Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-80 - Waiver approval process; authorizing and accessing services

Current through Register Vol. 40, No. 24, July 15, 2024
A. The support
				coordinator is notified that a slot is available when the regional supports
				specialist (RSS) moves the individual to projected enrollment status in the
				Virginia Waiver Management System (WaMS). The support coordinator shall notify
				the individual and family/caregiver of slot availability and available services
				within the offered waiver within seven calendar days of the waiver slot
				assignment date.
B. The
				individual/caregiver will confirm acceptance or declination of the slot within
				15 calendar days of notification of slot availability.
C. The individual and the individual's
				family/caregiver, as appropriate, shall meet with the support coordinator
				within 30 calendar days of the waiver assignment date to (i) discuss the
				individual's assessed needs, existing supports, and individual preferences;
				(ii) discuss obtaining a medical examination, which shall have been completed
				no earlier than 12 months prior to the initiation of waiver services; (iii)
				begin to develop the personal profile; and (iv) discuss the completion of the
				assessment as required by 12VAC30-122-200.
D. Prior to or at the meeting to discuss the
				individual's assessed needs, the support coordinator shall provide the
				individual with a choice of services identified as needed and available in the
				assigned waiver, providers, and settings alternatives.
E. After the individual has accepted the
				waiver slot offered by the CSB or BHA, the support coordinator shall submit a
				DMAS-225 (Medicaid Long-Term Care Communication Form) along with a
				computer-generated confirmation of level-of-care eligibility to the local
				department of social services to determine financial eligibility for Medicaid
				and the waiver and any patient pay responsibilities. The DMAS-225 is the form
				used by the support coordinator to report information about patient pay amount
				changes in an individual's situation.
F. After the support coordinator has received
				written notification of Medicaid eligibility from the local department of
				social services, the support coordinator shall inform the individual, submit
				information to DMAS or its designee to enroll the individual in the waiver, and
				develop the person-centered individual support plan (ISP).
G. Once the providers are chosen, a planning
				meeting shall be held by the support coordinator to develop the ISP based on
				the individual's assessed needs, the individual's preferences, and the
				individual's family/caregiver preferences, as appropriate.
H. Persons invited by the support coordinator
				to participate in the person-centered planning meeting may include the
				individual, providers, and others as desired by the individual. During the
				person-centered planning meeting, the services to be rendered to the
				individual, the frequency of services, the type of provider, and a description
				of the services to be offered are identified and included in the ISP. At a
				minimum, the individual enrolled in the waiver, and the family/caregiver as
				appropriate, and support coordinator shall sign and date the ISP.
I. The individual, family/caregiver, or
				support coordinator shall contact chosen providers so that services can be
				initiated within 30 calendar days of the support coordinator moving the
				individual to active enrollment status in WaMS or confirmation of Medicaid
				eligibility whichever comes last. If the services are not initiated by the
				provider within 30 days, the support coordinator shall notify the local
				department of social services so that reevaluation of the individual's
				financial eligibility can be made.
J. In the event services are not initiated
				within 30 calendar days and the individual wishes to retain the waiver slot,
				the support coordinator will electronically submit a request in WaMS to retain
				the designated slot pending the initiation of services.
1. A copy of the request shall be provided to
				the individual and the individual's family/caregiver, as appropriate.
2. After receipt and approval of the first
				request to retain the slot, DBHDS shall have the authority to approve the
				slot-retention request in 30-day extensions, up to a maximum of four
				consecutive extensions, or deny such request to retain the waiver slot for the
				individual when at the end of each extension time period there is no evidence
				of the individual's efforts to utilize waiver services. All written denial
				notifications to the individual, and family/caregiver, as appropriate, shall be
				accompanied by the standard appeal rights (12VAC30-110).
3. DBHDS shall provide an electronic response
				to the support coordinator indicating denial or approval of the slot extension
				request within 10 working days of the receipt of the request for
				extension.
4. The support
				coordinator shall notify the individual in writing of any denial of the slot
				extension request and the individual's right to appeal.