and food quality, foods shall be served as soon as possible after preparation. The AAA or service provider(s) shall make every effort not to exceed two hours of holding time between the completion of cooking and the serving of the meal and shall minimize, to the extent possible, the length of delivery routes for transporting meals to congregate sites.

Potentially hazardous hot food items shall be maintained at or above 135 degrees Fahrenheit (F) and potentially hazardous cold food shall be maintained at or below 41 degrees F.15 Fruits and vegetables that are cooked for hot holding shall be cooked to a temperature of 135°F.16 Frozen foods shall be maintained frozen.17 If food temperatures are found to be in the temperature danger zone (41 – 135 degrees F) for two or more hours, the food must be discarded (Two Hour Rule).

Potentially hazardous food that is cooked, cooled, and reheated for hot holding shall be reheated so that all parts of the food reach a temperature of at least 165 degrees F for 15 seconds.18 Food must be reheated within two (2) hours or thrown away, and can only be reheated once.19 Hot food holding facilities are prohibited for the rapid reheating of potentially hazardous foods.

Temperature checks on potentially hazardous food shall be taken, and documented, on a daily basis with a correctly calibrated food thermometer at the time all food leaves the production area 12 12 VAC 5-421-10, Food Regulations, Department of Health, Virginia Administrative Code 13 12 VAC 5-421-10, Food Regulations, Department of Health, Virginia Administrative Code 14 Serving Safe Food, Second Edition: Employee Guide, The Educational Foundation of the National Restaurant Association 1996 15 12 VAC 5-421-820, Food Regulations, Department of Health, Virginia Administrative Code 16 12 VAC 5-421-720, Food Regulations, Department of Health, Virginia Administrative Code 17 12 VAC 5-421-770, Food Regulations, Department of Health, Virginia Administrative Code 18 12 VAC 5-421-760, Food Regulations, Department of Health, Virginia Administrative Code 19 Serving Safe Food, Second Edition: Employee Guide, The Educational Foundation of the National Restaurant Association 1996 Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 11 of 19 (including the food service vendor’s kitchen) and again at the time the meal is served.

Thermometers and their cases must be kept clean. During temperature measuring, thermometers should be sanitized between each food; an alcohol swab may be used. After use, thermometers should be washed, rinsed, sanitized and allowed to air dry.

Metal stem-type food temperature measuring devices, accurate to + or – 2 degrees F shall be used to assure the attainment and maintenance of proper internal cooking, holding, or refrigeration temperatures of all potentially hazardous foods. Prior to use in a food product, thermometers shall be cleaned and sanitized according to industry standards. Food temperature measuring devices may not have sensors or stems constructed of glass, except that thermometers with glass sensors or stems that are encased in a shatterproof coating, such as candy thermometers, may be used.20 To maintain accuracy, thermometers must be calibrated regularly using the ice method or boiling point method. Thermometers must be calibrated after dropping and after extreme temperature changes. Even if the food thermometer cannot be calibrated, it must still be checked for accuracy using the ice method or boiling point method. Any inaccuracies must be taken into consideration when using the food thermometer or the food thermometer must be replaced. At a minimum, check and/or calibrate thermometers at least monthly and maintain records of check and/or calibration.

For milk stored in a refrigerator maintained at 41 degrees or below, the temperature of the refrigerated unit may be taken and documented, instead of the milk temperature. The accuracy of the refrigerator thermometer should be verified on an ongoing basis by taking a product temperature.

Each AAA or service provider shall have a written policy specifying the temperatures meals must meet in order to be delivered to program participants. The AAA or service provider shall also have written procedures for handling potentially hazardous food items that do not meet or maintain correct temperatures. This information will be provided to all site managers.

Food Quality All foods, whether purchased by or donated to the program, must meet the following criteria:  Food shall be obtained from sources that comply with law21  Meet or exceed all applicable federal, state and local laws, ordinances, and regulations  Safe and unadulterated22  Food in a hermetically sealed container shall be obtained from a food processing plant that is regulated by the food regulatory agency that has jurisdiction over the plant23  If served, hot dogs, luncheon meat, and soft cheeses (feta, Brie, Camembert, Blue veined, Mexican style) must meet temperature requirements  Pasteurized shell, liquid, frozen, or dry eggs or egg products shall be substituted for raw 20 12 VAC 5-421-1090, Food Regulations, Department of Health, Virginia Administrative Code 21 12 VAC 5-421-270, Food Regulations, Department of Health, Virginia Administrative Code 22 12 VAC 5-421-260, Food Regulations, Department of Health, Virginia Administrative Code 23 12 VAC 5-421-280, Food Regulations, Department of Health, Virginia Administrative Code Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 12 of 19 shell eggs in the preparation of foods such as Caesar salad, hollandaise or béarnaise sauce, mayonnaise, and egg-fortified beverages and for recipes in which more than one egg is broken and eggs are combined24 The following foods must not be used:25  Prepackaged un-pasteurized juice (including un-pasteurized apple cider)  Raw animal foods, such as raw fish raw-marinated fish, raw molluscan shellfish, and steak tartare  Partially cooked animal food such as lightly cooked fish, rare meat, soft-cooked eggs that are made from raw shell eggs, and meringue  Raw seed sprouts (including alfalfa, clover and radish)  Home-canned foods  Any foods prohibited under the Virginia Department of Health Food Regulations or updated versions of The Food Code

Handling Food Product Recalls AAAs, nutrition service providers, and subcontractors shall develop and implement policies and procedures that include information on responding to Food Recall Notices. Procedures to consider include:  Developing and completing a food recall action checklist.  Identifying the recalled food product.  Counting the recalled product in inventory.  Identifying where and how to segregate the recalled food.  Placing warning labels on the segregated food product.  Notifying staff not to use the segregated food product.  Counting the amount of recalled food product already used.  Accounting for the entire recalled food product by consolidating counts for product used and product in inventory.  Obtaining information needed for public communications; whether the product was served, to whom it was served, and the date served.

Handling Foodborne Illness Outbreaks AAAs, nutrition service providers, and contractors shall make reasonable efforts to avoid problems with food product contamination and with food borne illnesses through their food purchasing specifications and buying practices; product receiving and storage procedures; and food handling and delivery practices.

In the event of a complaint that a client became sick from a food and/or beverage they consumed at the meal site, the AAA, service provider, and contractor shall have policies and procedures in place to handle the suspected outbreak.

Complete information such as the following on the suspected outbreak should be gathered:  Name, address, and telephone number of the person reporting;  Who became ill and what were their symptoms; 24 12 VAC 5-421-950, Food Regulations, Department of Health, Virginia Administrative Code 25 12 VAC 5-421-950, Food Regulations, Department of Health, Virginia Administrative Code Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 13 of 19  Was the illness diagnosed by a physician (get the physician’s name and contact information);  What specific foods and/or drinks were consumed (save samples if any of the food remains);  What was the day and time the food was eaten;  Who was the person who served or provided the food, if any;  Other relevant information concerning the time, date, or circumstances of the suspected outbreak.

Outbreaks of suspected foodborne illness shall be reported to the local health department immediately for investigation and AAAs, service providers, and subcontractors shall cooperate fully in the investigation.

Administrative Elements Staff Qualifications Individuals responsible for the direction of Nutrition Services shall possess the following minimum qualifications:  Knowledge: Biological, psychological, and social aspects of aging; the impact of disabilities and illness on aging; community resources; public benefits eligibility requirements; food and nutrition; safe food handling; and disease prevention and health promotion  Skills: Management and supervisory principles; transportation scheduling, if appropriate; program planning; establishing and sustaining interpersonal relationships; problem solving.  Abilities: Communicate with persons with varying socioeconomic backgrounds; work independently.

Job Descriptions26 For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on Aging must maintain:  A current and complete job description which shall cover the scope of nutrition services staff duties and responsibilities; and  A current description of the minimum entry-level standards of performance for each job.

Units of Service Units of service must be reported in the DARS-VDA-approved client database for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.  Eligible Meals (required for the DARS-VDA-approved client database) – The number of eligible congregate meals served; see Definitions and Nutrition Services Incentive Program  Persons Served (unduplicated) - The number of eligible persons who received an eligible congregate meal; see “Eligible Population” 26 22 VAC 30-60-240, Grants To Area Agencies On Aging, Department for Aging and Rehabilitative Services Regulations, Virginia Administrative Code Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 14 of 19 Program Reports th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.  The DARS-VDA-approved client database client level data transmitted to DARS-VDA by the last day of the following month.

Consumer Contributions/Program Income There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations.27

Cost Sharing/Fee for Service: An Area Agency on Aging is not permitted to implement cost sharing/fee for service for recipients of this service.28  Aging Monthly Report (AMR) to DARS-VDA by the twelfth (12 Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service, provided that the method of solicitation is non-coercive. Voluntary contributions shall be encouraged for individuals whose self-declared income is at or above 185 percent of the poverty line, at contribution levels based on the actual cost of services.29

For voluntary contributions, the AAA shall consult with the relevant service providers and older individuals in the planning and service area to determine the best method for accepting voluntary contributions. The AAA and service providers shall not means test for any service for which contributions are accepted, or deny services to any individual who does not contribute to the cost of the service. The AAA shall ensure that each service provider will:  Provide each recipient with an opportunity to voluntarily contribute towards the cost of the service;  Clearly inform each recipient that there is no obligation to contribute and that the contribution is purely voluntary;  Assure that the method of solicitation is non-coercive;  Protect the privacy and confidentiality of each recipient with respect to the recipient’s contribution or lack of contribution;  Establish appropriate procedures to safeguard and account for all contributions; and  Use all collected contributions to expand the service for which the contributions were given and to supplement (not supplant) federal funds received.30 A sign large enough to be seen and read shall be posted about the opportunity to contribute to the cost of the meal and shall include a suggested amount and the cost of the meal for ineligible visitors and guests.

Nutrition Services Incentive Program 27 22 VAC 30-60-400, Grants To Area Agencies On Aging, Department for Aging and Rehabilitative Services Regulations, Virginia Administrative Code 28 Older Americans Act of 1965, as amended, Section 315(a) 29 Older Americans Act of 1965, as amended, Section 315(b) 30 Older Americans Act of 1965, as amended, Section 315(b) Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 15 of 19 Congregate Nutrition Service providers receiving Older Americans Act funds may participate in the Nutrition Services Incentive Program (previously USDA commodity food/cash distribution program).

To be counted as an eligible meal, and therefore, receive NSIP reimbursement, the following requirements must be met:  The person receiving a meal must meet eligibility requirements under Title III-C1 of the Older Americans Act  The participant or other eligible individual (not a volunteer) must be assessed using the Virginia Service Quick Form and the “Determine Your Nutritional Health” Nutrition Screening Checklist, and Federal Poverty/DARS-VDA Sliding Fee Scale (unless all information needed to determine federal poverty is documented on the Virginia Service Quick Form). Assessment data shall be documented in the DARS-VDA-approved client electronic database.  The question “Is Client in Federal Poverty?” (answer Yes or No) must be asked and recorded in the DARS-VDA-approved electronic client database.  Cost sharing does not apply to this service  For an individual who provides volunteer services during the meal hours (not a site participant) and receives a congregate meal: a Virginia Service Quick Form shall be requested. At a minimum, the full legal name and service units (collected at least on a monthly basis) must be entered into the DARS-VDA-approved electronic client database.  The participant may make a donation, but cannot be charged for the meal, means tested for participation, or asked for a cost-share  The AAA or service provider shall have a record keeping system that tracks frequency of participation and generate unduplicated count information (match the participant’s name with their meal)  The meal must meet DRI nutrient requirements and Dietary Guidelines defined above  Snacks, partial meals and second helpings cannot be counted as a “meal” for reporting purposes  Congregate meals programs are authorized to serve two- and even three-meal a day programs and each meal can be reported for reimbursement purposes.  Cash disbursements received under the Nutrition Services Incentive Program (NSIP) shall only be used to purchase United States agricultural commodities and other foods for their nutrition projects.31 Agencies are not eligible to receive Older Americans Act funding for meals nor eligible to receive funding under NSIP if the agency:  Is an adult day care agency that charges for meals in an adult day care facility as part of the total package of services  Is an adult day care agency that provides meals funded by the USDA Child and Adult Care Food Program and reports the same meal to both programs  Is an adult day care agency that provides meals funded through a Medicaid Waiver program

The meal is eligible if an adult day care provides meals only with Older Americans Act

31 Older Americans Act of 1965, as amended, Section 311(d)(2) Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 16 of 19 and matching funds.32 Congregate meals provided to resident(s) living at an Assisted Living facility (previously called Adult Care Residence) and receiving Auxiliary Grant are not eligible for NSIP funding. The Assisted Living must reimburse the AAA for the cost of the congregate meal if Older Americans Act funds are used. The AAA should develop a written agreement with each facility indicating the cost of each meal and specifics about how payment will be made. Each AAA should have a written policy regarding attendance of Assisted Living residents at congregate nutrition sites.

Congregate meals provided under the National Family Caregiver Support Program (Title III-E, Supplemental Services) can be counted as NSIP meals if they are provided to the older care recipient, a caregiver over the age of 60, or a caregiver under the age of 60 who is the spouse of the care recipient. If the meal is provided to a caregiver under age 60 who is not a spouse, Title III-E, Supplemental Services funds may be used but the meals are not NSIP eligible meals.

Quality Assurance Meal providers are encouraged to provide congregate meal services with the advice and expertise of (1) a dietitian or other individual with equivalent education and training in nutrition science, or if such an individual is not available, an individual with comparable expertise in the planning of nutritional services, (2) meal participants, and (3) other individuals knowledgeable with regard to the needs of older individuals.33

Staff Training  At hiring, staff involved with providing and assessing for nutrition services shall receive orientation on agency and nutrition services policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.  Workers shall receive a minimum of 10 (ten) documented hours of in-service or other training per year based on the need for professional growth and upgrading of knowledge, skills, and abilities. This may include participant donations, safe food handling, taking and recording food temperatures, and what to do if meal temperatures are not in compliance.  All individuals, including volunteers that prepare and/or serve food will receive training in personal hygiene, hand washing, health policies, and safe food handling.

Individuals responsible for the direction of Nutrition Services and/or AAA designees involved with nutrition services and/or meals subcontractor must receive and maintain certification in safe food handling. Central kitchens will abide by Virginia Department of Health Food Regulations.

Supervision Consultation and supervision shall be available to all staff providing the service. All staff working in the preparation of food must be under the supervision of a person qualified to ensure the application of hygienic techniques and practices in safe food handling, preparation, and service.

32 Administration on Aging, Nutritional Services Technical Assistance Brief Number 2, March 2001 33 Older Americans Act of 1965, as amended, Section 339 Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 17 of 19 Program Evaluation The agency must develop a written program evaluation plan to conduct regular systematic analysis of the persons served and the impact of the service. Evaluation may include client surveys for program planning and menu input. Surveys should be compiled and summarized in a format reporting how the data gathered will be used to improve services.

Local caterers and companies that provide subcontracted meal preparation and organizations that provide congregate site management, as well as those to which the entire program is subcontracted, shall be monitored at least annually. There shall be a written policy that includes: content of monitoring (such as use of DARS-VDA Monitoring Instrument), frequency, and reporting back to the AAA especially on any corrective action(s) recommended and carried out.

Policies and Procedures The AAA and service provider must maintain, at the minimum, the following policies and procedures:  Offering congregate meals to other eligible individuals  Use of Nutrition Screening results  Service Termination Policy  Collection, disposition and accounting for program income, including safeguarding and accounting for donations  Weather related emergencies and other situations that affect service delivery  Ill or injured participants  Removal of food items  Food server health and hygiene  Required meal temperatures  Handling potentially hazardous food items that do not meet temperature standards  Cleaning and sanitizing  Program evaluation plans, including monitoring of subcontractors  Medical Foods (if applicable)  Attendance of Assisted Living residents at congregate nutrition sites

Posted Information Posted information shall be large enough for participants to read, up to date, and organized. The following information shall be accessible to participants and staff:  Menu  Activity and program calendar  Opportunity for a voluntary donation, suggested amount of meal donation, meal cost for ineligible visitors and guests  Procedure to follow if a participant becomes ill or injured and/or “911” and address of the meal site  Removal of food items policy  Food permit, if applicable  Cleaning and sanitizing procedures (posted or readily available) Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 18 of 19 Service Records Service documentation that will be maintained according to AAA record retention policy (but not less than one year) includes, but is not limited to:  Site registration/transportation sign-in sheets that identify participants and volunteers, staff, and guests who receive a meal  Documentation of physical activity, disease prevention/health promotion, and nutrition education activities, such as activity calendars  Records of temperature checks  Current Health Department permit and inspection report, if issued  Fire Drills  All menus from all vendors with nutrient analysis or meal pattern worksheet

Client Records AAA and/or service providers must maintain client records in the approved DARS-VDA electronic database that include:  Virginia Service Quick Form  Answers to the “Determine Your Nutritional Health” Nutrition Screening Checklist  Federal Poverty documentation must be part of the client record. The answer to the question “Is Client in Federal Poverty?” (answer Yes or No) must be asked and recorded in the DARS-VDA-approved electronic client database. The Federal Poverty/DARS-VDA Sliding Fee Scale form may be used.  Care Plan (optional, but if completed must be recorded in the DARS-VDA-approved electronic client database.)  Service reassessment  Consent to Exchange Information, if information is shared with other agencies  Emergency Contact Information

The AAA or service provider must maintain the following additional records:  Service confirmation  Appeal process Service Standard: Congregate Nutrition (10/01/2014)

vda.virginia.gov 19 of 19 DISEASE PREVENTION & HEALTH PROMOTION

VIRGINIA DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES

VIRGINIA DIVISION FOR THE AGING

SERVICE STANDARD

Definitions

I. Evidence-Based

A. All programs using Title III-D funds must meet the definition of evidence-based programming. The program must include all of the following to be considered evidence-based:

 Demonstrated through evaluation to be effective for improving the health and wellbeing or reducing disease, disability and/or injury among older adults; and  Proven effective with older adult population, using Experimental or Quasi-Experimental Design; and  Research results published in a peer-review journal; and  Fully translated in one or more community site(s)*; and  Includes developed dissemination products that are available to the public.

• For purposes of the Title III-D definitions, being “fully translated in one or more community sites” means that the evidence-based program in question has been carried out at the community level (with fidelity to the published research) at least once before. Sites should only consider programs that have been shown to be effective within a real world community setting.

B. There are two ways to determine if a program meets the definition of evidence-based; either is acceptable.

 Document whether the program meets each of the 5 bullets in the definition. If it does, it can be supported with Title III-D funds; or  The program is considered to be evidence-based by any operating division of the U.S. Department of Health and Human Services (HHS). o HHS has eleven operating divisions o An HHS division has included the program on a registry of evidence-based programs, or has reviewed it and deemed it evidence-based.

For example, this would include programs listed on the Administration of Community Living (ACL), Aging and Disability Evidence-Based Programs and Practices; Centers for Disease Control and Prevention (CDC), Compendium of Effective Interventions;

Substance Abuse and Mental Health Services Administration (SAMHSA), National Registry of Evidence-Based Programs and Practices; and the National Institute of Health (NIH), Cancer Control Evidence-based Portal, etc.

Page 1 of 4 Disease Prevention & Health Promotion Effective July 1, 2012, Revised February 26, 2016 Virginia Department for Aging and Rehabilitative Services There are numerous evidence-based programs that are administered throughout HHS.

For a list of the HHS Family Agencies, visit http://www.hhs.gov/about/foa/index.html.

Additional information on Disease Prevention and Health Promotion Services, Older Americans Act (OAA) Title III-D, including Frequently Asked Questions, can be found at http://www.aoa.acl.gov/AoA_Programs/HPW/Title_IIID/index.aspx

II. Evidence-based program versus evidence-based service/practice:

While the terms “evidence-based program” and “evidence-based service/practice” are often used interchangeably, they are not the same. Evidence-based services/practices can be part of an evidence-based program, but the reverse is not always true. Title III-D funds are required to be used on evidence-based programs.

A. Evidence-based services/practices refer to strategies or activities utilized by evidence-based programs as part of their larger intervention. For example, evidence-based self-management programs (such as diabetes prevention programs or pain management programs) may incorporate similar evidence-based practices such as blood pressure screenings or glucose checks, even though the outcome goals of these programs may be very different.

B. Evidence-based programs refer to organized and typically multi-component interventions with clearly identified linkages between core components of the program and expected outcomes for an identified target population. For example, an evidence-based falls prevention program could involve educational enrichment classes, as well as one or more evidence-based services (for example, strength and balance building exercises and/or a home environmental assessment component).

Such programs must also have methods available to guide their dissemination in the community, such as materials and trainings.

Eligible Population Disease Prevention and Health Promotion Services are targeted to persons 60 years of age or older. Priority shall be given to older individuals with greatest economic and social need, with special emphasis on low- income minority individuals, older individuals with limited English proficiency, older persons residing in rural or geographically isolated areas, and older individuals at risk for institutional placement.

Service Delivery Elements

Program Requirements Disease prevention and health promotion services and information shall be provided at multipurpose senior centers and congregate meal sites, or at other appropriate community sites convenient and accessible to older individuals.

Page 2 of 4 Disease Prevention & Health Promotion Effective July 1, 2012, Revised February 26, 2016 Virginia Department for Aging and Rehabilitative ServicesAssessment  If the client does not already have an assessment in the Virginia Division for the Aging (VDA)-approved electronic client database, a Virginia Service – Quick Form or CRIA encounter is required for each person who participates in a program activity.  The answer to the question “Is Client in Federal Poverty?” (answer Yes or No) must be asked and recorded in the VDA-approved electronic client database.  Any fee for service charge to the client shall be determined by a VDA approved sliding fee scale. The Federal Poverty/VDA form may be used.

Administrative Elements

Staff Qualifications Staff conducting evidence-based programs shall meet the training and certification requirements set forth by the specific program.

Job Descriptions For each paid position funded by Title III of the Older Americans Act, an Area Agency on Aging must maintain:  A current and complete job description which shall cover the scope of staff disease prevention and health promotion service duties and responsibilities; and  A current description of the minimum entry-level standards of performance for each job.

Units of Service Units of service must be reported in the VDA-approved client database for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

 Sessions – Service activities provided to a specific individual. Activities can be provided one-to-one or in a group setting. A unit is one (1) session. A session is one event that lasts a part of an hour up to one full day.

For example, a six-week Chronic Disease Self-Management Program (CDSMP) workshop would equal 6 sessions or 6 units. If a workshop consists of 6 topics presented in a day, this would equal 1 session or 1 unit.  Persons served (unduplicated) - The number of persons who participate in a session.

Group Units – For this service, there are no group units; therefore, group units cannot be entered into the VDA-approved electronic client database.

Program Reports  Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.  Client level data from the VDA-approved electronic database shall be entered by the last day of the following month.

Page 3 of 4 Disease Prevention & Health Promotion Effective July 1, 2012, Revised February 26, 2016 Virginia Department for Aging and Rehabilitative ServicesConsumer Contributions/Program Income There must be a written policy on handling of Client Program Income (CPI) and other voluntary contributions and fees.

Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing /fee for service for recipients of this service.

And/or Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service, provided that the method of solicitation is non-coercive. Voluntary contributions shall be encouraged for individuals whose self-declared income is at or above 185% of the poverty line, at contribution levels based on the actual cost of services.

Quality Assurance

Staff Training  At hiring, staff shall receive orientation on agency and departmental policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.  Staff conducting evidence-based programs shall meet the training and certification requirements set forth by the specific program.

Supervision Consultation and supervision shall be available to all staff providing the service.

Program Evaluation The AAA shall conduct regular and systematic analysis of the persons served and the impact of the service, in accordance with the evidence-based program requirements. There shall be a written plan and a written report of findings. Evaluation may include client satisfaction surveys.

Client Records The AAA or service provider must maintain specific client records in the approved VDA electronic database that include:  Consent to Exchange Information, if information is shared with other agencies.  Virginia Service - Quick Form or CRIA encounter. At a minimum, this information must be updated annually.  The answer to the question “Is Client in Federal Poverty?” (answer Yes or No) must be asked and recorded in the VDA-approved electronic client database.

The AAA or service provider must maintain the following additional records:  Documentation that the service took place.  Cost Sharing (Fee for Service) calculations, if applicable. The Federal Poverty/VDA Sliding Fee Scale form may be used.

Page 4 of 4 Disease Prevention & Health Promotion Effective July 1, 2012, Revised February 26, 2016 Virginia Department for Aging and Rehabilitative Services ELDER ABUSE PREVENTION

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Elder Abuse Prevention services are programs to assist older individuals, their families and caregivers, to prevent and remedy neglect or exploitation. See 42 United States Code (USC) §3002 (22) & (23).

Eligible Population Individuals are eligible for Elder Abuse Prevention Services if they are 60 years of age or older. Preference shall be given to older individuals who are indigent; unable to care for themselves and who have no one available and willing to provide needed care. Services may also be provided to the family or caregiver of an older individual to assist the family caregiver to provide appropriate care. See 42 United States Code (USC) §3002 (35).

Service Delivery Elements

• Elder abuse prevention services should concentrate on public education. See 42 United States Code (USC) §3058i.
• Elder abuse prevention services will coordinate with the Long-Term Care Ombudsman Program.
• Abuse, neglect or exploitation of older persons must be reported to the local Department of Social Services. See Virginia Code §63.1-53.3. In addition, suspected sexual abuse of older persons must be reported to local law enforcement officials.

See Virginia Code §63.1-53.3.C.

• If there is reason to believe a crime has been committed, the suspected crime must be reported to the local law enforcement agency.
• Services for the elder abuse program include determining if additional services are needed and arranging for those services. Follow-up may also include advocacy for the older individual with the Department of Social Services staff.

Assessment: A service specific assessment should be performed on each individual client, utilizing the Virginia Service – Quick Form:

Federal Poverty/VDA Sliding Fee Scale is required, unless all information needed to determine federal poverty is documented on Virginia Service – Quick Form.

Administrative Elements Staff Qualifications: Staff should know the biological, psychological and social aspects of aging; Virginia's Adult Protective Services Law; elder abuse prevention and intervention; the services provided by community resources; and problem solving complaint resolution techniques.

See 42 United States Code (USC) §3058i. (b)(8)(C).

Page 1 of 2 Elder Abuse Prevention Effective 10/1/03, Revised 04/14/03 Virginia Department for the AgingUnits of Service: Units of service must be reported in AIM for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

• Persons Served – Unduplicated number of individuals for whom services were provided.
• Contacts – count each contact with the client and collateral contacts with agencies related to establishing services.

Optional Units of Service (Not Entered into AIM):

• Referrals* – Number of elder abuse and elder victim reports/referrals made to Department of Social Services and law enforcement agencies.
• Presentations* – Number of education/training group activities conducted.
• Participants* – Number of people attending education/training group presentations.

• These activities cannot be entered into the AIM system; but may be reported on the AMR Optional Unit Report.

Program reports:

• AIM client level data transmitted by the last day of the following month
• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month.

If the area agency on aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.

Quality Assurance Criminal Background Checks: VDA strongly recommends that the agency and its contractors protect their vulnerable older clients by conducting criminal background checks for staff providing any service where they go to or into a client’s home.

Staff Training: Training must be coordinated with the Department of Social Services staff and will include information about elder abuse, Virginia's Adult Protective Services law, and procedures for making referrals and coordinating with other agencies. Continuing education will update personnel on changes and improve professional skills about elder abuse prevention.

Page 2 of 2 Elder Abuse Prevention Effective 10/1/03, Revised 04/14/03 Virginia Department for the Aging EMERGENCY

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Providing financial aid and other resources, including referrals to other public and private agencies, to persons 60 and older who have an emergency need for help. The program provides for immediate and short-term assistance in getting resources in an emergency that endangers the health or well-being of older persons.

Eligible Population Persons 60 years of age and older with emergency needs that cannot be met through other services. Priority shall be given to older individuals who are in the greatest economic and social need, with preference given to low-income minority individuals and to those older persons residing in rural or geographically isolated areas.1

Service Delivery Elements Agencies providing Emergency service must perform all of the following components:

Resource file: The development and maintenance of accurate, up-to-date, and well-organized information on opportunities, services, and resources available in the community, including detailed data on service providers.

Information: The process of informing an older person of available opportunities, services, and resources.

Assessment: The process of identifying, analyzing, and prioritizing the needs of older persons, utilizing the Virginia Service – Quick Form, other client assessment documents, and Federal Poverty/VDA Sliding Fee Scale (unless all information needed to determine federal poverty is documented on Virginia Service – Quick Form).

Referral: The process of initiating an arrangement between the older person or caregiver and the service provider, which should include:

• advising older persons and their caregivers;
• providing information to older persons to link them with the opportunities, services, and resources available to meet their needs;
• assisting the person or caregiver to contact the appropriate community resource.
• if necessary, advocating with agencies on behalf of older persons.

1 Older Americans Act of 1965, as amended, Section 306(a)(4)(A)(i) Page 1 of 3 Emergency Effective 10/01/03, Revised 04/22/03 Virginia Department for the AgingAdministrative Elements Staff Qualifications:

• Knowledge: Emergency service staff should have an awareness of the biological, psychological, and social aspects of aging; the impact of disabilities and illnesses on aging; interviewing principles; community resources; and public benefits eligibility requirements.
• Skills: Emergency service staff should have skills in establishing and sustaining interpersonal relationships; problem-solving; and advocacy.
• Ability: Emergency service staff should have the ability to communicate with persons of different socio-economic backgrounds; conduct an effective interview; complete an assessment; arrange and negotiate service referrals; and work independently.

Job Descriptions: For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on Aging shall maintain:

• A current and complete job description which shall cover the scope of duties and responsibilities of Emergency service staff; and
• A current description of the minimum entry-level standards of each job.2

Units of Service: Units of service must be reported in AIM for each client receiving services. Services units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

• Contact; count those contacts with the client and collateral contacts with agencies/caregivers related to establishing services.
• Persons served (unduplicated): the client/caregiver who is to receive a service(s).

Program Reports

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.
• AIM client level data transmitted to VDA by the last day of the following month.

Consumer Contributions/Program Income The Area Agency on Aging shall formally adopt written policies and procedures, adopted by the governing board, regarding the collection, disposition, and accounting for program income.3

• Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service.4 And/or
• Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited provided that the method of solicitation is non-coercive.5

2 22 VAC 5-20-250, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 3 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 4 Older Americans Act of 1965, as amended, Section 315(a) Page 2 of 3 Emergency Effective 10/01/03, Revised 04/22/03 Virginia Department for the AgingQuality Assurance Staff Training:

• Emergency service staff should receive orientation on agency policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.
• Emergency service staff should receive a minimum of 10 hours of in-service training per year based on the need for professional growth and upgrading of knowledge, skills, and abilities.

Supervision/Case Review: Consultation, supervision and case review shall be available to all staff providing the service.

Program Evaluation: The agency should conduct regular systematic analysis of the persons served and the impact of the service. Subcontractors shall be monitored annually.

Client Records: Service providers must maintain specific program records that include:

• Virginia Service – Quick Form (At a minimum, this form must be updated annually).
• Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.
• Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

5 Older Americans Act of 1965, as amended, Section 315(b) Page 3 of 3 Emergency Effective 10/01/03, Revised 04/22/03 Virginia Department for the Aging Emergency Services Frequently Asked Questions

1. Q - What types of emergencies can the Area Agency on Aging provide assistance?

A - The most common requests are for: heating oil, electric bills, medications, hygiene supplies, medical equipment, in-home care, food, clothing, transportation, home repairs.

1. Q - Can the Area Agency on Aging provide reimbursement to someone who has already paid for an emergency situation?

A - No. Emergency services must be provided at the time of the emergency.

1. Q - Where can I get assistance with purchasing a haring aide or eyeglasses?

A - Contact the local Lions Club. The Area Agency on Aging may be aware of a resource in your area.

1. Q - I was just discharged from the hospital and need medical equipment to help me at home. What resources can help with this?

A - Contact your local Area Agency on Aging for listing of local loan closets. Work with your hospital discharge planner or local social worker. Medicaid or Medicare will cover some durable medical equipment if ordered by a physician.

1. Q - Where can I get help with purchasing medications?

A - The Area Agency on Aging can assist with applying for the Pharmacy Connection Program, which will provide free medications to eligible individuals. A physician must authorize the service. Also there are a number of private prescription plans to consider. Also you can apply for Medicaid through the local department of social services, which pays for medications.

1. Q - My utilities are being cut off. Where can I get assistance paying the bill?

A - Area Agencies on Aging can provide one-time emergency energy assistance, depending on available funds. The local department of social services administers a fuel assistance program.

1. Q - Where can I get assistance in repairing my home?

Page 1 of 2 FAQ Emergency Services Revised 02/15/02 Virginia Department for the Aging A - Contact you local Area Agency on Aging to see if they provide residential renovation and repair services. Also local Community Action Programs may be a resource for home repairs. Some localities have Christmas in April, the leading volunteer organization that rehabilitates the homes of low-income homeowners.

1. Q - I have received some important documents about my benefits that I cannot understand.

There are forms to complete and return. Where can I get assistance with the forms?

A - Contact your local Area Agency on Aging and request assistance with completing the forms.

1. Q - I need help with my insurance and doctor bills. Where can get assistance?

A - Contact your local Area Agency on Aging and request assistance from the Virginia Insurance Counseling Assistance Program (VICAP).

fdc 2/15/02

Page 2 of 2 FAQ Emergency Services Revised 02/15/02 Virginia Department for the Aging EMPLOYMENT – Title III

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Employment service as a Title III service is assisting person’s age 60 or older to obtain part-time or full-time employment.

Eligible Population Persons 60 years of age and older. Priority shall be given to older individuals who are in the greatest economic and social need, with preference given to low-income minority individuals and to those older persons residing in rural or geographically isolated areas.1

Service Delivery Elements Service-Specific Assessment: A service-specific assessment using at a minimum, the Virginia Service – Quick Form must be completed on each potential client that determines:

• Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.
• Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Preparation for Placement: Assistance to individuals seeking employment should include at least:

• Assessing what the person’s service-specific needs are; has a need for employment or for training to gain new job skills or upgrade current skills
• Providing information on available employment opportunities.
• Counseling the older person in preparation for job interviews with prospective employers.
• Coordinating with activities conducted under the Title V Senior Community Service Employment Program and the Workforce Investment Act.

Administrative Elements Staffing

Employment Staff Qualifications:

• Knowledge and awareness of biological, psychological, and social aspects of aging; the impact of disabilities and illnesses on aging; employment and training resources and opportunities available for older workers. Familiarity with employment opportunities.
• Skill in assessing the employment needs of older persons; establishing and sustaining interpersonal relationships; interviewing techniques; problem-solving; and team-building
• Ability to communicate with persons with different socio-economic backgrounds and work independently and to motivate people.

1 Older Americans Act of 1965, as amended, Section 306(a)(4)(A)(i) Page 1 of 3 Employment Title III Effective 10/01/03, Revised 04/22/03 Virginia Department for the AgingUnits of Service: Units of service must be reported in AIM for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

• individual hours
• persons served
• placement in employment or training program

Program Reports

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.
• AIM client level data transmitted to VDA by the last day of the following month.

Consumer Contributions/Program Income The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.2 There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations.

• Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service.3

And/or

• Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service, provided that the method of solicitation is non-coercive.4

Allowable Costs: Program costs may not be paid with funds from Title V of the Older Americans Act.

Quality Assurance Staff Training:

• (Initial) in-depth orientation on agency policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.
• (Ongoing) at least annual in-service training, the content of which to be based on the need for professional growth and upgrading of knowledge, skills, and abilities.
• Must attend training provided by Virginia Department for the Aging that is specifically for Employment service.

2 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 3 Older Americans Act of 1965, as amended, Section 315(a) 4 Older Americans Act of 1965, as amended, Section 315(b) Page 2 of 3 Employment Title III Effective 10/01/03, Revised 04/22/03 Virginia Department for the AgingCase Review

• Consultation, supervision, and case review shall be available to all staff providing the service.

Program Evaluation

• The agency should conduct regular systematic analysis of the persons served and the impact of the service.
• Subcontractors shall be monitored annually.

Client Records

• Virginia Services – Quick Form. (Must be updated annually). Client characteristics (age, race, residence, social need, economic need).
• Federal Poverty documentation and Cost Sharing (Fee for Service), if applicable, calculations must be part of the client record. The Federal Poverty/VDA Sliding Fee Scale form may be used.

Page 3 of 3 Employment Title III Effective 10/01/03, Revised 04/22/03 Virginia Department for the Aging FAQ ‘S Title III Employment

1. How does this program differ from Title V Employment?

Title III Employment is the means in which the AAA’s can assist a person in obtaining employment, i.e. how to write a resume, assess need for new job skills, counsel in preparation for job interviews.

1. What type of reports are required? How often?

The Aging Monthly Report (AMR) is due by the 12th of each month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.

AIM client level data transmitted to VDA by the last day of the following month.

Page 1 of 1 FAQ Title III Employment Revised 02/26/02 Virginia Department for the Aging HEALTH EDUCATION & SCREENING

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definitions Health Education: The provision of information or materials, or both, specifically designed to address a particular health related issue. The activity may be preventive in nature and may promote self-care and independence. Health and nutrition education services include information concerning prevention, diagnosis, treatment, and rehabilitation of age-related diseases and chronic disabling conditions.1

Health Screening: The provision of an assessment or screening to determine an individual’s current health status, including counseling, follow-up and referral as needed. Health screening services are designed to detect or prevent illnesses, or both, that occur most frequently in older individuals.2

Eligible Population Health Education and Screening Services are targeted to persons 60 years of age or older.

Priority shall be given to older individuals with greatest economic and social need, with special emphasis on low-income minority individuals, older individuals with limited English proficiency, older persons residing in rural or geographically isolated areas, and older individuals at risk for institutional placement.3

Service Delivery Elements Health Education The Area Agency on Aging or service provider must provide informative and educational opportunities for older persons to acquire knowledge about wellness, health related issues and self-care. These opportunities may include: group presentations and discussions, wellness clubs, classes, newsletters, and health fairs.

Health Screening The Area Agency on Aging or service provider must perform all of the following components of health screening:  Provide individual or group health screening.  Provide the individual with the opportunity to learn about individual health status.  Perform standard examinations, procedures, or tests to gather information about the individual’s health or medical status.  Assist the individual to follow up on screening results, if indicated.  Refer the individual to a physician or treatment facility if medical attention is needed.

1 Older Americans Act of 1965, as amended, Section 321 2 Ibid. 3 Older Americans Act of 1965, as amended, Section 306 (a)(4)(A)(i) Page 1 of 4 Health Education & Screening Effective 10/1/03, Revised 01/03/2012 Virginia Department for the AgingAssessment  A service-specific assessment shall be performed on each potential client that determines whether the individual is eligible for the service, the amount of the individual’s service-specific need, and the individual’s level of priority for service delivery.  If individual hours will be entered into the VDA-approved electronic client database, the Virginia Service – Quick Form (if Part “A” Uniform Assessment Instrument is not completed) is required.  Use of the Virginia Service – Quick Form is recommended, but not required, if there are only group hours or contacts that will not be entered into the VDA-approved electronic client database.  The answer to the question “Is Client in Federal Poverty?” (answer Yes or No ) must be asked and recorded in the VDA approved electronic client database.  Any fee for service charge to the client shall be determined by the applicable sliding fee scale. The Federal Poverty/VDA form may be used.

Administrative Elements Staff Qualifications Whenever possible, the Area Agency on Aging or service provider shall utilize health experts and other qualified community resources to provide information, conduct screenings and advise on appropriate follow-up. When AAA or service provider staff are used, they shall possess the following minimum qualifications:  Knowledge: Biological, psychological, and social aspects of aging; the impact of disabilities and illness on aging; community resources; public benefits eligibility requirements; disease prevention and health promotion; medical conditions; learning styles of older adults.  Skills: Establishing and sustaining interpersonal relationships; problem solving; designing educational materials; public speaking; health screening.  Abilities: Communicate with persons with varying socioeconomic backgrounds; work independently.

Job Descriptions4 For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on Aging must maintain:  A current and complete job description which shall cover the scope of health education and screening services staff duties and responsibilities; and  A current description of the minimum entry-level standards of performance for each job.

Units of Service Units of service must be reported in the VDA-approved client database for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

4 22 VAC 5-20-250, Grants to Area Agencies on Aging, Department for the Aging Regulations, Virginia Administrative Code.

Page 2 of 4 Health Education & Screening Effective 10/1/03, Revised 01/03/2012 Virginia Department for the Aging  Hours (individual) – The number of hours spent one-on-one providing health education and/or health screening services to the individual senior.  Persons served (unduplicated) – The number of persons who are provided with the service and who receive individual hours.

Individual Hours - Service activities provided to a specific individual; individual hours are required for AIM.

Optional Group Units (Not entered into the VDA-approved client database)  Group Participants – The number of people attending the presentation, meeting, or program (activity provided to more than one person or in a group setting).  Number of Group Presentations – Number of programs on health education/health screening topics.

Group Units – These activities cannot be entered into the VDA-approved client database. They are reported on the Optional Units page of the AMR.

Program Reports  Aging Monthly Reports (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.  Client level data from the VDA-approved electronic client database shall be transmitted to VDA by the last day of the following month.

Consumer Contributions/Program Income There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations. 5

Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service.6 And/or Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service, provided that the method of solicitation is non-coercive. Voluntary contributions shall be encouraged for individuals whose self-declared income is at or above 185 percent of the poverty line, at contribution levels based on the actual cost of services. 7

Quality Assurance Staff Training  At hiring, staff shall receive orientation on agency and departmental policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.

5 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 6 Older Americans Act of 1965, as amended, Section 315(a) 7 Older Americans Act of 1965, as amended, Section 315 (b) Page 3 of 4 Health Education & Screening Effective 10/1/03, Revised 01/03/2012 Virginia Department for the Aging Workers shall receive a minimum of 10 hours of in-service or other training per year based on the need for professional growth and upgrading of knowledge, skills, and abilities.

Supervision Consultation and supervision shall be available to all staff providing the service.

Program Evaluation The agency should conduct regular systematic analysis of the persons served and the impact of the service. Subcontractors shall be monitored annually.

Client Records The AAA or service provider must maintain specific client records in the approved VDA electronic database that include:  Consent to Exchange Information, if information is shared with other agencies.  Virginia Service - Quick Form (if Part “A” Uniform Assessment Instrument – page 1-3 minimum is not completed). At minimum, this form must be updated annually.  The answer to the question “Is Client in Federal Poverty?” (answer Yes or No) must be asked and recorded.

Service providers must maintain the following additional records:  Service documentation, such as activity calendars or service records documenting health education and screening programs took place.  Cost Sharing (Fee for Service) calculations, if applicable.

Page 4 of 4 Health Education & Screening Effective 10/1/03, Revised 01/03/2012 Virginia Department for the AgingVirginia Department for the Aging Health Education and Screening

Question: What happened? There used to be separate service standards for Health Education and Health Screening.

Answer: We combined the Health Education and Health Screening Service Standards into one. These are also now combined on the Aging Monthly Report (AMR).

Question: We offer health education and screening to groups. How do we report this in AMR and AIM?

Answer: Only individual hours may be reported in AIM and the AMR. Individual health risk assessments or individual nutrition counseling are examples of service activities provided one-on-one to an individual senior.

Even though group hours and contacts are not reported to VDA, agencies may continue to provide service activities to more than one person or in a group setting. Your agency will decide whether to continue to track group hours internally.

Question: We provide health education and screening services at community health fairs. It is very time intensive to have seniors fill out the Virginia Service – Quick Form, and some seniors resent the questions.

Answer: The Virginia Service – Quick Form is required only if individual hours will be entered into the AIM system and if Part “A” Uniform Assessment Instrument is not completed. Use of the Virginia Service – Quick Form is recommended, but not required, if there are only group hours or contacts that will not be entered into AIM.

You must present the Virginia Service – Quick Form to the senior if you wish to enter the individual hours into AIM and AMR. The senior may elect to not provide all of the information.

Each AAA will need to make a decision about whether to enter individual information for seniors attending a health fair if only 5 – 10 minutes will be reported.

Question: How do we report “persons served?”

Answer: “Persons served” are the number of seniors (unduplicated) who are provided with the service and who receive individual hours. Individual hours are the number of hours spent one-on-one providing the service to the individual senior.

Page 1 of 2 FAQ Health Education Screening Revised 03/01/02 Virginia Department for the Aging Persons who receive the service in a group setting (more than one person), such as attending a group presentation, are not reported to VDA through AIM or AMR. Your agency will decide whether to continue to track group hours internally.

Page 2 of 2 FAQ Health Education Screening Revised 03/01/02 Virginia Department for the Aging HOME DELIVERED NUTRITION (Title III – C2 & Fee for Service)

DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES-VIRGINIA DIVISION

FOR THE AGING SERVICE STANDARD Definition1 Provision, to an eligible client or other eligible participant at the client’s place of residence, a meal which:  Complies with the most recent edition of the Dietary Guidelines for Americans, published by the Secretary of Health and Human Services and the Secretary of Agriculture,  Provides a minimum of 33 1/3 percent of the dietary reference intakes (DRI) as established by the Food and Nutrition Board of the Institute of Medicine of the National Academy of Sciences, if one meal is provided per day,  Provides a minimum of 66 2/3 percent of the DRI if two meals are provided per day,  Provides 100 percent of the DRI if three meals are provided per day,  To the maximum extent practicable, are adjusted to meet any special dietary needs of program participants,  Complies with applicable provisions of State or local laws regarding the safe and sanitary handling of food, equipment, and supplies used in the storage, preparation, service, and delivery of meals to an older individual.

The meal must be delivered and received at the home of the eligible individual who is homebound.

Homebound: Someone unable to leave home to attend regular social activities such as a senior center or congregate nutrition site. The recipient may be able to go to medical appointments, but needs escort assistance to do so safely. A client without access to adequate nutrition and for whom transportation to a congregate site is unfeasible may be considered homebound.

Eligible Population Home Delivered Nutrition Services are targeted to persons 60 years of age or older. Priority shall be given to older individuals with greatest economic and social need, with special emphasis on low-income minority individuals, older individuals with limited English proficiency, older persons residing in rural or geographically isolated areas, and older individuals at risk for institutional placement.2

Eligibility criteria include:  The individual must be homebound as defined above.  The individual must be unable to prepare meals and have no one available to prepare meals.  The individual must be able to remain safely at home, with home delivered nutrition as a support service.

Other individuals eligible to receive home delivered nutrition services, include:  The recipient’s spouse, regardless of age or disability  At the discretion of the AAA, an individual with disabilities, regardless of age, who resides at

1 Older Americans Act of 1965, as amended, Section 339 (2) (A) 2 Older Americans Act of 1965, as amended, Section 306(a)(4)(A)(i) Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 1 of 16 home with the recipient over age 60 who receives a home delivered meal.

The AAA shall establish procedures for offering a meal on the same basis as meals are provided to participating older individuals, to other eligible individuals listed above. There is no prohibition against providing services to persons under age 60 with funds from other sources.3

Service Delivery Elements The Area Agency on Aging or service provider must perform all of the following components of Home Delivered Nutrition Services:

Program Requirements Each nutrition services provider must establish and operate nutrition projects for older individuals which, on 5 or more days a week (except when a lesser frequency is approved by the State agency or when a client’s individually assessed and documented need is less), provide per meal recipient at least one home delivered meal per day, which may consist of hot, cold, frozen, dried, canned, fresh, or supplemental food and any additional meals which the provider elects to provide.4

An inherent part of the home delivered meal program is the social contact and well-being check that naturally take place when the meal is delivered. It is a concern that this vital aspect of the program is lost when bulk meals are only delivered once or twice a month, especially in rural areas where clients are isolated, vulnerable, and may not have other contacts. It is likewise a concern when meals are delivered by commercial companies such as FedEx and UPS whose mission is package delivery and not necessarily the social, safety, nutritional, or functional needs of the HDM participant. Commercial package delivery of HDM shall be reserved for the small 1-2 percent of the population of a jurisdiction that is geographically isolated and remote from usual HDM routes, if applicable.

AAAs that deliver meals less than weekly to 25% or more of their total home delivered meal clients shall, along with their service provider(s), if applicable, develop and submit a plan for State agency (DARS-VDA) review and approval. The plan will consist of a narrative addressing the following points:

 The AAA shall describe the criteria they will use to identify the most vulnerable individuals receiving meals less than weekly. It is recommended that the AAA develop and describe their criteria with emphasis on using data that is collected using the UAI and other screening and assessment tools already in place. The AAA may consider using data found on pages 3 and 4 of the UAI (living arrangements and functional status) as some of their criteria. Suggested criteria include geographical isolation, lack of family contact and support, high nutrition risk, multiple medical conditions, ADL needs, lack of ability to communicate (such as no phone), structural problems in the home, etc.

 The AAA shall describe how they will provide, monitor, and document appropriate social contact and safety checks with the above-identified, most vulnerable individuals. Contact might be by/through telephone or technology, partnerships with local volunteer organizations, fire/police/TRIAD, enrollment in the agency’s already established checking

3 Older Americans Act of 1965, as amended 4 Older Americans Act of 1965, as amended, Section 336

Service Standard: Home Delivered Nutrition (10/01/2014) vda.virginia.gov 2 of 16program, etc. The frequency of contact must also be addressed in the plan narrative. The AAAs will fully describe the contact method and frequency, and provide all sample forms.

If the AAA is using an outside organization to perform the social contacts and safety checks, the formal agreement with the organization shall be attached. The agreement shall include a full description of the contact method and frequency and include all sample forms.  The narrative shall describe how the documentation will be maintained to demonstrate that the social contacts and safety and security checks are taking place and any issues identified are receiving appropriate follow-up. Documentation shall be available during monitoring.

 The AAA shall describe how they will conduct individual client follow-up evaluation every 6 months to ensure that the meals are still meeting the need and being used properly by the client. The AAA will monitor to make sure meals are not accumulating or being given away, sold, or discarded and that the client still has the facilities and physical ability necessary to store and heat the meals. If the client is not already being re-assessed bi-annually for another service, this evaluation may be, for example, a checklist completed by the driver, a survey asked of the client, or another method developed by the agency, described fully in the narrative, and sample forms attached to the narrative. Documentation of the 6-month evaluation/assessment shall demonstrate that the assessment is being conducted and any issues identified are receiving appropriate follow-up, and shall be maintained and available during monitoring.

 The narrative shall describe the AAA’s plan for nutrition education for the HDM participants.

 The narrative shall describe the AAA’s plan for solicitation of the HDM participants for voluntary contributions.

 The narrative shall provide a description of the delivery method, including whether volunteers or staff are delivering the meals. If commercial package delivery companies (FedEx, UPS) will be used to deliver meals, the narrative must include a full description of the delivery procedures including whether the client is required to sign for meals, what happens if the client is not there to receive meals, how meal non-delivery is reported to the AAA, what the AAA’s responsibility is when meals are not received, what the shelf-life of the meals is if they are not delivered in the expected time frame, how assistance is provided if required by a disabled client, and any other component related to delivery of meals, food safety, and integrity of the program.

 The AAA must attach the food vendor contract/agreement if the food vendor is shipping the meals directly to the client.  The AAA must attach the nutrient analyses documenting that the meals provided meet 1/3 of the nutrient needs of older individuals and, for example, they are not heavy on sodium or light on fiber, protein, and vegetables, as many shelf stable meals may be. Be reminded that breakfast may not be used as a standalone meal.

Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 3 of 16  Attach the Advisory Committee- and Governing Board-approved policy showing that infrequent delivery of HDM is an agency policy. If it is not a practice that the Advisory Council or Governing Board signs policies, then attach minutes showing that the specific policy/practice of infrequent delivery of HDM (not the Area Plan) was approved by the Advisory Committee and/or Governing Board.  Any other information the AAA deems relevant.

Plans shall be submitted for review and approval prior to the AAA beginning to deliver HDM less frequently than weekly and updated when significant changes are made to the plan. Thereafter, plans will be reviewed annually in conjunction with the Area Plan review.

A template is available.

The Older Americans Act (OAA) requires that meal providers solicit the advice and expertise of (1) a dietitian or other individual with equivalent education and training in nutrition science, or if such an individual is not available, an individual with comparable expertise in the planning of nutrition services, (2) meal participants, and (3) other individuals knowledgeable about the needs of older individuals.5 DARS-VDA recommends that AAA and nutrition service providers hire or contract with a registered dietitian (RD). Please see Guidance on Soliciting the Expertise of the RD.

Nutrition services providers shall design meals that are appealing to program participants and shall enter into contracts that limit the amount of time meals must spend in transit before they are consumed.6 Assessment  A service-specific assessment using the Uniform Assessment Instrument shall be performed on each potential client that determines whether the individual is eligible for the service, the amount of the individual’s service-specific need, and the individual’s level of priority for service delivery. A home visit to assess eligibility for home delivered nutrition services is strongly recommended.  Part “A” Uniform Assessment Instrument and “Determine Your Nutritional Health” Nutritional Screening are required. Client assessment data shall be documented in the DARS-VDA-approved electronic database.  Federal Poverty should be determined and documented. The answer to the question “Is Client in Federal Poverty?’ (answer Yes or No ) must be asked and recorded in the DARS-VDA-approved electronic client database. The Federal Poverty/DARS-VDA form may be used.  Any fee for service charge to the client shall be determined by the applicable sliding fee scale.  Emergency contact information.

Nutrition Screening The “Determine Your Nutritional Health” Nutrition Screening checklist developed and distributed by

5 Older Americans Act of 1965, as amended, Section 339 6 Ibid Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 4 of 16 the Nutrition Screening Initiative must be completed during assessment. The AAA or service provider will develop a written plan specifying how the agency will use the screening results.

At a minimum, the screening results may be used in the following ways:  Referral to appropriate services such as (1) dental professionals for those with tooth or mouth problems, (2) the food stamp program, food bank, or other social programs if they indicate they don’t have enough money to buy food, (3) their doctor or a dietitian if they have a chronic condition requiring a special diet, for example.  Planning nutrition education programs. For example, educating participants how to increase their fruit and vegetable intake or to shop for and prepare nutritious meals, depending on what screening forms show.  As a criterion in prioritizing client needs for nutrition service especially when program funding is limited.

Care Plan The Care Plan is optional and may be completed by another department within the AAA. If used, the Care Plan may include nutritional and social needs that can be met through home delivered nutrition services. Before the service is delivered, a written individualized care plan may be developed that identifies the service components to be provided to meet the client’s assessed need. The plan should be developed with involvement from the client. “Client” may include the individual’s authorized representative or family member. The client should be given the opportunity to provide input for the implementation and evaluation of the plan. The plan may be modified to reflect any change in the client’s needs. Each plan may include:  Identified service needs  Services to be delivered by the service provider or other sources  Goals and objectives of service to be provided  Quantity of service units to be provided

Service Confirmation A service confirmation, which may be in the form of a letter, packet, or handbook, shall be provided to the client to explain the service arrangement. The client shall receive a copy that includes:  Service to be provided  Scheduled days of service  Information regarding voluntary contributions  Description of procedures to be followed if a participant is ill or injured or not at home when the meal is delivered  Service interruption due to severe/inclement weather or other conditions  Explanation of the Service Termination Policy  Other policies deemed informative and appropriate by the service provider

If service is denied or the client is placed on a waiting list, written notice shall be provided to the client within 10 business days of the denial decision or placement on the waiting list. The agency’s process on filing an appeal shall be provided with the denial.

Service Termination Policy Service will be terminated at the discretion of the provider. Written notification of service termination Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 5 of 16 shall be mailed 10 business days prior to the date the action is to become effective. The agency’s process on filing an appeal shall be provided with the termination notice.

Reassessment  A review of the client’s need for services, the amount of services provided and the appropriateness of the care plan (if completed) shall be performed when the client’s condition or situation changes, but at least annually.  Part “A” Uniform Assessment Instrument and “Determine Your Nutritional Health” Nutrition Screening Checklist shall be updated at the same time. Client reassessment data shall be documented in the DARS-VDA-approved client electronic database.  Federal Poverty should be determined and documented. The question “Is Client in Federal Poverty?” (answer Yes or No) must be asked and recorded in the DARS-VDA-approved electronic client database. The Federal Poverty/DARS-VDA form may be used.  Any fee for service charge to the client shall be determined by the applicable sliding fee scale.  Update of emergency contact information.

Nutrition Education, Nutrition Counseling, and other Nutrition Services AAAs and nutrition service providers will provide nutrition education, nutrition counseling, and other nutrition services, as appropriate, based on the needs of meal participants.7 The nutrition services and programs offered by AAAs will be described in the Area Plan and comply with the following definitions:

Nutrition Education, Disease Prevention and Health Promotion Nutrition Education Definition: A program to promote better health by providing accurate and culturally sensitive nutrition, physical fitness, or health (as it relates to nutrition) information and instruction to participants, caregivers, or participants and caregivers in a group or individual setting overseen by a dietitian or individual of comparable expertise.8

Accurate information about Nutrition Education, Disease Prevention and Health Promotion shall be provided to the homebound participant on a continuing basis, but at least twice a year. Nutrition and health information will be obtained from a reputable source, registered dietitian, or other qualified individual. The information may be provided in such forms as a newsletter, flyer, brochure, article, or pamphlet and must be documented as having been distributed. A listing or calendar with the date and a copy of the item distributed is acceptable documentation.

Food Safety: At least once a year, Nutrition Education on food safety, such as information on proper handling, reheating, and storage of the home delivered meal or general food safety information for seniors, shall be provided.

Disease Prevention and Health Promotion: See Disease Prevention and Health Promotion Service Standard for definitions 7 Older Americans Act of 1965, as amended, Section 331(3). 8 Administration on Aging, Title III and Title VII, State Program Report Data Elements accessed at http://www.agid.acl.gov/Resources/DataSources/DataFiles/StateProgramReportForm053110.pdf page 23, accessed on July 8, 2014 .

Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 6 of 16 Immunization: AAAs and service providers must provide to homebound older individuals available medical information approved by health care professionals, such as informational brochures and information on how to get vaccines, including vaccines for influenza, pneumonia, and shingles, in the individuals’ communities.9

Nutrition Counseling (1 session per participant) -- Provision of individualized guidance to individuals, who are at nutritional risk, because of their health or nutritional history, dietary intake, chronic illnesses, or medications use, or to caregivers. Counseling is provided one-to-one by a registered dietitian, and addresses the options and methods for improving nutrition status.10

Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program The AAA or service provider must assist clients in taking advantage of benefits available under the SNAP Electronic Benefit Transfer (EBT) Card and may do so by assisting clients to apply for and use benefits. The AAA or service provider may, but is not required to, accept food stamps from eligible clients as their meal contribution. The AAA or service provider may encourage the seniors or their caregivers to use the food stamps to purchase additional nutritious food for the participant to consume in the home. AAAs or service providers that wish to accept food stamps must apply for authorization through their local USDA-FNS field office and assure that all federal, state, and local agency provisions relating to their use and handling are met.

Emergency Situations The AAA or provider shall have written procedures to follow in the event of weather-related emergencies or situations that may interrupt service or delivery of meals to the homebound participant.

A written plan that describes procedures to be followed if a client is ill or injured when a meal is delivered shall be explained to staff, volunteers, the homebound participant, and their authorized representative or emergency contact person.

Menu Planning Meals shall meet the requirements specified above under “Definitions.” In order to facilitate menu planning, DARS-VDA has developed Meal Planning Guidelines that nutrition program providers must use to ensure that meals meet the nutrient requirements. See DARS-VDA Menu Planning Guidelines.

Donated Foods The AAA or service provider may establish policies and procedures regarding use or distribution of foods donated by local vendors and retailers. All donated food prepared or served in the program shall meet quality standards. The AAA or service provider may determine which foods are acceptable, healthful, and/or nutritious for distribution to home delivered meals recipients.

Meal Preparation Home delivered nutrition services may be provided through a central kitchen or contracted through

9 Older Americans Act of 1965, as amended, Section 339 (2)(K)

10 Administration on Aging, Title III and Title VII, State Program Report Data Elements at http://www.agid.acl.gov/Resources/DataSources/DataFiles/StateProgramReportForm053110.pdf page 23, accessed on July 8, 2014 .

Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 7 of 16 other organizations. Central kitchens and subcontractors are required to follow all applicable regulations and standards of the Virginia Department of Health, Food Regulations and the DARS-VDA Menu Planning Guidelines. Whether the food service operation and delivery of meals are performed by the AAA or contracted out, the final responsibility for the overall service operation shall rest with the AAA.

Procurement When contracting for meal preparation and delivery of meals, all procurement transactions shall be conducted in a manner to provide open and free competition. Specifications for bids, and the terms and conditions of the resulting contracts, shall comply with service standards and guidelines as established by DARS General Services Division.

Food Service Operation Compliance with applicable provisions of State or local laws regarding the safe and sanitary handling of food, equipment, and supplies used in the storage, preparation, service, and delivery of meals to an older individual is required.11 This includes, but is not limited to health, fire and safety codes and regulations; building codes; purchasing regulations; licensure requirements; and any other requirements applicable to each meal preparation site and food service vendor used for the nutrition program.

If applicable, the current food permit and/or inspection report, issued by the Health Department shall be posted or be on file. The Nutrition Director shall maintain copies of all current inspection reports according to AAA record retention policy, but not less than one year.

Food must be prepared, plated and transported with the least possible manual contact, with suitable utensils and on surfaces that, prior to use, have been cleaned, rinsed and sanitized to prevent cross contamination. Effective procedures for cleaning (removing visible dirt and stains) and sanitizing (reducing the number of micro-organisms by using hot water at 171 degrees (77 degrees C) or above, or a chemical sanitizing solution) dishes, equipment, food contact surfaces, work areas, serving and dining areas shall be written, posted or readily available, and followed consistently.

Material Safety Data Sheets (MSDS) must be readily available on any chemicals. Employees must be informed about potentially dangerous chemicals used in the workplace and how to safely use them.

Toxic materials, such as cleaners and sanitizers, shall be maintained in the original container, or transferred to a clearly labeled appropriate container.

Health and Hygiene of Food Servers The AAA or service provider shall have policies and procedures regarding health and hygiene for all individuals who prepare and/or serve food that includes:  Infectious illness such as diarrhea, vomiting, fever, sore throat, etc.  Open sores on hands or arms  Gloves worn over nail polish and artificial fingernails for individuals serving food  Central kitchens will abide by Virginia Department of Health Food Regulations

Food Safety & Potentially Hazardous Food Items "Potentially hazardous food" is any food or food ingredient, natural or synthetic, which requires temperature control because it is in a form capable of supporting:

11 Older Americans Act of 1965, as amended, Section 339 Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 8 of 16  The rapid and progressive growth of infectious or toxigenic microorganisms;  The growth and toxin production of Clostridium botulinum; or  In raw shell eggs, the growth of Salmonella enteritidis.12

Potentially hazardous food includes:  An animal food (a food of animal origin) that is raw or heat-treated;  A food of plant origin that is heat-treated or consists of raw seed sprouts;  Cut melons; and  Garlic-in-oil mixtures that are not acidified or otherwise modified at a food processing plant in a way that results in mixtures that do not support growth as specified above in this definition.13

In addition, any food that consists in whole or in part of:  Milk or milk products;  Shell eggs;  Beef, poultry, pork, lamb, fish, and shellfish;  Tofu;  Soy protein foods; and  Cooked rice, beans, potatoes (baked or boiled), or other heat-treated plant foods.14

In order to retain maximum nutritional value and food quality, foods shall be served as soon as possible after preparation. The AAA or service provider(s) shall make every effort not to exceed two hours of holding time between the completion of cooking and the serving of the meal and shall minimize, to the extent possible, the length of delivery routes for transporting meals.

Potentially hazardous hot food items shall be maintained at or above 135 degrees Fahrenheit (F) and potentially hazardous cold food shall be maintained at or below 41 degrees F.15 Fruits and vegetables that are cooked for hot holding shall be cooked to a temperature of 135°F.16 Frozen foods shall be maintained frozen.17 If food temperatures are found to be in the temperature danger zone (41 – 140 degrees Fahrenheit) for two or more hours, the food must be discarded (Two Hour Rule).

Potentially hazardous food that is cooked, cooled, and reheated for hot holding shall be reheated so that all parts of the food reach a temperature of at least 165 degrees F for 15 seconds.18 Food must be reheated within two (2) hours or thrown away, and can only be reheated once.19 Hot food holding facilities are prohibited for the rapid reheating of potentially hazardous foods.

Temperature checks on potentially hazardous food shall be taken on a daily basis with a correctly 12 12 VAC 5-421-10, Food Regulations, Department of Health, Virginia Administrative Code 13 Ibid 14 Serving Safe Food, Second Edition: Employee Guide, The Educational Foundation of the National Restaurant Association 1996 15 12 VAC 5-421-820, Food Regulations, Department of Health, Virginia Administrative Code 16 12 VAC 5-421-720, Food Regulations, Department of Health, Virginia Administrative Code 17 12 VAC 5-421-770, Food Regulations, Department of Health, Virginia Administrative Code 18 12 VAC 5-421-760, Food Regulations, Department of Health, Virginia Administrative Code 19 Serving Safe Food, Second Edition: Employee Guide, The Educational Foundation of the National Restaurant Association 1996 Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 9 of 16 calibrated food thermometer at the time all food leaves the production area (including the food service vendor’s kitchen), at the first meal delivery stop and at the last meal delivery stop.

Thermometers and their cases must be kept clean. During temperature measuring, thermometers should be sanitized between each food; an alcohol swab may be used. After use, thermometers should be washed, rinsed, sanitized and allowed to air dry.

Metal stem-type food temperature measuring devices, accurate to + or – 2 degrees F shall be used to assure the attainment and maintenance of proper internal cooking, holding, or refrigeration temperatures of all potentially hazardous foods. Food temperature measuring devices may not have sensors or stems constructed of glass, except that thermometers with glass sensors or stems that are encased in a shatterproof coating, such as candy thermometers, may be used.20

To maintain accuracy, thermometers must be calibrated regularly using the ice method or boiling point method. Thermometers must be calibrated after dropping and after extreme temperature changes. Even if the food thermometer cannot be calibrated, it must still be checked for accuracy using the ice method or boiling point method. Any inaccuracies must be taken into consideration when using the food thermometer or the food thermometer must be replaced. At a minimum, check and/or calibrate thermometers at least monthly and maintain records of check and/or calibration.

For milk stored in a refrigerator maintained at 41 degrees or below, the temperature of the refrigerated unit may be taken and documented, instead of the milk temperature. The accuracy of the refrigerator thermometer should be verified on an ongoing basis by taking a product temperature.

Each AAA or service provider shall have a written policy specifying the temperatures meals must meet in order to be delivered to recipients. The AAA or service provider shall also have written procedures for handling potentially hazardous food items that do not meet or maintain correct temperatures. This information will be provided to all individuals who deliver meals.

Meal recipients should be advised to consume the meal immediately at delivery, refrigerate, or later reheat hot meals to a minimum temperature of 165 degrees for 15 seconds. Food containers may be labeled with this information.

Area Agency on Aging or service providers unable to take first and last meal temperatures on all routes shall work with all subcontractors to implement the following:  Meal temperatures will be documented when food leaves the central kitchen. Food must be over 135 degrees or under 41 degrees. Temperature and time records will be available during monitoring.  All ready-to-eat meals (not frozen or shelf stable) must be delivered within 2 hours of leaving the central kitchen.  The meal recipient will be advised to consume the meal immediately at delivery, refrigerate, or later reheat hot meals to a minimum temperature of 165 degrees for 15 seconds.  Documentation must be maintained with the time the meal left the central kitchen and the time at the last delivery stop. Records will be available during monitoring. As an alternative to recording the time at the last delivery stop, food containers will be labeled appropriately. For

20 12 VAC 5-421-1090, Food Regulations, Department of Health, Virginia Administrative Code

Service Standard: Home Delivered Nutrition (10/01/2014) vda.virginia.gov 10 of 16example, “Eat this hot meal immediately or refrigerate and later reheat to a minimum temperature of 165 degrees for 15 seconds.”  Whenever possible, random temperatures will be taken and documented for the first and last delivery stop.

Service providers shall have in place policies that ensure that home delivered meals are not left unattended if the client is not at home.

Food Quality All foods, whether purchased by or donated to the program, must meet the following criteria:  Food shall be obtained from sources that comply with law21  Meet or exceed all applicable federal, state and local laws, ordinances, and regulations  Safe and unadulterated22  Food in a hermetically sealed container shall be obtained from a food processing plant that is regulated by the food regulatory agency that has jurisdiction over the plant23  If served, hot dogs, luncheon meat, and soft cheeses (feta, Brie, Camembert, Blue veined, Mexican style) must meet temperature requirements  Pasteurized shell, liquid, frozen, or dry eggs or egg products shall be substituted for raw shell eggs in the preparation of foods such as Caesar salad, hollandaise or béarnaise sauce, mayonnaise, and egg-fortified beverages and for recipes in which more than one egg is broken and eggs are combined24

The following foods must not be used:25  Prepackaged un-pasteurized juice (including un-pasteurized apple cider)  Raw animal foods, such as raw fish raw-marinated fish, raw molluscan shellfish, and steak tartare  Partially cooked animal food such as lightly cooked fish, rare meat, soft-cooked eggs that are made from raw shell eggs, and meringue  Raw seed sprouts (including alfalfa, clover and radish)  Home-canned foods  Any foods prohibited under the Virginia Department of Health Food Regulations or updated versions of The Food Code.

Handling Food Product Recalls AAAs, nutrition service providers, and subcontractors shall develop and implement policies and procedures that include information on responding to Food Recall Notices. Procedures to consider include:  Developing and completing a food recall action checklist.  Identifying the recalled food product.  Counting the recalled product in inventory.

21 12 VAC 5-421-270, Food Regulations, Department of Health, Virginia Administrative Code 22 12 VAC 5-421-260, Food Regulations, Department of Health, Virginia Administrative Code 23 12 VAC 5-421-280, Food Regulations, Department of Health, Virginia Administrative Code 24 12 VAC 5-421-950, Food Regulations, Department of Health, Virginia Administrative Code 25 22 VAC 30-60-240, Grants to Area Agencies on Aging, Department for Aging and Rehabilitative Services Regulations, Virginia Administrative Code.

Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 11 of 16  Identifying where and how to segregate the recalled food.  Placing warning labels on the segregated food product.  Notifying staff not to use the segregated food product.  Counting the amount of recalled food product already used.  Accounting for the entire recalled food product by consolidating counts for product used and product in inventory.  Obtaining information needed for public communications; whether the product was served, to whom it was served, and the date served.

Handling Foodborne Illness Outbreaks AAAs, nutrition service providers, and contractors shall make reasonable efforts to avoid problems with food product contamination and with food borne illnesses through their food purchasing specifications and buying practices; product receiving and storage procedures; and food handling and delivery practices.

In the event of a complaint that a client became sick from a food and/or beverage they consumed from their home delivered meal, the AAA, service provider, and contractor shall have policies and procedures in place to handle the suspected outbreak.

Complete information such as the following on the suspected outbreak should be gathered:  Name, address, and telephone number of the person reporting;  Who became ill and what were their symptoms;  Was the illness diagnosed by a physician (get the physician’s name and contact information);  What specific foods and/or drinks were consumed (save samples if any of the food remains);  What was the day and time the food was eaten;  Who was the person who served or provided the food, if any;  Other relevant information concerning the time, date, or circumstances of the suspected outbreak.

Outbreaks of suspected foodborne illness shall be reported to the local health department immediately for investigation and AAAs, service providers, and subcontractors shall cooperate fully in the investigation.

Administrative Elements Staff Qualifications Individuals responsible for the direction of Nutrition Services shall possess the following minimum qualifications:  Knowledge: Biological, psychological, and social aspects of aging; the impact of disabilities and illness on aging; community resources; public benefits eligibility requirements; food and nutrition; safe food handling; and disease prevention and health promotion  Skills: Management and supervisory principles; transportation and meal delivery route scheduling, if appropriate; program planning; establishing and sustaining interpersonal relationships; problem solving.  Abilities: Communicate with persons with varying socioeconomic backgrounds; work independently.

Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 12 of 16 Job Descriptions26 For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on Aging must maintain:  A current and complete job description which shall cover the scope of nutrition services staff duties and responsibilities; and  A current description of the minimum entry-level standards of performance for each job.

Units of Service Units of service must be reported in the DARS-VDA-approved client database for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.  Meals (required for the DARS-VDA-approved client database) – The number of NSIP eligible home delivered meals served; see Definitions and Nutrition Services Incentive Program  Non NSIP Meals (required for the DARS-VDA-approved client database) – The number of fee for service home delivered meals served that are not eligible for NSIP reimbursement  Persons Served (unduplicated) – The number of persons who received home delivered nutrition services; see “Eligible Population”

Program Reports th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.  DARS-VDA-approved client database client level data transmitted to DARS-VDA by the last  Aging Monthly Report (AMR) to DARS-VDA by the twelfth (12 day of the following month.

Consumer Contributions/Program Income There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations.27 Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service only for recipients of the general fund (state funds) program.28 Cost sharing/fee for service does not pertain to meals that receive Nutrition Services Incentive Program (NSIP), Title III, or any Federal monies. Any fee for service charge to the client under the Fee for Service program shall be determined by the applicable sliding fee scale.

Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service, provided that the method of solicitation is non-coercive.29 For voluntary contributions, the AAA shall consult with the relevant service providers and older individuals in the planning and service area to determine the best method for accepting voluntary 26 22 VAC 30-60-400, Grants To Area Agencies On Aging, Department for Aging and Rehabilitative Services Regulations, Virginia Administrative Code 27 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 28 Older Americans Act of 1965, as amended, Section 315(a) 29 Older Americans Act of 1965, as amended, Section 315(b) Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 13 of 16 contributions. The AAA and service providers shall not means test for any service for which contributions are accepted, or deny services to any individual who does not contribute to the cost of the service. The AAA shall ensure that each service provider will:  Provide each recipient with an opportunity to voluntarily contribute towards the cost of the service;  Clearly inform each recipient that there is no obligation to contribute and that the contribution is purely voluntary;  Assure that the method of solicitation is non-coercive;  Protect the privacy and confidentiality of each recipient with respect to the recipient’s contribution or lack of contribution;  Establish appropriate procedures to safeguard and account for all contributions; and  Use all collected contributions to expand the service for which the contributions were given.30

Nutrition Services Incentive Program (NSIP) Home-Delivered Nutrition Services providers receiving Older Americans Act funds may participate in the Nutrition Services Incentive Program (previously USDA Commodity Food/Cash Distribution Program).

To be counted as an eligible meal, and therefore, receive NSIP reimbursement, the following requirements must be met:  The person receiving a meal must meet eligibility requirements under Older Americans Act  The client or other eligible individual must be assessed using Part “A” Uniform Assessment Instrument, “Determine Your Nutritional Health” Nutrition Screening Checklist, and Federal Poverty/DARS-VDA Sliding Fee Scale (unless all information needed to determine federal poverty is documented on UAI).  The client may make a donation, but cannot be charged for the meal, means tested for participation, or asked for a cost-share  The AAA or service provider shall have a record keeping system that tracks frequency of participation and generate unduplicated count information (match the client’s name with their meal)  The meal must meet DRI nutrient requirements and Dietary Guidelines defined above  Snacks and partial meals cannot be counted as a “meal” for reporting purposes  Home Delivered Meals programs are authorized to offer two- and even three-meal-a-day programs and each meal can be reported for reimbursement purposes  Cash disbursements received under the Nutrition Services Incentive Program shall only be used to purchase United States agricultural commodities and other foods for their nutrition projects.31

Home delivered meals provided under the National Family Caregiver Support Program (Title III-E, Supplemental Services) can be counted as NSIP meals if they are provided to the older care recipient, a caregiver over the age of 60, or a caregiver under the age of 60 who is the spouse of the care recipient.

If the meal is provided to a caregiver under age 60 who is not a spouse, Title III-E, Supplemental Services funds may be used but the meals are not NSIP eligible meals.

Quality Assurance

30 Older Americans Act of 1965, as amended, Section 315(b) 31 Older Americans Act of 1965, as amended, Section 311(d)(2) Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 14 of 16 Home delivered nutrition services shall be provided with the advice and expertise of (1) a dietitian or other individual with equivalent education and training in nutrition science, or if such an individual is not available, an individual with comparable expertise in the planning of nutritional services, (2) meal participants, and (3) other individuals knowledgeable with regard to the needs of older individuals.32

Criminal Background Checks Language is still being developed.

Staff Training  At hiring, staff involved with providing and assessing for nutrition services shall receive orientation on agency and nutrition services policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.  Workers shall receive a minimum of 10 (ten) documented hours of in-service or other training per year based on the need for professional growth and upgrading of knowledge, skills, and abilities. This may include participant donations, safe food handling, taking and recording food temperatures, and what to do if meal temperatures are not in compliance.  All individuals, including volunteers, that prepare and/or serve food will receive training in personal hygiene, hand washing, health policies, and safe food handling  All individuals, including volunteers, who deliver meals and document temperatures, will receive training in taking and recording food temperatures and what to do if meal temperatures are not in compliance. Written materials are acceptable for volunteers.

Individuals responsible for the direction of Nutrition Services and/or AAA designee involved with nutrition services and/or meals subcontractor must receive and maintain certification in safe food handling. Central kitchens will abide by the Virginia Department of Health Food Regulations.

Supervision Consultation and supervision shall be available to all staff providing the service. All staff working in the preparation of food must be under the supervision of a person qualified to ensure the application of hygienic techniques and practices in safe food handling, preparation, and service.

Program Evaluation The agency must develop a written program evaluation plan to conduct regular systematic analysis of the persons served and the impact of the service. Evaluation may include client surveys for program planning and menu input. Surveys should be compiled and summarized in a format reporting how the data gathered will be used to improve services.

Local caterers and companies that provide subcontracted meal preparation, as well as organizations to which the entire program is subcontracted, shall be monitored at least annually. There shall be a written policy that includes: content of monitoring (such as use of DARS-VDA Monitoring Instrument), frequency, and reporting back to the subcontractor especially on any corrective action(s) recommended and carried out. 32 Older Americans Act of 1965, as amended, Section 339 Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 15 of 16 Policies and Procedures The AAA and service provider must maintain, at the minimum, the following policies and procedures:  Offering home delivered meals to spouses and other eligible individuals  Use of Nutrition Screening results  Service Termination Policy  Collection, disposition and accounting for program income, including safeguarding and accounting for donations  Weather related emergencies and other situations that affect service delivery  Ill or injured client  Employee health and hygiene  Required meal temperatures  Handling potentially hazardous food items that do not meet temperature standards  Procedures for volunteers who deliver meals  Cleaning and sanitizing  Program evaluation plans, including monitoring of subcontractors  Liquid Nutrition Supplements (if applicable)

Service Records Service documentation that will be maintained according to AAA record retention policy (but not less than one year), includes, but is not limited to:  Documentation that identifies meal recipients and number of meals received  Records of temperature checks  Documentation of nutrition education  Current Health Department permit or inspection report, if issued  All menus from all vendors with nutrient analysis or meal pattern worksheet

Client Records AAA and/or service providers must maintain specific client records in the approved DARS-VDA electronic database that include:  Part “A” Uniform Assessment Instrument  “Determine Your Nutritional Health” Nutrition Screening Checklist  Federal Poverty documentation. The answer to the question “Is Client in Federal Poverty?” (answer Yes or No) must be asked and recorded in the DARS-VDA-approved electronic client database.  Care Plan (optional, but if completed must be documented in the DARS-VDA-approved client electronic database.)  Service reassessment  Consent to Exchange Information, if information is shared with other agencies The AAA or service provider must maintain the following additional records:  Service confirmation  Cost Sharing (Fee for Service), if applicable, calculations must be part of the client record. The Federal Poverty/DARS-VDA Sliding Fee Scale form may be used.  Appeal process Service Standard: Home Delivered Nutrition (10/01/2014)

vda.virginia.gov 16 of 16

HOMEMAKER

VIRGINIA DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES (DARS)

SERVICE STANDARD

Definition Homemaker services provide assistance to persons with the inability to perform one or more of the following activities of daily living: preparing meals, shopping for personal items, managing money, using the telephone or doing light housework.1

Eligible Population Homemaker services are targeted to persons 60 years of age or older who are frail, have disabilities, or who are at risk of institutional placement. Priority shall be given to persons who are in the greatest economic or social need and/or residing in rural or geographically isolated areas, with particular attention to low-income minority individuals and individuals with limited English proficiency.2

Service Delivery Elements The Area Agency on Aging (AAA) must perform all of the following components of homemaker services:

Service-Specific Assessment: A service-specific assessment using Part A of the Uniform Assessment Instrument shall be performed by the Area Agency on Aging on each potential client to determine whether the individual is eligible for the service, the amount of the individual’s service-specific need, and the individual’s level of priority for service delivery.  Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.  Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Care Plan: A written individualized care plan must be developed by the Area Agency on Aging that identifies the service components to be provided to meet the client’s assessed need. The plan must be developed prior to service commencement with involvement from the client or an authorized representative or family member. When “client” is used throughout the standards, it can also mean authorized representative or family member, as deemed appropriate by the agency and/or the client. The client shall be afforded the opportunity to participate in the implementation and evaluation of the plan. The plan may be modified to reflect any change in the client’s needs. Each plan must include:  identified service needs  services to be delivered by the service provider or other sources  goals and objectives of service to be provided  the quantity of service units to be provided

1 National Aging Program Information System Reporting Requirements – State Program Report Definitions 2 Older Americans Act of 1965, as amended 2006, Section 306(a)(4)(A)(i) Page 1 of 5 Effective 10/1/03, Revised 10/113 Virginia Department for Aging and Rehabilitative ServicesService Agreement: A service agreement shall be completed between the client and the service provider. If the Area Agency on Aging is the service provider, the AAA will complete the service agreement. A copy of the Service Agreement will be maintained at the Area Agency on Aging. The agreement will explain the service arrangement to the client. The client shall receive a copy of the agreement. The agreement shall include:  services to be provided  scheduled hours and days of service  information regarding voluntary contributions  emergency contacts  severe weather policy

Service Activities: Service activities provided by the provider agency may include:  Basic housekeeping and home management skills necessary to ensure safe, sanitary conditions in the client’s home, such as dusting, vacuuming, sweeping and mopping.

Housekeeping is performed only for the client;  Instructing client in home management, including maintaining an orderly environment, proper food storage, preparation of shopping lists, meal planning and preparation;  Shopping assistance with or without client;  Personal laundry and mending of clothing;  Client transportation may be provided only when other transportation services are unavailable and for scheduled appointments. Need must be clearly documented.

Routine transportation is not permitted.

Client assistance may include:  Assistance with eating, including set up, opening containers, and cutting food.

Feeding is not permitted.  Assistance with bathing of areas that the client cannot reach. Bed baths or transferring are not permitted.  Assistance with dressing of ambulatory clients, such as the fastening of clothing on the client. Lifting or putting on braces or other supports is not permitted.  Assistance with personal grooming, such as combing hair, brushing dentures and shaving with an electric razor. Cutting nails or shaving with a blade is not permitted;  Supportive assistance with ambulation, such as providing stabilization to the client while walking. Lifting and transferring are not permitted.

Service Record: A service record or log, signed by the client, shall record the date and duration of each time the service is provided. The service record or log shall be maintained at the Area Agency on Aging. Service units must be recorded in the approved DARS electronic data reporting system.

Page 2 of 5 Effective 10/1/03, Revised 10/113 Virginia Department for Aging and Rehabilitative Services Service Reassessment: A review of the client’s need for services, the amount of services provided and the appropriateness of the care plan shall be performed by the Area Agency on Aging when the client’s condition or situation changes, but at least annually.  Federal Poverty Level should be determined and documented. The Federal Poverty/VDA form may be used.  Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Service Termination Policy: Homemaker services can be terminated at the discretion of the Area Agency on Aging, the service provider or the client. The client shall receive a copy of the termination policy when service begins. The policy shall have provisions for: appropriate advance notice to client, preferably of ten business days; a service summary, and referrals to other community service programs, as appropriate.

Administrative Elements

Area Agency on Aging Staff Qualifications:  Knowledge: Area Agency on Aging staff should have an awareness of the biological, psychological, and social aspects of aging; an awareness of the impact of disability and illness on aging, and a knowledge of community resources and consumer rights.  Skills: Area Agency on Aging staff should have skills in establishing and sustaining interpersonal relationships and in problem solving.  Ability: Area Agency on Aging staff should have the ability to communicate with persons of different socioeconomic backgrounds and to work independently and in groups. Staff should have the ability to determine specific household tasks necessary to improve the environment and living conditions of the client.

Job Description: For each paid position, an Area Agency on Aging shall maintain:  A current and complete job description which shall cover the scope of a the staff member’s duties and responsibilities, and  A current description of the minimum entry-level standards of performance for each job.

Service Provider Staff Qualifications:  Knowledge: Service provider staff should have an awareness of the biological, psychological, and social aspects of aging; an awareness of the impact of disability and illness on aging, and an awareness of community resources and consumer rights.  Skills: Service provider staff should have skills in establishing and sustaining interpersonal relationships and in assessing what skills and equipment are essential to performing needed household tasks.  Ability: Service provider staff should have the ability to perform household tasks needed by the client.

Page 3 of 5 Effective 10/1/03, Revised 10/113 Virginia Department for Aging and Rehabilitative Services Units of Service: Units of service must be reported in the approved DARS data system for each client receiving the service. Service units can be reported by a client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.  Hours (All hours spent assessing the need for, arranging and delivering homemaker services for the client.)  Persons served (unduplicated)

Program Reports:  Aging Monthly Report (AMR) to DARS by the twelfth (12th) of the following month. If the Area Agency on Aging supports the homemaker service, this report must be updated and submitted even if no expenditures or units of service occurred.  AIM or PeerPlace client level data transmitted to DARS by the last day of the following month.  A completed and properly maintained electronic/digital Part A of the Uniform Assessment Instrument (UAI) is a mandatory requirement.  The question “Client in Federal Poverty?” (Answer Yes or No) must be asked and recorded.  A written Policies and Procedures Manual must be maintained for the service.

Consumer Contributions/Program Income: The Area Agency on Aging shall formally adopt written policies and procedures, approved by the agency’s governing board, regarding the collection, disposition, and accounting for program income.3 There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations.

Cost Sharing: An Area Agency on Aging is permitted to implement cost sharing for recipients of this service.4

Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service, provided that the method of solicitation is non-coercive. Such contributions shall be encouraged for individuals whose self-declared income is at or above 185 percent of the poverty line, at contribution levels based on the actual cost of services.5

Quality Assurance

Criminal Background Checks: DARS strongly recommends that the agency and its contractors protect their vulnerable older clients by conducting criminal background checks for staff providing any service when said staff goes to or into a client’s home.

3 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 4 Older Americans Act of 1965 as amended 2006, Section 315(a) 5 Older Americans Act of 1965 as amended 2006, Section 315(b) Page 4 of 5 Effective 10/1/03, Revised 10/113 Virginia Department for Aging and Rehabilitative Services Staff training: Each homemaker service provider agency providing the above mentioned service activities shall comply with the following:  At hiring, homemakers should receive orientation on agency policies and procedures, community characteristics and resources, and procedures for conducting the allowable activities under this service;  All homemakers shall have a minimum of 16 hours basic training within the first year of employment; training topics should include, but are not limited to ethics and confidentiality in patient care, home safety precautions, working with diverse populations, and home management.  Workers should receive a minimum of 8 hours per year of in-service training based on the need for professional growth and upgrading of knowledge, skills, and abilities.

Supervision/Case Review:  Consultation, supervision and case review shall be available to all staff providing the service.  The Case Monitor Section for this service must be completed in the approved DARS electronic data system

Program Evaluation: The Area Agency on Aging should conduct regular and systematic analysis of the persons served and the impact of the service.  Service providers must be monitored annually. A written copy of the monitoring report must be maintained by the agency.  Anonymous client surveys shall be conducted annually. A file of annual anonymous client surveys with a summary of the surveys shall be maintained by the agency.

Client Records: Area Agencies on Aging must maintain specific program records in the approved DARS electronic data system that includes:  Part A of the Uniform Assessment Instrument  Federal Poverty Level  Care Plan  Service Reassessment, as needed  Progress Notes  Consent to Exchange Information Form  A Caregiver Form, if this service is funded by OAA Title III E.

Area Agencies on Aging are to maintain the following additional client records:  Service plan/documentation, including any fee charged the client  Signed Client Bill of Rights/ Appeals Process  Denial or Termination of Service Notice

Page 5 of 5 Effective 10/1/03, Revised 10/113 Virginia Department for Aging and Rehabilitative Services Homemaker FAQ’s

1. Are certain activities prohibited to homemaker service providers?

Yes, providers should consult the Virginia Department for the Aging Service Standards to make sure they are knowledgeable about prohibited activities.

1. Is training required for homemaker service staff?

Yes, at hiring, homemakers should receive orientation on agency policies and procedures, community characteristics and resources, and procedures for conducting the allowable activities under this service. All homemakers shall have a minimum of 8 hours per year of inservice training after completing the first year of employment. Training programs that provide certification must comply with the guidelines of the Homecare University.

1. The VDA Homemaker Service Standard states that homemaker training that provides Certification must comply with training guidelines as established by the National HomeCaring Council. Where can I find information about this organization?

In 1986, the National Association for Home Care merged with the National Homecaring Council, which became part of the NAHC’s related Foundation for Hospice and Home Care. For further information on this organization, please consult its website at www.nahc.org.

Page 1 of 1 FAQ Homemaker Revised 12/11/03 Virginia Department for the Aging IDENTIFICATION DISCOUNT

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Provision to persons 60 years of age and older of a card which verifies their age and which can be used as identification to cash checks and to obtain discounts for goods and services.

Eligible Population Persons 60 years of age and older. Priority shall be given to older individuals who are in the greatest economic and social need, with preference given to low-income minority individuals and to those older persons residing in rural or geographically isolated areas.1

Service Delivery Elements Agencies providing an Identification/Discount service must perform all of the following component:

Assessment: The process of identifying, analyzing, and prioritizing the needs of older persons, utilizing the Virginia Service – Quick Form and other client assessment documents. Federal Poverty/VDA Sliding Fee Scale is required, unless all information needed to determine federal poverty is documented on Virginia Service – Quick Form.

Card: The process of issuing an identification/discount card to persons 60 years of age and older.

Administrative Elements Staff Qualifications: Staff qualifications for the Identification/Discount service shall be established by Area Agency on Aging policy.

Job Descriptions: For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on aging shall maintain:

• A current and complete job description which shall cover the scope of a I.D. Discount staff duties and responsibilities; and
• A current description of the minimum entry-level standards of performance for each job.2

Units of Service: Units of service must be reported in AIM for each client receiving services. Services units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

• The number of cards issued to an individual.

1 Older Americans Act of 1965, as amended, Section 306(a)(4)(A)(i) 2 22 VAC 5-20-250, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code Page 1 of 2 Identification/Discount Effective 10/01/03, Revised: 4/29/03 Virginia Department for the AgingProgram Reports

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.
• AIM client level data transmitted to VDA by the last day of the following month.

Consumer Contributions/Program Income The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.3

• Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service.4 And/or
• Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited provided that the method of solicitation is non-coercive.5

Quality Assurance Staff Training:

• Identification/Discount Program staff should receive orientation on agency policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.
• Identification/Discount Program staff should receive a minimum of 10 hours in-service training, the content of which to be based on the need for professional growth and upgrading of knowledge, skills, and abilities.

Supervision/Case Review: Consultation, supervision and case review shall be available to all staff providing the service.

Program Evaluation: The agency shall conduct regular systematic analysis of the persons served and the impact of the service. Subcontractors shall be monitored annually.

Client Records: Service providers must maintain specific program records that include:

• Virginia Service – Quick Form (At a minimum, this form must be updated annually).
• Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.
• Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

3 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 4 Older Americans Act of 1965, as amended, Section 315(a) 5 Older Americans Act of 1965, as amended, Section 315(b) Page 2 of 2 Identification/Discount Effective 10/01/03, Revised: 4/29/03 Virginia Department for the Aging Identification/Discount Program Frequently Asked Questions

1. Q - Who is eligible to participate in Area Agency on Aging identification/discount programs?

A - Individuals must be age 60 and older.

1. Q - Is there a cost for the identification/discount card?

A - No, although voluntary contributions are appreciated.

1. Q - What should I present to receive the identification/discount card?

A - You should provide verification of your age and identity, such as a birth certificate, a driver’s license or Social Security card.

Page 1 of 1 FAQ ID DISCOUNT PROG Revised 02/15/02 Virginia Department for the Aging Virginia Legal Assistance Standard – Effective 1/1/2009

LEGAL ASSISTANCE

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD1 (Effective 1/1/09)

I. SERVICE PROVIDED

Legal Assistance funded by Title III-B of the Older Americans Act (OAA)

II. DEFINITIONS

“Legal Assistance” as defined in the Older Americans Act --(A) means legal advice and representation provided by an attorney to older individuals (60 years of age and older) with economic or social needs; and (B) includes--(i) to the extent feasible, counseling or other appropriate assistance by a paralegal or law student under the direct supervision of an attorney; and (ii) counseling or representation by a nonlawyer where permitted by law.

Public Law 109-365, §102(33) enacted 10/17/062 In Virginia, “Legal Assistance” also may include – Outreach to those in greatest social or economic need targeted under the Older Americans Act, education, group presentations and training designed to protect the legal rights of older adults using materials developed under the direct supervision of an attorney.

Terms used in the OAA definition of Legal Assistance have the following meanings:

• “Attorney” means: A lawyer licensed and authorized by the Virginia State Bar to practice law in the Commonwealth of Virginia.
• “Nonlawyer” means: A person who is not a licensed attorney, but who is specifically permitted by federal or state law to provide limited counseling or representation (for example representation in Social Security administrative hearings and certain other public benefit hearings).
• “Economic Need”: The OAA does not define this term, but it does define

1 If you have questions about anything contained in this Standard, please contact the Legal Services Developer at the Virginia Department for the Aging 2 All sections of the Older Americans Act as Amended in 2006 {Public Law (P.L.) 109-365} referenced in this Standard can be found on both the Administration on Aging and The Center for Social Gerontology web sites: http://www.aoa.dhhs.gov/OAA2006/Main_Site/oaa/oaa_full.asp and http://www.tcsg.org/law/2006OAACompleteComp.pdf

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“Greatest Economic Need” as “ … the need resulting from an income level at or below the poverty line.” (P.L. 109-365, §102(23),(43)) * “Social Need”: The OAA does not define “social need,” but it does define “Greatest Social Need” as “… the need caused by non-economic factors, which include – (A) physical and mental disabilities; (B) language barriers; and (C) cultural, social, or geographical isolation, including isolation caused by racial or ethnic status, that – (i) restricts the ability of an individual to perform normal daily tasks; or (ii) threatens the capacity of the individual to live independently.

P.L. 109-365, §102(24)

“Unduplicated Client”: The US Administration on Aging requires states to report the numbers of “unduplicated” persons served with OAA funds. For legal assistance, this means the number of different individuals who received legal assistance from the legal provider during a federal fiscal year. For the “unduplicated count,” a client is counted only once for the year regardless of how many times the client returned that year for assistance on either the same or different legal issues. Thus the number of “cases” handled by a legal provider is often greater than the number of “unduplicated clients.”

III. ELIGIBLE POPULATION

As defined in the OAA, Legal Assistance is for persons aged 60+ “in social or economic need.” The Act further specifies that services be particularly targeted to older individuals: with greatest economic need; with greatest social need; at risk for institutional placement; with limited English proficiency; low-income minority older individuals; and, those residing in rural areas. (See for example, P.L. 109-365, §306(a)(4)). In Virginia, residents of long-term care facilities are also a very important group to be targeted for legal assistance.

However, while the Act requires that these groups be particularly targeted for service, mechanisms to achieve targeting may not include the use of a means test. Allowable and effective mechanisms to achieve targeting without means testing include strategic outreach to specific target groups of older persons and/or persons who work with them, and focusing on particular types of legal issues that reflect the most critical and basic needs of the target populations, for example public benefits, housing, and long term care.

IV. SERVICE DELIVERY ELEMENTS

A. TYPES OF LEGAL ASSISTANCE PROVIDERS Legal assistance must be provided by an attorney or by a paralegal/law student

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under the direct supervision of a licensed attorney. The Act calls for Area Agencies on Aging (AAAs) to select as their legal assistance provider the entity that is best able to provide the targeted legal services described in the Act.

Examples of things to consider in selecting the “best entity,” include such things as the capacity of the provider to: ♦ Protect the autonomy, dignity and independence of vulnerable older persons; ♦ Focus outreach and service on those in the greatest social and economic need – often those least able to advocate on their own behalf; ♦ Foster cost-effective, high quality legal services, having maximum impact on those in greatest social and economic need and their most critical legal needs; ♦ Assist vulnerable older persons in preventing legal problems through education and outreach; and ♦ Be accessible throughout the Planning and Service Area (PSA), particularly to the target populations specified in the OAA.

See the OAA, P.L. 109-365, §307(a)(11) for required contract provisions or contact the State Legal Services Developer at VDA for technical assistance (see Footnote 1).

AAAs can accomplish this through one, or a combination, of the following methods:

1. CONTRACT WITH A LEGAL AID FUNDED BY LEGAL SERVICES CORPORATION

(LSC).

This means that the AAA contracts with an existing licensed local legal aid program that is funded by the LSC and operates in accordance with Federal law.

2. CONTRACT WITH A LEGAL AID NOT FUNDED BY LSC.

This means that the AAA contracts with an existing licensed local aid program that is not funded by the LSC. In this case, the OAA requires the Legal Aid not funded by LSC to coordinate services with any existing LSC-funded program in the area (usually a different local legal aid program) in order to maximize the use of limited OAA Title III-B funds.

1. STAFF ATTORNEY HOUSED IN AAA: This means an attorney employed by the AAA who provides legal assistance directly to older clients in social or economic need. In this case, the OAA requires coordination of services with an existing LSC-funded program (usually a local legal aid program) in order to maximize the use of limited OAA Title III-B funds. It is important that, under this model, the attorney not serve as in-house counsel to the AAA. Further, under the OAA, the AAA would need a waiver from VDA in order for the AAA staff attorney to provide direct service to clients.

4. CONTRACT WITH A PRIVATE ATTORNEY.

This means that the AAA contracts with a private attorney to provide legal assistance to older clients in social or economic need. In this case, the

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OAA requires coordination of services with an existing LSC-funded program (usually a local legal aid program) in order to maximize the use of limited OAA Title III funds.

5. CONTRACT WITH A LAW SCHOOL CLINICAL PROGRAM.

If an AAA is considering a law school, please contact the Legal Services Developer at VDA (see Footnote 1)

In all cases where practical, an attempt should be made to involve the private bar in legal assistance activities, including groups within the private bar willing to furnish legal assistance to older adults on a pro bono or reduced fee basis.

B. PRIORITY SERVICES: The Older Americans Act uses the term “priority services” in two ways.

First, it designates legal assistance services as one of three priority services (access, in-home, and legal) that in the absence of a waiver from VDA, must be funded by every AAA. At a minimum, each AAA must fund each of the priority services at a base level established by VDA. The current base level for Virginia is 1% of Title III-B allocated funds. However, AAAs are permitted and encouraged to increase the base level as appropriate. (P.L. 109—365 §306(a)(2), §307(a)(2)(C))

Second, the Act addresses the types of legal issues that are to receive priority in delivering services. It requires that in funding legal assistance services, area agencies “… give priority to legal assistance related to income, health care, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination.” (P.L. 109—365 §307(a)(11) (E))

C. OUTREACH TO TARGET GROUPS, EDUCATION, TRAINING &

PRESENTATIONS: Recognizing that OAA III-B resources are inadequate to meet the legal needs of all older persons, legal assistance services must be particularly targeted to older persons in greatest economic and social need. The OAA specifies a number of target groups, with emphasis on low-income older persons, low-income minority older persons, older persons with limited English proficiency, and those residing in rural areas. Often, the target populations don’t recognize their problems as being legal in nature and don’t know where or how to access affordable legal services. Further, they are often the least able to advocate on their own behalf, while they are the most difficult to reach and serve. Targeted outreach and strategic education/presentations on critical legal issues affecting the most vulnerable older persons are essential to effective targeting. This type of outreach and education is best achieved through joint planning by the AAA and legal provider and coordinating efforts to conduct outreach and education.

Qualified individuals will conduct outreach, education and training, and legal training materials will be developed under the direct supervision of an attorney.

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D. PROHIBITED SERVICES: Legal Assistance will not be provided for:

• Any criminal matter;
• Any civil action involving post criminal conviction relief;
• Any action concerning euthanasia or abortion;
• Any strike, boycott, picketing or demonstration; or
• Any illegal activity.

See 42 United States Code §2996e; 42 United States Code §2996f and 42 United States Code (USC) §14404.

Further, the OAA Regulations (Title 45 Code of Federal Regulations (CFR), §1321.71(g)-(k)) include prohibitions specific to III-B legal assistance providers and the use of III-B legal assistance funds. These include:

• Providing legal assistance in fee-generating cases, with certain exceptions (45 CFR §1321.71(g));
• Engaging in specified prohibited political activities (45 CFR §1321.71(h));
• Engaging in lobbying activities as described in the Regulation (45 CFR §1321.71(i));
• Participating in any public demonstrations, boycotts, etc. as described in the Regulation (45 CFR §1321.71(j));
• Paying dues exceeding $100 to any organization (other than a bar association) that engages in the above prohibited activities (45 CFR §1321.71(k)).

V. ASSESSMENT:

The Virginia Service Quick Form (July 2008)3 is used for legal assistance services.

Federal poverty should be determined and documented on this form.

A. ADMINISTRATIVE/REPORTING ELEMENTS

1. UNITS OF SERVICE DEFINED: As used here, “unit of service” is for reporting purposes only, not for billing purposes. Under the Administration on Aging NAPIS reporting system, a unit of service for legal assistance is one hour. What this means is that each hour of providing legal assistance (including such things as case preparation, legal research, drafting documents, preparing materials for outreach/community education, conducting the outreach/education, etc.) is equal to the corresponding number of “units.”

2. PROGRAM REPORTS:

3 The Virginia Service Quick Form was revised in July 2008 to make clear that name, address and telephone numbers are not permitted for Legal Assistance and Elder Abuse Services. In order to protect client confidentiality and the attorney-client relationship, a unique number (or numbers and letters) should be used to track services and outcomes.

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Information to be reported is captured at three different points: (a) at client intake; (b) at case closing; and (c) when special outreach/community legal education activities are conducted.

(a) At Client Intake: At the time of client intake, a client- specific assessment should be performed to capture information relevant to targeting and needed for reporting. This includes:

• Client demographics/characteristics such as age, gender, ethnicity, race; and
• The type of legal issue on which the client is seeking assistance.

(b) At Case Closing: Information to be captured at the time of case closing includes:

• The type of legal issue on which service was provided to the client;
• The outcome of the service for the client; and
• The total number of hours (“units”) spent by the provider on the client’s case.

(c) When Special Outreach/Community Legal Education Activities are Conducted: Information to be captured will include:

• Dates and locations of outreach and educational activities;
• Type of outreach conducted or topic of educational presentation;
• Specific groups targeted by the outreach or types of persons attending the educational activity;
• Estimated number of people reached through the outreach or educational activity;
• Estimated number of hours spent in preparation, travel, and conduct of the outreach or educational activity.

1. INFORMATION REPORTED TO VDA & DUE DATES The information that must be reported by AAAs to the Virginia Department for the Aging (VDA) includes:

• Number of “Unduplicated” Clients/Persons Served. See the definition of “unduplicated” under roman numeral II above.
• Number of Hours/”Units of Service” provided. See definition of “unit of service” under V.A.1. above.

Due Dates: Aging Monthly Report (AMR) must be submitted monthly to VDA by the 12th day of the following month. Client level data must be transmitted to VDA by the last day of the following month.

Optional Group Units cannot be entered into AIM/NWD tools but may be reported on the AMR Optional Unit Report. These include:

• Group Participants – Number of people attending a presentation, meeting or program provided to more than one person.
• Group Presentations – Number of education/training group presentations on legal assistance topics.

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B. QUALITY ASSURANCE & CAPACITY

1. LEGAL ASSISTANCE PROVIDER/STAFF QUALIFICATIONS: AAAs are to select as their legal providers, the entity that best meets certain capacity criteria that are important to quality assurance. Examples of important elements of quality assurance include:

• All attorneys are licensed to practice law in the Commonwealth of Virginia and adhere to the Virginia Rules of Professional Conduct and all professional regulatory requirements to practice law in the Commonwealth;
• Program staff (including attorneys and paralegals) have experience in serving older adults, and knowledge and understanding of legal issues most critical to those in greatest social and economic need;
• Programs have mechanisms in place to protect against conflict of interest and to assure client confidentiality.

1. CRIMINAL BACKGROUND CHECKS: VDA strongly recommends that the agency and its contractors protect their vulnerable older clients by conducting criminal background checks for staff providing any service where they visit or enter a client’s home.

1. STAFF TRAINING: At a minimum, legal provider staff must meet continuing legal education requirements to practice law in the Commonwealth. In addition, they should have sufficient training to remain current on the most critical legal issues affecting older persons in greatest economic or social need.

4. PROGRAM EVALUATION (BEST PRACTICE RECOMMENDATION):

The agency should conduct regular and systematic analysis of the persons served and the impact of the service. Service providers should be monitored annually. Evaluation may include client satisfaction surveys.

5. RECORDS:

The AAA or service provider must maintain specific program documentation that includes:

• A unique identifier for each client served (e.g. case number)
• Virginia Service Quick Form or electronic data equivalent
• Service provided and case outcome if applicable

Acknowledgment VDA gratefully acknowledges the assistance of The Center for Social Gerontology, Administration on Aging, Virginia Poverty Law Center, Virginia Area Agencies on Aging and Legal Aid Programs of Virginia for legal research, formatting and other valuable contributions to this Legal Assistance Service Standard revision.

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VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Provides for the active participation of the Area Agency on Aging staff on local long-term care coordinating committee(s), i.e., in the planning and implementation of a coordinated service delivery system to insure the development and delivery of an adequate supply of home- and community-based services to assist older persons to avoid or delay unnecessary institutionalization, and to assure maximum efficiency and cost-effectiveness in the delivery of those services.

Eligible Population Not applicable

Service Delivery Elements Agencies conducting Long-Term Care Coordinating Activities must perform the following components:1

Active participation on long-term care coordinating committees and other groups and organizations involved in the development and delivery of long-term care services, such as interagency task groups, planning councils, Medicaid Pre-admission Screening Teams, and other interagency activities aimed at planning and coordinating new or existing services.

Administrative Elements Staffing:

• As established by AAA policy

Units of Service:

• hours of participation

Program Reports:

• AMR (Aging Monthly Report) due by the 12th of the month. If the area agency on aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.
• Annual program performance report

Allowable Costs: Costs associated with activities of this service are allowable

1 Older Americans Act of 1965, as amended, Section 304(d)(1)(A) Page 1 of 2 Long Term Care Coordinating Activity Effective 10/1/03, Revised 04/14/03 Virginia Department for the AgingQuality Assurance Staff Training:

• (Initial) in-depth orientation on agency policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.
• (On-going) at least annual in-service training, the content of which to be based on the need for professional growth and upgrading of knowledge, skills, and abilities.

Case Review:

• Not applicable

Program Evaluation: The area agency on aging should conduct a regular systematic analysis of the persons served and the impact of the service.

Records:

• Minutes of meetings of local long-term care coordinating committee.

Page 2 of 2 Long Term Care Coordinating Activity Effective 10/1/03, Revised 04/14/03 Virginia Department for the AgingMEDICATION MANAGEMENT

DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES

VIRGINIA DIVISION FOR THE AGING SERVICE STANDARD Definitions

Medication Management Services refer to the following activities:

Medication management: Information and education that helps older citizens understand how to take prescription, over-the-counter (OTC), and herbal medications in a safe and proper manner including following the regimen provided by their physician or pharmacist. Includes information about the use of devices (pill boxes, pill cutters, timers, etc.) that assist persons to take their medications properly.

Medication screening: Referral of older citizens to a physician or pharmacist for information and assistance with their medications. May include invitations to pharmacists to provide this information on an individual basis and/or in group settings.

Medication education: Provision of information to older citizens about prescription, OTC, and herbal medications including common side effects, the dangers of mixing medications, and other issues related to medication management and screening. May include the development of brochures, videos, or other materials or resources that provide information about, or assistance with, the proper management of prescription, OTC, and herbal medications.

Eligible Population

Medication management Services are targeted to persons 60 years of age or older. Priority shall be given to older individuals with greatest economic and social need, with special emphasis on low- income minority individuals, older individuals with limited English proficiency, older persons residing in rural or geographically isolated areas, and older individuals at risk for institutional placement.

Service Delivery Elements Program Requirements The purpose of this program is to encourage older persons to communicate with their physician(s) and pharmacist about medications and to provide services to prevent medication misuse and adverse medication reactions. Services may be provided directly to older persons.

Information and/or training about medication management may also be provided to family members, friends, and health care and human services professionals who work with or come into contact with older persons.

Assessment

• If the client does not already have an assessment in the VDA-approved electronic client database, a Virginia Service – Quick Form is required for each person who participates in a medication management program activity where individual hours will be entered into the client database. 1 Medication Management Effective 7/31/2012 Virginia Department for Aging and Rehabilitative Services
• Use of the Virginia Service – Quick Form is recommended, but not required, if there are only group hours or contacts that will not be entered into the VDA-approved electronic client database.
• The answer to the question “Is Client in Federal Poverty?” (answer Yes or No) must be asked and recorded in the VDA-approved electronic client database.
• Any fee for service charge to the client shall be determined by the applicable sliding fee scale. The Federal Poverty/VDA form may be used.

Administrative Elements Staff Qualifications Whenever possible, the Area Agency on Aging or service provider shall utilize health experts and other community resources to provide services. When AAA or service provider staff is used, they shall possess the following minimum qualifications:

• Knowledge: Biological, psychological, and social aspects of aging; the impact of disabilities and illness on aging; community resources; public benefits eligibility requirements; disease prevention and health promotion; medical conditions; learning styles of older adults.
• Skills: Establishing and sustaining interpersonal relationships; problem solving; designing educational materials; public speaking.
• Abilities: Communicating with persons with varying socioeconomic backgrounds; working independently.

Job Descriptions For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on Aging must maintain:

• A current and complete job description which shall cover the scope of medication management services staff duties and responsibilities; and
• A current description of the minimum entry-level standards of performance for each job.

Units of Service Units of service must be reported in the VDA-approved client database for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

• Hours (individual) – The number of hours spent one-to-one providing medication management services to the individual senior, family member, or caregiver.
• Persons served (unduplicated) - The number of persons who are provided with the service and who receive individual hours.

Individual Hours - Service activities provided to a specific individual; individual hours are required for the VDA-approved client database. 2 Medication Management Effective 7/31/2012 Virginia Department for Aging and Rehabilitative Services Optional Group Units (Not entered into the VDA-approved client database)

• Group Participants – The number of people attending the presentation, meeting, or program (activity provided to more than one person or in a group setting).
• Number of Group Presentations – The number of programs on medication management topics.

Group Units – These activities cannot be entered into the VDA-approved client database. They are reported on the Optional Units page of the AMR.

Program Reports

• Aging Monthly Report (AMR) is due to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.
• Client level data from the VDA-approved electronic database shall be transmitted to VDA by the last day of the following month.

Consumer Contributions/Program Income There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations.1

Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing /fee for service for recipients of this service.2

And/or

Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service, provided that the method of solicitation is non-coercive. Voluntary contributions shall be encouraged for individuals whose self-declared income is at or above 185% of the poverty line, at contribution levels based on the actual cost of services. 3

Quality Assurance Staff Training

• At hiring, staff shall receive orientation on agency and departmental policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.
• Workers shall receive a minimum of 10 hours of in-service or other training per year based on the need for professional growth and upgrading of knowledge, skills, and abilities.

1 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 2 Older Americans Act of 1965, as amended, Section 315 (a) 3 Older Americans Act of 1965, as amended, Section 315 (b) 3 Medication Management Effective 7/31/2012 Virginia Department for Aging and Rehabilitative ServicesSupervision Consultation and supervision shall be available to all staff providing the service.

Program Evaluation The AAA shall conduct regular and systematic analysis of the persons served and the impact of the service, with findings used as a basis for planning and implementing changes in program goals, procedures and resources. There shall be a written plan and a written report of findings.

Evaluation may include client satisfaction surveys.

The AAA or service provider must maintain specific client records in the approved VDA electronic database that include:

• Consent to Exchange Information, if information is shared with other agencies.
• Virginia Service - Quick Form, if required. At a minimum, this form must be updated annually.
• The answer to the question “Is Client in Federal Poverty?” (answer Yes or No) must be asked and recorded in the VDA-approved electronic client database.

The AAA or service provider must maintain the following additional records:

• Documentation that the service took place.
• Cost Sharing (Fee for Service) calculations, if applicable. The Federal Poverty/VDA Sliding Fee Scale form may be used. 4 Medication Management Effective 7/31/2012 Virginia Department for Aging and Rehabilitative Services

MONEY MANAGEMENT

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Money Management service is assisting eligible older persons in making decisions and completing tasks necessary to manage day-to-day financial matters. The objective of money management services is to enable older persons to maintain financial stability, thereby promoting their well being, independence and self-determination, while protecting their interests and rights.

Eligible Population Money Management services are targeted to persons 60 years of age or older who are in the greatest economic and social need, with preference given to low-income minority individuals and those older persons residing in rural or geographically isolated areas.1

Service Delivery Elements The Area Agency on Aging or service provider must perform all of the following components of money management services:

Assessment The process of identifying, analyzing and prioritizing the needs of older persons utilizing the Virginia Service – Quick Form and other client assessment documents.

• Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.
• Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

A service specific assessment shall be performed on each potential client, which determines:

• Whether the person meets the criteria specified in eligible population
• Identifies the person’s service-specific needs
• What level of priority for service delivery the person meets

Service Plan A written individualized service plan shall be developed (with client input) which identifies the service activities to be provided for the client in response to established need. The plan is to be established prior to service commencement by the service provider. The service plan shall include:

• Identified service needs
• Services to be delivered
• Goal(s) and objective(s) of service(s)
• Service unites to be provided

1 Older Americans Act of 1965 as amended, Section 306(a)(4)(A)(i) Page 1 of 5 Money Management Effective 10/01/03, Revised 04/29/03 Virginia Department for the AgingService Agreement A service agreement shall be completed between the older person and the service provider. Both must sign the agreement and the older person must receive a copy. The service agreement shall:

• Explain the service activities to be provided
• List scheduled hours/days of service provision
• Provide information regarding voluntary contributions/fees
• Explain emergency procedures

Independence Encouragement It is important to elicit the older person’s participation in Money Management activities to the greatest extent of their capabilities. Making lists of things for the client to do between visits can be helpful. Using difference colors of paper for different types of tasks can also help the client with organizing. If only some bills are a problem, the client should continue to handle those that are not. For example, the client may always pay the rent on time, but cannot manage other bills.

The client should continue to pay the rent, therefore, while the service provider handles the other bills. The provider shall record evidence of this activity in the client record.

Service Activities Service activities provided may include performing or providing assistance with:

• Budget set-up and monitoring
• Establishing a checking and/or savings account
• Arranging direct deposit for all income sources
• Making bank deposits
• Planning, organizing, and managing bill payment
• Writing checks for client’s signature for bill payment
• Making cash transactions/change
• Checkbook balancing
• Bank statement reconciliation
• Organizing and managing Medicare benefits reconciliation
• Organizing and managing Medicare supplemental insurance benefits reconciliation
• Organizing and managing long-term care insurance benefits reconciliation
• Organizing and managing other health/medical insurance benefits reconciliation
• Organizing and managing and any other insurance (e.g. homeowners, renters, automobile, etc.) benefits reconciliation

Prohibited Activities Include

• Any activity related to being a “credit services business,” i.e., receiving any form of payment for: o Improving a consumer’s credit report, history or rating o Obtaining an extension of credit for a consumer o Providing advice or assistance to a consumer with regard to either of the previous two items.
• Managing or giving advice on investments, trusts, etc.
• Income tax preparation, completion and/or filing

Page 2 of 5 Money Management Effective 10/01/03, Revised 04/29/03 Virginia Department for the Aging • Maintaining possession of an older person’s money for man than 48 hours

• Any activity related to appointment as Power of Attorney

Documentation Service provision shall be recorded following each time service is provided.

Reassessment A reassessment of the older person’s continued need for service(s), the amount of service(s) provided and the appropriateness of the service plan shall be performed annually, or when the older person’s condition/situation changes.

Administrative Elements Termination Service will be terminated at the discretion of the provider. Written notifications of service termination shall be mailed 10 business days prior to the date the action is to become effective.

Staff Qualifications Staff qualifications for the Money Management service shall be established by AAA and/or provider policy and shall include:

• Knowledge of: o Biological, psychological and social aspects of aging o Impact of disabilities and illnesses on aging o Community resources and consumer rights o Sound money management practices
• Skill in: o Establishing and sustaining interpersonal relationships o Planning, organizing and managing financial matters o Analyzing and solving problems o Advocacy o Negotiation
• Ability to: o Communicate with persons of diverse socio-economic backgrounds o Work independently o Allow the older person to participate in money management activities to the greatest extent of their capabilities

Job Descriptions For each paid and volunteer position funded by Title III of the Older American’s Act, an Area Agency on Aging shall maintain:

• A current and complete job description which shall cover the scope of an Money Management services staff duties and responsibilities
• A current description of the minimum entry-level standards of performance for each job.2

2 22VACS5-20-250 Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code Page 3 of 5 Money Management Effective 10/01/03, Revised 04/29/03 Virginia Department for the Aging Units of Service Units of service must be reported in AIM for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

• Individual hours
• Persons served (unduplicated)

Program Reports:

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.
• AIM client level data transmitted to VDA by the last day of the following month.

Consumer Contributions/Program Income The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.3 There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations.4

Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service.5

AND/OR

Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service, provided that the method of solicitation is non-coercive.

Allowable Costs Incurred costs shall conform to cost principals and other applicable federal and state regulations and shall be attributable to the specific service activities.

Quality Assurance

Criminal Background Checks:

• VDA strongly recommends that the agency and its contractors protect their vulnerable older clients by conducting criminal background checks for staff providing any service where they go to or into a client’s home.

3 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 4 Older Americans Act of 1965, as amended, Section 315(b) 5 Older Americans Act of 1965, as amended, Section 315(a) Page 4 of 5 Money Management Effective 10/01/03, Revised 04/29/03 Virginia Department for the AgingStaff Training

• (Initial) in-depth orientation on agency policies and procedures, community characteristics and resources and procedures for delivering allowable activities under this service.
• (On-going) a minimum of ten (10)hours of in-service or other training per year, the content of which shall be based on the need for professional growth and upgrading of knowledge, skills and abilities.

Supervision Consultation, supervision and case review shall be available to all staff providing this service.

Program Evaluation

• The agency should conduct regular systematic analysis of the persons served and the impact of the service.
• Subcontractors shall be monitored annually.

Monitoring: Annually each MM client’s financial records will be reviewed by a person independent of program supervision and program service delivery with review findings documented.

Records

• Virginia Service – Quick Form (At a minimum, this form must be updated annually).
• Federal Poverty documentation and Cost Sharing (Fee for Service) calculations must be part of the client record. The Federal Poverty/VDA Sliding Fee Scale form may be used.
• Service plan
• Service agreement
• Service delivery documentation; progress reports
• Independence encouragement of documentation
• Consent to Exchange Information form as necessary
• Reassessment documentation
• Termination documentation as necessary
• Program evaluation
• Supervision documentation
• Monitoring documentation

Page 5 of 5 Money Management Effective 10/01/03, Revised 04/29/03 Virginia Department for the Aging FAQ ‘S Money Management

1. Are there any activities that are prohibited?

Yes, there are.

• Any activity related to being a “credit services business”.
• Managing or giving advice on investments, trusts, etc.
• Income tax preparation, completion or filing
• Maintaining possession of an older person’s money for more than 48 hours
• Any activity related to appointment as guardian or Power of Attorney

1. How does the client know what type of services to expect?

A service agreement shall be completed between the older person and the service provider. Both must sign the agreement and the older person must receive a copy. The service agreement shall:

• Explain the service activities to be provided
• List scheduled hours/days of service provision
• Provide information regarding voluntary contributions/fees
• Explain emergency procedures.

1. What type of reports are required? How often?

The Aging Monthly Report (AMR) is due by the 12th of each month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.

AIM client data transmitted to VDA by the last day of the following month.

Page 1 of 1 FAQ Money Management Revised 02/01/2005 Virginia Department for the AgingNUTRITION EDUCATION

VIRGINIA DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES

DIVISION FOR COMMUNITY LIVING: OFFICE FOR AGING SERVICES

SERVICE STANDARD

Definition

Nutrition services are authorized under Title IIIC of the Older Americans Act (OAA) and are designed to promote the general health and well-being of older individuals, particularly to:

• Reduce hunger, food insecurity and malnutrition,
• Promote socialization, and
• Delay the onset of adverse health conditions.

The OAA Nutrition Programs include the Congregate Nutrition Program and the Home Delivered Nutrition Program. The OAA Nutrition Programs also provide a range of related nutritional services that include, but are not limited to, nutrition screening, assessment, nutrition counseling and nutrition education.1

Nutrition education must be provided regularly to all OAA Nutrition Program participants. The Administration on Aging defines nutrition education as an intervention targeting OAA participants and caregivers that uses information dissemination, instruction, or training with the intent to support food, nutrition, and physical activity choices and behaviors (related to nutritional status) in order to maintain or improve health and address nutrition-related conditions.

Instruction is defined as imparting knowledge or information.

Intervention is defined as action taken to improve a situation.

Eligible Population

Nutrition education services will be available to eligible participants which include: older individuals, spouses of any age and caregivers, and may be made available to individuals with disabilities who are not older individuals but who reside in housing facilities occupied primarily by older individuals at which congregate nutrition services are provided.2 Nutrition and health related education is provided to a group or individuals 60 years and older as an educational and informative session, which complements health promotion goals for participants.

Service Delivery Elements

Nutrition Education, Nutrition Counseling, and other Nutrition Services 1 https://acl.gov/programs/health-wellness/nutrition-services 2 Older Americans Act, as amended through As Amended Through P.L. 116–131, Enacted March 25, 2020 , Section 339(A) (2) (I); State Performance Report, Appendix A, Data Elements Definitions, Version 1.4 6-2021 P a g e | 1 Nutrition education for senior nutrition program participants should:

• Meet OAA nutrition program goals
• Be relevant and of interest to the audience
• Support adult learning needs3 which may include hands-on activities
• Build off previous knowledge of the participants
• Actively involve individuals in determining personal goals
• Focus on behavior modification
• Be achievable or able to be implemented by participants
• Include contact with health or nutrition professionals
• Preferably, be presented in short sessions
• Have an evaluation component that allows for both process and outcome measures to be tracked4

In order to meet the OAA requirements for nutrition education, each Area Agency on Aging (AAA) nutrition program must create a Nutrition education policy on how this service requirement is met. The AAA and service provider must maintain, at a minimum, a policy with procedures that include how often this service is provided, how it is implemented, reputable sources of written materials and utilization of an annual education plan in accordance with the oversight of a RDN.

The AAAs and nutrition service providers will provide nutrition education, nutrition counseling, and other nutrition services, as appropriate, based on the needs of participants. The nutrition services and programs offered by the AAAs will be described in the Area Plan and comply with the following definitions:

Nutrition education: (Each session is an intervention which may be delivered in-person or via video, audio, online or hardcopy.5) -- An intervention targeting OAA participants and caregivers that uses information dissemination, instruction, or training with the intent to support food, nutrition, and physical activity choices and behaviors (related to nutritional status) in order to maintain or improve health and address nutrition-related conditions.

Content is consistent with the Dietary Guidelines for Americans; it is accurate, culturally sensitive, regionally appropriate, and considers personal preferences; and is overseen by a registered dietitian or individual of comparable expertise as defined in the OAA.6 The participant shall be provided with information on a continuing basis, but at least quarterly, for congregate and two times per year for home delivered meal participants. Scheduled programs shall be documented as having taken place including dates, tracking of participant attendance in the DARS-OAS-approved client database, the source of the written material(s) and the presenter of the information. 3 https://www.researchgate.net/publication/332588190_Learning_process_and_how_adults_learn 4 https://seniornutrition.acl.gov/documents/ServiceProviders/VirtualNutritionEducationOlderAdults_508.pdf 5 Administration on Aging, Title III and Title VII, State Program Report: Appendix A: Definitions - Version: 1.4 6 National Nutrition Monitoring and Related Research Act of 1990 and Input Committee 6-2021 P a g e | 2 Nutrition education topics will be based on the needs of the participants and should be culturally appropriate. A variety of educational methods such as food demonstrations and interactive activities may be utilized for presentations. Group presentations may vary in length, including short sessions (e.g., 5-15 minutes), as appropriate to the content and venue or based on the presenter’s professional judgement. All nutrition programs shall educate, make referrals and/or assist participants in taking advantage of benefits under other programs such as the Supplemental Nutrition Assistance Program (SNAP) and one-to-one nutrition counseling. Nutrition education may be provided at a mutually agreed upon location or modality, for example, in-person or via video, audio, online or hardcopy.7

Teaching methods and instructional materials must accommodate the older adult learners; these may include large print handouts, interactive demonstrations and/or closed captioning.

Examples of nutrition education activities include, but are not limited to, presentations, cooking classes or food preparation demonstrations, food tasting sessions, gardening, physical activity programs, or discussion of community resources that can support participants’ health and nutrition. Nutrition Education providers should utilize a lesson plan.8 Approved materials for nutrition education can also be obtained from federal agencies including the Administration for Community Living, Centers for Disease Control and Prevention, National Institute of Health, National Institute on Aging, National Resource Center for Nutrition and Aging, US Department of Agriculture, and the Cooperative Extension Service, as well as professional resources like the Academy of Nutrition and Dietetics, American Heart Association, and the American Diabetes Association. All nutrition education materials should reference the source of the information directly on the materials, as appropriate, or include references in the annual Nutrition Education plan. Nutrition education should be provided at the initial nutrition risk assessment, when feasible (i.e., upon completion of the “Determine Your Nutritional Health” Nutrition Screening checklist developed and distributed by the Nutrition Screening Initiative), and appropriate referrals should be made.

Based on the AAA’s annual plan for nutrition education services, the RDN should provide and must oversee group nutrition presentations at congregate sites. Other staff may present under the direction of the RDN. Dietetic students or interns may present under the direction of the RDN.

In a congregate setting, nutrition education may include reviewing the main concepts of nutrition education materials prior to the meal. In a home setting, a nutrition education session may include reviewing educational materials that relate to the initial or annual nutrition risk assessment with the client and/or caregiver or other relevant nutrition education topics.

Additional nutrition education session(s) provided to a home delivered meal client may be related to a current nutritionally relevant topic.

Distributing newsletters or brochures that contain nutrition information from a trusted source regarding topics that are pertinent to home delivered meal (HDM) clients and providing some form of instruction to a group of (or individual) congregate clients constitutes nutrition education. 7 https://seniornutrition.acl.gov/documents/ServiceProviders/VirtualNutritionEducationOlderAdults_508.pdf 8 Template pg. 16, https://seniornutrition.acl.gov/documents/ServiceProviders/VirtualNutritionEducationOlderAdults_508.pdf 6-2021 P a g e | 3 Assessment/Reassessment and Screening

The purpose of nutrition assessment is to obtain, verify, and interpret data needed to identify nutrition-related problems, their causes, and significance.9 Nutrition screening is the process of identifying patients, clients, or groups who may have a nutrition diagnosis and benefit from nutrition assessment and intervention by a registered dietitian nutritionist (RDN). Nutrition screening is a supportive task, which relies on tools that are quick and easy-to-use (<10 minutes to complete) and that requires minimal training.10 Its purpose is to identify individuals who may be at risk of poor nutritional health. If an individual is found to be at high nutritional risk per the nutritional screening tool an intervention should be provided. An example of an intervention would be a note to the individual’s primary care physician or nutrition counseling by a RDN. For congregate clients, the Virginia Service Quick Form or CRIA Encounter and the “Determine Your Nutritional Health” Nutrition Screening (NSI) shall be completed. For home delivered meal clients, Part “A” of the Uniform Assessment Instrument and the “Determine Your Nutritional Health” Nutritional Screening are required. Client assessment data shall be documented in the DARS-OAS approved electronic database. The AAA or service provider will develop a written plan specifying how the agency will use the screening results in order to perform further assessments and referrals.

The results of the “Determine Your Nutritional Health” Nutrition Screening checklist should be used to target specific nutrition education intervention(s). The “Determine Your Nutritional Health” Nutrition Screening checklist, developed and distributed by the Nutrition Screening Initiative, must be completed during assessment and reassessment for both congregate and home delivered meal services. This screening can be self-administered or conducted by anyone that interacts with older adults. It highlights the warning signs of poor nutritional status. Questions to which the client answers “YES” may trigger the staff to ask additional questions regarding the client’s nutritional health, or to refer the client to other resources. The results of the Nutrition Screening checklist guides the following actions: Score of 0-2 = Low nutritional risk; no further action needed at this time.

Score of 3-5 = Moderate nutritional risk; based on the answers to the questions, may need further screening or referral to community based resources; refer as appropriate.

Score of 6-10 = High nutritional risk; based on the answers to the questions, may need further screening or referral to a health care provider, social services, an RDN or other community based resources; refer as appropriate.

A score of 11 or higher and a “Yes” answer to question 9, “Without wanting to, I have lost or gained 10 pounds in the last 6 months,” requires a referral to the AAA’s RDN.

Screening is used to differentiate those at high risk for nutrition related deficiencies who require a referral for further assessment or counseling. Screening results should also be used to plan nutrition education programs. For example, educating participants on how to increase fruit and vegetable intake or to shop for and prepare nutritious meals, depending on individual or aggregate screening results.

9 https://www.andeal.org/vault/2440/web/files/20140602-NA%20Snapshot.pdf 10 https://www.andeal.org/topic.cfm?menu=5382 6-2021 P a g e | 4 In addition to the appropriate screening and assessment for congregate or home delivered meal clients, the “Determine Your Nutritional Health” Nutrition Screening checklist shall be updated when the individual’s condition or situation has changed (for example, a new diagnosis of Diabetes), but at least annually as part of the annual registration process.

Administrative Elements

Staff Qualifications

The AAA must employ or retain the services of a RDN through a contract or a partnership agreement. The RDN must be available to the program with sufficient time to perform nutrition related responsibilities, as determined by the AAA.

Nutrition Education shall be overseen by a RDN for each congregate nutrition and home delivered meal program. Information provided shall be checked for accuracy and reliability by the RDN.

Units of Service

Units of service must be reported in the DARS-OAS approved client database for each client receiving the nutrition education service when the person being served can be uniquely identified.

Sessions are service activities provided to a specific client in a group setting or individually. A unit of service is one (1) session that should be recorded with a unit type of Individual Session in the DARS-OAS approved electronic database. Sessions may be delivered in-person or via video, audio, online or the distribution of hardcopy materials. If the nutrition education is provided in-person or via online, a session is one event that lasts any part of an hour, up to one full day.

Some examples are provided below:  Eat Smart, Live Strong online session on “Colorful and Classic Favorites” is offered. It is considered one session. A different Eat Smart, Live Strong session, on “Eat Smart, Spend Less” would count as a separate session.  Each newsletter is counted once, even if it contains more than one nutrition article.  A flyer about the importance of calcium counts as one session. Each set of flyers, each covering a different topic or message, will count as separate sessions, respectively.  Table tents that inform participants of the low sodium items on that month’s menu count as one session even if there are ten tables and each has a table tent. Table tents on a different topic would count as a separate session.  A referral letter to a participant’s doctor from the RDN or a care coordinator for an intervention related to nutrition would count as a separate session.  If the same message is used across more than one mechanism, e.g. high fiber foods in menu notes and flyers, it’s only counted once as a session.  Unique social media messages on a specific topic are encouraged and can be provided; however, they cannot be reported in the DARS-OAS approved database or on the Aging Monthly Report (AMR) because a unique individual cannot be identified. 6-2021 P a g e | 5 Persons Served

Persons served are the number of persons who participate in a session. Nutrition education can be in a group setting or on an individual basis. An individual who receives a service funded in whole or in part with OAA funds is included.

Program Reports The Aging Monthly Report (AMR) is submitted to DARS-OAS by the twelfth (12th) of the following month. This report must be updated and submitted even if no expenditures or units of service occurred.

The DARS-OAS approved client database client level data must be transmitted to DARS-OAS by the twelfth day of the following month.

Quality Assurance

Policies and Procedures Each Area Agency on Aging (AAA) nutrition program must create a policy regarding how this requirement to provide nutrition education will be met. The AAA and service provider must maintain, at the minimum, a nutrition education policy with procedures that include how often this service is provided, how it is implemented, reputable sources of written materials and utilization of an annual education plan in accordance with the oversight of a RDN. AAAs should consider including malnutrition awareness and interventions into their annual Nutrition Education plan.11

Service Records Service documentation will be maintained according to the AAA record retention policy, but not less than five years from the date the nutrition education service was provided. The AAA and/or service provider must develop and annually update a Nutrition Education plan. If the Nutrition Education plan is developed by a service provider, it must be approved by the AAA.

Documentation should include the RDN’s approval for the nutrition education sessions and materials with the source noted.

Program Evaluation The AAA shall conduct regular and systematic analysis of the persons served and the impact of the service; an example resource is provided on this topic for AAA consideration12. There shall be a written evaluation plan and a written report of evaluation findings and outcomes.

Evaluation may include client satisfaction surveys, pre & post-tests, client interviews, etc. Tools and methods that will be used to implement evaluations must be included in the annual nutrition education evaluation plan. 11https://www.defeatmalnutrition.today/sites/default/files/National_Blueprint_MAY2020_Update_OnlinePDF_FIN AL.pdf 12 https://fns-prod.azureedge.net/sites/default/files/SNAPEDWaveII_Guide.pdf 6-2021 P a g e | 6 FINAL:  May 11, 2012

OPTIONS COUNSELING

VIRGINIA STATEWIDE STANDARDS

Title: Options Counseling Statewide Standards

1. 0 Introduction

1. 1 Guiding Principles

A. Options Counseling involves respecting the right of individuals to control and make choices about their own lives.

B. Relationship-building and establishing trust are essential to understanding individuals’ preferences and needs; counselors must take time to listen and use culturally competent, person-centered approaches.

C. Options Counseling is a process, not an event. It may include multiple contacts over a short-term period, or may be ongoing over a longer period of time.

1. 2 Definitions

Individual Action Plan: A documented plan developed by the individual with the support of the Options Counselor as a result of Options Counseling that contains the individual’s goals, along with the action steps, resources needed, time lines and responsible parties to achieve the goals.

Individual Support Record: Documentation, by an agency offering Options Counseling, that captures the information required in Section 5.1 (B) through (D) of these Standards. The record may be written or electronic and may incorporate processes and documentation tools already in place or may be a form used exclusively for Options Counseling.

Options: All alternatives that are available in an individual’s community from which the individual can choose to reach the individual’s goal/s.

Options Counseling: An interactive decision-support process whereby individuals, with support from family members, caregivers, and /or significant others, are supported in their deliberations to make informed long-term support choices in the context of the individual’s preferences, strengths, needs, values, and individual circumstances.

Options Counselor: Any individual who provides Options Counseling as described in these Standards. Care coordinators, transition coordinators, peer counselors, case managers and others, who have been trained in the standards, may provide Options Counseling.

Person-Centered Practices: Practices that focus on the preferences and needs of the individual, empower and support the individual in defining the direction for his or her life, and promote self-Page 1 of 10 Options Counseling Standards Effective May 11, 2012 FINAL:  May 11, 2012 determination, community involvement, contributing to society and emotional, physical and spiritual health.

Surrogate Decision-Maker: A person legally authorized to make decisions on behalf of an individual who has been declared legally incapacitated.

Unit of Service: The number of contacts (interactions), and the time spent in hours or portions thereof, with and on behalf of each individual. The hours shall be recorded in 15-minute increments

1. 3 Eligible Individuals

A. Options Counseling is available to all individuals age 18 and over with a disability and to adults age 60 and over who request long-term supports and/or who are planning for the future regarding long-term supports.

B. Individuals are eligible for Options Counseling regardless of their ability to pay.

1. 0 Awareness, Education, Outreach and Marketing

A. Agencies providing Options Counseling shall use statewide universal language to raise awareness, provide education, and/or actively market the availability of Options Counseling to the following, within the agencies’ local or regional services areas:

1. Adults 60 and older; and adults 18 and older who have a disability;
2. Individuals residing in hospitals and other institutional settings;
3. Family members, caregivers and supporters;
4. The general public;
5. The medical community, including hospitals;
6. Administrators and staff of long-term support facilities;
7. Long-term support ombudsmen;
8. Providers of long-term community supports and other local agencies having regular contact with older adults and/or individuals with disabilities;
9. Social workers; 10. Health and human services agencies; 11. Local government officials and policy makers; and 12. Advocates and advocacy organizations.

B. Awareness and education activities shall include both outreach and response to inquiries for information.

Page 2 of 10 Options Counseling Standards Effective May 11, 2012 FINAL:  May 11, 2012 C. Awareness, education and marketing activities shall be directed both to individuals who pay privately, and to individuals who cannot pay.

D. An agency providing Options Counseling shall identify key partners to assure streamlined eligibility and access to federal, state and local supports and work collaboratively with them to develop an overall Options Counseling implementation strategy.

1. 0 Supports Delivery Elements

1. 1 Initiating the Options Counseling Process

A. The situational elements that can trigger Options Counseling include, but are not limited to:

1. A life altering personal event or situation;
2. A significant change in the individual’s circumstances;
3. Concerns expressed by the individual or the individual’s family member or surrogate decision-maker;
4. A life transition;
5. A referral or self-referral to Options Counseling; and/or
6. Availability of new benefits and supports.

B. During an eligible individual’s initial contact with the agency, the situational elements that trigger Options Counseling can be identified by use of a standardized questionnaire and response to the following questions:

1. Do you understand the information I have given you? (if “no,” refer to Options Counseling; if “yes,” ask next question);
2. Do you need additional information? (if “yes,” refer to Options Counseling; if “no,” ask next question);
3. Do you know what your next steps are? (if “no,” refer to Options Counseling; if “yes,” do not refer to Options Counseling).

C. Options Counseling is initiated by:

1. The request of an eligible individual or the individual’s surrogate decision-maker; or
2. The consent of an eligible individual who is offered Options Counseling or the consent of the individual’s surrogate decision-maker.

D. Agencies shall assure that no eligible individual is excluded from Options Counseling.

1. Agencies may set fee schedules that are designed to assure maximum participation of eligible individuals in Options Counseling.
2. Agencies shall assure that Options Counseling is coordinated with any applicable points of entry into support systems.

Page 3 of 10 Options Counseling Standards Effective May 11, 2012 FINAL:  May 11, 2012

1. Agencies shall assure that individuals receive and have access to the agency’s existing bill of rights and grievance procedures.

1. 2 Providing Options Counseling

A. Options Counselors shall actively encourage the eligible individual to involve others, who provide support to the individual, in the Options Counseling process.

B. Options Counselors shall involve the eligible individual and all others the individual wishes to involve in Options Counseling except as follows:

1. When the individual declines to have other individuals present at any point in the counseling, the Options Counselor shall respect the individual’s wishes.
2. If the individual has been declared legally incapacitated, the Options Counselor shall require that the individual’s surrogate decision-maker be present through all phases of Options Counseling.

C. Options Counselors must make every effort to understand each individual’s preferences, needs, values and circumstances by:

1. Developing rapport and trust with the individual;
2. Listening to the individual;
3. Understanding that no two individuals have exactly the same preferences, needs, values or circumstances;
4. Using person-centered practices; and
5. Using a series of questions and scenarios that assist the individuals in evaluating options.

D. The following information must be provided during Options Counseling, dependent upon the individual’s unique needs, values and circumstances:

1. Existing long-term support options available in the individual’s community tailored to the individual and including information about the individual’s current situation;
2. Planning ahead for long-term support;
3. Understanding self-directed and agency-directed supports, and the differences between the two;
4. Medicare and Medicaid benefits and options; and
5. Other supports and benefits available in the individual’s community including: a. Informal supports; b. Social security benefits; c. Financial and legal planning resources; d. Older adult or disability rights resources;

Page 4 of 10 Options Counseling Standards Effective May 11, 2012 FINAL:  May 11, 2012 e. Housing and transportation resources; f. Opportunities for employment or volunteering; g. Social and recreational resources; h. Communication and assistive technology resources; and i. Caregiver support.

E. The following support, as applicable, shall be provided to the individual while the individual is considering and making decisions:

1. Honoring requests for additional information;
2. Providing Options Counseling in the environment that the individual chooses;
3. Using the method or mode of communication that the individual uses and prefers;
4. Explaining potential risks, consequences and costs of each available option;
5. Exploring alternatives and arranging on-site or virtual tours;
6. Coordinating transportation or giving the individual the information to coordinate transportation;
7. Helping the individual articulate his or her own values, needs and preferences;
8. Listing options, as requested, and their consistency with the individual’s stated goals;
9. Clarifying roles of the individual and the Options Counselor; and 10. Providing information and facilitating decision-making at a pace appropriate to the individual.

F. Decisions made as a result of Options Counseling shall be made by the individual or the individual’s surrogate decision-maker. The Options Counselor shall respect the individual’s right to make decisions that entail a certain amount of risk and shall take action to prevent an individual from engaging in risky behavior consistent with legal requirements.

G. The Options Counselor shall work with the individual to develop an individual action plan for implementing the decisions made as a result of Options Counseling.

1. 3.

Implementing and Following up Decisions Made as a Result of Options Counseling

A. The Options Counselor shall arrange for delivery of the supports chosen by an individual as a result of Options Counseling, involving others as needed to get the supports fully in place by:

1. Assisting with referrals; and
2. Conducting follow up to assure referrals are in place and adequate for the individual’s support.

Page 5 of 10 Options Counseling Standards Effective May 11, 2012 FINAL:  May 11, 2012 B. The Options Counselor shall assist the individual to make an effective transition to the supports that the individual has chosen by:

1. Contacting the individual and conducting other follow-up as necessary to verify referrals made;
2. Determining whether the referrals were implemented effectively; and
3. If adjustments are needed, supporting the individual in determining the best alternative course of action.

C. Once the supports are in place:

1. The Options Counselor shall follow up to determine the extent to which the individual’s goals have been met.
2. Agencies shall also follow up using a uniform instrument, administered in the method or mode of communication that the individual uses and prefers, to measure individuals’ satisfaction with the Options Counseling process and the choices the individual has made.

D. Evaluation for the purpose of quality improvement/quality assurance and program compliance shall be conducted on three levels:

1. System-wide;
2. Agency, in accordance with Section 4.5 A. below; and
3. Individual, using the following domains: a. Choice (Whether the individual was in charge of plan that is developed); b. Heard (Individual’s perspectives, values and preferences were understood and respected); c. Supports (Whether the individual received supports needed towards accomplishing their goals); d. Informed (Whether the individual was given comprehensive information about options available at the time); and e. Autonomy (Whether the individual was empowered to make his or her own decisions)

E. Options Counseling may be terminated when an individual:

1. Is no longer seeking support;
2. No longer has unmet goals;
3. After six months has not responded when contacted;
4. Has exhausted an appeals process and there is a finding that termination is necessary; or
5. Is dissatisfied and the Options Counselor has no further alternatives available to the individual.

Page 6 of 10 Options Counseling Standards Effective May 11, 2012 FINAL:  May 11, 2012 F. An individual shall be re-engaged in Options Counseling at any point he or she indicates a desire to pursue additional support options.

1. 0 Staffing

1. 1 Core competencies

A. Staff who determine the need for Options Counseling must :

1. Have training in the statewide protocol set out in section 3.1 B. of these Standards; and
2. Demonstrate accurate use of the protocol.

B. Agency staff who deliver Options Counseling must have training in the statewide Options Counseling curriculum and be able to:

1. Understand individuals’ unique preferences, values, needs and circumstances;
2. Understand and educate individuals about public and private sector resources;
3. Facilitate knowledge of informal supports and self-direction;
4. Encourage future orientation and goal-setting;
5. Follow up after Options Counseling is complete; and
6. Communicate with sufficient skill and clarity, using the individual’s preferred mode of communication, so that individuals will be able to make informed choices.

1. 2 Staff Roles

A. The following agency staff shall be able to determine an individual’s need for Options Counseling:

1. Staff who typically have initial contact with individuals, family members, caregivers and/or health and human service providers who contact the agency;
2. Staff who typically provide transition assistance to individuals; and
3. Staff who provide benefits counseling, assist in determination of eligibility or otherwise facilitate the delivery of supports.

B. An agency providing Options Counseling shall have a minimum of one staff who delivers, and is held out to the public as delivering, Options Counseling.

1. 3 Credentials

A. Staff who determine the need for Options Counseling shall have the following minimum qualifications:

1. Good listening, interviewing and communication skills;

Page 7 of 10 Options Counseling Standards Effective May 11, 2012 FINAL:  May 11, 2012

1. Knowledge of the issues confronting older adults and individuals with disabilities; and
2. Successful completion of the statewide training module in determining the need for Options Counseling.

B. Staff who deliver Options Counseling shall have the following minimum qualifications:

1. Bachelor’s degree, or equivalent experience as determined in writing by the hiring agency;
2. At least one year of experience working directly with older adults and/or individuals with disabilities;
3. Knowledge about long term supports and funding systems;
4. Knowledge about the issues confronting older adults and individuals with disabilities;
5. Good listening, interviewing and communication skills; and
6. Successful completion of the statewide Options Counseling training curriculum.

1. 4 Continuing Training

Agencies providing Options Counseling shall require successful completion of an annual statewide Options Counseling best practices training to ensure that staff who deliver Options Counseling have appropriate decision-support skills and knowledge about available resources.

1. 5 Monitoring and Supervision

A. Agencies providing Options Counseling shall implement ongoing monitoring to ensure that:

1. Options Counseling is delivered in accordance with these standards; and
2. The outcomes of Options Counseling can be tracked and measured for evaluation.

B. Agencies providing Options Counseling shall implement ongoing supervision for all staff involved in determining the need for and delivering Options Counseling.

C. Options Counseling supervisors must have training in the Options Counseling administration curriculum and must possess the experience or educational training to oversee staff development, program management, program planning, policy/procedural maintenance, and program evaluation.

1. 6 Staffing ratios

Agencies providing Options Counseling shall assure that staff who determine the need for and who deliver Options Counseling have sufficient time to devote to their Options Counseling duties.

Page 8 of 10 Options Counseling Standards Effective May 11, 2012 FINAL:  May 11, 2012

1. 0 Administrative

1. 1 Individual support records

A. Individual support records shall be maintained for each individual receiving Options Counseling.

B. Staff who determine the need for Options Counseling shall document the following information in the individual support record:

1. Person making the original contact and relationship to the individual who receives Options Counseling (self, family member, surrogate decision-maker, caregiver, health or human service provider, other);
2. Situation that triggered Options Counseling;
3. The individual’s demographic profile;
4. The individual’s preferred contact information;
5. The individual’s or surrogate decision maker’s permission to share information with an Options Counselor; and
6. The date of referral to Options Counseling.

C. Staff who deliver Options Counseling:

1. Shall document the following information in the individual support record: a.

The date the initial contact was made by the Options Counselor; b.

Whether the individual is new to Options Counseling or is reengaging in Options Counseling and if reengaging, the reason why; c.

Others involved in Options Counseling, their relationship to the individual and contact information; d.

The individual’s preferred method or mode of communication and preferred environment for Options Counseling; e.

The individual’s relevant current circumstances, which may include: i.

Paid and informal supports; ii.

Employment/ financial resources and benefits; iii.

Financial/legal plan for future; iv.

Housing; v.

Transportation; vi.

Social and recreational activities; and vii.

Assistive technology;

Page 9 of 10 Options Counseling Standards Effective May 11, 2012 FINAL:  May 11, 2012 f.

The options discussed with the individual including alternative supports and, if the individual requests it, the risks and benefits of each; g.

The individual’s action plan reflecting the individual’s preferences, needs, values, personal goals/desired outcomes, and definition of success; decision/s made by the individual or the surrogate decision-maker; referrals made by name, date and type of support; and confirmation of implementation of the plan, including enrollment or other evidence of actual receipt of any support to which the individual was referred; and h.

Progress notes referencing each interaction, including the date of contact.

1. Are encouraged to document the individual’s future projected immediate, intermediate and long term support needs.

D. Staff who provide follow-up shall document the following information in the individual support record:

1. The date contact is made with the individual;
2. The outcome of the follow up;
3. Whether the individual’s goals have been achieved, are unmet or have changed; including what supports the individual received, ;
4. Whether the individual has followed the plan, and, if not, the reason why; or whether the individual needs direct assistance to continue implementing the plan; and
5. The date and reason for termination of Options Counseling.

1. 2 Data collection and reporting

A. The agency shall collect the following data on an individual basis and report it on an aggregate level:

1. Demographics of individuals served;
2. Level of individual satisfaction with the Options Counseling process (Choice, Heard, Supports, Informed, and Autonomy) and other evaluation measures such as individual satisfaction with choices and decisions made;
3. Number of individuals, whose goals include living in the community, and who are living in the community six months and 12 months following termination of Options Counseling;
4. Number of individuals: a. Provided Options Counseling; b. Terminated from Options Counseling; and c. Reengaged in Options Counseling; and
5. Number of individuals achieving their goals.

Page 10 of 10 Options Counseling Standards Effective May 11, 2012

PERSONAL CARE

VIRGINIA DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES (DARS)

SERVICE STANDARD

Definition Personal Care services provide personal assistance, stand-by-assistance, supervision or cues for persons with the inability to perform one or more of the following activities of daily living: eating, dressing, bathing, toileting, grooming, transferring in and out of bed/chair or walking.1

Eligible Population Personal Care services are targeted to persons 60 years of age or older who are frail, have disabilities, or who are at risk of institutional placement. Priority is given to persons in the greatest economic or social need and/or who reside in rural or isolated areas, with particular attention to low-income minority individuals and limited English proficient individuals.2

Service Delivery Elements The Area Agency on Aging (AAA) or service provider must perform all of the following components of personal care services:

Service-Specific Assessment: A service-specific assessment utilizing the full Uniform Assessment Instrument (UAI) must be performed by the Area Agency on Aging on each potential client to determine whether the person meets the criteria specified in eligible population and the amount of the individual’s service specific need.  Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.  Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Care Plan: A written individualized care plan must be developed by the Area Agency on Aging that identifies the service components to be provided to the client in response to established need.

The plan must be developed prior to service commencement by the Area Agency on Aging with involvement from the client or authorized representative or family member. When “client” is used throughout the standards, it can also mean authorized representative or family member, as deemed appropriate by the agency and/or the client. The client shall be afforded the opportunity to participate in the implementation and evaluation of the plan. The plan may be modified to reflect any change in the client’s needs. Each plan shall include:  identified service needs  services to be delivered by the service provider and/or by other sources  goal(s) and objective(s) of service(s) to be provided  service units to be provided

1 National Aging Program Information System Reporting Requirements – State Program Report Definitions 2 Older Americans Act of 1965, as amended 2006, Section 306(a)(4)(A)(i) Page 1 of 6 Effective 10/1/03, Revised 10/01/13 Virginia Department for the Aging and Rehabilitative Services Service Agreement: A service agreement shall be completed between the client and the service provider. If the Area Agency on Aging is the service provider, the AAA will complete the service agreement. A copy of the service agreement will be maintained at the Area Agency on Aging. The agreement will explain the service arrangement to the client. The client must receive a copy of the agreement. The agreement should include:  services to be provided  scheduled hours/days of service  information regarding voluntary contributions/payment for service  emergency procedures (what to do/who to contact)  severe weather policy

Service Activities: Service activities provided by the provider agency may include:  assisting with care of teeth and mouth  assisting with grooming, to include care of hair, shaving, and ordinary care of nails  assisting with bathing of individual in bed, in tub, or shower, or sponge bath  assisting individual with dressing and undressing  assisting individual to move on/off bed pan, commode or toilet  assisting individual to turn/change position, transfer, and ambulate  assisting individual with eating or feeding  assisting individual with self-administered medications and assuring that individual receives medications at prescribed times; not to include pouring or, in any way, determining dosage of medication  preparing/serving meals, not to include menu planning for special diets

And services as permitted by the licensing entity, and the Virginia Department of Medical Assistance Services if a Medicaid provider.

Service Record: Service documentation on each client must be in accordance with the requirements of the agency’s certifying entity. A service record or log, signed by the client shall record the date and duration of each time the service is provided. The record or log shall be maintained at the Area Agency on Aging. Service units must be recorded in the appropriate electronic data system.

Service Reassessment: A review of the client’s need for services, the amount of services provided and the appropriateness if the care plan shall be performed by the Area Agency on Aging when the client’s condition or situation changes, but at least annually. Service reassessment on each client shall also be in accordance with the requirements of the agency’s certifying entity.3  Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.

3 Older Americans Act of 1965, as amended, Section 314 Page 2 of 6 Effective 10/1/03, Revised 10/01/13 Virginia Department for the Aging and Rehabilitative Services  Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Service Termination Policy: Personal Care services can be terminated at the discretion of the Area Agency on Aging, the service provider, or the client. The client shall receive a copy of the termination policy when service begins. The policy shall have provisions for: appropriate advance notice to the client, preferably ten business days; a service summary and, referrals to other community service programs. Requirements of the licensing agency should be followed.

Administrative Elements

Licensure: Personal Care providers, including Area Agencies on Aging and their contractors, must be licensed by the Virginia Department of Health.

Area Agency on Aging Staff Qualifications:  Knowledge: Area Agency on Aging staff should have an awareness of the biological, psychological, and social aspects of aging; an awareness of the impact of disability and illness on aging and, a knowledge of community resources and consumer rights.  Skills: Area Agency on Aging staff should have skills in establishing and sustaining interpersonal relationships and in problem solving.  Ability: Area Agency on Aging staff should have the ability to communicate with persons of different socioeconomic backgrounds and to work independently and in groups. Staff should have the ability to assess functional limitations and determine necessary tasks to ensure the safety and well-being of the client.

Job Description: For each paid position, an Area Agency on Aging shall maintain:  A current and complete job description which shall cover the scope of a the staff member’s duties and responsibilities, and  A current description of the minimum entry-level standards of performance for each job.

Service Provider Staff Qualifications:  Knowledge: Service provider staff should have an awareness of the biological, psychological, and social aspects of aging; an awareness of the impact of disability and illness on aging and an awareness of community resources and consumer rights.  Skills: Service provider staff should have skills in establishing and sustaining interpersonal relationships and in assessing what skills and equipment are essential to performing needed personal care services.  Ability: Service provider staff should have the ability and training required to perform personal care services as needed by the client.

Page 3 of 6 Effective 10/1/03, Revised 10/01/13 Virginia Department for the Aging and Rehabilitative Services Job Description: For each paid position, the service provider shall maintain:  A current and complete job description which shall cover the scope of a personal care worker’s duties and responsibilities, and  A current description of the minimum entry-level standards of performance for each job.

Service provider agencies shall meet or exceed all personnel requirements as set forth by the provider agency’s certifying entity.

Units of Service: Units of service must be reported in the AIM or PeerPlace database for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.  Hours (All hours spent assessing the need for; and, arranging and delivering personal care services for the client)  Persons served (Unduplicated)

Program Reports:  Aging Monthly Report (AMR) to DARS by the twelfth (12th) of the following month.

If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.  AIM or PeerPlace client level data transmitted to DARS by the last day of the following month.  A completed and properly maintained electronic/digital Full Uniform Assessment Instrument (UAI) is a mandatory requirement.  The question “Client in Federal Poverty?” (Answer Yes or No) must be asked and recorded.  A written Policies and Procedures Manual will be maintained for the service.

Consumer Contributions/Program Income The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.4 There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations.

Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service. A fee scale for personal care services shall be updated annually and shall include the full cost of providing one unit of service.

Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited provided that the method of solicitation is non-coercive. Such contributions shall be

4 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code Page 4 of 6 Effective 10/1/03, Revised 10/01/13 Virginia Department for the Aging and Rehabilitative Services encouraged for individuals whose self-declared income is at or above 185 percent of the poverty line, at contribution levels based on the actual cost of services. 5

Quality Assurance

Criminal Background Checks: VDA strongly recommends that the agency and its contractors protect their vulnerable older clients by conducting criminal background checks for staff providing any service where they go to or into a client’s home.

Staff training:  At hiring, personal care workers should receive orientation on agency policies and procedures, community characteristics and resources, and procedures for conducting allowable activities under this service;   Workers shall receive a minimum of twelve (12) hours per year of in-service training based on the need for professional growth and upgrading of knowledge, skills, and abilities. In addition, training policies of the licensing agency should be followed.

Service providers shall meet or exceed all requirements for staffing as set forth by the provider agency’s certifying entity.

Supervision/Case Review: Consultation, supervision and case review shall be available to all staff providing the service. The Case Monitor Section for this service must be completed in the approved DARS electronic data system.

Program evaluation: The agency or contractor should conduct regular and systematic analysis of the persons served and the impact of the service.  Service providers shall be monitored annually. A written copy of the monitoring report must be maintained by the agency.  Anonymous client surveys shall be conducted annually. A file of annual anonymous client surveys with a summary of the surveys shall be maintained by the agency.

Client Records: Area Agencies on Aging are to maintain specific client records in the approved DARS electronic database that include:  Full Uniform Assessment Instrument  Federal Poverty Level  Care Plan  Service Reassessment, as needed  Progress Notes  Consent to Exchange Information Form

5 Older Americans Act of 1965, as amended, Section 315(b) Page 5 of 6 Effective 10/1/03, Revised 10/01/13 Virginia Department for the Aging and Rehabilitative Services  A Caregiver Form, if this service is funded by OAA Title III E.

Area Agencies on Aging are also to maintain the following additional client records:  Service documentation, including any fee charged the client  Signed Client Bill of Rights/ Appeals Process  Other forms as required by the provider’s certifying entity.  Denial or Termination of Service Notice

Service providers shall meet or exceed all record requirements as set forth by the provider agency’s certifying entity.

Page 6 of 6 Effective 10/1/03, Revised 10/01/13 Virginia Department for the Aging and Rehabilitative ServicesPersonal Care FAQ’s

1. What activities can be performed when providing personal care?

Service activities listed in the Virginia Department for the Aging Personal Care Service Standard or services listed in the Department of Medical Assistance Services or other services as noted by the provider’s certifying body.

1. What activities should be included in the time reported for personal care services?

All hours spent in assessing the need for; and, arranging and delivering personal care services for the client.

Page 1 of 1 FAQ Personal Care Revised 03/01/02 Virginia Department for the Aging

PREPARATION AND ADMINISTRATION OF THE AREA PLAN

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Encompasses the overall planning and implementation of the Area Plan and management of the agency, as well as the lead role for providing a coordinated and comprehensive system for older persons to locate and access needed services.

Service/Administrative Elements Preparation and Administration of the Area Plan includes all of the following components:1

• Monitoring, evaluating, and commenting on policies, programs, hearings, levies, and community actions that affect older persons and their families.
• Soliciting comments from the public on the needs of older persons and their caregivers.
• Representing and advocating for the interests of older persons to local level and executive branch officials, public and private agencies and organizations.
• Coordinating plans and activities with all other public and private organizations with responsibilities affecting older persons and their caregivers.
• Promoting new or expanded benefits and opportunities for older persons and their caregivers.
• Planning, including such responsibilities as needs assessment; plan development, budgeting analysis, inventory, standards development and policy analysis.
• Development includes such responsibilities as resource development, training and education, and research and development activities.
• Administration includes such responsibilities as bidding, contract negotiation, reporting, accounting, auditing, program monitoring, and quality assurance.

Staffing Elements Staff Qualifications:

• Knowledge: Should have an awareness of the basic principles including budget preparation and administration; current issues, trends, and problems in aging; service planning; advocacy strategies; consumer rights; community resources; public benefits eligibility and principles of record management.
• Skills: Should have skills in establishing and sustaining productive relationships; leading and effectively managing personnel; negotiating with consumer and service providers; coordinating the provision of services by diverse public and private providers.
• Ability: Agency managers should have the ability to communicate with persons of different socio-economic and ethnic backgrounds; work independently, performing position duties under general supervision; work as a team member, maintaining effective inter- and intra-agency working relationships; and communicate effectively, verbally and in writing.

Job Descriptions For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on Aging shall maintain:

1 Older Americans Act of 1965, as amended, Section 304(d)(1)(A) Page 1 of 2 Prep and Admin Effective 10/1/03, Revised 4/14/03 Virginia Department for the Aging• A current and complete job description which shall cover the scope of duties and responsibilities of the position; and

• A current description of the minimum entry-level standards of each job.2

Quality Assurance Staff Training

• Administration staff should receive in-depth orientation on agency policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.
• Administration staff should receive at least annual in-service training, the content of which to be based on the need for professional growth and upgrading of knowledge, skills and abilities.
• Administration staff must attend training provided by the Virginia Department for the Aging

Program Evaluation The agency should conduct regular systematic analysis of the persons served and the impact of the service.

Records Record keeping and documentation should comply with guidelines established by the Virginia Department for the Aging.

Units of Service Not applicable

Reports

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.

Allowable Costs Cost for Preparation and Administration of the Area Plan may not exceed the limits prescribed by 45 CFR 1321.

2 22 VAC 5-20-250, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code

Page 2 of 2 Prep and Admin Effective 10/1/03, Revised 4/14/03 Virginia Department for the Aging FAQ ‘S Preparation and Administration

1. What is the definition of Prep and Admin?

Prep and Admin encompasses the overall management and supervisory functions of the Area Plan, as well as the lead role for providing a coordinated and comprehensive system for older persons to locate and access needed services.

1. What is the match for Prep and Admin?

75% federal, 25% non-federal.

1. What is the maximum you can spend of your Title III funding?

Can spend up to 10% of federal award, but must come from Title III B, III CI, III C2 or E.

Page 1 of 1 FAQ Prep & Admin Revised 02/26/02 Virginia Department for the Aging PUBLIC INFORMATION/EDUCATION

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Public Information/Education service is the process of informing older persons and the general public about the programs, services, and resources available to elderly persons and their caregivers.

Service activity involves a contact with several elderly clients or potential clients (group services).

The service may incorporate the development of special information campaigns to inform older people and the general public about issues, problems and benefits important to older people.

Eligible Population Individuals are eligible for Public Information/Education service if they are 60 years of age or older.

Preference shall be given to older individuals with greatest economic need or older individuals with greatest social need, with preference given to low-income minority individuals, and to those older persons residing in rural or geographically isolated areas.1 Families, friends and referral sources may also receive information and suggestions for needed services.

Service Delivery Elements Agencies providing Public Information/Education service must perform all of the following components:

Information: The process of informing older persons and the general public of available opportunities, services and resources. This may be done by preparing and distributing agency newsletters, brochures, facts sheets, and resource guides; making presentation to community groups; and preparing and distributing media releases and public service announcements.

Electronic Media: The process of receiving and soliciting information via the Internet and e-mail.

Planning and Evaluation: The process of aggregating and analyzing information collected through the provision of the service. Collecting and reporting data on unmet needs are also part of the service delivery element. There should be an evaluation process to determine the overall effectiveness of the program.

Administrative Elements Staff Qualifications: Staff proving Public Information/Education service shall possess the following qualifications:

• Knowledge: Public Information/Education service staff should have an awareness of the problems and needs of older persons; community resources for older persons; community organizations who may wish to schedule presentations or receive written information; community media resources; group dynamics; how to reach older people in the community; basic journalistic writing techniques; and desktop publishing, brochure preparation, etc.

1 Older Americans Act of 1965, as amended, Section 306(a)(4)(A)(i) Page 1 of 3 Public Information & Education Effective 10/01/03, Revised: 06/30/03 Virginia Department for the Aging• Skill: Public Information/Education service staff should have skills in interviewing; working with groups; effective oral and written communication techniques; an overview of community services; preparation of audio-visual materials; lay-out of written materials.

• Ability: Public Information/Education service staff should have ability to conduct an effective interview; arrange and negotiate service referrals; communicate effectively orally with groups of persons, with persons of different socio-economic backgrounds, including persons with disabilities; write creatively, using correct grammar, spelling, and punctuation; and work independently.

Job Descriptions: For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on aging shall maintain:

• A current and complete job description which shall cover the scope of duties and responsibilities of service staff; and
• A current description of the minimum entry-level standards of each job.2

Units of Service:

• Contacts: the number of people in a group or circulation counts for a publication.

Optional Group Units (Not Entered into AIM)

• Group Participants – The number of people attending the presentation, meeting or program (activity provided to more than one person or in a group setting).
• Number of Group Presentations – Number of presentations.
• Number of Publications Distributed

Group Units – These activities cannot be entered into the AIM system.

Program Reports

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.

Quality Assurance Staffing Training:

• Staff should receive orientation on agency policies and procedures, community characteristics and resources, and procedures for conducting the allowable activities under the service.
• Staff should receive a minimum of 10 hours of in-service training per year, the content of which to be based on the need for professional growth and upgrading of knowledge, skills, and abilities.

Supervision/Case Review: Consultation, supervision and case review shall be available to all staff providing the service.

2 22 VAC 5-20-250, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code Page 2 of 3 Public Information & Education Effective 10/01/03, Revised: 06/30/03 Virginia Department for the AgingProgram Evaluation: The agency should conduct regular systematic analysis of the persons served and the impact of the service. Subcontractors shall be monitored annually.

Service Records: Service providers must maintain specific program records that includes;

• compilation of presentations conducted year-to-date;
• the number of publications distributed year-to-date;
• compilation of individual contacts year-to-date.

Page 3 of 3 Public Information & Education Effective 10/01/03, Revised: 06/30/03 Virginia Department for the AgingREGISTERED DIETITIAN NUTRITIONIST SERVICES

VIRGINIA DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES

VIRGINIA DIVISION FOR THE AGING

SERVICE STANDARD

Definition

The Older Americans Act (OAA) requires that meal providers utilize the expertise of a dietitian or other individual with equivalent education and training in nutrition science, or if such an individual is not available, an individual with comparable expertise in the planning of nutritional services;1 and ensure that the project provides for nutrition screening and nutrition education, and nutrition assessment and counseling if appropriate.2 The Administration on Aging defines nutrition counseling as the provision of individualized guidance to persons who are at nutritional risk because of their health or nutrition history, dietary intake, chronic illness, or medication use; or to their caregivers. Nutrition counseling is provided one-to-one by a registered dietitian nutritionist (RDN), and addresses the options and methods for improving nutrition status.

In order to meet the OAA requirements for nutrition counseling, each Area Agency on Aging (AAA) nutrition program must create a policy on how this OAA requirement will be met. The AAA must employ or retain the services of a RDN through a contract or a partnership agreement. The program RDN must be available to the program in sufficient time to perform nutrition counseling and other nutrition related responsibilities, as determined by the AAA.

Credentials/Qualifications

Registered Dietitian (RD) or Registered Dietitian Nutritionist (RDN) is an individual who has:

• completed the minimum of a Baccalaureate degree granted by a U.S. regionally accredited college or university, or foreign equivalent;
• met current minimum academic requirements (Didactic Program in Dietetics) as approved by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) of the Academy of Nutrition and Dietetics;
• completed a supervised practice program accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) of the Academy of Nutrition and Dietetics;
• successfully completed the Registration Examination for Dietitians;
• complied with the Professional Development Portfolio (PDP) recertification requirements. 1 Older Americans Act of 1965, as amended through P.L. 114-144, enacted 4-19-2016, Section 339 (A) (1)2 Older Americans Act of 1965, as amended through P.L. 114-144, enacted 4-19-2016, Section 339 (A) (2) (J) 2 https://nutritionandaging.org/wp-content/uploads/2017/01/DetermineNutritionChecklist.pdf 7-12-19 P a g e | 1 In addition, it is preferred that the RDN have work experience or specialized training in gerontology or geriatrics, and the planning and supervision of food and nutrition services in home and community-based or facility-based settings.

Individual of Comparable Expertise

If a Registered Dietitian is not available through reasonable recruitment means, the AAA may use an individual with comparable expertise in the planning of nutrition services.

Individuals with comparable expertise will be defined as follows:

• An individual who has completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work accredited or approved by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) of the Academy of Nutrition and Dietetics, or

• A dietetic technician, registered (DTR), who has met the following criteria to earn the DTR credential: o Completed a dietetic technician program accredited by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) of the Academy of Nutrition and Dietetics, that includes 450 hours of supervised practice experience in various community programs, health-care and foodservice facilities and has completed at least a two year associate’s degree at a U.S. regionally accredited college or university, or o Completed an ACEND accredited didactic program or coordinated program in dietetics and has completed at least a bachelor’s degree at a U.S. regionally accredited college or university or foreign equivalent, and o After completing the degree and dietetics coursework, passing a national examination administered by the Commission on Dietetic Registration (CDR), and o Completed continuing professional educational requirements to maintain registration status.

Either category of individual with comparable expertise shall be expected to have work experience or specialized training in gerontology or geriatrics, and the planning and supervision of food and nutrition services in home- and community-based or facility-based settings.

Individuals who are not considered to have comparable expertise are nurses, dietary managers, dietary supervisors, chefs, cooks, diabetes educators, home economists, food service managers, food service sanitarians, or extension agents unless they also meet one of the two sets of criteria listed above for individuals with comparable expertise.

Eligible Population

Nutrition services will be available to older individuals and to their caregivers, and may be made available to individuals with disabilities who are not older individuals but who reside in housing 7-12-19 P a g e | 2 facilities occupied primarily by older individuals at which congregate nutrition services are provided.3 Nutrition Screening, Nutrition Assessment and Nutrition Counseling Service Delivery Elements

Screening

Screening is used to identify characteristics associated with dietary or nutrition deficiencies, and to differentiate those at high risk for nutrition related deficiencies who should be referred for further assessment or counseling.

The “Determine Your Nutritional Health” Nutrition Screening checklist developed and distributed by the Nutrition Screening Initiative must be completed during assessment and re-assessment for both congregate and home delivered meal services. This screening can be self-administered or conducted by anyone that interacts with older adults. It highlights the warning signs of poor nutritional status.

Questions to which the client answers “YES” may trigger the staff to ask additional questions regarding the client’s nutritional health. The results of the Nutrition Screening checklist guides the following actions:

Score of 0-2 = Low nutritional risk; no further action needed at this time.

Score of 3-5 = Moderate nutritional risk; based on the answers to the questions, may need further screening or referral to community based resources; refer as appropriate.

Score of 6-10 = High nutritional risk; based on the answers to the questions, may need further screening or referral to a health care provider, social services, an RDN or other community based resources; refer as appropriate.

Score of 11 or higher and a “Yes” answer to question 9, “Without wanting to, I have lost or gained 10 pounds in the last 6 months,” requires a referral to the AAA’s RDN. In addition to other service requirements, AAA staff or contractors must also complete page 5 of the Uniform Assessment Instrument (UAI) as part of the RDN referral and maintain this additional documentation in the DARS approved client database. If the individual accepts the referral for nutrition counseling, then the RDN must complete page 6 of the Uniform Assessment Instrument (UAI) and maintain this additional documentation in the DARS approved client database. The RDN may use additional malnutrition screening and assessment tools.4 If the client refuses individual nutrition counseling, this must be documented within the program notes in the DARS approved client database. 3 Older Americans Act, as amended through P.L. 114-144, enacted 4-19-2016, Section 339(A) (2) (I) 4 A list of such tools can be found at: https://www.ncoa.org/assessments-tools/malnutrition-screening-assessment-tools/7-12-19 P a g e | 3 Information such as additional questions and answers shall be documented on the NSI screen, in the comments section, in the DARS approved client database. Service referrals are completed as a New Encounter, then as a CRIA2 Encounter in the DARS approved client database.

Assessment/Reassessment

Assessment is a measurement of dietary or nutrition-related indicators, such as body mass index or nutrient intake, used to identify the presence, nature, and extent of impaired nutritional status.

Individuals screened by assigned AAA staff that are identified at highest nutritional risk will be offered additional assessment by the RDN for appropriate nutrition intervention and/or referral to other programs.

The “Determine Your Nutritional Health” Nutrition Screening checklist shall be updated when the individual’s condition or situation has changed, but at least annually as part of the reassessment process.

Nutrition Counseling

All congregate and home delivered meal clients of the AAA will receive written information at orientation on the availability of the nutrition counseling service for those deemed high risk.

Based on the assessment, the RDN determines individual client nutrition needs, develops and implements a nutrition care plan, evaluates the client’s outcomes and maintains documentation.

Counseling may be provided to the client and/or caregiver at a congregate site, in home, office, or by phone. Written instruction and/or handouts are provided, as needed. Nutrition counseling sessions must be documented in the DARS approved client database within the program notes.

Nutrition counseling notes are NEVER to be entered as General Comments.

Administrative Elements

Units of Service (Hours)

Units of service must be reported in the DARS approved client database for each client receiving the nutrition counseling service.

• Hours – Service activities provided to a specific client one-to-one. An hour or part of an hour in 15-minute increments is a unit of service.
• Persons served (unduplicated) - The number of persons who participate in a session. (Nutrition counseling is one to one.)

Job Description

The AAA must maintain a current and complete job description, which shall cover the scope of nutrition services provided by the RDN. 7-12-19 P a g e | 4 Optional Responsibilities of the RDN

The following is a non-inclusive list of responsibilities that may be expected of the RDN. The responsibilities of the RDN may vary depending on the hours employed/contracted, the structure of the AAA’s nutrition program, whether meals are planned and prepared onsite or contracted out, etc.

• Menu Planning: the RDN plans menus considering individuals’ preferences, meal satisfaction, dietary needs, dietary guidelines, food availability, and cost. The RDN reviews menus if other staff or contractors are responsible for planning menus.
• Menu Verification: the RDN reviews menus and performs nutrient analyses or completes meal pattern worksheets to verify that meals comply with menu planning guidelines, provide nutrient content requirements and are appropriate for the program and participants. The RDN reviews nutrient analyses or meal pattern worksheets if performed by others and verifies that meals comply with requirements.
• Monitoring Kitchens: the RDN monitors directly operated or subcontracted kitchens, caterers, and HDM packaging sites. The RDN reviews food and supply specifications, food quality and cost, food preparation methods, adherence to menu, use of standardized recipes and portion control, HDM and bulk food packaging, handling of leftovers, inventory and storage, temperature monitoring, compliance with the sanitary code and equipment maintenance.
• Monitoring Congregate Sites: the RDN checks food services including portion control and the serving of food, checking temperatures taken by site staff, compliance with the sanitary code, condition of equipment, handling of leftovers, serving of meals, and client satisfaction. The RDN checks that sites with kitchens are monitored and monitors client records and program functions such as meal records, assessments, contributions, etc.
• Monitoring Home Delivered Meal Delivery: the RDN checks food portions, temperature monitoring, and meal delivery including driver techniques, such as the handling of meals and carriers. The RDN observes client condition and solicits comments on meals and service. The RDN reviews assessment records, verifies eligibility, checks contribution procedures, etc.
• Nutrition Education Development: the RDN develops or reviews and approves nutrition information (handouts and/or presentations) and develops an annual nutrition education plan.
• Nutrition Education Presentations: the RDN provides group nutrition presentations at congregate sites. Other staff may present under the direction of the RDN. Dietetic students or interns may present under the direction of the RDN.
• Administration: the RDN prepares reports on monitoring activities, findings, recommendations, and nutrition education and counseling units of service. The RDN 7-12-19 P a g e | 5 attends staff meetings to review monitoring activities, provides technical assistance on program development, and comments on program policies and procedures. The RDN participates in statewide conference calls and trainings with other AAA RDNs and nutrition directors.
• Technical Assistance and Training: the RDN provides technical assistance and training in food service practices, food and equipment specifications, sanitary code, new products, production efficiency, staff requirements, kitchen plans, and the nutritional needs of the elderly.
• Staff Management: Other staff, under the direction of the RDN, may assist in the above, as well as, provide assistance with areas such as the use of computer software, networking with other agencies, initiating new services, contracting, client screening/assessments, application of program standards, developing job descriptions and job tasks, and reviewing and evaluating program costs and recommending cost saving measures.
• Diet Prescription Review: the RDN evaluates the diet orders, if any, and determines the type of diets to be provided by the program. The RDN reviews the appropriateness and necessity of nutrition supplements, if provided by the program.
• Case Management/Client Team Review: the RDN may participate in the team review and discussion of the client’s assessment and care plan.
• Contract Management: the RDN may review, update, and procure new contracts related to food. 7-12-19 P a g e | 6 RESIDENTIAL REPAIR & RENOVATION

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Provides for home repairs and/or home maintenance to persons 60 years of age and older, includes weatherization provided with Older Americans Act funds to assist them in maintaining their homes in conformity with minimum housing standards and/or to adapt their homes to meet their needs.

Eligible Population Individuals are eligible for Residential Repair and Renovation service if they are 60 years of age and older. Priority shall be given to older individuals who are in the greatest economic and social need, with preference given to low-income minority individuals and to those older persons residing in rural or geographically isolated areas.1

Service Delivery Elements Agencies providing Residential Repair & Renovation service must perform all of the following component:

Repairs or modifications to the homes of person, that are essential to the health and safety of the older occupants. The types of repairs or modifications may include repairs to the structure itself, electrical and plumbing repairs, weatherization, accessibility modifications, security modifications, and yard work and home maintenance essential to maintaining the health and safety of the older person.

Administrative Elements Qualifications:

• Knowledge: Residential Repair and Renovation service staff, subcontractor or volunteers should have an awareness of biological, psychological and social aspects of aging; the impact of disabilities and illnesses on aging; the housing needs of older persons.
• Skill: Residential Repair and Renovation Services staff, subcontractor or volunteers should have skills in repairing or modifying the homes of older persons to meet their specialized needs.
• Ability: Residential Repair and Renovation staff, subcontractor or volunteers should have the ability to communicate with persons of different socio-economic backgrounds; conduct an effective interview; complete an assessment; arrange and negotiate service referrals; and work independently.

Job Descriptions: For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on aging shall maintain:

1 Older Americans Act of 1965, as amended, Section 306(a)(4)(A)(i) Page 1 of 3 Residential Repair & Renovation Effective 10/01/2003, Revised: 10/14/2004 Virginia Department for the Aging• A current and complete job description which shall cover the scope of duties and responsibilities of service staff; and

• A current description of the minimum entry-level standards of each job.2

Units of Service: Units of service must be reported in AIM for each client receiving the service.

• Number of homes repaired
• Persons served (unduplicated): the client/caregiver who is to receive a service(s)

Program Reports:

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.
• AIM client level data transmitted to VDA by the last day of the following month.

Consumer Contributions/Program Income The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.3

• Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service.4 And/or
• Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited provided that the method of solicitation is non-coercive.5

Allowable Costs: Costs associated with activities of this service are allowable.

Quality Assurance

Staff Training:

• Staff should receive orientation on agency policies and procedures, community characteristics and resources, and procedures for conducting the allowable activities under this service.
• Staff should receive a minimum of 10 hours of in-service training, the content of which to be based on the need for professional growth and upgrading of knowledge, skills, and abilities.

Supervision/Case Review:

2 22 VAC 5-20-250, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 3 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 4 Older Americans Act of 1965, as amended, Section 315(a) 5 Older Americans Act of 1965, as amended, Section 315(b) Page 2 of 3 Residential Repair & Renovation Effective 10/01/2003, Revised: 10/14/2004 Virginia Department for the AgingConsultation, supervision and case review shall be available to all staff providing the service.

Program Evaluation: The agency should conduct regular systematic analysis of the persons served and the impact of the service. Subcontractors shall be monitored annually.

Client Records: Service providers must maintain specific program records that include:

• Virginia Service – Quick Form (At a minimum, this form must be updated annually).
• Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.
• Any fee for service charge to the client shall be determined by the applicable sliding fee scale.
• Other housing assessment documents.

Page 3 of 3 Residential Repair & Renovation Effective 10/01/2003, Revised: 10/14/2004 Virginia Department for the Aging Residential Repair & Renovation Program Frequently Asked Questions

1. Q - Who is eligible to receive residential repair & renovation services through the Area Agency on Aging

A - Applicants must be age 60 and older. Priority shall be given to older individuals who are in the greatest economic and social need, with preference given to low-income minority individuals and to those older persons residing in rural or geographically isolated areas

1. Q - How can I apply for home repair services?

A - Contact your local Area Agency on Aging who will inform you of residential repair & renovation programs in your community. Area Agency on Aging that provide home repair services will complete a client assessment to determine your home repair needs. There is a limit on how much can be spent on each project. A program brochure will be provided, if available.

1. Q - What repair and renovations services are available through the Area Agencies on Aging?

A - The types of repairs or modifications may include repairs to the structure itself, electrical and plumbing repairs, weatherization, accessibility modifications, security modifications, and yard work and home maintenance essential to maintaining the health and safety of the older person.

1. Q - I am in a wheelchair and I need a ramp built. Where can I get assistance with this?

A - Consult your local Area Agency on Aging, Community Action Program or other non-profit housing programs that provide home modification/rehabilitation services.

1. Q - I need grab bars in my bathroom, but I do not have anyone to install him. Where can I get assistance?

A - Some Area Agencies on Aging provide residential renovation and repair services to individuals who are age 60 and older and meet service requirements. Also local Community Action Programs may be a resource for installing grab bars and other home modifications.

fdc2/15/02

Page 1 of 1 FAQ Residential Repair Revised 3/01/2002 Virginia Department for the Aging Senior Outreach to Services (S.O.S.)

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Senior Outreach to Services (S.O.S.) is a model of service coordination that is designed to provide a mobile, brief intervention that links seniors to supports and services available in their community. Aggressive information and assistance/outreach services are used to reach seniors. A face-to-face interview is conducted with a senior to determine available services that can support him/her living in the community. The seniors are provided aid in accessing and implementing the needed supports and services. Program evaluation is conducted on a regular basis.

Eligible Population Individuals are eligible for S.O.S. if they are 60 years of age or older and living in the community.

Service Delivery Elements

Program Components: S.O.S. provider agencies must include the following elements in their programs:

 Resource File: S.O.S. service providers must maintain an accurate, up-to-date, and well-organized information system on the opportunities, services and resources available to seniors in the community, including detailed data on service providers.

 Electronic Media: The use of electronic media to receive and solicit information via the internet is encouraged in the S.O.S. program.

Electronic screening tools and web-based systems, such as Virginia Easy Access, Virginia Navigator, BenefitsCheckUp.org and Social Security Administration on-line screening tools can be utilized to benefit the S.O.S. client.

Outreach: Outreach is the proactive seeking of older persons who may be in need of S.O.S. assistance. Strategies for outreach include, but are not limited to:

 Resource/educational programming provided to congregate housing residents, senior centers, adult day care centers and other locations where seniors gather.

Page 1 of 5 S.O.S. (Senior Outreach to Services) Effective 10/18/2011 Virginia Department for the Aging  Service provider information provided to individuals residing in single family homes and congregate housing and to seniors visiting the local Area Agency on Aging seeking services.

Screening/Assessment: S.O.S. requires a face-to-face interview that informs older persons of available opportunities, services and resources. Screenings/assessments are conducted in the client’s home, in community settings, or at the Area Agency on Aging with the older person and, if applicable, with the older person’s permission, his or her caregiver.

 The S.O.S. referral form is to be completed in assessments conducted in the client’s home and in community settings.

 Home visit and Area Agency on Aging assessments must utilize pages 1 and 4 of the Uniform Assessment Instrument (UAI) (Page 3 optional).

 Community and congregate setting assessments must utilize Page 1 of the UAI or the Quick Form. In the community setting, page 4 of the UAI is to be completed if warranted by the privacy of the setting.

Cost Sharing: S.O.S. is not a cost sharing program.

Referral/Assistance: The S.O.S. referral/assistance process includes:

 Advising older persons and their caregivers;

 Providing information to older persons to link them with the opportunities, services, and resources available to meet their needs;

 Assisting the person or caregiver to contact the appropriate community resources; and, if necessary,

 Advocating with agencies on behalf of older persons.

Evaluation: Program evaluation is an integral part of the S.O.S. model. The process includes, but is not limited to:

 Contacting individuals to determine the outcome of the referral.

 Determining the quality and effectiveness of the referral and the service provided to the person referred.

Page 2 of 5 S.O.S. (Senior Outreach to Services) Effective 10/18/2011 Virginia Department for the Aging  Additional assistance to the individual in locating or using needed services may be part of the follow-up.

 Administering, yearly, an anonymous client satisfaction survey to at least 10% of the clients served in the S.O.S. program.

 Aggregating and analyzing information collected through monthly reports and the yearly client satisfaction survey.

Administrative Elements A qualified service coordinator must administer the S.O.S. program. A qualified service coordinator must possess a combination of relevant work experience in human services or health care and relevant education that indicates the individual possesses the following knowledge, skills and abilities at entry level. These must be documented on the service coordinator’s job application, or observable in the job or promotion interview.

Staff Qualifications:

 Knowledge: Service coordinators should have a knowledge of: aging and/or the impact of disabilities and illness on aging; how to conduct interviews; consumers’ rights; person-centered practices; local human and health service delivery systems, including support services and public benefits eligibility requirements; effective oral, written, and interpersonal communication principles and techniques.

 Skills: Service coordinators should have skills in negotiating with consumers and service providers; identifying and documenting a consumer’s needs and preferences; identifying services within the established services system to meet the consumer’s needs and preferences; and coordinating the provision of services and supports by diverse public and private providers.

 Ability: Service coordinators should have the ability to demonstrate a positive regard for consumers and their families; be persistent and remain objective; work as a team member, maintaining effective inter-and intra-agency working relationships; work independently, performing position duties under general supervision; communicate effectively, verbally and in writing; develop a rapport and to communicate with different types of persons from diverse cultural backgrounds; and conduct interviews.

Individuals meeting all the above qualifications shall be considered a qualified S.O.S. service coordinator. However, it is preferred that the service coordinator will posses a minimum of an undergraduate degree in a human service field, or be a licensed nurse. In

Page 3 of 5 S.O.S. (Senior Outreach to Services) Effective 10/18/2011 Virginia Department for the Agingaddition, it is preferable that the service coordinator will have two years of satisfactory experience in the human services field working with older adults or individuals with disabilities.

It is acceptable for administrative staff to coordinate the Resource/Educational program component of S.O.S.

Units of Service: Units of service must be reported in Peer Place for each client receiving services. Service units can be reported on a daily basis, but not aggregated (summarized) beyond more than one calendar month. S.O.S. units of service include:

 Persons served (unduplicated);

 The number of referrals made to service providers, including referrals for area agency on aging services;

 Implementations: the number of services implemented and,

 Number of clients (unduplicated) with two or more deficiencies in Activities of Daily Living (ADLs)

Program Monthly Reports

 Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. This report must be updated and submitted even if no expenditures or units of service occurred.  PeerPlace or AIM client level data transmitted to VDA by the last day of the following month.

Criminal Background Checks: VDA requires that the agency and their contractors protect clients by conducting criminal background checks for staff providing any service where they go to or into a client’s home.

Staff Training:  Staff should receive orientation on agency policies and procedures, client rights, community characteristics and resources, techniques for conducting interviews, and procedures for conducting the allowable activities under this service.

 Service coordinators should receive a minimum of 8 hours of in-service training per year based on the need for professional growth and upgrading of knowledge, skills, and abilities.

Supervision/Case Review:

Page 4 of 5 S.O.S. (Senior Outreach to Services) Effective 10/18/2011 Virginia Department for the AgingConsultation, supervision and case review shall be available to all staff providing the service.

Client Records: Service providers must maintain specific program records that include:  S.O.S. Referral Form

 UAI – pages 1 and 4 for home visits and area agency on aging assessments; Page 3 is optional. Page 4 of the UAI will be used to determine ADL deficiencies as warranted by the client’s condition and status.

 In community and congregate settings, the Quick Form may be used instead of Page 1 of the UAI. Page 4 is to be completed, if warranted by the privacy of the setting. For example, questions related to incontinence may be omitted.

 Consent to Exchange Information Form – signed by the client.

PeerPlace users must make sure that the required data is entered/scanned into that electronic record system.

Page 5 of 5 S.O.S. (Senior Outreach to Services) Effective 10/18/2011 Virginia Department for the Aging Service Coordination Level One

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Service coordination Level One (1) is assistance, either in the form of accessing needed services, benefits, and/or resources or, arranging, in circumstances where the older person and/or their caregivers are experiencing diminished functioning capacities, personal conditions or other characteristics, the needed services by providers.1 It entails investigating a person’s needs, preferences and resources, linking the person to a full range of appropriate services and supports, using all available funding sources, and monitoring to ensure that services specified in the support plan are being provided.

Eligible Population Service Coordination Level One shall be targeted to those older persons, age 60 years and over, who are deficient in one (1) Activity of Daily Living (ADL), and the older individual must be in need of either mobility assistance (either human or mechanical) or suffer from a cognitive impairment, such as Alzheimer’s disease or related disorder. Such persons shall also be unable to maintain independent living and self-sufficiency in their community due to the inability to define, locate, secure or retain the necessary resources and services of multiple providers on an on-going basis.

The Service Coordination Level One Program is part of the state-funded Care Coordination for Elderly Virginians Program and is not an entitlement program. Service Coordination Level One shall be available to the extent that state appropriations allow.

Service Delivery Elements

Service Coordination Level One providers must perform all of the following:

Outreach: Outreach is the proactive seeking of older persons who may be in need of coordinated services to maintain that older person’s living in the community as opposed to an institution.

Intake/Screening Intake/screening is an initial evaluation of a person’s needs for services. The purpose is to obtain enough information to determine the person’s likelihood of needing services and whether a full assessment is needed. The information obtained includes the reason for the referral or for the individual seeking help, the informal and formal supports already available, and basic information such as age and income that relates to eligibility for services. Intake/Screening may be provided in the area agency on aging offices, at senior centers and other community facilities, in the older person’s residence or by telephone.

1 National Aging Program Information System Reporting Requirements – State Program Report Definitions Page 1 of 7 Service Coordination Level 1 Effective 10/18/2011 Virginia Department for the AgingAssessment: The assessment, using the full Uniform Assessment Instrument (UAI), identifies the person’s care needs beyond the presenting problem in the areas of physical, cognitive, social and emotional functioning, as well as financial and environmental needs. It also includes a detailed review of the person’s current support from family, friends and formal service providers.

The assessment is conducted prior to provision of any service coordination. The assessment interview is conducted with the older person and, if applicable and with the person’s permission, his or her caregiver(s). It is conducted in the person’s residence. If the person is institutionalized or temporarily in another residence, a home visit is conducted after the person’s return to the residence. No longer than fifteen (15) working days shall pass between the time a client is referred for service coordination and a full Uniform Assessment Instrument is completed. In addition,

 A nutritional screening shall be completed on each client.

 Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.

 Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Service Planning: The care plan is the link from the assessment to the delivery of services. Working with the individual and the caregiver(s), the service coordinator develops a plan to: address the problems and strengths identified in the assessment and reflect the person’s values and preferences; establish desired person-specific goals; develop a complete list of services and supports to achieve these goals, outline responsibilities of the service coordinator, individual, and informal and formal supports; and identify payment sources for services.

The client’s agreement with the care plan must be documented. The care plan must be developed within fifteen (15) working days of the completion of the full Uniform Assessment Instrument. Written notification of denial into service coordination shall be mailed or conveyed by electronic communication within five (5) working days of completion of the plan of care.

Service Delivery: Service delivery is the process through which the Service Coordinator arranges and/or authorizes services to implement the care plan. This may involve arranging for services to be provided by outside agencies through collaboration, formal request, or the use of purchase-of-service agreements; coordinating help given by family, friends, and volunteers; and requesting services provided directly by the service coordination agency.

Page 2 of 7 Service Coordination Level 1 Effective 10/18/2011 Virginia Department for the Aging Monitoring: Monitoring is the maintenance of regular contact with the individual, informal caregivers, and other providers of service. The purpose is to evaluate whether the services are appropriate, of high quality, and are meeting the individual’s current needs. Monitoring includes the function of verifying whether a service has been delivered and altering the care plan as the individual’s needs and preferences change. Contact must be made monthly with the individual for purposes of monitoring the implementation of the care plan.

Reassessment: Reassessment is the formal review of the individual’s status to determine whether their situation and functioning have changed in relation to the goals established in the initial care plan. Again, service is reviewed for quality and appropriateness. If the person’s needs and preferences have changed, the care plan is adjusted. This review is done at least every six months if the individual remains open to care coordination or with any significant change in the person’s condition or services. The reassessment interview is conducted with the person in their home and, if applicable and with the person’s permission, his or her caregiver(s).

If a change is needed on the care plan prior to the six months reassessment, it can be facilitated with a phone call to the individual. The change should be noted on the care plan and in the Service Coordination Level One progress notes. The service coordinator should make two copies of the revised care plan, mailing one to the individual and retaining the other in the individual’s support record.  Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.  Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Termination: Service coordination can be terminated at the discretion of the service provider or the individual. Service coordination should be terminated when the individual’s service goals are met. Written notification of termination of service coordination shall be mailed to the individual by the agency 10 business days in advance of the date the action is to become effective.

Administrative Elements The area agency on aging shall have a written Policies and Procedures Manual for service coordination.

A qualified service coordinator must possess a combination of relevant work experience in human services or health care and relevant education that indicates the individual possesses the following knowledge, skills, and abilities at entry level. These must be documented on the service coordinator’s job application form or supporting documentation, or observable in the job or promotion interview.

Page 3 of 7 Service Coordination Level 1 Effective 10/18/2011 Virginia Department for the Aging Staff Qualifications:  Knowledge: Service coordinators should have a knowledge of: aging and/or the impact of disabilities and illness on aging; how to conduct assessments (including psychosocial, health and functional factors) and use them in care planning; interviewing techniques; consumers’ rights; person-centered practices; local human and health service delivery systems, including support services and public benefits eligibility requirements; the principles of human behavior and interpersonal relationships; effective oral, written, and interpersonal communication principles and techniques; general principles of record documentation; and the service planning process and the major components of a service plan.

 Skills: Service coordinators should have skills in negotiating with consumers and service providers; observing, documenting and reporting behaviors; identifying and documenting a consumer’s needs and preferences for resources, services and other assistance; identifying services within the established services system to meet the consumer’s needs and preferences; coordinating the provision of services and supports by diverse public and private providers; analyzing and planning for the service needs of older adults and individuals with disabilities, and assessing individuals using the Uniform Assessment Instrument (UAI).

 Ability: Service coordinators should have the ability to demonstrate a positive regard for consumers and their families; be persistent and remain objective; work as a team member, maintaining effective inter-and intra-agency working relationships; work independently, performing position duties under general supervision; communicate effectively, verbally and in writing; develop a rapport and to communicate with different types of persons from diverse cultural backgrounds; and conduct interviews.

It is required that an individual complete training on the UAI prior to performing Service Coordination Level One.

Individuals meeting all the above qualifications shall be considered a qualified service coordinator; however, it is preferred that the service coordinator will possess a minimum of an undergraduate degree in a human service field, or be a licensed nurse. In addition, it is preferable that the Care Coordinator will have two years of satisfactory experience in the human services field working with the older adults or individuals with disabilities.

Job Description: For each paid and volunteer position an Area Agency on Aging shall maintain:  A current and complete job description which shall cover the scope of each position-holder’s duties and responsibilities and which shall be updated as often as required, and

Page 4 of 7 Service Coordination Level 1 Effective 10/18/2011 Virginia Department for the Aging  A current description of the minimum entry-level standards of performance for each job.

Units of Service: Units of service must be reported in the AIM or PeerPlace database for each client receiving the service. Service Units can be reported on a daily basis, but not aggregated (summarized) more than beyond one calendar month.  Hours (All hours relating to Service Coordination Level One, including travel time for Service Coordination Level One clients. Assessment time is included in hours, if this process leads to Service Coordination Level One. An hour or part of an hour in 15-minute increments is a unit of service.)  Persons served (unduplicated)

Program Reports:

 Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month.

If the area agency on aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.  AIM or PeerPlace client level data transmitted to VDA by the last day of the following month.  A completed and properly maintained electronic/digital full Uniform Assessment Instrument (UAI) is a mandatory requirement.  The question “Client in Federal Poverty?” (answer Yes or No) must be asked and recorded.

Organizational Structure: Service Coordination Level One is a separate and discreet service of an area agency on aging. Service coordinators must be organizationally separate from management of services provided by the agency that the service coordination clients might receive.

Consumer Contributions/Program Income: The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.

 Cost Sharing/Fee for Service: Cost sharing/fee for service is permitted for Service Coordination Level One Clients And/Or

 Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service provided that the method of solicitation in non-coercive.

Such contributions shall be encouraged for individuals whose self-declared income is at or above 185 percent of the poverty line, at contribution levels based on the actual

Page 5 of 7 Service Coordination Level 1 Effective 10/18/2011 Virginia Department for the Aging cost of services. 2

Quality Assurance: Criminal Background Checks:  VDA requires that the agency and its contractors protect clients by conducting criminal background checks for staff providing any service where they go to or into a client’s home.

Staff Training:  All new staff must receive an in-depth orientation on policies and procedures; client’s rights; characteristics and resources of the community; and techniques for conducting the assessment, care planning, arranging services, and monitoring.

 Each staff person must participate in eight (8) hours of in-service training per year.

Content should be based on the service coordinator’s need for professional growth and upgrading of skills.

Caseload Size: The ratio of clients to service coordinator must be reviewed annually and is dependent on the following:  characteristics of the target population served (e.g., very frail, disoriented, without family support);  complexity of the care plan;  geographical size of the area covered, taking transportation difficulties into account;  availability of community-based services; and the extent of responsibility and control over funds that is exercised by the service coordinator.

Supervision/Case Review: Consultation, supervision and case review shall be available to all staff providing the service. The Case Monitor Section for this service must be utilized in the approved Virginia Department for the Aging electronic data system.

Program Evaluation: The area agency on aging should conduct a regular systematic analysis of the persons served and the impact of the service and use this analysis to improve the quality of service planning and delivery.

Anonymous client surveys of the service shall be done annually. At least 10% of the clients shall be surveyed. Surveys should be maintained in an agency file with a summary of the survey results.

Complaint and Appeals:

2 Older Americans Act of 1965 as amended 2006, Section 315(b) Page 6 of 7 Service Coordination Level 1 Effective 10/18/2011 Virginia Department for the AgingService coordination agencies shall have in place a written Complaint Procedures and Appeals Process.

Client Bill of Rights: Area Agencies on Aging shall make a bill of rights available to all clients. This is a statement of the rights of the person receiving services and includes basic tenets that should be followed in providing the service. Individuals should receive copies of the bill of rights on commencement of the Service Coordination Level One, and a signed, dated copy must be kept in the individual’s support record.

Individual Support Records: Records must be maintained for all recipients of services. The approved Virginia Department for the Aging electronic record system must contain:  Consent to Exchange Information Form - signed by the client  Full Uniform Assessment Instrument (UAI)  Determine Your Nutritional Health Nutritional Checklist  Federal Poverty documentation  Care Plan (original and revisions) - signed by the client  Monthly Progress Notes  Care Coordination Outcome Report Closing Summary  The Client Fee recorded in the progress notes  The Gap Filling Service Form information recorded in the progress notes

The Area Agency on Aging will maintain:  A copy of the Denial or Termination of Service Coordination Services Letter  A signed copy of the Client’s Bill of Rights/Service Appeals/Termination Policy  The Client Fee Form  The Gap Filling Service Form

Page 7 of 7 Service Coordination Level 1 Effective 10/18/2011 Virginia Department for the Aging Service Coordination Level Two

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Service Coordination Level Two (2) is assistance, either in the form of accessing needed services, benefits, and/or resources or, arranging, in circumstances where the older person and/or their caregivers are experiencing diminished functioning capacities, personal conditions or other characteristics, the needed services by providers.1 It entails investigating a person’s needs, preferences, and resources, linking the person to a full range of appropriate services and supports, using all available funding sources, and monitoring to ensure that services specified in the support plan are being provided.

Eligible Population Service coordination shall be targeted to those older persons, age 60 years and over, who are frail, or have disabilities, or who are at risk of institutional placement. Priority shall be given to older persons who are in the greatest economic or social need and/or residing in rural and geographically isolated areas with particular attention to low-income minority individuals or individuals with limited English proficiency.2 Such persons shall also be unable to maintain independent living and self-sufficiency in their community due to the inability to define, locate, secure or retain the necessary resources and services of multiple providers on an on-going basis; shall be dependent in two (2) or more activities of daily living; and have significant unmet needs that result in substantive limitations in major life activities.

Service Coordination Level Two is part of the state-funded Care Coordination for Elderly Virginians Program and is not an entitlement program. Service Coordination Level Two shall be available to the extent that state appropriations allow.

Service Delivery Elements

Service Coordination Level Two providers must perform all of the following:

Outreach: Outreach is the proactive seeking of older persons who may be in need of service coordination. It involves defining and identifying a target population, and devising an outreach mechanism for educating this population about the program. Outreach makes the service known to other providers and helps assure proper referrals and service implementation.

Intake/Screening: Intake/screening is an initial evaluation of a person’s needs for service coordination and/or another service. The purpose is to obtain enough information to determine the person’s likelihood of needing service coordination or another service and whether a full assessment

1 National Aging Program Information System Reporting Requirements – State Program Report Definitions 2 Older Americans Act of 1965 as amended 2006, Section 306 (a)(4)(A)(i) Page 1 of 7 Service Coordination Level 2 Effective 10/18/2011 Virginia Department for the Agingis needed. The information obtained includes the reason for the referral or for the individual seeking help, the informal and formal supports already available, and basic information such as age and income that relates to eligibility for services. Intake/Screening may be provided in the area agency on aging offices, at senior centers and other community facilities, in the older person’s residence or by telephone.

Assessment: The assessment, using the full Uniform Assessment Instrument (UAI), identifies the person’s care needs beyond the presenting problem in the areas of physical, cognitive, social and emotional functioning, as well as financial and environmental needs. It also includes a detailed review of the person’s current support from family, friends and formal service providers.

The assessment is conducted prior to provision of any further care coordination services.

The assessment interview is conducted with the older person and, if applicable and with the person’s permission, his or her caregiver(s). It is conducted in the person’s residence. If the person is institutionalized or temporarily in another residence, a home visit is conducted after the person’s return to the residence. No longer than fifteen (15) working days shall pass between the time a client is referred for care coordination services and a full Uniform Assessment Instrument is completed.

 A nutritional screening shall be completed on each client.

 Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.

 Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Service Planning: The care plan is the link from the assessment to the delivery of services. Working with the individual and the caregiver(s), the service coordinator develops a plan to: address the problems and strengths identified in the assessment and reflect the person’s values and preferences; establish desired person-specific goals; develop a complete list of services and supports to achieve these goals, outline responsibilities of the service coordinator, individual, and informal and formal supports; and identify payment sources for services.

The client’s agreement with the care plan must be documented. The care plan must be developed within fifteen (15) working days of the completion of the full Uniform Assessment Instrument. Written notification of denial into service coordination shall be mailed or conveyed by electronic communication within five (5) working days of completion of the plan of care.

Service Delivery: Page 2 of 7 Service Coordination Level 2 Effective 10/18/2011 Virginia Department for the Aging Service delivery is the process through which the service coordinator arranges and/or authorizes services to implement the care plan. This may involve arranging for services to be provided by outside agencies through collaboration, formal request, or the use of purchase-of-service agreements; coordinating help given by family, friends, and volunteers; and requesting services provided directly by the service coordination agency.

Monitoring: Monitoring is the maintenance of regular contact with the individual, informal caregivers, and other providers of service. The purpose is to evaluate whether the services are appropriate, of high quality, and are meeting the individual’s current needs. Monitoring includes the function of verifying whether a service has been delivered and altering the care plan as the individual’s needs and preferences change. Contact must be made monthly with the individual for purposes of monitoring the implementation of the care plan.

Reassessment: Reassessment is the formal review of the individual’s status to determine whether their situation and functioning have changed in relation to the goals established in the initial care plan. Again, service is reviewed for quality and appropriateness. If the person’s needs and preferences have changed, the care plan is adjusted. This review is done at least every six months if the individual remains open to care coordination or with any significant change in the person’s condition or services. The reassessment interview is conducted with the person in their home and, if applicable and with the person’s permission, his or her caregiver(s).

If a change is needed on the care plan prior to the six months reassessment, it can be facilitated with a phone call to the individual. The change should be noted on the care plan and in the Service Coordination Level Two progress notes. The service coordinator should make two copies of the revised care plan, mailing one to the individual and retaining the other in the individual’s support record.  Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.  Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

Termination: Service coordination can be terminated at the discretion of the service provider or the individual. Service coordination should be terminated when the individual’s service goals are met. Written notification of termination of service coordination shall be mailed to the individual by the agency 10 business days in advance of the date the action is to become effective.

Administrative Elements The area agency on aging shall have a written Policies and Procedures Manual for service coordination.

Page 3 of 7 Service Coordination Level 2 Effective 10/18/2011 Virginia Department for the AgingA qualified service coordinator must possess a combination of relevant work experience in human services or health care and relevant education that indicates the individual possesses the following knowledge, skills, and abilities at entry level. These must be documented on the service coordinator’s job application form or supporting documentation, or observable in the job or promotion interview.

Staff Qualifications:  Knowledge: Service coordinators should have a knowledge of: aging and/or the impact of disabilities and illness on aging; how to conduct assessments (including psychosocial, health and functional factors) and use them in care planning; interviewing techniques; consumers’ rights; person-centered practices; local human and health service delivery systems, including support services and public benefits eligibility requirements; the principles of human behavior and interpersonal relationships; effective oral, written, and interpersonal communication principles and techniques; general principles of record documentation; and the service planning process and the major components of a service plan.

 Skills: Service coordinators should have skills in negotiating with consumers and service providers; observing, documenting and reporting behaviors; identifying and documenting a consumer’s needs and preferences for resources, services and other assistance; identifying services within the established services system to meet the consumer’s needs and preferences; coordinating the provision of services and supports by diverse public and private providers; analyzing and planning for the service needs of older adults and individuals with disabilities, and assessing individuals using the Uniform Assessment Instrument (UAI).

 Ability: Service coordinators should have the ability to demonstrate a positive regard for consumers and their families; be persistent and remain objective; work as a team member, maintaining effective inter-and intra-agency working relationships; work independently, performing position duties under general supervision; communicate effectively, verbally and in writing; develop a rapport and to communicate with different types of persons from diverse cultural backgrounds, and conduct interviews.

It is required that an individual complete training on the UAI prior to performing service coordination.

Individuals meeting all the above qualifications shall be considered a qualified service coordinator; however, it is preferred that the service coordinator will possess a minimum of an undergraduate degree in a human service field, or be a licensed nurse. In addition, it is preferable that the service coordinator will have two years of satisfactory experience in the human services field working with older adults or individuals with disabilities.

Job Description: For each paid and volunteer position an Area Agency on Aging shall maintain:

Page 4 of 7 Service Coordination Level 2 Effective 10/18/2011 Virginia Department for the Aging  A current and complete job description which shall cover the scope of each position-holder’s duties and responsibilities and which shall be updated as often as required, and

 A current description of the minimum entry-level standards of performance for each job.

Units of Service: Units of service must be reported in the AIM or PeerPlace database for each client receiving the service. Service Units can be reported on a daily basis, but not aggregated (summarized) more than beyond one calendar month.  Hours (All hours relating to service coordination, including travel time for Service Coordination Level Two clients. Assessment time is included in hours, if this process leads to service coordination. An hour or part of an hour in 15-minute increments is a unit of service.)  Persons served (unduplicated)

Program Reports: Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the area agency on aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.  Aim or PeerPlace client level data transmitted to VDA by the last day of the following month.  A completed and properly maintained electronic/digital full Uniform Assessment Instrument (UAI) is a mandatory requirement.  The AIM question “Client in Federal Poverty?” (answer Yes or No) must be asked and recorded.

Organizational Structure: Service Coordination Level Two is a separate and discreet service of an area agency on aging. Service coordinators must be organizationally separate from management of services provided by the agency that the service coordination clients might receive.

Consumer Contributions/Program Income: The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.

 Cost Sharing/Fee for Service: Cost sharing/fee for service is permitted for Care Coordination for Elderly Virginians Program Service Level Two Clients.

And/Or

 Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service provided that the method of solicitation in non-coercive.

Such contributions shall be encouraged for individuals whose self-declared income is

Page 5 of 7 Service Coordination Level 2 Effective 10/18/2011 Virginia Department for the Aging at or above 185 percent of the poverty line, at contribution levels based on the actual cost of services. 3

Quality Assurance: Criminal Background Checks:  VDA requires that the agency and its contractors protect clients by conducting criminal background checks for staff providing any service where they go to or into a client’s home.

Staff Training:  All new staff must receive an in-depth orientation on policies and procedures; client’s rights; characteristics and resources of the community; and techniques for conducting the assessment, care planning, arranging services, and monitoring.

 Each staff person must participate in eight (8) hours of in-service training per year.

Content should be based on the service coordinator’s need for professional growth and upgrading of skills.

Caseload Size: The ratio of clients to service coordinator must be reviewed annually and is dependent on the following:  characteristics of the target population served (e.g., very frail, disoriented, without family support);  complexity of the care plan;  geographical size of the area covered, taking transportation difficulties into account;  availability of community-based services; and the extent of responsibility and control over funds that is exercised by the service coordinator.

Supervision/Case Review: Consultation, supervision and case review shall be available to all staff providing the service. The Case Monitor Section for this service must be utilized in the approved Virginia Department for the Aging electronic data system.

Program Evaluation: The area agency on aging should conduct a regular systematic analysis of the persons served and the impact of the service and use this analysis to improve the quality of service planning and delivery.

Anonymous client surveys of the service shall be done annually. At least 10% of the clients shall be surveyed. Surveys should be maintained in an agency file with a summary of the survey results.

3 Older Americans Act of 1965 as amended 2006, Section 315(b) Page 6 of 7 Service Coordination Level 2 Effective 10/18/2011 Virginia Department for the AgingComplaint and Appeals: Service coordination agencies shall have in place a written Complaint Procedures and Appeals Process.

Client Bill of Rights: Service coordination agencies shall make a bill of rights available to all clients. This is a statement of the rights of the person receiving service coordination and includes basic tenets that should be followed in providing the service. Individuals should receive copies of the bill of rights on commencement of Service Coordination Level Two, and a signed, dated copy must be kept in the individual’s support record.

Individual Support Records: Records must be maintained for all recipients of services. The approved Virginia Department for the Aging electronic record system must contain:  Consent to Exchange Information Form – signed by the client  Full Uniform Assessment Instrument (UAI)  Determine Your Nutritional Health Nutritional Checklist  Federal Poverty documentation.  Care Plan (original and revisions) – signed by the client  Monthly Progress Notes  Care Coordination Outcome Report Closing Summary  The Client Fee recorded in the progress notes  The Gap Filling Service Form information recorded in the progress notes.

The Area Agency on Aging will maintain:  A copy of the Denial or Termination of Service Coordination Services Letter  A signed copy of the Client’s Bill of Rights/Service Appeals/Termination Policy  The Client Fee Form  The Gap Filling Service Form

Page 7 of 7 Service Coordination Level 2 Effective 10/18/2011 Virginia Department for the AgingGap-Filling Services Purchase of Gap-Filling Services Form

Gap-filling services provide a mechanism to fill critical gaps in services which are short term and essential, but unavailable through any other means. These services are necessary to maintain the care coordination client safely in the community and may be purchased on behalf of care coordination clients.

The purchase of gap-filling services is subject to the same client cost sharing as applies to care coordination services. Further, no expenditure for service acquisition shall replace existing funding through other service programs. The percentage of care coordination funds that can be used to purchase services is given in the contracts between the projects and the Virginia Department for Aging and Rehabilitative Services.

Medicaid eligible and non-Medicaid eligible elderly care coordination clients may benefit from the purchases of services with state care coordination funds. If a Medicaid eligible client is receiving elderly care coordination through a Medicaid certified care coordination agency other than a CCEVP agency, the Medicaid care coordination may submit requests for the purchase of gap-filling services to the CCEVP team.

Appropriate Purchase of Goods/Services Include, but are not limited to:

1. Assistive transportation to medical appointments /services.
2. Nutritional supplements, ordered by a physician.
3. Incontinence supplies.
4. Durable medical equipment (not covered by insurance) ordered by a physician. Rentals should be encouraged when needed for limited use.
5. Prescription assistance.
6. An interim in-home service while Medicaid application is in process.
7. Adaptive equipment (i.e., microwaves, raised commode seats, special eating utensils) when documented that this equipment allows the client to maintain or increase functioning.
8. Minor home repairs (such as hand rails, steps) when documented that this repair is necessary in order for the client to remain safely at home.
9. Cleaning of the home or extermination of pests and rodents so that home services can be delivered. 10. Smoke detectors, and/or hearing aids (not covered by insurance) ordered by a physician. 11. Glasses, dentures, and/or hearing aids (not covered by insurance) ordered by a physician. 12. Utility assistance for the clients subject to disconnection when loss of service would affect the safety, health and well-being of the client. This would also include heating assistance with oil, coal and wood. 13. Rent, groceries, blankets, clothes in order to provide time to receive assistance from other sources. 14. Purchase of services such a homemaker, personal care-type services, companion/chore and respite care. 15. Purchase of services (listed above) to leverage additional service support for the client.

Page 1 of 3 Gap-Filling Services It is inappropriate to purchase services that are provided by the same agency providing care coordination (i.e., homemaker, home delivered meals). Exceptions will be allowed for emergency situations and for agencies that document in the client’s file that there are no other agencies providing the needed service in the area or that other agencies cannot serve the client.

Documentation must include other funding sources explored and the reason why each source would not fund part or all of the service or equipment.

Gap-Filling Services Allocation

Purchases must be prioritized based on the necessity of the service in allowing the client to remain safely in the community setting. Gap-filling funds shall be made available to care coordination clients throughout the funding cycle. Each agency shall develop a cap on the maximum allowable expenditures per care coordination client. The agency shall retain documentation of how the cap was determined and any situations in which the cap is waived.

Care coordination and gap-filling funds must not be offered to individuals who have a one-time need and who do not require coordination of multiple services (e.g., Individuals not receiving care coordination service). All gap-filling fund purchases shall be approved by one of the following: a committee, the care coordination case supervisor or the agency director. However, agencies may allow care coordinators the flexibility in approving the use of gap-filling funds for purchases. The agencies must develop written criteria under which care coordinators can authorize purchases. Such purchases must be monitored on a periodic basis by the care coordination supervisor.

Questions to ask before allocating funds for goods or services:

1. Has the client received gap filling funded goods or services in the past? If so, why does the client need them again? Is this the most cost effective approach for this client? Does the total service package cost less than institutional care?
2. Are services/goods available through any other funding sources?
3. Is it necessary to maintain or increase the person’s level of independence?
4. Is it truly a one-time purchase or an interim measure? Is there a long-range plan for meeting the need? What are the long-term benefits of the purchase?
5. Are there any cost sharing options – family, other service groups, etc?
6. Does the service/equipment provided require assistance from others or training? If yes, is it available? Will the client use it?

Documentation of Gap-Filling Service Purchases

There must be documentation of each gap-filling service purchase that includes, at a minimum, the following:

• Name of client.
• Service/good received.
• Delivery date(s) of the service/good.
• Client benefits expected from purchasing the service/good.
• Total amount requested.
• Total cost of purchase.

Page 2 of 3 Gap-Filling Services

• Client cost sharing amount.
• Organization (explanation required if this is the same organization which employs the case manager authorizing the service).
• Other organizations/funding sources explored.
• Purchase order number.
• Signature and title of who authorized, date signed.

Care coordination agencies may use the Purchase of Gap-filling Service Form found on the next page or develop an alternative which meets the above criteria. A copy of this form must be included in each client file if gap-filling funds are used for the client. It is acceptable to have documentation noted throughout the client file on progress notes, the care plan or other notes, but it must be consolidated on one form. A copy of the form must also be in one central location in order to have documentation of all gap-filling service purchases made on behalf of all care coordination clients. It is not necessary to include a copy of the invoice in the client’s file. The invoice may be in a central location and easily retrieved by the purchase order number on the client’s documentation sheet.

Page 3 of 3 SOCIALIZATION & RECREATION

MULTIPURPOSE SENIOR CENTER

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definitions Socialization and Recreation Services: These programs provide an opportunity for the individual to interact with others and participate in leisure time activities. They are designed to enable older individuals to attain and maintain physical and mental well-being through programs of regular physical activity, exercise, music therapy, art therapy, and dance-movement therapy. 1

Multipurpose Senior Center: A community facility for the organization and provision of a broad spectrum of services, which shall include provision of health (including mental health), social, nutritional, and educational services and the provision of facilities for recreational activities for older individuals.2

Eligible Population Socialization and Recreation Services are targeted to persons 60 years of age or older whose lifestyle may be enhanced through opportunities for socialization and participation that may alleviate isolation and loneliness. Priority shall be given to older individuals with greatest economic and social need, with special emphasis on low- income minority individuals, older individuals with limited English proficiency, older persons residing in rural or geographically isolated areas, and older individuals at risk for institutional placement. 3

Service Delivery Elements Program Requirements The area agency or service provider must provide supervised leisure time activities, including but not limited to: sports, performing arts, games, arts and crafts, and fine arts.

Assessment  A service-specific assessment shall be performed on each potential client that determines whether the individual is eligible for the service, the amount of the individual’s service-specific need, and the individual’s level of priority for service delivery.  If individual hours will be entered into the VDA-approved electronic client database, Virginia Service – Quick Form (if Part “A” Uniform Assessment Instrument is not completed) is required.  Use of the Virginia Service – Quick Form is recommended, but not required, if there are only optional group units that will not be entered into the VDA-approved electronic client database.  The answer to the question “Is Client in Federal Poverty?” (answer Yes or No ) must be asked and recorded in the VDA-approved electronic client database. Any fee charged to

1 Older Americans Act of 1965, as amended, Section 321 2 Older Americans Act of 1965, as amended, Section 102 3 Older Americans Act of 1965, as amended, section 306(a)(4)(A)(i) Page 1 of 4 Socialization & Recreation Services, Multipurpose Senior Center Effective 10/1/03, Revised 01/03/2012 Virginia Department for the Aging the client shall be determined by the applicable sliding fee scale. The Federal Poverty/VDA Sliding Scale form may be used.

Reassessment  A review of the participant’s need for services, the amount of services provided and the appropriateness of the care plan (if completed) shall be performed when the participant’s condition or situation changes, but at least annually.  Virginia Service – Quick Form (if UAI – page 1-3 minimum is not required) shall be updated at the same time.  The answer to the question “Is Client in Federal Poverty?” (answer Yes or No) must be asked and recorded.  Any fee charged to the client shall be determined by the applicable sliding fee scale. The Federal Poverty/VDA Sliding Scale Fee form may be used.

Administrative Elements Staff Qualifications The AAA or service provider staff shall possess the following minimum qualifications:  Knowledge: Biological, psychological, and social aspects of aging; the impact of disabilities and illness on aging; community resources; public benefits eligibility requirements; medical conditions; activity programming.  Skills: Establishing and sustaining interpersonal relationships; problem solving; activity planning.  Abilities: Communicate with persons with varying socioeconomic backgrounds; work independently.

Job Descriptions4 For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on Aging must maintain:  A current and complete job description which shall cover the scope of socialization and recreation services staff duties and responsibilities; and  A current description of the minimum entry-level standards of performance for each job.

Units of Service Units of service must be reported in the VDA-approved electronic client database for each client receiving the service. Service units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.  Hours (individual hours are required for the VDA-approved electronic client database) – The number of hours the individual participates in the activity at the senior center.  Persons served (unduplicated) – The number of persons who participate in the activity at the senior center.

4 22 VAC 5-20-250, Grants to Area Agencies on Aging, Department for the Aging Regulations, Virginia Administrative Code.

Page 2 of 4 Socialization & Recreation Services, Multipurpose Senior Center Effective 10/1/03, Revised 01/03/2012 Virginia Department for the AgingIndividual hours – Service activities provided to a specific individual; individual hours are required for the VDA-approved electronic client database.

Optional Group Units (Not entered into the VDA-approved electronic client database)  Group Participants – The number of people attending the presentation, meeting, or program (activity provided to more than one person or in a group setting).  Number of Group Presentations – Number of programs on socialization and recreation topics

Group Units – These activities cannot be entered into the VDA-approved electronic client database. They are reported on the Optional Units page of the AMR.

Program Reports  Aging Monthly Reports (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.  Client level data from the VDA-approved client database shall be transmitted to VDA by the last day of the following month.

Consumer Contributions/Program Income There must be a written policy on handling of Client Program Income (CPI) and other gratuities and donations5

Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service. 6 And/or Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited for this service, provided that the method of solicitation is non-coercive. Voluntary contributions shall be encouraged for individuals whose self-declared income is at or above 185% percent of the poverty line, at contribution levels based on the actual cost of services.7

Quality Assurance Staff Training  At hiring, staff shall receive orientation on agency and departmental policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.  Workers shall receive a minimum of 10 hours of in-service or other training per year based on the need for professional growth and upgrading of knowledge, skills, and abilities.

Supervision Consultation and supervision shall be available to all staff providing the service.

5 22 VAC 5-20-410, Grants to Area Agencies on Aging, Department for the Aging Regulations, Virginia Administrative Code 6 Older Americans Act of 1965, as amended, Section 315(a) 7 Older Americans Act of 1965, as amended, Section 315(b) Page 3 of 4 Socialization & Recreation Services, Multipurpose Senior Center Effective 10/1/03, Revised 01/03/2012 Virginia Department for the AgingProgram Evaluation The AAA shall conduct regular and systematic analysis of the persons served and the impact of the service. Subcontractors shall be monitored annually.

Client Records The AAA or service provider must maintain specific client records in the approved VDA electronic database that include:  Consent to Exchange Information, if information is shared with other agencies.  Virginia Service - Quick Form (if Part “A” Uniform Assessment Instrument – page 1-3 minimum is not completed).  The answer to the question “Is Client in Federal Poverty?” (answer Yes or No ) must be asked and recorded

Service providers must maintain the following additional records:  Service documentation, such as activity calendars or service records documenting that the social or recreational programs took place.  Cost Sharing (Fee for Service) calculations, if applicable.

Page 4 of 4 Socialization & Recreation Services, Multipurpose Senior Center Effective 10/1/03, Revised 01/03/2012 Virginia Department for the Aging FAQ’S Socialization and Recreation

Question: My AAA provides socialization and recreation, but we don’t have a senior center. What do I report?

Answer: Annually, each AAA completes a plan that describes services to be provided and reported to VDA. Checking your AAA’s Area Plan should answer your question.

Question: Do we fill out Part “A” Uniform Assessment Instrument, Virginia Service – Quick Form, or both, for seniors that participate in socialization and recreation activities at congregate nutrition sites and senior centers?

Answer: An assessment must be done on each potential client. Virginia Service – Quick Form is required if Part “A” Uniform Assessment Instrument is not completed.

Question: What are the Units of Service for Socialization and Recreation?

Answer: The Units of Service are Individual Hours and Persons Served. Individual hours are the number of hours the individual participates in the activity at the senior center. Persons served (unduplicated) are the number of persons who participate in the activity at the senior center.

Page 1 of 1 FAQ Soc and Rec Revised 03/01/2002 Virginia Department for the AgingTRANSPORTATION SERVICES

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Transportation is the provision of a means of going from one location to another. It does not include any other activity.1

Eligible Population Individuals are eligible for Transportation Services if they are 60 years of age or older, lack the ability to transport themselves, and lack other means of transportation. Priority shall be given to older individuals who are in the greatest economic and social need, with preference given to low-income minority individuals and to those older persons residing in rural or geographically isolated areas.2

Service Delivery Elements Area Agencies providing transportation service either directly, through contract or a combination of means must satisfy the following:

Assessment: Assessment should determine at least the following, utilizing the Virginia Service - Quick Form:

• Individual is at least age 60.
• Individual cannot drive and lacks other modes of transport by self, community support group or public transportation.
• Whether the individual has significant economic or social need.
• Whether individual requires any special assistance.
• Reassessment determining the client’s level of need for the service shall the service shall be done at least annually.

Federal Poverty/VDA Sliding Fee Scale is required, unless all information needed to determine federal poverty is documented on the Virginia Service - Quick Form.

Safety Policies: Written policies must be adopted by the governing board and include at least the following:

• All passengers must wear safety belts and when, where available and practical.
• Each vehicle must be equipped with a fire extinguisher, first aid kit, and emergency signaling devices.
• Inspection procedures for safety equipment, including the method and frequency of inspection. 1 National Aging Program Information System Reporting Requirements – State Program Report Definitions 2 Older Americans Act of 1965, Section 306(a)(4)(A)(i) Page 1 of 5 Transportation Services Revised: 10/01/2003 Administrative Elements Driver Testing:
• The Area Agency or its provider must adopt and implement a behind-the-wheel driving test to be administered to each potential driver prior to transporting passengers.

Driver Record Check:

• The Area Agency or its provider must adopt a written policy regarding a minimum acceptable driving record for all drivers who transport passengers.
• At hiring and at least annually thereafter, drivers must provide the Agency with a copy of their driving records from the Virginia Department of Motor Vehicles.
• VDA strongly recommends that the AAA adopts a policy for driver alcohol and drug testing.
• At hiring the Area Agency and its providers must complete drug and alcohol testing of drivers. Drug and alcohol testing of drivers shall be conducted when the driver is involved in an accident, if indicated.

Records: The following records, at a minimum, must be maintained either by the Area Agency or its provider(s), with access permitted in accordance with VDA contract requirements:

1. For each vehicle:

• Vehicle maintenance/repair history
• Pre-trip checklists
• Vehicle logs (mileage, passengers, etc.)
• A certificate of insurance showing the vehicle identification number (VIN)
• Vehicle accident records
• Service plans
• Safety inspection logs

2. For each driver:

• Behind-the-wheel testing results
• Annual DMV record checks
• Drug and Alcohol testing upon hiring.

Job Descriptions: For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on aging or provider shall maintain:

• A current and complete job description of the duties, responsibilities of each transportation services staff position; and
• A current description of the minimum entry-level standards of each job.3 3 22VAC5-20-250, Grants to Area Agencies on Aging, Department for the Aging Regulations, Virginia Administrative Code Page 2 of 5 Transportation Services Revised: 10/01/2003 Maintenance:
• The Area Agency or its provider must perform preventive maintenance procedures, including daily pre-trip vehicle inspections and an appropriate plan for regularly scheduled maintenance of vehicles.
• Written documentation of maintenance and repairs performed on each vehicle must be maintained.
• Maintenance standards must meet or exceed the manufacturer’s recommendation for the vehicle, or those standards of the Virginia Department of transportation, whichever may be applicable.

Insurance:

• Appropriate fleet liability insurance or, when utilizing volunteers, ensuring possession of adequate personal liability coverage.
• The Area Agency must possess a governing board-approved policy that addresses the issue of volunteer liability, including situations of volunteers driving personal as well as agency vehicles.

Vehicle Accidents:

• The Area Agency or its provider must develop and implement written procedures for drivers to respond to and report accidents.
• Procedures must include instructions for accidents without injuries and with injuries; accidents involving one or more other vehicles; single vehicle accidents; preparing written accident report; and post-accident testing.

Units of Service: Units of service must be reported in AIM for each client receiving services. Services units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month. Units of service for required VDA reports are as follows:

• Unit 1: Total number of one-way trips Y-T-D: carrying one eligible passenger from one location to another for an eligible purpose.
• Unit 2: Total number of unduplicated persons served Y-T-D: the client who receives at least one (1) one-way trip for an eligible purpose.

Program Reports:

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the

Area Agency on Aging provides this service, this report must be updated and submitted

even if no expenditures or units of service occurred.

• AIM client level data transmitted to VDA by the last day of the following month.

Page 3 of 5 Transportation Services Revised: 10/01/2003 Consumer Contributions/Program Income The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.4

• Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service.5 and/or
• Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited provided that the method of solicitation is non-coercive.6

Quality Assurance

Service Personnel: All drivers must meet the following requirements:

• Prior to employment, pass an Area Agency-approved behind-the-wheel driving test.
• Maintain appropriate operator’s license.
• Satisfy an annual Division of Motor Vehicles (DMV) driving record check.
• Have no physical or health limitations that interfere with the safe performance of the driver’s

assigned duties.

• Be sensitive to the needs aid concerns of older persons.

Staff Training All new drivers must receive the following training within the first year of employment:

• Passenger assistance training, including assistance to developmental, physical or sensory

disabilities.

• Orientation to the safe operation of the vehicle(s) in service.
• Daily vehicle inspections and record-keeping.
• Emergency procedures for responding to and reporting vehicle accidents, passenger injuries and equipment breakdowns.
• Defensive driving course and a behind-the-wheel examination.

Current drivers must complete annual refresher courses of at least one hour each in passenger assistance, emergency procedures and defensive driving.

Supervision/ Case Review: Consultation, supervision and case review shall be available to all staff providing the service.

Program Evaluation: The agency should conduct regular systematic analysis of the persons served and the impact of the service. Subcontractors shall be monitored annually.

4 22VAC 5-20-410, Grants to Area Agencies on Aging, Department for the Aging Regulations, Virginia Administrative Code 5 Older Americans Act of 1965, as amended, Section 315(a) 6 Older Americans Act of 1965, as amended, Section 315(b) Page 4 of 5 Transportation Services Revised: 10/01/2003 Client Records: Service providers must maintain specific program records that include:

• Virginia Service - Quick Form (At a minimum, this form must be updated annually).
• Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.
• Any Fee for service charge to the client shall be determined by the applicable sliding fee scale.

Page 5 of 5 Transportation Services Revised: 10/01/2003 Transportation Service Standards Frequently Asked Questions

Q. Do I count the trip to deliver a hot home meal, or a shipment of frozen home meals, to a client’s residence as a “Transportation Service” and thus a 1-way trip for this client?

A. No. This does not involve “carrying one eligible passenger from one location to another for an eligible purpose ”, as defined under the Units of Service section of the Transportation Service Standard.

Q. What is an “eligible” purpose?

A. Any purpose for which an eligible person desires to be “carried from one location to another”.

Q. If I already have a current UAI on a client, must I also complete a Quick Form?

A. No. A UAI contains even more information than is contained in the Quick Form.

The Quick Form is more appropriate for individuals who are not receiving other services from the AAA and thus have never had a UAI.

Q. The manufacturer’s recommended maintenance schedule is not the same as the minimum maintenance schedule published in the Transportation Service Standard. Which standard should I follow?

A. Generally, you should follow the manufacturer’s recommended maintenance schedule for the type of driving conditions to which the vehicle is being subjected.

However, unless your fleet is extremely uniform in make, model, year and usage, this can present difficulties in maintenance scheduling and tracking. Thus, any reasonable basic schedule developed from the manufacturer’s recommendations and vehicle usage of all the vehicles in your fleet may be approved. At a minimum, this schedule should do the following: a. Specify the mileage interval for gauging the tire pressure and checking tire wear (should perform this as part of the daily pre-trip inspection) (tires must be replaced by the time they get to the “wear bars”, earlier under some circumstances of uneven wear or sidewall damage) b. Specify the mileage and time intervals for inspecting, and if needed, topping off fluid levels (should perform this as part of the daily pre-trip inspection) c. Specify the mileage interval for inspection of belts and hoses, replacing if needed (belt and hose inspection should also be part of the daily pre-trip inspection)

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FAQ Transportation

Revised 02/15/02

Virginia Department for the Aging d. Specify the mileage and / or time intervals for inspecting lights, signals, mirrors, signage (should perform this as part of the daily pre-trip inspection) e. Specify the mileage interval for changes or engine oil and filter and chassis lubrication, including inspection of the oil level in the differential (rear end) f. Specify the mileage interval for lubrication of the wheelchair lift, if so equipped g. Specify the mileage and / or time interval for changing antifreeze / coolant h. Specify the mileage interval for changing transmission fluid and filter i. Specify the mileage interval for inspecting and if needed replacing the air filter, PCV valve, fuel filter and other filters j. Specify the mileage interval for inspecting and if needed replacing shocks, struts and other suspension components k. Specify the mileage interval for inspecting and if needed replacing tie rods, drag link, steering box and other front end components. l. Specify the mileage interval for inspecting and if needed replacing brake pads / shoes m. Specify the mileage interval for inspecting and if needed turning (machining on a brake lathe) or replacement with new brake rotors / drums n. Specify the mileage interval for inspecting and if needed draining the water trap for diesel engines o. Other items as may be specified by the manufacturer

Q. I have CDL (Commercial Drivers License) drivers and we are enrolled in the Virginia DMV Automatic Notification program, wherein we receive written notice of any motor vehicle convictions. Must I also pull an annual motor vehicle record on these drivers?

A. No, but you must still do so with any drivers not covered by this program.

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FAQ Transportation

Revised 02/15/02

Virginia Department for the Aging VOLUNTEER

VIRGINIA DEPARTMENT FOR THE AGING

SERVICE STANDARD

Definition Assisting older persons to obtain a suitable volunteer placement.

Eligible Population Persons 60 years of age and older with priority given to older individuals who are in the greatest economic and social need, and preference given to low-income minority individuals and to those older persons residing in rural or geographically isolated areas.1

Service Delivery Elements Agencies providing volunteer programs must perform all of the following component:

Informing the community of the need for volunteers.

Developing meaningful activities and opportunities for volunteers.

Linking older persons with appropriate volunteer opportunities.

Administrative Elements Qualifications: Persons providing volunteer services shall possess the following qualifications:

• Knowledge: Volunteers should have an awareness of the biological, psychological and social aspects of aging; the needs of older persons for meaningful leisure-time activity.
• Skill: Volunteers should have skills in establishing and maintaining interpersonal relationships; developing meaningful volunteer opportunities for older persons.
• Ability: Volunteers should have the ability to communicate with persons with different socio-economic background; work independently.

Job Descriptions: For each paid and volunteer position funded by Title III of the Older Americans Act, an Area Agency on aging shall maintain:

• A current and complete job description which shall cover the scope of duties and responsibilities of the volunteer; and
• A current description of the minimum entry-level standards of each job.2

Units of Service: Units of service must be reported in AIM for each client receiving services. Services units can be reported by client on a daily basis, but not aggregated (summarized) more than beyond one calendar month.

• volunteer hours: the number of volunteer hours provided by a volunteer.

1 Older Americans Act of 1965, as amended, Section 306(a)(4)(A)(i) 2 22 VAC 5-20-250, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code Page 1 of 3 Volunteer Effective 10/01/03, Revised: 04/22/03 Virginia Department for the Aging• persons served (unduplicated): the number of volunteers who have generated a Virginia Service – Quick Form. “Persons served” does not apply to the person(s) receiving a service from a volunteer. Those persons must be counted under the Title III program that is providing the service.

Program Reports

• Aging Monthly Report (AMR) to VDA by the twelfth (12th) of the following month. If the Area Agency on Aging provides this service, this report must be updated and submitted even if no expenditures or units of service occurred.
• AIM client level data transmitted to VDA by the last day of the following month.

Consumer Contributions/Program Income The Area Agency on Aging shall formally adopt written policies and procedures, approved by the governing board, regarding the collection, disposition, and accounting for program income.3

• Cost Sharing/Fee for Service: An Area Agency on Aging is permitted to implement cost sharing/fee for service for recipients of this service.4 And/or
• Voluntary Contributions: Voluntary contributions shall be allowed and may be solicited provided that the method of solicitation is non-coercive.5

Quality Assurance Staff Training:

• Volunteers should receive orientation on agency policies and procedures, client rights, community characteristics and resources, and procedures for conducting the allowable activities under this service.
• Volunteers should receive in-service training appropriate to the position in which they are serving. Where practical the content should include opportunities that foster professional growth and increase knowledge, skills, and abilities.

Supervision/Case Review: Consultation, supervision and case review shall be available to all staff providing the service.

Program Evaluation: The agency should conduct regular systematic analysis of the persons served and the impact of the service. Subcontractors shall be monitored annually.

Client Records:

• Virginia Service – Quick Form (At a minimum, this form must be updated annually).
• Federal Poverty should be determined and documented. The Federal Poverty/VDA form may be used.

3 22 VAC 5-20-410, Grants To Area Agencies On Aging, Department for the Aging Regulations, Virginia Administrative Code 4 Older Americans Act of 1965, as amended, Section 315(a) 5 Older Americans Act of 1965, as amended, Section 315(b) Page 2 of 3 Volunteer Effective 10/01/03, Revised: 04/22/03 Virginia Department for the Aging• Any fee for service charge to the client shall be determined by the applicable sliding fee scale.

• For congregate meal site volunteers, see the congregate nutrition service standard.

Page 3 of 3 Volunteer Effective 10/01/03, Revised: 04/22/03 Virginia Department for the Aging Volunteer Program Frequently Asked Questions

1. Q - Who is eligible to participate in Area Agency on Aging volunteer programs?

A - Individuals must be age 60 and older.

1. Q - Will I be restricted in the amount of hours I volunteer?

A - The number of hours you volunteer will depend on the volunteer assignment and hours the setting is open for business.

1. Q - What volunteer opportunities exist with the Area Agency on Aging?

A - Some Area Agencies on Aging sponsor Retired Senior Volunteer Programs (RSVP) where volunteer assignments are found. Examples of volunteer opportunities within the agency might include administrative tasks, assisting at nutrition dining centers, assisting seniors with recreational and socialization activities, and telephone reassurance programs.

1. Q - I work as a volunteer for the Area Agency on Aging home-delivered meals program. Can I take a friend along when I deliver meals?

A - Yes, your friend can also help you with the delivery, however, he may be asked to complete a volunteer application.

1. Q - Who is “persons served” for the service unit under the volunteer program.

A - “Persons served” (unduplicated) is the number of volunteers who have generated a Virginia Service - Quick Form. “Persons served” does not apply to the person(s) receiving a service from a volunteer. Those persons must be counted under the Title III program that is providing the service

fdc2/15/02 Page 1 of 1 FAQ Volunteer Revised 02/15/02 Virginia Department for the Aging