The Virginia DMAS-7 form, formally the Medical Needs Assessment and Personal Care Services Referral, is the document a licensed medical professional uses to request Medicaid-funded personal care services for a member in the Commonwealth. It is submitted, along with supporting clinical documentation, through the Atrezzo online portal, and the Department of Medical Assistance Services uses it to decide whether personal care services are medically necessary.1Virginia Medicaid. DMAS-7 Medical Necessity Assessment and Personal Care Service Authorization Form
When the DMAS-7 Is Used
The form covers two scenarios. The first is a new referral: a Medicaid member requesting personal care services for the first time. The second is reauthorization, when an existing member’s services are up for renewal. It also applies when a member is receiving or seeking personal care or private duty nursing services delivered in a school setting and paid for by Medicaid, though that path requires additional school records.
One boundary worth naming: the DMAS-7 is not the Uniform Assessment Instrument. The UAI is the screening tool used to evaluate eligibility for nursing facility admission and home and community-based waiver programs such as CCC Plus. The DMAS-7 feeds specifically into the personal care services track, even though some of the functional assessment concepts overlap.
Who Fills Out the Form
A medical professional completes the DMAS-7, not the Medicaid member or a family caregiver. The referral source section requires the person completing it to identify their credentials, and only four categories qualify: MD/DO, PA, NP, or RN/LPN.2Department of Medical Assistance Services. DMAS-7 Medical Needs Assessment and Personal Care Services Referral The provider order and attestation at the end must be signed by an MD/DO, NP, or PA. No stamps are accepted.
For families, this means the process starts at a medical appointment. If you believe a relative needs personal care services, raise it with their primary care physician, nurse practitioner, or another treating provider. You can help by gathering medical records, medication lists, and specific details about the member’s daily limitations before the visit, so the provider has what they need to complete an accurate referral.
What Information the Form Captures
The DMAS-7 collects demographics, functional status ratings, and clinical details in a structured format. Having everything ready before the provider sits down with the form prevents the back-and-forth that slows referrals down.
Member Demographics
The top of the form asks for the member’s name, Medicaid ID number, date of birth, gender, address, and phone number. If the member has a parent or guardian, that person’s name, phone number, and address go here as well. The form also asks whether the member has an active protective services case, and it requires the primary care physician’s name and phone number.2Department of Medical Assistance Services. DMAS-7 Medical Needs Assessment and Personal Care Services Referral
Activities of Daily Living
The heart of the form is its functional assessment. The medical professional rates the member’s ability to perform six activities of daily living:2Department of Medical Assistance Services. DMAS-7 Medical Needs Assessment and Personal Care Services Referral
- Bathing: ability to wash independently in a tub, shower, or by sponge bath.
- Dressing: ability to put on and remove clothing, including fasteners.
- Transferring: ability to move between a bed and a chair.
- Eating and feeding: ability to feed oneself once food is prepared.
- Continence and toileting: ability to manage bladder and bowel function and use the toilet.
- Ambulation: ability to walk or move around the living environment.
Each ADL is rated by the member’s highest level of independence or dependence. The form’s additional guidance section provides definitions for each rating level, and the assessor should work from those definitions rather than general impressions. This is where most errors happen. A vague or inconsistent rating can lead DMAS to request clarification, which delays the determination.
Instrumental Activities of Daily Living
The form also captures the member’s ability to handle instrumental activities of daily living, which are tasks needed to live independently but less physically fundamental than ADLs. The DMAS-7 covers meal preparation, house cleaning, grocery shopping, and transportation.2Department of Medical Assistance Services. DMAS-7 Medical Needs Assessment and Personal Care Services Referral Deficits in these areas help show how much assistance the member needs day to day.
Documents That Must Go With the Form
The DMAS-7 by itself is not enough. The form explicitly requires supporting clinical documentation submitted alongside it, and missing documents are probably the single most common reason referrals stall. The required attachments are:2Department of Medical Assistance Services. DMAS-7 Medical Needs Assessment and Personal Care Services Referral
- The DMAS-7A or equivalent plan of care, and the DMAS-99 service authorization request. Both must accompany the DMAS-7.
- Recent clinical documentation. For a new referral, that means records such as hospital or facility discharge summaries and the last three physician visit notes from primary or specialty care. For a reauthorization review, include the most recent two weeks of personal care services progress notes.
- IEP records for school-based services only. If the member receives or is seeking personal care or private duty nursing services in a school setting paid for by Medicaid, include the Department of Education’s most recent Individual Education Plan.
Treat that list as a checklist before submission. A referral missing the DMAS-7A, or lacking recent visit notes, will not move forward until the gap is filled.
How to Submit the DMAS-7
The completed form and all supporting clinical documentation must be submitted through the Atrezzo portal at atrezzo.kepro.com.2Department of Medical Assistance Services. DMAS-7 Medical Needs Assessment and Personal Care Services Referral Atrezzo is the web-based platform Virginia’s service authorization contractor uses to process these requests. Providers who have not previously used the portal will need to register for an account before submitting. DMAS also accepts service authorization requests by telephone, fax, and paper submission, though the portal is the standard electronic method referenced on the form itself.3Virginia Medicaid. Service Authorization
The blank form can be downloaded as a PDF from the Virginia Medicaid website.1Virginia Medicaid. DMAS-7 Medical Necessity Assessment and Personal Care Service Authorization Form Providers typically fill it out electronically or by hand, then upload the completed form and the supporting documents through Atrezzo.
What Happens After Submission
Once DMAS receives the referral, a medical necessity review begins. DMAS evaluates whether the documented functional limitations and medical conditions justify personal care services, based on the ADL and IADL ratings, the diagnoses, the physician visit notes, and the plan of care.1Virginia Medicaid. DMAS-7 Medical Necessity Assessment and Personal Care Service Authorization Form
If the documentation supports medical necessity, DMAS authorizes personal care services and specifies the approved number of hours. The standard maximum is 56 hours per week. Members with more severe needs can qualify for additional hours, but to exceed the cap the member must have a minimum level of care rating of B (a composite ADL score between 7 and 12 with a medical nursing need) or C (a composite ADL score of 9 or higher with a skilled medical nursing need), plus documented dependencies in specific ADL combinations or an active protective services case.4Virginia Code Commission. Virginia Administrative Code 12VAC30-120-927 – Exception Criteria for Personal Care Services
If the documentation is incomplete or does not demonstrate medical necessity, DMAS may request additional information or deny the referral. A denial notice will explain the specific reason and inform the member of their right to appeal.
If the Referral Is Denied
When DMAS denies a personal care services referral, the member has the right to appeal. For members enrolled in a managed care organization under CCC Plus, the MCO’s internal appeals process must be exhausted before requesting a state fair hearing with DMAS.5Virginia Code Commission. Virginia Administrative Code 12VAC30-120-640 – State Fair Hearing Process After the MCO issues its final appeal decision, the member can file a state fair hearing request by mail, fax, telephone, email, or in person.
If the member wants benefits to continue during the appeal, the request must be filed within 10 calendar days of the mail date on the MCO’s final appeal decision.5Virginia Code Commission. Virginia Administrative Code 12VAC30-120-640 – State Fair Hearing Process An expedited appeal is available when a treating provider indicates that standard resolution timelines could seriously jeopardize the member’s health or ability to function. Expedited appeals must be resolved within 72 hours of receipt.
Sometimes the better response to a denial is not an appeal but a stronger resubmission. Request a written explanation of the specific reason for the denial and talk with the member’s medical provider about whether more thorough documentation, or a more carefully rated DMAS-7, would support a new referral.