For providers seeking customized rate funding through the Virginia Department of Behavioral Health and Developmental Services (DBHDS), timely and complete documentation is becoming even more important.
On September 8, 2026, DBHDS announced a new pending, or “pend,” policy for Customized Rate Applications. The policy establishes clearer timelines for providers, limits the number of pend requests during the review period, and explains what happens when an application remains incomplete.
This change matters because DBHDS Customized Rate Applications already require substantial supporting documentation demonstrating an individual’s exceptional medical or behavioral support needs and the provider’s ability to deliver those supports.
What Is a Customized Rate Application?
A customized rate provides an alternative to the standard reimbursement structure for qualifying individuals whose complex medical or behavioral needs require additional resources.
According to DBHDS, customized rates may support individuals whose needs exceed the resources available under the standard waiver rate structure. Depending on the individual’s circumstances, the request may involve enhanced staffing, specialized staff, or increased programmatic oversight.
Providers must support their requests with appropriate documentation, including evidence of staff qualifications, training, and other resources necessary to meet the individual’s exceptional needs.
What Is the New 30-Day Response Window?
Under the new policy, providers have 30 calendar days from the date the Customized Rate Application is submitted to provide the required documentation and information needed for review.
Therefore, providers should not view the initial submission as the end of the process. They must continue monitoring communications and promptly address any requests from DBHDS.
How Do Pend Requests Work?
DBHDS may issue up to two pend requests during the 30-day review period.
When DBHDS places an application on pend, the provider must respond to that request within 10 calendar days.
However, there is an important distinction: the 10-day response period does not restart or extend the overall 30-day application period.
For example, if a provider receives a pend request on Day 15, responding within 10 days does not give the provider another 30 days. The application remains subject to the applicable overall timeframe.
What Happens If DBHDS Needs More Time Internally?
The policy also addresses delays caused by DBHDS’s internal processing.
If DBHDS holds an application in its internal review queue for more than three calendar days, the days beyond those three will be deducted from the provider’s 30-day response window.
This adjustment helps ensure providers are not penalized for qualifying internal processing delays.
What Happens After the 30-Day Period?
If the provider does not complete the required submissions within the adjusted 30-day timeframe, the application will automatically move to committee review.
The committee will evaluate the application based on the information available at that point.
Consequently, missing essential documentation can have serious consequences. An application may be denied if the committee cannot adequately evaluate the request because key information is missing.
Furthermore, a Customized Rate Technical Consultant may deny an application before committee review if critical components are missing and the application cannot reasonably proceed to committee consideration.
DBHDS’s current Customized Rate materials already emphasize that applications must contain sufficient supporting information and that inadequate documentation can result in denial before committee review.
Why Providers Should Take This Policy Seriously
The new pend policy makes application management and deadline tracking just as important as initial documentation.
A provider may have a strong case for a customized rate. However, if the supporting evidence is incomplete or the provider fails to respond to a pend request on time, the application could move forward without the information needed to support approval.
DBHDS also requires providers to upload supporting documentation through WaMS, and the department’s current 2026 materials identify Form SF-20 as a required document for customized rate applications.
Therefore, providers should establish an internal process for:
• Reviewing the application before submission
• Organizing supporting documentation
• Monitoring WaMS and DBHDS communications
• Tracking every deadline
• Assigning responsibility for responding to pend requests
• Maintaining copies of submitted documentation
• Escalating unanswered requests internally before deadlines expire
Next Steps for Providers
If you are preparing a DBHDS Customized Rate Application, do not wait for a pend request to identify missing information. Review the application and supporting documentation before submission, establish a system for monitoring the 30-day timeframe, and respond to every DBHDS request within the required deadline. Providers should also use the current DBHDS Customized Rate guidance and 2026 forms when preparing submissions.
At Magnate Consulting LLC, we help providers approach regulatory processes with structure, documentation, and compliance in mind. Proper preparation can reduce avoidable delays and strengthen the quality of a customized rate submission.
Frequently Asked Questions
1. How long do providers have to respond to a DBHDS Customized Rate Application?
Under the new September 8, 2026 pend policy, providers have 30 calendar days from submission to provide the required documentation and information, subject to the policy’s adjustment for qualifying DBHDS internal processing delays.
2. How many pend requests can DBHDS issue?
DBHDS may issue up to two pend requests during the 30-day review period.
3. How quickly must a provider respond to a pend request?
Providers must respond to each pend request within 10 calendar days.
4. Does responding to a pend request extend the 30-day deadline?
No. The pend response deadline does not extend the overall 30-day application period. The applicable timeframe continues to run, subject to any adjustment for qualifying DBHDS internal processing time.
5. What happens if essential documentation is still missing after 30 days?
The application may automatically proceed to committee review based on the information submitted at that time. If essential documentation is missing, the application may be denied. A Customized Rate Technical Consultant may also deny an application before committee review when key components are missing.
