Department of Medical Assistance Services
LONG TERM CARE & WAIVER SERVICES

ANNOUNCEMENT:
Daily Operations of the DD Waiver
DD Waiver Operational Changes effective Nov. 10, 2013
LONG-TERM CARE RESOURCES & GUIDEBOOKS
Guide for Long-Term Care Services in Virginia
Virginia Medicaid Program at Glance
Virginia's Long Term Care Partnership
PHONE NUMBERS FOR MEDICAID RECIPIENTS:
• Questions, contact the Recipient Helpline # 1-804-786-6145
• Questions related to Consumer Direction, contact the PPL Help Desk # 1-866-259-3009
PURPOSE OF THE DIVISION OF LONG-TERM CARE
The Division of Long-Term Care (LTC) oversees the provision of services and programs to the elderly and individuals with disabilities. This oversight includes assuring the health, safety, and welfare of Medicaid long-term care individuals, program development, program operations, regulatory development, legislative review, maintenance of programs, provider and participant training, education, and development of LTC policy and special reports (such as required legislative reports). LTC Division focuses on the health, safety, and welfare of all persons who receive Medicaid long-term care services.
ORGANIZATIONAL STRUCTURE OF THE DIVISION OF LONG TERM CARE
The Division has three functional units:
• Aging and Medical Services
• Data and Quality Management Review
• Waiver Operations and Contracts
AGING AND MEDICAL SERVICES
• Nursing Facilities including Specialized Care
• Long-Stay Hospitals
• Elderly or Disabled with Consumer Direction (EDCD) Waiver
• Technology Assisted Waiver
• Program for All-Inclusive Services for the Elderly (PACE)
• Level of Care (LOC) Review
• Alzheimer’s Assisted Living (AAL) Waiver
• Home Health
• Hospice
• Out of State Placement
• Durable Medical Equipment (DME)
DISABILITY AND SUPPORT SERVICES (at DBHDS for program operational management)
• Individual and Family Developmental Disabilities Support (DD) Waiver
• Day Support (DS) Waiver
• Intellectual Disabilities (ID) Waiver
DATA AND QUALITY MANAGEMENT REVIEW
QMR Data
Quality Management Review
• Elderly Disabled Consumer Directed (EDCD) Waiver
• Technology Assisted (Tech) Waiver
• Intellectual Disabilities (ID) Waiver
• Day Support (DS) Waiver
• Alzheimer’s Assisted Living Waiver
• DD Waiver
WAIVER OPERATIONS & CONTRACTS
• Special Projects
• Waiver Application And Renewals
• Division Regulations
• Division Policy Manuals
• Money Follows The Person (MFP) Program
• Contract Monitoring For Fiscal/Employer Agent Contractor For Consumer-Directed Services
• Lead for Division legislative issues and studies
• Rehabilitative Services (inpatient and outpatient)
REGULATORY FUNCTIONS & RESPONSIBILITIES
The Division of LTC has regulatory and legislative responsibility for the programs that are administered by the Division. The Division develops, reviews, and updates regulations and provides training to providers and individuals on regulatory and legislative requirements.
LTC RESPONSIBILITY TO ENSURE QUALITY SERVICES
The Division of LTC is responsible for quality management review (QMR) for all home-and community-based services waivers. Division staff performs random on-site reviews and desk reviews as well as reviews that are a result of complaints received. The purposes of the reviews are to:
• Assure the health, safety, and welfare of individuals;
• Determine the appropriateness and quality of services provided to Medicaid waiver individuals;
• Monitor provision of services based on State and federal regulations;
• Monitor provision of services based on policy and procedures; and
• Provide education/training to providers on policies and regulation.
The LTC Quality Improvement Team (QIT) consists of representatives from each unit within the Division. The QIT developed performance measures for each of CMS’ Waiver assurances and meets quarterly to review compliance with each of the performance measures. When areas of deficiency are noted, the QIT reviews remediation steps taken and makes recommendations for additional process or systems changes when indicated.
OVERVIEW OF MEDICAID FACT SHEETS
Alzheimer’s Assisted Living Waiver
Consumer Directed Model
Day Support Waiver
Developmental Disability Waiver
Durable Medical Equipment and Supplies
EDCD Waiver
Technology Assisted Waiver
PACE
Intellectual Disability (ID) Waiver
Money Follows the Person (MFP) Program
DMAS LTC Regulation Summary
Waiver Services by Home & Community Based Services Chart
INFORMATION FOR PROVIDERS
Provider Manuals, Provider Forms, Provider Search, and Service Authorization, access at:
Virginia Medicaid Portal
Provider Training Presentations/WebEx Sessions, access the "Learning Network" link from left column of the screen, or DMAS home page at:
DMAS Home
• Medicaid Provider Call Center Helpline # 1-800-552-8627
• Medicaid Provider Service Authorization (through KEPRO) Phone # 1-888-827-2884