Virginia Regulatory Town Hall

Proposed Text

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Action:
Amend Auxiliary Grant Program
Stage: Fast-Track
5/21/08  12:14 PM
 

22VAC40-25-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Adult foster care (AFC)" means a locally optional program that provides room and board, supervision, and special services to an adult who has a physical or mental health need. Adult foster care may be provided for up to three adults by any one provider who is approved by the local department of social services.

"Applicant" means an adult currently residing or planning to reside in an assisted living facility or in adult foster care and who has applied for financial assistance under the Auxiliary Grants Program.

"Assisted living" means a level of service provided by an assisted living facility for adults who may have physical or mental impairments and require at least moderate assistance with the activities of daily living. Included in this level of service are individuals who are dependent in behavior pattern (i.e., abusive, aggressive, disruptive) as documented on the uniform assessment instrument Uniform Assessment Instrument.

"Assisted living facility" means any congregate residential setting that provides or coordinates personal and health care services, 24-hour supervision, and assistance (scheduled and unscheduled) for the maintenance or care of four or more adults who are aged, infirm or disabled and who are cared for in a primarily residential setting, except (i) a facility or portion of a facility licensed by the State Board of Health or the Department of Mental Health, Mental Retardation and Substance Abuse Services, but including any portion of such facility not so licensed; (ii) the home or residence of an individual who cares for or maintains only persons related to him by blood or marriage; (iii) a facility or portion of a facility serving infirm or disabled persons between the ages of 18 and 21, or 22 if enrolled in an educational program for the handicapped pursuant to §22.1-214 of the Code of Virginia, when such facility is licensed by the department as a children's residential facility under Chapter 17 (§63.2-1700 et seq.) of Title 63.2 of the Code of Virginia, but including any portion of the facility not so licensed; and (iv) any housing project for persons 62 years of age or older or the disabled that provides no more than basic coordination of care services and is funded by the U.S. Department of Housing and Urban Development, by the U.S. Department of Agriculture, or by the Virginia Housing Development Authority. Included in this definition are any two or more places, establishments or institutions owned or operated by a single entity and providing maintenance or care to a combined total of four or more aged, infirm or disabled adults. Maintenance or care means the protection, general supervision and oversight of the physical and mental well-being of an aged, infirm or disabled individual.

"Audit report" is an annual report prepared by the assisted living facility's private auditor. The auditor shall determine that the financial statements of the auditee are presented fairly and in conformity with generally accepted accounting principles.

"Auxiliary Grants Program" means a state and locally funded assistance program to supplement income of a Supplemental Security Income (SSI) recipient or adult who would be eligible for SSI except for excess income, who resides in an assisted living facility or in adult foster care with an approved rate.

"Certification" means an annual report prepared by the assisted living facility certifying that the assisted living facility has properly managed the resident's payment and personal needs allowance and is in compliance with Program regulations and appropriate licensing regulations.

"Department" means the Virginia Department of Social Services.

"Established rate" means the auxiliary grant rate as set forth in the appropriation act Appropriations Act or as set forth to meet federal maintenance of effort requirements.

"Newly licensed assisted living facility" means a facility that has been licensed for 12 months or less.

"Other operating expense" means expenses incurred by the provider for activities that are not directly related to the care of residents.

"Other operating revenue" means income earned by the provider for activities that are not directly related to the care of residents.

"Operating costs" means the allowable expenses incurred by a provider for activities directly related to the care of residents.

"Personal needs allowance" means an amount of money reserved for meeting the adult's personal needs when computing the amount of the auxiliary grant.

"Personal representative" means the person representing or standing in the place of the recipient for the conduct of his affairs. This may include a guardian, conservator, attorney-in-fact under durable power of attorney, next-of-kin, descendent descendant, trustee, or other person expressly named by the recipient as his agent.

"Program" means the Auxiliary Grant Program.

"Provider" means an assisted living facility that is licensed by the Department of Social Services or an adult foster care provider that is approved by a local department of social services.

"Provider agreement" means a document that the assisted living facility must complete and submit to the department when requesting to be licensed as an assisted living facility provider and approved for admitting auxiliary grant recipients.

"Qualified assessor" means an individual who is authorized by 22 VAC 40-745-100 to perform an assessment, reassessment, or change in level of care for an applicant to or resident of an assisted living facility.

"Rate" means the approved auxiliary grant established rate.

"Recipient" means an adult approved to receive financial assistance under the Auxiliary Grants Program when residing in a licensed assisted living facility or an approved adult foster care provider with an approved established rate.

"Residential living" means a level of service provided by an assisted living facility for adults who may have physical or mental impairments and require only minimal assistance with the activities of daily living. Included in this level of service are individuals who are dependent in medication administration as documented on the uniform assessment instrument Uniform Assessment Instrument.

"Uniform assessment instrument Assessment Instrument" means the department-designated assessment form. It is used to record assessment information for determining the level of service that is needed.

"Virginia Department of Medical Assistance Services (DMAS)" means the single state agency designated to administer the Medical Assistance Program in Virginia.

Statutory Authority

§§63.2-217 and 63.2-800 of the Code of Virginia; §416.2001 of the Social Security Act.

Historical Notes

Derived from VR615-01-51 §1, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 20, eff. August 1, 2007.

22VAC40-25-20. Assessment.

A. In order to receive payment from the Auxiliary Grants Program for care in an assisted living facility or in adult foster care, applicants shall have been assessed by a qualified assessor using the uniform assessment instrument Uniform Assessment Instrument and determined to need residential or assisted living care or adult foster care.

B. As a condition of eligibility for the Auxiliary Grants Program, a uniform assessment instrument Uniform Assessment Instrument shall be completed on a recipient prior to admission, at least once annually, and whenever there is a significant change in the individual's level of care, and a determination is made that the individual needs residential or assisted living care in an assisted living facility or adult foster care.

C. The assisted living facility or adult foster care provider are prohibited from charging a security deposit or any other form of compensation for providing a room and services to the recipient. The collection or receipt of money, gift, donation or other consideration from or on behalf of a recipient for any services provided is prohibited.

Statutory Authority

§§63.2-217 and 63.2-800 of the Code of Virginia; §416.2001 of the Social Security Act.

Historical Notes

Derived from VR615-01-51 §2, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 20, eff. August 1, 2007.

22VAC40-25-30. Basic services.

The rate established under the Auxiliary Grants Program shall cover the following services:

1. Room and board.

a. Provision of a furnished room;

b. Housekeeping services based on the needs of the recipient;

c. Meals and snacks provided in accordance with 22VAC40-72 including, but not limited to, food service, nutrition, number and timing of meals, observance of religious dietary practices, special diets, menus for meals and snacks, and emergency food and water. A minimum of three well-balanced meals shall be provided each day. When a diet is prescribed for a resident by his physician, it shall be prepared and served according to the physician's orders. Basic and bedtime snacks shall be made available for all residents desiring them and shall be listed on the daily menu. Unless otherwise ordered in writing by the resident's physician, the daily menu, including snacks, for each resident shall meet the guidelines of the U.S. Department of Agriculture's Food Guide Pyramid, taking into consideration the age, sex and activity of the resident. Second servings shall be provided, if requested, at no additional charge. At least one meal each day shall include a hot main dish.

d. Clean bed linens and towels as needed by the recipient and at least once a week.

2. Maintenance and care.

a. Minimal assistance with personal hygiene including bathing, dressing, oral hygiene, hair grooming and shampooing, care of clothing, shaving, care of toenails and fingernails, arranging for haircuts as needed, and care of needs associated with menstruation or occasional bladder or bowel incontinence;

b. Medication administration as required by licensing regulations including insulin injections;

c. Provision of generic personal toiletries including soap and toilet paper;

d. Minimal assistance with the following:

(1) Care of personal possessions;

(2) Care of funds if requested by the recipient and provider policy allows this practice, and are in compliance with 22VAC40-72-440 through 22VAC40-72-460, Standards for Licensed Assisted Living Facilities;

(3) Use of the telephone;

(4) Arranging transportation;

(5) Obtaining necessary personal items and clothing;

(6) Making and keeping appointments; and

(7) Correspondence;

e. Securing health care and transportation when needed for medical treatment;

f. Providing social and recreational activities; and

g. General supervision for safety.

Statutory Authority

§§63.2-217 and 63.2-800 of the Code of Virginia; §416.2001 of the Social Security Act.

Historical Notes

Derived from VR615-01-51 §3, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 20, eff. August 1, 2007.

22VAC40-25-45. Conditions of participation in the Auxiliary Grants Program.

A. Provider agreement for assisted living facilities.

1. As a condition of participation in the Auxiliary Grants Program, the assisted living facility provider is required to complete and submit to the department a signed provider agreement as stipulated below. The agreement is to be submitted with the application to be a licensed assisted living facility.

2. The assisted living facility provider shall agree to the following conditions in the provider agreement to participate in the Auxiliary Grants Program:

a. Provide services in accordance with all laws, regulations, policies, and procedures that govern the provision of services in the facility;

b. Submit an annual financial audit certification form by June 30 of each year;

c. Care for auxiliary grant recipients in accordance with the requirements herein at the current established rate;

d. Refrain from charging the recipient, his family, or his authorized personal representative a security deposit or any other form of compensation as a condition of admission or continued stay in the facility;

e. Accept the auxiliary grant payment from the Program as payment in full for services rendered, except as permitted herein;

f. Account for the resident's personal needs allowance separate separately and apart from other facility funds;

g. Provide the local department of social services a 60-day written notice when a recipient is to be discharged from the facility;

h. Provide a 60-day written notice to the department in the event of the facility's closure or ownership change; and

i. Return to the local department of social services determining the resident's auxiliary grant eligibility, all auxiliary grant funds received after the death or discharge date of an auxiliary grant recipient in the facility.

B. As a condition of participation in the Auxiliary Grants Program, the adult foster care provider shall be approved by a local department of social services and comply with the requirements set forth in 22VAC40-770 22VAC40-771.

Statutory Authority

§§63.2-217 and 63.2-800 of the Code of Virginia; §416.2001 of the Social Security Act.

Historical Notes

Derived from Virginia Register Volume 23, Issue 20, eff. August 1, 2007.

22VAC40-25-50. Establishment of rate.

A. Submission of an audit report to the department is required for an assisted living facility to accept residents who receive an auxiliary grant.

B. The rate shall be valid unless the assisted living facility is required to submit a new audit report as a result of (i) significant operational changes as defined by department policy, (ii) the assisted living facility changes ownership, (iii) the assisted living facility changes location, or (iv) the adult foster care provider is no longer approved by the local department of social services.

C A. The auxiliary grant established rate for recipients authorized to reside in an assisted living facility or in adult foster care is the established rate as set forth in the appropriation act Appropriations Act or as set forth by changes in the federal maintenance of effort formula, plus the personal needs allowance minus the recipient's countable income. The effective date is the date of the individual's approval by the local department of social services for an auxiliary grant.

D. Assisted living facilities that have been in licensed operation in excess of 12 months shall submit an annual audited financial report by June 30 for the preceding calendar year. In lieu of an audited financial report, facilities that are licensed for 19 or fewer beds may submit an audited report that includes only the following: validation that resident funds are held separately from any other funds of the facility; number of resident beds occupied during the reporting period; operating revenue and expenses; and average monthly cost per resident. The audit report shall be reviewed by the department. The approved rate shall be the established rate as set forth in the appropriation act or as set forth by changes in the federal maintenance of effort formula. The approved rate will be retroactive to the first month of the calendar year. If a provider fails to submit an annual audit report for a new calendar year, the provider will not be authorized to accept new auxiliary grant recipients.

Statutory Authority

§§63.2-217 and 63.2-800 of the Code of Virginia; §416.2001 of the Social Security Act.

Historical Notes

Derived from VR615-01-51 §5, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 20, eff. August 1, 2007.

22VAC40-25-60. Reimbursement.

Any moneys in excess of the provider's established rate contributed toward the cost of care pending public pay eligibility determination shall be reimbursed to the recipient or contributing party by the assisted living facility or adult foster care provider once eligibility for public pay is established and that payment received. The auxiliary grants payment shall be made payable to the recipient, who will then reimburse the provider for care. If the recipient is not capable of managing his finances, his personal representative is responsible for reimbursing the provider. In the event an assisted living facility is closed or sold, the facility shall provide verification that all recipient funds, including auxiliary grants funds, have been transferred and shall obtain a signed receipt from the new owner or new facility prorate the rate up to the date of the resident's discharge and return the balance to the local department of social services which determined the resident's eligibility for the grant.  Within 60 days of the resident's discharge, the facility shall provide a final accounting of the resident's personal needs allowance account.  Verification of the accounting and of the reimbursement to the resident shall be mailed to the case management agency responsible for the resident's annual reassessment.  In the event of a recipient's death or discharge, the provider shall give to the resident's personal representative a final accounting of the recipient's funds within 30 60 calendar days of the event. All auxiliary grants funds received after the death or discharge date shall be returned to the local department of social services responsible for determining the resident's eligibility as soon as practicable. Providers who do not comply with the requirements of this regulation may be subject to adverse action.

Statutory Authority

§§63.2-217 and 63.2-800 of the Code of Virginia; §416.2001 of the Social Security Act.

Historical Notes

Derived from VR615-01-51 §6, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 20, eff. August 1, 2007.

22VAC40-25-70. Audits Certification.

A. Assisted living facilities that have been in licensed operation in excess of 12 months shall submit an annual certification form by June 30 of each year for the preceding state fiscal year.  The certification shall include the following: certification that resident funds are held separately from any other funds of the facility as required by the Program and licensing regulations; number of licensed beds; average monthly census of all residents; average monthly census of Auxiliary Grant residents; a list of all Auxiliary Grant residents of the assisted living facility during the reporting period; including certain identifying information; the average yearly Auxiliary Grant revenue for the assisted living facility; the number of Auxiliary Grant residents for whom the facility maintains a personal needs allowance account; the total funds within the accounts at the beginning of the reporting period; the total amount of funds deposited in the accounts; the total disbursement from the accounts; and the total amount of personal needs allowance funds maintained at the end of the reporting period.  If a provider fails to submit an annual certification form for a new state fiscal year, the provider will not be authorized to accept new Auxiliary Grant recipients.

A B. All financial information reported by an assisted living facility on the annual audit report shall be reconcilable to the residence's general ledger system or similar records. The audit shall account separately for the personal needs allowance of auxiliary grant recipients. All reports are subject to audit by the department certification form shall be subject to audit by the department. Financial information that is not reconcilable to the provider's general ledger or similar records could result in retroactive adjustment of the rate and establishment of a liability to the provider. Records shall be retained for three years after the end of the reporting period or until audited by the department, whichever is first.

B C. All records maintained by an adult foster care provider, as required by 22VAC40-770 22VAC40-771, shall be made available to the department or the approving local department of social services upon request. All records are subject to audit by the department. Financial information that is not reconcilable to the provider's records could result in retroactive adjustment of the rate and establishment of a liability to the provider. Records shall be retained for three years after the end of the reporting period or until audited by the department, whichever is first.

Statutory Authority

§§63.2-217 and 63.2-800 of the Code of Virginia; §416.2001 of the Social Security Act.

Historical Notes

Derived from VR615-01-51 §7, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 20, eff. August 1, 2007.