August 2026 Newsletter

Health Insurance Premium Benefit

If the Program pays your health insurance premiums directly to your insurance carrier, please provide your Case Specialist with your current billing statement so we can confirm your current premium amount.

Insurance carriers do not automatically notify the Program of premium changes, and HIPAA privacy laws prevent us from contacting them on your behalf. To help avoid payment delays or policy cancellation, especially during open enrollment or your plan’s renewal period, please notify your Case Specialist of any premium changes and submit an updated billing statement as soon as possible.

Submitting Expenses

Continue using the Rising “Vision” Portal to submit most reimbursement requests.

Some newer benefits, including housing modification benefits (such as temporary relocation), rental assistance, educational advocate services, guardianship benefits, and other current Program-administered benefits, are submitted directly to the Program rather than through the portal. Please refer to the Benefit Submission Guide or contact your Case Specialist if you have questions about where to submit a request.

Simplified Documentation for Nursing and Caregiver Services 

The Program has simplified the documentation process for nursing, caregiver, and related services to reduce paperwork for families and providers.

What's changing?

• The Patient and Nursing Caregiver Form is now the primary form used to document medically necessary care hours.
• Once approved, the form only needs to be updated if the participant's care hours or level of care changes.
• Annual Letters of Medical Necessity are no longer required for routine nursing and caregiver services.
• New forms for medical supplies/equipment and therapeutic services are available to streamline future requests.
• Providers may still submit separate orders or Letters of Medical Necessity when appropriate, particularly for specialized equipment or unique requests that require additional documentation.

All forms are available on the Program website. If you have questions, your Case Specialist is happy to help.

Caregiving Policy Update

Families identified competitive caregiver reimbursement rates as the Program's highest policy priority. In partnership with the Family Advisory Committee (FAC), the Program has begun developing an updated caregiving policy focused on helping families recruit and retain qualified caregivers.

Policy development is underway and expected to conclude this fall. The process includes data analysis, policy development, and family feedback. Any approved caregiver rate increases will be applied retroactively to July 1.

We appreciate the input families continue to provide and remain committed to developing a policy that better supports participants and their caregivers.

DSP Certification Reimbursement Update

Effective July 31, 2026, and retroactive to June 1, 2026, the Program will reimburse family caregivers and independent caregivers who hold a current Direct Support Professional (DSP) certification, awarded through the Virginia Department of Behavioral Health and Developmental Services (DBHDS) or interstate equivalent, at the same reimbursement rate as Certified Nursing Assistants (CNAs), based on the 90th percentile of the applicable wage data. This is an interim policy clarification to ensure consistency among family and independent caregivers with CNA and DSP certifications. Please contact your case specialist to provide documentation of certification.

As referenced above, the Program, in collaboration with the Family Advisory Committee, is undertaking a broader review of caregiving policy and reimbursement rates with the goal of ensuring that all families can hire and retain caregivers who meet participants' needs.

Planning for Future Legislation

The Program is committed to working with families and other partners to identify future legislative changes that strengthen services and supports for participating families.

During the family Bridge Call on July 30, the Program began gathering family feedback on potential legislative priorities, including, but not limited to, adding a future planning benefit to help families prepare for participants' changing needs over time (such as long-term care and financial planning) and increasing or removing the current $10,000 statutory limit on end-of-life expenses.

If you would like to share your ideas, please complete this short survey by August 21st. In partnership with interested families, we will continue refining these proposals in preparation for the 2027 and future legislative sessions.

Each month, we will take a moment to highlight the people who make our work possible. This month, we'd like you to introduce you to Bri Tocci, Claims Analyst at the Program.

"I've pretty much always been surrounded by kids. I grew up babysitting, and in high school I had the chance to be a temporary assistant teacher in a special needs elementary school classroom. Those experiences really sparked my love for helping others and being part of a community. 

I moved from Brick Township, New Jersey, to Virginia in 2015. These days, I call the Willow Lawn area of Richmond home! Along the way, I've been lucky to meet and work with so many different people and building relationships has always been one of my favorite parts of anything I do. 

At the Program, I'm a Claims Analyst II specializing in vehicle claims. I earned my Professional Coder Certification in 2021 and am currently working toward a double major in Human Services and Business Management. I love finding ways to combine my passion for helping people with learning new things and growing in my career. 

I have a huge love for people and animals! I genuinely enjoy getting to know people and their families. The best part of being at the Program has been getting to know the incredible families we serve. They have taught me so much, and I truly cherish the relationships we've built. I'm so grateful to be part of a community where I get to learn from such amazing people every day!" 

Thanks for all you do for the Program, Bri!