"The Department of Medical Assistance Services (DMAS) is committed to helping families adjust to the new reimbursement policy that allows legally responsible individuals (parents of children under age 18 and spouses) to continue to provide personal care/personal assistance services and be paid for those services.
As you noted, COVID-19 changed a lot in the world, including the ability to allow payments to legally responsible individuals (LRIs). Temporary federal flexibilities were granted to ensure members could access needed services while limiting exposure to COVID-19. The flexibility to reimburse LRIs was originally limited to the time period of the public health emergency, but was later extended. Prior to COVID-19, state policy prohibited reimbursement to legally responsible individuals.
Due to an extension of the federal flexibility and positive feedback from members and their families, Virginia worked to make LRI reimbursements a permanent policy. In 2022, Virginia’s General Assembly mandated DMAS implement a new policy that would “…allow legally responsible individuals (parents of children under age 18 and spouses) to provide personal care/personal assistance services and be paid for those services when circumstances prevent an individual from being cared for by a non-parent caregiver.”
There are additional safeguards required for a permanent policy that were not required during the temporary flexibilities of the public health emergency. DMAS worked with its federal partners at the Centers for Medicare and Medicaid Services (CMS) to ensure the policy complied with the safeguards required for CMS approval and the General Assembly guidelines. This policy could not be offered to members without CMS approval.
CMS approved Virginia’s new policy on September 18, 2023. It goes into effect on March 1, 2024 to give families enough time to complete the process required for them to remain paid caregivers.
DMAS is monitoring legislative proposals on this issue and supporting the Governor’s work with the General Assembly on this and other topics throughout this Session. DMAS will seek approval from CMS on any changes directed by Virginia’s legislature and will continue to work with members, their families, and stakeholders to ensure a successful transition. DMAS's priority is always the health and well-being of our members.
To ensure that there is no disruption in payment on March 1, 2024, current LRIs should complete the LRI application [dmas.virginia.gov]form [dmas.virginia.gov] and securely email it to the following email address: CDLRI@dmas.virginia.gov."
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