Other Waiver Roles

Backup Plan

A Backup caregiver is a secondary person who assumes the role of providing direct care to and support of a person in instances of emergencies and in the absence of the primary caregiver who is unable to care for the person. The backup caregiver shall perform the duties needed by the person without compensation and shall be trained in the skilled needs and technologies required by the person. The backup caregiver shall be identified in the person’s records.
 

The inability to identify and document a Backup caregiver for the Primary Caregiver, may result in termination of home and community based services (HCBS).

DD Support Coordinator (SC)

Support Coordinators are employed by the Department of Behavioral Health and Developmental Services (DBHDS) in Community Services Board (CSB) offices throughout Virginia. They are responsible for determining eligibility for CL, FIS, and BI waivers when allocated funds for slots are available.

Support coordination consists of assessing and planning of services; linking the person to services and supports identified in the person’s support plan; assisting the person directly for the purpose of locating, developing, or obtaining needed services and resources; coordinating services and service planning with other agencies and providers involved with the person; enhancing community integration; making collateral contacts to promote the implementation of the person’s support plan and community integration; monitoring the person to assess ongoing progress and ensuring that authorized services are delivered; and educating and counseling the person to guide them to develop supportive relationships that promote the person support plan.

MCO Care Coordinator

Care Coordinators are employed by respective Managed Care Organizations (MCOs). In Virginia, those MCOs are:

  • Aetna
  • Anthem
  • Magellan
  • Optima
  • United Healthcare
  • VA Premier

Care Coordinators are responsible for completing Health Risk Assessments (HRA) for newly enrolled members and reassessments every 6 months. HRAs are comprehensive assessments of a member’s medical, psycho-social, cognitive, and functional status in order to determine their medical, behavioral health, Long-term Services and Supports (LTSS), and social needs.

The MCO will assign a Care Coordinator to work with the person and their doctor to create a health care plan tailored to their needs. The Care Coordinator can answer questions about health benefits and help the person get the care they need. The Care Coordinator will:

  • Be the main contact for questions about healthcare services.
  • Ask questions about the person’s health.
  • Work with the person to make a written plan to help them meet their health goals.
  • Help make doctor appointments if needed.
  • Help find transportation for doctor visits.
  • Make sure the person has all preapprovals and referrals when needed.
  • Help the person access community and social services.
  • Talk with the person and their health care team to make sure their needs are met.

Care Coordination Helpline:

  • Aetna Better Health: 1-855-652-8249
  • Anthem Healthkeepers Plus: 1-855-323-4687
  • Magellan Complete Care of VA: 1-800-424-4524
  • Optima Health Community Care: 757-552-8398
  • United Healthcare Community Plan: 1-866-622-7982
  • Virginia Premier Health Plan: 1-877-719-7358

Primary Caregiver (PCG)

A Primary Caregiver is the primary person who consistently assumes the role of providing direct care and support of the person to live successfully in the community without compensation for providing such care.
 
Translate »
Scroll to Top