{"data":{"id":"us-va/12vac30-50-440","jurisdiction":"us-va","citation":"12VAC30-50-440","heading":"Support coordination/case management services for individuals with  intellectual disability","body":"A. Target Group. Medicaid eligible individuals who  have an intellectual disability as defined in  § 37.2-100 of the Code of Virginia.\n\n1. An active  individual for  intellectual disability support coordination/case management shall mean  a person for whom there is  an individual support plan (ISP) (as defined in 12VAC30-122-20) in effect  that requires  direct or -related individual-related contacts or communication or activity with the  individual, the individual's family or caregiver, service providers, significant others, and others including at least one face-to-face contact with the individual every  90 days. Billing can be submitted for an active  individual only for months in which direct or -related individual-related contacts, activity, or communications occur, consistent with the ISP.\n\n2. The unit of service is one month. There shall be no maximum service limits for  support coordination/case management services except  services for as related to individuals residing in institutions or medical facilities. For these individuals, reimbursement for  support coordination/case management shall be limited to  30 days immediately preceding discharge.  Support coordination/case management for  individuals who reside in an institution may be billed for no more than two predischarge periods  within 12 months.\n\nB. Services will be provided in the entire  state.\n\nC. Comparability of  services: Services are not comparable in amount, duration, and scope. Authority of  § 1915(g)(1) of the Social Security Act (the Act) is invoked to provide services without regard to the requirements of § 1902(a)(10)(B) of the Act.\n\nD. Definition of  services.  Intellectual disability support coordination/case management services to be provided include:\n\n1. Assessment and planning services, to include developing  an individual support plan (ISP) as defined on 12VAC30-122-20 and in accordance with the requirements of the Final Rule found at 42 CFR 441.725, which does not include performing medical and psychiatric assessment but does include referral for  assessment;\n\n2. Linking the individual to services and supports specified in the  ISP;\n\n3. Assisting the individual directly for the purpose of locating,  identifying, or obtaining needed services and resources;\n\n4. Coordinating services and service planning with other agencies and providers involved with the individual;\n\n5. Enhancing community integration by contacting other entities to arrange community access and involvement, including opportunities to learn community living skills and to use vocational, civic, and recreational services;\n\n6. Making collateral contacts with the individual's significant others to promote implementation of the  ISP and community  integration;\n\n7.  Following up and monitoring to assess ongoing progress and ensuring services are delivered; and\n\n8. Education and counseling  that guides the  individual and develops a supportive relationship that promotes the  ISP.\n\nE. Qualifications of providers:\n\n1.  are not comparable in amount, duration, and scope. Authority of § 1915(g)(1) of the Act is invoked to limit   Support coordination/case management providers for individuals with  intellectual disability    shall be limited to the  community services boardsally. References to providers in this section shall refer to enrolled community services boards.\n\n2. To qualify as a provider of services  enrolled with DMAS for  intellectual disability support coordination/case management, the provider of the services  shall meet certain criteria. These criteria shall be:\n\na. The provider  shall guarantee that s individuals have access to emergency services on a 24-hour basis;\n\nb. The provider  shall demonstrate the ability to serve individuals in need of comprehensive services regardless of the individual's ability to pay or eligibility for Medicaid reimbursement;\n\nc. The provider  shall have the administrative and financial management capacity to meet state and federal requirements;\n\nd. The provider  have the ability to shall document and maintain individual case records in accordance with state and federal requirements;\n\ne. The provider shall submit the individual support plan in an electronic format in the state DD home and community-based services (HCBS) waiver management system for service authorization and data management for individuals enrolled in any DD HCBS waiver. The provider shall submit evidence to Department of Medical Assistance Services (DMAS) or the Department of Behavioral Health and Developmental Services (DBHDS) in specified format of follow-up and monitoring to assess ongoing progress of the ISP, ensuring services are delivered and health and safety is maintained;\n\nf. The provider shall participate in activities designed to safeguard participants' health and safety in accordance with approved DD HCBS waiver requirements or DBHDS licensing standards; and\n\ng. The provider shall participate in activities designed to assure ongoing compliance by DD HCBS waiver participants' providers of service subject to the Final Rule Settings Requirements found at 42 CFR 441.301(4) and as described in the approved Statewide Transition Plan;\n\nh. The services shall be in accordance with the Virginia  State Plan for  Medical Assistance; and\n\ni. The provider must be  licensed as a   developmental disability support coordination/case management agency by the  Department of Behavioral Health and Developmental Services.\n\n3. Providers may bill for Medicaid  intellectual disability support coordination/case management only when the services are provided by qualified  managers support coordinators/case managers. The  manager must support coordinator/case manager shall possess a combination of  intellectual disability work experience  and relevant education  that indicates that the  incumbent, at entry level, possesses the  knowledge, skills, and abilities listed in this subdivision.  These must be documented  observable in the application form or supporting documentation or  observable and documented during the interview (with appropriate supporting documentation).\n\na. Knowledge of:\n\n(1) The definition and causes of intellectual disability and  best practices in supporting individuals who have intellectual disability;\n\n(2) Treatment modalities and intervention techniques, such as  positive behavior supports, person-centered practices, independent living skills training, community inclusion/employment skills, supportive  guidance, family education, crisis intervention, discharge planning, and  support coordination;\n\n(3) Different types of assessments and their uses in  service planning;\n\n(4)  Individuals' civil and human rights;\n\n(5) Local community resources and service delivery systems, including support services, eligibility criteria and intake process, termination criteria and procedures, and generic community resources;\n\n(6) Types of  intellectual disability programs and services;\n\n(7) Effective oral, written, and interpersonal communication principles and techniques;\n\n(8) General principles of  documentation; and\n\n(9) The service planning process and the major components of   an ISP.\n\nb. Skills in:\n\n(1) Interviewing;\n\n(2) Negotiating with  individuals and service providers;\n\n(3) Observing recording and reporting and documenting an individual's behaviors;\n\n(4) Identifying and documenting  an individual's needs for resources, services, and other assistance;\n\n(5) Identifying services within the established service system to meet the  individual's needs and preferences;\n\n(6) Coordinating the provision of services for the individual by diverse public and private providers, generic and natural supports;\n\n(7) Using information from assessments, evaluations,  observations, and interviews to develop and revise as needed  support plans;\n\n(8) Formulating, writing, and implementing ized consumer  individual support plans to promote goal attainment and community integration for individuals with  intellectual disability;\n\n(9) Using information from assessment tools, evaluations, observations, and interviews to develop and revise as needed individual support plans (for example to ensure the ISP is implemented appropriately, identify change in status or to determine risk of crisis/hospitalization); and\n\n(10) Identifying community resources and organizations and coordinating resources and activities.\n\nc. Abilities to:\n\n(1) Demonstrate a positive regard for  individuals and their families (e.g., treating  people as individuals, allowing risk taking, avoiding stereotypes of people with  intellectual disability, respecting  individual and  family privacy, and believing  individuals can grow and contribute to their communities);\n\n(2) Be persistent and remain objective;\n\n(3) Work as team member, maintaining effective ter- interagency and intra-agency working relationships;\n\n(4) Work independently, performing position duties under general supervision;\n\n(5) Communicate effectively, verbally and in writing; and\n\n(6) Establish and maintain ongoing supportive relationships.\n\nF. The  state assures that the provision of  support coordination/case management services will not restrict an individual's free choice of providers in violation of § 1902(a)(23) of the Act and the Final Rule at 42 CFR 441.301(c)(1)(vi).\n\n1.  Enrolled individuals will have free choice of the available providers of  support coordination/case management services.\n\n2.  Enrolled individuals will have free choice of the providers of other medical care under the  State Plan for Medical Assistance.\n\nG. Payments for  support coordination/case management services under the  does State Plan for Medical Assistance shall not duplicate payments made to public agencies or private entities under other program authorities for this same purpose.","path":["Title 12. Health","Agency 30. Department of Medical Assistance Services","Chapter 50. Amount, Duration, and Scope of Medical and Remedial Care Services","Part IV. Case Management Services"],"source_url":"https://law.lis.virginia.gov/admincode/title12/agency30/chapter50/section440/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:50:56Z","sha256":"085ff7cb0f570cf0612fa4a1894f48e51a30c2467f08bfe9bc7ee53ef9964611","source_id":"us-va-vac","stale":false,"prev":"us-va/12vac30-50-430","next":"us-va/12vac30-50-480"},"notice":"GroundRules: Original legal text. Not legal advice."}