Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department Of Medical Assistance Services
Chapter 122. Community Waiver Services for Individuals with Developmental Disabilities
1/21/2022

FORMS (12VAC30-122).

Supports Intensity Scale - Adult VersionTM (ages 16 and up), SIS-A, copyright 2015, American Association on Intellectual and Developmental Disabilities

Supports Intensity Scale - Children's VersionTM (ages 5-16), SIS-C, copyright 2016, American Association on Intellectual and Developmental Disabilities

Virginia Supplemental Questions (eff. 10/2014)

Virginia Developmental Disabilities Autism Competencies, DMAS P-201 (rev. 9/2017)

Medicaid Long-Term Care Communication Form, DMAS-225 (rev. 12/2015)

Virginia Individual Developmental Disabilities Eligibility Survey - Infants' Version, DMAS-P235 (eff. 3/2016)

Virginia Individual Developmental Disabilities Eligibility Survey - Children's Version, DMAS-P236 (eff. 4/2016)

Virginia Individual Developmental Disabilities Eligibility Survey - Adult Version, DMAS-P237 (eff. 3/2016)

Virginia Developmental Disabilities Behavioral Competencies, DMAS P241a (rev. 9/2017)

Developmental Disabilities DSP and Supervisor Competencies Checklist, DMAS 241a (eff. 5/2021)

Direct Support Professional Assurance to Confirm Successful Completion of Training and Testing Requirements for the DD Waivers, DMAS P242a (eff. 5/2021)

Department of Behavioral Health and Developmental Services Health Competencies Checklist, DMAS P244a and P241a (rev. 1/2017)

Community Housing Guide: Housing Road Map (form date 10/2019)

Community Housing Guide: Tenant Screening (form date 10/2019)

Family and Individual Supports Request for Supervision Hours in Personal Assistance, DMAS-P257 (05/28)

Community Learning Request for Supervision Hours in Personal Assistance, DMAS-P257 (05/28)

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