Developmental Disability Waivers

Overview

The state of Virginia currently offers three Developmental Disability waivers. Moms In Motion (Moms) / At Home Your Way (AHYW) offers the following services (as noted in the table below) under two of the waivers:

  • Community Living (CL)
  • Family and Individual Supports (FIS)
DD Waiver Services Community Living (CL) Family & Individual Supports (FIS)
CD Companion Services
CD Personal Assistance Services
CD Respite
CD Services Facilitation
Assistive Technology*
Environmental Modifications*
Click here for a comprehensive list of additional services offered through these waivers.
*For access to these particular services, please visit Ability Unlimited.

The Process

Criteria

  • Must have documented diagnosis of developmental disability or intellectual disability.
  • Must be eligible for Medicaid when assigned to a waiver.
    • Medicaid eligibility is not necessary when applying for a screening or to be added to the wait list.

Before Requesting a DD Waiver Screening

  • Call the Moms / AHYW Family Resource Specialist team at (800) 417-0908, option 2 for waiver coaching.
    • Waiver coaching includes:
      • Explaining the benefits of applying for a DD Waiver.
        • DD Waivers have a wait list. While waiting, you are eligible to apply for an annual IFSP grant.
        • While CCC Plus Waivers require some medical nursing needs, DD Waivers do not.
      • Discussing potential eligibility for the CCC Plus Waiver or EPSDT.
        • Reviewing eligibility criteria and how to apply for both.
      • What to expect during your screening.
      • Defining an ID/DD diagnosis based on Virginia’s definition.
      • How to respond to questions based on the VIDES and functional capacity.
        • Refer to the Screening section below for more information concerning VIDES.
      • After completing the first VIDES, contacting the assigned Case Manager frequently to keep it updated, as well as scheduling annual meetings with them to keep the VIDES updated.
      • Waiver slots are assigned during the beginning of the state’s fiscal year (July).
        • There are a limited number of emergency slots to be assigned throughout the fiscal year (July – June).

What to Expect After Receiving a CL/FIS Waiver

  • You will be assigned a Support Coordinator.
    • The Support Coordinator will be responsible for guiding the person through what services they are eligible for.
    • The Support Coordinator will schedule a meeting to establish the Individual Support Plan (ISP) with all providers of services.
      • The person will be required to have a physical exam within 1 year of start of services.
      • The person will be required to have a VIDES dated within 6 months of the start of services.
    • If selecting Consumer-Directed Waiver services through the DD Waiver assignment, they may begin the first of the following month if you are transitioning from CCC Plus.
      • If the person is new to all Waivers and is selecting Consumer-Directed Waiver services, those services can begin at any time. 

Screening

  • Contact your local Community Services Board (CSB) to schedule an intake appointment.
  • A case manager will screen the person using the assessment form called the Virginia ID/DD Eligibility Survey (VIDES) that will measure the following:
    • Functional capacity: the level of support needed for ADLs and IADLs.
    • Meet Virginia’s definition of a developmental disability.

I/DD Definition

  • A severe, chronic disability of a person that is:
    • Attributable to a mental or physical impairment, or a combination of mental and physical impairments, other than a sole diagnosis of mental illness.
    • Manifested before the person reaches 22 years of age.
    • Likely to continue indefinitely.
    • Results in substantial functional limitations in three or more of the following areas of major life activity: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency.
    • Reflects the person’s need for a combination and sequence of special interdisciplinary or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are 2 of 3 individually planned and coordinated.
  • A person from birth to age nine, inclusive, who has a substantial developmental delay or specific congenital or acquired condition may be considered to have a developmental disability without meeting three or more of the criteria described above if the person, without services and supports, has a high probability of meeting those criteria later in life.

Wait List

The DD Waivers (CL, FIS, and BI) are coordinated by the local CSB. Waivers are assigned based on the urgency of need for support. People who meet the eligibility criteria are placed on the needs based waiting list due to the limited number of waivers funded. It is not a chronological waiting list. During this waiting period, you are eligible to apply for IFSP.

The CSB staff will assess and discuss the person’s needs and situation to establish their Priority Level of 1, 2, or 3 while on the waiting list. A Critical Needs Summary will be generated which is reviewed and updated annually. If the person’s needs change, a different priority needs score will be generated. The priority needs score is relative to the person’s priority level at the local CSB. Keep a copy of the Critical Needs Summary and contact the case manager/support coordinator when the person’s support needs change or they move. It is recommended to contact the case manager at least annually for the person’s support needs (find your local CSB).

When waiver slots are funded and available for assignment, people with the highest priority needs scores at each local CSB are considered for a waiver. If the person is in the pool of people with the highest scores, then the case manager/support coordinator will prepare a written summary of the person’s needs and situation on the Slot Assignment Review Form and present for review to the Waiver Slot Assignment Committee. Reviews presented to the Committee are anonymous. The Committee scores each person on the Waiver Slot Assignment Scoring Summary to determine who will be assigned waivers.

It is important for Virginia and the Federal Government to know how many people are in need of services and not getting them. Emergency Waivers are assigned by the VA Dept. of Behavioral Health & Developmental Services (DBHDS) to people who meet the Emergency Waiver Criteria. There are a limited number of emergency waivers.

Waiver Assignment

Applying for Medicaid

  • Print and complete a Medicaid Application. Only include information regarding the person requesting Medicaid. Do not complete with the household information, even though it asks for it. If completing for someone else, please answer the questions on behalf of that person, not yourself. Write “CL/FIS (DD Waivers)/Long Term Care” at the top of the form.
  • Print and complete the financial component of the Medicaid Application, known as Appendix D. If completing for someone else, please answer the questions on behalf of that person, not yourself. Do not complete with the household information. Only the income/assets of the person seeking eligibility are considered.
  • Bring completed Application and Appendix D to your local Department of Social Services (DSS) and request a screening for Long Term Care.

Renewing Medicaid

People on the CL/FIS Waiver are required to renew their Medicaid annually. DSS will mail out a renewal application typically the month before the person’s renewal month. You will not be required to have another screening.

Only include information regarding the person requesting Medicaid. Do not complete with the household information, even though it asks for it. If completing for someone else, please answer the questions on behalf of that person, not yourself. Write “CL/FIS (DD Waivers): Medicaid Renewal” at the top of the form.

Section 5: Renewal of coverage in future years (optional) – to make it easier to determine your eligibility for help paying for health coverage in future years, you can agree to allow the Medicaid or FAMIS programs or the Marketplace to use income data, including information from tax returns. You will not receive a renewal application. Instead, you will receive notification of the outcome of your renewal. 5 years is the maximum number of years allowed.

When your waiver has been assigned

    • You will receive a letter or phone call, advising you of your awarded waiver.
      • You will need to accept or deny.
    • You will have an intake meeting with a Case Manager (CM) who will:
      • Complete a Level of Function (LOF)
      • Complete another VIDES to determine functional capacity
      • Require a recent annual physical exam performed by a doctor
    • At this point, you will be required to meet Medicaid eligibility.
    • A Support Coordinator (SC) will be assigned to you to coordinate all services available.
      • Services include but are not limited to:
        • Benefits planning
        • Crisis support services: center-/community-based
        • Community coaching
        • Community engagement
        • Group day service
        • Group/Person supported employment
        • Peer support service
        • For a comprehensive list, click here
    • For services such as Personal Care, Respite, and/or Companion, you will select a model of service delivery and choose a provider.
      • Consumer-Directed:
      •  Agency-Directed:
        • You choose the Agency who will then place their hired staff with you and take responsibility for continued scheduling, staffing, and paperwork.
DD Waiver Services Community Living (CL) Family & Individual Supports (FIS)
CD Companion Services
CD Personal Assistance Services
CD Respite
CD Services Facilitation
Assistive Technology*
Environmental Modifications*
Click here for a comprehensive list of additional services offered through these waivers.
*For access to these particular services, please visit Ability Unlimited.

Consumer-Directed Model

People choosing to receive services through the Consumer-Directed model may do so by choosing an SF to provide the training and guidance needed to be an EOR. As the EOR, the person is responsible for hiring, training, supervising, and firing attendants. The person may choose to designate a person to serve as the EOR on their behalf. If the person is under 18 years of age the parent or responsible adult must serve as the EOR. A person serving as the EOR cannot be the paid caregiver, attendant, or SF. An EOR can only serve on behalf of one person. The only exception to this is that EORs can serve on behalf of multiple people only if the people reside at the same address. All CD services must be authorized by the service authorization contractor and require the services of an SF. Specific duties of the person or EOR, as the employer of the CD personal care attendant, include the following:

  • Checking references
  • Determining that the employee meets basic qualifications
  • Submitting required hiring documentation to the fiscal employer agent (F/EA)
  • Training, supervising performance, and submitting time sheets to the F/EA on a consistent and timely basis

CD attendants are not eligible for Worker’s Compensation, overtime, or holiday pay.

Initial visit with Service Facilitator (Intake)

  • Visit conducted in the home with the person present.
  • Consumer-Directed services and process are explained.
  • EOR is identified and established.
  • Support needs of the people are identified and developed in the Plan of Care (POC).
  • Signatures are collected on all DMAS-required documentation, including the EOR’s contract with the SF.
  • Electronic Visit Verification (EVV) requirement is discussed with the EOR.
  • SF and EOR schedule next visit date.
  • After the intake, the following will occur:
    • Level of Care (LOC) determined and prior-authorization for hours are requested through the Virginia Waiver Management System (WaMS).
    • Fiscal Agent Request Form (FARF) sent to FA to establish the person and EOR with the FA.

Routine on-site visits (Monthly)

  • Visit conducted in the home with the person present.
  • EOR may receive Management Training (MT) on hiring responsibilities and any changes implemented by DMAS.
  • SF and EOR discuss any updates needed for the person’s POC or any changes that have occurred since the last visit. Examples of this may include:
    • Health of the person
    • Medication changes
    • Recent hospitalizations
  • SF and EOR discuss any changes to the person’s support plan (ISP), FA issues, and attendant issues (hiring/onboarding/etc.).
  • Signatures are collected on all DMAS-required documentation.
  • SF and EOR schedule next visit date.

Useful Links

Virginia Sites

Additional Resources

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