The DMAS-99 form, field by field

The DMAS-99 — officially the Community-Based Care Member Assessment — is the two-page form Virginia Medicaid expects at every Services Facilitator home visit for Personal Care and Respite under the CCC+, DD (CL/FIS), and EPSDT waivers. It's the form DMAS opens first in a utilization review. Most of what gets flagged at audit traces back to a box left empty, a date missing, or a functional status that doesn't line up with the Plan of Care.

This is the practitioner walkthrough I wish I'd had on day one. We'll go section by section, call out what DMAS actually looks at, and name the mistakes that turn into clawback.

Three visit types, three different workloads

The top of page one has three checkboxes that determine how much of the form you actually have to fill in:

• Initial Visit. Everything gets completed. This is also the visit you bill under H2000 (Initial Comprehensive Visit) — $323.64/hr ROS, $360.54/hr NOVA on the current rate schedule. Get this one wrong and the mistake follows the client for the life of the case.
• Routine Supervisory Visit. You can omit the member's address, DOB, start-of-care, and phone if they haven't changed. Functional Status can be shortcut with “No Change” if you've genuinely observed no change. Medical/Nursing Information must still be updated every time. Bills under 99509 ($101.14 ROS / $112.67 NOVA).
• Six-Month Re-assessment. Everything gets completed, same as Initial. Bills under T1028 ($161.82 ROS / $180.27 NOVA). Miss this and you break the annual reassessment trail.

Also at the top: the Agency-Directed vs. Consumer-Directed checkbox. Mark the wrong one and you've booked the wrong procedure code family. DMAS cross-checks this against the authorization on file.

The demographic block (don't underestimate it)

Name, DOB, Medicaid ID, start-of-care, agency name, Provider ID/NPI, phone, address. It looks easy. It's where careers die at audit. Three rules:

• Use the legal name on the Medicaid card. “Bob” vs. “Robert” is enough to kick a claim back. If the member goes by a nickname, write the legal name and note the preferred name in the SF/Nursing Notes.
• Medicaid ID must match the 12-digit number, not the member handbook ID. Members sometimes give you the MCO membership card number, which isn't the same thing.
• Provider ID / NPI is yours, not the MCO's. If you serve multiple MCOs, they'll all credential under your same NPI; fill in your NPI, not whichever MCO authorized this particular client.

Functional Status — the biggest source of audit findings

This is the ADL grid: Bathing, Dressing, Toileting, Transferring, Eating/Feeding. Each row has six columns ranging from “Needs No Help” (fully independent) to “Is Not Performed At All.” Plus Continence (bowel and bladder), Mobility, Orientation, Behavior, Joint Motion, and Medication Administration.

DMAS's own instruction sheet tells you to apply the Virginia Uniform Assessment Instrument (UAI) User's Manual definitions when checking these boxes. That's not a suggestion; the definitions of “MH” (Mechanical Help), “Supervise,” and “Phys. Asst.” are specific. If you haven't read the UAI definitions recently, you're probably scoring some ADLs the way you think they should be scored, not the way DMAS defines them.

Two things that will save you a finding:

• If you're unsure whether a member can perform a task, ask them to demonstrate it. The DMAS instructions literally say this. “She said she can bathe herself” is not a defensible score. “Member bathed face and arms independently; required physical assistance to transfer into tub” is.
• Functional Status scores must match the Plan of Care. If the DMAS-97 says the member needs physical assistance with bathing, and the DMAS-99 box is checked “MH Only,” the auditor now has a reason to read both documents line by line. This is the single most common mismatch finding.

Medical/Nursing Information — write the narrative, not a summary

Seven fields: Diagnoses, Medications, Current Health Status/Condition, Current Medical Nursing Needs, Therapies/Special Medical Procedures, Hospitalizations, Critical Incidents. The most commonly weak fields are Current Health Status and Current Medical Nursing Needs.

DMAS's own instructions are unusually specific here. They want you to ask pointed questions: “Have you seen the doctor since I was here last time? Did the doctor change your medication? Have you been having any dizzy spells? Have you been able to eat all of your meals without vomiting afterward? Have you been checking your sugar four times a day?” Then write what the member said, not a general impression.

“Member stable” is a one-word field completion that will not survive a review. “Member reports no ED visits or hospitalizations since last visit; blood glucose logged 4x daily, range 118–164 per member's log; new prescription for Metformin 500 mg BID started 03/15; member tolerating without GI complaints” is the DMAS-99 narrative that shows up fine in audit.

Critical Incidents has a Yes/No checkbox and a description field. DMAS defines critical incidents broadly: abuse, neglect, exploitation, theft, medical error, deviation from standards of care, serious injury. You're being asked whether any of those happened in the last 3 months. If yes, DMAS wants the date, circumstances, and what you did about it. This is also a mandatory reporting trigger independent of the form — don't let the form be the first time you're thinking about whether an incident occurred.

Support System — the Medicaid-specific details

This section maps what the member actually receives. Check every waiver service that applies (Agency Personal Care, CD Personal Care, Agency Respite, CD Respite, ADHC, PDN) and name the provider agency. The numbers matter:

• Total Weekly Hours and Days per Week must match the current Plan of Care. If authorized hours changed and the DMAS-97 was updated but the DMAS-99 still shows the old number, you've created a paper trail that looks like billing the wrong hours.
• Specific Hours the aide/attendant is in the member's home — this is the literal time-of-day schedule. “Mon-Fri 9–1” is adequate; “weekdays, variable” is not.
• Does the aide live with the member? This question has billing consequences — live-in attendants are subject to different EVV requirements.
• Primary caregiver paid or unpaid? If the spouse is the paid attendant, that's a disclosure that matters for conflict-of-interest review.

Consumer-Directed Services block (CD cases only)

Two lines: the person directing/managing the care (the Employer of Record) and the person providing it (the attendant). Include the relationship to the member on both. If the EOR is someone other than the member — a parent for a minor, a legal guardian for an adult with cognitive impairment — this is where the authority is documented. Don't skip this section on a CD case assuming “it's obvious,” because nothing is obvious at audit.

SF Supervision block — the part that's specifically you

Three fields drive most of the SF-specific scrutiny:

• Dates of RN/LPN supervisory / SF visits for the last 6 months. This is where the 90-day rule lives. List every visit date. A gap longer than 90 days is a finding, even if you have a good reason. If there was a legitimate gap (hospitalization, member refused, you were in the process of case transfer), document the reason in the Nursing Notes and attach documentation to the file.
• Agreed frequency: 30 / 60 / 90 days. Pick one. It must be documented in the member's file as agreed upon with the member/caregiver, not imposed by you.
• Does the Service Plan reflect the needs of the member? If you check “No,” you have to describe what you're doing about it. A “No” with no follow-up narrative is a finding. A “No” with “Plan update submitted 04/12 to add PERS” is acceptable.

Consistency and Continuity

Completed on the six-month reassessment. Four questions that together tell DMAS whether the case is being delivered:

• Days of no service in the last 6 months (excluding hospitalizations and member/family-requested gaps)
• Number of regular aides/attendants assigned, and number of substitute aides used
• Any problems with care reported by member/caregiver, and follow-up taken
• Member satisfaction — and if no, what you did

This is the section reviewers read when they're deciding whether the case is actually being run, or whether boxes are just being checked. Over-document here. A case with no problems is fine — write “Member reports no concerns; continuity of care maintained with one regular aide, no substitutes needed.”

The footer block that costs people money

Bottom of page two: most recent DMAS-225 date and Patient Pay Amount, aide present during visit (yes/no + name), the SF/Nursing Notes free-text field, and two signature lines with dates.

The signature + date line is where the most expensive mistakes happen. DMAS's instructions are explicit: “The RN/LPN should sign his/her full name and title clearly and legibly and include the date the home visit was conducted. DMAS will look for the date by the RN/LPN's signature when conducting utilization review.” Same rule for SFs. No signature, no date, or a date that doesn't match the assessment date at the top — every one of those is a finding.

And the rule nobody mentions until it's too late: the DMAS-99 must be filed in the member's record within five days of the date of the last visit. If a utilization review samples a case and pulls a form with a visit date from two months ago that was only filed last week, that's a finding too.

The top audit findings I see again and again

1. Missing or illegible signature / date on the SF line. Highest-volume finding. Triggers clawback on the associated visit.
2. Gap greater than 90 days between supervisory visits, with no documented reason for the gap.
3. ADL/IADL scores that don't match the current Plan of Care. Reviewer opens the DMAS-97, sees a discrepancy, and now reads both documents line-by-line.
4. “Current Health Status” written as one or two words with no clinical narrative.
5. DMAS-99 filed more than 5 days after the visit, based on the timestamp in the member's record vs. the visit date on the form.

Any one of these alone triggers clawback on the affected visit. A pattern across a caseload triggers a broader review. The forms don't have to be perfect — they have to be complete, internally consistent, and filed on time.

A workflow that holds up

The SFs who pass audits cleanly tend to share a pattern:

1. Pre-visit: pull the DMAS-97 and last DMAS-99. Know what the Plan of Care says about hours and ADLs before you walk in. Your DMAS-99 has to line up with it.
2. During the visit: capture to a structured form, not a blank page. Free-text word docs are where inconsistencies hide. If you use DocHub, pdfFiller, or a purpose-built tool, the fields prompt you to fill each one.
3. Same-day: sign, date, and file. The 5-day rule isn't theoretical; DMAS samples timestamps. Filing the day of the visit makes the rule moot.
4. Cross-check ADLs against the Plan of Care before finalizing. Two documents, same answers.
5. Keep a running visit-date log. Whether it's a spreadsheet, a calendar, or a tool that tracks the 90-day cycle automatically, the worst finding to get is the one that's easiest to prevent — a gap you didn't notice.

The honest pitch

Evanni exists because most of the above is mechanical. Matching ADLs across forms, tracking 90-day cadence, filing same-day, surfacing narrative prompts — none of it requires clinical judgment, all of it prevents findings. If you're running a caseload of 50+ clients on Excel and DocHub, the math catches up to you eventually.

If you're running 15 clients and paper works, paper works. The DMAS-99 is one of those forms where the problem isn't the form — it's the workflow around it.