Policy Unit | Facility and Home-Based Services | Waiver Services | Waiver Rates | Manuals and Forms | External Links to Related Programs
Overview of Division of Long-Term Care
The Division of Long-Term Care provides policy and operational support for the long-term care programs of the Department. Services include: Facility and Home-Based Care, Waiver Programs, and Long-Term Care Policy.
Virginia's Medicaid Waivers for Persons with Disabilities, Their Parents, and Caregivers
Overview of Medicaid Fact Sheets
Long-Term Care Policy
Overview of LTC Policy Unit
Long-Term Care Policy staff provides policy analysis, regulatory procedure and program development and implementation of Medicaid-funded long-term care services. The staff supports long-term care programs and have responsibility for legislative issues affecting long-term care services.
Update policy manuals.
Maintains regulations related to the long-term care.
Prepares applications to the Centers for Medicare and Medicaid Services for waivers.
Develops and renews waivers.
Prepares statistical reports, manages special projects, and implements new programs as needed.
Facility and Home-Based Services
Overview of Facility and Home-Based Services
Staff are responsible for overseeing programs and conducting quality management reviews of the providers and recipients being served in long-term care facilities and in certain home-based care programs. Oversight includes responding to policy inquiries and input into the development of policy and procedure manuals. The Facility and Home-Based Services staff are responsible for the following programs:
Nursing Facility
Assisted Living Services
Pre-Admission Screening for Nursing Facility and Assisted Living Services
Intermediate Care Facilities for the Mentally Retarded
Program for All-Inclusive Care of the Elderly (PACE)
Long-Stay Hospitals
Specialized Care
Hospice Care
Home Health Services
Durable Medical Equipment and Supplies
Rehabilitation Services (Inpatient, Outpatient, and School)
Alzheimer’s Assisted Living (AAL) Waiver
Pre-Admission Screening
Program of All-Inclusive Care for the Elderly (PACE)
Overview of PACE Program
The Program for All-Inclusive Care for the Elderly (PACE) was established in Virginia in 1998 to provide a community-based alternative to nursing facility care integrating all aspects of care. The PACE program allows elders to remain in familiar surroundings, maintain self-sufficiency, and preserve the highest level of physical, social, and cognitive function and independence. A nursing facility preadmission screening team must authorize PACE services.
Services include primary medical and specialty care, nursing, social services, personal care, in-home supportive services, rehabilitative therapies, meals and nutritional care, transportation, hospitalization, and nursing home care. Services are provided in a PACE center, at home, and, if needed, in the hospital or other institutional setting. Specialty and ancillary medical services are provided, as are long-term care services. The goal is to keep the elderly in the community and provide the entire continuum of medical and supportive services as needed.
Through a pre-PACE provider in the Tidewater area, 125 enrolled participants were served in FY 05 at a cost of $3.6 million for an average of approximately $29,500 per person. The program is expanding statewide in 2006.
Waiver Services
Overview of Waiver Services
There are seven waivers administered by the Commonwealth of Virginia:
Elderly or Disabled with Consumer Direction (EDCD)
Individual and Family Developmental Disabilities Supports (IFDDS)
HIV/AIDS
Technology Assisted (Tech)
Mental Retardation (MR) *
Day Support *
Alzheimer’s Assisted Living (AAL) Waiver managed by the Facility and Home-Based Care Unit
Five waiver programs are managed by the Department of Medical Assistance Services. DMAS Waiver Services staff are responsible for the development, oversight, and quality management review of these waivers. Staff responds to requests for policy interpretation, prior authorization services, and technical assistance to providers.
* Effective August 28, 2006, daily administration of the waiver will be managed by the Department of Mental Health, Mental Retardation and Substance Abuse Services, Office of Mental Retardation (OMR), in collaboration with DMAS. For information, please refer to the DMHMRSAS website at http://www.dmhmrsas.virginia.gov/OMR-MRWaiverInformation.htm.Mental Retardation (MR) Waiver
* Effective August 28, 2006, daily administration of the waiver will be managed by the Department of Mental Health, Mental Retardation and Substance Abuse Services, Office of Mental Retardation (OMR), in collaboration with DMAS. For information, please refer to the DMHMRSAS website at http://www.dmhmrsas.virginia.gov/OMR-MRWaiverInformation.htm.
Elderly or Disabled with Consumer Direction (EDCD) Waiver
Overview of EDCD
The EDCD Waiver got its start in Virginia in 2005, merging two existing waivers. Eligible individuals must the nursing facility eligibility criteria.
Available services are:
Personal Care Aide Services
Adult Day Health Care
Respite Care
Personal Emergency Response System (PERS)
Medication Monitoring
Consumer-Directed Services
Nursing facility pre-admission screening teams conduct a pre-admission screening. A pre-authorization contractor performs prior authorizations of services. Providers are an institution, facility, agency, partnership, corporation, or association that meets the standards and requirements set forth by DMAS and has a current, signed contract with DMAS to be a provider of waiver services.
Elderly or Disabled with Consumer Direction Waiver Application
Training Information
Individual and Family Developmental Disabilities Support (IFDDS) Waiver
Overview of IFDDS Waiver
The IFDDS Waiver provides services to individuals 6 years of age and older with a condition related to mental retardation, but who do not have a diagnosis of mental retardation, and who have been determined to require the level of care provided in an ICF/MR. An individual is eligible for services based on three factors: diagnostic eligibility, functional eligibility, and financial eligibility.
Available services include:
Day Support
Companion Services (Agency or Consumer Directed)
Supported Employment
In-home Residential Support
Therapeutic Consultation
Personal Care Services
Respite Care (Agency or Consumer Directed)
Supported Employment
Skilled Nursing Services
Attendant Services
Family and Caregiver Training
Crisis Supervision
Environmental Modifications
Assistive Technology
Personal Emergency
Response System (PERS)
Support Coordination
Prevocational Services
- Eligibility Criteria for Emergency Access to the IFDD Waiver
- Request for Screening Form
Alzheimer's Assisted Living (AAL) Waiver
- Overview of AAL Waiver Waiver
- The 2004 General Assembly mandated that DMAS develop a home- and community-based care waiver for individuals with Alzheimer’s disease or a related dementia. This waiver became a reality in 2005 and will initially serve 200 individuals. Participants must reside in an assisted living facility (ALF) licensed by the Virginia Department of Social Services, be in a safe and secure environment, meet Virginia’s criteria for nursing facility placement and be receiving an Auxiliary Grant (AG). In order to participate in the program, the ALF must meet certain criteria. The individual must not have a diagnosis of mental retardation or serious mental illness. It is estimated that the waiver would be approximately $50 a day per participant.
Individuals eligible to be placed on this waiver are currently either 1) remaining at home where an adult child is typically serving as primary caregiver; 2) residing in an ALF without the benefit of specialized services, which are not provided in the base $50 per day rate; or c) residing in a more expensive institutionalized nursing facility setting. Through the Alzheimer’s Assisted Living Waiver, recipients would be able to receive an appropriate level of care within special care units of ALFs.
To initiate services, call the local department of social services to schedule an appointment to be screened for long-term care services. If hospitalized, request a screening from the hospital social worker or discharge planner. There is no cost to be screened to determine eligibility for the waiver. Individuals receiving AAL Wavier services must also be receiving an Auxiliary Grant (AG) and have no patient pay for waiver services. DSS determines eligibility for the AG program.
Enrollment is limited to 200 individuals and once 200 individuals have enrolled, DMAS will begin a waiting list.
Services available in the AAL waiver are:
- Assisted Living: Assistance with activities of daily living, housekeeping, and supervision.
- Medication Administration: Medication administered by a licensed professional.
- Nursing evaluations: Evaluation by a registered nurse.
- Therapeutic and Recreational Programming: Weekly activity program based on needs and interests.
- Individuals receiving AAL Waiver services also receive services through the Medicaid program. Examples include medications (for those individuals not covered under Medicare), physician visits, acute care hospitalizations, and certain therapies.
- AAL Waiver Regulations
Technology Assisted (Tech) Waiver
- Overview of Tech Waiver
- The Technology Assisted Waiver began in 1988. This waiver is a program designed to allow eligible recipients to be cared for in the community rather than remain institutionalized. Eligible recipients are children under the age of 21, who have exhausted available third party benefits for private duty nursing and are dependent on a technology to substitute for a vital body function and adults, over age 21. All recipients must require substantial and ongoing skilled nursing services. While assistance with the cost of room and board is not available through Medicaid waivers, waivers provide supports that help individuals to live as independently as possible in the community.
Available services include:
- Personal care (Adults Only)
- Private duty nursing
- Respite care
- Environmental Modifications
- Assistive Technology
- Individuals receiving Tech Waiver services have their care coordinated by a DMAS staff. Individuals receiving waiver services also receive other services offered through Medicaid. Examples include medications (for those individuals not covered by Medicare), physician visits, acute care hospitalizations, and certain therapies.
Who qualifies for services?
Individuals who require ongoing skilled nursing care.
Individuals 21 and older who are dependent at least part of each day on a mechanical ventilator or meet complex tracheotomy criteria.
Individuals under the age of 21 who meet certain criteria based on various methods of respiratory or nutritional support.
Individuals who meet Medicaid eligibility criteria as determined by the local department of social services. Parents’ income and resources are not considered by DSS when making a financial eligibility determination for a child under the age of 18 who is enrolling in the Tech Waiver.
Tech Waiver services may be limited or denied for those individuals who are able to receive services through a third-party payment source.
Who can help initiate services?
DMAS conducts the screenings for individuals under the age of 21 who request Tech Waiver services. A DMAS staff person for the Tech Waiver can be reached at 804-786-1465. If hospitalized, the hospital social worker or discharge planner can assist in coordinating a screening with DMAS.
Individuals aged 21 and older must first be screened by the local department of social services or if hospitalized, the hospital social worker or discharge planner. A DMAS staff person should be contacted following this screening for a screening for the tech waiver.
There is no cost to be screened to determine eligibility for the waiver. There may be a patient pay for services based on the individual’s earned and unearned income. The local department of social services eligibility worker will determine if an individual has a patient pay.
Day Support (DS) Waiver
Effective August 28, 2006 daily management of the waiver was shifted from DMAS to the Department of Mental Health, Mental Retardation and Substance Abuse Services, Office of Mental Retardation (OMR).
For information, please refer to the DMHMRSAS website at http://www.dmhmrsas.virginia.gov/OMR-MRWaiverInformation.htm.
HIV/AIDS Waiver
- Overview of HIV/AIDS Waiver
- The HIV/AIDS Waiver was developed in 1991. This waiver provides services to individuals who are diagnosed with the human immunodeficiency virus (HIV), who are experiencing the symptoms associated with acquired immune deficiency syndrome (AIDS), and who would otherwise require care provided in a nursing facility or a hospital.
Available services include:
- Case management
- Nutritional supplements
- Private duty nursing
- Personal care (agency or consumer-directed options)
- Respite care (agency or consumer-directed options)
Who qualifies for services?
Individuals must have a diagnosis of HIV or AIDS and be experiencing medical and functional symptoms associated with the disease that require hospital or nursing facility care to receive services under the waiver.
Individuals must meet Medicaid eligibility criteria as determined by the local department of social services. Individuals who are found to be eligible for the HIV/AIDS Waiver and choose to receive services may apply for Medicaid using special rules which allow the individual to receive a higher income and still qualify for Medicaid.
Who can help initiate services?
Call the local department of social services in your area to schedule an appointment to be screened for long-term care services or if hospitalized, request a screening from the hospital social worker or discharge planner.
There is no cost to be screened to determine the eligibility for the waiver. Individuals found eligible for waiver services must apply and be found eligible for Medicaid. The DSS worker who processes the Medicaid application will use special rules that apply to individuals found eligible for the HIV/AIDS waiver.
Return to top of the page
2007 Waiver Rates
Manuals and Forms
Consumer-Directed Services in the Community-Based Waivers Employer Manual Rev.(04/07).
Virginia Uniform Assessment Instrument (UAI) (external link)
User’s Manual: Virginia Uniform Assessment Instrument (UAI) (revised 7/2005) (external link)
Assisted Living Facility Assessment Manual website (external link)
External Links to Related Programs
Virginia Regulatory Town Hall (to access DMAS regulations)
Virginia Legislative Information System (General Assembly information, Code of Virginia, and state agency regulations)
Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services
Virginia Department of Health (VDH) Office of Licensure and Certification
Virginia Department of Social Services (VDSS) Adult Services Program
Assisted Living Facility (ALF) and Adult Day Care Search (VDSS)
SeniorNavigator (General information about long-term care services in Virginia)
Nursing Home Compare (Center for Medicare and Medicaid Services)