How to Fill Out and Submit the DBHDS Quarterly Review Form

Virginia providers document each waiver participant’s progress on the DBHDS Quarterly Person Centered Review form every three months, and the completed DBHDS quarterly review form must reach the assigned support coordinator within 10 calendar days after the end of each quarter.¹ The current template (revised July 2024) is a Word document on the DBHDS site organized into three sections: Desired Outcomes, Essential Supports, and five Quarterly Review Questions.²

Gather Your Records First

Every entry on the form should trace back to something already in the individual’s record. Pull these before you open the template:

The current Individualized Service Plan, with its start date, end date, and revision date. You will reference each desired outcome and essential support it lists.
Daily progress notes from direct support staff. These give you the dates, counts, and concrete examples the status descriptions need.
Health and behavioral records from the quarter — hospital visits, medication changes, new diagnoses, behavioral incidents. These feed the safety and significant-event questions.
The individual’s or substitute decision-maker’s feedback on services and any desired changes. Collect this before filling out the form, not after.

Header Fields

The top of the form asks for the reporting period dates, service type, provider name, the individual’s name and ID number, and the ISP start, end, and revision dates. Confirm these match both your internal filing system and WaMS. Mismatched dates or ID numbers create audit problems that are entirely avoidable.

Desired Outcomes Section

This section evaluates progress toward each goal in the ISP. Virginia regulation requires the review to “document evidence of progression toward or achievement of a specific targeted outcome for each goal and objective.”³ For each outcome you fill in four pieces:

The outcome statement, copied or referenced from the ISP. For example, “John will independently prepare a simple meal twice per week.”
A status checkbox with three options: Achieved (goal accomplished and removable from the plan), On track (progressing as expected, no gaps or barriers), or Limited or no progress (gaps, barriers, or regression).²
A status description that explains the checkbox with data from progress notes. “John prepared sandwiches independently on 18 of 24 tracked occasions” is what auditors expect. “John is doing well with meals” is not. Compare against the baseline set at the ISP’s start.
A Yes/No for whether a plan change is needed. If yes, describe what should change — a revised timeline, a different teaching strategy, or a new support level.

When a goal was not accomplished by its target date, the regulation requires the provider and appropriate team members to review the reasons and give the individual an informed choice about how to proceed.³ Document that conversation in the status description: who participated, what options were discussed, and what the individual chose.

Essential Supports Section

This section covers two categories, both using the same status-and-description format as Desired Outcomes.

Risks

For each risk area in the ISP, mark whether it is an identified risk (already documented and being managed) or a potential risk (foreseeable but not yet realized). Choose Achieved, On track, or Limited or no progress, and describe the current situation. If the risk status changed during the quarter — say, a fall risk that resulted in an actual fall — describe what happened and what adjustments were made or are still needed.

Routine Supports

Check every routine support category that currently applies: bathing, medication use, meal preparation, transportation, communication support, banking, medical appointments, and so on. The form includes “other” checkboxes for specialized medical needs such as respiratory care or G-tube management, and for behavioral supports.² Then rate overall status and describe whether the current level of routine support is meeting the individual’s needs or needs adjustment.

The Five Quarterly Review Questions

The final section is five yes-or-no questions, each with a description field. Providers often rush these. They carry real weight during audits and plan meetings because they cover safety, satisfaction, and service delivery.

Question 1 — Safety risks. Were any health or behavioral safety risks identified during the reporting period? If yes, describe what happened, how it was addressed, and how the plan was updated. This covers hospitalizations, emergency room visits, new behavioral concerns, and environmental hazards.
Question 2 — Desired changes. Does the individual or substitute decision-maker want any changes to the plan or services? Federal regulation requires the planning process to be driven by the individual to the maximum extent possible. If yes, describe what the person wants changed and the steps being taken.⁴
Question 3 — Satisfaction. Is the individual satisfied with all services and supports? The form specifically asks you to describe how you know. Document the conversation or observation behind your answer, not just the checkbox.
Question 4 — Service implementation. Were all Medicaid services in the plan actually delivered? If a service was authorized but not provided — a missed respite session, a lapse in community engagement hours — describe what happened and how the gap will be resolved.
Question 5 — Significant events. Anything meaningful during the quarter not already captured above: a change in residential setting, a new relationship, a job, a legal matter.

Sign and date the form. The closing fields also ask for ISP revision dates if the plan was modified during the quarter.

Submitting Through WaMS

Virginia’s Waiver Management System (WaMS) is the central platform for the developmental disability waivers and the communication channel between providers, support coordinators, and DBHDS.⁵ Most providers submit the completed review through WaMS by logging in, navigating to the individual’s record, and uploading the document. The WaMS Provider User Guide describes an attachment process where you click “Attach File,” browse to the saved document, and select the file.⁶

The deadline is 10 calendar days after the end of each quarter. The DMAS provider manual states that “the content of each review must be discussed with the individual and family member/caregiver, as applicable and submitted to the Support Coordinator within 10 calendar days following the end of each quarter.”¹ Keep the WaMS tracking number or timestamp with your compliance records.

One scheduling note: the three-month clock in 12VAC35-105-675 runs from the ISP implementation date, not the calendar quarter.³ Each individual you serve has a review schedule tied to their own plan.

What Auditors Look For

DBHDS licensing specialists examine these records during annual unannounced inspections. A 2026 DBHDS memo confirms that at each annual inspection, “the licensing specialist will review a sample of individual and employee/contractor records along with several policies and procedures to ensure that the provider is complying with the regulatory requirements.”⁷ Two consequences follow when reviews are missing or late:

Corrective action plans. For any noncompliance found during an inspection, DBHDS issues a licensing report and requires a written corrective action plan within 15 business days. The plan must describe the corrective actions, completion dates, and a designated person responsible for oversight. If the violations pose a danger to individuals, an immediate corrective action plan is required.⁸
Reimbursement recovery. The DMAS provider manual states that “claims for payment that are not supported by supporting documentation are subject to recovery by DMAS or its designee as a result of utilization reviews or audits.” A missing quarterly review means missing documentation for services billed in that period, and those reimbursements are at risk of clawback.¹

Mistakes That Cause Problems

Vague status descriptions. “Doing well” or “making progress” without data does not meet the evidence-of-progression standard. Use numbers, dates, and concrete examples from progress notes.
Skipping the “how you know” part of the satisfaction question. A blank explanation field signals that no one actually asked the individual.
Checking Yes on service implementation without verifying. If authorized hours were not fully delivered, a Yes here conflicts with billing records, and auditors will find the gap.
Missing the 10-day submission window. Late reviews delay plan updates and flag your agency at the next inspection.
Failing to address unmet goals. Limited or no progress requires a team review of the reasons and an informed choice by the individual about next steps, and that conversation has to be documented.

1
Virginia Department of Medical Assistance Services. Provider Manual – Developmental Disabilities Waivers (BI, FIS, CL)
2
Virginia Department of Behavioral Health and Developmental Services. Quarterly Person Centered Review (PCR) Word Template ISP v4.0
3
Virginia Code Commission. 12VAC35-105-675 – Reassessments and ISP Reviews
4
eCFR. 42 CFR 441.725 – Person-Centered Service Plan
5
My Life My Community. WaMS
6
Virginia Department of Behavioral Health and Developmental Services. WaMS Provider User Guide
7
Virginia Department of Behavioral Health and Developmental Services. 2026 Annual Inspections for Providers of Developmental Services Memo
8
Virginia Code Commission. 12VAC35-105-170 – Corrective Action Plan