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module 2 menu module 1 Module 3-Part A Module 4-Part A Module 2-Part B Module 3-Part B Module 4-Part 4

registration and assessment



registration and assessment








  module 2 intro

This module includes information on the steps a services facilitator is responsible for as referrals are received and initial contact is made with the individual and employer of record.


Time: 25 minutes

Module 2: Part A
Narrated PowerPoint

PowerPoint Script - Text Document


Module 2: Materials:
A Guide for Long-Term Care Services in Virginia
DMAS Employer of Record Manual
DMAS-7 EPSDT Personal Care Services Functional Status Assessment
DMAS-95 addendum Questionnaire To Assess An Applicant's Ability to Independently Manage CD Services
DMAS-95B CD Services Management Questionnaire
DMAS-96 Medicaid Funded Long-Term Care Service Authorization Form
DMAS-97 Individual Choice – Institutional Care or Waiver Services
DMAS-97A/B Agency or Consumer Direction Provider Plan of Care
DMAS-98 KePRO Community Based Care Request for Services Form
DMAS-99 Community –Based Care Recipient Assessment Report
DMAS-99 LOC Community-Based Level of Care Review Instrument
DMAS-219 Authorization for Release of Information
DMAS-225 Medicaid LTC Communication Form
DMAS-456 DD Waiver Plan of Care
DMAS-458 LOF Summary Sheet
DMAS-459 DD Waiver Documentation of Individual Choice Between Institutional Care or HCBS
DMAS-459C ID Waiver Documentation of Individual Choice Between Institutional Care or HCBS
DMAS-460 ID Virginia HCB Waiver Choice of Providers
DMAS-486 Service Agreement between the Individual and the CD Services Facilitator
DMAS-489 Individual Selection of CD Services
EDCD Waiver Process Flow for Enrollment
Level of Functioning (LOF) Survey
Sample Form for Emergency Contacts
Uniform Authorization to Use and Exchange Information













Please note: Effective September 1, 2016, the names of two of the Medicaid Waivers referenced in the modules changed.

The Intellectual Disability (ID) Waiver is now the Community Living (CL) Waiver.

The Individual and Family Developmental Disabilities Support (IFDDS or DD) Waiver is now the Family and Individual Supports (FIS) Waiver.

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