How to Complete the DMAS-90: Virginia Medicaid Provider Aide Record

The DMAS-90 form is Virginia Medicaid’s Provider Aide Record, a weekly log that a personal care aide fills out each day of service to document what was done in a waiver recipient’s home, when the aide arrived and left, and anything unusual observed during the week.¹ It is a documentation form, not an eligibility or screening form, and it stays in the provider’s file rather than being submitted to the state. Getting it right matters because it is the proof that services billed to Medicaid were actually delivered.

When You Use the DMAS-90

The DMAS-90 is the required aide record for agency-directed personal care under Virginia’s Medicaid waiver programs, including the CCC Plus Waiver and EPSDT Personal Care, and for unskilled respite care provided by an aide.² One form covers one calendar week per individual, so a fresh DMAS-90 begins each week for each person receiving care. Respite documentation must be kept separate from other non-waiver service records.³

Skilled respite care delivered by an RN or LPN uses a different form, the DMAS-90A, which requires detailed clinical assessments the aide form does not.⁴ If a nurse is providing the service, the DMAS-90 is the wrong form.

Agencies may not modify the DMAS-90. It must be used exactly as published by DMAS.² The current version is available on the Virginia Department of Medical Assistance Services website.¹

How to Fill Out the DMAS-90

The form has three working areas: identifying information at the top, a daily activity grid in the middle, and a weekly observation section near the bottom. It must be completed on the day the service is delivered, not filled in later from memory.²

Identifying Information

At the top, enter the individual’s name and phone number. The form does not ask for Social Security number or Medicaid ID because it stays in the provider’s file rather than going to the state for an eligibility decision.⁵

Daily Activity Grid

The middle of the form is a grid listing more than 20 care activities with a column for each day of the week. Mark only the activities the aide actually performed or assisted with on that visit.⁵ The listed activities cover:

Personal care such as bathing, dressing, toileting, transferring, grooming, feeding assistance, and ambulation
Health-related tasks such as vital signs, assistance with self-administered medication, bowel and bladder care, wound care, range of motion, and turning or repositioning
Household support including meal preparation, kitchen cleaning and dishes, linens, cleaning areas used by the individual, shopping and supply lists, and laundry
Community access for medical appointments, work, school, or social activities
Supervision, as a separate line when the aide’s role that day is monitoring rather than hands-on care

Record the aide’s actual arrival and departure times each day. These must reflect real clock times, not the scheduled shift.⁶ Auditors compare these times directly against billing, and mismatches are one of the quickest paths to a payment retraction.

Weekly Observations

Below the grid, the aide answers four yes-or-no questions covering the week:⁵

Any change in the individual’s physical condition?
Any change in the individual’s emotional condition?
Any change in the individual’s regular daily activities?
Any observation about the individual’s response to services?

If any answer is yes, write a brief explanation. Virginia regulations require that weekly comments address the individual’s physical and emotional condition, daily activities, and responses to services.⁶ A short note such as “individual refused meals two days this week” or “new bruising on left arm” gives the supervising nurse something to act on.

Signatures and Timing

The bottom of the form has three signature lines: the individual or family member, the aide, and a supervising RN. The individual and aide signatures are required every week, each with the date, confirming that the services documented were actually delivered.⁶ The RN signature line is marked “not mandatory” on the form itself, though supervising nurses often sign when reviewing the record during supervisory visits.⁵

Timing is strict. No one may sign the form before the last day of the week in which services were provided, and no signature may be placed more than seven calendar days after the last service that week.⁶ An employee of the provider agency may not sign on the individual’s behalf unless that employee is a family member or unpaid caregiver.

Fixing Mistakes

If something is written incorrectly, draw a single line through the error so the original text remains legible, write the correct information nearby, and add your initials and the date of the correction. Correction fluid or white-out is never allowed.² Every form in the record must carry original notes, dates, and signatures. Photocopied forms, re-dated entries, and copied signatures are prohibited.⁷ File completed forms in the individual’s record within two weeks of the visit.

How Long to Keep the Records, and What Happens If They’re Missing

Providers must retain DMAS-90 records for at least six years from the last date of service, or longer if another law requires it. Records for minors must be kept for at least six years after the individual turns 18. If DMAS or its designee begins an audit within that period, the records must be held until the audit is fully completed and every exception is resolved.⁷

Documentation must support every claim submitted for Medicaid reimbursement. Claims without supporting documentation are subject to recovery through utilization reviews or audits.³ Noncompliance with documentation policies can also result in termination of the provider agreement.⁷ A missing box of aide records from two years ago can become tens of thousands of dollars in recouped payments.

How the DMAS-90 Connects to the Plan of Care

Eligibility and planning happen before the aide shows up. The individual has already been screened using the Virginia Uniform Assessment Instrument, had a Plan of Care drawn up on the DMAS-97AB, and received a community-based care assessment on the DMAS-99.² The aide’s job is to deliver what the Plan of Care calls for and document it on the DMAS-90. If conditions change, needs shift, or the individual refuses certain services, note it in the weekly observations and tell the supervising RN. Those notes can prompt a reassessment or a revision to the plan.

1
Virginia Medicaid. DMAS-90
2
Virginia Department of Medical Assistance Services. EPSDT Personal Care Services Chapter
3
Virginia Code Commission. Virginia Administrative Code 12VAC30-122-490 – Respite Service
4
Virginia Department of Medical Assistance Services. DMAS-90A Skilled Respite Record
5
Virginia Regulatory Town Hall. DMAS-90 Provider Aide Record
6
Virginia Register of Regulations. Virginia Administrative Code 12VAC30-120-935 – Waivered Services
7
Legal Information Institute. Virginia Administrative Code 12VAC30-120-930 – General Requirements for Home and Community-Based Waivered Services