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My-Life-My-Community-Waiver-Redesign

DBHDS is committed to being good listeners, good partners and good stewards of the public resources entrusted to the agency. As we meet the challenges that lie ahead, we are dedicated to a system re-design that truly provides opportunity for citizens to receive the supports they need to live full lives in the community.

Questions on Waiver Redesign:  If you have questions on the redesign of the intellectual, developmental or day support waivers and the changes associated with waiver redesign, please contact:

  • 1-844-603-9248

Please click the link below to access an interactive map with information relating to services in the community:

Stakeholder Informational Call Schedule: 

Waiver Amendments/Regulations:

The federal Centers for Medicare and Medicaid Services (CMS) has approved Virginia's waiver amendments for implementation. This affects the ID, DD, and Day Support Waivers.  Those waivers will now be called the Community Living (CL), the Family and Individual Support (FIS), and the Building Independence (BI) Waivers, respectively.  The approved implementation date is September 1, 2016. 

 Emergency Regulations regarding the above waivers have been approved and are located at:

Waiver Billing: (UPDATED 9/26/16)

Update for providers who are receiving billing denials for group home residential (for procedure code H2022, error message 309) related to the absence of tier assignment in VAMMIS for some individuals: 

We apologize for any inconvenience this has caused and appreciate your patience with working  through WaMS initial implementation issues. We are please to inform you that DBHDS Service Authorization staff have now entered 5,812 out of the last 5,812, or 100%, of the required tiers in VAMMIS. 

If you bill this procedure code and receive the “309” error message, please contact Laura Lupejkis, at DBHDS (804-786-8051), and be prepared to relay to her the name and Medicaid number of the individual for whom you are receiving this error message.  She will research the problem and work with you to resolve it. 

Regarding billing for H2022, which replaced 97535 for group homes, you will need to bill with the appropriate modifier for the size of your home.  Please reference Medicaid Memo dated 9/1/16 that reviews this information.  VAMMIS will accept what you submit during the billing process regarding size through 10/31/16.  After that you will need to ensure that you have entered into the new Waiver Management System (WaMS), for each individual you support, a request for authorization which includes the licensed capacity of the home in which he/she resides. 

To know the modifier for your group home size(s) see the 5/31/16 Medicaid Memo regarding residential services changes at https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/MedicaidMemostoProviders.

WaMS  Online Training/Manual:

  • For WaMS training materials, please visit the Training Manuals, Webinars and FAQs section of the WaMS Homepage
  • Provider Registration for WaMS

Waiver Redesign Training/Handouts/ Stakeholder (MLMC) Weekly Calls Q&As (NEW 7/1/16):

Single Point of Entry:

As of July 1, 2016 CSBs will bill for screenings for individuals with development disabilities who originally were screened for eligibility by the Child Development Centers.  CSBs will be paid for the screenings at either the state rate or the NOVA rate as set by DMAS.  The DD Waiver Unit will submit this billing to DMAS at the end of each month.  When a screening is completed, please fax the screening to 804-225-3390 for processing.  The CSB will not need to send an invoice as the screening itself acts as an invoice.  Screeners need to note on the form if the individual lives in a community/county which has the enhanced NOVA rate.  Noting on the form, NOVA and county/community covered as listed by DMAS. 

If you have questions regarding this procedure please contact the DD Waiver Helpline at 804-663-7290

Trainings:  There are upcoming trainings for families and individuals about waiver redesign for individuals with an intellectual disability or developmental disability.  Please see the below for dates and locations.

  • Stay tuned for new dates and times for stakeholder informational phone calls

Waiver Updates:

Waiver Redesign Information:

Public Comments

History

As of January 2014, the second phase of the My Life, My Community has begun. This will involve a cost study to review service reimbursement rates and result, most likely, in a revised rate schedule. In addition, DBHDS and DMAS will explore options for developing fair and reliable means resource allocation. We are hopeful that a new waiver system will be implemented in January 2016.

 

DBHDS leadership is establishing an Advisory group and related subcommittees to consider the recommendations made by HSRI, provide input on the new waiver design, and make suggestions regarding means of enhancing system processes. These groups will be facilitated by DBHDS and HSRI. The work of these groups is crucial to ensuring transparency and a well vetted waiver. The Waiver Design and Advisory Committee (WDAC) and subcommittee membership will be comprised of ID and DD self-advocates, family members, representatives from CSBs, provider agencies, advocacy groups, and parent groups from across the Commonwealth. A listing of WDAC and subcommittee members follows.

The groups’ charges are as follows:
WDAC:
  • Developing a new waiver concept paper from which elements of the CMS waiver application(s) will be drawn.
  • Providing input to the new waiver development process particularly with regard to training, implementation, and evaluation.
Eligibility:
  • Clarifying & creating one set of criteria for eligibility for ID/DD services in Virginia.
  • Advising on related policy and regulation development, as well as training and implementation strategies.
Case Management:
  • Clarifying & creating one set of criteria for effective support coordination/case management for individuals with ID/DD, including individuals who do not receive waiver services.
  • Reviewing and recommending changes to guidelines, policies and regulations for the provision of support coordination/case management.
Waiting List:
  • Clarifying & creating one set of criteria for managing the ID/DD waiting list for services in Virginia.
  • Proposing and evaluating the impact of combining the current ID/DD waiting lists.
  • Advising on policy and regulation development.
  • Advising on a means of meeting inter-rater reliability standards as well as to securing a valid assessment via the Supports Intensity Scale.
Provider Advisory Committee:
  • Offering guidance, from a provider perspective, to Burns & Associates (HSRI’s subcontractor) in their work of gathering and synthesizing information for the rate study portion of the overall waiver study.
  • WDAC Subcommittees Membership 

Presentations: (NEW)

One task in the first phase of the My Life, My Community project was an evaluation of the current administration of the Supports Intensity Scale® (SIS) in Virginia. The purpose was to review present assessment practices and determine what might be done to improve the assessment process for resource allocation purposes.

Also in Phase One of My Life, My Community we were required to conduct of interviews and public forums and then prepare a report to describe methods and findings. To this end, staff of Parent to Parent of Virginia (PTPofVA) and the Partnership for People with Disabilities at Virginia Commonwealth University (Partnership) convened multiple open forums at eight sites across the state to offer the public opportunities to comment on the performance of the present HCBS waivers and solicit input on what could be done to improve system performance.

The Human Services Research Institute is under contract to the Virginia Department of Behavioral Health and Developmental Services (DBHDS) to: (a) evaluate the State’s current service delivery system for individuals with intellectual and developmental disabilities (I/DD); (b) make recommendations to move the system to a more person-focused/needs-based system of care; and (c) in conjunction with that evaluation, review the existing rates paid to service providers and the current method of allocating resources to support individuals receiving services.