1. Program Definition and Services

Case Management Services (often referred to as Support Coordination) in Virginia provide person-centered, non-medical planning and advocacy supports designed to help individuals with intellectual or developmental disabilities (I/DD), physical disabilities, or complex functional limitations acquire, maintain, and improve skills necessary for everyday living. Administered under multiple Home and Community-Based Services (HCBS) waivers via the Department of Medical Assistance Services (DMAS) and the Department of Behavioral Health and Developmental Services (DBHDS), these services promote independence and inclusion. Services include:

• In-Home & Community Support: Comprehensive face-to-face service coordination assessments, regular safety evaluations, resource navigation support, and localized development of the Individual Support Plan (ISP) delivered inside the individual's private home or primary residence
• Community Access & Participation: Tailored advocacy training, crisis plan modeling, community program mapping, and functional service monitoring practice designed to expand functional safety, self-determination, and active neighborhood civic involvement

2. Regulations

The program is governed by the following regulations:

• Virginia Regulations Implementing the Developmental Disabilities Services Act
• Virginia Community Services Board and Developmental Services Minimum Standards and Performance Regulations
• Federal Home and Community-Based Services (HCBS) Final Settings Rule (42 CFR 441.301)
• Virginia Mandated Reporter Laws (Protection Against Abuse, Neglect, and Exploitation)

3. Licensing or Certification

Providers must secure an agency service contract, subcontractor agreement, or formal provider approval via an authorized regional Community Services Board (CSB) or Managed Care Organization (MCO) and maintain compliance with Virginia HCBS quality frameworks.

4. Responsible State Agency

The Virginia Department of Medical Assistance Services (DMAS), in collaboration with the Department of Behavioral Health and Developmental Services (DBHDS), acts as the primary administrative authority. Background clearances are processed by DMAS and the Virginia State Corporation Commission (SCC).

5. Application Process

• Register the corporate entity with the Virginia State Corporation Commission, Corporate Division
• Apply for a background clearance profile and submit provider affiliation credentials to the regional CSB/MCO network
• Enroll the corporation through the state portal as an active Virginia Medicaid provider with DMAS via the MES portal
• Execute a formal service delivery plan and matching sequence through the electronic network

6. Required Documentation

• Verified business formation records, active Federal EIN, and corporate Type 2 NPI
• Active Service Agreement or formal provider approval credentials from the CSB or MCO
• Case Management Services Policy & Procedure Manual (covering intake, assessment schedules, ISP tracking rules, crisis management, and mandatory abuse reporting protocols)
• Signed HCBS Settings Transition Provider Self-Assessment Tool and formal Attestation documents
• Certificates of commercial general liability and professional liability insurance

7. Timeline for Approval

The combined processing pipeline spanning contracting reviews, background registry clearings, DMAS provider enrollment, and final authorization matching typically averages 2 to 3 months.

8. Pre-Application Process

Prospective providers must form an LLC or Corporation with the Virginia State Corporation Commission, secure an EIN, and obtain a corporate Type 2 National Provider Identifier (NPI) mapped to case management, support coordination, or specialized developmental disabilities taxonomy paths.

9. Pre-Application Training

The state hosts mandatory administrative and compliance training modules online. Agency owners, designated program managers, and case management specialists must successfully complete the formal DBHDS-approved Person-Centered Planning and Core Competency Orientation sequences.

10. Additional Notes

• All provided support goals must directly link to the participant's Individual Support Plan (ISP) and focus explicitly on building long-term independence and community access
• Providers must formalize a clear Service Agreement for every participant, detailing specific monitoring targets, crisis backup lines, and client-specific contact lists
• Any vehicle utilized for community site visits or client assessment transit must satisfy state safety rules and maintain proper auto liability limits
• Monthly case management notes, annual ISP review charts, and incident forms must be archived chronologically within each participant file to satisfy state Medicaid and DMAS accountability audits

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

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