Virginia DSP Training Requirements: DMAS Waiver & DBHDS Rules

Virginia sets direct support professional (DSP) training in two layers. The Department of Medical Assistance Services (DMAS) regulates what DSPs must complete before providing billable services in the state's developmental disabilities (DD) waivers. The Department of Behavioral Health and Developmental Services (DBHDS) licenses providers and adds the employment-cycle rules: orientation, retraining policy, first aid and CPR, emergency training and records. This guide walks through both layers, shows what each one actually says, and ends with a file checklist.

You may see a figure of 55 training hours quoted online for Virginia DSPs. The regulations covered in this guide do not set a fixed number of hours. They set a test score, deadlines, competency checks and a requirement that providers write their own retraining policy.

Layer 1: DD waiver orientation and competencies (12VAC30-122-180)

12VAC30-122-180 applies to providers of agency-directed personal assistance, companion and respite services, center-based crisis supports, crisis support services, community engagement, community coaching, group day, group home residential, independent living supports, individual and group supported employment, in-home support, sponsored residential, supported living residential and workplace assistance services. For those providers it requires the following.

Orientation test before billable work

• Providers must ensure DSPs and DSP supervisors receive or have received training on five areas, which the DMAS-approved orientation training addresses: the characteristics of developmental disabilities and Virginia's DD waivers; person-centeredness, positive behavioral supports and effective communication; identified health risks of people with developmental disabilities and the appropriate interventions; community integration and social inclusion; and best practices in supporting people with developmental disabilities.
• DSPs and supervisors must pass a DMAS-approved, objective, standardized test on those topics with a score of at least 80% before providing direct, reimbursable services.
• Until a new DSP passes, other qualified staff who have passed the knowledge-based test must work alongside that DSP.
• For DSPs, the personnel file holds a copy of the completed test with its score and the assurance document signed by the DSP and the supervisor or designee. For supervisors, the file holds a certificate of completion from a DMAS-approved supervisory training in place of the written test.

A DMAS provider bulletin (last updated March 9, 2022) says the test was revised effective November 15, 2021 to add sections on choking risk and changes in mental status. It says the training and test are required for DSPs and supervisors hired on or after that date, and that a pass requires 89 of the 111 questions correct to reach 80%.

Observed competencies within 180 days

For the services listed in subsection B of the regulation, providers must ensure DSPs and DSP supervisors, including relief and contracted staff, complete competency observation and the competency checklist within 180 days from the date of hire. Contracted and relief staff count from the first date of hire or original contract. For sponsored residential services, the date of hire can be the date the sponsor begins providing service in the sponsored home.

• Supervisors of DSPs complete the competencies checklist (DMAS Form P241a) for each DSP they supervise within 180 days of the DSP's hire date, then update it annually. The director or the director's designee does the same for each DSP supervisor.
• Evidence of completed core competency observation and demonstrated proficiency, plus the assurance documentation (DMAS Form P242a or P245a), goes in the personnel record.
• The health and safety skills on the checklist may be performed only under the direct supervision, observation and guidance of qualified staff until competence is observed and documented.
• Checklists and annual updates stay in the personnel records, subject to review by DBHDS for licensing and by DMAS for quality management, utilization and financial audit purposes.

What happens when a competency slips

After the first 180 days, a DSP or supervisor found deficient in a competency area (the regulation defines this as an established pattern of inability to demonstrate one or more skills) triggers a set sequence if the agency wants to keep billing for the related supports:

1. The provider has seven calendar days to begin remediation of the skills and document the issue and the actions taken. That is treated as a first episode.
2. If proficiency is not reconfirmed within seven days following discovery of a second episode that occurs within three months, the skills being remediated may be performed only under the direct supervision, observation and guidance of qualified staff who document the supports in the person's record.
3. Once proficiency is demonstrated, the provider keeps a signed confirmation describing the actions taken, completed by the DSP supervisor for DSPs or by the agency director or designee for supervisors. Billing for those supports can resume from that date forward.

Advanced competencies for the most intensive needs

Subsection C adds requirements for DSPs and supervisors who support people assigned to Level 6 or 7 of Tier 4. They must receive training developed or approved by a qualified professional in the areas of health, behavioral needs, autism, or all three, based on the needs of the people supported. DSPs supporting people at other levels who receive a customized rate must be trained in the areas related to the person's needs. The director or designee completes the advanced core competency checklists (DMAS Forms P240a, P244a and P201) within 180 days of the date of hire, or within 180 days of the first admission of a person with related needs or identification of the person's level, with annual updates after that. Supervisors complete the same checklists for each DSP they supervise, and the same seven-day remediation sequence applies.

DBHDS has posted draft updates to its DD waiver basic and complex supports competencies for public comment. Until a revision is final, use the forms and protocol your DBHDS and DMAS contacts currently require.

Layer 2: DBHDS licensing rules (12VAC35-105)

The licensing regulation, 12VAC35-105, applies to each service a provider is licensed to deliver. Check each section's scope against your license, because some rules carve out services. For example, the emergency preparedness section states that it does not apply to home-based or noncenter-based services. These are the staff-related sections most DSP employers meet first.

Orientation within 15 business days (12VAC35-105-440)

New employees, contractors, volunteers and students must be oriented, commensurate with their function or job-specific responsibilities, within 15 business days. The provider must document that orientation covers each of these:

1. Practices of confidentiality, including access, duplication and dissemination of any part of an individual's record
2. Practices that ensure an individual's rights, including orientation to the human rights regulations
3. Emergency preparedness procedures
4. Person-centeredness
5. Infection control practices and measures
6. Other policies and procedures that apply to specific positions and duties
7. Serious incident reporting, including when, how and under what circumstances a serious incident report must be submitted, and the consequences of failing to report one to DBHDS

A retraining policy you write yourself (12VAC35-105-450)

12VAC35-105-450 requires providers to offer training and development opportunities that let employees support the people they serve and carry out their jobs. The provider must develop a training policy that addresses the frequency of retraining on serious incident reporting, medication administration, behavior intervention, emergency preparedness, and infection control, including flu epidemics. Employee participation must be documented and accessible to DBHDS. The rule does not fix the frequencies. Your policy does, and then your records must show you followed it.

First aid, CPR and emergency training

• First aid and CPR (12VAC35-105-460): at least one employee or contractor on duty at each location must hold a current certificate in standard first aid and CPR from the American Red Cross, the American Heart Association or a comparable authority, or be an emergency medical technician. The certification process must include a hands-on, in-person demonstration of competency. A licensed medical professional with a current license is deemed to hold a current first aid certificate, but not a CPR certificate.
• Emergency preparedness (12VAC35-105-530): providers must implement annual emergency preparedness and response training for all employees, contractors, students and volunteers covering alerting emergency personnel and sounding alarms, evacuation procedures (including for people who are deaf, blind or nonambulatory), using emergency equipment, accessing emergency medical information, and using community support services. The plan is reviewed annually, and fire and evacuation drills are conducted at least monthly.
• Tuberculosis screening (12VAC35-105-510): new employees, contractors, students and volunteers with direct contact must obtain a qualified licensed practitioner's statement of the absence of communicable TB within 30 days of employment or initial contact, with an exception for certain staff coming from another licensed provider after a short break in service.

Medication, behavior supports and rights training

• Medication (12VAC35-105-770): providers must have written policies on training requirements for staff authorized to administer medication, and medications may be administered only by persons authorized under the Drug Control Act.
• Behavior interventions (12VAC35-105-800 and -810): staff trained in behavior support interventions must implement and monitor all behavior interventions, and behavioral treatment plans must be developed, implemented and monitored by staff trained in behavioral treatment.
• Restraint and time out (12VAC35-115-110): only staff trained in the proper and safe use of seclusion, restraint and time out techniques may initiate, monitor and discontinue their use.
• Human rights (12VAC35-115-260): providers must require competency-based training of employees on the human rights regulations upon employment and at least annually thereafter, and document that competency in the personnel file.

Supervision, evaluation and records

• Supervision of developmental services (12VAC35-105-590): supervision must be provided by a person with at least one year of documented experience working directly with people with developmental disabilities and at least a bachelor's degree in a human services field, though experience may be substituted for the education requirement. The staffing plan must describe how supervision is documented.
• Performance evaluation (12VAC35-105-480): a written evaluation policy, evaluations at least annually, and employee development needs and plans as part of each evaluation.
• Personnel records (12VAC35-105-430): records include education and training history and are kept in their entirety for at least three years after the employee's or contractor's termination.

How the two layers fit together

A Virginia DSP file checklist

• Scored orientation test (80% or better) and signed assurance document, dated before the DSP's first billable service.
• Orientation record showing all seven 12VAC35-105-440 topics covered within 15 business days.
• Competency checklist dated and initialed, with the 180-day deadline calendared from the hire (or contract) date, including relief and contracted staff.
• Annual competency update on the anniversary, plus remediation notes if any skill slipped.
• Advanced checklists where a person supported is at Tier 4 Level 6 or 7 or has a customized rate.
• Human rights competency documentation, repeated each year.
• Your written training policy, and attendance records for each retraining it requires.
• First aid and CPR certificates, with proof the skills demonstration was in person, and a roster showing a certified person on duty at each location.
• TB screening statement, medication-administration authorization and any behavior-support training records for the staff who need them.
• Annual performance evaluation with a development plan.

How TES helps

Our catalog includes general courses on topics that overlap with Virginia's orientation and retraining subjects:

• Human Rights and Recognizing Abuse, Neglect, and Exploitation
• Fundamental Rights for Direct Support Professionals
• Abuse, Neglect, and Exploitation for Direct Support Professionals
• Person Centered Planning for Direct Support Professionals
• Infection Control: Universal Precautions and Basic Safety
• Emergency Preparedness
• Fire Safety for Direct Support Professionals

These are general courses. They do not replace the DMAS-approved orientation test, the observed competency checklists, an in-person first aid and CPR skills demonstration, or the site-specific parts of your emergency plan, so confirm what DBHDS and DMAS accept before assigning a course to meet a specific requirement.

The Virginia DSP compliance training pathway is built around 12VAC30-122-180 and the 12VAC35-105-440 and -450 topics, and it tracks the state-authored orientation test and checklists as external evidence completed in your agency. Our Virginia DSP requirements page and Virginia training audit checklist can help you review your files.

Training & eTracking Solutions is an NADSP Accredited Education provider whose courses count toward DSP-I and DSP-II. We have trained more than 200,000 professionals since 2010, and our catalog includes 400+ courses and programs. Deadlines like 15 business days, 180 days and annual updates are easy to miss on a spreadsheet, so read how to track employee training in a care agency. You can also contact us to set up training for your team.

This article summarizes 12VAC30-122-180, 12VAC35-105 (sections 430, 440, 450, 460, 480, 510, 530, 590, 770, 800 and 810), 12VAC35-115 (sections 110 and 260) and a DMAS provider bulletin as published by the Commonwealth of Virginia. It is not legal advice. State rules differ, change often and may add requirements, so check the current text and confirm with DBHDS or DMAS before making compliance decisions.