Final Text
CHAPTER 200
REGULATIONS FOR [ RESPITE AND ] EMERGENCY [ AND
RESPITE ] CARE ADMISSION TO MENTAL RETARDATION FACILITIES STATE
TRAINING CENTERS
12VAC35-200-10. Definitions.
The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Applicant" means a person for whom respite care
or emergency care services are sought.
"Authorized representative" means a person permitted by law or regulations to authorize the disclosure of information or consent to treatment and services, including medical treatment, or for the participation in human research on behalf of an individual who lacks the mental capacity to make these decisions.
[ "Case management community services board ]
(CSB) [ "or "CSB" means a citizens board
established pursuant to ] § 37.1-195 [ § 37.2-501
of the Code of Virginia that serves the area in which an adult resides or in
which a minor's parent, guardian or ] legally [ authorized
representative resides. ] The case management CSB is responsible
for case management, liaison with the facility when an individual is admitted
to a state training center, and predischarge planning. If an individual, or the
parents, guardian or legally authorized representative on behalf of an
individual, chooses to reside in a different locality after discharge from the
facility, the community services board serving that locality becomes the case
management CSB and works with the original case management CSB, the individual
receiving services and the state facility to effect a smooth transition and discharge.
[ For the purpose of these regulations, CSB also includes a
behavioral health authority established pursuant to § 37.2-602 of the Code of
Virginia. ]
"Catastrophe" means an unexpected or imminent
change in an individual's living situation or environment that poses a risk of
serious physical or emotional harm to that individual.
"Commissioner" means the Commissioner of the
Department of [ Mental Health, Mental Retardation and Substance Abuse
Behavioral Health and Developmental ] Services.
[ "Community services board" or "CSB" means a public body established pursuant to § 37.2-501 of the Code of Virginia. For the purpose of these regulations, CSB also includes a behavioral health authority established pursuant to § 37.2-602 of the Code of Virginia. ]
"Discharge plan" or "predischarge plan"
means a written plan prepared by the [ case management ] CSB
[ providing case management, ] in consultation with the
[ state facility training center ] pursuant to §
37.1-197.1 [ § 37.2-505 §§ 37.2-505 and 37.2-837 ]
of the Code of Virginia. This plan is prepared when the individual is admitted
to the [ facility training center ] and documents the
[ planning for ] services [ after to be
provided upon ] discharge.
"Emergency care admission" means the temporary
[ placement acceptance ] of an individual with mental
retardation [ in (intellectual disability) into ] a
[ facility training center ] when immediate care is
necessary due to a catastrophe and no other community alternatives are
available. The total number of days that emergency or respite care services,
or both, are used shall not exceed 21 consecutive days or 75 days in a calendar
year. This emergency care is not intended as a means of providing evaluation
and program development services, nor is it intended to be used to obtain
treatment of medical or behavioral problems.
[ "Facility" means a state training center
for individuals with mental retardation under the supervision and management of
the Commissioner of the Department of Mental Health, Mental Retardation and
Substance Abuse Services. ]
"Guardianship Guardian" means:
1. For minors -- An an adult who is either
appointed by the court as a legal guardian of said a minor or
exercises the rights and responsibilities of legal custody by delegation from a
biological or adoptive parent upon provisional adoption or otherwise by
operation of law.
2. For adults -- a person appointed by the court who is
responsible for the personal affairs of an incapacitated adult under the order
of appointment. The responsibilities may include making decisions regarding the
individual's support, care, health, safety, habilitation, education and
therapeutic treatment. Refer to definition of "incapacitated person"
at § 37.1-134.6 § 37.2-1000 of the Code of Virginia.
"Individual" means a person for whom respite or emergency services are sought.
"Least Less restrictive setting" means
the treatment and conditions of treatment that, separately or in
combination, are service location that is no more intrusive or
restrictive of freedom than reasonably necessary to achieve a substantial
therapeutic benefit and protection from harm (to self and others) based on an
individual's needs.
"Legally authorized representative" means a
person permitted by law or regulations to give informed consent for disclosure
of information and give informed consent to treatment including medical
treatment on behalf of an individual who lacks the mental capacity to make
these decisions.
"Mental retardation [ "(intellectual
disability)" ] means the substantial subaverage general
intellectual functioning that originates during the developmental period and is
associated with impairment in adaptive behavior a disability,
originating before the age of 18 years, characterized concurrently by (i)
significantly subaverage intellectual functioning as demonstrated by
performance on a standardized measure of intellectual functioning, administered
in conformity with accepted professional practice, that is at least two
standard deviations below the mean; and (ii) significant limitations in
adaptive behavior as expressed in conceptual, social, and practical adaptive
skills.
"Respite [ care ]" means the placement
of an individual with mental retardation in a state facility when placement is
solely for the purpose of providing [ temporary care and support
to an individual with mental retardation because of medical or other urgent
conditions of the ] caretaking [ person providing
care. ] The total number of days that respite or emergency care
services, or both, are used is not to exceed 21 consecutive days or 75 days in
a calendar year. Respite care services are not intended as a means of providing
evaluations and program development services, nor are they intended to be used
to obtain treatment of medical or behavioral problems or both. [ care
provided to an individual with mental retardation (intellectual disability) on
a short-term basis because of the emergency absence of or need to provide
routine or periodic relief of the primary caregiver for the individual.
Services are specifically designed to provide temporary, substitute care for
that which is normally provided by the primary caregiver.
"Training center" means a facility operated by the Department of Behavioral Health and Developmental Services for the treatment, training, or habilitation of persons with mental retardation (intellectual disability). ]
12VAC35-200-20. Respite [ care ] admission.
A. Applications for respite [ care ] in [ state
facilities training centers ] shall be processed through the
[ case management ] CSB [ providing case management ].
A parent, guardian, or legally authorized representative seeking respite
[ care services ] for an individual with mental
retardation [ (intellectual disability) ] shall apply first to
the CSB that serves the area where the applicant individual, or if
a minor, his parent, or guardian, or legally authorized
representative is currently residing. If the case management CSB
determines that respite [ care services ] for the applicant
individual [ are is ] not available in the community,
it shall forward an application to the [ facility training
center ] serving individuals with mental retardation [ (intellectual
disability) ] from that geographic section of the state in which the applicant
individual or his parent, or guardian, or legally
authorized representative is currently residing.
The application shall include:
1. An application for services;
2. A medical history indicating the presence of any current medical problems as well as the presence of any known communicable disease. In all cases, the application shall include any currently prescribed medications as well as any known medication allergies;
3. A social history and current status;
4. A psychological evaluation that has been performed in the
past three years unless the facility director or designee determines that
sufficient information as to the applicant's abilities and needs is included in
other reports received reflects the individual's current functioning;
5. A current individualized education plan for school aged applicants
individuals unless the [ facility training center ]
director or designee determines that sufficient information as to the applicant's
individual's abilities and needs is included in other reports received;
6. A vocational assessment for adult applicants adults
unless the [ facility training center ] director or
designee determines that sufficient information as to the applicant's individual's
abilities and needs is included in other reports received;
7. A statement from the case management CSB that respite
[ care services is not available in the community ] for
the applicant individual [ are not available in the
community ]; and
8. A statement from the case management CSB that the
appropriate arrangements will be are being made to return the
individual to the CSB within the time frame required under this regulation;
and
9. A statement from the individual, a family member, or
authorized representative specifically requesting services in the [ facility
training center ].
B. Determination of eligibility for respite [ care ] services shall be based upon the following criteria:
1. The applicant individual has a primary
diagnosis of mental retardation [ (intellectual disability) ]
and functions on a level that meets the [ facility's training
center's ] regular admission criteria;
2. The applicant's individual's needs for care
and supervision are such that, in the event of a need for temporary care,
respite [ care services ] would not be available in a less
restrictive setting; and
3. The [ facility training center ] has
appropriate resources to meet the care and supervision needs of the applicant
individual.
Within a reasonable time of the receipt of the completed
application By the end of the next working day following receipt of a
complete application package, the [ facility training center ]
director, or his designee, shall provide written notice of his decision
to the case management CSB. This notice shall state the reasons for the
decision.
If it is determined that the applicant individual
is not eligible for respite [ care ], the person seeking respite
[ care services ] may ask for reconsideration of the decision
by submitting a written request for such reconsideration to the commissioner.
Upon receipt of such request, the commissioner or designee shall notify
the [ facility training center ] director and the
[ facility training center ] director shall forward the
application packet and related information to the commissioner or designee
within 48 hours. The commissioner or designee shall also provide
an opportunity for the person seeking respite [ care services ]
to submit for consideration any additional information or reasons as to why the
admission should be approved. The commissioner shall render a written decision
on the request for reconsideration within 10 days of the receipt of such
request and notify all involved parties. The commissioner's decision shall be
binding.
C. Respite [ care ] is [ shall be ]
provided in [ state facilities training centers ] under
the following conditions:
1. The length of the respite [ care ] stay at the
[ facility training center ] shall not exceed 21
consecutive days or a total of 75 days in a calendar year the limits
[ defined established ] in § 37.2-807 of the
Code of Virginia;
2. Information on file at the facility is current;
3. 2. Space and adequate staff coverage are
available on a [ unit residential living area ] with an
appropriate peer group for the applicant individual and suitable
resources to meet his care and supervision needs; and
4. 3. [ A physical examination performed
by the facility's health service personnel at the time of the respite care
admission has determined that the applicant's individual's health care
needs can be met by the facility's resources during the scheduled respite care
stay The training center has resources to meet the individual's health
care needs during the scheduled respite stay as determined by a physical
examination performed by the training center's health service personnel at the
time of the respite admission ].
If for any reason a person admitted for respite [ care services ]
is not discharged at the agreed upon time, the case management CSB shall
develop a an updated discharge plan as provided in §§ 37.1-98
and 37.1-197.1 §§ 37.2-505 and 37.2-837 of the Code of
Virginia.
Respite care shall not be used as a mechanism to
circumvent the [ standard voluntary ] admissions
procedures as provided in § 37.1-65.1 § 37.2-806 of the Code of
Virginia. [ No person who is admitted to a training center ] in
response to [ under the provisions of this chapter shall,
during the time of such respite ] care [ admission, be
eligible for admission to any training center ] in response to §
37.1-65.1 [ under § 37.2-806 of the Code of Virginia. ]
12VAC35-200-30. Emergency care admission.
A. In the event of a catastrophe change in an
individual's circumstances necessitating immediate, short-term care for an
individual with mental retardation [ (intellectual disability) ],
[ emergency care admission may be requested by ] a
parent, guardian, or legally authorized representative [ may
request emergency admission ] by calling the case management
CSB [ serving the area where the individual, or in the case of a minor,
his parent or guardian resides ]. [ If Under these
circumstances if ] the case management CSB determines that
[ respite ] care services for the applicant individual
are not available in the community, it may request an emergency admission to
the [ facility training center ] serving that
geographic area [ in which the ] applicant [ individual,
or in case of a minor, his parent, or guardian ], or
legally authorized representative [ resides ].
The case management CSB shall make every effort to
obtain the same case information required for respite care admissions,
as described in 12VAC35-200-20 A, before [ assuming the training
center assumes ] responsibility for the care of the individual in need
of emergency services. However, if the information is not available, this
requirement may temporarily be waived if, and only if, arrangements have been
made for receipt of the required information within 48 hours of the emergency care
admission.
B. Acceptance for emergency care admissions admission
shall be based upon the following criteria:
1. A catastrophe change in the individual's
circumstances has occurred requiring immediate alternate arrangements to
protect the individual's health and safety;
2. The individual has a primary diagnosis of mental
retardation [ (intellectual disability) ] and functions on
a level that meets the [ facility's training center's ]
regular admissions criteria;
3. All other alternate care resources in the community have been explored and found to be unavailable;
4. Space is available on a [ unit residential
living area ] with appropriate resources to meet the individual's care
and supervision needs;
5. The [ facility's training center's ]
health services personnel have determined that the individual's health care
needs can be met by the [ facility's training center's ]
resources; and
6. The length of the emergency care stay at the [ facility
will training center shall ] not exceed 21 consecutive days
or a total of 75 days in a calendar year the limits [ defined
established ] in § 37.2-807 of the Code of Virginia.
C. Within 24 hours of receiving a request for emergency care
admission, the [ facility training center ]
director, or his designee, [ will shall ] inform
the case management CSB whether the applicant individual
is eligible for emergency care admission and whether the [ facility
training center ] is able to provide emergency care
services.
If the [ facility training center ] is
able to provide emergency care services, arrangements shall be made to
effect the admission as soon as possible.
If the [ facility training center ] is
unable to provide emergency care services to an eligible applicant
individual, the [ facility training center ]
director or designee shall provide written notice of this determination to the case
management CSB and may offer [ in consultation with department
staff ] to try to obtain emergency care services from another
appropriate facility.
If for any reason a person admitted to a [ facility
training center ] for emergency care services is not
discharged at the agreed upon time, the case management CSB shall
develop a discharge plan as provided in §§ 37.1-98 and 37.1-197.1 §§ 37.2-505
and 37.2-837 of the Code of Virginia.