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Division of Long Term Care and Quality Assurance

Policy Unit | Facility and Home-Based Services | Waiver Services | Manuals and Forms | External Links to Related Programs

Overview of Division of LTC/QA

  • The Division of Long-Term Care and Quality Assurance provides policy and operational support for the long-term care programs of the Department. The Division has three units: Facility and Home-Based Services, Waiver Services, and Long-Term Care Policy.

Long-Term Care Policy Unit

  • Overview of LTC Policy Unit
     

    • Long-Term Care Policy staff provides policy analysis and program development and implementation of Medicaid-funded long-term care services. The unit:• Supports long-term care programs and have responsibility for legislative issues affecting long-term care services.

      • Updates policy manuals.

      • Maintains regulations related to the Division.

      • Prepares applications to the Centers for Medicare and Medicaid for waivers.

      • Works with the units to develop and renew waivers.

      • Prepares statistical reports, manages special projects, and implements new programs as  needed.

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Facility and Home-Based Services Program

  • Overview of Facility and Home-Based Services Program
     

    • This unit is 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 development of policy and procedure manuals. Staff also assists the training unit in provider training for these programs. The Facility and Home-Based Services Unit is 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.

      To be eligible for PACE, participants must:

      •  Be 55 years of age or older.

      •  Be screened as meeting nursing facility care criteria.

      •  Reside in the service area of a PACE provider.

      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.
       

  • PACE information and frequently asked questions

Training Information

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Waiver Services Program

  • Overview of Waiver Services Program
     

    • The Waiver Services Unit is responsible for the development, oversight, and quality management review of Virginia’s Medicaid waivers. Staff responds to requests for policy interpretation, preauthorization services, and technical assistance to providers.

      The waivers managed by this unit are:

      • Elderly or Disabled with Consumer Direction (EDCD)

      • Mental Retardation (MR)

      • Individual and Family Developmental Disabilities Supports (IFDDS)

      • HIV/AIDS

      • Technology Assisted (Tech)

      • Day Support

      • Alzheimer’s Assisted Living (AAL) Waiver managed by the Facility and Home-Based Care Unit

    DMAS currently manages a total of seven waivers.

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Elderly of Disabled with Consumer Direction (EDCD) Waiver

  • Overview of EDCD
     

    • The EDCD Waiver got its start in Virginia in 2005, merging two existing waivers. This waiver provides services to individuals who are 65 and older or who has a disability. Eligible individuals must be eligible for care in a nursing facility.

      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 pre-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.
       

  • EDCD Waiver Regulations

  • Elderly or Disabled with Consumer Direction Waiver Application

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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

      •  Supported Employment

      •  In-home Residential Support

      •  Therapeutic Consultation

      •  Personal Care Services

      •  Respite Care

      •  Skilled Nursing Services

      •  Attendant Services

      •  Family and Caregiver Training

      •  Crisis Stabilization

      •  Environmental Modifications

      •  Assistive Technology

      •  Personal Emergency

      •  Response System (PERS)

      •  Support Coordination
         

  • IFDDS Waiver Regulations

  • Eligibility Criteria for Emergency Access to the IFDD Waiver
  • Request for Screening Form

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Alzheimer's Assisted Livinng (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, be 55 years of age or older, 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

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Mental Retardation (MR) Waiver Services

  • Overview of MR Waiver
     

    • The waiver for individuals with mental retardation was started in Virginia in 1991. Services are available to individuals who are up to 6 years of age who are at developmental risk and individuals age 6 and older who have mental retardation. All individuals must: (1) meet the ICF/MR level of care criteria (i.e., they meet two out of seven levels of functioning in order to qualify); (2) are at imminent risk of ICF/MR placement; and (3) are determined that community-based care services under the waiver are the critical services that enable the individual to remain at home rather than being placed in an ICF/MR. In FY 05, 6,421 participants received MR Waiver services. Total expenditures were $280 million.

       

      MR WAIVER SERVICES AND NUMBER OF PARTICIPANTS FY 05
      SERVICE #  PARTICIPANTS RECEIVING SERVICE
      Day Support 4,216
      Congregate Residential Support 3,420
      In-home Residential Support 1,214
      Pre-vocational Services 541
      Respite Care 527
      Supported Employment 499
      Therapeutic Consultation 471
      Personal Care 374
      Assistive Technology 162
      Environmental Modifications 129
      Skilled Nursing  77
      Crisis Stabilization 33
      Companion Care 28
      Crisis Supervision  25
      Personal Emergency Response Services (PERS) 16

       

  • MR Waiver Regulations

  • MR Waiver Advisory Committee Membership

  • MR Waiver Application effective July 1, 2004

  • Copy of agreement between DMAS and DMHMRSAS

  • Virginia Olmstead Initiative

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Technology Assisted (Tech) Waiver

  • Overview of Tech Waiver
     
    • The Technology Assisted Waiver was begun 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 no third-party hospitalization insurance and are dependent on a technology to substitute for a vital body function and adults, over age 21, who currently reside in a specialized nursing facility paid for by Medicaid and who are dependent on a technology to substitute for a vital body function. 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
      •  Private duty nursing
      •  Respite care
      •  Environmental Modifications
      •  Assistive Technology
         
    • Individuals receiving Tech Waiver services have their care coordinated by a DMAS Health Care Coordinator. 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 are dependent on a medical device and require ongoing skilled nursing care.

Individuals 21 and older must spend at least part of each day on a mechanical ventilator or meet complex tracheostomy criteria.

Individuals under the age of 21 may qualify 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 initiated services?

DMAS conducts the screenings for individuals under the age of 21 who request Tech Waiver services. A DMAS health care coordinator for the Tech Waiver can be reached at 804-786-1454. 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.

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.

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Day Support Waiver

  • Overview of Day Support Waiver
     
    • This waiver began in 2005 as a partnership between DMAS and the Department of Mental Health, Mental Retardation and Substance Abuse Services to help reduce the MR Waiver waiting list by providing services to support families. It is in the beginning stages of implementation. Services will be available to individuals with mental retardation who have been determined to meet the level of care provided in an ICF/MR. Covered services include day support services and prevocational services. To date, there are 219 active Day Support Waiver slots.
       
  • Day Support Regulations

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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. In FY 2005, 94 percent of individuals on the HIV/AIDS Waiver were between the ages of 21 and 65

      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 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 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.

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2006 Waiver Rates

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Manuals and Forms

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External Links to Related Programs

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