RESPITE CARE SERVICES PROVIDER IN VIRGINIA

Fatumata Kaba
3 days ago
3 min read

GIVING FAMILIES A BREAK WHILE ENSURING QUALITY, COMPASSIONATE CARE FOR THEIR LOVED ONES

Respite Care Services in Virginia offer temporary relief to unpaid caregivers—often family members—who provide ongoing support to individuals with disabilities, medical complexities, or behavioral health needs. These services give caregivers essential downtime while ensuring that care recipients receive safe, supportive, and person-centered care in their home or community. Respite Care is a covered service under the Community Living (CL), Family and Individual Supports (FIS), and Commonwealth Coordinated Care Plus (CCC Plus) Waivers. Oversight is provided by the Department of Medical Assistance Services (DMAS), with service coordination by Community Services Boards (CSBs) and Managed Care Organizations (MCOs).

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1. GOVERNING AGENCIES

Agency: Virginia Department of Medical Assistance Services (DMAS)

Role: Administers Medicaid waiver programs and processes provider enrollment and reimbursement.

Agency: Community Services Boards (CSBs)

Role: Authorize respite services for individuals on the CL and FIS Waivers and approve them in the Individual Support Plan (ISP).

Agency: Managed Care Organizations (MCOs)

Role: Authorize and oversee respite services under the CCC Plus Waiver.

2. RESPITE CARE SERVICES OVERVIEW

Respite may be provided in-home, in a community-based setting, or at a licensed facility. Services are intended to provide short-term care for individuals while their regular caregiver is unavailable due to rest, illness, emergencies, or personal obligations.

Types of Respite include:

In-Home Respite Care – Direct support provided at the individual’s home
Center-Based or Group Respite – Care in a licensed group setting
Skilled Respite – When the individual requires nursing-level care (must be provided by an RN or LPN)
Crisis Respite – For emergency caregiver absences or behavioral health stabilization

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Virginia State Corporation Commission (SCC)
Obtain an EIN and Type 2 NPI
If providing group-based services, obtain a DBHDS license for Group Home or Respite
Create a Respite Services Policy & Procedure Manual
Complete DBHDS Human Rights Office affiliation
Enroll as a Medicaid provider via the MES portal
Contract with CSBs or MCOs based on waiver population served

4. VIRGINIA PROVIDER ENROLLMENT PROCESS

Step 1: Register business, obtain EIN and NPI

Step 2: Apply for DBHDS license (if providing facility- or group-based care)

Step 3: Prepare P&P Manual, background checks, and Human Rights affiliation

Step 4: Enroll with Virginia Medicaid via MES

Step 5: Contract with CSBs (CL/FIS) or MCOs (CCC Plus)

Step 6: Begin services upon ISP authorization and referral

5. REQUIRED DOCUMENTATION

SCC registration, EIN, and NPI
Medicaid enrollment confirmation
Staff background checks and training records
DBHDS license and Human Rights documentation (for licensed settings)
Respite Services Policy & Procedure Manual including:
- Admission and service delivery policies
- Emergency contact and incident response protocols
- Daily shift logs and activity tracking
- Caregiver notes and ISP goal documentation
- Supervision plans and client-specific instructions
- Medication management (if applicable)
- HIPAA, client rights, and safety procedures

6. STAFFING REQUIREMENTS

Role: Respite Care Provider / Direct Support Professional (DSP)

Requirements:

High school diploma or GED
CPR/First Aid certification
Background checks (CPS, criminal, DMV)
Trained in ADLs, supervision, and safety

Optional Role: Licensed Nurse (for skilled respite)

Requirements:

LPN or RN license in Virginia
Must follow physician-ordered care instructions

All staff must complete:

HIPAA and confidentiality training
Person-centered and emergency preparedness training
Documentation and incident reporting protocols
Annual competency revalidation

7. MEDICAID WAIVER PROGRAMS

Respite Care is available under:

Community Living (CL) Waiver – For individuals needing routine or emergency caregiver support
Family and Individual Supports (FIS) Waiver – Supports family caregivers of individuals with ID/DD
CCC Plus Waiver – For medically complex or elderly individuals with caregiver relief needs

Service hours and delivery settings must be approved in the Individual Support Plan (ISP) and authorized by the appropriate CSB or MCO.

8. TIMELINE TO LAUNCH

Phase: Business Formation & Staff Recruitment

Timeline: 2–4 weeks

Phase: Licensing & Medicaid Enrollment

Timeline: 1–2 months

Phase: Staff Training, Readiness & Contracting

Timeline: 2–4 weeks

Phase: Launch of Services

Timeline: Begins after referral and ISP approval

9. CONTACT INFORMATION

Virginia Department of Medical Assistance Services (DMAS)

Website: https://www.dmas.virginia.gov

MES Provider Portal (Medicaid Enrollment)

Website: https://vamedicaid.dmas.virginia.gov/provider

Virginia Department of Behavioral Health and Developmental Services (DBHDS)

Website: https://dbhds.virginia.gov

Community Services Boards Directory

Website: https://dbhds.virginia.gov/community-services-boards/

RESPITE CARE SERVICES PROVIDER IN VIRGINIA

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — VIRGINIA RESPITE CARE PROVIDERWCG helps agencies design flexible, high-quality respite programs that meet Virginia Medicaid requirements and promote family well-being.

Scope of Work: