1. Program Definition and Services

Individual & Family Support Services in Virginia provide person-centered, non-medical 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), these services promote independence and family stability. Services include:

• In-Home & Community Support: Individualized evaluation, selection, customization, and deployment of hands-on life skills coaching, service navigation assistance, educational resource coordination, and flexible respite delivered inside the individual’s private home or primary residence
• Community Access & Participation: Tailored community engagement activities, self-direction skill-building, transit safety coaching, and advocacy development designed to expand functional safety, personal autonomy, and active neighborhood inclusion

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
• 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 strict 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. Corporate entity registrations and initial legal screenings are processed by 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 local regional CSB network
• Enroll the corporation through the state portal as an active Virginia Medicaid provider with DMAS via the MES (Medicaid Enterprise System) portal
• Execute a formal service delivery plan and matching sequence through the electronic network to accept individual ISP referrals

6. Required Documentation

• Verified business formation records, active Federal EIN, and corporate Type 2 NPI
• Active CSB Service Agreement or formal provider approval credentials
• Individual & Family Support Services Policy & Procedure Manual (covering family intake, progress tracking, safety risk 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 CSB 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 developmental disabilities or specialized home-based habilitation taxonomy paths.

9. Pre-Application Training

The state hosts mandatory administrative and compliance training modules online. Agency owners, designated program managers, and direct-care workers must successfully complete the formal DBHDS-approved 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 reducing caregiver burnout
• Providers must formalize a clear Service Agreement for every participant, detailing specific skill targets, family communication lines, and emergency contact lists
• Any vehicle utilized for community access or client transportation must satisfy state safety rules and maintain proper auto liability limits
• Daily service notes, goal progress charts, and incident forms must be archived chronologically within each participant file to satisfy state Medicaid audits

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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.

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