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12VAC30-120-924. Covered services; limits on covered services. (Commonwealth Coordinated Care Plus Waiver)

Virginiaprimary-regulationVirginia Department of Medical Assistance Services (DMAS)· effective 2024-06-19

What this rule requires your agency to do

  • 1Agency-directed and consumer-directed personal care and respite care services shall be subject to the electronic visit verification requirements set out in 12VAC30-60-65 (12VAC30-120-924.A.4, .D.2.f, .E.5.d, .G.2.d, .H.4).(12VAC30-120-924. Covered services; limits on covered services. (Commonwealth Coordinated Care Plus Waiver))
  • 2Agency-directed personal care shall be hands-on care including assistance with ADLs, community access, medication assistance per VDH licensing requirements, supervision, and health monitoring; it excludes skilled nursing except delegable tasks under 18VAC90-19-240 through -280 (12VAC30-120-924.D).(12VAC30-120-924. Covered services; limits on covered services. (Commonwealth Coordinated Care Plus Waiver))
  • 3Individuals choosing consumer-directed services shall receive support from a DMAS-enrolled services facilitator and shall have an EOR with capability to hire, train, fire, and supervise the attendant including approving work shift entries; where the individual cannot direct care or is under 18, a family member/caregiver/designated person shall serve as EOR (12VAC30-120-924.F.1-2).(12VAC30-120-924. Covered services; limits on covered services. (Commonwealth Coordinated Care Plus Waiver))
  • 4Respite care shall be limited to 480 hours per individual per calendar year combined across agency-directed and consumer-directed models; PDN shall not exceed 112 hours per week (12VAC30-120-924.E.5.a, .H.5.a, .M.3-4).(12VAC30-120-924. Covered services; limits on covered services. (Commonwealth Coordinated Care Plus Waiver))
  • 5The fiscal/employer agent shall handle payroll, employment taxes, and background checks for CD attendants and obtain necessary IRS authorizations (12VAC30-120-924.F.5).(12VAC30-120-924. Covered services; limits on covered services. (Commonwealth Coordinated Care Plus Waiver))
  • 6The services facilitator shall not be the waiver individual, a CD attendant, a provider of other Medicaid services, the spouse, the parent/legal guardian of a minor, or the EOR (12VAC30-120-924.F.4).(12VAC30-120-924. Covered services; limits on covered services. (Commonwealth Coordinated Care Plus Waiver))
  • 7Agency-directed and consumer-directed personal care services shall be limited to 56 hours per week for 52 weeks per year, with exceptions under 12VAC30-120-927; supervision services are capped at 8 hours per day (12VAC30-120-924.D.2.d-e, .G.2.b-c).(12VAC30-120-924. Covered services; limits on covered services. (Commonwealth Coordinated Care Plus Waiver))
  • 8The individual, family, or caregiver shall have a backup plan or caregiver for provision of services when the agency cannot provide an aide or when a CD attendant does not show or terminates without notice (12VAC30-120-924.D.1.c, .E.5.c, .F.3).(12VAC30-120-924. Covered services; limits on covered services. (Commonwealth Coordinated Care Plus Waiver))

Applies to: DMAS-enrolled waiver providers, MCOs, services facilitators, fiscal/employer agents, and CCC Plus Waiver individuals/EORs in Virginia

Defines CCC Plus Waiver covered services and their limits, including agency-directed and consumer-directed personal care and respite, services facilitation, EOR employer duties, disenrollment from consumer direction, and dollar/hour caps. Establishes that agency-directed and consumer-directed personal care and respite are subject to electronic visit verification under 12VAC30-60-65. Amended effective June 19, 2024.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.