allowable activities. Each of the allowable activities is available contingent
on the individual meeting criteria for receipt of the service activity. Receipt
of this service shall not be tied to the receipt of any other covered waiver or
Medicaid service. This service may be authorized one time per allowable
activity per individual per calendar year. However, a service may be
reauthorized within a calendar year if the individual's situation has changed
in terms of disability conditions, benefit type, or employment status.
Allowable activities include the following, which may be appropriate for the
individual as documented in his plan for supports:
Pre-employment benefits review that may
a. Benefits planning query (BPQY)
from Social Security Administration (SSA). Description: A BPQY provides
information about an individual's disability cash benefits, health insurance,
scheduled continuing disability reviews, representative payee, and work
history, as stored in SSA's electronic records. The BPQY is an important
planning tool for the individual or other person who may be developing
customized services for an individual who expresses interest in employment or
remaining on the job.
Pre-employment benefits summary and analysis (BS&A). Description: Work with
and on behalf of the individual to develop a benefits and net income analysis
report with both a current scenario and at least two other potential scenarios
involving Social Security work incentives.
c. Employment change benefits summary and
analysis. Description: Work with and on behalf of the individual when the
individual experiences a change in employment status to develop a benefits and
net income analysis report with both a current scenario and at least two other
potential scenarios involving Social Security work incentives.
Work incentives development or
revisions (PASS, IRWE, BWE, IDA): Work with the individual and family/legal
representative to develop:
Plan to achieve
(1) Part 1 description:
In collaboration with the individual and support system, develop a plan to
achieve self-support (PASS) and ensure submission to the SSA.
(2) Part 2 description: Ensure the approval
of the PASS plan from the SSA PASS cadre through modifications or other
Impairment related work expenses (IRWE). Description: IRWEs reduce the amount
of income that Social Security counts against an individual's benefits by
deducting the expense from their total countable wages. In order to qualify for
the IRWE, the expense shall be related to the individual's disability, work,
and be an expense without which the individual cannot work. This service
involves working with the individual to develop and submit appropriate forms
and supporting documents to SSA to successfully obtain the IRWE work
c. Blind work expenses
(BWE). Description: Work with and on behalf of an individual confirmed to be
blind to develop and submit appropriate forms and supporting documents to SSA
to successfully obtain the BWE work incentive. Given these circumstances, SSI
will not count any earned income when the primary diagnosis is blindness and
the expense is reasonably attributed to earning the income, that is, guide dog,
transportation to and from work, etc.
d. Individual development accounts (IDA).
Description: Work with and on behalf of the individual to develop matched
savings accounts to assist the individual in saving toward the purchase of a
lifelong asset such as a home.
Student earned income exclusion (SEIE). Description: Work with and on behalf of
the individual to develop and submit appropriate documents to SSA to receive
benefits under the SEIE work incentive. SEIE allows individuals younger than 22
years of age who regularly attend school or are involved in a vocational
education program to exclude earned income up to a certain amount per a
f. Medicaid while working
(Social Security Act § 1619(b)). Description: Work with and on behalf of
the individual to develop and submit an appropriate letter and supporting
documents to SSA, Virginia Department of Social Services (VDSS), and Medicaid
to receive benefits under § 1619(b), which provides the continuation of
Medicaid when a beneficiary loses his SSI due to earnings above the SSI
g. Medicaid works
(Virginia's Medicaid Buy-In Program). Description: Work with and on behalf of
the individual who is currently eligible for or receiving Medicaid to complete
and submit the Medicaid Works agreement and supporting documents to the VDSS to
enroll in the Medicaid Buy-In Program (may include Medicaid application or
updating the resource section of the Medicaid application). This enables
workers with disabilities the opportunity to earn higher income and retain more
in savings or resources than is typically allowed by Medicaid.
h. Work incentive revisions. Description:
Work with and on behalf of the individual to revise one of the work incentives
plans listed in this subdivision B 2 as determined necessary by a significant
change in status.
Resolution of SSA benefits issues (e.g., overpayments, subsidies, student
earned income exclusion, Medicaid while working):
a. Overpayments. Description: Work with and
on behalf of the individual to address Social Security overpayments that
b. Subsidies. Description:
Work with and on behalf of the individual to develop and submit appropriate
documents to SSA to receive the subsidy work incentive.
c. Work activity reports. Description: Assist
the individual family/legal representative in filling out and returning forms
a. ABLEnow. Description: Work with
and on behalf of the individual and family, if applicable, to open an ABLEnow
b. Financial health
assessment. Description: The financial health assessment (FHA) is a tool used
to gauge an individual's understanding of his current financial
Service units and limitations. Providers may not bill for waiver benefits
planning services while the eligible individual has an open employment services
case with DARS and is eligible for the same service through DARS.
1. The annual year limit for benefits
planning services is $3,000. No unspent funds from one plan year may be
accumulated and carried over to subsequent plan years.
Hourly limits per activity:
a. Plan for Achieving Self-Support-Part 1 7.0
b. Plan for Achieving Self
Support-Part 2 12.5 hours.
Impairment Related Work Expense 9.0 hours.
d. Blind Work Expense 9.0 hours.
e. Section 1619(b) Medicaid 4.5
f. Student Earned Income
Exclusion 9.0 hours.
g. Subsidy 9.0
h. Work Activity Reports:
i. Medicaid Works 5.5
j. Overpayment 3.5
k. Benefits Planning Query
l. Pre-Employment BSA
m. WorkWORLD Summary and
Analysis 7.0 hours.
Development Accounts 7.0 hours.
Section 301/Able Now 4.5 hours.
Financial Health Assessment 3.5 hours.
q. WI Revisions 7.0 hours.
qualifications and requirements.
providers of benefits planning services shall maintain and adhere to current,
signed participation agreements with DMAS. The provider designated in this
agreement shall directly submit claims to DMAS for reimbursement.
Eligible providers for benefits planning
services shall possess written verification that they are one of the following:
a. A nationally certified SSA community work
incentive coordinator (CWIC); or
A DARS certified work incentive specialist advocate (WISA) approved
providers that have completed required community financial empowerment and
financial literacy training from the Consumer Financial Protection Bureau
(CFPB) and Your Money, Your Goals will be eligible to receive payment for a
completed financial health assessment.
Documentation requirements for service
Providers shall include in each
The provider's plan
for supports per requirements detailed in 12VAC30-122-120
b. Documentation that shall confirm the
amount of time spent with the individual, as well as the amount of time
dedicated to completion of the work surrounding the benefits planning
to support units of service delivered, and the documentation shall correspond
with billing. Providers shall maintain separate documentation for each type of
service rendered for an individual.
d. All documents shall be completed as they
relate to benefits planning activities. If the individual or the family has
withdrawn from the process prior to the document's completion, all portions
that were completed should be documented along with a note that describes the
circumstances during each session.
e. A written review supported by
documentation in the individual's record shall be submitted to the support
coordinator quarterly, during any quarters in which the service was provided,
with the plan for supports if modified.
f. Documentation that all available and
appropriate funding sources (including those offered by Virginia Medicaid State
Plan, DARS, and the Department of Education), have been explored and
g. All correspondence to
the individual and the individual's family/caregiver, as appropriate, the
support coordinator, DMAS, and DBHDS.
2. Provider documentation shall support all
claims submitted for DMAS reimbursement. Claims that are not supported by
appropriate documentation shall be subject to recovery by DMAS as a result of
utilization reviews and audits.