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Remote Support in Virginia: Every Service It Fits, and How It Is Paid

Virginia already pays for in-home technology through Electronic Home-Based Supports (EHBS) in its Building Independence, Family and Individual Supports, and Community Living waivers. Any Virginia provider agency can get Vista Enterprise™, the remote support solution, the way it gets an EHR or payroll system, with no state approval. Billing is separate. The agency’s own trained team responds and decides.

Can any Virginia agency buy a remote support solution?

Yes. Any Virginia provider or agency can get Vista Enterprise™, the remote support solution, which includes VistaLink™, the technology. Like an EHR or payroll system, getting it needs no approval from the Department of Medical Assistance Services (DMAS), the Department of Behavioral Health and Developmental Services (DBHDS), a Community Services Board, a managed care plan, or anyone else.

Billing is a separate question. It depends on the program, the service, your agency’s provider status, and each person’s plan. The rest of this page walks through every place remote support fits in Virginia.

Where does remote support fit in Virginia?

Setting or programHow technology is usually paidWhat to know
DD waivers, person in their own or family homeEHBS and AT, per person, from one shared calendar-year budgetAdults 18 and older for EHBS; independent assessment and service authorization first
DD waivers, group home, sponsored residential or supported livingNot EHBS or PERS; the provider’s own costThose daily-rate residential services exclude EHBS and PERS
CCC Plus Waiver (older adults and people with disabilities)PERS and AT, per personPERS only alongside personal care, respite or adult day health care
ICF/IIDThe facility’s own costFederal staffing floor stays
Nursing homes and assisted livingThe facility’s own costResident privacy rules apply
Home care organizationsThe agency’s own cost, or the person’s waiver where it appliesSupport between visits
Any agency, any settingThe agency’s own budgetNo approval needed to buy

What is Electronic Home-Based Supports in Virginia?

EHBS is the service in Virginia’s developmental disabilities (DD) waivers that pays for technology in the person’s home. Under the state’s rule, EHBS:

  • Provides devices, equipment or supplies based on current technology, so the person can live more safely and take part in the community while needing less of other services, such as staff supports.
  • Is bought for the person and is usually installed in their home. Portable devices can go with them into the community.
  • Can include ongoing electronic monitoring, which is the provision of oversight and monitoring within the home through off-site monitoring, along with training, maintenance and service calls.
  • Is covered in three waivers: Building Independence (BI), Family and Individual Supports (FIS), and Community Living (CL).

What has to happen before EHBS starts in Virginia?

  1. The person is 18 or older and able to use the equipment.
  2. An independent professional consultant completes a preliminary needs assessment on the best type and use of technology and the most cost-effective option. This may be an occupational therapist or a similarly credentialed specialist.
  3. Service authorization comes first. The assessment goes to the DMAS designee before any goods or services are delivered or billed.
  4. The need is in the person’s Individual Support Plan (ISP), which the person leads with their support coordinator.
  5. The provider installs, tests and demonstrates the equipment to the person and their family or caregiver before billing.

Who can deliver and bill EHBS in Virginia?

Under the state’s rule, an EHBS provider has a signed participation agreement with DMAS, renders the service directly, and bills DMAS. It must be one of these:

  • A Medicaid-enrolled licensed personal care agency
  • A Medicaid-enrolled durable medical equipment provider
  • A Community Services Board or Behavioral Health Authority
  • A center for independent living
  • A licensed, Medicaid-enrolled home health provider
  • An EHBS manufacturer or a company that has the ability to provide electronic home-based equipment, direct services (installation, equipment maintenance and service calls) and monitoring, or a PERS manufacturer or Medicaid-enrolled company with the same abilities

When an authorization includes ongoing electronic monitoring, Virginia’s rule adds requirements for the provider of ongoing monitoring systems, including an emergency response center with fully trained operators. That is Virginia’s program rule for billing EHBS, not a VistaLink™ feature. An agency that simply gets Vista Enterprise™ for its own team does not bill EHBS at all.

How does Virginia pay for remote support?

Virginia has several paths, and they work together.

1. EHBS and AT, per person. Since September 1, 2025, EHBS and AT share one calendar-year budget per person in the BI, FIS and CL waivers, authorized by need. Unused funds do not carry over, and a single item cannot be split across two years. Environmental modifications have their own separate budget. The regulation text online still shows an older, separate plan-year limit, so go by the DMAS bulletin of August 12, 2025 and check the current limit with the person’s support coordinator.

2. PERS, for people who are often alone. In the DD waivers, PERS is for people who live alone or are alone for long parts of the day with no regular caregiver.

3. Not inside group home or supported living rates. EHBS and PERS are not covered for people receiving group home, sponsored residential or supported living residential services. Residential providers that want remote support for quality or privacy get Vista Enterprise™ as their own operating cost.

4. From the agency’s own budget. Any agency can get Vista Enterprise™ as its own remote support solution, paid from its own budget, whether or not it bills a service. This is how ICFs, nursing homes, assisted living and home care organizations use it.

Sources, checked October 25, 2026: DMAS bulletin on the HCBS waiver amendments, August 12, 2025; 12VAC30-122-360, Electronic Home-Based Supports; 12VAC30-122-470, personal emergency response systems in the DD waivers; 12VAC30-120-924, CCC Plus Waiver covered services.

What about older adults and people with physical disabilities in Virginia?

Remote support is not only for disability services. Virginia’s Commonwealth Coordinated Care Plus (CCC Plus) Waiver serves older adults and people with disabilities who would otherwise need nursing facility care. It covers two kinds of technology:

  • Personal emergency response systems, for people 14 and older who live alone or are alone for long parts of the day. PERS is provided only alongside personal care, respite or adult day health care, and it does not relieve caregivers of their responsibilities.
  • AT, portable equipment in the person’s plan of care that is not available under the State Plan, authorized each calendar year.

CCC Plus has no separate remote support staffing service. Agencies that serve CCC Plus members, including personal care and home care agencies, can still get Vista Enterprise™ for their own team.

How do consent and privacy work in Virginia?

The person supported decides whether remote support is used and where devices go, with help from the people they choose. The Individual Support Plan is person-centered and led by the person with their support coordinator. When the person has a legal guardian or authorized representative, that person takes part in consent. Consent is informed, voluntary and written down. The person can say no or withdraw consent at any time, and consent is revisited whenever the plan changes. The agency’s own trained team responds and decides, following the plan.

No cameras are required in bedrooms, bathrooms or other personal spaces.

What if our staffing stays the same, as in an ICF or a fully staffed group home?

An agency in Virginia can keep every in-person shift and still use remote support, because technology raises quality even with full staff.

Even a fully staffed overnight shift cannot be in every room at once, stay fully alert through every hour of the night, or carry every detail from one shift to the next. When nothing answers those human limits, they quietly become limits on the outcomes people supported can reach. That is a limit of people, not a failing of staff.

Enabling technology for human services fills those gaps without replacing anyone. It gives trained people better information and more of their time for the moments that need a person in the room.

  • Fewer night checks that wake people up. For people whose plans do not call for hands-on checks through the night, a door opening on a schedule interrupts sleep and privacy. Non-wearable sensors the person agreed to can let overnight staff know when something may need a person. Whether a plan moves away from scheduled checks is decided through the person’s plan, by the person and their team, with input from the agency’s own nurse or clinician.
  • Better information. Plain-language daily reports on sleep, activity and safety events give nurses and the team a fuller picture than a shift note alone.
  • Closing gaps in data and judgment. A steady record across shifts means handoffs rest on more than memory, and a change that is hard to read in the middle of the night comes to a trained person with the facts in front of them.

Know the limits.

  • Federal ICF rules set the staffing floor. In an intermediate care facility for individuals with intellectual disabilities (ICF/IID), federal rules require responsible direct care staff on duty around the clock when people are present, awake in some living units, plus minimum direct care staff ratios. Remote support adds to on-site staff. It does not replace them.
  • Privacy comes first. Federal rules require ICFs to give each person the opportunity for personal privacy. CMS guidance for surveyors says video or audio never takes the place of staff. No cameras are required in bedrooms, bathrooms or other personal spaces, and non-wearable sensors fit that approach.
  • The facility pays. An ICF/IID is paid as a facility, not through a person’s waiver plan, so an ICF that uses Vista Enterprise™ pays for it as its own operating cost.
  • In Virginia, EHBS and PERS are waiver services for people in their own homes, so an ICF does not bill them. ICF/IIDs are licensed by DBHDS under 12VAC35-105-30.
  • Group homes and privacy. Federal home and community-based settings rules give each person privacy in their sleeping or living unit. Any limit on that must be based on a specific assessed need, written into the person’s plan, and agreed to with informed consent.

Can nursing homes and assisted living in Virginia use remote support?

Yes. Nursing homes and assisted living communities get Vista Enterprise™ the same way any agency does, and the facility’s own trained team responds and decides.

  • Nursing homes. Federal rules give each resident a right to personal privacy, and require the facility to give each resident adequate supervision and assistance devices to prevent accidents. Better information can help staff see who needs them without waking everyone. Remote support does not prevent falls, and it is not a promise that every fall will be noticed. A trained person on the facility’s own team decides each step. Nursing homes are paid as facilities, so Vista Enterprise™ is the facility’s own purchase. In-person staffing rules do not change.
  • Assisted living. Residents live in their own units, with their own rights to privacy and choice. Technology placed with each resident’s consent gives staff better information between scheduled visits.
  • In Virginia, nursing facilities are licensed by the Virginia Department of Health under 12VAC5-371, and assisted living facilities are licensed by the Department of Social Services under 22VAC40-73.

How does remote support help home care agencies in Virginia?

Home care agencies send aides into people’s homes for set hours. Between visits, no one is there. Remote support fills that gap: the person keeps their privacy, and the agency’s own trained team can see when something may need attention and decide who should go.

  • Better visits. Aides arrive knowing how the night went.
  • Earlier notice. Changes in routine can show up before they become a crisis.
  • In Virginia, home care organizations are licensed by the Virginia Department of Health under 12VAC5-381. Licensed personal care and home health agencies that are Medicaid-enrolled are also among the provider types that can bill EHBS.

Who else can remote support help in Virginia?

It is not all about disability. Remote support is enabling technology for human services as a whole. It works for people with intellectual and developmental disabilities (IDD), older adults, people with physical disabilities, people recovering from an illness or injury, faith-based organizations that run health ministries, and the staff and families who support them.

How does VistaLink™ fit Virginia’s rules?

VistaLink™ uses non-wearable sensors and a display in the home to send events to your agency’s own trained team, and it never acts alone. The agency’s own trained team responds and decides, following each person’s plan.

Your agency stays the provider. It confirms that its full setup meets Virginia’s rules for the service it bills, or the rules for its license if it bills nothing. For EHBS, that includes the independent assessment, service authorization and the DMAS participation agreement.

For states and government agencies

Vista can also work with Virginia’s Department of Behavioral Health and Developmental Services (DBHDS), and with other state and government agencies, for example through a procurement or a contract. Any single agency can already get Vista Enterprise™ with no state approval.

Remote support for states and government agencies

What does remote support look like for a Virginia agency? (composite example)

This is a composite example built from common situations. It is not a real person.

A young man in the Family and Individual Supports Waiver lives with his mother, who works nights. An independent consultant recommends non-wearable sensors and a display in the home, and he and his support coordinator add EHBS to his plan, paid from his shared calendar-year budget. On nights his mother is at work, a trained staff member at his personal care agency gets an event when he gets up and checks in the way his plan says.

Questions and answers

Can any Virginia agency buy a remote support solution?

Yes. Any Virginia provider or agency can get Vista Enterprise™, which includes VistaLink™. Like an EHR, it needs no DMAS, DBHDS or managed care approval. Billing follows each program’s rules.

Which Virginia waivers cover Electronic Home-Based Supports?

EHBS is covered in the Building Independence, Family and Individual Supports, and Community Living waivers for people with developmental disabilities.

How is EHBS budgeted in Virginia?

Since September 1, 2025, EHBS and AT share one calendar-year budget per person in the three DD waivers, authorized by need. Unused funds do not carry over. Check the current limit with the person’s support coordinator.

Can EHBS be used in a Virginia group home?

No. EHBS and PERS are not covered for people receiving group home, sponsored residential or supported living residential services. Those providers can get Vista Enterprise™ as their own operating cost.

Who can bill EHBS in Virginia?

An enrolled provider with a DMAS participation agreement, such as a personal care agency, durable medical equipment provider, Community Services Board, center for independent living, home health provider, or an equipment company that meets the rule.

What does Virginia cover for older adults?

The CCC Plus Waiver covers personal emergency response systems, alongside personal care, respite or adult day health care, and portable AT in the person’s plan of care.

Can a Virginia ICF, nursing home or assisted living facility use remote support?

Yes, as its own tool alongside on-site staff. Federal and state staffing rules still apply in full, no cameras are required in bedrooms or bathrooms, and the facility pays for Vista Enterprise™ as its own cost.

Who responds when remote support is in place?

Your agency’s own trained team responds and decides, following each person’s plan. VistaLink™ never acts alone.

Is remote support in Virginia only for disability services?

No. It fits any human service where staff cannot be everywhere at once: disability services, older adults, assisted living, nursing homes, home care and faith-based health ministries.

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