reglab/statecodes huggingface dataset:
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-260 - Services covered in the Family and Individual Support Waiver

Current through Register Vol. 40, No. 24, July 15, 2024
A. The Family and
				Individual Support Waiver is designed to support individuals who live with
				their families or in their own homes.
B. The services covered in the Family and
				Individual Support 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 and individual
				supported employment service (12VAC30-122-400 ).
14. In-home support service (12VAC30-122-410
				).
15. Individual and
				family/caregiver training service (12VAC30-122-430 ).
16. Employment and community transportation
				service (12VAC30-122-440 ).
17.
				Peer mentor supports service 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. Supported
				living residential service (12VAC30-122-540 ).
26. Therapeutic consultation service
				(12VAC30-122-550 ).
27. Transition
				service (12VAC30-122-560 ).
28.
				Workplace assistance service (12VAC30-122-570 ).
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-270 - Assistive technology service

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Service description. Assistive technology (AT) service shall entail the
				provision of specialized medical equipment and supplies including those
				devices, controls, or appliances specified in the individual support plan but
				that are not available under the State Plan for Medical Assistance that (i)
				enable individuals to increase their abilities to perform activities of daily
				living (ADLs); (ii) enable individuals to perceive, control, or communicate
				with their environment; (iii) actively participate in other waiver services
				that are part of their plan for supports; or (iv) are necessary for life
				support, including the ancillary supplies and equipment necessary to the proper
				functioning of such items. The AT service shall be covered in the FIS, CL, and
				BI waivers.
B. Criteria and
				allowable activities.
1. To qualify for the
				assistive technology service, the individual shall have a demonstrated need for
				equipment for remedial or direct medical benefit in the individual's primary
				home, primary vehicle, community activity setting, or day program to increase
				his ability to control his environment, support ISP outcomes as identified, and
				live safely and independently in the least restrictive community setting. The
				AT service shall be covered in the least expensive, most cost-effective manner
				and shall be limited to $5,000 per calendar year. There shall be no carryover
				of unspent funds from year to year. The covered equipment and activities shall
				include:
a. Specialized medical equipment and
				ancillary equipment;
b. Durable or
				nondurable medical equipment and supplies that are not otherwise available
				through the State Plan for Medical Assistance;
c. Adaptive devices, appliances, and controls
				that enable an individual to be independent in areas of personal care and ADLs;
				and
d. Equipment and devices that
				enable an individual to communicate more effectively.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-290 - Center-based crisis support service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Center-based crisis
				support service means planned crisis prevention and emergency crisis
				stabilization services in a crisis therapeutic home using planned and emergency
				admissions. Planned admissions shall be provided to individuals receiving
				crisis services and who need temporary, therapeutic interventions outside of
				their home setting to maintain stability. Emergency admissions shall be
				provided to individuals who are experiencing an identified behavioral health
				need or behavior challenge that is preventing them from reaching stability
				within their home settings. Center-based crisis support service shall be
				covered in the FIS, CL, and BI waivers.
B. Criteria and allowable activities.
1. Center-based crisis support service is
				designed for individuals with a history of at least one of the following:
a. Psychiatric hospitalization;
b. Incarceration;
c. Residential or day placement that was
				terminated; or
d. Behavior that has
				significantly jeopardized placement.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-300 - Community-based crisis support service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Community-based
				crisis support service means planned crisis prevention and emergency crisis
				stabilization services provided to individuals experiencing crisis events that
				put them at risk for homelessness, incarceration, or hospitalization or that
				creates danger to self or others. This service shall provide supports to
				individuals in their homes and other community settings. This service provides
				temporary intensive services and supports that avert emergency psychiatric
				hospitalization or institutional placement or prevent other out-of-home
				placement. This service shall be designed to stabilize the individual and
				strengthen the current living situation so that the individual can be
				maintained during and beyond the crisis period. Community-based crisis support
				service shall be covered in the FIS, CL, and BI waivers.
B. Criteria and allowable activities.
1. Community-based crisis support service
				provides ongoing supports to the individual who may have:
a. A history of multiple psychiatric
				hospitalizations, frequent medication changes, or setting changes; or
b. A history of requiring enhanced staffing
				due to the individual's mental health or behavioral issues.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-310 - Community coaching service

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Service description. Community coaching is a service designed for individuals
				who need one-to-one support in a variety of community settings in order to
				build a specific skill or set of skills to address particular barriers that
				prevent individuals from participating in activities of community engagement.
				In addition to skill building, this service includes routine and safety
				supports. Community coaching service shall be covered in the FIS, CL, and BI
				waivers.
B. Criteria and allowable
				activities. Community coaching service shall be provided to individuals who
				require one-to-one support to address identified barriers in their plans for
				supports that prevent them from participating in the community engagement
				service. Community coaching activities shall be documented in the plan for
				supports and be sensitive to the individual's age, abilities, and personal
				preferences. Allowable activities shall include, as may be appropriate for the
				individual as documented in his plan for supports:
1. One-on-one skill building and coaching to
				facilitate participation in community activities and opportunities such as:
a. Activities and public events in the
				community;
b. Community education,
				activities, and events; and
c. Use
				of public transportation if available and accessible.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-320 - Community engagement service

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Service description.
1. Community engagement
				service means a service that supports and fosters an individual's abilities to
				acquire, retain or improve skills necessary to build positive social behavior,
				interpersonal competence, greater independence, employability, and personal
				choices necessary to access typical activities and functions of community life
				such as those chosen by the general population. The community engagement
				service may include community education or training and volunteer
				activities.
2. The community
				engagement service shall provide a wide variety of opportunities to facilitate
				and build relationships and natural supports in the community, while utilizing
				the community as a learning environment. These activities are conducted at
				naturally occurring times and in a variety of natural settings in which the
				individual may actively interact with persons without disabilities, other than
				those who are being paid to support the individual. The activities shall
				enhance the individual's involvement with the community and facilitate the
				development of relationships and natural supports.
3. The community engagement service shall be
				covered in the FIS, CL, and BI waivers.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-340 - Companion service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service
				description. The companion service provides nonmedical care, socialization, or
				general support to adults 18 years of age or older. This service shall be
				provided in either the individual's home or at various locations in the
				community. The companion service may be coupled with waiver residential support
				service as defined in the ISP.
1. The
				companion service shall be provided in accordance with the individual's plan
				for supports to meet an assessed need of the individual for assistance with
				IADLs, community access, reminders for medication self-administration, or for
				support to ensure his safety and shall not be purely recreational in
				nature.
2. The companion service
				may be provided and reimbursed either through an agency-directed or a
				consumer-directed model (12VAC30-122-150 ).
3. The companion service shall be covered in
				the FIS and CL waivers.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-360 - Electronic home-based support service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Electronic home-based
				support service shall provide devices, equipment, or supplies, based on current
				technology to enable the individual to more safely live and participate in his
				community while decreasing the need for other services such as staff supports.
				The equipment or devices shall be purchased for the individual and typically
				shall be installed in the individual's home. Portable hand-held devices may be
				used by the individual at home or in the community. These devices and this
				service shall support the individual's greater independence and self-reliance
				in the community. This service may also include ongoing electronic monitoring,
				which is the provision of oversight and monitoring within the home through
				off-site monitoring. The electronic home-based service shall be covered in the
				FIS, CL, and BI waivers.
B.
				Criteria and allowable activities.
1. In
				order to qualify for the electronic home-based support (EHBS) service, the
				individual shall be at least 18 years of age and capable of using the equipment
				provided via EHBS service.
2. A
				preliminary needs assessment shall be completed by an independent professional
				consultant to determine the best type and use of technology and overall cost
				effectiveness of various options. This assessment shall be submitted to the
				DMAS designee for service authorization prior to the delivery of any goods and
				services and prior to the submission of any claims for Medicaid reimbursement.
				The independent professional consultant conducting the preliminary assessment
				may be an occupational therapist, or other similarly credentialed specialist,
				who is licensed or certified by the Commonwealth and specializes in assistive
				technologies, mobile technologies, and current accommodations for individuals
				with developmental disabilities.
3.
				EHBS service shall support training in the use of these goods and services,
				ongoing maintenance, and monitoring to address an identified need in the
				individual's ISP, including improving and maintaining the individual's
				opportunities for full participation in the community.
4. Items or services purchased through EHBS
				service shall be designed to decrease the need for other Medicaid services,
				such as reliance on staff supports, promote inclusion in the community, and
				increase the individual's safety in the home environment.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-370 - Environmental modifications service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Environmental
				modifications service means physical adaptations to the individual's home or
				primary vehicle that are necessary to ensure the individual's health and
				welfare or to enable functioning with greater independence. Environmental
				modifications service shall be covered in the FIS, CL, and BI
				waivers.
B. Criteria and allowable
				activities.
1. To qualify for environmental
				modifications (EM) service, the individual enrolled in the waiver shall have a
				demonstrated need for:
a. Installation of
				ramps and grab-bars, widening of doorways, modification of bathroom facilities,
				or installation of specialized electric and plumbing systems that are necessary
				to accommodate the medical equipment and supplies that are necessary for the
				individual and are consistent with the plan for supports
				requirements.
b. Modifications to a
				primary automotive vehicle in which the individual is transported that is owned
				by the individual, a family member with whom the individual lives or has
				consistent and ongoing contact, or a nonrelative who provides primary long-term
				support to the individual and is not a paid provider of environmental
				modifications.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-380 - Group day service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service
				description. Group day service means a service provided to help the individual
				acquire, retain, or improve skills of self-help, socialization, community
				integration, career planning, and adaptation via opportunities for peer
				interactions, community integration, and enhancement of social networks. This
				service typically shall be offered in a nonresidential setting. Skill-building
				shall be a component of this service unless the individual has a documented
				progressive condition, in which case group day service may focus on maintaining
				skills and functioning and preventing or slowing regression rather than
				acquiring new skills or improving existing skills. Group day service shall be
				covered in the FIS, CL, and BI waivers.
B. Criteria and allowable activities. For
				group day service, an individual shall demonstrate the need for skill-building
				or supports offered primarily in settings other than the individual's own
				residence that allows the individual an opportunity for being a productive and
				contributing member of his community. In addition, group day service shall be
				available for individuals who can benefit from the supported employment
				service, but who need group day service as an appropriate alternative or in
				addition to the supported employment service.
1. Allowable activities shall include, as may
				be appropriate for the individual as documented in his plan for supports:
a. Developing problem-solving abilities;
				sensory, gross, and fine motor control abilities; and communication and
				personal care skills;
b. Developing
				self, social, and environmental awareness skills;
c. Developing skills as needed in (i)
				positive behavior, (ii) using community resources, (iii) community safety and
				positive peer interactions, (iv) volunteering and participating in educational
				programs in integrated settings, and (v) forming community connections or
				relationships;
d. Supporting older
				adults in participating in meaningful retirement activities in their
				communities (i.e., clubs and hobbies);
e. Skill-building and providing routine
				supports related to ADLs and IADLs.
f. Monitoring the individual's health and
				physical condition and providing supports with medication and other medical
				needs.
g. Providing safety supports
				in a variety of community settings;
h. Career planning and resume developing
				based on career goals, personal interests, and community experiences;
				and
i. Providing routine supports
				and safety supports with transportation to and from community locations and
				resources.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-390 - Group home residential service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Group home
				residential service shall consist of skill-building, routine supports, general
				supports, and safety supports that are provided to enable an individual to
				acquire, retain, or improve skills necessary to successfully live in the
				community. This service shall be provided to individuals who are living in (i)
				a group home or (ii) the home of an adult foster care provider. Group home
				residential service shall be a tiered service for reimbursement purposes (as
				described in 12VAC30-122-210 ) based on the individual's assigned level and
				tier and licensed bed capacity of the home. The number of licensed beds in a
				setting reimbursed for group home residential services shall not exceed six.
				Group home settings larger than six licensed beds that became DD Waiver
				providers prior to March 31, 2021, may continue to operate and receive Medicaid
				reimbursement. If a group home larger than six licensed beds changes ownership,
				the group home will be considered a new setting and the licensed bed capacity
				limit of six beds shall apply for Medicaid reimbursement purposes. Group home
				residential service shall be provided to the individual continuously up to 24
				hours per day performed by paid staff that shall be physically present. This
				service may be provided either individually or simultaneously to more than one
				individual living in that home, depending on the required support. Group home
				residential service shall be covered in the CL waiver.
B. Criteria and allowable activities.
1. The allowable activities shall include, as
				may be appropriate for the individual as documented in his plan for supports:
a. Skill-building and providing routine
				supports related to ADLs and IADLs;
b. Skill-building and providing routine
				supports and safety supports related to the use of community resources, such as
				transportation, shopping, restaurant dining, and participating in social and
				recreational activities;
c.
				Supporting the individual in replacing challenging behaviors with positive,
				accepted behavior for home and community environments;
d. Monitoring the individual's health and
				physical condition and providing supports with medication and other medical
				needs;
e. Providing routine
				supports and safety supports with transportation to and from community
				locations and resources;
f.
				Providing general supports, as needed; and
g. Providing safety supports to ensure the
				individual's health and safety.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-410 - In-home support service

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Service description. In-home support service means a residential service that
				takes place in the individual's home, family home, or community settings that
				typically supplement the primary care provided by the individual, family, or
				other unpaid caregiver and is designed to ensure the health, safety, and
				welfare of the individual. The individual shall be living in his own home or
				his family home. This service shall include a skill building (formerly called
				training) component, along with the provision of supports that enable an
				individual to acquire, retain, or improve the self-help, socialization, and
				adaptive skills required for successfully living in his community. In-home
				support service shall be covered in the FIS and CL waivers.
B. Criteria and allowable activities. To be
				eligible for in-home support service, individuals shall require help with
				adaptive skills necessary to reside successfully in the home and
				community-based settings.
Allowable activities include the following as may be
				  appropriate for the individual as documented in his plan for supports:
1. Skill-building and routine supports
				related to ADLs and IADLs;
2.
				Skill-building, routine supports, and safety supports related to the use of
				community resources, such as transportation, shopping, dining at restaurants,
				and participating in social and recreational activities;
3. Supporting the individual in replacing
				challenging behaviors with positive, accepted behaviors for home and community
				environments;
4. Monitoring the
				individual's health and physical condition and providing routine and safety
				supports with medication or other medical needs;
5. Providing supports with transportation to
				and from community sites and resources; and
6. Providing general supports as
				needed.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-420 - Independent living support service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Independent living
				support service means a service provided to adults 18 years of age and older
				that offers targeted skill building and supports necessary for individuals to
				secure and maintain their own home in the community. An individual receiving
				this service typically lives alone or with roommates in the individual's own
				home or apartment. The supports may be provided in the individual's residence
				or in other community settings. Independent living support service shall be
				covered in the BI waiver.
B.
				Criteria and allowable activities. The need for independent living support
				service shall be clearly indicated in the ISP. Independent living support
				service shall be authorized for Medicaid reimbursement only when the individual
				requires this service and the service is set out in the plan for supports. This
				service shall include a skills development component along with the provision
				of supports as needed. Allowable activities include the following:
1. Skill building and supports necessary to
				promote the individual's stability in the individual's own home and community
				in the absence of a primary caregiver living in the residence;
2. Skill-building and supports to promote the
				individual's community participation and inclusion in meaningful
				activities;
3. Skill-building and
				supports to increase the individual's socialization skills and maintain
				relationships;
4. Skill-building
				and supports to improve and maintain the individual's health, safety, and
				fitness, as necessary;
5.
				Skill-building and supports to promote the individual's decision-making and
				self-determination;
6.
				Skill-building and supports to improve and maintain, as needed, the
				individual's skills with ADLs and IADLs;
7. Routine supports with transportation to
				and from community locations and resources; and
8. General supports, as needed.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-430 - Individual and family/caregiver training service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Individual and
				family/caregiver training service provides training and counseling to
				individuals, families, or caregivers of individuals enrolled in the waiver
				including participation in educational opportunities designed to improve the
				family's or caregiver's ability to care for and support the individual enrolled
				in the waiver. This service shall also provide educational opportunities for
				the individual to better understand his disability and increase his
				self-determination and self-advocacy. Individual and family/caregiver training
				service shall be covered in the FIS waiver.
B. Criteria and allowable activities.
1. Individuals who are enrolled in the FIS
				waiver and their family/caregivers, as appropriate, may participate in this
				service. DMAS shall cover this service as authorized by the individual's
				ISP.
2. For the purpose of this
				service, "family" means the same as set forth in 12VAC30-122-20.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-440 - Employment and community transportation service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. This service is
				offered in order to enable individuals to gain access to an individual's place
				of employment or volunteer activity, other community services or events,
				activities and resources, homes of family or friends, civic organizations or
				social clubs, public meetings or other civic activities, and spiritual
				activities or events as specified by the support plan and when no other means
				of access is available. The goal of this service is to promote the individual's
				independence and participation in the life of the individual's community. Use
				of this service shall be related to the individual's desired outcomes as stated
				in the ISP. This service is offered in addition to medical transportation
				required under 42 CFR 431.53 and transportation services under the State Plan,
				defined at 42 CFR 440.170(a), and does not replace them.
B. Criteria and allowable activities.
1. The service may include transportation in
				a private vehicle by a person such as a coworker or other community member or
				the purchase of tickets for public transportation such as bus or subway. In
				either case, an administering agency shall coordinate and bill DMAS.
2. Up to three individuals may be transported
				in a single, private vehicle per trip.
3. The administering agency will ensure that
				pertinent information about the individual is relayed to the driver.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-460 - Personal assistance service

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Service description. Personal assistance service may be provided either through
				an agency-directed or a consumer-directed model.
1. Personal assistance service means direct
				support or supervision with (i) ADLs, (ii) IADLs, (iii) access to the
				community, (iv) monitoring the self-administration of medication or other
				medical needs, (v) monitoring health status and physical condition, or (vi)
				work or postsecondary school-related personal assistance. Personal assistance
				service substitutes for the absence, loss, diminution, or impairment of a
				physical, behavioral, or cognitive function.
2. When specified in the plan for supports,
				personal assistance service may include assistance with IADLs. Assistance with
				IADLs shall be documented in the plan for supports as essential to the health
				and welfare of the individual, rather than for the individual's
				family/caregiver's comfort or convenience, or both. In order to be approved for
				IADL support, the individual shall also require ADL supports.
3. An additional component to personal
				assistance service is work personal assistance or postsecondary school-related
				personal assistance that allows the personal assistance service provider to
				provide assistance and supports to individuals in the workplace and
				postsecondary educational institutions. Work-related personal assistance
				service shall not duplicate supported employment service. Personal assistance
				can be provided simultaneously with supported employment services and can be
				billed concurrently.
4. Personal
				assistance service shall be covered in the FIS and CL waivers.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-470 - Personal emergency response system service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Personal emergency
				response system (PERS) service is an electronic device and monitoring service
				that enables certain individuals to secure help in an emergency. PERS service
				shall be limited to those individuals who live alone or are alone for
				significant parts of the day and who have no regular caregiver for extended
				periods of time and who would otherwise require supervision. PERS service shall
				be covered in the FIS, CL, and BI waivers.
B. Criteria. PERS may be authorized when
				there is no one else in the home with the individual enrolled in the waiver who
				is competent or continuously available to call for help in an
				emergency.
C. Service units and
				service limitations.
1. The one-time
				installation of the unit shall include installation, account activation,
				individual and caregiver instruction, and removal of PERS equipment. A unit of
				service is the one-month rental price set by DMAS.
2. PERS service shall be capable of being
				activated by a remote wireless device and shall be connected to the
				individual's telephone system. The PERS console unit shall provide hands-free
				voice-to-voice communication with the response center. The activating device
				shall be waterproof, automatically transmit to the response center an activator
				low battery alert signal prior to the battery losing power, and be able to be
				worn by the individual.
3. PERS
				service shall not be used as a substitute for providing adequate supervision
				for the individual enrolled in the waiver.
4. Physician-ordered medication monitoring
				units shall be provided simultaneously with PERS service.
5. PERS service shall not be covered for
				individuals who are simultaneously receiving group home residential service,
				sponsored residential service, or supported living residential
				service.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-480 - Private duty nursing service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Private duty nursing
				(PDN) service means individual and continuous nursing care that shall be
				provided due to the intensity of medical supports required by individuals who
				have complex health care needs that have been certified by a physician as
				medically necessary to enable the individual to remain at home rather than in a
				hospital, nursing facility, or ICF/IID.. PDN shall be provided on a one-to-one
				basis, and cannot be provided concurrently with skilled nursing services,
				personal assistance services, respite services, or companion services.
				Individuals receiving PDN services shall not be authorized for skilled nursing
				services except in the case of nurse delegation responsibility activities. PDN
				shall support and not replace caregiver responsibilities. PDN service shall be
				covered in the FIS and CL waivers.
B. Criteria and allowable activities.
1. The individual shall require PDN service
				that has been certified by a Virginia-licensed physician as medically necessary
				to enable the individual to remain at home or otherwise in the community rather
				than in a hospital, a nursing facility, an ICF/IID, or any other type of
				institution.
2. The medical
				necessity for PDN service shall be documented in the individual's ISP. Once the
				medical necessity can no longer be demonstrated, this service shall be
				terminated.
3. Allowable activities
				shall include:
a. On-going monitoring of an
				individual's medical status as it relates to the specified medical and nursing
				needs;
b. Administering medications
				or other medical treatment; and
c.
				Assistance with ADLs in conjunction with medical treatment and care.
d. Training for family or other caregivers in
				relation to those activities that are part of the nursing plan for supports.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-490 - Respite service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service
				description.
1. Respite service is temporary,
				substitute care that is normally provided on a short-term basis for temporary
				relief of the primary caregiver.
2.
				Respite service enables an individual to maintain the health status and
				functional skills necessary to live in the community or participate in
				community activities.
3. Respite
				service may be provided either through an agency-directed or consumer-directed
				model. Respite service shall be provided:
a.
				In home and community settings, which may be based in the individual's home;
				or
b. Under the agency-directed
				model by enrolled providers licensed to provide center-based respite service,
				to include a group home or a sponsored residential home.
4. Respite service shall be covered in the
				FIS and CL waivers.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-510 - Shared living service

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Service description. Shared living service means Medicaid coverage of a portion
				of the total cost of rent, food, and utilities that can be reasonably
				attributed to a live-in roommate who has no legal responsibility to financially
				support the individual who is enrolled in the waiver. The types of assistance
				provided are expected to vary from individual to individual and shall be set
				out in a detailed, signed, and dated agreement between the individual and
				roommate. This service shall require the use of a shared living service
				administrative provider enrolled with DMAS that shall be responsible for
				directly coordinating the service and directly billing DMAS for reimbursement.
				Shared living service shall be covered in the FIS, CL, and BI
				waivers.
B. Criteria and allowable
				activities.
1. The individual, who shall be
				at least 18 years of age, shall select his roommate, who shall also be at least
				18 years of age, and, together through a person-centered planning process, they
				shall determine the assistance to be provided by the roommate based on the
				individual's needs and preferences. The individual shall reside in his own home
				or in a residence leased by the individual.
2. Reimbursable room and board for the
				roommate shall be established through the service authorization process per the
				CMS-approved rate methodology.
3.
				The individual shall be receiving at least one other waiver service in order to
				receive Medicaid coverage of shared living service.
4. Allowable activities shall include:
a. Fellowship, which means a close
				association or communion with friends or equals with whom an individual has
				shared interests, experiences, and purpose ;
b. Safety supports;
c. Limited help with ADLs and IADLs that
				shall account for no more than 20% of the anticipated roommate time and may
				include:
(1) Meal preparation;
(2) Light housework;
(3) Medications reminders; and
(4) Routine prompting or intermittent direct
				assistance with ADLs.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-520 - Skilled nursing service

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Services description. Skilled nursing service shall provide intermittent care,
				up to, but not to exceed 21 hours per week, that may be provided concurrently
				with other services due to the medical nature of the supports provided,
				excluding private duty nursing services. Skilled nursing service shall be
				provided for individuals enrolled in the waiver having serious medical
				conditions and complex health care needs who have exhausted their home health
				benefits and who require specific skilled nursing services. Skilled nursing
				service shall be covered in the FIS and CL waivers.
B. Criteria and allowable activities. The
				individuals who are authorized to receive this service shall require specific
				skilled nursing service as documented in the plan for supports and ordered by a
				physician. This service shall be rendered to the individual in his residence or
				other community settings on a regularly scheduled or intermittent basis in
				accordance with the plan for supports. Allowable activities shall be ordered
				and certified as medically necessary by a Virginia-licensed physician. The
				ordered services may include:
1.
				Administering medications and other medical treatment;
2. Skilled training of family and other
				caregivers;
3. Monitoring an
				individual's medical status;
4.
				Consultation, guidance, and delegation of skilled tasks to direct support staff
				in accordance with
				18VAC90-19-280;
				or
5. Assurance that all items
				listed in subdivisions B 1 through B 4 of this section are carried out in
				accordance with the plan for supports.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-530 - Sponsored residential service

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Service description. Sponsored residential service means a residential service
				that consists of skill-building, routine supports, general supports, and safety
				supports that are provided in the homes of families or persons (sponsors)
				providing supports under the supervision of a DBHDS-licensed provider that
				enable an individual to acquire, retain, or improve the self-help,
				socialization, and adaptive skills necessary to reside successfully in home and
				community settings. This service shall include skills development with the
				provision of supports, as needed. Sponsored residential service shall be
				covered in the CL waiver.
B.
				Criteria and allowable activities.
1. This
				service shall only be authorized for Medicaid reimbursement when through the
				person-centered planning process this service is determined necessary to meet
				the individual's needs. This service may be provided individually or
				simultaneously to up to two individuals living in the same home, depending on
				the required support.
2. Allowable
				activities shall include:
a. Skill-building
				and routine supports related to ADLs and IADLs;
b. Skill-building and routine and safety
				supports related to the use of community resources, such as transportation,
				shopping, restaurant dining, and participating in social and recreational
				activities. The cost of participation in the actual social or recreational
				activity shall not be reimbursed;
c. Supporting the individual in replacing
				challenging behaviors with positive, accepted behaviors for home and community
				environments;
d. Monitoring and
				supporting the individual's health and physical condition and providing
				supports with medication management and other medical needs;
e. Providing routine supports and safety
				supports with transportation to and from community locations and
				resources;
f. Providing general
				supports, as needed; and
g.
				Providing safety supports to ensure the individual's health and
				safety.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-540 - Supported living residential service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service description. Supported living
				residential service shall take place in a residential setting operated by a
				DBHDS-licensed provider of supervised living residential service or supportive
				in-home service and consists of skill-building, routine and general supports,
				and safety supports that enable an individual to acquire, retain, or improve
				the self-help, socialization, and adaptive skills necessary to reside
				successfully in home and community-based settings. Supported living residential
				service shall be authorized for Medicaid reimbursement in the plan for supports
				only when the individual requires this service. This service shall include a
				skills development component along with the provision of supports, as needed.
				Supported living residential service shall be covered in the FIS and CL
				waivers.
B. Criteria and allowable
				activities.
1. Skill-building and routine
				supports related to ADLs and IADLs;
2. Skill-building and routine and safety
				supports related to the use of community resources such as transportation,
				shopping, restaurant dining, and participating in social and recreational
				activities. The cost of participation in the actual social or recreational
				activity shall not be reimbursed;
3. Supporting the individual in replacing
				challenging behaviors with positive, accepted behaviors for home and
				community-based environments;
4.
				Monitoring and supporting the individual's health and physical conditions and
				providing supports with medication or other medical needs;
5. Providing routine supports and safety
				supports with transportation to and from community locations and
				resources;
6. Providing general
				supports as needed; and
7.
				Providing safety supports to ensure the individual's health and
				safety.
Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 122 - COMMUNITY WAIVER SRVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES › Section 12VAC30-122-560 - Transition service

Current through Register Vol. 40, No. 24, July 15, 2024
A. Service
				description. Transition service shall be consistent with the requirements and
				limits set out in
				12VAC30-120-2010.
B. Criteria and allowable required
				activities. This service shall be the same as set out in
				12VAC30-120-2010.
C. Service units and limits shall be the same
				as those set out in
				12VAC30-120-2010.
D. Provider requirements shall be the same as
				those set out in
				12VAC30-120-2010.
				All transition service provided in this waiver shall be reimbursed consistent
				with the agency's service limits and payment amounts as set out in the fee
				schedule.
E. Service documentation
				and requirements shall be the same as those set out in
				12VAC30-120-2010.
F. Transition service is covered in the FIS,
				CL, and BI waivers.
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 12VAC30-122-570 - Workplace assistance service

Current through Register Vol. 40, No. 24, July 15, 2024
A.
				Service description. Workplace assistance service means supports provided to an
				individual who has completed job development and completed or nearly completed
				job placement training (i.e., individual supported employment) but requires
				more than the typical job coach services, as in 12VAC30-122-400, to maintain
				stabilization in his employment. This service is supplementary to individual
				supported employment service. Workplace assistance service shall be covered in
				the FIS and CL waivers.
B. Criteria
				and allowable activities.
1. The activity
				shall not be work skills training that would normally be provided by a job
				coach.
2. This service shall be
				delivered in their natural employment setting, where and when the service is
				needed.
3. The service shall
				facilitate the maintenance of and inclusion of the individual in an employment
				situation.
4. Allowable activities
				include:
a. Habilitative supports related to
				nonwork skills needed for the individual to maintain employment such as
				appropriate behavior, health maintenance, time management, or other skills
				without which the individual's continued employment would be
				endangered;
b. Habilitative
				supports needed to make and strengthen community connections;
c. Routine supports with personal care needs;
				however, this cannot be the sole use of workplace assistance service;
				and
d. Safety supports needed to
				ensure the individual's health and safety.