RESPITE CARE SERVICES PROVIDER IN VIRGINIA
GIVING FAMILIES A BREAK WHILE ENSURING QUALITY, COMPASSIONATE CARE FOR THEIR LOVED ONES

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Respite Care Services in Virginia offer temporary relief to unpaid caregivers—often family members—who provide ongoing support to individuals with disabilities, medical complexities, or behavioral health needs. These services give caregivers essential downtime while ensuring that care recipients receive safe, supportive, and person-centered care in their home or community.

Respite Care is a covered service under the Community Living (CL), Family and Individual Supports (FIS), and Commonwealth Coordinated Care Plus (CCC Plus) Waivers. Oversight is provided by the Department of Medical Assistance Services (DMAS), with service coordination by Community Services Boards (CSBs) and Managed Care Organizations (MCOs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers Medicaid waiver programs and processes provider enrollment and reimbursement.

Agency: Community Services Boards (CSBs)
Role: Authorize respite services for individuals on the CL and FIS Waivers and approve them in the Individual Support Plan (ISP).

Agency: Managed Care Organizations (MCOs)
Role: Authorize and oversee respite services under the CCC Plus Waiver.

2. RESPITE CARE SERVICES OVERVIEW

Respite may be provided in-home, in a community-based setting, or at a licensed facility. Services are intended to provide short-term care for individuals while their regular caregiver is unavailable due to rest, illness, emergencies, or personal obligations.

Types of Respite include:

In-Home Respite Care – Direct support provided at the individual’s home

Center-Based or Group Respite – Care in a licensed group setting

Skilled Respite – When the individual requires nursing-level care (must be provided by an RN or LPN)

Crisis Respite – For emergency caregiver absences or behavioral health stabilization

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)

Obtain an EIN and Type 2 NPI

If providing group-based services, obtain a DBHDS license for Group Home or Respite

Create a Respite Services Policy & Procedure Manual

Complete DBHDS Human Rights Office affiliation

Enroll as a Medicaid provider via the MES portal

Contract with CSBs or MCOs based on waiver population served

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI
Step 2: Apply for DBHDS license (if providing facility- or group-based care)
Step 3: Prepare P&P Manual, background checks, and Human Rights affiliation
Step 4: Enroll with Virginia Medicaid via MES
Step 5: Contract with CSBs (CL/FIS) or MCOs (CCC Plus)
Step 6: Begin services upon ISP authorization and referral

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI

Medicaid enrollment confirmation

Staff background checks and training records

DBHDS license and Human Rights documentation (for licensed settings)

Respite Services Policy & Procedure Manual including:

Admission and service delivery policies

Emergency contact and incident response protocols

Daily shift logs and activity tracking

Caregiver notes and ISP goal documentation

Supervision plans and client-specific instructions

Medication management (if applicable)

HIPAA, client rights, and safety procedures

6. STAFFING REQUIREMENTS

Role: Respite Care Provider / Direct Support Professional (DSP)
Requirements:

High school diploma or GED

CPR/First Aid certification

Background checks (CPS, criminal, DMV)

Trained in ADLs, supervision, and safety

Optional Role: Licensed Nurse (for skilled respite)
Requirements:

LPN or RN license in Virginia

Must follow physician-ordered care instructions

All staff must complete:

HIPAA and confidentiality training

Person-centered and emergency preparedness training

Documentation and incident reporting protocols

Annual competency revalidation

7. MEDICAID WAIVER PROGRAMS

Respite Care is available under:

Community Living (CL) Waiver – For individuals needing routine or emergency caregiver support

Family and Individual Supports (FIS) Waiver – Supports family caregivers of individuals with ID/DD

CCC Plus Waiver – For medically complex or elderly individuals with caregiver relief needs

Service hours and delivery settings must be approved in the Individual Support Plan (ISP) and authorized by the appropriate CSB or MCO.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Staff Recruitment
Timeline: 2–4 weeks

Phase: Licensing & Medicaid Enrollment
Timeline: 1–2 months

Phase: Staff Training, Readiness & Contracting
Timeline: 2–4 weeks

Phase: Launch of Services
Timeline: Begins after referral and ISP approval

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Provider Portal (Medicaid Enrollment)
Website: https://vamedicaid.dmas.virginia.gov/provider

Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Website: https://dbhds.virginia.gov

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA RESPITE CARE PROVIDER
WCG helps agencies design flexible, high-quality respite programs that meet Virginia Medicaid requirements and promote family well-being.

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Scope of Work:

Medicaid enrollment and CSB/MCO contracting assistance

Respite Services Policy & Procedure Manual development

Licensing support for in-home and center-based respite models

Staff training plans and credentialing packets

Emergency protocols, incident forms, and daily documentation tools

HIPAA compliance and caregiver support systems

SUPPORTED EMPLOYMENT SERVICES PROVIDER IN VIRGINIA
EMPOWERING INDIVIDUALS WITH DISABILITIES TO ACHIEVE MEANINGFUL, COMPETITIVE EMPLOYMENT THROUGH PERSONALIZED SUPPORT AND VOCATIONAL GUIDANCE

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Supported Employment Services in Virginia help individuals with intellectual or developmental disabilities (ID/DD) prepare for, obtain, and maintain employment in integrated, competitive work environments. These services emphasize individual choice, inclusion, and long-term employment success, often involving direct, one-on-one assistance at every stage of the employment journey.

Supported Employment is a covered service under the Community Living (CL) and Family and Individual Supports (FIS) Waivers. Oversight is provided by the Virginia Department of Medical Assistance Services (DMAS) and the Department of Behavioral Health and Developmental Services (DBHDS), with service planning and coordination through Community Services Boards (CSBs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers waiver programs and sets provider payment policies for employment services.

Agency: Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Role: Licenses employment services providers, defines service models, and enforces regulatory compliance.

Agency: Community Services Boards (CSBs)
Role: Authorize Supported Employment services within the Individual Support Plan (ISP) and provide referrals.

2. SUPPORTED EMPLOYMENT SERVICES OVERVIEW

Supported Employment is designed for individuals seeking to work in competitive, integrated job settings. Services must be person-centered, time-limited (in some phases), and outcome-focused.

Service models include:

Individual Supported Employment – One-on-one job coaching and supports

Group Supported Employment – Supervised work in a group setting (e.g., mobile crews, enclaves)

Job Development – Identifying job opportunities, résumé building, interview coaching

Workplace Supports – On-site training, cueing, transportation, or behavior supports

Job Retention Services – Ongoing follow-up to sustain employment over time

All services must be tied to a Person-Centered Plan (PCP) and ISP, with progress documentation and collaboration with employers.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register with the Virginia State Corporation Commission (SCC)

Obtain EIN and Type 2 NPI

Apply for a DBHDS license under the Supported Employment service category

Complete DBHDS Human Rights Office affiliation

Develop a Supported Employment Services Policy & Procedure Manual

Enroll as a Medicaid provider via the MES portal

Contract with local CSBs for service referrals

Optional: Providers may also coordinate with DARS (Department for Aging and Rehabilitative Services) for pre-employment transition services (Pre-ETS).

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI
Step 2: Apply for DBHDS Supported Employment license and submit policies
Step 3: Affiliate with the Human Rights Office and complete compliance setup
Step 4: Enroll in Medicaid through the MES Provider Portal
Step 5: Contract with CSBs for referrals and ISP alignment
Step 6: Launch services upon authorization of ISP and completion of staffing

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI

DBHDS license and Medicaid enrollment approval

Human Rights policies and incident reporting procedures

Supported Employment Services Policy & Procedure Manual including:

Job development tracking and employer contact logs

Staff qualifications, training records, and supervision plans

Transportation safety protocols

Participant progress and ISP alignment documentation

Participant rights, privacy, and informed choice procedures

Crisis prevention, emergency protocols, and backup staffing

6. STAFFING REQUIREMENTS

Role: Employment Specialist / Job Coach
Requirements:

High school diploma or GED (bachelor’s preferred)

Valid driver’s license (if transporting clients)

Training in person-centered practices and employment supports

Background checks and First Aid/CPR certification

Role: Program Supervisor (optional but recommended)
Responsibilities:

Quality assurance, service oversight, staff support

All staff must complete:

DBHDS-mandated orientation and ongoing training

HIPAA, confidentiality, and documentation protocols

Employment coaching, job analysis, and community integration strategies

Annual performance evaluations and skills revalidation

7. MEDICAID WAIVER PROGRAMS

Supported Employment is offered through:

Community Living (CL) Waiver – For adults in supervised or supported living environments

Family and Individual Supports (FIS) Waiver – For individuals living independently or with family

Note: Pre-vocational services may be authorized separately if the individual is not yet job-ready

Each service must be tied to the ISP and tracked through structured employment support documentation.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensing Application
Timeline: 4–6 weeks

Phase: Medicaid Enrollment & CSB Contracting
Timeline: 1–2 months

Phase: Staff Recruitment & Training
Timeline: 30–45 days

Phase: Launch of Services
Timeline: Begins upon CSB referral and ISP approval

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Medicaid Provider Enrollment Portal
Website: https://vamedicaid.dmas.virginia.gov/provider

Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Website: https://dbhds.virginia.gov

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

Virginia Department for Aging and Rehabilitative Services (DARS)
Website: https://www.vadars.org

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA SUPPORTED EMPLOYMENT PROVIDER
WCG partners with mission-driven organizations to launch employment services that foster inclusion, vocational success, and long-term community engagement.

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Scope of Work:

DBHDS licensing and Medicaid enrollment support

Supported Employment Policy & Procedure Manual development

Staff onboarding packets and ISP-aligned tracking tools

Job development logs, progress notes, and employer engagement templates

Transportation and workplace safety documentation

Human Rights and incident reporting systems

PERSONAL CARE SERVICES PROVIDER IN VIRGINIA
SUPPORTING DAILY LIVING THROUGH HANDS-ON ASSISTANCE THAT HELPS INDIVIDUALS LIVE SAFELY, COMFORTABLY, AND INDEPENDENTLY AT HOME

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Personal Care Services in Virginia provide essential, hands-on assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) for individuals with disabilities, chronic illnesses, or age-related conditions. These services empower individuals to remain in their homes and communities while receiving the support needed to maintain independence.

Personal Care is a covered service under Virginia Medicaid’s CCC Plus (Commonwealth Coordinated Care Plus) Waiver and the Family and Individual Supports (FIS) and Community Living (CL) Waivers. Oversight is provided by the Virginia Department of Medical Assistance Services (DMAS) and coordinated through Managed Care Organizations (MCOs) or local Community Services Boards (CSBs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Regulates Medicaid-funded personal care services and issues provider enrollment requirements.

Agency: Community Services Boards (CSBs)
Role: Authorize personal care under the CL and FIS Waivers for individuals with developmental disabilities.

Agency: Managed Care Organizations (MCOs)
Role: Manage authorizations and reimbursement under the CCC Plus Waiver.

2. PERSONAL CARE SERVICES OVERVIEW

Personal Care Services are non-medical supports provided in the home or community to assist eligible individuals with functional needs.

Covered services include:

Bathing, grooming, and hygiene assistance

Dressing and undressing

Meal preparation and feeding support

Toileting and incontinence care

Mobility and transferring assistance

Light housekeeping (related to personal care)

Medication reminders (non-clinical)

Safety monitoring and supervision as specified in the Plan of Care

Services are based on a Person-Centered Plan and must be delivered by trained staff under supervision by a Registered Nurse (RN) or designated manager.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Virginia State Corporation Commission (SCC)

Obtain an EIN and Type 2 NPI

Obtain a Home Care Organization (HCO) license from the Virginia Department of Health (VDH)

Hire a Registered Nurse (RN) to oversee assessments and staff supervision

Develop a Personal Care Policy & Procedure Manual compliant with DMAS and VDH

Secure liability, workers’ comp, and auto insurance (if transporting clients)

Enroll with DMAS and applicable MCOs or CSBs based on the waiver you serve

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN and NPI
Step 2: Apply for Home Care Organization (HCO) license via VDH
Step 3: Hire RN Supervisor and develop Policy & Procedure Manual
Step 4: Enroll as a Medicaid provider through DMAS (via MES portal)
Step 5: Contract with CSBs for CL/FIS Waiver or MCOs for CCC Plus Waiver
Step 6: Complete staff hiring, background checks, and training
Step 7: Begin providing services upon authorization and Plan of Care approval

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI

VDH-issued HCO license

DMAS approval and Medicaid provider agreement

MCO or CSB service authorization letters

Personal Care Policy & Procedure Manual including:

ADL/IADL service protocols

Plan of Care implementation and tracking

RN supervisory visit schedule and documentation

Staff credentialing and annual competency evaluation procedures

HIPAA compliance and client rights

Emergency preparedness and incident reporting

Billing documentation and shift notes

6. STAFFING REQUIREMENTS

Role: Personal Care Aide (PCA)
Requirements:

Must complete DMAS-approved 40-hour PCA training or be a CNA

CPR certification (recommended)

Background check and TB screening

Role: RN Supervisor
Requirements:

Active Virginia RN license

Responsible for developing Plans of Care, conducting assessments, and supervising aides

All staff must complete:

HIPAA and confidentiality training

Client rights and abuse prevention

Infection control and universal precautions

Documentation and reporting protocols

Annual performance evaluations and in-service training

7. MEDICAID WAIVER PROGRAMS

Personal Care Services are included in:

CCC Plus Waiver – For adults with disabilities, older adults, and medically fragile individuals

Community Living (CL) Waiver – For individuals with developmental disabilities needing daily personal care

Family and Individual Supports (FIS) Waiver – For individuals with DD living with family or independently

All services must be prior authorized and linked to functional needs identified in the Person-Centered Plan or Uniform Assessment Instrument (UAI).

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensing
Timeline: 2–3 months (includes VDH HCO licensing)

Phase: DMAS & MCO/CSB Enrollment
Timeline: 1–2 months

Phase: Staff Hiring & Training
Timeline: 2–4 weeks

Phase: Service Launch
Timeline: Begins upon authorization of Plan of Care and participant assignment

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

Virginia Department of Health (VDH) – Home Care Licensing
Website: https://www.vdh.virginia.gov/olc/home-care/

Community Services Boards Directory
Website: https://dbhds.virginia.gov

MCO Plan Information for CCC Plus Providers
Website: https://www.virginiamanagedcare.com

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA PERSONAL CARE PROVIDER
WCG helps agencies successfully launch Personal Care programs in Virginia with comprehensive compliance, documentation, and staff onboarding support.

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Scope of Work:

HCO license application and compliance support

Medicaid provider enrollment and MCO/CSB contracting

Personal Care Policy & Procedure Manual creation

RN supervision tools and care plan templates

Shift documentation, task logs, and billing sheets

HIPAA compliance and staff training packets

ADAPTIVE EQUIPMENT SERVICES PROVIDER IN VIRGINIA
ENABLING INDEPENDENCE, SAFETY, AND MOBILITY THROUGH SPECIALIZED EQUIPMENT THAT SUPPORTS INDIVIDUAL NEEDS IN HOME AND COMMUNITY SETTINGS

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Adaptive Equipment Services in Virginia provide individuals with disabilities or chronic conditions access to medically necessary tools and technologies that promote independence, communication, mobility, and daily functioning. These services ensure that participants in Medicaid waiver programs have the equipment needed to live safely and successfully outside of institutional settings.

These services are covered under Virginia’s Community Living (CL), Family and Individual Supports (FIS), and Commonwealth Coordinated Care Plus (CCC Plus) Waivers. Oversight is provided by the Department of Medical Assistance Services (DMAS), with service coordination from Community Services Boards (CSBs) or Managed Care Organizations (MCOs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers Medicaid waiver services and sets provider reimbursement policies for adaptive equipment.

Agency: Community Services Boards (CSBs)
Role: Authorize equipment requests for CL and FIS Waiver participants and ensure ISP alignment.

Agency: Managed Care Organizations (MCOs)
Role: Manage service authorizations and reimbursement under the CCC Plus Waiver.

2. ADAPTIVE EQUIPMENT SERVICES OVERVIEW

Adaptive Equipment Services include the assessment, purchase, delivery, customization, and training on durable and adaptive items that increase the participant’s ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

Examples of covered items include:

Mobility devices (e.g., walkers, manual or power wheelchairs)

Adaptive utensils, reachers, or transfer aids

Bathing and toileting safety equipment

Communication devices (e.g., speech-generating devices)

Hospital beds, hoyer lifts, and gait trainers

Modified computer or remote access devices

Customized home-use environmental controls

All equipment must be identified in the Individual Support Plan (ISP) or Plan of Care (POC) and be medically necessary and not covered by other insurance.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)

Obtain an EIN and Type 2 NPI

If providing, assembling, or customizing equipment, register with the FDA as a medical device distributor (if applicable)

Develop an Adaptive Equipment Services Policy & Procedure Manual

Enroll as a provider with DMAS through the MES portal

Contract with CSBs (CL/FIS) and/or MCOs (CCC Plus)

If selling or fabricating custom equipment, providers may also need:

A retail sales license or DME supplier credentialing (depending on scope)

Technicians trained in equipment setup and user instruction

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register entity, obtain EIN and NPI
Step 2: Confirm business scope and licensure (e.g., DME, retail, or technical service provider)
Step 3: Develop policies, safety protocols, and delivery documentation
Step 4: Enroll as a Medicaid provider via the MES portal
Step 5: Contract with MCOs and/or CSBs for service referrals
Step 6: Begin delivering equipment upon authorization through the ISP

5. REQUIRED DOCUMENTATION

SCC registration, EIN, NPI

Medicaid provider agreement and approvals

Equipment authorization forms from MCO/CSB

Adaptive Equipment Services Policy & Procedure Manual including:

Equipment procurement and customization process

Delivery and setup protocols

User training and caregiver education documentation

Manufacturer warranties and repair service policy

Risk assessments and post-delivery evaluations

HIPAA compliance and client confidentiality forms

Return, replacement, and disposal procedures

6. STAFFING REQUIREMENTS

Role: Equipment Technician / Delivery Specialist
Requirements:

Basic training in setup and demonstration of adaptive devices

Background check and safety training

Ability to document installation and provide end-user support

Role: Assistive Technology Professional (ATP) or Rehab Specialist (optional but recommended)
Requirements:

Certification through RESNA or similar body

Supports assessments, selection, and customization of devices

All staff must complete:

HIPAA and confidentiality training

Client safety and incident reporting procedures

Documentation and ISP alignment training

Annual skills validation for equipment assembly and instruction

7. MEDICAID WAIVER PROGRAMS

Adaptive Equipment Services are reimbursable under:

Community Living (CL) Waiver – For individuals with ID/DD needing customized tools to support independent living

Family and Individual Supports (FIS) Waiver – Supports individuals living independently or with family

CCC Plus Waiver – For individuals with medical needs or disabilities in need of supportive devices

All equipment must be documented in the ISP/POC and be approved by CSBs or MCOs with medical justification.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Development
Timeline: 2–3 weeks

Phase: Medicaid Enrollment & Contracting
Timeline: 4–6 weeks

Phase: Staff Hiring, Vendor Setup, and Readiness Review
Timeline: 2–4 weeks

Phase: Service Launch
Timeline: Begins after equipment authorization and ISP documentation

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Provider Portal (Medicaid Enrollment)
Website: https://vamedicaid.dmas.virginia.gov/provider

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

Centers for Medicare & Medicaid Services – DME Guidelines
Website: https://www.cms.gov

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA ADAPTIVE EQUIPMENT SERVICES PROVIDER
WCG supports providers offering assistive and adaptive technologies with full setup services, compliance documentation, and Medicaid readiness.

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Scope of Work:

Medicaid provider enrollment and contracting support

Equipment setup, training, and documentation templates

Adaptive Equipment Services Policy & Procedure Manual

Client delivery logs, ISP alignment forms, and usage instructions

Staff onboarding materials and HIPAA documentation

Inventory, maintenance, and warranty tracking tools

SKILLED NURSING SERVICES PROVIDER IN VIRGINIA
DELIVERING CLINICAL CARE AT HOME TO SUPPORT MEDICAL STABILITY, INDEPENDENCE, AND QUALITY OF LIFE

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Skilled Nursing Services in Virginia offer medically necessary nursing care to individuals with chronic conditions, disabilities, or post-acute needs in a home or community setting. These services are essential in preventing unnecessary hospitalizations and supporting individuals who require regular clinical oversight while remaining at home.

Skilled Nursing is covered under Virginia Medicaid’s CCC Plus Waiver, Community Living (CL) Waiver, Family and Individual Supports (FIS) Waiver, and the EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) program for children. Services are regulated by the Virginia Department of Medical Assistance Services (DMAS) in partnership with the Virginia Department of Health (VDH).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers Medicaid coverage and enrollment for nursing services.

Agency: Virginia Department of Health (VDH)
Role: Licenses Home Health and Private Duty Nursing providers.

Agency: Managed Care Organizations (MCOs)
Role: Coordinate authorization and reimbursement under the CCC Plus program.

Agency: Community Services Boards (CSBs)
Role: Coordinate services under the CL and FIS Waivers.

2. SKILLED NURSING SERVICES OVERVIEW

Skilled Nursing involves the delivery of clinical, hands-on care provided by licensed nurses under physician oversight.

Covered services may include:

Medication administration (oral, IM, IV)

Wound care and dressing changes

Tracheostomy or ventilator care

Catheter or ostomy maintenance

Tube feedings and suctioning

Chronic disease monitoring (e.g., diabetes, epilepsy)

Care coordination and caregiver education

RN assessments and health documentation

All services must be medically necessary and tied to a physician-ordered Plan of Care.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Virginia State Corporation Commission (SCC)

Obtain EIN and Type 2 NPI

Apply for a Home Care Organization (HCO) license from VDH

Employ a Director of Nursing (RN) to oversee care plans and supervision

Secure general liability, workers’ comp, and clinical malpractice insurance

Enroll as a Medicaid provider through DMAS via the MES portal

Contract with CSBs or MCOs depending on the waiver

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your business, obtain EIN and NPI
Step 2: Apply for an HCO license from the Virginia Department of Health
Step 3: Hire RN Supervisor and develop skilled nursing protocols
Step 4: Enroll as a Medicaid provider via the MES portal
Step 5: Contract with MCOs (CCC Plus) or CSBs (CL/FIS Waivers)
Step 6: Begin services upon Plan of Care approval and service authorization

5. REQUIRED DOCUMENTATION

EIN, NPI, Articles of Incorporation

VDH HCO license and inspection certificate

Medicaid enrollment and provider agreement

MCO or CSB authorizations

Skilled Nursing Policy & Procedure Manual, including:

Clinical care protocols and Plan of Care management

RN/LPN job descriptions and supervision schedules

Medication administration procedures

Infection control and wound care standards

Emergency response and reporting protocol

Documentation templates and billing tools

HIPAA, grievance, and patient rights compliance

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements:

Active Virginia RN license

Responsible for assessments, Plan of Care development, and staff supervision

Role: Licensed Practical Nurse (LPN)
Requirements:

Virginia LPN license

Works under RN direction; provides direct clinical care

Role: Skilled Nursing Coordinator (optional)
Responsibilities: Oversees scheduling, documentation, and quality control

All staff must complete:

CPR and First Aid certification

HIPAA and documentation training

Infection control and universal precautions

Annual skills validation and clinical competency checks

7. MEDICAID WAIVER PROGRAMS

Skilled Nursing Services are included in:

CCC Plus Waiver – For medically fragile adults requiring ongoing clinical care

Community Living (CL) Waiver – For individuals with I/DD and complex health needs

Family and Individual Supports (FIS) Waiver – Case-by-case for in-home clinical needs

EPSDT – Pediatric nursing services under age 21 for eligible children

Services must be prescribed by a physician, included in a Plan of Care, and authorized by the payer (MCO or CSB).

8. TIMELINE TO LAUNCH

Phase: Business Formation & HCO Licensing
Timeline: 2–3 months (includes VDH inspection and approval)

Phase: Medicaid Enrollment & MCO/CSB Contracts
Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, & Policy Development
Timeline: 4–6 weeks

Phase: Launch of Services
Timeline: Begins upon Plan of Care approval and service authorization

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

Virginia Department of Health – Home Care Licensing
Website: https://www.vdh.virginia.gov/olc/home-care/

MES Provider Portal (Medicaid Enrollment)
Website: https://vamedicaid.dmas.virginia.gov/provider

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA SKILLED NURSING PROVIDER
WCG assists healthcare agencies in launching fully compliant Skilled Nursing programs with clinical documentation, staffing compliance, and Medicaid readiness.

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Scope of Work:

VDH Home Care Organization license support

MES Medicaid provider enrollment

Skilled Nursing Policy & Procedure Manual creation

Plan of Care templates and nurse supervision tools

Shift notes, MARs, and billing documentation

Infection control, HIPAA, and emergency response systems

HABILITATION SERVICES PROVIDER IN VIRGINIA
BUILDING SKILLS FOR DAILY LIVING, INDEPENDENCE, AND COMMUNITY PARTICIPATION FOR INDIVIDUALS WITH DEVELOPMENTAL AND INTELLECTUAL DISABILITIES

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Habilitation Services in Virginia support individuals with intellectual or developmental disabilities (ID/DD) in acquiring, retaining, or improving skills needed for everyday living. Unlike rehabilitative care, which restores lost abilities, habilitation focuses on foundational skills—such as self-care, communication, socialization, and mobility—tailored to the individual's unique goals.

These services are available under the Community Living (CL), Family and Individual Supports (FIS), and Building Independence (BI) Waivers. Oversight is provided by the Virginia Department of Medical Assistance Services (DMAS) and Department of Behavioral Health and Developmental Services (DBHDS). Authorizations are handled through Community Services Boards (CSBs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Sets reimbursement rules, service definitions, and Medicaid enrollment processes.

Agency: Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Role: Licenses providers, ensures quality standards, and oversees service implementation.

Agency: Community Services Boards (CSBs)
Role: Approve Individual Support Plans (ISPs), authorize services, and coordinate care for waiver participants.

2. HABILITATION SERVICES OVERVIEW

Habilitation is delivered in the individual's home or a community setting and is customized based on their ISP goals. Services aim to promote autonomy, reduce dependency on others, and foster community involvement.

Covered activities include:

Skill-building for ADLs and IADLs (e.g., hygiene, meal prep, money management)

Social skills and interpersonal communication development

Community navigation (e.g., using public transport, accessing local resources)

Health and safety awareness

Behavior support and self-regulation strategies

Decision-making and problem-solving coaching

Support with organizing and structuring daily routines

Services are non-clinical and must be person-centered and goal-oriented.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Virginia State Corporation Commission (SCC)

Obtain EIN and Type 2 NPI

Apply for a DBHDS license in In-Home Support Services or Community Engagement

Complete DBHDS Human Rights Office affiliation

Develop a Habilitation Services Policy & Procedure Manual

Enroll as a Medicaid provider via the MES portal

Contract with local CSBs to receive referrals

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your business and obtain EIN and NPI
Step 2: Apply for DBHDS license and complete Human Rights documentation
Step 3: Develop policies, procedures, and staff training materials
Step 4: Enroll in Medicaid through the MES portal
Step 5: Contract with CSBs for waiver program referrals
Step 6: Begin delivering services after ISP approval

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI

DBHDS license and inspection approvals

Medicaid enrollment confirmation

Habilitation Services Policy & Procedure Manual including:

Individualized service delivery planning

Progress tracking and data collection forms

Staff training and supervision requirements

Emergency response and health safety procedures

Client rights, HIPAA, and informed consent documentation

Community access protocols and activity safety plans

6. STAFFING REQUIREMENTS

Role: Direct Support Professional (DSP)
Requirements:

High school diploma or GED

Criminal and CPS background checks

CPR, First Aid, and behavioral support training

Knowledge of person-centered practices and goal tracking

Role: Program Supervisor / Service Coordinator (recommended)
Responsibilities:

Oversee ISP implementation, review progress notes, and supervise DSPs

All staff must complete:

DBHDS-mandated training (e.g., person-centered planning, human rights)

HIPAA and incident reporting

Documentation and service note protocols

Annual skills assessments and professional development

7. MEDICAID WAIVER PROGRAMS

Habilitation services are available under:

Community Living (CL) Waiver – For individuals living in staffed or independent residences

Family and Individual Supports (FIS) Waiver – For individuals living with family or independently

Building Independence (BI) Waiver – For individuals with minimal paid support who still benefit from skill development

Service units and outcomes must be tied to ISP goals and tracked for CSB monitoring and DMAS audits.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Staffing
Timeline: 2–3 weeks

Phase: DBHDS Licensing & Medicaid Enrollment
Timeline: 1–2 months

Phase: Policy Manual Completion & CSB Contracting
Timeline: 3–5 weeks

Phase: Launch of Services
Timeline: Begins after ISP authorization and staff onboarding

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Medicaid Provider Portal
Website: https://vamedicaid.dmas.virginia.gov/provider

Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Website: https://dbhds.virginia.gov

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA HABILITATION SERVICES PROVIDER
WCG empowers new providers to launch impactful habilitation services with tools to track client progress, meet compliance standards, and support daily life skill-building.

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Scope of Work:

Medicaid and DBHDS licensing support

Habilitation Policy & Procedure Manual development

Staff onboarding tools and training plans

ISP goal tracking sheets and documentation templates

Client participation logs and daily support documentation

Emergency procedures and HIPAA-compliant systems

ADULT HEALTH CARE SERVICES PROVIDER IN VIRGINIA
DELIVERING MEDICALLY-NECESSARY SERVICES AND HEALTH MONITORING FOR ADULTS IN A SUPPORTIVE, COMMUNITY-BASED ENVIRONMENT

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Adult Health Care Services in Virginia provide structured, clinic-based medical and therapeutic care to adults with disabilities, chronic health conditions, or behavioral health challenges. These services promote preventive care, health monitoring, and functional maintenance, helping individuals remain healthy and engaged in their communities.

Covered under Virginia’s Community Living (CL), Family and Individual Supports (FIS), and Commonwealth Coordinated Care Plus (CCC Plus) Waivers, Adult Health Care Services must align with a person’s Individual Support Plan (ISP) and are coordinated through Community Services Boards (CSBs) or Managed Care Organizations (MCOs). Oversight is provided by the Department of Medical Assistance Services (DMAS) and the Virginia Department of Health (VDH) when licensing applies.

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers Medicaid waiver programs, provider enrollment, and billing oversight.

Agency: Virginia Department of Health (VDH)
Role: May license Adult Day Health Centers that provide skilled care or clinical oversight.

Agency: Community Services Boards (CSBs)
Role: Approve service authorizations for CL and FIS participants and monitor ISP outcomes.

Agency: Managed Care Organizations (MCOs)
Role: Approve services under CCC Plus and oversee utilization and care coordination.

2. ADULT HEALTH CARE SERVICES OVERVIEW

These services are generally delivered in a structured facility or day setting and focus on health monitoring, medication management, and preventative nursing services, as well as rehabilitation and health education.

Core components may include:

Routine vital sign monitoring and symptom management

Medication administration and reminders

Nutrition and meal planning (with medical oversight)

Health education and chronic disease support

PT, OT, and cognitive maintenance (as authorized)

Medical social services or counseling

Nursing assessments and care coordination

Social interaction and wellness activities

Participants typically attend on a part-time or full-time basis based on their assessed needs and ISP goals.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)

Obtain an EIN and Type 2 NPI

Secure an Adult Day Health license from the Virginia Department of Social Services (VDSS) or VDH (depending on services)

Ensure your site meets accessibility and safety standards

Create an Adult Health Care Policy & Procedure Manual

Enroll as a Medicaid provider via the MES portal

Contract with CSBs or MCOs for client referrals

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN and NPI
Step 2: Apply for appropriate licensure with VDH or VDSS
Step 3: Prepare facility for inspection (health and safety compliance)
Step 4: Enroll in Virginia Medicaid via the MES portal
Step 5: Contract with MCOs and CSBs
Step 6: Launch services after approval and ISP authorization

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI

Adult Day Health or Health Facility license

Medicaid enrollment confirmation

Staff credentialing and background checks

Adult Health Services Policy & Procedure Manual including:

Admission and discharge criteria

Nursing protocols and documentation

Emergency and medication management plans

Meal and nutrition logs and medical diets

Staff-to-client ratios and supervision policies

Service notes, ISP tracking, and billing templates

HIPAA and human rights compliance procedures

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN) or Licensed Practical Nurse (LPN)
Requirements:

Virginia licensure

Responsible for health assessments, med admin, and oversight

Role: Direct Support Professional (DSP) / Health Aide
Requirements:

High school diploma or GED

Trained in ADLs, safety, and health supports

Background checks and CPR/First Aid required

Optional Roles:

Program Director / Health Services Coordinator

Dietitian, Therapist, or Medical Social Worker (if needed by ISP)

All staff must complete:

HIPAA and documentation training

Infection control and emergency procedures

Annual clinical skills and competency evaluation

DBHDS-required human rights and person-centered training

7. MEDICAID WAIVER PROGRAMS

Adult Health Care Services are available under:

Community Living (CL) Waiver – For individuals needing daytime medical support

Family and Individual Supports (FIS) Waiver – For family-living individuals requiring ongoing health monitoring

CCC Plus Waiver – For adults with significant medical needs or chronic illnesses

Service frequency and intensity must be outlined in the participant’s ISP and approved by the CSB or MCO.

8. TIMELINE TO LAUNCH

Phase: Business Setup & Licensing Prep
Timeline: 2–3 months

Phase: Medicaid Enrollment & Contracting
Timeline: 4–6 weeks

Phase: Staff Hiring & Site Readiness
Timeline: 30–60 days

Phase: Launch of Services
Timeline: Begins upon ISP authorization and client referral

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Provider Portal (Medicaid Enrollment)
Website: https://vamedicaid.dmas.virginia.gov/provider

Virginia Department of Health (VDH)
Website: https://www.vdh.virginia.gov

Virginia Department of Social Services (VDSS) – Licensing
Website: https://www.dss.virginia.gov

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA ADULT HEALTH CARE PROVIDER
WCG helps new Adult Health programs get licensed, Medicaid-approved, and equipped to deliver high-quality, community-based medical care to waiver participants.

​

Scope of Work:

Medicaid enrollment and waiver alignment strategy

Adult Health Services Policy & Procedure Manual development

Facility inspection checklists and licensing guidance

Staff credentialing packets and supervision protocols

Nursing documentation templates and shift notes

Safety plans, emergency drills, and HIPAA compliance resources

ASSISTIVE TECHNOLOGY SERVICES PROVIDER IN VIRGINIA
DELIVERING PERSONALIZED TECHNOLOGICAL SOLUTIONS THAT ENHANCE COMMUNICATION, MOBILITY, INDEPENDENCE, AND DAILY LIVING FOR INDIVIDUALS WITH DISABILITIES

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Assistive Technology (AT) Services in Virginia provide individuals with disabilities the assessment, acquisition, customization, and training needed to use devices that support communication, mobility, and independent functioning. AT enables participants in Medicaid waiver programs to overcome barriers and actively participate in home, work, school, and community life.

These services are authorized under Virginia’s Community Living (CL), Family and Individual Supports (FIS), and Commonwealth Coordinated Care Plus (CCC Plus) Waivers. Oversight is provided by the Virginia Department of Medical Assistance Services (DMAS) and coordinated through Community Services Boards (CSBs) or Managed Care Organizations (MCOs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers waiver coverage and provider enrollment for Assistive Technology services.

Agency: Community Services Boards (CSBs)
Role: Authorize AT services for CL and FIS Waiver participants, ensuring alignment with the ISP.

Agency: Managed Care Organizations (MCOs)
Role: Approve service authorizations under the CCC Plus Waiver and manage care coordination.

2. ASSISTIVE TECHNOLOGY SERVICES OVERVIEW

Assistive Technology services involve evaluating needs, acquiring devices, and providing user training to help participants gain independence in areas like mobility, communication, learning, and environmental control.

Examples of covered technologies include:

Communication devices (e.g., speech-generating devices, AAC systems)

Adaptive switches and software for computer or phone use

Environmental control units (e.g., smart home tech, remote controls)

Augmented vision or hearing tools

Adapted educational and learning devices

Customized seating systems or ergonomic tools

Modifications to existing technologies for accessibility

All devices must be medically necessary, linked to ISP goals, and not covered by other insurance.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Virginia State Corporation Commission (SCC)

Obtain an EIN and Type 2 NPI

If selling or distributing devices, register as a medical device vendor (as needed)

Hire or contract with a qualified Assistive Technology Professional (ATP) or licensed therapist for assessments

Develop an Assistive Technology Services Policy & Procedure Manual

Enroll as a Medicaid provider through the MES portal

Contract with CSBs (CL/FIS) and/or MCOs (CCC Plus)

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI
Step 2: Hire/contract AT professionals or specialists
Step 3: Prepare documentation protocols and consent forms
Step 4: Enroll as a provider via the MES Medicaid portal
Step 5: Contract with CSBs or MCOs for service referrals
Step 6: Begin service delivery upon ISP authorization

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI

Medicaid provider enrollment confirmation

AT Services Policy & Procedure Manual including:

Evaluation procedures and assessment forms

ISP coordination and medical justification protocols

Device delivery and installation documentation

Training and follow-up support logs

Maintenance and repair plans

HIPAA, safety, and client rights policies

Technology use agreements and return policies

6. STAFFING REQUIREMENTS

Role: Assistive Technology Professional (ATP) / Specialist
Requirements:

Certification (e.g., RESNA ATP) or licensed therapist with AT experience

Skilled in assessing needs and matching technology solutions

Must collaborate with CSBs, MCOs, and therapists

Role: Technician / Installer / Trainer (optional)
Responsibilities:

Equipment setup, user training, and maintenance

All staff must complete:

HIPAA and safety training

Documentation and client education protocols

Person-centered planning and ISP goal alignment

Annual skills updates and technology refreshers

7. MEDICAID WAIVER PROGRAMS

Assistive Technology is reimbursed under:

Community Living (CL) Waiver – For individuals with ID/DD needing AT to improve function

Family and Individual Supports (FIS) Waiver – For participants living with family or independently

CCC Plus Waiver – For individuals with physical disabilities or complex medical needs

All services must be included in the participant’s ISP or Plan of Care and be approved by the CSB or MCO. Annual caps and pre-approval may apply.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Policy Manual Prep
Timeline: 2–3 weeks

Phase: Medicaid Enrollment & Staffing
Timeline: 4–6 weeks

Phase: Contracts with CSBs or MCOs
Timeline: 3–5 weeks

Phase: Service Launch
Timeline: Begins after device authorization and ISP documentation

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Medicaid Provider Portal
Website: https://vamedicaid.dmas.virginia.gov/provider

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

Virginia Assistive Technology System (VATS)
Website: https://www.vats.org

RESNA Certification for ATPs
Website: https://www.resna.org

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA ASSISTIVE TECHNOLOGY PROVIDER
WCG guides providers through the full launch of AT services—from certification and compliance to service tracking and Medicaid billing.

​

Scope of Work:

Medicaid enrollment and CSB/MCO contracting

Policy & Procedure Manual development tailored for AT services

Evaluation templates and device authorization forms

ISP-aligned documentation and training logs

Maintenance tracking and return policies

Staff credentialing tools and RESNA certification guidance

BEHAVIORAL HEALTH SERVICES PROVIDER IN VIRGINIA
DELIVERING MENTAL HEALTH, SUBSTANCE USE, AND EMOTIONAL WELL-BEING SUPPORT THROUGH EVIDENCE-BASED, COMMUNITY-INTEGRATED CARE

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Behavioral Health Services in Virginia address the mental, emotional, and behavioral needs of individuals living with psychiatric conditions, trauma, developmental challenges, or substance use disorders. These services help participants improve functioning, develop coping skills, and achieve stability in their home and community environments.

Behavioral health services may be covered through Virginia Medicaid State Plan, CCC Plus Waiver, or Behavioral Health Redesign services. Oversight is provided by the Virginia Department of Medical Assistance Services (DMAS) and the Department of Behavioral Health and Developmental Services (DBHDS), with authorizations managed through Managed Care Organizations (MCOs) or Community Services Boards (CSBs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers Medicaid programs, sets service definitions and provider requirements.

Agency: Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Role: Licenses behavioral health providers, oversees quality and human rights compliance.

Agency: Managed Care Organizations (MCOs)
Role: Authorize and manage Medicaid behavioral health benefits under CCC Plus and other plans.

Agency: Community Services Boards (CSBs)
Role: Coordinate services for waiver participants, refer individuals for treatment, and provide crisis support.

2. BEHAVIORAL HEALTH SERVICES OVERVIEW

Behavioral health services include mental health counseling, crisis stabilization, skill-building, and clinical support to treat psychiatric, developmental, or substance use-related conditions.

Examples of covered services:

Outpatient psychotherapy (individual, family, group)

Intensive In-Home (IIH) Services

Mental Health Skill-Building (MHSS)

Crisis Intervention and Crisis Stabilization

Applied Behavior Analysis (ABA)

Peer Support Services

Substance Use Disorder (SUD) treatment

Psychiatric medication management and telepsychiatry

Case management and care coordination

Services must be medically necessary, supervised by qualified professionals, and aligned with the Individualized Treatment Plan (ITP) or ISP.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your entity with the Virginia State Corporation Commission (SCC)

Obtain EIN and Type 2 NPI

Apply for a DBHDS Behavioral Health license under the relevant service categories (e.g., MHSS, IIH, Outpatient)

Complete DBHDS Human Rights Office affiliation

Develop a Behavioral Health Services Policy & Procedure Manual

Enroll with DMAS via the MES Provider Portal

Contract with MCOs and/or CSBs for referrals and authorizations

Note: Clinical supervisors, licensed providers, and QMHP/QPP staff must meet DBHDS credentialing requirements.

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN and NPI
Step 2: Apply for the appropriate DBHDS license(s)
Step 3: Affiliate with Human Rights and complete policies
Step 4: Enroll in Virginia Medicaid via the MES portal
Step 5: Contract with MCOs and CSBs
Step 6: Hire and credential staff; begin services upon referral and plan approval

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI

DBHDS license and Human Rights affiliation

Medicaid enrollment confirmation

Credentialing files for licensed and unlicensed staff

Behavioral Health Policy & Procedure Manual including:

Admission criteria and clinical supervision protocols

Treatment planning and service note templates

Safety, risk assessment, and suicide prevention procedures

Crisis and emergency response guidelines

HIPAA and client rights documentation

Quality assurance and incident reporting processes

6. STAFFING REQUIREMENTS

Role: Licensed Mental Health Professional (LMHP, LPC, LCSW, LMFT, etc.)
Requirements:

Active Virginia license

Responsible for assessments, treatment plans, and supervision

Role: Qualified Mental Health Professional (QMHP-A/C)
Requirements:

Registered with the Virginia Board of Counseling

Bachelor's degree + behavioral health experience

Role: Peer Support Specialist / Behavioral Technician (as applicable)
Requirements:

Certified by DBHDS or under clinical supervision

All staff must complete:

HIPAA and documentation training

DBHDS human rights and abuse prevention

Suicide prevention and de-escalation training

Annual clinical competencies and CEUs

7. MEDICAID WAIVER PROGRAMS & OTHER COVERAGE

Behavioral Health Services may be provided through:

CCC Plus Waiver – For adults with disabilities or behavioral health needs

CL/FIS Waivers – May include behavioral support and ABA for ID/DD individuals

Virginia Medicaid Behavioral Health Redesign – Covers enhanced services under standard Medicaid

EPSDT (Early Periodic Screening, Diagnosis, and Treatment) – For children and adolescents under age 21

Authorization and eligibility vary by service type and are determined by CSBs, MCOs, or treating physicians.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Clinical Staffing
Timeline: 2–4 weeks

Phase: DBHDS Licensing & Medicaid Enrollment
Timeline: 2–3 months

Phase: Policy Development & Contracts
Timeline: 3–5 weeks

Phase: Launch of Services
Timeline: Begins upon authorization of treatment plans

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Medicaid Provider Enrollment Portal
Website: https://vamedicaid.dmas.virginia.gov/provider

Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Website: https://dbhds.virginia.gov

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

MCO Contacts (Aetna, Anthem, Molina, etc.)
Available via: https://www.virginiamanagedcare.com

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA BEHAVIORAL HEALTH SERVICES PROVIDER
WCG partners with licensed clinicians and community agencies to build high-impact behavioral health programs backed by compliance, clinical integrity, and sustainability.

​

Scope of Work:

DBHDS and Medicaid enrollment assistance

Policy & Procedure Manual development

Treatment planning and clinical documentation templates

Staff credentialing logs and supervision trackers

Human rights, HIPAA, and risk mitigation systems

Audit preparation, chart review, and compliance coaching

ENVIRONMENTAL MODIFICATION SERVICES PROVIDER IN VIRGINIA
ENHANCING SAFETY, ACCESSIBILITY, AND INDEPENDENCE AT HOME THROUGH STRUCTURAL ADAPTATIONS FOR INDIVIDUALS WITH DISABILITIES

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Environmental Modification Services in Virginia provide physical adaptations to the home that enable individuals with disabilities to live safely and independently in their own residences. These modifications help reduce risks, increase mobility, and support daily functioning—ultimately avoiding the need for institutional care.

Environmental Modifications are covered under Virginia’s Medicaid Community Living (CL) Waiver, Family and Individual Supports (FIS) Waiver, and Commonwealth Coordinated Care Plus (CCC Plus) Waiver. Oversight is provided by the Department of Medical Assistance Services (DMAS) and coordinated locally by Community Services Boards (CSBs) or Managed Care Organizations (MCOs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Defines allowable modifications, approves provider enrollment, and oversees Medicaid funding.

Agency: Community Services Boards (CSBs)
Role: Authorize modifications under the CL and FIS Waivers, ensure ISP alignment, and monitor compliance.

Agency: Managed Care Organizations (MCOs)
Role: Coordinate authorizations for CCC Plus Waiver participants and manage reimbursement.

2. ENVIRONMENTAL MODIFICATION SERVICES OVERVIEW

Environmental modifications are permanent or semi-permanent physical adaptations to a participant’s primary residence that address functional limitations and promote safe home-based living.

Examples of covered modifications:

Wheelchair ramps and widened doorways

Roll-in showers and accessible tubs

Grab bars, stair lifts, or transfer poles

Lowered counters, sinks, and cabinets

Specialized lighting or door hardware

Floor surface changes to reduce tripping hazards

Reinforced walls or safety glass (for behavioral needs)

Non-covered items include: General home repairs, luxury upgrades, appliances, and furnishings not tied to the individual’s disability-related needs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)

Obtain EIN and Type 2 NPI

Hold a Virginia Contractor’s License through the Department of Professional and Occupational Regulation (DPOR)

Carry commercial liability and workers’ comp insurance

Develop an Environmental Modification Policy & Procedure Manual

Complete enrollment as a Medicaid provider with DMAS via the MES portal

Be approved by relevant MCOs (for CCC Plus) or CSBs (for CL/FIS Waivers)

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business and obtain EIN, NPI, and DPOR contractor license
Step 2: Enroll as a Medicaid provider through the MES portal
Step 3: Submit insurance, licensing, and Policy Manual documentation
Step 4: Contract with MCOs or CSBs for waiver-specific service delivery
Step 5: Complete home evaluations and submit modification quotes for approval
Step 6: Begin work after service authorization and funding approval

5. REQUIRED DOCUMENTATION

SCC registration, EIN, NPI

DPOR contractor license

Medicaid enrollment confirmation

MCO or CSB contracts or referral authorizations

Environmental Modification Policy & Procedure Manual including:

Scope of services and materials

Worksite safety and cleanup standards

Estimate, bidding, and quote submission process

Project approval and documentation workflow

Incident reporting and client communication policy

Before-and-after photo protocol

Warranty or maintenance procedures for installed modifications

6. STAFFING REQUIREMENTS

Role: Licensed Contractor / Construction Technician
Requirements:

Virginia DPOR contractor license in applicable trades

Liability insurance

Experience with accessibility, safety, and ADA-compliant construction

Optional Role: Environmental Modification Coordinator
Responsibilities:

Conducts pre-assessments, collaborates with CSBs/MCOs, and submits documentation

All staff must complete:

HIPAA and client confidentiality training

Disability sensitivity and home access training (recommended)

Safety and worksite cleanliness protocols

7. MEDICAID WAIVER PROGRAMS

Environmental Modifications are authorized under:

Community Living (CL) Waiver – For individuals living in their own home or family home

Family and Individual Supports (FIS) Waiver – For individuals with developmental disabilities in a family residence

CCC Plus Waiver – For medically fragile adults requiring home adaptations

All modifications must be medically necessary, tied to a documented need in the Individual Support Plan (ISP), and pre-approved by the service coordinator.

8. TIMELINE TO LAUNCH

Phase: Business Registration & Licensing
Timeline: 2–4 weeks

Phase: Medicaid Enrollment via MES
Timeline: 4–6 weeks

Phase: MCO/CSB Contracting & Readiness Review
Timeline: 3–4 weeks

Phase: Service Launch
Timeline: Begins after project approval and written authorization

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

Virginia DPOR – Contractor Licensing
Website: https://www.dpor.virginia.gov

MES Provider Portal (Medicaid Enrollment)
Website: https://vamedicaid.dmas.virginia.gov/provider

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

​

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA ENVIRONMENTAL MODIFICATION PROVIDER
WCG assists contractors and disability-access professionals in launching compliant Medicaid Environmental Modification programs across Virginia.

​

Scope of Work:

MES Medicaid enrollment support

Contractor licensing and credentialing guidance

Policy & Procedure Manual tailored for environmental modifications

Sample quote forms, pre/post evaluation tools, and billing sheets

HIPAA compliance, warranty logs, and safety checklists

Collaboration templates for CSBs, MCOs, and family communication

NURSING FACILITY TRANSITION SERVICES PROVIDER IN VIRGINIA
HELPING INDIVIDUALS SAFELY RETURN TO THE COMMUNITY FROM INSTITUTIONAL SETTINGS WITH DIGNITY, SUPPORT, AND A PERSON-CENTERED PLAN

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Nursing Facility Transition (NFT) Services in Virginia are designed to assist individuals who live in nursing homes or other institutional facilities and wish to transition back into the community. These services ensure that individuals have the supports, resources, and housing arrangements necessary for a successful and sustainable move.

NFT services are a key component of Virginia’s Commonwealth Coordinated Care Plus (CCC Plus) Waiver and are overseen by the Department of Medical Assistance Services (DMAS). Service coordination is carried out in collaboration with Managed Care Organizations (MCOs) and, in many cases, transition coordination agencies approved by DMAS.

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers the CCC Plus Waiver and sets standards for transition services.

Agency: Managed Care Organizations (MCOs)
Role: Identify eligible individuals, authorize transition services, and coordinate care.

Agency: Virginia Housing (formerly VHDA)
Role: Offers housing assistance through vouchers and community-based housing programs (when applicable).

2. NURSING FACILITY TRANSITION SERVICES OVERVIEW

NFT services help eligible individuals move from a nursing facility into a home or community-based setting. Services are short-term, person-centered, and aim to reduce re-institutionalization.

Key covered activities include:

Pre-transition assessments and person-centered planning

Identifying and securing housing

Arranging household items and accessibility modifications

Coordinating home and community-based services (e.g., personal care, transportation)

Providing financial support for moving expenses (within limits)

Ensuring follow-up and post-move stabilization

These services are authorized by the individual's MCO and must be documented in a transition plan.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)

Obtain an EIN and Type 2 NPI

Ensure staff meet minimum qualifications (see below)

Create a Transition Services Policy & Procedure Manual

Enroll as a Medicaid provider via the MES portal

Contract with MCOs for CCC Plus Waiver service authorizations

Build partnerships with local housing authorities and CSBs for referrals and support

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register entity, obtain EIN and NPI
Step 2: Prepare policies, staffing plans, and documentation tools
Step 3: Enroll as a Medicaid provider through DMAS MES portal
Step 4: Contract with CCC Plus MCOs for service authorization
Step 5: Begin services upon transition plan approval and MCO referral

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI

Medicaid provider enrollment confirmation

MCO contracts and service referral forms

NFT Policy & Procedure Manual including:

Intake and pre-transition planning process

Transition service delivery timeline and staff roles

Coordination procedures with housing agencies and HCBS providers

Expense tracking and reporting templates

Post-transition follow-up and satisfaction surveys

Documentation of person-centered planning and community integration efforts

Emergency contacts and contingency planning protocols

6. STAFFING REQUIREMENTS

Role: Transition Coordinator / Specialist
Requirements:

Bachelor’s degree in human services or related field (or equivalent experience)

Knowledge of Medicaid waivers, person-centered planning, and housing options

Strong coordination and communication skills

Background check and training in HIPAA, rights, and documentation

Role: Program Supervisor (optional)
Responsibilities:

Oversight of transition services, quality assurance, and staff support

All staff must complete:

HIPAA and confidentiality training

Emergency relocation protocols

Housing navigation and tenancy support

Person-centered planning documentation and MCO compliance training

7. MEDICAID WAIVER PROGRAMS

NFT services are primarily authorized under:

CCC Plus Waiver – For individuals in nursing facilities who qualify for home and community-based services

Services must be coordinated with an MCO Transition Coordinator and included in the participant’s Transition Plan and subsequent ISP

Funding may support one-time expenses such as:

First month’s rent and security deposit

Utility setup and basic furnishings

Moving services and minor home modifications

8. TIMELINE TO LAUNCH

Phase: Business Registration & Staffing
Timeline: 2–3 weeks

Phase: Medicaid Enrollment & MCO Contracts
Timeline: 4–6 weeks

Phase: Policy Manual Finalization & Readiness Review
Timeline: 2–3 weeks

Phase: Service Launch
Timeline: Begins after MCO referral and transition plan approval

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Medicaid Provider Enrollment Portal
Website: https://vamedicaid.dmas.virginia.gov/provider

Virginia Housing
Website: https://www.virginiahousing.com

CCC Plus Managed Care Information
Website: https://www.virginiamanagedcare.com

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA NURSING FACILITY TRANSITION PROVIDER
WCG helps providers navigate the complex requirements of starting a Medicaid-eligible NFT service, with a focus on housing coordination, waiver transitions, and person-centered relocation support.

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Scope of Work:

Medicaid enrollment and MCO contracting support

NFT Policy & Procedure Manual tailored to Virginia standards

Transition planning templates and expense tracking forms

Staff credentialing and training toolkits

Post-move checklists and documentation logs

Housing agency coordination resources and referrals

COMMUNITY INTEGRATION SERVICES PROVIDER IN VIRGINIA
SUPPORTING INDIVIDUALS WITH DISABILITIES TO LIVE, PARTICIPATE, AND THRIVE IN THEIR COMMUNITIES WITH DIGNITY AND PURPOSE

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Community Integration Services in Virginia are designed to help individuals with intellectual or developmental disabilities (ID/DD) develop meaningful connections, gain skills, and engage in everyday life outside of institutional settings. These services promote independence, social inclusion, and self-determination by supporting participation in volunteerism, recreation, lifelong learning, and civic life.

Community Integration is a core feature of the Community Living (CL) and Family and Individual Supports (FIS) Waivers, with coordination and oversight by Community Services Boards (CSBs) and standards set by the Virginia Department of Medical Assistance Services (DMAS) and Virginia Department of Behavioral Health and Developmental Services (DBHDS).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers Medicaid reimbursement and program eligibility.

Agency: Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Role: Licenses and regulates providers delivering community engagement and skill-building services.

Agency: Community Services Boards (CSBs)
Role: Authorize services through the ISP, monitor progress, and ensure alignment with waiver goals.

2. COMMUNITY INTEGRATION SERVICES OVERVIEW

Community Integration may be delivered 1:1 or in small groups based on individual preferences and needs. Services should reflect the person’s goals in their Individual Support Plan (ISP) and emphasize full participation in community life.

Covered activities may include:

Volunteering and civic participation (e.g., food banks, animal shelters)

Attending classes, workshops, or community events

Visiting libraries, parks, or museums

Participating in recreational or wellness activities

Building relationships with non-paid community members

Exploring interests like gardening, art, or local clubs

Services must be person-centered, non-facility-based, and promote skills, autonomy, and community presence.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)

Obtain an EIN and Type 2 NPI

Apply for a DBHDS license for Community Engagement or Community Coaching

Develop a Community Integration Services Policy & Procedure Manual

Obtain affiliation with DBHDS Human Rights and submit policies

Enroll as a Medicaid provider through the MES portal

Contract with CSBs to receive referrals and service authorizations

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your business, obtain EIN and NPI
Step 2: Apply for DBHDS license (Community Engagement or Community Coaching)
Step 3: Complete Human Rights affiliation and prepare policy documents
Step 4: Enroll as Medicaid provider through the MES portal
Step 5: Submit staffing plans and documentation tools
Step 6: Contract with local CSBs and begin services after ISP authorization

5. REQUIRED DOCUMENTATION

SCC registration, EIN, NPI

DBHDS license and inspection certificate

Medicaid provider agreement

CSB referral forms and ISP alignment

Community Integration Services Policy & Procedure Manual including:

Person-centered planning and goal tracking

Supervision and staffing ratios

Transportation and activity safety

Incident reporting, emergency preparedness, and risk assessment

Documentation templates for daily progress and participation

Community partnership tracking and inclusion outcomes

HIPAA and client rights protections

6. STAFFING REQUIREMENTS

Role: Community Engagement Specialist / Direct Support Professional (DSP)
Requirements:

High school diploma or GED

Clean background check and CPS registry clearance

Person-centered planning and inclusion training

CPR, First Aid, and behavior support (if needed)

Role: Program Supervisor (optional)
Responsibilities:

Monitors ISP implementation, community partnerships, and staff compliance

All staff must complete:

DBHDS-mandated onboarding and annual training

Human Rights and person-centered services training

Emergency protocols and transportation safety

Documentation and ISP goal tracking training

7. MEDICAID WAIVER PROGRAMS

Community Integration services are available under:

Community Living (CL) Waiver – Individuals living in group homes or supported apartments

Family and Individual Supports (FIS) Waiver – Individuals living with family or independently

Building Independence (BI) Waiver – Limited community-based activities based on need

These services must be part of the ISP and cannot occur in segregated or institutional settings.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensing Preparation
Timeline: 2–3 months (includes DBHDS review)

Phase: Medicaid Enrollment & CSB Contracting
Timeline: 1–2 months

Phase: Hiring, Training & Activity Plan Development
Timeline: 3–5 weeks

Phase: Launch of Services
Timeline: Begins after CSB referral and ISP authorization

9. CONTACT INFORMATION

Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Website: https://dbhds.virginia.gov

DBHDS Office of Licensing
Website: https://dbhds.virginia.gov/office-of-licensing/

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Provider Portal (Medicaid Enrollment)
Website: https://vamedicaid.dmas.virginia.gov/provider

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA COMMUNITY INTEGRATION PROVIDER
WCG helps human services agencies build inclusive, impactful community integration programs that meet DBHDS licensing standards and align with person-centered planning.

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Scope of Work:

DBHDS license and Human Rights affiliation support

Medicaid enrollment and CSB contracting assistance

Community Integration Policy & Procedure Manual development

Goal tracking logs and person-centered participation forms

Staff onboarding packets and training schedules

Emergency preparedness, incident reporting, and documentation templates

INDIVIDUAL & FAMILY SUPPORT SERVICES PROVIDER IN VIRGINIA
EMPOWERING INDIVIDUALS WITH DISABILITIES AND THEIR FAMILIES TO LIVE FULLY AND SAFELY WITHIN THEIR COMMUNITIES

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Individual & Family Support Services in Virginia provide flexible, person-centered supports that strengthen the capacity of individuals with disabilities and their families to live independently, access services, and actively engage in community life. These services are designed to help individuals avoid institutional care, support family caregivers, and promote self-determination.

These supports are available through the Family and Individual Supports (FIS) Waiver, Community Living (CL) Waiver, and occasionally through the Commonwealth Coordinated Care Plus (CCC Plus) Waiver, depending on the participant's needs. Oversight is provided by the Department of Medical Assistance Services (DMAS) and administered in partnership with local Community Services Boards (CSBs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers Medicaid Waiver programs, issues provider standards, and monitors compliance.

Agency: Department of Behavioral Health and Developmental Services (DBHDS)
Role: Manages developmental disability services and coordinates with CSBs.

Agency: Community Services Boards (CSBs)
Role: Authorize services, oversee Individual Support Plans (ISPs), and coordinate family and individual supports.

2. INDIVIDUAL & FAMILY SUPPORT SERVICES OVERVIEW

These services are highly individualized and tailored to meet the needs of both the individual receiving services and their caregivers. They include support with daily living, coordination of care, and skill development.

Examples of covered services:

Assistance with managing medical appointments, transportation, or service navigation

Help coordinating educational and community resources

In-home training and coaching for life skills

Family and caregiver training or support

Crisis support planning and access to backup staff

Advocacy and self-direction skill-building

Community engagement and inclusion activities

Flexible respite for unpaid caregivers

All services must be part of the individual’s Person-Centered Plan and authorized by the local CSB.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)

Obtain EIN and Type 2 NPI

Contract with a Community Services Board (CSB) as a Waiver service provider

Enroll as a Medicaid provider through DMAS

Create a Policy & Procedure Manual tailored to Individual & Family Services

Maintain staff training documentation and background check records

Carry general liability and workers’ compensation insurance

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your legal entity, obtain EIN and NPI
Step 2: Apply to provide services through your local CSB
Step 3: Complete enrollment in DMAS via the MES (Medicaid Enterprise System) provider portal
Step 4: Submit documentation (manuals, staff credentials, insurance, etc.)
Step 5: Pass provider readiness review by CSB or DBHDS (if applicable)
Step 6: Begin delivering services upon ISP authorization

5. REQUIRED DOCUMENTATION

EIN, NPI, Articles of Incorporation

CSB agreement and DMAS approval

Policy & Procedure Manual including:

Scope of support services and staff roles

Service delivery documentation and progress tracking

Family communication protocols

Client rights, HIPAA compliance, and grievance processes

Emergency procedures and crisis planning

Person-centered planning and ISP coordination

Training and supervision procedures for staff and family trainers

6. STAFFING REQUIREMENTS

Role: Direct Support Professional (DSP)
Requirements:

High school diploma or GED

Experience with I/DD or behavioral health populations preferred

Background check and abuse registry clearance

CPR and First Aid certification

Optional Role: Family Support Specialist or Coach
Responsibilities: Supports caregivers through training, resource referrals, and coaching

Optional Role: Program Coordinator
Responsibilities: Manages referrals, ISP compliance, and quality assurance

All staff must complete:

Orientation to person-centered practices and DD Waiver requirements

HIPAA, documentation, and abuse prevention training

Annual competency assessments and continuing education

7. MEDICAID WAIVER PROGRAMS

Individual & Family Support Services may be authorized under:

Family and Individual Supports (FIS) Waiver – For individuals with developmental disabilities living with family

Community Living (CL) Waiver – For individuals in their own homes or provider-operated settings

CCC Plus Waiver – May allow related supports (e.g., service coordination or respite) for adults with physical disabilities or complex needs

All services must be documented in the Person-Centered ISP and approved by the CSB.

8. TIMELINE TO LAUNCH

Phase: Business Setup & Policy Development
Timeline: 3–4 weeks

Phase: CSB Contracting & DMAS Enrollment
Timeline: 1–2 months

Phase: Staff Hiring & Credentialing
Timeline: 2–3 weeks

Phase: Service Launch
Timeline: Begins upon ISP referral and authorization

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

Department of Behavioral Health and Developmental Services (DBHDS)
Website: https://dbhds.virginia.gov

MES Provider Portal (Medicaid Enrollment)
Website: https://vamedicaid.dmas.virginia.gov/provider

Community Services Board Directory
Website: https://dbhds.virginia.gov/community-services-boards/

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA INDIVIDUAL & FAMILY SUPPORT PROVIDER
WCG supports new and established agencies in developing effective and compliant support programs for individuals and caregivers across Virginia.

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Scope of Work:

CSB contracting and Medicaid provider enrollment support

Custom Policy & Procedure Manual for family-centered support models

ISP coordination templates and documentation guides

Staff training resources and onboarding materials

HIPAA, grievance, and emergency response tools

Outcome tracking sheets and family communication logs

CASE MANAGEMENT SERVICES PROVIDER IN VIRGINIA
COORDINATING CARE, ADVOCACY, AND ACCESS TO SERVICES FOR INDIVIDUALS WITH COMPLEX NEEDS ACROSS HOME AND COMMUNITY SETTINGS

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Case Management Services in Virginia provide critical support to individuals with disabilities, chronic health conditions, or behavioral health needs by helping them navigate the system of care, develop individualized service plans, and access the right resources at the right time. Case Managers act as advocates and coordinators—connecting individuals to services while ensuring those services align with their preferences and functional needs.

These services are authorized under Medicaid through programs such as the CCC Plus Waiver, the Community Living (CL) Waiver, and the Family and Individual Supports (FIS) Waiver. Oversight is provided by the Department of Medical Assistance Services (DMAS) and coordinated through Community Services Boards (CSBs) or Managed Care Organizations (MCOs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Defines standards for case management services, processes provider enrollment, and oversees claims.

Agency: Community Services Boards (CSBs)
Role: Oversee case management for individuals with intellectual and developmental disabilities (IDD), approve service plans, and monitor service delivery.

Agency: Managed Care Organizations (MCOs)
Role: Coordinate case management under the CCC Plus Waiver and ensure compliance with person-centered planning principles.

2. CASE MANAGEMENT SERVICES OVERVIEW

Case Management includes a wide range of activities aimed at developing and maintaining an Individual Support Plan (ISP), monitoring services, and empowering individuals to live as independently as possible.

Core services include:

Person-centered assessments and planning

Identification of service needs and supports

Development and coordination of the ISP

Assistance with accessing Medicaid and non-Medicaid services

Crisis planning and referral to emergency resources

Monitoring service quality, documentation, and satisfaction

Advocacy to ensure dignity, choice, and integration

All services must follow a person-centered approach and adhere to timelines and review standards set by DMAS.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)

Obtain an EIN and Type 2 NPI

Hire or contract with Qualified Case Managers (credentials required)

Obtain affiliation with Virginia DBHDS Human Rights Office

Develop a Case Management Policy & Procedure Manual per DMAS and DBHDS standards

Enroll as a Medicaid provider through the MES portal

Contract with appropriate CSBs (CL/FIS Waivers) or MCOs (CCC Plus)

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your entity with SCC, obtain EIN and NPI
Step 2: Hire qualified staff and create policy documentation
Step 3: Enroll through DMAS MES Provider Portal
Step 4: Submit Human Rights and Licensing documentation (for CL/FIS Waivers)
Step 5: Contract with MCOs or CSBs depending on waiver type
Step 6: Launch services following ISP approval and referral

5. REQUIRED DOCUMENTATION

SCC registration, EIN, NPI

Staff credentials and background checks

Medicaid enrollment confirmation and CSB/MCO referral forms

Case Management Policy & Procedure Manual including:

Intake, eligibility, and assessment protocols

ISP development, updates, and review timelines

Documentation and service tracking tools

Crisis management and emergency protocols

HIPAA compliance and client confidentiality

Person-centered planning training and forms

Client grievance procedures

6. STAFFING REQUIREMENTS

Role: Case Manager or Support Coordinator
Minimum Requirements:

Bachelor’s degree in human services or related field

One year of experience with the target population

Knowledge of Medicaid waiver programs and person-centered planning

Background check, CPR/First Aid, and DBHDS-required trainings

Role: Clinical Supervisor or Program Director (optional)
Responsibilities: Oversight of service quality, staff training, and ISP compliance

All staff must complete:

DBHDS-approved person-centered training

Human Rights and HIPAA training

Crisis de-escalation and emergency response training

Documentation and service coordination workshops

7. MEDICAID WAIVER PROGRAMS

Case Management is a required or optional component of the following:

Community Living (CL) Waiver – Support Coordination is mandatory and managed by CSBs

Family and Individual Supports (FIS) Waiver – Also managed through CSBs

CCC Plus Waiver – Case Management may be provided by MCO-contracted providers

Early Intervention and EPSDT Services – Targeted case management for children with developmental delays

All activities must be authorized through the ISP and documented according to DMAS and DBHDS protocols.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Staff Recruitment
Timeline: 2–3 weeks

Phase: Policy Manual Development & Medicaid Enrollment
Timeline: 4–6 weeks

Phase: CSB or MCO Contracting & Readiness Review
Timeline: 2–3 weeks

Phase: Launch of Services
Timeline: Begins after referral and service authorization

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Provider Enrollment Portal
Website: https://vamedicaid.dmas.virginia.gov/provider

Virginia Department of Behavioral Health and Developmental Services (DBHDS)
Website: https://dbhds.virginia.gov

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA CASE MANAGEMENT PROVIDER
WCG equips new case management agencies with the tools, training, and documentation needed to support waiver participants with excellence.

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Scope of Work:

Medicaid provider enrollment and CSB/MCO contracting

Policy & Procedure Manual tailored to Virginia case management rules

Person-centered ISP templates and service coordination logs

Staff credentialing packets and training compliance tools

HIPAA and Human Rights forms, grievance procedures, and documentation templates

Crisis plan templates and monitoring systems

NON-MEDICAL TRANSPORTATION SERVICES PROVIDER IN VIRGINIA
HELPING INDIVIDUALS WITH DISABILITIES ACCESS THEIR COMMUNITIES, SERVICES, AND DAILY ACTIVITIES SAFELY AND RELIABLY

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Non-Medical Transportation (NMT) Services in Virginia support individuals with disabilities by providing rides to and from community-based programs, jobs, appointments, and other non-emergency destinations that align with their Individual Support Plan (ISP). This service promotes independence, community inclusion, and access to essential supports beyond traditional healthcare.

NMT is covered under the Community Living (CL) and Family and Individual Supports (FIS) Waivers, and can also be authorized through the Commonwealth Coordinated Care Plus (CCC Plus) Waiver when no other transportation resource is available. Oversight is provided by the Department of Medical Assistance Services (DMAS), with coordination by Community Services Boards (CSBs) and Managed Care Organizations (MCOs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Defines covered NMT services, processes Medicaid reimbursement, and handles provider enrollment.

Agency: Community Services Boards (CSBs)
Role: Authorize NMT services for CL and FIS waiver participants and ensure alignment with the ISP.

Agency: Managed Care Organizations (MCOs)
Role: Coordinate and authorize NMT for CCC Plus Waiver participants.

2. NON-MEDICAL TRANSPORTATION SERVICES OVERVIEW

NMT providers help individuals access services, employment, education, and social activities when public or family transport isn’t available or appropriate.

Examples of eligible transportation destinations:

Day support programs or employment sites

Community activities (e.g., library, volunteer sites, recreation centers)

Grocery stores or essential errands (when approved in ISP)

Medical or therapy appointments (if not covered by NEMT)

Visits to family or friends supporting ISP goals

Service types include:

Door-to-door or curb-to-curb transport

Wheelchair-accessible vehicles

One-on-one or group rides depending on ISP

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)

Obtain an EIN and Type 2 NPI

Hold liability insurance and vehicle insurance (commercial)

Complete background checks for all drivers (criminal + DMV)

Maintain a fleet safety and maintenance program

Enroll as a Medicaid provider via the MES portal

Contract with CSBs (CL/FIS Waiver) or MCOs (CCC Plus Waiver)

Develop a Non-Medical Transportation Policy & Procedure Manual

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register entity with SCC, obtain EIN and NPI
Step 2: Prepare vehicles to meet accessibility and safety standards
Step 3: Enroll as a Medicaid provider via DMAS MES portal
Step 4: Submit insurance, driver background checks, and vehicle logs
Step 5: Contract with CSBs or MCOs
Step 6: Begin accepting referrals after ISP authorization

5. REQUIRED DOCUMENTATION

EIN, NPI, and Articles of Incorporation

Medicaid enrollment confirmation

Fleet maintenance logs and vehicle insurance

Driver background checks and driving records

CSB/MCO authorization forms and client trip logs

Non-Medical Transportation Policy & Procedure Manual including:

Trip scheduling and route documentation

Vehicle cleaning, inspection, and maintenance schedules

Incident response and emergency protocols

Rider safety procedures and accessibility standards

Billing and mileage tracking templates

HIPAA compliance and client confidentiality policy

6. STAFFING REQUIREMENTS

Role: Transportation Driver
Requirements:

Valid Virginia driver’s license (clean record)

Background check and DMV record review

CPR/First Aid and safety training

Passenger Assistance Training (recommended for wheelchair users)

Optional Role: Dispatcher or Trip Coordinator
Responsibilities:

Manages ride scheduling, documentation, and communication with CSBs/MCOs

All staff must complete:

HIPAA and confidentiality training

Client rights and safety orientation

Annual driver re-training and documentation updates

Training in transporting individuals with disabilities

7. MEDICAID WAIVER PROGRAMS

NMT is available under:

Community Living (CL) Waiver – For individuals living in group homes or supported living needing rides to work, community events, or appointments

Family and Individual Supports (FIS) Waiver – For individuals living with family who need assistance accessing daily services

CCC Plus Waiver – May authorize NMT in specific cases where no Non-Emergency Medical Transport (NEMT) or other option exists

Transportation must support the goals identified in the ISP, and cannot duplicate other paid transportation services.

8. TIMELINE TO LAUNCH

Phase: Business Setup & Fleet Readiness
Timeline: 2–3 weeks

Phase: Medicaid Enrollment & CSB/MCO Contracting
Timeline: 4–6 weeks

Phase: Staff Hiring, Training & Policy Development
Timeline: 2–4 weeks

Phase: Service Launch
Timeline: Begins upon receipt of authorization in the ISP

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Provider Enrollment Portal
Website: https://vamedicaid.dmas.virginia.gov/provider

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

Virginia Department of Motor Vehicles (DMV)
Website: https://www.dmv.virginia.gov

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA NON-MEDICAL TRANSPORTATION PROVIDER
WCG helps transportation entrepreneurs and human service agencies launch accessible, Medicaid-compliant ride services that align with waiver goals.

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Scope of Work:

Medicaid provider enrollment through MES

CSB/MCO contracting and readiness review

Policy & Procedure Manual development for NMT

Driver hiring packets and background check protocols

Trip log templates and billing documentation

Fleet safety checklists and incident response tools

HOME HEALTH CARE SERVICES PROVIDER IN VIRGINIA
BRINGING SKILLED MEDICAL CARE AND THERAPEUTIC SUPPORT TO INDIVIDUALS IN THE COMFORT OF THEIR OWN HOMES

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Home Health Care Services in Virginia provide short-term or long-term skilled nursing and therapeutic support for individuals recovering from illness, injury, surgery, or managing chronic health conditions. These services help prevent unnecessary hospitalization, support faster recovery, and allow clients to remain independent at home.

Home Health is covered under Virginia Medicaid State Plan services, the Commonwealth Coordinated Care Plus (CCC Plus) Waiver, and may also be available through EPSDT for children under 21. Oversight is provided by the Virginia Department of Medical Assistance Services (DMAS) and Virginia Department of Health (VDH).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Administers Medicaid enrollment, reimbursement, and claims for home health providers.

Agency: Virginia Department of Health (VDH) – Office of Licensure and Certification (OLC)
Role: Issues Home Care Organization (HCO) licenses and enforces regulations for skilled home health agencies.

Agency: Managed Care Organizations (MCOs)
Role: Handle referrals and service authorization for Medicaid recipients under the CCC Plus program.

2. HOME HEALTH CARE SERVICES OVERVIEW

Home health services are provided under a physician’s order and must be documented in a Plan of Care (POC). Services are delivered by licensed professionals and are designed to be intermittent, not continuous.

Covered services may include:

Skilled Nursing: IV therapy, wound care, injections, chronic condition monitoring

Physical Therapy (PT)

Occupational Therapy (OT)

Speech-Language Pathology (SLP)

Home Health Aide Services: Personal care under RN supervision

Medical Social Work

Medication Management and Health Education

Discharge planning and care coordination

All services must be medically necessary and align with federal Conditions of Participation (CoPs) if Medicare-certified.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)

Obtain an EIN and Type 2 NPI

Apply for a Home Care Organization (HCO) license via VDH Office of Licensure and Certification (OLC)

Hire a Registered Nurse (RN) as Director of Nursing

Secure general liability, professional, and workers’ compensation insurance

Develop a Home Health Care Policy & Procedure Manual per DMAS and CMS standards

Enroll as a Medicaid provider through the MES portal

Optionally pursue Medicare certification (if seeking dual reimbursement)

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register entity, obtain EIN and NPI
Step 2: Apply for HCO license via VDH
Step 3: Hire clinical leadership and develop policy manual
Step 4: Submit Medicaid provider enrollment via MES
Step 5: Contract with MCOs for CCC Plus referrals
Step 6: Complete site readiness inspections and credentialing
Step 7: Begin accepting physician referrals and create POCs

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI

HCO license and VDH inspection report

Medicaid enrollment confirmation

MCO contracts or referrals

Home Health Care Policy & Procedure Manual including:

Scope of skilled services and therapy programs

Plan of Care documentation and physician order tracking

Medication management and nursing protocols

Staff credentialing and supervision policies

Infection control, wound care, and emergency response

Client rights, grievance policy, and HIPAA compliance

Shift notes, MARs, billing logs, and discharge summaries

6. STAFFING REQUIREMENTS

Role: Registered Nurse (RN)
Requirements:

Active Virginia RN license

Oversees assessments, care plans, and supervision

Role: Licensed Practical Nurse (LPN)
Requirements:

Active Virginia license

Provides skilled services under RN direction

Role: Certified Home Health Aide (CHHA)
Requirements:

Trained and supervised by RN

Provides hands-on personal care

Role: Physical/Occupational/Speech Therapists (PT/OT/SLP)
Requirements:

Licensed in Virginia

Service must be prescribed and authorized

Role: Medical Social Worker (optional)
Requirements:

Licensed for care coordination and patient counseling

All staff must complete:

HIPAA, safety, and emergency training

Annual clinical competency validation

Documentation and infection control protocols

7. MEDICAID WAIVER PROGRAMS

Home Health Services are covered under:

Virginia State Plan Medicaid

CCC Plus Waiver – For individuals with complex medical needs

EPSDT – For children under age 21 who require skilled care

CL and FIS Waivers – May authorize in-home skilled services in special cases

All services must be included in a physician-authorized Plan of Care and approved by the payer (DMAS, MCO, or CSB).

8. TIMELINE TO LAUNCH

Phase: Business Formation & HCO Licensing
Timeline: 2–3 months (includes inspections and credentialing)

Phase: Medicaid Enrollment & MCO Contracting
Timeline: 1–2 months

Phase: Staff Hiring, Training & Clinical Readiness
Timeline: 30–60 days

Phase: Launch of Services
Timeline: Begins upon physician referral and POC approval

9. CONTACT INFORMATION

Virginia Department of Health – Office of Licensure and Certification (OLC)
Website: https://www.vdh.virginia.gov/olc/home-care/

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

MES Provider Portal
Website: https://vamedicaid.dmas.virginia.gov/provider

CCC Plus MCO Plan Information
Website: https://www.virginiamanagedcare.com

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA HOME HEALTH CARE PROVIDER
WCG helps healthcare entrepreneurs and clinical teams launch fully licensed, compliant Home Health programs with confidence.

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Scope of Work:

HCO license application and VDH compliance support

Medicaid enrollment and MCO contracting guidance

CMS-compliant Policy & Procedure Manual creation

Plan of Care templates and clinical documentation tools

Staff credentialing packets and shift logs

Infection control, HIPAA, and emergency preparedness systems

MEAL & NUTRITION SERVICES PROVIDER IN VIRGINIA
FUELING HEALTH, WELLNESS, AND INDEPENDENCE THROUGH NUTRITIOUS MEALS AND DIETARY SUPPORT AT HOME AND IN THE COMMUNITY

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Meal & Nutrition Services in Virginia provide essential nutritional support to individuals with disabilities, chronic illnesses, or functional limitations who are unable to prepare adequate meals on their own. These services promote health, reduce risk of malnutrition, and support independent living in home and community settings.

Meal services are covered under Virginia Medicaid’s Community Living (CL) and Family and Individual Supports (FIS) Waivers, and may also be available under the Commonwealth Coordinated Care Plus (CCC Plus) Waiver. Oversight is provided by the Department of Medical Assistance Services (DMAS) in coordination with Community Services Boards (CSBs) or Managed Care Organizations (MCOs).

1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)
Role: Oversees Medicaid reimbursement and provider standards.

Agency: Community Services Boards (CSBs)
Role: Authorize meals and nutrition services as part of the Individual Support Plan (ISP) for CL/FIS waiver participants.

Agency: Managed Care Organizations (MCOs)
Role: Manage referrals, authorizations, and claims for CCC Plus Waiver members.

2. MEAL & NUTRITION SERVICES OVERVIEW

Meal and nutrition supports include direct delivery of meals, assistance with food preparation, and guidance for maintaining healthy diets tailored to individual needs.

Covered services may include:

Home-delivered meals (frozen, fresh, or shelf-stable)

Meal prep support in the home (as part of ADL/IADL assistance)

Special diets (e.g., low sodium, diabetic-friendly, texture-modified)

Nutrition risk screenings and dietary education

Assistance with grocery shopping or meal planning

Collaborative planning with dietitians or nutritionists (if included in the ISP)

Services must be authorized and linked to specific needs in the Person-Centered Plan.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Virginia State Corporation Commission (SCC)

Obtain EIN and Type 2 NPI

Ensure food operations comply with Virginia Department of Health (VDH) food safety requirements

If preparing or delivering meals directly, obtain a VDH Food Establishment Permit

Develop a Meal & Nutrition Services Policy & Procedure Manual

Enroll as a Medicaid provider through the MES portal

Contract with CSBs (for CL/FIS Waivers) or MCOs (for CCC Plus)

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register your business, obtain EIN and NPI
Step 2: Obtain VDH food service license (if handling food preparation or delivery)
Step 3: Create service delivery protocols and documentation tools
Step 4: Enroll as a Medicaid provider through DMAS MES portal
Step 5: Contract with CSBs or MCOs for service authorization
Step 6: Begin services upon authorization and ISP alignment

5. REQUIRED DOCUMENTATION

SCC registration, EIN, NPI

VDH food permit (if applicable)

Medicaid provider enrollment confirmation

CSB or MCO authorization documents

Meal & Nutrition Policy & Procedure Manual including:

Nutrition risk screening protocol

Meal delivery and dietary documentation

Infection control, food handling, and storage standards

Coordination with care team and dietitians

Client rights, grievances, and confidentiality protections

Documentation templates for delivery, preferences, and dietary notes

6. STAFFING REQUIREMENTS

Role: Meal Delivery Driver or Nutrition Assistant
Requirements:

Valid driver’s license and background check

Food handler safety certification (as required by VDH)

Knowledge of special diets or meal preferences

Optional Role: Registered Dietitian (RD)
Responsibilities:

Provides nutrition assessments, care planning, and education

Collaborates with care team and supports ISP goals

All staff must complete:

HIPAA and client confidentiality training

Universal precautions and food safety procedures

Emergency response and incident reporting training

Annual review of infection control and dietary protocols

7. MEDICAID WAIVER PROGRAMS

Meal & Nutrition Services may be included under:

Community Living (CL) Waiver – Often authorized as part of residential or supported living supports

Family and Individual Supports (FIS) Waiver – For individuals living with family or independently

CCC Plus Waiver – May cover home-delivered meals or nutrition risk reduction services

Services must align with the Individual Support Plan (ISP) and may be bundled with personal care or IADL supports.

8. TIMELINE TO LAUNCH

Phase: Business Setup & Food Safety Readiness
Timeline: 2–4 weeks

Phase: Medicaid Enrollment & CSB/MCO Contracting
Timeline: 1–2 months

Phase: Menu Planning, Staff Hiring, and Documentation Prep
Timeline: 2–3 weeks

Phase: Launch of Services
Timeline: Begins upon ISP approval and participant authorization

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)
Website: https://www.dmas.virginia.gov

Virginia Department of Health – Food Safety
Website: https://www.vdh.virginia.gov/environmental-health/food-safety/

MES Provider Portal (Medicaid Enrollment)
Website: https://vamedicaid.dmas.virginia.gov/provider

Community Services Boards Directory
Website: https://dbhds.virginia.gov/community-services-boards/

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WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA MEAL & NUTRITION SERVICES PROVIDER
WCG helps nutrition-focused providers launch Medicaid-eligible programs with safe, nutritious service models that meet dietary and documentation requirements.

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Scope of Work:

Medicaid enrollment and CSB/MCO contracting support

Food safety compliance and VDH permit guidance

Policy & Procedure Manual development

Meal delivery and dietary documentation templates

HIPAA, infection control, and special diet training tools

Coordination templates for ISPs and care team collaboration