DMAS-97AB Form: Free Fillable PDF (Revised 8/2026)
The Virginia DMAS-97A/B Agency or Consumer Direction Provider Plan of Care, current revision 8/2026, with typeable fields. Download it free, with no sign-up. DMAS requires this version as of October 1, 2026.
Download the fillable DMAS-97A/B (PDF)
What is the DMAS-97A/B?
The DMAS-97A/B (often written DMAS-97AB or DMAS 97 A/B) is the Agency or Consumer Direction Provider Plan of Care used in Virginia's CCC Plus Waiver. It lays out the personal care or respite tasks the aide or attendant performs each day of the week: activities of daily living such as bathing, dressing and toileting, special maintenance tasks, supervision, and instrumental activities of daily living such as meal preparation and laundry. Page 1 also holds the composite ADL score that sets the member's level of care, and page 2 holds the plan type, backup plan, total weekly hours and signatures.
What's new in the 8/2026 revision?
- Personal care plans must show the time for each task, to the nearest 15 minutes, instead of a check mark. Respite plans still use a check mark for each task.
- New boxes for the plan type: Personal Care/Assistance, LRI Personal Care/Assistance, or Respite. Select only one per form.
- Supervision and household tasks (IADLs) are marked not eligible when the paid caregiver is a legally responsible individual (LRI), such as a parent of a minor or a spouse.
- A larger required backup plan section, with the person's name and phone number.
- A new section for LRI plans of care explaining how provider decisions were made on the member's behalf.
Tips for completing the DMAS-97A/B
- Record the actual time the aide or attendant needs for each task, in 15-minute steps, based on discussion with the member and family.
- Check that the total weekly hours line up with the level of care from the composite ADL score: about 25 hours for Level A, 30 for Level B and 35 for Level C.
- Use a separate DMAS-97A/B for personal care and for respite.
- For an LRI, include only activities of daily living that go beyond typical care for the member's age, up to 40 hours per week.
DMAS-97AB questions
Is this the official DMAS-97A/B? It is the current DMAS-97A/B Revised 8/2026 published by Virginia DMAS, with fillable fields added so you can type, save and print it. The official form is also posted on the Virginia Medicaid provider portal.
Can I still use the older DMAS-97AB with check marks? No. DMAS required providers to adopt the new version by October 1, 2026, and says service authorization requests on older versions will be denied.
Do I need a DMAS-99 too? Yes, the nurse or Services Facilitator also completes a DMAS-99 assessment. Get the free fillable DMAS-99 form (rev. 09/26).
For a full walk-through of what changed on both forms and why, read Virginia's new DMAS-97 and DMAS-99: what changed in 2026.