MedicaidAdministrativeMedium impact
Home and Community-Based Services (HCBS) Grievance System
Virginia Medicaid - DMAS·VA · Occupational Therapy, Physical Therapy, Speech Therapy·Specialty Services
Effective date
Jun 10, 2026
We identified it
Jul 22, 2026
Summary
Virginia Medicaid is implementing a new Home and Community-Based Services (HCBS) Fee-for-Service grievance system effective June 10, 2026, requiring providers to establish grievance procedures, disclose grievance rights to individuals annually, and train staff on the grievance process. This applies to Developmental Disability Waiver, Building Independence Waiver, Community Living Waiver, Family and Individual Supports Waiver, and CCC Plus (FFS only) services.
Action Required
Before June 10, 2026: (1) Providers must update home and community-based rights disclosure documents to include a section informing individuals of their right to file a grievance and what constitutes a grievance, using the sample form available at https://www.dmas.virginia.gov/media/05wbj5lq/grievance-rights-and-responsibilities.pdf. (2) Billing/Operations team must ensure this grievance rights information is reviewed with every individual upon admission to service and annually thereafter. (3) Provider staff must be trained on the grievance process and how grievances can be submitted on behalf of individuals. (4) Establish written policies prohibiting discouragement or prevention of grievance filing by waiver individuals, family members, caregivers, or staff. (5) Implement procedures to comply with investigation and resolution of grievances filed on behalf of waiver individuals. (6) Periodically verify provider enrollment, contact information, and license information is current in the PRSS (Provider Services Solution) portal to avoid claims payment disruption. Additional requirements will be provided in a forthcoming Medicaid provider memo and manual changes.