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DMAS-99 rev. 09/09. Page 1. This form contains patient-identifiable information and is intended for review and use of no one except authorized parties. Misuse .

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How to fill out the Community-Based Care Recipient Assessment Report online

The Community-Based Care Recipient Assessment Report is essential for evaluating the needs of individuals receiving care services. This guide provides clear, step-by-step instructions to assist you in completing the report accurately and efficiently online.

Follow the steps to complete the assessment report thoroughly.

  1. Click ‘Get Form’ button to obtain the assessment report and open it in your preferred editing platform.
  2. Begin by filling in the recipient’s details. Enter the recipient’s name, date of birth, Medicaid ID number, current address, phone number, and the provider agency’s name.
  3. Specify the assessment type by checking the appropriate box for either initial visit, routine visit, or six-month re-assessment.
  4. Complete the functional status section. For each activity of daily living (ADL), indicate the level of assistance required by selecting the corresponding option.
  5. In the medical and nursing information section, provide details about the recipient’s diagnoses, medications, health status, current medical nursing needs, therapies, and any hospitalizations.
  6. Document the support system utilized by the recipient. List any waiver services, total weekly care hours, and the primary caregiver's information.
  7. If applicable, fill out sections specific to either consumer-directed or agency-directed services, providing additional details as required.
  8. Ensure that the supervisory visit details are accurately recorded, including the frequency of visits and any issues with care provision.
  9. Review all sections for completeness and accuracy before saving your changes. If necessary, you can download, print, or share the report once completed.

Get started on filling out the Community-Based Care Recipient Assessment Report online today.

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About the Agency The mission of the Virginia Department of Medical Assistance Services (DMAS) is improving the health and well-being of Virginians through access to high-quality health care coverage.

This covered group is for Virginians who are Aged, Blind, or Disabled, and who have income at or below 80% of the Federal Poverty Level (FPL). This group, like other ABD groups, must meet resource requirements, too. The “ABD ≤80% FPL” group receives full Medicaid benefits.

Income & Asset Limits for Eligibility 2023 Virginia Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleMarried (both spouses applying)Medicaid Waivers / Home and Community Based Services$2,742 / month†$5,484 / month†Regular Medicaid / Aged Blind and Disabled$972 / month$1,315 / month2 more rows • Jun 20, 2023

Who is eligible for Virginia Medicaid? Household Size*Maximum Income Level (Per Year)1$19,3922$26,2283$33,0644$39,9004 more rows

"DMAS" or "the department" means the Virginia Department of Medical Assistance Services. "DMAS-225" means the Medicaid Communication form used for the provider and the DSS eligibility worker to report changes including requests for adjustments to the patient pay.

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