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EDCD (CCC+) Waiver Process

Waiver Screening for Children

Effective July 1, 2017, the state will combine what is currently the EDCD waiver and the Technology Assisted waiver into one new waiver called the CCC Plus Waiver (not to be confused with the CCC Plus Program). If you are on the EDCD waiver, you will automatically be switched over to the new waiver and do not need to do anything.

The EDCD Waiver is a Medicaid program for elderly and individuals with disabilities, to receive services in their homes and communities. These services can be consumer directed.


The Application Process – Two Approvals Needed:

Apply for Medicaid:

  1. Online – CommonHelp – Apply for Assistance (Medical Assistance for the individual and Appendix D).
  2. For live assistance completing this form, call (855) 242-8282 (available in English and Spanish).
  3. On paper – Bring a completed financial application for Adult Medicaid and Appendix D to your local Department of Social Services (DSS) and request a screening for Long Term Care.
  4. Write “EDCD/Long Term Care Screening” on the top of the form.
  5. Print The Application:
    1. English Version
    2. Spanish Version
  6. Print The Appendix D
  7. Find Your Local DSS
  8. For children, find your local DOH

Waiver Screening – A social worker from DSS or a nurse from the local Department of Health (DOH) will schedule an assessment with you. Click here to see list by county (list is updated frequently and could be out of date, contact DSS as needed – keep in mind, financial application must be done with DSS even if screening is done with DOH.):

  1. This should take place in your home.
  2. The individual must be in attendance.
  3. The team will use the Uniform Assessment Instrument to assess the individual.
  4. They will be looking for (see Pre-Admission Screening Manual Appendix B for details):
    1. A Disability
    2. Functional Dependencies (see Functional Dependency Categories for details and specific Criteria)
      1. Criteria for Joint Motion:
        1. Ability to move his or her fingers, arms and legs.
        2. Active ROM (ability to move own extremities)
        3. Passive ROM (assisted movement by others)
      2. Criteria for Medication Administration:
        1. Medication Administration refers to the person(s) who administers medications such as the child and caregiver as a unit, the child as age appropriate, or if the child is being referred elsewhere, the person(s) who will administer medications following referral.
      3. Criteria for Behavior Pattern and Orientation:
      4. Behavior Pattern is the manner of conducting oneself within one’s environment.
      5. Orientation is the awareness of an individual within his or her environment in relation to time, place, and person.
      6. Screening considerations for children, as age appropriate, include: assistance to engage in safe actions and interactions; refrain from unsafe actions and interactions; exhibits disruptive or dangerous behavior such as: verbal and physical abuse to self or others; wandering; removing or destroying property; acting in a sexually aggressive manner; reported neurological impairment; hyper/hypo sensitivity to external stimulus; constant vocalizations/perseveration; impaired safety skills; engages in smearing behavior; sleep deprivation; reported cognitive impairment; lack of awareness; unable to respond to cues; unable to communicate basic needs and wants; disorientation/disassociation; unable to follow directions; unable to process information or social cues; and unable to recall personal information. If the child exhibits any of these, as age appropriate, score accordingly.
    3. Medical/Nursing Needs
    4. Risk of Placement with Specialized Care (It is often helpful to have a letter from your physician supporting this need)

What are the Criteria?

  1. A Child may meet the criteria for Risk of Placement with Specialized Care when ONE of the following is true:
    1. Rated dependent in two to four ADLs AND also rated semi-dependent OR dependent in behavior pattern AND orientation, AND also semi-dependent in joint motion OR dependent in medication administration.
    2. Rated dependent in five to seven ADLs AND also rated dependent in mobility.
    3. Rated semi-dependent in five to seven of the ADLs AND also rated dependent in mobility AND behavior pattern AND orientation.
    4. ADLs Examples:
      1. Bathing
      2. Dressing
      3. Toileting
      4. Transferring
      5. Eating/Feeding
      6. Bowel/Bladder Continence
      7. Mobility
  2. Must have Medical / Nursing Needs (Medical or nursing supervision or care is required when the Child meets ONE of the following requirements):
    1. The Child’s medical condition requires observation and assessment to assure evaluation of the child’s need for modification of treatment or additional medical procedures to prevent destabilization and the child, as developmentally appropriate, has demonstrated an inability to self – observe or evaluate the need to contact skilled medical professionals.
    2. Due to the complexity created by the child’s, multiple, inter-related medical conditions, the potential for the child’s medical instability in high or medical instability exists.
    3. The Child requires at least one ongoing medical or nursing service. Ongoing refers to the need for daily direct care and/or supervision by a licensed nurse that cannot be managed on an outpatient basis.
  3. AND – Risk For Placement with Specialized Care (“individual’s current condition and available support are insufficient to enable the individual to remain in the home.” – Va Regs):
    1. Evidence that deterioration in individual’s condition or change in support prevents needs from being met:
    2. Behaviors increasing
    3. Medical condition worsening
    4. Change in family situation (new child, deployment, new demands from other family members)
    5. No change in condition or support, but evidence that functional, medical or nursing needs are not being met:
      1. Not able to potty train
      2. Unable to manage all therapies
  1. When Department of Social Services or Department of Health asks you to define “Imminent Risk”:
  • The regulation DOES NOT REQUIRE THAT A FAMILY WOULD PUT THE INDIVIDUAL IN A SPECIALIZED CARE FACILITY if they don’t get help.
    • The individual meets the Imminent Risk criteria if:
      • They have been accepted to a specialized care facility
      • Their health is deteriorating such that they WILL require a specialized care facility placement in 30 days
      • Even if their health is NOT deteriorating, if a doctor certifies that they have health care needs that cannot be met at home without additional services.

After Approval

  1. Select Model of Service Delivery and Choose Provider
    1. Agency Directed:
      1. You chose an agency.
      2. They place their hired staff with you.
    2. Consumer Directed:
      1. You are the boss.
      2. You choose a provider such as Moms In Motion to be your “Service Facilitator.”
      3. You hire and schedule your own attendants.
      4. A Service Facilitator helps you continually.

If You Choose Consumer-Directed Care:

Service Facilitator Conducts Initial Visit:

  1. Trains Employer of Record (EOR) on hiring procedures.
  2. Initiates process by contacting Medicaid’s Fiscal Agent (PPL).
  3. Conducts initial assessment.
  4. Creates Plan of Care (POC).
  5. Estimates how many hours the Individual will qualify for.

Post Initial Meeting:

  1. Service Facilitator – Requests prior-authorization for hours through a prior authorization 3rd party.
  2. EOR is set up to be employer.
  3. EOR recruits, hires, and schedules attendants.

To Review the DMAS EDCD Waiver Manual (manual will be updated to the CCC Plus Waiver manual when it becomes available):

Visit DMAS’s Website:

https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/ProviderManual

Select the drop down option of: “Elderly or Disabled with Consumer Direction Services.” This will return all the chapters of the manual.  Chapter four outlines the services available via this waiver.

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