State HCBS Assessment Tools

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• Waiver/Program TitleVA Building Independence Waiver

  State

  Virginia

  Waiver Type

  1915(c)

  Waiver Population

  Intellectual and Developmental Disability

  Waiver Age Group

  18 Years and Over

  Eligibility / Support Assessments

  • VA Individual Developmental Disabilities Eligibility Survey - Adult Version (VIDES-A)
  • Supports Intensity Scale (SIS)

  Quality / Outcome Assessments

  • National Core Indicators Adult Consumer Survey (NCI ACS)
  • VA Qlarant Quality Service Reviews - Individual Interview Tool (VA-QSR-IIT)

• Waiver/Program TitleVA Commonwealth Coordinated Care (CCC) Plus

  State

  Virginia

  Waiver Type

  1915(c)

  Waiver Populations

  • Age Related Disability
  • Physical Disability

  Waiver Age Group

  All Ages

  Eligibility / Support Assessments

  • VA Uniform Assessment Instrument (VA-UAI)
  • VA Level of Care Eligibility Re-determination Instrument (DMAS-99)
  • VA Private Duty Nursing Adult Referral Form (DMAS-108)
  • VA Private Duty Nursing Pediatric Referral Form (DMAS-109)

• Waiver/Program TitleVA Community Living (CL) Waiver

  State

  Virginia

  Waiver Type

  1915(c)

  Waiver Population

  Intellectual and Developmental Disability

  Waiver Age Group

  All Ages

  Eligibility / Support Assessments

  • VA Individual Developmental Disabilities Eligibility Survey - Adult Version (VIDES-A)
  • VA Individual Developmental Disabilities Eligibility Survey - Children's Version (VIDES-C)
  • VA Individual Developmental Disabilities Eligibility Survey - Infant's Version (VIDES-I)
  • Supports Intensity Scale (SIS)
  • Supports Intensity Scale - Children's Version (SIS-C)
  • Vineland Adaptive Behavior Scale (VABS)
  • Brigance Inventory (BI)
  • Choosing Outcomes and Accomodations for Children (COACH)

  Quality / Outcome Assessments

  • National Core Indicators Adult Consumer Survey (NCI ACS)
  • VA Qlarant Quality Service Reviews - Individual Interview Tool (VA-QSR-IIT)

• Waiver/Program TitleVA Family and Individual Support Waiver

  State

  Virginia

  Waiver Type

  1915(c)

  Waiver Population

  Intellectual and Developmental Disability

  Waiver Age Group

  All Ages

  Eligibility / Support Assessments

  • VA Individual Developmental Disabilities Eligibility Survey - Adult Version (VIDES-A)
  • VA Individual Developmental Disabilities Eligibility Survey - Children's Version (VIDES-C)
  • VA Individual Developmental Disabilities Eligibility Survey - Infant's Version (VIDES-I)
  • Supports Intensity Scale (SIS)
  • Supports Intensity Scale - Children's Version (SIS-C)
  • Vineland Adaptive Behavior Scale (VABS)
  • Brigance Inventory (BI)
  • Choosing Outcomes and Accomodations for Children (COACH)

  Quality / Outcome Assessments

  • National Core Indicators Adult Consumer Survey (NCI ACS)
  • VA Qlarant Quality Service Reviews - Individual Interview Tool (VA-QSR-IIT)