Last year, on 9/1/2018, Medicaid CCC Plus Waiver Personal Care for people under the age of 21 was changed. The change required new forms (the DREADED DMAS-7 & DMAS-7A) and a new process for authorizing Personal Care using standards for Early and Periodic Screening, Diagnosis and Treatment (EPSDT). It required the child’s doctor to fill out the DMAS-7 form and left no room for error. The changes were confusing and resulted in some young people experiencing a lapse in Personal Care services while waiting on the form and/or receiving fewer hours of Personal Care than they had in the past.
The Virginia Department of Medical Assistance Services (DMAS) has worked with the federal Centers for Medicare and Medicaid Services (CMS) to reverse the change that was made last year. The new changes will be effective May 1 for people under the age of 21 who use the CCC Plus Waiver. Effective May 1, Personal Care hours for those under 21 who are on the CCC Plus Waiver will no longer go through Early and Periodic Screening, Diagnosis and Treatment (EPSDT)!
What does this mean for those under 21 on the CCC Plus Waiver? It means you will no longer be required to get the DMAS-7 form filled out and signed by the doctor in order to get an authorization for Personal Care hours. Instead, your Service Facilitator will be able to do a plan of care which does not necessarily require input from your doctor (unless certain supervision tasks are needed), just like they used to prior to the EPSDT change on September 1, 2018. This is great news for all involved!!!
For the time being, individuals with the Community Living (CL) or Family and Individual Supports (FIS) Waivers will continue to get the Personal Care authorizations through EPSDT. We believe and are hopeful that this requirement will change also – CL & FIS families – Keep ADVOCATING! :-). Also, those on straight EPSDT that do not have a waiver will continue to need the DMAS-7 filled out by the doctor in order to get an authorization for Personal Care hours. Also those with the CCC Plus Waiver that receive Personal Care hours in school, these Personal Hours will also be through EPSDT.
A few Q’s & A’s. Only applies to those under 21 with a CCC Plus Waiver:
Q: So is EPSDT totally gone?
Q: What if my authorization for Personal Care ends on 4/29/19? My new authorization will start on 4/30/19, so do I need a DMAS-7 from my doctor?
Q: What if my authorization for Personal Care ends on 4/30/19? My new authorization will start on 5/1/19, so do I need to get the DMAS-7 from my doctor?
Q: What if my Personal Care hours were reduced when I submitted the DMAS-7 form? Do I get those hours back now?
Q: What if I made the decision to just use Respite hours instead of dealing with the DMAS-7? Can I now get Personal Care hours back without getting my doctor involved?
Q: What if my Personal Care hours lapsed while I was trying to get the DMAS-7 from my doctor, will I be able to get my authorization back dated to cover that gap now?
Q: Does this change mean that I cannot get more than 35 hours per week of Personal Care?