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Virginia - Assisted Living Facility — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Virginia Department of Social Services (VDSS) Division of Licensing Programs licenses Assisted Living Facilities (ALFs) under 22VAC40-73, while the Department of Medical Assistance Services (DMAS) reimburses for personal care and assisted living services through the Commonwealth Coordinated Care Plus (CCC Plus) Waiver and the state Auxiliary Grant (AG) program. Facilities provide 24-hour supervision, personal care, and health coordination for four or more adults who are aged, infirm, or disabled.

Applicants must complete mandatory VDSS commissioner-approved training, specifically the Introduction to Licensing and Introduction to Assisted Living Facilities modules, before an initial license application is accepted. Medicaid reimbursement requires both VDSS licensure and subsequent enrollment through the Virginia Medicaid Enterprise System (MES) Provider Services Solution (PRSS) portal, alongside contracting with the managed care organizations administering the CCC Plus program.

1. Service Definition and Scope

Under 22VAC40-73, an Assisted Living Facility in Virginia is a non-medical group residential setting providing personal and health care services, 24-hour supervision, and assistance for four or more adults. VDSS licenses two levels of care: residential living care (minimal assistance) and assisted living care (moderate assistance).

Medicaid does not pay for room and board in an ALF; these costs are supported for eligible low-income individuals by the Virginia Auxiliary Grant (AG) program. DMAS covers the medical and personal care components for eligible residents enrolled in the CCC Plus Waiver.

2. Regulatory and Oversight Agencies

VDSS handles the physical facility licensure, inspections, and enforcement of health and safety standards. DMAS manages the Medicaid waiver funding, provider enrollment, and sets reimbursement policies.

Because Virginia utilizes a managed care delivery system for the CCC Plus Waiver, enrolled providers must also credential and contract with the designated Managed Care Organizations (MCOs) operating in their region.

3. Gatekeeping Prerequisites: Who Can Even Apply

Virginia does not require a Certificate of Need (CON) or a Request for Proposals (RFP) procurement to open an ALF. The market is open to any qualified applicant who meets the structural and training prerequisites.

The state mandates that any person applying to operate an ALF who has not previously owned or managed a licensed ALF in Virginia must undergo specific training by the VDSS commissioner prior to submitting the application.

4. Licensure and Certification Requirements

Initial licensure involves submitting a comprehensive application packet to the VDSS Division of Licensing Programs, including architectural plans, policies, and financial disclosures. Facilities must comply with the Standards for Licensed Assisted Living Facilities (22VAC40-73).

Facilities must maintain specific liability insurance coverage based on their licensed capacity and undergo initial and annual unannounced inspections by VDSS licensing inspectors.

5. Medicaid Provider Enrollment

After obtaining the VDSS license, the facility must enroll as a Medicaid provider through the DMAS MES PRSS portal to bill for CCC Plus Waiver services.

Enrollment requires signing a Medicaid Provider Agreement, passing federal database exclusion checks, and subsequently credentialing with the CCC Plus MCOs.

6. Staffing, Training and Background Checks

ALF administrators must be licensed by the Virginia Board of Long-Term Care Administrators. Direct care staff must meet specific training requirements, such as completing a Virginia Board of Nursing-approved curriculum or a DMAS-approved personal care aide training program.

Comprehensive background checks are mandatory for all staff, and individuals convicted of specific barrier crimes outlined in the Code of Virginia are prohibited from employment.

7. Documentation, Policies and Records

Facilities must maintain detailed resident records, including the Uniform Assessment Instrument (UAI) and Individualized Service Plans (ISPs).

DMAS requires providers to use designated forms for service documentation and prohibits altering these forms without prior written approval.

8. Billing, Rates and Claims

Medicaid does not reimburse ALFs for room and board; these costs are covered by the resident's income and the state Auxiliary Grant (AG) for eligible individuals.

Waiver services are billed to the respective CCC Plus MCOs using standard HIPAA-compliant claims formats, adhering to the DMAS fee schedule for waiver services.

9. Approval Sequence and Timeline

The process begins with the mandatory VDSS commissioner training, followed by local zoning and building approvals. The applicant then submits the initial licensure application to VDSS.

Once licensed by VDSS, the provider applies for Medicaid enrollment via the PRSS portal, which typically takes 30-60 days, followed by MCO credentialing which can take an additional 90-120 days.

10. Common Denials and Survey Findings

Licensure applications are frequently delayed or denied due to incomplete financial documentation, failure to secure local zoning approvals, or administrators lacking the required Board license.

During unannounced VDSS surveys, common citations include medication administration errors, outdated Individualized Service Plans (ISPs), and incomplete staff background checks.

11. Key Contacts and Resources

Providers should utilize the VDSS and DMAS websites for the most current regulations, forms, and training materials.

The MES PRSS portal provides resources for Medicaid enrollment, while the CCC Plus MCOs offer specific provider manuals for billing and authorizations.

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