Virginia launched its new Developmental Disabilities (DD) Medicaid Waiver Program on Sept. 1, 2016. The DD Waiver Program is in a period of transition as it implements many system changes.
NEW Customized Rates July 2017 Customized rates are for individuals who have exceptional medical and/OR behavioral support needs that outweigh the resources available within the current waiver reimbursement rate structure. As a result the customized rate may result in: higher level staffing ratios Or
higher credentialed direct support staff to ensure proper supports is given AND Increased programmatic costs. Customized Rate Guidelines
The Community Living Waiver, the former Intellectual Disability Waiver, is one of the three Developmental Disability Waivers. It has new eligibility requirements, services, reimbursement rates and other changes. It serves people of any age with the most comprehensive continuum of services available in the Developmental Disabilities Waiver Program.
The Community Living (CL) Waiver provides services and supports in the areas of community engagement, employment, day services, residential, crisis, medical, assistive and Smart Home technology, environmental modifications and more.
Services are provided by agencies and some services are also available in the consumer/self-directed model of service delivery. Consumer directed services allow you/family caregiver to direct and control whom, how, and when services are provided.
If you are interested in applying for the Community Living Waiver and are not already on the Developmental Disability Waiver Wait List list or receiving the Building Independence or Family and Independence Waiver then go to “Medicaid Waivers” to find out how to apply for the Community Living Waiver in the Developmental Disabilities Waiver Program.
- Screened and found eligible by your local Community Services Board.
- Meet the Definition of Developmental Disability.
- Meet the VIDES screening criteria. Every year, individuals using the Waiver are re-screened with the VIDES to determine if they continue to meet the criteria for the waiver.`VIDES ADULT,VIDES CHILD, VIDES INFANT.
- Meet Adult monthly income limit of $2,205.00
- Qualify and maintain Medicaid eligibility. To utilize the waiver and to maintain the waiver you must be qualified for Medicaid. Click to view how to Apply for Medicaid by phone, online or at your local Department of Social Services. It is very important that you renew your Medicaid eligibility annually through your local Dept. of Social Services. If you move be sure to notify your local Dept. of Social Services of your new address.
Case Management/Support Coordination with Choice of Case Manager
- Case management services are provided by your local Community Services Board (CSB) or another organization approved by your local CSB.
- You have a choice of case manager/support coordinator within the CSB.
- You may request to change your case manager at any time.
- You may request to receive services from another CSB or another organization that is approved by your local CSB.
Supports Intensity Scale or “SIS”
Individuals receiving the waiver have their support needs assessed with the Supports Intensity Scale or the “SIS”. It measures needs in the areas of home and community living, lifelong learning, social activities, health, safety, employment, protection and advocacy. The interview questions focus on the support(s) you need if you were to do activities like any other person of the same age living in the community without a disability.
The SIS assessment is performed by Ascend, a contractor for the VA Dept. of Behavioral Health & Developmental Services. Participants at the SIS assessment in addition to you and your case manager, may include family, friends, service providers and others who know you well.
The SIS is performed at the time of receiving a waiver and it is performed every three years thereafter for individuals 16 years and older. It is performed every two years for children up to age 16. If there are significant changes in the your/the individual’s condition, a new SIS assessment may be requested.
The SIS uses a formula to assign a SIS Score and a Support Level for ADULTS. The Support Level determines the reimbursement rate paid to your service providers. Your case manager will provide you with your SIS report and your Support Level. Click to view the Support Levels.
Only SIS procedures may be reviewed. There is no appeal process. The SIS procedures (not score) may be reviewed if there is evidence that the VA Standard Operating Procedures were not followed. Click to view details about the SIS Review Process.
Find more information here about the SIS:
ISupport Levels, Tiers and Reimbursement Rates
There are seven supports needs levels for adults determined by the Supports Intensity Scale (SIS) and Supplemental Questions. The support levels are tied to four reimbursement tiers to pay service providers. Click to view the Support Levels and Tiers.
Some services (group home, sponsored residential, supported living, independent living, group day, community engagement and group supported employment) are reimbursed according to tiers. This process provides greater reimbursement for smaller settings and for supporting individuals with more intensive needs.
Click to view the Reimbursement Rates for waiver service providers.
Click to view more detail about the services with side by side comparison of all DD Waiver services.
Note that not all services are available in all areas of the state.
See Important Note re: Access to Services below.
Individual Support Plan with Person-Centered Planning
Your Individual Support Plan (ISP) sets out the supports, services and actions to be taken during the year by each service provider to achieve your desired outcomes. Your case manager plans and coordinates the ISP meeting time with you. Others who are important to you such as family, friends and service providers may participate at the meeting.
- Your needs, preferences and desires are the basis of your person-centered ISP.
- You have right to choose the services and supports you desire to meet your aspirations, health, safety and other needs.
- A list of qualified providers should be provided to you.
- You may visit, interview and research providers.
- You may decide how and when services will be provided in the most integrated setting of your choosing.
Click to view the Waiver Services with a side by side comparison of the services in each of the waivers.
Changing Services and Waivers
You may want to add or change the waiver services you are receiving. You may request a change at any time. New interests, preferences, age, housing, health and family conditions may require that you change your services within the waiver you have OR you may need to move to another waiver.
When you need changes in services or the type of waiver, discuss this with your case manager and request the changes you want.
Important Note re: Access to Services:
- You have the right to receive any service in the DD Waiver program that helps you to live, work, or recreate in the most integrated setting that meets your support needs.
- You have the right to receive services in non-disability specific settings (meaning in the community where anyone with or without a disability would go).
- If you are having trouble accessing integrated services, for any reason including a lack of providers, the VA Dept. of Behavioral Health and Developmental Services (DBHDS) has a team of Community Resource Consultants tasked to trouble-shoot access issues, Regional Support Teams tasked to trouble-shoot unresolved access issues and record data. Ask your case manager/support coordinator to contact the Resource Consultants or the Regional Support Team to assist.
- If you have complex support needs, either medical or behavioral, the Complex Case Consultation Team will help trouble shoot complex access issues, including negotiating a reimbursement rate to providers to cover the cost of care.
- If you are unable to access services, please ask your case manager to contact your local Community Resource Consultant (CRC) to help troubleshoot.
Appeal Rights: You have the right to challenge decisions and actions regarding Medicaid and waiver services. An Appeal must be requested within 30 days of the decision or action that you disagree with. Click to view Medicaid Appeal information.
Regulations: Click to view the Developmental Disability Waiver Waiver Emergency Regulations starting on p. 97.
Are you interested in moving to your own “place” (house, apartment, etc.)? Maybe you want to live by yourself or with a friend or have a “live-in” aide. Housing Vouchers and Rental Assistance are financial assistance programs to help pay for your housing costs (rent, utilities). Flexible Funds provide assistance for other costs associated with moving and getting your place furnished. Talk to your case manager about housing vouchers, rental assistance and flexible funds. For more information click here and scroll to “Housing” in the middle of the page.
Keeping You Informed
- Information Presentations: The Arc of Virginia is available to make presentations about the Developmental Disabilities Waiver Program with partnering organizations. The free presentations provide information for individuals, families, educators, service providers and other stakeholders about changes including eligibility, services, prioritization levels, waiver allocation process, etc. To request a presentation email: firstname.lastname@example.org or call (804) 649-8481.
- As Virginia continues its implementation of the DD Waiver Program, The Arc of Virginia will update information as it becomes available on this website. The VA Departments of Behavioral Health & Behavioral Health (DBHDS) and Medical Assistance Services(DMAS) are still transitioning the system and developing processes to address the changes.
- Information Calls: The Virginia Departments of Behavioral Health & Developmental Services(DBHDS) and Medical Assistance Services(DMAS) provide Wednesday Waiver Redesign Information Calls about the Developmental Disabilities Waiver Program for individuals receiving or waiting for a waiver, families, services providers and all other stakeholders. Information is provided and questions from callers are answered. Click for the schedule.
- Call the VA Dept. of Behavioral Health and Developmental Services: 1-844-603-9248
- Website click VA Department of Behavioral Health and Developmental Services