Chapter 230. Operation of the Individual and Family Support Program
12VAC35-230-10. Definitions.
The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Commissioner" means the Commissioner of the Department of Behavioral Health and Developmental Services.
"Custodial family member" means a family member who has primary authority to make all major decisions affecting the individual and with whom the individual primarily resides.
"Department" means the Department of Behavioral Health and Developmental Services.
"Developmental disability" or "DD" means a severe, chronic disability of an individual that:
1. Is attributable to a mental or physical impairment or combination of mental and physical impairments, other than a sole diagnosis of mental illness;
2. Is manifested before the individual reaches 22 years of age;
3. Is likely to continue indefinitely;
4. Results in substantial functional limitations in three or more of the following areas of major life activity: (i) self-care, (ii) receptive and expressive language, (iii) learning, (iv) mobility, (v) self-direction, (vi) capacity for independent living, or (vii) economic self-sufficiency; and
5. Reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated.
An individual from birth to age nine years, inclusive, who has a substantial developmental delay or specific congenital or acquired condition may be considered to have a developmental disability without meeting three or more of the criteria described in subdivisions 1 through 5 of this definition if the individual, without services and supports, has a high probability of meeting those criteria later in life.
"Family member" means an immediate family member of an individual receiving services or the principal caregiver of that individual. A principal caregiver is a person who acts in the place of an immediate family member, including other relatives and foster care providers, but does not have a proprietary interest in the care of the individual receiving services. (§ 37.2-100 of the Code of Virginia)
"Individual and Family Support Program" or "IFSP" means an array of individualized person-centered and family-centered resources, supports, items, services, and other assistance approved by the department that are intended to support the continued residence of individuals with developmental disabilities who are on the waiting list for a Medicaid Home and Community-Based Services Developmental Disability Waiver in each individual's own home or the family home, which includes the home of the principal caregiver.
"Individual and Family Support Program State Council" or "IFSP State Council" means an advisory group of stakeholders selected by the department that shall provide consultation to the department on creating a family support program intended to increase the resources and supports for individuals and families and promote community engagement and coordination. The IFSP State Council shall include individuals with DD and family members of individuals with DD.
"Medicaid HCBS DD Waiver" means a Medicaid Home and Community-Based Services Developmental Disability Waiver.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; amended, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-20. Program description.
A. The Individual and Family Support Program assists individuals with developmental disabilities and their family members to access needed person-centered and family-centered resources, supports, services, and other assistance. The overall objective of the Individual and Family Support Program is to support the continued residence of individuals with developmental disabilities in each individual's own home or the family home, which includes the home of a principal caregiver.
B. The department shall administer the IFSP funding awards directly or through a third party designated by the department to administer all or part of the IFSP, based on annual funding priorities and program criteria developed by the department in consultation with the department's IFSP State Council.
C. IFSP funds shall be distributed directly to the requesting individual or custodial family member or a third party designated by the individual or custodial family member. IFSP funds shall not supplant or in any way limit the availability of services provided through Medicaid programs.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; amended, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-30. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; repealed, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-31. Community coordination.
The department shall:
1. Ensure an annual public input process that encourages the continued residence of individuals on the waiting list for a Medicaid HCBS DD Waiver in community settings and includes a survey of needs and satisfaction.
2. Establish the IFSP State Council.
3. Develop, in coordination with the IFSP State Council, a strategic plan that is consistent with this chapter and the purpose of the IFSP and that is updated as necessary as determined by the department.
4. Provide technical assistance to individuals or family members to facilitate an individual's or a family member's access to covered services and supports listed in 12VAC35-230-55 that are intended to enhance or improve the individual's or family member's quality of life and promote the independence and continued residence of an individual with DD in the individual's own home or the family home, which includes the home of a principal caregiver.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-35. Program eligibility requirements and policies.
A. Eligibility for IFSP funds shall be limited to individuals who are living in their own home or a family home and are on the statewide waiting list for a Medicaid HCBS DD Waiver and their custodial family members who are assisting those individuals.
B. The department, based on information gathered through public input and in consultation with the IFSP State Council, shall annually establish eligibility criteria, the award process, the appeals process, and any other protocols necessary for ensuring the effective use of state funds. All procedures used by the department for determining funding awards shall be published annually in draft form for public comment and in final form prior to opening the funding opportunity using the Virginia Regulatory Town Hall and the Virginia Register of Regulations.
C. For each funding period, the department shall base funding awards on the following published information:
1. Criteria for prioritized funding categories;
2. A summary of allowable expenditures;
3. Application deadlines; and
4. Award notification schedules.
D. All procedures used by the department for funding awards shall be reviewed annually.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-40. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; repealed, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-45. Program implementation.
A. IFSP funds shall be limited by the amount of funds allocated to the IFSP by the General Assembly. The department approval of funding requests shall not exceed the funding available for the fiscal year. Based on information gathered through relevant data and public input, and in collaboration with the IFSP State Council, the department shall establish annual funding categories.
B. IFSP funds may be provided to individuals or custodial family members in varying amounts, as determined by the department's annually prioritized funding categories.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-50. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; repealed, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-55. Covered services and supports.
Services and items funded through the IFSP, as published annually using the Virginia Regulatory Town Hall and the Virginia Register of Regulations, in accordance with this chapter, are intended to support the continued residence of an individual in that individual's own home or the family home and may be approved in the following three main categories: (i) safe community living, (ii) improved health outcomes, and (iii) community integration. No services or items shall be funded by the IFSP if not listed in the department's procedures or if covered by another entity.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-60. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; repealed, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-65. Application for funding.
A. Eligible individuals or custodial family members who choose to apply for IFSP funds shall submit a completed application to the department.
B. Completed applications shall include the following information:
1. A description of the services or items for which funding is requested;
2. Acknowledgment that the requested services or items are needed to support the continued residence of the individual with DD in that individual's own home or the family home and no other public funding sources are available;
3. The requested funding amount; and
4. A statement in which the individual or custodial family member:
a. Agrees to provide to the department, if requested, documentation that the requested funds were used to purchase only services or items described in the application and approved by the department; and
b. Acknowledges that failure to provide documentation, when requested, that the funds applied for were used to purchase only services or items described in the application and approved by the department may result in recovery of such funds and denial of subsequent funding requests.
C. The application shall be signed by the individual or custodial family member requesting the funding.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-70. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; repealed, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-75. Reporting.
A. For each funding period, the department shall develop and publish a summary, using the Virginia Regulatory Town Hall and the Virginia Register of Regulations, that details the total dollar amount of funded awards, a summary of expenditure requests, the number of applications received, and the number of applications and individuals approved for receipt of IFSP funds.
B. The department, with input from the IFSP State Council, shall develop an annual summary of accomplishments toward meeting the goals of the Virginia State Plan to Increase Individual and Family Supports.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-80. (Repealed.)
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; repealed, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-85. Funding decision-making process.
A. Applications shall be denied if the department determines that the service or item for which funding is requested is not eligible for funding in accordance with 12VAC35-230-55, other public funding sources are available, or the total annual IFSP funding appropriated by the General Assembly has been expended for the applicable fiscal year.
B. Additionally, applications for IFSP funds may be denied if the requesting individual or custodial family member has not used previously received IFSP funds in accordance with the department's written notice approving the request or has failed to comply with this chapter.
C. The department shall provide a written notice to the individual or custodial family member who submitted the application indicating the funding decision, including the reason for denial of funding, if applicable.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-90. Requests for reconsideration.
A. Individuals or custodial family members who disagree with the determination of the department may submit a written request for reconsideration to the commissioner or the commissioner's designee within 30 days of the date of the written notice of denial or approval at a reduced amount.
B. The commissioner or the commissioner's designee shall provide an opportunity for the person requesting reconsideration to submit for review any additional information or reasons why the funding should be approved as originally requested.
C. The commissioner or the commissioner's designee, after reviewing all submitted materials, shall render a written decision on the request for reconsideration within 30 calendar days of the receipt of the request and shall notify all involved parties in writing. The decision shall be binding.
D. Applicants may obtain further review of the decision in accordance with the Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia).
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; amended, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-100. Post-funding review.
A. Utilization review of documentation or verification of funds expended may be undertaken by department staff. Reviews may include home visits to view items purchased or services delivered.
B. Individuals and family members receiving IFSP funds shall permit department representatives to conduct utilization reviews, including home visits.
C. Individuals and family members receiving IFSP funds shall fully cooperate with such reviews and provide all information requested by the department.
D. Failure to use funds in accordance with the procedures for funding awards or provide documentation, if requested, that the funds were used to purchase only approved services or items as described in the application and approved by the department may result in recovery of such by the department.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; amended, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
12VAC35-230-110. Termination of funding for services, supports, or other assistance.
Funding through the IFSP shall be terminated when the individual is enrolled in a Medicaid HCBS DD Waiver if the individual is found to be no longer eligible to be on a waiting list for a Medicaid HCBS DD Waiver in accordance with 12VAC30-122-90 and any appeal has been exhausted or if approved funds are used for purposes not approved by the department in its written notice. In such circumstance, any funds approved but not yet released shall not be disbursed.
Statutory Authority
§ 37.2-203 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 30, Issue 7, eff. January 16, 2014; amended, Virginia Register Volume 40, Issue 22, eff. July 17, 2024.
Forms (12VAC35-230)
Individual and Family Support Program Funding Application online application available at the Virginia Waiver Management System (WaMS) Portal at https://www.dbhds.virginia.gov/waitlistforms