How to Fill Out and Submit the DMAS-62: Scoring, Documents, and Renewals

The DMAS-62 is Virginia Medicaid’s Private Duty Nursing Medical Needs Assessment and Referral form. A physician, physician assistant, nurse practitioner, or registered nurse completes it to document a person’s skilled nursing needs, a physician signs and dates it, and the nursing agency submits it with a physician-signed Plan of Care through the Atrezzo portal so DMAS or the member’s managed care organization can authorize a specific number of Private Duty Nursing hours.¹

You use it for one purpose: to get scheduled, continuous skilled nursing shifts approved for someone whose medical condition would otherwise require a hospital or nursing facility. The score you enter on the form drives the number of hours per day or week DMAS will pay for.²

Who Fills Out the Form and Who Signs It

A physician, physician assistant, nurse practitioner, or registered nurse can complete the DMAS-62. A family member, the member themselves, or a case manager can ask a qualifying clinician to do the assessment. Whoever fills it out, a physician must sign and date the form before it goes to the payer for authorization.³

You can download a blank DMAS-62 as a Word document from Virginia Medicaid’s Service Authorization forms page.⁴

Member Information at the Top

The top of the form collects the member’s name, Medicaid ID number, date of birth, gender, address, and phone number, along with the name and contact information of a parent or guardian when one applies. It does not ask for a Social Security number.¹

Scoring the Medical Needs Section

The main body of the DMAS-62 is a point-based scoring system. You assign points across several categories based on the frequency and complexity of the nursing tasks the person actually needs. Every point you claim has to correspond to a task a nurse will perform and document during a shift, and each point must be backed by clinical records. A minimum score of 1 point is required to qualify for any Private Duty Nursing at all.¹

The scored categories on the form are:

Respiratory: tracheostomy care, tracheal or nasal/oral suctioning, ventilator use, oxygen, BiPAP or CPAP, chest physiotherapy, and nebulizer treatments. Ventilator dependence carries the highest values, up to 25 points for 22–24 hours per day on a ventilator.
Cardiovascular access and medications: central lines, IV medications, continuous IV fluids, total parenteral nutrition (TPN), dressing changes, line flushes, oral and tube medications, subcutaneous or intramuscular injections, and continuous glucose monitoring.
Wound care: ostomy care and wound vacuum or drain management.
Feeding: NG tube feeding (continuous or bolus), prolonged oral feeding, and J/G tube feeding, including water boluses and flushes.
Central nervous system: seizure activity, scored by frequency and whether intervention is required.
Assessments: vital signs, neurological checks, respiratory monitoring, and other assessments that require a nurse’s skills.
Elimination and toileting: intermittent, indwelling, and straight catheterization.
Other: uncontrolled incontinence, splinting, lifting and transfers, combative or aggressive behavior, disorientation, and communication deficits.

Within each subcategory the points scale with how often the task happens. Tracheal suctioning, for example, scores 8 points when needed more often than every hour, 6 points every one to four hours, and 4 points less frequently. Match the individual’s actual care routine to the value the form lists for that frequency, and use the comments section to document any medical monitoring that supports the score.¹

What the Total Score Authorizes

The total Medical Needs Score at the bottom of the form sets a ceiling on the Private Duty Nursing hours DMAS will approve. The general adult scale on the form runs:¹

1–4 points: individual consideration; DMAS may suggest home health, skilled nursing for individuals with intellectual or developmental disabilities, personal care, or adaptive technology instead.
5–10 points: up to 6 hours per day or 42 hours per week.
11–20 points: up to 8 hours per day or 56 hours per week.
21–35 points: up to 12 hours per day or 84 hours per week.
36–45 points: up to 16 hours per day.
Above 45 points: individual consideration for higher-intensity care.

Children under 21 receive Private Duty Nursing through EPSDT, which uses a different point scale with different thresholds. Under the EPSDT manual, 7–22 points authorizes up to 8 hours per day and 23–36 points authorizes up to 12 hours per day; children scoring above 49 get individual consideration and can be authorized up to 24 hours per day when medically necessary.³

Approved hours cover the skilled nursing tasks and any personal care that is incidental to them. If the person’s condition improves and their score drops at the next review, the authorized hours drop with it.¹

Documents You Submit with the Form

The DMAS-62 alone is not a complete submission. You also need:

A Home Health Certification and Plan of Care (CMS-485), physician-signed, certifying that Private Duty Nursing is required. Providers may use the standard CMS-485 or another form with the same information.
Clinical documentation from medical professionals that supports every point claimed on the DMAS-62.
For reauthorization requests, the most recent two weeks of nursing notes.

Services that are not documented in the individual’s record as having been provided can be treated as if they were never delivered, and DMAS can recover the resulting overpayment.³

Where to Submit the DMAS-62

The nursing agency submits the packet through the Atrezzo portal at atrezzo.kepro.com. DMAS’s Medical Services Unit reviews and re-scores the assessment for final approval.¹

Which entity issues the authorization depends on the member’s Medicaid program:³

Fee-for-service Medicaid: DMAS or its contractor authorizes services directly.
Medallion 4.0 or FAMIS managed care: the managed care organization authorizes non-school hours; DMAS or its contractor handles school-hour authorization.
CCC Plus managed care: the MCO authorizes all hours. Contact the MCO for its specific process.
Community Living (CL) and Family and Individual Supports (FIS) waivers: the Department of Behavioral Health and Developmental Services (DBHDS) authorizes services.

Reassessment and Renewals

Authorization is not permanent. DMAS’s Medical Services Unit re-scores the DMAS-62 at each initial evaluation, renewal request, status change, and triggering event, and the individual must be reassessed by a physician after any hospital discharge to determine whether care needs have changed.¹

For a renewal, submit an updated DMAS-62 with the last two weeks of nursing notes and a current physician-signed Plan of Care. Under Virginia’s EPSDT Private Duty Nursing manual, individuals receiving these services must be reassessed by a physician every six months, and the updated form must accompany each service authorization request.³

An RN supervisor also has to visit the individual at least every 30 days to review the plan of care, verify current physician orders are in the home, and check satisfaction with services. Missing that supervisory visit can lead DMAS to recover payments for the period without supervision.²

If Hours Are Denied or Reduced

If DMAS or the MCO denies Private Duty Nursing or cuts authorized hours, you have appeal rights. The process has two stages.

For managed care members, the first step is an internal appeal with the MCO, filed within 60 days of the adverse decision. The MCO has 30 days to decide. If waiting could harm the member’s health, you can request an expedited appeal, which the MCO must resolve within 3 business days. If the MCO upholds the denial, you have 120 days from that final internal decision to request a State Fair Hearing through DMAS.⁵

One detail catches families out. If the MCO is reducing or ending services the member is already receiving, you can ask to keep the current level in place during the appeal, but you must request that within 10 days of the adverse decision or before the change takes effect, whichever comes first. If you ultimately lose, you may have to pay back the cost of the services delivered during the appeal.

For children under 21, a denied or reduced request must undergo a secondary review under EPSDT criteria. EPSDT requires Virginia to provide any medically necessary service to correct or improve a child’s condition, so a denial that might stand for an adult can sometimes be overturned for a child on EPSDT grounds.²

Not to Be Confused With the LTSS Screening

The DMAS-62 is not Virginia’s Long-Term Services and Supports screening. The LTSS screening uses the Universal Assessment Instrument to evaluate a person’s functional capacity for activities of daily living and to determine eligibility for nursing facility care, home and community-based waivers, and PACE; it is done by a community-based team from the local health department and social services and recorded in the eMLS system.⁶⁷ The DMAS-62 covers only skilled nursing needs and is completed by a clinician and submitted by the nursing agency. Some individuals go through both: the LTSS screening to qualify for a waiver, then the DMAS-62 to authorize the Private Duty Nursing hours inside it.

1
Virginia Department of Medical Assistance Services. DMAS-62 Medical Needs Assessment and Private Duty Nursing Referral
2
Cornell Law Institute. Virginia Code 12VAC30-50-132 – Private Duty Nursing
3
Virginia Medicaid. EPSDT Private Duty Nursing Program Manual
4
Virginia Medicaid. Service Authorization Related Forms
5
Virginia Code Commission. 12VAC30-120-650 – Appeal Timeframes
6
Virginia Medicaid. Screening Manual for Long-Term Services and Supports
7
Department of Medical Assistance Services. LTSS Screening