Requesting information

Please support HB191. With mental healthcare facilities understaffed, this is a step in the right direction to provide a direct line to the governor of effective changes that need to be made. Please support HB98. Obtaining guardianship is a difficult process. The more open and easier to navigate will help families in crisis.

Re: HB94 - Overall, AARP Virginia supports the creation of the Public Guardianship and Conservator Ombudsman Office, but we strongly encourage inclusion of monitoring and oversight of private, as well as public, guardians. Re: HB98 - Creation of an APS Central Registry complies with our policy of using multi-disciplinary team approaches to fight abuse by bad actors, and AARP has supported similar efforts in other states. We understand that other organizations may have concerns over the broad scope of this publicly-accessible registry and would like to more narrowly tailor it to ensure that only those intending to do harm are included. While AARP Virginia would not oppose the bill without those concerns being addressed, as the current language does include an appeals process, we would be supportive of that more narrow scope.

I do not support any bills that criminalize folks

Good afternoon, Mr. Chairman, and committee members: Thank you for the opportunity to comment on HB 16 and thank you, Delegate Fowler, for your work updating our state’s Safe Haven law. We, Virginia is for Children (an advocacy group for the lives of vulnerable children in our state), are following the Safe Haven law efforts and are fully supportive of the extension to thirty days of age for infant relinquishment. This is a reasonable, standard amount of time for a mom/parent to conclude that they cannot parent their baby OR, change their mind and decide they can parent their baby. Such a significant, life-altering decision does not need to be rushed or hurried. We know that moms who have just given birth, especially those who are alone, need time to recover physically and emotionally. Moms can experience postpartum depression after the birth of child, this typically occurs within the first 1-3 weeks after birth, parents can be in desperate situations- experiencing homelessness, abuse, addiction and need time to get help. Twenty-one states are now at thirty days for age of relinquishment. Utah just extended their law to thirty days in February, 2020 and approved funding for safe haven law awareness. Extending this law can potentially save more infants from abuse, neglect, and abandonment and give parents the time they need to make important decisions. We hope the committee will approve the extension and consider providing state funding for safe haven law awareness and promotion of safe haven locations or “safe baby sites”. Not enough parents are informed about the law’s existence and the process involved. Our group is especially interested in a state funded, DSS promoted, 24-hour confidential, crisis hotline that would provide intervention and support for women in crisis pregnancies and struggling parents, so that they can get the help they need to parent their baby. Thank you, Mr. Chairman, and committee members for your time and for the opportunity to voice our support of this bill. Sincerely, Leah Kipley VA is for Children

As an occupational therapist working directly with wheelchair users, I am in support of H.B. 241. I have worked with motivated and hardworking patients who have been done everything on their part to heal and recover from their injuries. Based on their needs, they qualified for custom equipment but this gap in care left them stuck with difficult decisions. They either had to languish in the hospital waiting for a placement that would accept them and their equipment needs or go to a facility with equipment that was not custom and not appropriate. Many times, both options led to significant harm for these people, both mentally and physically. I had one patient who passed away because of this gap in care. Please support H.B. 241, which will prevent this dilemma and make sure these patients no longer have to make unnecessary compromises in their health care.

I am writing in support of H.B. 241. It is my experience as a clinician working with patients with complex rehab needs that everyone should be able to get medical equipment made to their specifications no matter what insurance or aid they have or whether it is needed for home or a facility. It is a common for patients to discharge to a skilled nursing facility or similar initially after a significant injury as patients are attempting to organize the care or home modifications needed for home. Without being able to access the custom medical equipment that they need and are entitled to, these patients are at risk of developing secondary conditions further limiting their ability to return home. It is imperative to these patients life and wellbeing that they have access to the medical equipment they require to regain independence and mobility..

Thank you for the opportunity to provide comment on HB241 and the related Fiscal Impact Statement. We appreciate the hard work of the individuals at DMAS who work to ensure that this bill has the appropriate funding to close the gap in care. However, we are in disagreement of what the impact of the bill will actually be. 1. The average cost of a custom/specialty wheelchair is not $15,000. We believe the information provided by DMAS is simply an average of the MSRP of the most and least expensive equipment. This is not what the insurance company actually pays to the DME provider (they are reimbursed at a much lower rate than the MSRP and what is billed to the insurance company). Additionally, there are far fewer individuals who need the MOST expensive equipment than who need the least expensive equipment. While it is true that a power wheelchair with many accessories is costly, there are far fewer individuals who require this level of support from their wheelchair than who require a manual wheelchair. 2. We based our average of $5,800 to determine our average cost of a custom wheelchair on 2 years worth of data provided to use by one of the largest DME providers in the state. They provided us with total reimbursement for custom wheelchairs for over 300 pieces of equipment for 2 years and $5,800 was the average for an individual piece of equipment. We believe this is a more accurate reflection of what the average cost of a custom wheelchair will be as it reflects what was actually ordered and reimbursed for over a 2 year time period for individuals with TBI, SCI and CVA which reflect a large portion of the individuals that this bill intends to assist. This would lower the total fiscal impact statement by bringing the average cost from $15,000 to $5,800 per unit. 3. Our budget amendments also break the initial total cost into 2 separate years to catch up the back log of individuals that we believe to be eligible to receive a custom wheelchair. Which would divide the fiscal impact provided by DMAS in half lowering the overall fiscal impact. 4. After the first 2 years, individuals are only eligible for new equipment every 5 years. So once all of the current folks are caught up the fiscal impact would be a fraction annually of the first 2 years. We believe that our numbers provided to get to our budget amendment dollars request are accurate and would like to request that this information be brought to the attention of DMAS and the members of this committee for consideration. Thank you all for your service to our great Commonwealth of Virginia. We hope you support HB241 and associated budget amendments to help our friends with disabilities residing in nursing homes throughout our communities gain access to independent mobility.

Chairman Fariss, distinguished delegates… I appreciate the opportunity to request your support for House Bill 241 and its accompanying budget item. My name is Richard Bagby. I serve as the Director of the United Spinal Association and am representing a group of dedicated volunteers comprised of clinicians, effected Virginians with disabilities, and other compassionate stakeholders. This bill will close a critical gap in coverage for Virginians with disabilities who receive Medicaid and reside in nursing homes by giving them access to wheelchairs prescribed by their doctors which they would otherwise be able to get if they lived in the community. Increasing their health and quality of life. Additionally, it will save the Virginia taxpayer a substantial amount of money. First and foremost, the Fiscal Impact Statement forecast is grossly inflated beyond the ask of the budget item. For example it relies on an average cost of a wheelchair to be $15,000. We strongly believe that the ask reflected in the budget item is far more accurate based on the commonwealth’s largest durable medical equipment provider’s data, which shows the average cost of the relevant equipment to be $5,500. I suspect the impact statement mistakenly cites the amount billed as opposed to actual reimbursement amounts. Further, the impact statement forecasts the initial ask to be ongoing year over year until at least 2029. The reality is that our ask of $3.8 million divided over the next two years will clear the backlog of eligible Virginians currently living in nursing facilities. Beyond 2024, the budget would decrease exponentially as new beneficiaries per year would only amount to the number of new admissions, likely less than 300 people, as opposed to the 1,500 from the current ask. Finally, what is not addressed in the fiscal impact statement is the cost savings associated with this bill. Studies overwhelmingly show that properly fitted wheelchairs and cushions significantly decrease the likelihood of pressure sores and other secondary complications. The incident rate of pressure injuries in nursing facilities is 44%....each pressure injury costs DMAS on average $86,500. House Bill 241’s ask of $3.8 million over the next 2 years will take a significant bite out of the $200 million plus dollars DMAS currently has budgeted for treating pressure wounds…while also giving Virginians with disabilities a chance at realizing independence again. Thank you for your consideration of his incredibly important bill.

I am in support of H.B. 241. Everyone should be able to get medical equipment made to their specifications no matter what insurance or aid they have or whether it is needed for home or a facility.

As a wheelchair user, I support HB 241. Medical equipment- such as a prescribed/recommended wheelchair- is vital to human autonomy, independence, and overall health.

Save tax payers money by providing the necessary equipment in nursing facilities! Save patients from having residual health problems by giving them wheel chairs and other necessary equipment!

I have worked in the physical rehabilitation field for over 30 years and know how critical it is for individuals to have access to appropriate equipment to maintain a level of independence and quality of life . Decisions on funding of equipment needs for an individual has a direct impact on their long term outcomes . Access to appropriate equipment impacts physical health , mental health , quality of life , and level of independence . Appropriate equipment is a necessity wether living at home or in a facility .Please support HB241 to ensure equitable funding of equipment to meet the individual needs regardless of someone's living disposition . Finding a wheelchair that meets the needs of a patient and denying them access based on their disposition is detrimental to physical and mental well being . Adjustment to loss of mobility and physical functioning is challenging enough, but not providing the appropriate equipment to best meet the patients needs , level of independence , and mobility is detrimental.

Virginia Medicaid recipients who live in nursing facilities are denied wheelchairs prescribed by their doctors, solely because they live in nursing facilities. If they had the means/support to return home after an injury Medicaid would pay for their wheelchairs. If this legislation passes, it would cost Virginians about $3.8million…but would save the taxpayers 10’s of millions of dollars ATLEAST. While also giving people the chance to get: out of bed/out of the nursing facility/back to their homes/back to work/back to life.

As a retired physical therapist I repeatedly saw the inequity for Medicaid recipients forced to live in a nursing home for medically necessary supplies/ devices. There is no rationalization for denying the need for wheelchair payment when prescribed by the attending physician. How is the same chair an approved device at home but not approved in a more limited environment ( less assistance )? If anything, the nursing facilities are understaffed and not able to address the daily needs of residents. The wheelchair makes them more independent leading to fewer associated illnesses. Approval for payment should be a no brainer, please correct this injustice .

This bill should be passed. Providing these wheelchairs will have multiple positive effects. Having the ability to be mobile will decrease incidence of depression, provide a sense of independence and decrease medical care. With the use of the wheelchair you may even see some patients able to transition home. I urge all to vote for this bill

I support H.B. 241

As a medical professional I have seen many patients go without the medical equipment necessary to improve independence only because of where they live i.e. a nursing home. Please consider this when voting for this bill. How would you feel if your mother developed bed sores that require hospitalization and contractures that prevent her from getting around only because her Medicaid policy would not pay for a wheelchair that would allow her the ability to get out of bed. No one should be denied the ability to navigate their living environment just because of where they live.. If Medicaid can pay for it at home why not a nursing home???

I am in support of H.B. 241. Everyone should be able to get medical equipment made to their specifications no matter what insurance or aid they have or whether it is needed for home or a facility.

I have worked with patients who require specialized equipment for over 18 years. I have seen many unfortunate trends in insurance coverage resulting in a significant reduction of daily independence versus a persons ability to be independent when provided with the right equipment. There are many young people (early 20s) who have suffered from a traumatic injury and are permanently disabled who are residing in nursing homes due to a lack of consistent caregiver support and lack of needed specialized durable medical equipment. If they were able to achieve a level of independence with therapy and empowered by the right equipment, they would be able live a life of independence and productivity. The current law wastes MANY taxpayer dollars. The recommended bill would resolve this issue What’s the issue?: Virginia Medicaid recipients who live in nursing facilities are denied wheelchairs prescribed by their doctors, solely because they live in nursing facilities. If they had the means/support to return home after an injury Medicaid would pay for their wheelchairs. How would this legislation save taxpayer dollars?: Good question! Since the folks we’re talking about cannot access appropriate equipment, they are relegated to lie in bed or use equipment that is not appropriate. This leads to secondary complications like bed sores…which Medicaid pays for…to the tune of hundreds of millions of dollars per year! If this legislation passes, it would cost Virginians about $3.8million…but would save the taxpayers 10’s of millions of dollars ATLEAST. While also giving people the chance to get: out of bed/out of the nursing facility/back to their homes/back to work/back to life. Therefore, I urge you to support this bill to reduce unnecessary skilled nursing facility stays, reduce wasted dollars, and empower many Virginians to live productive lives.

In regards to HB241, I can personally attest to the need for patients to have access to complex medical equipment when transferring to skilled nursing facilities. I work in inpatient rehab and am appalled that patients have their one means of independence (complex power wheelchairs) taken away just because they require extended care at a long term facility. This must be passed and changed.

As a person with a disability and dependent on a motorized wheelchair, I was astounded to learn the people who live in nursing facilities in Virginia cannot receive medically necessary equipment prescribed by a physician in a rehab setting. I have visited people in nursing homes and, without my wife and my community, I would have to live in a nursing home also. Hi am often one bad situation away from living in a nursing home. Without access to a suitable motorized wheelchair and other durable medical equipment I would be bedbound or would be waiting for someone on staff to push me from place to place in a standard wheelchair. When I have durable medical equipment I can get around independently once someone gets me up and then my wheelchair. I can even get out and about in my community. This does so much for my psyche! When it is well maintained my chairs and motors and batteries will last five, seven, or 10 years. It is an investment that, all in all, pays off in my independence and overall health. I support this legislation and the efforts to provide funding for people in nursing facilities who depend upon durable medical equipment to meet their unique needs.

I have been a paraplegic for nine years and use a wheelchair full time for mobility. My wheelchair has been made specifically for me to maximize my quality of life and minimize the likelihood of developing pressure sores, which can involve lengthy hospital stays for treatment and observation. Currently, Virginia's Medicaid program does not cover wheelchairs for people who have a similar condition to me but who's situation requires that they stay in a skilled nursing facility. Without the use of a properly fitting wheelchair, medical problems related to skin breakdown are far more likely to occur which is ultimately several times more expensive to treat than a wheelchair would have been in the first place. Please vote yes on HB241 to improve the quality of life for disabled Virginians and ultimately save the Commonwealth money on Medicaid disbursements for preventable pressure sore treatments.

I support H.B.241 because I believe Virginians living with disabilities should have the same access to prescribed equipment no matter whether they live in a nursing facility or the community. Precision fitting is so important to the long term health of an individual, it would seem there should be no distinction based on residence. From a financial standpoint, well-fitted equipment potentially saves money by lowering the chances of issues such as pressure sores, improving cardiovascular function through improved mobility, and other factors that could affect costly secondary treatments.

I’m Kent Keyser. I vote in Arlington County. I am an advocate with the United Spinal Association for equal access to health care for people with disabilities. Delegates, thank you for your public service. I hope you will support Delegate Adams’ bill, HB 241, to amend the Virginia’s Medicaid budget to cover customized power and manual wheelchairs which are medically necessary and are prescribed by a physician to meet the daily needs of residents of skilled nursing and long term care facilities. Not only do these customized wheelchairs prevent medical complications, like bed sores, aka Pressure Injuries, which can cost over $150,000, studies overwhelmingly agree that these customized wheelchairs, prescribed by physicians, improve the physical health, mental health, and overall independence of people living with disabilities. Let me give you an example. These customized wheelchairs include components that are known as complex rehabilitative and seating technologies. For people like me who have a spinal cord injury, or for others with traumatic brain injuries or strokes, these medically prescribed components allow us to be able to use a wheelchair. Let me explain. I still need someone to help me in and out of bed, mornings and nights. But because my spinal cord injury limits my trunk control, my ability to hold myself back in my wheelchair, I have a complex rehab component on my wheelchair that allows me to tilt back so I can function independently all day. Without that tilt function, long ago, I would have rotted away by being bedridden. Instead for fourteen years that tilt function and the customized cushion I sit on have helped keep me healthy – fourteen years and no pressure wounds – fourteen years and no spinal cord injury related hospital readmissions. Fourteen years of earning a living and fourteen years of paying Virginia taxes. Please vote to close this critical gap. Every Virginian prescribed medically necessary equipment should have equal access to the technologies available to meet their health and safety needs regardless of where they live in Virginia.

Subcommittee members, I am contacting you today to encourage you to support HB 241 regarding power wheelchairs in nursing homes. This subject has become important to me because my own son is recovering from a spinal cord injury suffered July ’20 which resulted in quadriplegia. Fortunately, he has good insurance through his wife and we have been able to care for him at home, though it has taken a team of us 24/7. But this has all left me with insights which compel me to advocate for others who find themselves in similar circumstances as my son but without his considerable resources. It is my understanding that Medicaid does not currently provide power chairs for nursing home residents, even for those whose extreme physical limitations leave them vulnerable to pressure ulcers (bedsores). For these patients, bedsores are not just a simple nuisance; they can quickly lead to expensive hospitalizations in the ICU, and sometimes ultimately even death due to sepsis. The most important strategy to help PREVENT bedsores is changing a patient’s position at least once every two hours. Unfortunately, a patient who is paralyzed due to stroke, spinal cord injury, etc. cannot do this for themselves. Therefore, it is up to the busy nursing home staff to be sure that position changes are done, eating up much of the care-givers’ time. Power chairs have the ability to recline, which enables the patient to shift their weight themselves without having to rely on a staff member to do it for them. Making power chairs available to these severely disabled patients could literally help make the difference between life and death for them. The loss of life due to sepsis resulting from pressure ulcers is tragic, especially since in many cases it can be avoided. This tragedy is aggravated by the fact that the cost of the basic powerchairs which could be supplied to these patients is far less than the overall cost for wound care and hospitalization. It might also increase efficiency in nursing homes, as less staff-time would be required for such frequent re-positioning during the day. I firmly believe that having a power chair available was a game-changer for my son. Although a bedsore was beginning to form after a month of being bed-ridden in the ICU at VCU Medical Center (under the very best of care), he has not suffered one since. Getting up out of bed and into a chair was important; being able to recline very frequently in order to shift his position was key. On a personal note, having the ability to move from one room to the next without depending on anyone else is priceless. As a voter, I appreciate a commonsense approach to keeping Medicare costs and expenditures down. In my opinion, preventative measures make more sense than expensive wound-care and hospitalizations. Approval of power chairs for those nursing home residents most in need of them is the smart thing to do. The improved quality of life afforded to these patients by the independence provided by those power chairs makes it the right thing to do. Please consider supporting this bill. Sincerely, Lesa Collins Ph 434-665-4105

We support the bill.

As a nursing home resident in Arlington, not having access to a custom fitted CRT Wheelchair has been a barrier in my ability to re-engage with my life and my community post injury. It effects my independence, the quality of my life and what I can or cannot do. It can make a difference between whether I am bedridden or able to engage outside of the walls of the nursing home and live more independently. As a quadriplegic, I received my first motorized wheelchair As a gift through a charitable organization, but it was not fitted to me. Consequently, it caused pressure sores that kept me primarily bedridden during the first two critical years post injury. If I had been mobile, I would I have had more opportunity to gain strength and develop more independent skills through the use of the chair. Instead, I was essentially warehoused as a bedridden nursing home resident, with virtually no mobility and zero independence. Later, my high school graduating class generously donated money to help me purchase a used motorized Wheelchair and have it fitted to me. Unfortunately, properly seating and fitting me to the chair to me was easier said than done. It took approximately 18 months before the chair was comfortable and more usable by me. This involved paying out-of-pocket for dozens of appointments and countless hours of labor by Wheelchair technicians. The modifications and adjustments are ongoing and I have a $1900+ invoice for custom padding as recent as two weeks ago. I want the same right to necessary, appropriate and fitted equipment as my fellow Virginia Medicaid neighbor living across the street in an apartment.

This issue is important to me because I am an Occupational Therapists that has dedicated my career to working with people with disabilities for the past 20 years. I have seen first-hand how not having access to appropriate medical equipment for seating and mobility has resulted in significant medical complications, functional declines, and devastating psychological concerns. When a person has access to their medically appropriate seating and mobility device, they have improved functional capacity, independent mobility, proper stability and support, reduced pain, reduced need for caregiver assistance, reduced risk of pressure injuries, and an improved quality of life. Everybody has the right to have functional mobility, it is a basic human right! Not only does providing our nursing home residents with the custom equipment they need to be functional, safe, and more independent, but it has a huge impact on the financial and caregiver strain that facilities experience. It’s pretty simple, what would you want your loved one to have access to?

Comments Document

A year and a half ago I had an accident that changed my life forever. I was mountain biking at Bell Isle here in Richmond when I crashed. I couldn't move and had difficulty breathing because the crash severely damaged the spinal cord in my neck. Five days later I woke up with a tube in my stomach, another one in my throat, and no sensation below my shoulders. I was unable to eat, speak, move, or breathe on my own. I laid in bed like this for 1 month and my only source of physical activity was having a foam wedge alternate from being under my left and right side every 4 hours. When I left the ICU I went to an inpatient rehab facility that specialized in spinal cord injuries. They noticed a small white dot above my tailbone that looked like a pimple. Later that week I received a power chair that allowed me to travel around the facility and tilt back every 20 minutes. By tilting back I relieved pressure off of that white dot. It completely healed the following week. I cannot begin to express how important that power chair was to every aspect of my health. It did relieve pressure off of my tailbone, but I honestly couldn't feel that part of my body. What I did feel what is the overwhelming sense of Joy to independently travel around the facility. I was motivated to see what other parts of my life I could get back. When you have a condition like mine you need to count your blessings. I try not to look back and think about how my life could be different, but when I do I remain thankful. I'm thankful that I had good insurance. I'm thankful that I went to a specialized facility. I'm thankful that the experts around me took the extra precaution the treat that white dot as the beginning of a pressure sore and not a pimple. I could be one out of 10 people in a hospital right now that has a pressure wound. I could be taking up space in a hospital bed for a month and a half, the average length of time to heal a pressure wound. I could be in nursing facility, without a power chair, still rotating every four hours on a foam wedge. Approximately 4% of the Medicaid budget is spent treating pressure wounds. The average cost of a power chair is $5500 and the average cost of a pressure wound is over $86,000. A person on Medicaid is able to receive a power chair UNLESS they go to a nursing facility. HB 241 simply removes this exception. Vote yes on HB 241. It's not just right for the budget, it's right for the people.

Approximately 15,000 Virginians who are Medicaid beneficiaries reside in nursing facilities across the state. About 10% of these people live with disabilities which require specialized wheelchairs for their mobility, independence and to prevent secondary medical complications like bed sores. These wheelchairs provide people living with disabilities access to independent functional mobility, and access to social, recreational and community activities, they also prevent pain and suffering from these secondary medical complications. By providing people with disabilities living in nursing facilities specialized wheelchairs, this legislation will promote their optimal health and well-being and also will create a cost savings in prevention of costly medical complications that occur when people do not have access to medically necessary equipment. As a wheelchair user living with quadriplegia, this issue is important to me because everyone deserves the right to have their health and mobility. People with mobility impairments like mine should not be confined to a bed or improper mobility aides. This causes an unnecessary and depressing lack of independence, drastically reducing quality of life. More importantly, it leads to many health complications which bring about costly surgeries and in some cases even death. I hope you'll consider passing this bill and its corresponding budget amendment Item 304#40h. Thank you, Josh Sloan

I am writing to voice my support for bill HB241. I work in the Complex Rehab industry, helping to provide wheelchairs as a licensed Assistive Technology Professional. I work with individuals day in and day out who have had a tough situation take their life and turn it upside down and cause them to require the need of a power wheelchair. Whether it is because of an accident that has caused physical trauma to the spinal cord or because of a neurodegenerative disease like ALS or MS, when the ability to walk is taken from someone it is always life changing and devastating. Imagine you are no longer able to independently get yourself from one spot to the next without the aid of a wheelchair and for a lot of these individuals you require assistance to do simple things like eating, toileting, and dressing. For many people in these situations their wheelchairs are the key to the little bit of independence they have left. What is frustrating in the state of Virginia is if your situation requires you to go to a skilled nursing facility, your ability to get the mobility equipment that you need is taken from you. This is unfair. This is unjust. This absolutely needs to change so that for people in these situations they have the ability to live their life to the fullest extent possible with the same technology available to everyone else.

Providing people with appropriate equipment will help them maintain their health, quality of life, and safety. People with sensation deficits will obtain skin breakdown when sitting on inappropriate cushions this will cause health issues such as infection leading to hospitalization and possibly sepsis or osteomyelitis. When people have wheelchairs they are unable to maneuver their overall health both physical and mental health decline. These chairs can also cause poor posture placing them at risk for scoliosis, shoulder pain, and inability to maintain balance to perform their activities of daily living independently. Why should people in facilities not have the quality of life compared to those who are in the community. If you allow them to have the proper equipment they will have more opportunity to be independent with their activities of daily living, be more independent with leisure activities, social interaction and an improved quality of life.

My name is Dr. Megan Murphey and I am the Assistive Technology Specialist at a large free standing inpatient rehabilitation hospital. I spend my days helping people recover from devastating injuries such as traumatic brain injuries and spinal cord injuries, as well as medical issues like stroke and Multiple Sclerosis. I also help prescribe custom wheelchairs for individuals with disabilities. When someone is admitted to our facility they work hard to regain their independence and return to their home, families, work and community. Unfortunately, not every patient has the support system or resources to return to their home when they discharge, and are forced to transition into skilled nursing or long term care facilities. Because of the current statute they are now also unable to have access to the prescribed wheelchair. This wheelchair is vital to their ability to get out of bed, to look out the window, to go the bathroom to use the toilet or to brush their teeth at the sink. Lack of access to this equipment not only takes their only source of independence and ability to perform necessary daily tasks but also can lead to bed sores from lack of mobility. Bed sores cause pain and suffering and can lead to infection and death. Bedsores are also significantly more expensive to treat than what the cost of providing a custom wheelchair is. Not only will this legislation improve the quality of life for Virginian’s with disabilities living in nursing facilities but will provide a way to prevent costly medical issues and save the health care system money. It should not matter where people with disabilities live, if they need a medically necessary wheelchair they should have access to one. Please pass this legislation and associated budget amendments so I never have to tell another patient they cannot have the wheelchair we worked so hard together to perfect.

I work in a group home for youth who are in foster care and also diversion programs from the Department of Juvenile Justice. Once a young person turns 18, they are released with little to no support. Even in re-entry, housing is not an option or priority for a young person because there are no hotels/motels that will allow a person under the age of 21 to stay temporarily. There are few transitional options for young people and we know from studies and data that having the least amount of resources leads to criminal activity, behavioral health issues, often times, substance use disorder and introduction into the adult carceral systems. Youth gun violence has increased because we have more young people being forced to live on their own without support from parents and other community members. They are being robbed of their potential because they are often thrust into adult situations the moment the clock strikes 12am on their 18th birthday. We have to do more to embrace our young people and provide housing for them during this pivotal transitional period in their lives. I would love to see this bill passed and more support be made available for young people leaving foster care and the juvenile justice system.

Voices for Virginia's Children is in support of this bill. Virginia continues to rank 49th in the country for youth in foster care aging out without a permanent connection. For these reasons, we urge your support of the bill.

Children's Home Society is a 122 year old private licensed child placing agency. We find adoptive families for children in foster care and supports for youth who age out of foster care. We support this bill as it will encourage collaboration, puts the children first and will ultimately help find the best family for each child more often.

Dear Members of the House Committee on Health, Welfare and Institutions, Please vote YES on HB991. This is an important bill for families, like mine, attempting to use Medicaid services to adapt their homes for the care of their disabled loved one. My son, Tommy, is 29 years old, has a severe seizure disorder, and is medically fragile. In the last two years, he has become almost exclusively dependent on his stroller/wheelchair. In December 2021, we had to widen three interior doors to accommodate his new chair. The total cost was $15,600. While we appreciate the $5,000 that was approved, it still leaves us with a financial burden to add to the next project, exterior ramps, as stairs are no longer feasible. These modifications are needed for everyday life, but also, our only chance at getting Tommy out of the house in the event of a fire. HB991 would look to amend waivers providing services for individuals with developmental disabilities, giving greater financial flexibility for certain services, including environmental modifications. Currently, there is an annual limit of $15,000 spilt between three areas. SB231 would allow the annual amount to be used in one area, such as environmental modifications. This would give families the flexibility to make important environmental/assistive technology accommodations to be able to support their disabled loved one in the home. Realigning the amount would help us tremendously. It would allow us to focus on our son, instead of having to worry about how to pay for expensive modifications just to be able to keep our son home… where he belongs. Thank you for supporting HB991. Teresa Elder Teresa911@aol.com 571-278-3511

This bill will provide more flexibility for families and individuals adapting their home to accommodate someone with disabilities or special needs and allow them to live at home in the community. This will allow Medicaid Waiver recipients to prioritize and fund the modifications and accommodations they need to remain in the home.

VOTE YES on arc of va recue plan bills!!! 991 bill will provide more flexibility for families and individuals adapting their home to accommodate someone with disabilities or special needs and allow them to live at home in the community. This will allow Medicaid Waiver recipients to prioritize and fund the modifications and accommodations they need to remain in the home. 990 billwil help some of my folks get the tech and supprot they need for stufs and evreything sooget a nciedeal done!

suppprot arc of va rescue plan build back va better!!!! get a ncie deal done plaease!

Please VOTE YES on HB991 This is an important bill for families whose loved one receives a Medicaid Waiver. The combination of the three traunchs of $5,000 into one annual amount that totals $15,000- that can be used at the individual and family's discretion gives necessary flexibility. There are modifications to the home that have to be made when someone is being cared for in the home setting in order to be able to remain in the community. Frequently those modifications, especially environmental modifications cost more than the $5,000 annual cap. this would allow a family to have the discretion as to how to focus their annual allowance. Please VOTE YES on HB991 thank you

I oppose multiple bills that have made it to the house the one bill regarding Emergency Sex Offenders is the most absurd bill I have ever heard in my life. No one is going to be worried about sexual offending in a State of Emergency number one. For example Dad is on a registry and he has three children who are accepted inside without supervision while dad is kept outside in the storm or natural catastrophe. When you pass bills like this your punishing innocent children and families. What about people who committed murder or child abusers are they treated the same? You Senators and delegates got this wrong and this is harmful to innocent families and children. Now let's talk about the 13,000 children on Sex Offender Registries in Virginia some as young as 7 years of age so Mom , Dad and entire family is allowed in but the child is made to stand outside during a castophre alone and sacred while his or her family are allowed inside these laws are based off fear and gives a false sense of security to the general public. Sex Offense is to broad, urination in public is a registable offense as a Violent Sex Offender, Reprorting a Sex Crime will land you on a Violent Sex Offender Registry such is my sistuation. Please reconsider the harm the harm of this bill

Good afternoon, Mr. Chairman, and committee members: Thank you for the opportunity to comment on HB 16 and thank you, Delegate Fowler, for your work updating our state’s Safe Haven law. We, Virginia is for Children (an advocacy group for the lives of vulnerable children in our state), are following the Safe Haven law efforts and are fully supportive of the extension to thirty days of age for infant relinquishment. This is a reasonable, standard amount of time for a mom/parent to conclude that they cannot parent their baby OR, change their mind and decide they can parent their baby. Such a significant, life-altering decision does not need to be rushed or hurried. We know that moms who have just given birth, especially those who are alone, need time to recover physically and emotionally. Moms can experience postpartum depression after the birth of child, this typically occurs within the first 1-3 weeks after birth, parents can be in desperate situations- experiencing homelessness, abuse, addiction and need time to get help. Twenty-one states are now at thirty days for age of relinquishment. Utah just extended their law to thirty days in February, 2020 and approved funding for safe haven law awareness. Extending this law can potentially save more infants from abuse, neglect, and abandonment and give parents the time they need to make important decisions. We hope the committee will approve the extension and consider providing state funding for safe haven law awareness and promotion of safe haven locations or “safe baby sites”. Not enough parents are informed about the law’s existence and the process involved. Our group is especially interested in a state funded, DSS promoted, 24-hour confidential, crisis hotline that would provide intervention and support for women in crisis pregnancies and struggling parents, so that they can get the help they need to parent their baby. Thank you, Mr. Chairman, and committee members for your time and for the opportunity to voice our support of this bill. Sincerely, Leah Kipley VA is for Children