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