12VAC30-60-306. Submission of screenings.
A. The screening entity shall complete and submit the following forms to DMAS electronically via ePAS:
1. DMAS-95 - MI/IDD/RC (Supplemental Assessment Process Form Level I), as appropriate;
2. DMAS-96 (Medicaid-Funded Long-Term Care Service Authorization Form);
3. DMAS-97 (Individual Choice - Institutional Care or Waiver Services), as applicable;
4. UAI (Uniform Assessment Instrument);
5. DMAS-108 (Tech Waiver Adult Referral); and
6. DMAS-109 (Tech Waiver Pediatric Referral).
B. For screenings performed in the community, the screening entity shall submit to DMAS via ePAS each screening form listed in subsection A of this section within 30 days of the individual's request date for screening.
C. For screenings performed in a hospital, the hospital team
shall submit to DMAS via ePAS each screening form listed in subsection A of
this section, which shall be completed prior to the individual's discharge.
individuals who will be admitted to a Medicare-funded skilled NF or to a
Medicare-funded rehabilitation hospital (or rehabilitation unit) directly upon
discharge from the hospital, the hospital screener shall have up to an
additional three days post-discharge to submit the screening forms via ePAS.