12 Va. Admin. Code § 30-122-90 - Waiting list; criteria; slot assignment; emergency access; reserve slots
A. There shall
be a current and accurate statewide waiting list, called the DD Waivers waiting
list, for the DD Waivers. This waiting list shall be created and maintained by
DBHDS, which shall update it no less than annually.
B. Individuals on this waiting list shall
have (i) a diagnosis of developmental disability pursuant to §
37.2-100 of the Code
of Virginia, (ii) a completed VIDES form, and (iii) a priority designation
consistent with subsection D of this section.
C. Individuals who accompany parents or
guardians deployed overseas for active duty U.S. military or Foreign Service
assignment but retain Virginia residency shall remain on the statewide DD
Waivers waiting list and be considered for DD Waivers slot assignment when they
are within three months of returning to Virginia.
D. To be placed in one of the following
prioritization levels, the support coordinator shall determine through inquiry
of the individual and family/caregiver, as appropriate, and consideration of
the information reflected in the individual's diagnosis and VIDES form, which
priority category the individual meets. The individual shall be placed in the
prioritization level that best describes his need for waiver services by
meeting at least one criterion in the category:
1. Priority One shall include individuals who
require a waiver service within one year and are determined to meet at least
one of the following criteria:
a. An
immediate jeopardy exists to the health and safety of the individual due to the
unpaid primary caregiver having a chronic or long-term physical or psychiatric
condition that currently significantly limits the ability of the primary
caregiver to care for the individual; or there are no other unpaid caregivers
available to provide supports;
b.
There is immediate risk to the health or safety of the individual, primary
caregiver, or other person living in the home due to either of the following
conditions:
(1) The individual's behavior,
presenting a risk to himself or others, cannot be effectively managed even with
support coordinator-arranged generic or specialized supports; or
(2) There are physical care needs or medical
needs that cannot be managed even with support coordinator-arranged generic or
specialized supports;
c.
The individual lives in an institutional setting and has a viable discharge
plan; or
d. The individual is a
young adult who is no longer eligible for IDEA services and has expressed a
desire to live independently. After individuals attain 27 years of age, this
criterion shall no longer apply.
2. Priority Two shall include individuals who
will need a waiver service in one to five years and are determined to meet at
least one of the following criteria:
a. The
health and safety of the individual is likely to be in future jeopardy due to:
(1) The unpaid primary caregiver having a
declining chronic or long-term physical or psychiatric condition that currently
significantly limits his ability to care for the individual;
(2) There are currently no other unpaid
caregivers available to provide supports; or
(3) The individual's skills are declining as
a result of lack of supports;
b. The individual is at risk of losing
employment supports;
c. The
individual is at risk of losing current housing due to a lack of adequate
supports and services; or
d. The
individual has needs or desired outcomes that with adequate supports will
result in a significantly improved quality of life.
3. Priority Three shall include individuals
who will need a waiver slot in five years or longer as long as the current
supports and services remain and have been determined to meet at least one of
the following criteria:
a. The individual is
receiving a service through another funding source that meets current
needs;
b. The individual is not
currently receiving a service but is likely to need a service in five or more
years; or
c. The individual has
needs or desired outcomes that with adequate supports will result in a
significantly improved quality of life.
E. Waiver slots shall be assigned subject to
available funding.
1. A Waiver Slot
Assignment Committee (WSAC) is the impartial body of trained volunteers
established for each locality or region with responsibility for recommending
individuals eligible for a waiver slot according to their urgency of need. All
WSACs shall be composed of community members who shall not be employees of a
CSB or a private provider of either support coordination or waiver services and
shall be knowledgeable and have experience in the developmental disabilities
service system.
2. For FIS and CL
waiver slots, individuals who are in the Priority One category who are
determined to be most in need of supports at the time a slot is available shall
be reviewed by an independent WSAC for the area in which the slot is available.
The determination of which individuals in Priority One are to be reviewed by
the WSAC is accomplished through completion by the support coordinator of the
Critical Needs Summary-Step 1 Review Form (CNS), which assigns numeric ratings
to various circumstances that are deemed to affect urgency of need. A Slot
Assignment Review Form (SARF), also completed by the support coordinator, is
given to the WSAC members for each individual in the review pool in order to
provide the committee with information about the individuals' needs, current
services, and DD Waiver services that would best meet their needs.
3. The individual who has the highest need as
designated by the committee shall be recommended for the available waiver slot.
DBHDS shall make the final determination for slot assignment and to the most
appropriate waiver to address the assessed needs of the individual. FIS slots
will be offered unless the individual demonstrates an immediate need for
sponsored residential, group home residential, or support living which are only
offered in the CL waiver.
3. For BI
waiver slots, each of five regional WSACs composed of one representative from
each existing WSAC within the region shall make assignment recommendations for
BI waiver slots. If the number of individuals interested in a BI waiver slot
with Priority One status for all CSBs in a region is less than the number of
available slots, those individuals are assigned a slot without a regional WSAC
session occurring. A regional WSAC session will then be held for the remainder
of available slots, reviewing those individuals meeting criteria for Priority
Two and then Priority Three.
F. If the individual determines at any time
that he no longer wishes to be on the DD Waiver waiting list, he may contact
his support coordinator to request removal from the waiting list. The support
coordinator shall notify DBHDS so that the individual's name can be removed
from the waiting list.
G.
Eligibility criteria for emergency access to either the FIS, CL, or BI waiver.
1. Subject to available funding of waiver
slots and a finding of eligibility under 12VAC30-122-50 and 12VAC30-122-60,
individuals shall meet at least one of the emergency criteria of this
subdivision to be eligible for immediate access to waiver services without
consideration to the length of time they have been waiting to access services.
The criteria shall be one of the following:
a. Child protective services has
substantiated abuse or neglect against the primary caregiver and has removed
the individual from the home; or for adults where (i) adult protective services
has found that the individual needs and accepts protective services or (ii)
abuse or neglect has not been founded, but corroborating information from other
sources (agencies) indicate that there is an inherent risk present and there
are no other caregivers available to provide support services to the
individual.
b. Death of primary
caregiver or lack of alternative caregiver coupled with the individual's
inability to care for himself and endangerment to self or others without
supports.
c. An individual who
transitioned from one of the DD Waivers to the Medicaid Works program who
chooses to resume DD Waiver services.
2. Requests for emergency slots shall be
forwarded by the CSB or BHA to DBHDS.
a.
Emergency slots may be assigned by DBHDS to individuals until the total number
of available emergency slots statewide reaches 10% of the emergency slots
funded for a given fiscal year, or a minimum of three slots. At that point, the
next nonemergency waiver slot that becomes available at the CSB or BHA in
receipt of an emergency slot shall be reassigned to the emergency slot pool to
ensure emergency slots remain to be assigned to future emergencies within the
Commonwealth's fiscal year.
b.
Emergency slots shall also be set aside for those individuals meeting
eligibility criteria and not on the DD Waivers waiting list but newly
identified as meeting all eligibility criteria and in need of supports
resulting from an emergent situation described in subdivision 1 of this
subsection.
H. Reserve slots and the reserve waiting
list.
1. Reserve slots may be used for
transitioning an individual who, due to (i) a documented change in his assessed
support needs, which requires a service that is not available in the DD Waiver
in which the individual is presently enrolled or (ii) a preference for supports
found in a waiver with a less comprehensive array of supports, requires and
requests a move from the DD Waiver in which he is presently enrolled into
another of the DD Waivers to access necessary services.
a. An individual who needs to transition
between the DD Waivers shall not be placed on the DD Waivers waiting list.
b. CSBs or BHAs shall document and
notify DBHDS in writing when an individual meets the criteria in subdivision 1
b of this subsection within three business days of knowledge of need. The
assignment of reserve slots shall be managed by DBHDS, which will maintain a
chronological list of individuals in need of a reserve slot in the event that
the reserve slot supply is exhausted. Within three business days of adding an
individual's name to the reserve slot list, DBHDS shall advise the individual
in writing that his name is on the reserve slot list and his chronological
placement on the list.
c. Within
three business days of receiving a request from an individual for a status
update regarding his placement on the list, DBHDS shall advise the individual
of his current chronological list number.
2. When a reserve slot becomes available and
an individual is identified from the chronological list to access the slot, the
support coordinator will assure to DBHDS that the service that warranted the
transfer to the new waiver (e.g., group home residential) is (i) identified and
(ii) a targeted date of service initiation is in place prior to the reserve
slot assignment to the new waiver.
3. When an individual transitions to a new DD
waiver using a reserve slot, the waiver slot vacated by that individual shall
be offered to the next individual in that CSB's chronological queue for a
reserve slot by DBHDS. If the individual chooses to accept the slot, DBHDS will
assign in accordance with subdivision 2 of this subsection. The individual
receiving that slot must initiate services with the service that made him
eligible for the reserve waiting list within 60 calendar days. If he is unable
to initiate those services, he will remain in the slot he currently occupies
and may remain on the reserve slot waiting list until another slot becomes
available.
4. If there is not an
individual in that CSB's chronological queue for a reserve slot, the vacated
slot will be assigned to an individual on the statewide waiting list who
resides in the CSB's or BHA's catchment area by DBHDS after review and
recommendations from the local WSAC.
5. When a slot is vacated in one of the DD
Waivers (e.g., due to the death of an individual), the slot shall be assigned
to the next individual in that CSB's chronological queue for a reserve slot in
accordance with the procedures outlined in subdivision 3 of this
subsection.
I.
Individuals and family/caregivers shall have the right to appeal the
application of the prioritization criteria, emergency criteria, or reserve
criteria to their circumstances pursuant to 12VAC30-110. All notifications of
appeal shall be submitted to DMAS.
Notes
Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.
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