Introduction 

Becoming a licensed Medicaid Waiver provider in Virginia involves a detailed, multi-step process that requires adherence to state-specific guidelines and federal Medicaid regulations. Virginia’s Medicaid Waiver programs provide home and community-based services (HCBS) to individuals who are elderly, disabled or have developmental or intellectual disabilities. This guide outlines each stage of the application process for obtaining a Medicaid Waiver provider license in Virginia. 

1. Understand the Medicaid Waiver Programs in Virginia 

Description: 

Virginia operates several Medicaid Waiver programs, each serving different populations and offering specific services. Before beginning the application process, it's important to determine which waiver program aligns with the services your agency intends to provide. 

Key Virginia Waiver Programs: 

CCC Plus Waiver (Commonwealth Coordinated Care Plus Waiver): Supports individuals with complex medical needs and those requiring long-term care. 

DD Waivers (Developmental Disabilities Waivers): Includes the Building Independence (BI) Waiver, Family and Individual Supports (FIS) Waiver, and Community Living (CL) Waiver, serving individuals with developmental and intellectual disabilities. 

Technology-Assisted (Tech) Waiver: For individuals who are ventilator-dependent or require other intensive technological support. 

Key Steps: 

Identify the Target Population: Determine the population you want to serve (e.g., elderly, individuals with intellectual or developmental disabilities, or those with complex medical needs). 

Review Waiver Services: Visit the Virginia Medicaid Waiver Services Guide or the Virginia Department of Medical Assistance Services (DMAS) website to review services covered under each waiver, such as personal care, respite care, skilled nursing, or behavioral health support. 

Tips: 

Contact DMAS for clarification on waiver programs and services to ensure your agency’s offerings align with the specific needs of Medicaid recipients in Virginia. 

2. Meet the Basic Provider Requirements in Virginia 

Description: 

Before applying for a license, providers must ensure that their agency meets Virginia’s eligibility criteria. These requirements ensure that providers have the necessary resources, staffing, and infrastructure to deliver high-quality services. 

Key Steps: 

Establish a Legal Business Entity: Register your business with the Virginia State Corporation Commission (SCC) and obtain an Employer Identification Number (EIN) from the IRS. 

Obtain Liability Insurance: Virginia requires Medicaid Waiver providers to carry liability insurance. Make sure your policy includes general liability, professional liability, and workers’ compensation (if applicable). 

Meet Staffing Requirements: Ensure that your staff meet the minimum qualifications for the services you plan to provide: 

Direct care workers (personal care aides, CNAs) may need certifications such as First Aid and CPR. 

Licensed clinical staff (RNs, social workers, therapists) must have current Virginia licenses. 

Comply with Criminal Background Checks: Virginia mandates background checks for all staff providing direct care. You will need to submit these checks through the Virginia State Police or use the Virginia Department of Social Services (DSS) OBI background investigation unit for specific positions. 

Tips: 

Ensure your liability insurance policy covers the specific services provided under the Medicaid Waiver program (e.g., in-home care, behavioral health services). 

3. Complete the Pre-Licensing Process through DBHDS 

Description: 

Providers in Virginia must be licensed by the Department of Behavioral Health and Developmental Services (DBHDS) if they plan to offer services under the Developmental Disabilities Waiver or similar programs. DBHDS oversees and certifies providers offering behavioral health, developmental, and disability services. 

Key Steps: 

Submit a Letter of Intent: Notify DBHDS of your intention to apply for a license by submitting a Letter of Intent (LOI). This letter should include: 

The types of services you plan to provide. 

The population you plan to serve. 

The locations where services will be provided (home-based, community-based, or residential). 

Attend a Licensing Information Session: DBHDS requires potential providers to attend a licensing orientation session. This session outlines the licensing process, provider requirements, and service expectations. 

Prepare Policies and Procedures: Develop comprehensive policies and procedures that align with DBHDS standards, covering areas such as: 

Client intake and care plans. 

Incident reporting and emergency preparedness. 

Staff training and supervision. 

Service delivery and client rights. 

Complete the Licensing Application: Once the policies are ready, submit the DBHDS licensing application along with all required documentation. The application may include: 

Proof of business registration. 

A business plan detailing how you will deliver services and maintain financial viability. 

Proof of liability insurance and staff qualifications. 

Tips: 

Review DBHDS provider requirements thoroughly on the DBHDS website and attend the orientation to ensure you understand the detailed steps required. 

4. Submit the Virginia Medicaid Provider Enrollment Application 

Description: 

After DBHDS licensure, you must apply for enrollment as a Virginia Medicaid provider through the Department of Medical Assistance Services (DMAS) to be reimbursed for Medicaid Waiver services. DMAS oversees the Medicaid provider enrollment process. 

Key Steps: 

Obtain a National Provider Identifier (NPI): Before applying to become a Medicaid provider, you need to secure a National Provider Identifier (NPI) through the National Plan and Provider Enumeration System (NPPES). 

Complete the DMAS Provider Enrollment Application: Visit the DMAS Provider Enrollment portal to access the application. You will need to provide: 

Business information (EIN, NPI, business structure). 

DBHDS licensure documentation. 

Liability insurance information. 

Banking information for electronic funds transfers (EFT). 

Completed IRS W-9 form for tax purposes. 

Submit Required Documentation: Ensure all documentation is complete and aligned with DMAS provider enrollment requirements. This will include: 

A copy of your DBHDS license. 

Proof of liability insurance coverage. 

Proof of staff certifications and qualifications. 

Register for Virginia Medicaid’s Electronic Data Interchange (EDI): Enroll in the EDI system, which allows you to submit claims electronically for Medicaid reimbursement. Providers must use EDI for billing purposes. 

Tips: 

Review the Virginia Medicaid Provider Manual for detailed instructions on how to navigate the DMAS enrollment process. 

5. Prepare for Site Visits and Inspections (If Required) 

Description: 

DMAS or DBHDS may conduct site visits as part of the approval process to verify that your facility and services meet Virginia's health and safety standards. 

Key Steps: 

Prepare for DBHDS or DMAS Inspections: Make sure your facility is compliant with safety standards, including: 

Proper fire and safety protocols (smoke detectors, fire extinguishers, evacuation routes). 

ADA-compliant facilities (for accessibility by individuals with disabilities). 

Clean and well-maintained environments for client care. 

Ensure Staff Readiness: Staff should be trained and ready to demonstrate compliance with service delivery standards. This includes showing knowledge of emergency procedures, documentation processes, and client rights. 

Organize Documentation: Ensure that all required documentation, such as client intake forms, service logs, and staff certifications, is well-organized and available for review during inspections. 

Tips: 

Perform a mock inspection using DBHDS guidelines to ensure that all standards are met before the official visit. 

6. Receive Medicaid Waiver Provider Approval 

Description: 

After successfully completing the application process and any necessary inspections, you will receive official approval as a Medicaid Waiver provider in Virginia. This approval allows you to begin delivering services to eligible Medicaid recipients and submitting claims for reimbursement. 

Key Steps: 

Receive Your Medicaid Provider Number: Once your application is approved, you will be assigned a Medicaid Provider Number, which you will use to bill for services rendered. 

Sign Provider Agreements: Complete any final steps required by DMAS, such as signing provider agreements that outline your responsibilities as a Medicaid Waiver provider. 

Begin Service Delivery: Once you have received your provider number, you can begin offering Medicaid Waiver services and billing for reimbursement through the DMAS system. 

Tips: 

Keep your Medicaid Provider Number and approval documentation on hand for audits, billing, and inspections. 

7. Maintain Compliance and Renew Licensure 

Description: 

Once you are a licensed provider, you must maintain compliance with DBHDS and DMAS regulations, including annual reporting, staff training, and adherence to service standards. 

Key Steps: 

Submit Annual Reports: DBHDS may require annual reports to ensure compliance with service delivery standards. These reports may include financial statements, client service data, and staff certifications. 

Maintain Staff Certification and Training: Ensure that your staff meet all ongoing certification requirements, including completing mandatory training and renewing licenses (e.g., CPR, First Aid). 

Participate in Audits and Inspections: Be prepared for periodic audits and site inspections to ensure continued compliance with DBHDS and DMAS regulations. Keep all documentation, such as care plans, service logs, and billing records, up to date and organized. 

Renew Licenses: Depending on your provider type, you may need to renew your DBHDS license periodically. Ensure you submit renewal applications on time to avoid any lapses in licensure. 

Tips: 

Use a compliance calendar or software to track important deadlines for license renewals, staff certifications, and training updates. 

How Waiver Consulting Group Can Help 

Waiver Consulting Group provides expert assistance to help Medicaid Waiver providers in Virginia navigate the licensing and enrollment process. Our services include: 

Application Support: We assist with preparing and submitting your DBHDS and DMAS applications, ensuring all documentation is complete and compliant. 

Policy and Procedure Development: We help develop the necessary policies and procedures required for DBHDS licensing and DMAS approval. 

Staff Training: We offer training programs to ensure your staff are equipped with the knowledge and certifications required for Medicaid Waiver services. 

Ongoing Compliance Support: We provide ongoing support to help your agency maintain compliance with state regulations, including audits, inspections, and licensure renewals. 

For more information on how we can assist your agency, get started with Waiver Consulting Group or schedule a consultation. 

Conclusion 

Navigating the licensing process for Medicaid Waiver services in Virginia requires a clear understanding of the state’s requirements, thorough preparation, and ongoing compliance. By following the step-by-step process outlined in this guide, you can successfully obtain your provider license and begin delivering high-quality services to eligible Medicaid recipients. Waiver Consulting Group is here to support you at every stage, ensuring your agency remains compliant and successful in providing critical care to Virginia’s vulnerable populations. 

For additional resources or support, visit Waiver Consulting Group Services.