12 Va. Admin. Code § 30-122-70 - Assessment and enrollment; Virginia Individual Developmental Disabilities Eligibility Survey
Current through Register Vol.. 38, No. 17, April 11, 2022
A. Home
and community-based waiver services shall be considered only for individuals
eligible for admission to an ICF/IID due to the individuals' diagnoses of
developmental disabilities and documented functional support needs. For the
support coordinator to make a recommendation for the DD Waivers services, the
services shall be determined to be an appropriate service alternative to delay
or avoid placement in an ICF/IID or to promote exiting from an ICF/IID or other
institutional placement provided that a viable discharge plan that preserves
the individual's health, safety, and welfare in the community has been
developed.
B. The support
coordinator shall confirm diagnostic and functional eligibility for individuals
with input from the individual and the individual's family/caregiver, as
appropriate, and service or support providers involved in the individual's
support prior to DMAS assuming payment responsibility for covered home and
community-based waiver services. This confirmation shall be accomplished
through the completion of the following:
1. A
psychological or other evaluation of the individual that affirms that the
individual meets the diagnostic criteria for developmental disability as
defined in §
37.2-100 of the Code
of Virginia; and
2. The required
level-of-care determination through the Virginia Individual Developmental
Disabilities Eligibility Survey (VIDES) appropriate to the individual according
to his age, completed no more than six months prior to waiver
enrollment.
C. To
receive waiver services, the individual shall be found to be eligible for
Medicaid pursuant to 12VAC30-122-60.
D. The individual who has been found to be
eligible for these services consistent with subsections A and B in this section
shall be given by the support coordinator his choice of either institutional
placement or receipt of home and community-based waiver services.
E. If the individual chooses home and
community-based waiver services and an ISP that ensures the individual's safety
can be developed, then the support coordinator shall recommend the individual
for home and community-based waiver services.
F. Consistent with 12VAC30-122-90 E, if the
individual selects waiver services and a slot is available, then the support
coordinator shall enroll the individual in the waiver. The CSB or BHA shall
only enroll the individual following electronic confirmation by DBHDS that a
slot is available.
G. If no slot is
available, the support coordinator shall place the individual on the DD Waivers
waiting list consistent with criteria established for the DD Waivers in
12VAC30-122-90 until such time as a slot becomes available. Once the
individual's name has been placed on the DD Waivers waiting list, the support
coordinator shall (i) notify the individual in writing within 10 business days
of his placement on the DD Waivers waiting list and his assigned prioritization
level, as set out in 12VAC30-122-90, and (ii) offer appeal rights pursuant to
12VAC30-110.
H. There shall be
documentation of contact with the individual at least annually while the
individual is on the waiting list to provide the choice between institutional
placement and waiver services consistent with the requirements of
12VAC30-50-440
or
12VAC30-50-490,
as applicable.
I. Every place in
this chapter that requires physician action, DMAS permits nurse practitioners
to perform those tasks in accordance with §
54.1-2957
of the Code of Virginia.
Notes
Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
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