Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-280 - Benefits planning service

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Service description. Benefits planning is an individualized analysis and
				consultation service. This service assists recipients of a DD Waiver and social
				security (SSI, SSDI, SSI/SSDI) to understand their personal benefits and
				explore their options regarding working, how to begin employment, and the
				impact employment will have on their state and federal benefits. This service
				includes education and analysis about current benefits status and
				implementation and management of state and federal work incentives as
				appropriate. Benefits planning involves the development of written resource
				materials that aid individuals and their families/legal representatives in
				understanding current and future rewards that come from working, thereby
				reducing uncertainties associated with losing necessary supports and benefits
				if they choose to work or stay on the job. This service facilitates individuals
				in making informed choices concerning the initiation of work. Furthermore, it
				provides information and education to individuals currently employed in making
				successful transition to financial independence.
B. Criteria and allowable activities. Each of
				the allowable activities is available contingent on the individual meeting
				criteria for receipt of the service activity. Receipt of this service shall not
				be tied to the receipt of any other covered waiver or Medicaid service. This
				service may be authorized one time per allowable activity per individual per
				calendar year. However, a service may be reauthorized within a calendar year if
				the individual's situation has changed in terms of disability conditions,
				benefit type, or employment status. Allowable activities include the following,
				which may be appropriate for the individual as documented in his plan for
				supports:
1. Pre-employment benefits review
				that may include:
a. Benefits planning query
				(BPQY) from Social Security Administration (SSA). Description: A BPQY provides
				information about an individual's disability cash benefits, health insurance,
				scheduled continuing disability reviews, representative payee, and work
				history, as stored in SSA's electronic records. The BPQY is an important
				planning tool for the individual or other person who may be developing
				customized services for an individual who expresses interest in employment or
				remaining on the job.
b.
				Pre-employment benefits summary and analysis (BS&A). Description: Work with
				and on behalf of the individual to develop a benefits and net income analysis
				report with both a current scenario and at least two other potential scenarios
				involving Social Security work incentives.
c. Employment change benefits summary and
				analysis. Description: Work with and on behalf of the individual when the
				individual experiences a change in employment status to develop a benefits and
				net income analysis report with both a current scenario and at least two other
				potential scenarios involving Social Security work incentives.