Department of Medical Assistance Services
LONG TERM CARE & WAIVER SERVICES
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ANNOUNCEMENTS:
Under 42 CFR 441.304(f) The agency must establish and use a public input process, for any changes in the services or operations of the waiver. Notice is hereby given that the Department of Medical Assistance Services (DMAS) will welcome public comments regarding the submission to the Centers for Medicare and Medicaid Services (CMS) a Technology Assisted Waiver (Tech) amendment to reflect a change in provider qualifications. The entire public notice, including the change in qualifications and the Technology Assisted Waiver application can be viewed at the links below.
Bullet EDCD Waiver Regulations – Effective February 13, 2015
PRE-ADMISSION SCREENING
Bullet FAQs from Hospital PAS Webinar – August 7, 2015
Bullet ePAS Demonstration for Hospitals - August 7, 2015
Bullet ePAS MMIS Resolution Reference for Denial Messages
Bullet Questions and Answers from Hospital ePAS WebEx Session – July 15, 2015
Bullet ePAS Demo and Tips from Local Agencies
Bullet ePAS – A Tool for Pre-Admission Screening – June 12, 2015 (power point presentation)
Bullet Community Pre-Admission Screenings – Process Enhancements – May 15, 2015 (power point presentation)
Bullet Questions and Answers from ePAS WebEx Sessions – May 1, 2015 (Sessions I and II)
Bullet Community Pre-Admission Screenings – Process Enhancements – May 1, 2015 (power point presentation)
Bullet Community Pre-Admission Screenings – Process Enhancements – March 20, 2015 (power point presentation)
Bullet Community Pre-Admission Screenings – Process Enhancements – March 13, 2015 (power point presentation)
Bullet ePAS Questions and Answers
Bullet Preadmission Screening Process – House Bill 702 – Frequently Asked Questions
LONG-TERM CARE RESOURCES & GUIDEBOOKS
Bullet Check List for Hospital Case Managers/Social Workers for Discharge Planning
Bullet Hospital Responsibilities for Long Term Care Preadmission Screening
Bullet Guide for Long-Term Care Services in Virginia
Bullet Virginia Medicaid Program at Glance
Bullet The Virginia Partnership for Long Term Care
LTC DIVISION MEDICAID FACT SHEETS AND RELATED DOCUMENTS
Bullet Division of Long-Term Care – Overview
Bullet Patient Pay Fact Sheet – August 2015
Bullet Alzheimer’s Assisted Living (AAL) Waiver
Bullet Consumer Directed Model (CD)
Bullet Day Support Waiver
Bullet Durable Medical Equipment (DME) and Supplies Program
Bullet Elderly or Disabled with Consumer Direction (EDCD) Waiver
Bullet Developmental Disability (DD) Waiver
Bullet Intellectual Disability (ID) Waiver
Bullet Money Follows the Person (MFP) Program
Bullet Program of All-Inclusive Care for the Elderly (PACE) Program
Bullet Technology Assisted Waiver
Bullet Waiver Services by Home and Community Based Waiver (Chart)
Bullet Key Provisions of the Medicaid Home and Community Based Waiver (HCBS) Rule
Bullet Virginia Administrative Code (VAC) – DMAS Long-Term Care State Regulation Summary
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 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
Bullet QMR Data
Bullet Quality Management Review
Bullet • Elderly Disabled Consumer Directed (EDCD) Waiver
Bullet • Technology Assisted (Tech) Waiver
Bullet • Intellectual Disabilities (ID) Waiver
Bullet • Day Support (DS) Waiver
Bullet • Alzheimer’s Assisted Living Waiver
Bullet • 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
• Contract Monitoring of DBHDS for the ID, DD, and DS Waiver Operations
• 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.
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INFORMATION FOR PROVIDERS
Provider Manuals, Provider Forms, Provider Search, and Service Authorization, access at:
Bullett Virginia Medicaid Portal
Provider Training Presentations/WebEx Sessions, access the "Learning Network" link from left column of the screen, or DMAS home page at:
Bullett DMAS Home
• Medicaid Provider Call Center Helpline # 1-800-552-8627
• Medicaid Provider Service Authorization (through KEPRO) Phone # 1-888-827-2884