reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-30

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-40

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-45

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-50

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-60

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-70

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-73

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-75

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-78

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-80

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-83

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-85

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-90

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-100

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-110

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-120

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-130

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-140

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-145

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-150

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-160

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-170

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-180

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-190

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-195

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-200

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-210

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-220

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-230

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-240

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section 12VAC30-121-250

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 121 › Section

Current through Register Vol. 40, No. 24, July 15, 2024
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1315 and 42 USC § 1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-10 - Purpose; legal authority; covered services; aggregate cost effectiveness; required individual and provider enrollment; individual costs

Current through Register Vol. 40, No. 24, July 15, 2024
A.
1. Supports individuals with developmental
				disabilities to live integrated and engaged lives in their
				communities;
2. Standardizes and
				simplifies access to services;
3.
				Sets out and defines services that promote community integration and
				engagement; and
4. Improves
				provider capacity and quality to render covered services;
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-30 - Waiver populations; single waiver enrollment; waiver termination upon loss of eligibility

Current through Register Vol. 40, No. 24, July 15, 2024
A. The
				waiver services set out in 12VAC30-122-240, 12VAC30-122-250, and
				12VAC30-122-260 shall be provided for eligible individuals, including children,
				with a developmental disability (DD) as defined in §
									37.2-100 of the Code
				of Virginia and who have been determined to require the level of care provided
				in an ICF/IID. These services can only be covered if required by the individual
				to avoid institutionalization. These services shall be appropriate and
				medically necessary to ensure community integration.
B. An individual shall not be simultaneously
				enrolled in more than one waiver. An individual who has a diagnosis of DD may
				be on the waiting list for one of the DD Waivers (FIS, CL, or BI) while
				simultaneously being enrolled in the Elderly or Disabled with Consumer
				Direction (EDCD) (12VAC30-120-900 et
				seq.) or the Technology Assisted (12VAC30-120-1700 et
				seq.) waivers if he meets applicable criteria for either.
C. DMAS or its designee shall ensure only
				eligible individuals receive home and community-based waiver services and shall
				terminate the individual from the waiver and such services when the individual
				is no longer eligible for the waiver. Termination from the DD Waivers shall
				occur when, for example, (i) the individual's health, safety, and welfare and
				medical needs can no longer be safely met in the community; (ii) when the
				individual is no longer eligible for either Medicaid or no longer meets the
				ICF/IID level of care; or (iii) when the individual was eligible for one of the
				waivers and accepted a waiver slot but did not start services for five
				months.
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-40 - Waiver services; when not authorized

Current through Register Vol. 40, No. 24, July 15, 2024
A. The FIS, CL, and BI waiver services,
				collectively known as Developmental Disabilities (DD) Waivers, shall not be
				authorized or reimbursed by DMAS for an individual who resides outside of the
				physical boundaries of the Commonwealth.
B. Waiver services (with the exception of
				transition services) shall not be furnished to individuals who are inpatients
				of a hospital, nursing facility, ICF/IID, or inpatient rehabilitation facility.
				Individuals with DD who are inpatients of these facilities may receive support
				coordination services as described in
				12VAC30-50-440
				or
				12VAC30-50-490.
1. The support coordinator may recommend
				waiver services that would promote the individual's exiting from an
				institutional placement.
2.
				However, the FIS, CL, or BI waiver services shall not be provided until the
				individual has exited the institution and has been enrolled in the
				waiver.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-45 - Waiver slot allocation process

Current through Register Vol. 40, No. 24, July 15, 2024
A. When the General Assembly has approved
				less than 40 slots for a given waiver, the available slots will be allocated by
				DBHDS to regions or sub-regions of the state for distribution to the
				individuals in that region or sub-region who are determined to have the most
				urgent needs. If there are BI slots to be allocated, the BI slots will be
				allocated by region.
B. When at
				least 40 new waiver slots are funded by the General Assembly, one slot will be
				allocated by DBHDS to each CSB. Additional slots up to the total number of
				available slots for a given waiver will be allocated by DBHDS to CSBs for
				individuals living within that CSB's catchment area based upon the following
				objective factors and criteria:
1. The
				region's population;
2. The
				percentage of Medicaid eligible individuals in the catchment area;
				and
3. Each CSB's percentage of
				individuals on the "Priority One" portion of the statewide waiting
				list.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-50 - Criteria for all individuals seeking Developmental Disability Waivers services

Current through Register Vol. 40, No. 24, July 15, 2024
The following three criteria shall apply to all individuals
				  who seek DD Waivers services:
1. The
				need for DD Waivers services shall arise from an individual having a diagnosed
				condition of developmental disability as defined in §
									37.2-100 of the Code
				of Virginia.
2. Individuals
				qualifying for the DD Waivers services shall meet the level-of-care provided in
				an ICF/IID as set forth in the VIDES and shall demonstrate this need at least
				annually consistent with 42 CFR 441.302. This is demonstrated by having
				significant functional limitations in major life activities as documented on
				their VIDES forms. The VIDES forms shall be conducted in person, unless the
				individual to be screened resides out of state, by a qualified support
				coordinator to establish if the individual meets the level of care required for
				the DD Waivers.
a. VIDES for infants shall be
				used for the evaluation of individuals who are younger than three years of age
				(DMAS-P235).
b. VIDES for children
				shall be used for the evaluation of individuals who are three years of age
				through 17 years of age (DMAS-P-236).
c. VIDES for adults shall be used for the
				evaluation of individuals who are 18 years of age and older
				(DMAS-P237).
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-70 - Assessment and enrollment; Virginia Individual Developmental Disabilities Eligibility Survey

Current through Register Vol. 40, No. 24, July 15, 2024
A. Home and
				community-based waiver services shall be considered only for individuals
				eligible for admission to an ICF/IID due to the individuals' diagnoses of
				developmental disabilities and documented functional support needs. For the
				support coordinator to make a recommendation for the DD Waivers services, the
				services shall be determined to be an appropriate service alternative to delay
				or avoid placement in an ICF/IID or to promote exiting from an ICF/IID or other
				institutional placement provided that a viable discharge plan that preserves
				the individual's health, safety, and welfare in the community has been
				developed.
B. The support
				coordinator shall confirm diagnostic and functional eligibility for individuals
				with input from the individual and the individual's family/caregiver, as
				appropriate, and service or support providers involved in the individual's
				support prior to DMAS assuming payment responsibility for covered home and
				community-based waiver services. This confirmation shall be accomplished
				through the completion of the following:
1. A
				psychological or other evaluation of the individual that affirms that the
				individual meets the diagnostic criteria for developmental disability as
				defined in §
										37.2-100 of the Code
				of Virginia; and
2. The required
				level-of-care determination through the Virginia Individual Developmental
				Disabilities Eligibility Survey (VIDES) appropriate to the individual according
				to his age, completed no more than six months prior to waiver
				enrollment.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-90 - Waiting list; criteria; slot assignment; emergency access; reserve slots

Current through Register Vol. 40, No. 24, July 15, 2024
A. There shall
				be a current and accurate statewide waiting list, called the DD Waivers waiting
				list, for the DD Waivers. This waiting list shall be created and maintained by
				DBHDS, which shall update it no less than annually.
B. Individuals on this waiting list shall
				have (i) a diagnosis of developmental disability pursuant to §
									37.2-100 of the Code
				of Virginia, (ii) a completed VIDES form, and (iii) a priority designation
				consistent with subsection D of this section.
C. Individuals who accompany parents or
				guardians deployed overseas for active duty U.S. military or Foreign Service
				assignment but retain Virginia residency shall remain on the statewide DD
				Waivers waiting list and be considered for DD Waivers slot assignment when they
				are within three months of returning to Virginia.
D. To be placed in one of the following
				prioritization levels, the support coordinator shall determine through inquiry
				of the individual and family/caregiver, as appropriate, and consideration of
				the information reflected in the individual's diagnosis and VIDES form, which
				priority category the individual meets. The individual shall be placed in the
				prioritization level that best describes his need for waiver services by
				meeting at least one criterion in the category:
1. Priority One shall include individuals who
				require a waiver service within one year and are determined to meet at least
				one of the following criteria:
a. An
				immediate jeopardy exists to the health and safety of the individual due to the
				unpaid primary caregiver having a chronic or long-term physical or psychiatric
				condition that currently significantly limits the ability of the primary
				caregiver to care for the individual; or there are no other unpaid caregivers
				available to provide supports;
b.
				There is immediate risk to the health or safety of the individual, primary
				caregiver, or other person living in the home due to either of the following
				conditions:
(1) The individual's behavior,
				presenting a risk to himself or others, cannot be effectively managed even with
				support coordinator-arranged generic or specialized supports; or
(2) There are physical care needs or medical
				needs that cannot be managed even with support coordinator-arranged generic or
				specialized supports;
c.
				The individual lives in an institutional setting and has a viable discharge
				plan; or
d. The individual is a
				young adult who is no longer eligible for IDEA services and has expressed a
				desire to live independently. After individuals attain 27 years of age, this
				criterion shall no longer apply.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-100 - Modifications to or termination of services

Current through Register Vol. 40, No. 24, July 15, 2024
A. DMAS or its designee shall have the
				authority to approve modifications to an individual's ISP, based on the
				recommendations of the support coordinator.
B. The provider shall be responsible for
				modifying an individual's plan for supports, with the involvement of the
				individual enrolled in the waiver and the individual's family/caregiver, as
				appropriate, and submitting such revised plan for supports to the support
				coordinator any time there is a modification in the individual's condition or
				circumstances that may warrant a change in the amount or type of service
				rendered by the provider.
1. The support
				coordinator shall review the need for a modification and may recommend a
				modification to the plan for supports to DBHDS. If the support coordinator does
				not recommend a modification to the plan for supports and that results in the
				denial of the requested service, the support coordinator shall inform the
				individual of his right to appeal.
2. DBHDS shall approve, deny, or pend for
				additional information the provider's requested modification to the
				individual's plan for supports as recommended by the support coordinator. DBHDS
				shall communicate its determination to the support coordinator within 10
				business days of receiving all supporting documentation regarding the request
				for modification or in the case of an emergency, within three business days of
				receipt of the request for modification.
3. The individual enrolled in the waiver and
				the individual's family/caregiver, as appropriate, shall be notified in writing
				by the support coordinator of his right to appeal, pursuant to DMAS client
				appeals regulations (12VAC30-110), all decisions to reduce, deny, or terminate
				services. The support coordinator shall submit this written notification to the
				individual enrolled in the waiver or the family/caregiver, as appropriate,
				within 10 business days of the decision. Once the individual or
				family/caregiver receives the written notification, the clock for filing an
				appeal, as set forth in the DMAS client appeals regulations, shall begin to
				run.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-110 - Waiver provider enrollment

Current through Register Vol. 40, No. 24, July 15, 2024
DMAS or its designee shall be responsible for assuring
				  continued adherence to provider participation standards. DMAS or its designee
				  shall conduct ongoing monitoring of compliance with provider participation
				  standards and applicable laws, regulations, and DMAS policies. A provider's
				  noncompliance with applicable federal and state Medicaid laws, regulations, and
				  DMAS policies as required in the provider's participation agreement, may result
				  in termination of the provider participation agreement. For DMAS to approve
				  enrollment of a provider for home and community-based waiver services, the
				  following standards shall be met:
1.
				Licensure or certification requirements, or both as applicable, for services
				that have licensure or certification requirements;
2. Disclosure of ownership pursuant to 42 CFR
				455.104, 42 CFR 455.105, and 42 CFR 455.106; and
3. The ability to document and maintain
				individual records in accordance with federal and state requirements.
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-125 - Electronic visit verification

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Except as specified in subsection B of this section, the requirements of
				12VAC30-60-65 shall apply for personal care services, respite care services,
				and companion services.
B. EVV
				requirements shall not apply to respite care services provided by a
				DBHDS-licensed provider in a DBHDS-licensed program site, such as a group home
				or sponsored residential home or a supervised living, supported living, or
				similar facility or location licensed to provide respite care services as
				permitted by the Centers for Medicare and Medicaid Services.
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-130 - Provider termination

Current through Register Vol. 40, No. 24, July 15, 2024
A. Except
				as otherwise provided by applicable federal or state law, the Medicaid provider
				agreement may be terminated by DMAS (i) pursuant to §
									32.1-325
				of the Code of Virginia, (ii) as may be required by federal law for federal
				financial participation, and (iii) in accordance with the provider
				participation agreement, including termination at will on 30 days written
				notice. The agreement may be terminated if DMAS determines that the provider
				poses a threat to the health, safety, or welfare of any individual enrolled in
				a DMAS administered program. DMAS may also terminate a provider's participation
				agreement if the provider does not fulfill its obligations as described in the
				provider participation agreement. Such provider agreement terminations shall be
				in accordance with §
									32.1-325
				of the Code of Virginia,
				12VAC30-10-690,
				and Part XII (12VAC30-20-500 et
				seq.) of 12VAC30-20. Termination precludes further payment by DMAS for services
				provided for individuals subsequent to the date specified in the termination
				notice.
B. A provider who has been
				convicted of a felony, or who has otherwise pled guilty to a felony, in
				Virginia or in any other state, the District of Columbia, or the United States
				territories shall, within 30 days of such conviction, notify DMAS of this
				conviction and relinquish his provider agreement. Such provider agreement
				terminations shall be effective immediately and conform to §
									32.1-325
				of the Code of Virginia and
				12VAC30-10-690.
				Providers shall not be reimbursed for services that may be rendered between the
				conviction of a felony and the provider's notification to DMAS of the
				conviction.
C. A participating
				provider may voluntarily terminate his participation with DMAS by providing 30
				days written notification.
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-140 - Provider confidentiality; change of ownership; completion of assessment instruments

Current through Register Vol. 40, No. 24, July 15, 2024
A. Pursuant
				to subpart F of 42 CFR Part 431,
				12VAC30-20-90,
				and any other applicable federal or state law or regulation, all providers
				shall hold confidential and use for DMAS or DBHDS authorized purposes only all
				medical assistance information regarding individuals served. A provider shall
				disclose information in his possession only when the information is used in
				conjunction with a claim for health benefits or the data are necessary for
				purposes directly related to the administration of the State Plan for Medical
				Assistance and related waivers.
B.
				When ownership of the provider changes, the provider shall notify DMAS pursuant
				to 42 CFR 420.206.
C. For ICF/IID
				facilities covered by § 1616(e) of the Social Security Act in which
				respite care as a home and community-based waiver service will be provided, the
				facilities shall be in compliance with applicable regulatory
				standards.
D. Providers shall make
				available, as may be requested, specific, relevant information about the
				individual enrolled in the waiver.
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-150 - Requirements for consumer-directed model of service delivery

Current through Register Vol. 40, No. 24, July 15, 2024
A. Criteria for
				consumer-directed model of service delivery.
1. The FIS and CL Waivers have three services
				that may be provided through a consumer-directed (CD) model: companion
				services, personal assistance services, and respite services.
2. Requirements for individual.
a. The individual or a person designated by
				the individual shall serve as the employer of record (EOR). If an individual is
				unable to direct his own care or is younger than 18 years of age, he shall
				designate another person older than 18 years of age to serve as the EOR on his
				behalf. If the individual is younger than 18 years of age, a legally
				responsible individual shall serve as the EOR.
b. The EOR shall be the employer in this
				service and shall be responsible for recruiting, interviewing, hiring,
				training, supervising, and firing CD assistants. Specific EOR duties include
				checking references of assistants, determining that assistants meet basic
				qualifications, training assistants, supervising the assistant's performance,
				and submitting and approving the assistant's timesheets to the DMAS designated
				fiscal employer agent on a consistent and timely basis.
c. The individual, the family/caregiver, or
				EOR, as appropriate, shall have a back-up plan in case the assistant does not
				show up for work.
d. Individuals
				choosing consumer-directed services may receive support from a CD services
				facilitator. Services facilitators shall assist the individual or his EOR, as
				appropriate, in accessing and receiving consumer-directed services. This
				function shall include providing the individual or EOR, as appropriate, with
				employer of record management training including a review and explanation of
				the employee management manual and routine and reassessment visits to monitor
				the CD services.
e. If an
				individual choosing consumer-directed services chooses not to receive support
				from a CD services facilitator, then another family member or caregiver other
				than the EOR shall perform all of the duties and meet all of the requirements
				of a CD services facilitator, including documentation requirements identified
				for services facilitation. However, the family member or caregiver serving as
				the services facilitator shall not be reimbursed by DMAS for performing these
				duties or meeting these requirements.
f. The individual's support coordinator/case
				manager may also function as the paid services facilitator.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-160 - Voluntary or involuntary disenrollment of consumer-directed services

Current through Register Vol. 40, No. 24, July 15, 2024
Either voluntary or involuntary disenrollment of the
				  consumer-directed (CD) model of personal assistance, companion, or respite
				  services may occur. In either voluntary or involuntary disenrollment, the
				  individual enrolled in the waiver shall be permitted to select an agency from
				  which to continue to receive his personal assistance services, companion
				  services, or respite services. If the individual either fails to select an
				  agency or refuses to do so, then personal assistance services, companion
				  services, or respite services, as appropriate, will be discontinued.
1. An individual who has chosen consumer
				direction may choose, at any time, to change to the agency-directed model as
				long as he continues to qualify for the specific services. The services
				facilitator or support coordinator shall assist the individual with the change
				of services from consumer-directed to agency-directed.
2. The services facilitator or support
				coordinator, as appropriate, shall initiate involuntary disenrollment from
				consumer direction of an individual enrolled in the waiver when any of the
				following conditions occur:
a. The health,
				safety, or welfare of the individual enrolled in the waiver is at
				risk;
b. The individual or EOR
				demonstrates consistent inability to hire and retain a CD assistant;
				or
c. The individual or EOR, as
				appropriate, is consistently unable to manage the CD assistant, as may be
				demonstrated by a pattern of serious discrepancies with timesheets.
d. If the individual does not choose a
				services facilitator and a family member, other caregiver, or the support
				coordinator is not willing or able to assume the services facilitation duties,
				then the support coordinator shall notify DMAS or its designated service
				authorization contractor and the consumer-directed services shall be
				discontinued.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-170 - Fiscal employer/agent requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. Pursuant to a duly negotiated contract or
				interagency agreement, the DMAS designated fiscal employer/agent shall be
				reimbursed by DMAS to perform certain employer functions, including payroll and
				bookkeeping functions, on behalf of the EOR or individual who is receiving
				consumer-directed personal assistance services, companion services, and respite
				services. "Fiscal employer/agent" means a state agency or other entity as
				determined by DMAS to meet the requirements of 42 CFR 441.484 and the Virginia
				Public Procurement Act (Chapter 43 (§
									2.2-4300
				et seq.) of Title 2.2 of the Code of Virginia) that performs an employer's
				salary payment and tax reporting functions for assistants employed for
				consumer-directed services.
B. The
				DMAS designated fiscal employer/agent shall be responsible for administering
				payroll services on behalf of the individual enrolled in the waiver.
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-180 - Orientation testing; professional competency requirements; advanced competency requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Orientation training and testing for providers of agency-directed personal
				assistance services, agency-directed companion services, agency-directed
				respite services, center-based crisis supports, crisis support services,
				community engagement services, community coaching services, group day services,
				group home residential services, independent living support services,
				individual and group supported employment, in-home support services, sponsored
				residential services, supported living residential services, and workplace
				assistance.
1. Providers shall ensure that
				direct support professionals (DSPs) and DSP supervisors providing services to
				individuals with developmental disabilities receive or have received training
				on the following knowledge, skills, and abilities. These knowledge, skills, and
				abilities are addressed in the DMAS-approved orientation training.
a. The characteristics of developmental
				disabilities and Virginia's DD Waivers;
b. Person-centeredness, positive behavioral
				supports, and effective communication;
c. Identified potential health risks of
				individuals with developmental disabilities and the appropriate
				interventions;
d. Community
				integration and social inclusion; and
e. Best practices in the support of
				individuals with developmental disabilities.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-190 - Individual support plan; plans for supports; reevaluation of service need

Current through Register Vol. 40, No. 24, July 15, 2024
A. Every individual
				who has been approved to receive FIS, CL, or BI waiver services shall have a
				unique person-centered individual support plan (ISP) that sets out his unique,
				specific needs and the services designed to meet those needs.
1. The ISP shall be collaboratively developed
				at the onset of waiver services and redeveloped, at a minimum, annually by the
				support coordinator with the individual and the individual's family/caregiver,
				as appropriate, other providers, consultants as may be needed, and other
				interested parties at the individual's discretion.
2. The support coordinator shall be
				responsible for continuously monitoring the appropriateness of the individual's
				services and making timely revisions to the ISP as indicated by the changing
				needs of the individual.
3. Any
				modification to the amount or type of services in the ISP shall be service
				authorized by DMAS or its designee.
4. The support coordinator shall monitor the
				providers' plans for supports to ensure that all providers are working toward
				the desired outcomes with the individuals supported.
5. Support coordinators shall be required to
				conduct and document evidence of monthly onsite visits for all individuals
				enrolled in the DD Waivers who are residing in VDSS-licensed assisted living
				facilities or approved adult foster care homes.
6. Support coordinators shall conduct and
				document a minimum of quarterly face-to-face visits to all other individuals
				with at least one visit annually occurring in the home.
7. All requests for increases in DD waiver
				services shall be reviewed by the support coordinator. The support coordinator
				shall ensure that the request is based on the individual's demonstrated need
				for the increased service, as documented by appropriate assessment criteria and
				a written plan for supports, and that those services are necessary to promote
				the individual's health, safety, and welfare in the community and can be safely
				and cost effectively provided in the community.
8. Support coordinators shall provide an
				individual and the family/caregiver, as appropriate, with a copy of the
				individual's ISP.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-220 - Appeals

Current through Register Vol. 40, No. 24, July 15, 2024
A. Providers shall
				have the right to appeal actions taken by DMAS or its designee in accordance
				with §
									32.1-325.1
				of the Code of Virginia, the Virginia Administrative Process Act (Chapter 40
				(§
									2.2-4000 et
				seq.) of Title 2.2 of the Code of Virginia),
				12VAC30-10-1000,
				and
				12VAC30-20-500 et
				seq.
B. Individuals shall have the
				right to appeal an action taken by DMAS or its designee in accordance with
				12VAC30-110-10
				through
				12VAC30-110-370
				and 42 CFR Part 431 subpart E. The individual shall be advised in writing of
				the action and of his right to appeal consistent with federal requirements and
				DMAS client appeals regulations (12VAC30-110-10
				through
				12VAC30-110-370
				).
Statutory Authority: §
											32.1-325
					 of the Code of Virginia;
					 42 USC §
												1396 et
					 seq.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-230 - Utilization review and quality management review

Current through Register Vol. 40, No. 24, July 15, 2024
A. Quality management review shall be
				performed by DMAS or its designee. Utilization review of rendered services
				shall be conducted by DMAS or its designee.
B. DMAS staff shall conduct utilization
				review of individual-specific provider documentation, which shall be forwarded
				by providers upon DMAS or DBHDS request.
C. Utilization review requirements specific
				to services in the developmental disability waivers shall be as follows:
1. To apply to be reimbursed as a Medicaid
				provider, the required DBHDS license shall be either a conditional or full
				(either annual or triennial) license.
2. Providers with provisional licenses issued
				by DBHDS shall not be reimbursed as Medicaid providers beginning 60 days from
				the issuance of the provisional license. Providers shall not request or receive
				authorizations or reauthorizations for services for new or currently supported
				individuals upon the issuance of the provisional license.
3. Reimbursement shall not be permitted to
				providers that fail to enter into a provider agreement with DMAS for a service
				prior to rendering that service or fail to maintain a current Medicaid Provider
				Enrollment Agreement.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-240 - Services covered in the Building Independence Waiver

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Building Independence Waiver is
				designed to support individuals who reside in an integrated, independent living
				arrangement who can be supported through the provision of a minimal level of
				supports.
B. The services covered
				in the Building Independence Waiver for adults who are 18 years of age or older
				shall be:
1. Assistive technology service
				(12VAC30-122-270 ).
2. Benefits
				planning service (12VAC30-122-280 ).
3. Center-based crisis support service
				(12VAC30-122-290 ).
4.
				Community-based crisis support service (12VAC30-122-300 ).
5. Community coaching service
				(12VAC30-122-310 ).
6. Community
				engagement service (12VAC30-122-320 ).
7. Community guide service (12VAC30-122-330
				).
8. Crisis support service
				(12VAC30-122-350 ).
9. Electronic
				home-based support service (12VAC30-122-360 ).
10. Environmental modifications service
				(12VAC30-122-370 ).
11. Group day
				service (12VAC30-122-380 ).
12.
				Group and individual supported employment service (12VAC30-122-400 ).
13. Independent living support service
				(12VAC30-122-420 ).
14. Employment
				and community transportation service (12VAC30-122-440 ).
15. Peer mentor supports service
				(12VAC30-122-450 ).
16. Personal
				emergency response system service (12VAC30-122-470 ).
17. Shared living service (12VAC30-122-510
				).
18. Transition service
				(12VAC30-122-560 ).
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-250 - Services covered in the Community Living Waiver

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Community Living Waiver is the
				developmental disabilities waiver designed particularly to support those
				individuals who require some form of a residential service 24 hours per day,
				seven days per week.
B. The
				services covered in the Community Living Waiver are:
1. Assistive technology service
				(12VAC30-122-270 ).
2. Benefits
				planning service (12VAC30-122-280 ).
3. Center-based crisis support service
				(12VAC30-122-290 ).
4.
				Community-based crisis support service (12VAC30-122-300 ).
5. Community coaching service
				(12VAC30-122-310 ).
6. Community
				engagement service (12VAC30-122-320 ).
7. Community guide service (12VAC30-122-330
				).
8. Companion service
				(12VAC30-122-340 ).
9. Crisis
				support service (12VAC30-122-350 ).
10. Electronic home-based support service
				(12VAC30-122-360 ).
11.
				Environmental modifications service (12VAC30-122-370 ).
12. Group day service (12VAC30-122-380
				).
13. Group home residential
				service (12VAC30-122-390 ).
14.
				Group and individual supported employment service (12VAC30-122-400 ).
15. In-home support service (12VAC30-122-410
				).
16. Employment and community
				transportation service (12VAC30-122-440 ).
17. Peer mentor supports service
				(12VAC30-122-450 ).
18. Personal
				assistance service (12VAC30-122-460 ).
19. Personal emergency response system
				service (12VAC30-122-470 ).
20.
				Private duty nursing service (12VAC30-122-480 ).
21. Respite service (12VAC30-122-490
				).
22. Services facilitation
				service (12VAC30-122-500 ).
23.
				Shared living service (12VAC30-122-510 ).
24. Skilled nursing service (12VAC30-122-520
				).
25. Sponsored residential
				service (12VAC30-122-530 ).
26.
				Supported living residential service (12VAC30-122-540 ).
27. Therapeutic consultation service
				(12VAC30-122-550 ).
28. Transition
				service (12VAC30-122-560 ).
29.
				Workplace assistance service (12VAC30-122-570 ).