Proposed Text
Part I
Definitions
22VAC40-745-10. Definitions.
The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:
"Activities of daily living (ADLs)" or
"ADLs" means bathing, dressing, toileting, transferring, bowel
control, bladder control, and eating/feeding. A person's An
individual's degree of independence in performing these activities is a
part of determining appropriate level of care and services.
"Applicant" means an adult planning to reside in
an assisted living facility.
"Administrator" means the licensee or person designated by the licensee who is responsible for the general administration and management of an assisted living facility and who oversees the day-to-day operation of the facility, including compliance with all regulations for assisted living facilities and meets the requirements of 22VAC40-72.
"Assessment" means a standardized approach using
common definitions to gather sufficient information about applicants to and
residents of assisted living facilities an individual applying to or
residing in an assisted living facility to determine the need for
appropriate level of care and services.
"Assisted living care" means a level of service provided
by an assisted living facility for adults to individuals who may
have physical or mental impairments and require at least moderate assistance
with the activities of daily living. Moderate assistance means dependency in
two or more of 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.
"Assisted living facility (ALF)" or
"ALF" means any public or private assisted living facility
ALF that is required to be licensed as an assisted living facility
ALF by the Department of Social Services under Chapter 17 (§ 63.2-1700
et seq.) of Title 63.2 of the Code of Virginia, specifically, 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 Behavioral Health and Developmental 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. Assuming
responsibility for the well-being of individuals, either directly or through
contracted agents, is considered "general supervision and oversight."
"Assisted living facility administrator" means
any individual charged with the general administration of an assisted living
facility, regardless of whether he has an ownership interest in the facility
and meets the requirements of 22VAC40-72.
"Auxiliary Grants Program" means a state and locally
funded assistance program to supplement the income of a an
individual who is receiving Supplemental Security Income (SSI) recipient
or adult an individual who would be eligible for SSI except for
excess income, and who resides in an assisted living facility ALF
with an approved rate.
"Case management" means multiple functions designed to link individuals to appropriate services. Case management may include a variety of common components such as initial screening of need, comprehensive assessment of needs, development and implementation of a plan of care, service monitoring, and follow-up.
"Case management agency" means a public human service agency which employs a case manager or contracts for case management.
"Case manager" means an employee of a public human
services agency who is qualified to perform assessments and designated
to develop and coordinate plans of care.
"Consultation" means the process of seeking and
receiving information and guidance from appropriate human services agencies and
other professionals when assessment data indicate certain social, physical and
mental health conditions.
"Department" or "DSS" means the Virginia Department of Social Services.
"Dependent" means, for activities of daily living
(ADLs) ADLs and instrumental activities of daily living (IADLs), the
individual needs the assistance of another person or needs the assistance of
another person and equipment or device to safely complete the activity. For
medication administration, dependent means the individual needs to have
medications administered or monitored by another person or professional staff.
For behavior pattern, dependent means the person's individual's
behavior is aggressive, abusive, or disruptive.
"Discharge" means the movement of a resident out
of process that ends an individual's stay in the assisted living
facility ALF.
"Emergency placement" means the temporary status of
an individual in an assisted living facility ALF when the person's
individual's health and safety would be jeopardized by not permitting
entry into the facility until requirements for admission have been met.
"Facility" means an assisted living facility ALF.
"Independent physician" means a physician who is
chosen by the resident of an individual residing in the assisted
living facility ALF and who has no financial interest in the assisted
living facility ALF, directly or indirectly, as an owner, officer,
or employee or as an independent contractor with the facility.
"Instrumental activities of daily living (IADLs)"
or "IADLs" means for the purposes of this regulation,
meal preparation, housekeeping, laundry, and money management. A person's
An individual's degree of independence in performing these activities is
a part of determining appropriate level of care and services.
"Maximum physical assistance" means that an individual has a rating of total dependence in four or more of the seven activities of daily living as documented on the uniform assessment instrument.
"Medication administration" means for purposes of
this regulation, assessing the degree of assistance required an
individual requires to take medications and is a part of determining
in order to determine the individual's the need for appropriate
level of care and services.
"Private pay" means that a resident of an
individual residing in an assisted living facility is not eligible for
benefits under the Auxiliary Grants Program.
"Prohibited conditions" means physical or mental health conditions or care needs as described in §63.2-1805 of the Code of Virginia. An ALF shall not admit or allow the continued residence of an individual with a prohibited condition. Prohibited conditions include but are not limited to an individual who requires maximum physical assistance as documented on the uniform assessment instrument and meets nursing facility level of care criteria as defined in the State Plan for Medical Assistance. Unless the individual's independent physician determines otherwise, an individual who requires maximum physical assistance and meets nursing facility level of care criteria as defined on the State Plan for Medical Assistance shall not be admitted to or continue to reside in an ALF.
"Public human services agency" means an agency established or authorized by the General Assembly under Chapters 2 and 3 (§§ 63.2-203 et seq. and 63.2-300 et seq.) of Title 63.2, Chapter 14 (§ 51.5-116 et seq.) of Title 51.5, Chapters 1 and 5 (§§ 37.2-100 et seq. and 37.2-500 et seq.) of Title 37.2, or Article 5 (§ 32.1-30 et seq.) of Chapter 1 of Title 32.1, or hospitals operated by the state under Chapters 6.1 and 9 (§§ 23-50.4 et seq. and 23-62 et seq.) of Title 23 of the Code of Virginia and supported wholly or principally by public funds, including but not limited to funds provided expressly for the purposes of case management.
"Public pay" means that a resident of an
individual residing in an assisted living facility ALF is
eligible for benefits under the Auxiliary Grants Program.
"Qualified assessor" means an individual a
person who is authorized to perform an assessment, reassessment, or change
in level of care for an applicant to or resident of an assisted living
facility individual who is seeking admission to an ALF or who resides in
an ALF. For public pay individuals, a qualified assessor is an employee of
a public human services agency who is trained in the completion of the
uniform assessment instrument and is authorized to approve placement for an
individual who is seeking admission to or residing in an ALF. For private
pay individuals, a qualified assessor is staff of the assisted living
facility ALF trained in the completion of the uniform assessment
instrument or an independent private physician or a qualified
assessor for public pay individuals.
"Reassessment" means an update of information on
the uniform assessment instrument at any time after the initial assessment.
In addition to a periodic an annual reassessment, a reassessment should
shall be completed whenever there is a significant change in the resident's
individual's condition.
"Resident" means an individual who resides in an
assisted living facility.
"Residential living care" means a level of service
provided by an assisted living facility ALF for adults individuals
who may have physical or mental impairments and require only minimal assistance
with the activities of daily living. Minimal assistance means dependency in
only one activity of daily living ADL or dependency in one or
more of the selected instrumental activities of daily living IADLs as
documented on the uniform assessment instrument. Included in this level of
service are individuals who are dependent in medication administration as
documented on the uniform assessment instrument. This The
definition of residential living care includes independent living
facilities that voluntarily become licensed the services provided by the
ALF to individuals who are assessed as capable of maintaining themselves in an
independent living status.
"Significant change" means a change in a
resident's an individual's condition that is expected to last longer
than 30 days. It does not include short-term changes that resolve with or
without intervention, a short-term acute illness or episodic event, or a
well-established, predictive, cyclic pattern of clinical signs and symptoms
associated with a previously diagnosed condition where an appropriate course of
treatment is in progress.
"Targeted case management" means the provision of
ongoing case management services by an employee of a public human services
agency contracting with the Department of Medical Assistance Services to an auxiliary
grant resident of individual who is receiving an Auxiliary Grant in
an assisted living facility ALF who meets the criteria set forth
in 12VAC30-50-470.
"Total dependence" means the individual is entirely
unable to participate in the performance of an activity of daily living ADL.
"Uniform assessment instrument" or
"UAI" means the department-designated assessment form. There is
an alternate version of the uniform assessment instrument which that
may be used for private pay residents; individuals paying privately.
social Social and financial information which that
is not relevant because of the resident's individual's payment
status is not included on this the private pay version.
"User's Manual: Virginia Uniform Assessment Instrument" means the department-designated handbook containing common definitions and procedures for completing the department-designated assessment form.
"Virginia Department of Medical Assistance Services (DMAS)"
or "DMAS" means the single state agency designated to
administer the Medical Assistance Services Program in Virginia.
Part II
Assessment Services
22VAC40-745-20. Persons Individuals to be
assessed.
A. All residents of and applicants to individuals
applying to or residing in an ALF assisted living facilities must
shall be assessed face-to-face using the uniform assessment
instrument UAI prior to admission, at least annually, and whenever
there is a significant change in the resident's individual's
condition.
B. For private pay individuals, qualified staff of the assisted
living facility ALF or an independent private physician may
complete the uniform assessment instrument UAI. Qualified staff of
the assisted living facility are ALF employees of the
facility who have successfully completed state-approved training on the uniform
assessment instrument UAI for either public or private pay
assessments. The assisted living facility ALF maintains
documentation of the completed training. The administrator or the
administrator's designated representative must shall approve and
sign the completed uniform assessment instrument UAI for private
pay individuals. A private pay individual may request the assessment be
completed by a qualified public human services agency assessor. When a public
human services agency assessor completes the uniform assessment instrument
UAI for a private pay individual, the agency may determine and charge a
fee for private pay applicants and residents assessments; the
fee which may not exceed the fee paid by amount DMAS reimburses
for public pay applicants and residents assessments.
C. For public pay individuals, a uniform assessment
instrument the UAI shall be completed by a case manager or a
qualified assessor to determine the need for residential care or assisted
living care services. The assessor is qualified to complete the assessment if
the assessor has completed a state-approved training course on the state-designated
uniform assessment instrument UAI. Public human services agency
assessors Assessors who prior to January 1, 2004, routinely complete,
completed UAIs as part of their job descriptions, uniform assessment
instruments for applicants to or residents of assisted living facilities prior
to January 1, 2004, may be deemed to be qualified assessors without the
completion of the training course. Qualified assessors who may initially
authorize assisted living facility ALF services for public pay
individuals are employees of (i) local departments of social services; (ii)
area agencies on aging; (iii) centers for independent living; (iv) community
services boards; (v) local departments of health; (vi) state facilities
operated by the Department of Mental Health, Mental Retardation and Substance
Abuse Services, (vii) acute-care hospitals, and (viii) Department of
Corrections Community Release Units; and independent physicians.
1. Local departments of social services;
2. Area agencies on aging;
3. Centers for independent living;
4. Community services boards or behavioral health authorities;
5. Local departments of health;
6. State facilities operated by the Department of Behavioral Health and Developmental Services;
7. Acute-care hospitals;
8. Department of Corrections Community Release Units; and
9. Independent physicians who have a contract with DMAS to conduct ALF assessments.
D. For public pay individuals, The the assisted
living facility ALF must shall coordinate with the
assessor to ensure that the uniform assessment instrument UAI is
completed as required. If the individual has not been assessed, the local
department of social services eligibility worker shall inform the individual or
the individual's legal representative of the need to be assessed by a qualified
assessor prior to admission. If the individual has not applied for an
Auxiliary Grant, the qualified assessor conducting the assessment shall inform
the individual or the individual's legal representative of the need to submit
an application for an Auxiliary Grant.
22VAC40-745-30. Determination of services to be provided.
A. The assessment shall be conducted with the
department-designated uniform assessment instrument using the UAI
which that sets forth a resident's an individual's
care needs. The uniform assessment instrument UAI is designed to
be a comprehensive, accurate, standardized, and reproducible assessment of
individuals seeking or receiving long-term care services. The uniform
assessment instrument UAI is comprised of a short assessment and a
full assessment. The short assessment is designed to briefly assess the
individual's need for appropriate level of care and services and to determine
if a full assessment is needed. The uniform assessment instrument shall
contain the following items: Full name of the individual; social security
number; current address; date of birth; sex; marital status; racial/ethnic
background; education; method for communication of needs; primary caregiver or
emergency contact or both; usual living arrangements; problems with physical
environmental; use of current formal services; annual income; sources of
income; legal representatives; benefits or entitlements received; types of
health insurance; performance on functional status which includes ADLs,
continence, ambulation and IADLs; physician information; admissions to
hospitals, nursing facilities or assisted living facilities for medical or
rehabilitation reasons; advance directives; diagnoses and medication profile;
sensory functioning; joint motion; presence of fractures/dislocations; missing
limbs or paralysis/paresis; nutrition; smoking history; use of rehabilitation
therapies; presence of pressure ulcers; need for special medical procedures;
need for ongoing medical/nursing needs; orientation; memory and judgment;
behavior pattern; life stressors; emotional status; social history which
includes activities, religious involvement; contact with family and friends;
hospitalization for emotional problems; use of alcohol or drugs; assessment of
caregivers; and an assessment summary.
B. Sections The following sections of the uniform
assessment instrument UAI which must shall be
completed are as follows:
1. The assessment for private pay individuals shall include
the following portions of the uniform assessment instrument: For private
pay individuals, the assessment shall include sections related to
identification and background, name of the individual; social security
number; current address; birthdate; sex; marital status; performance on
functional status, which includes ADLs, continence, ambulation, IADLs,
medication administration, and behavior pattern. In lieu of completing
selected parts of the department-designated uniform assessment instrument, the
alternate uniform assessment instrument developed for private pay applicants
and residents The private pay or public pay UAI may be used.
2. For public pay individuals, the short form of the uniform
assessment instrument UAI shall be completed. The short form
consists of sections related to identification and background, and
functional status (i.e., the first four pages of the UAI), plus
sections on medication administration, and behavior pattern. If, upon
assessment, it is determined that the individual is dependent in at least two activities
of daily living ADLs or is dependent in behavior, then the full
assessment must shall be completed.
C. 1. The uniform assessment instrument UAI
shall be completed within 90 days prior to the date of admission to the assisted
living facility ALF. If there has been a significant change in the
individual's condition since the completion of the uniform assessment
instrument UAI which that would affect the admission
to an assisted living facility ALF, a new uniform assessment
instrument UAI shall be completed as specified in 22VAC40-745-20.
2. D. When a resident an individual
moves to an assisted living facility ALF from another assisted
living facility ALF a new uniform assessment instrument UAI
is not required except that a new uniform assessment instrument UAI
shall be completed whenever there is a significant change in the resident's
individual's condition or the assessment was completed more than 12
months ago.
3. E. In emergency placements, the uniform
assessment instrument UAI must shall be completed
within seven working days from the date of placement. An emergency placement
shall occur only when the emergency is documented and approved by a Virginia
adult protective services worker for public pay individuals or by a Virginia
adult protective services worker or independent physician for private pay
individuals.
D. F. The uniform assessment instrument UAI
shall be completed at least annually on all residents individuals
residing in of assisted living facilities ALFs. Uniform
assessment instruments UAIs shall be completed as needed
whenever there is a significant change in the resident's individual's
condition. All uniform assessment instruments UAIs shall be
completed as required by 22VAC40-745-20. The ALF shall provide an area for
assessments and reassessment to be conducted that ensures the individual's
privacy and protects confidentiality.
E. G. At the request of the assisted living
facility ALF, the resident individual residing in the ALF,
the resident's individual's legal representative, the resident's
individual's physician, DSS, or the local department of social services,
an independent assessment using the uniform assessment instrument UAI
shall be completed to determine whether the resident's individual's
care needs are being met in the current placement ALF. An
independent assessment is an assessment that is completed by an entity other
than the original assessor. The assisted living facility ALF
shall assist the resident individual in obtaining the independent
assessment as requested. If the request is for a private pay resident individual,
and the independent assessment confirms that the resident's placement is
appropriate, then the entity requesting the independent assessment shall be
responsible for payment of paying for the assessment, if
applicable.
F. H. The assessor shall consult with other
appropriate human service professionals as needed to complete the assessment.
G. I. DMAS shall reimburse for completion of
assessments and authorization of assisted living facility ALF
placement for public pay applicants and residents individuals
pursuant to this section.
22VAC40-745-40. Discharge.
A. Discharge is the process that ends the stay in an
assisted living facility. Staff of the assisted living facility ALF
staff must shall plan for post-discharge services assist
the individual and legal representative in the discharge or transfer process
when the public pay resident is returned to a home-based placement, a
nursing facility, or other placement. For public pay individuals,
Assisted living facility ALF staff shall notify in writing
provide written notification of the individual's date and place of discharge
or of the individual's death to the local department of social services financial
eligibility worker in the jurisdiction responsible for authorizing the auxiliary
grant Auxiliary Grant and the public human services agency qualified
assessor who conducted the most recent assessment. of the date
and place of discharge as well as when a resident dies. The assisted
living facility ALF must shall make these notifications
at least 14 calendar days prior to the resident's individual's
planned discharge or within five calendar days after the individual's
death of the resident. In the event of an emergency discharge as defined
by 22VAC40-71-160 specified in 22 VAC 40-72-420, the notification
shall be made as rapidly as possible, but must be made by close of business on
the day following the emergency discharge.
B. Upon issuing a notice of summary order of suspension to an assisted
living facility ALF, the Commissioner of the Virginia Department of
Social Services or his designee shall contact the appropriate local department
of social services to develop a relocation plan. The residents of an
assisted living facility Individuals residing in an ALF whose
license has been summarily suspended pursuant to § 63.2-1709 of the Code of
Virginia shall be relocated as soon as possible to reduce the risk of
jeopardizing the to their health, safety, and welfare of
residents. An assessment of the relocated resident is New
assessments of the individuals who are relocating are not required,
pursuant to 22VAC40-745-30 C 3 22 VAC40-745-30 D.
22VAC40-745-50. Authorization of services to be provided.
A. The assessor is responsible for authorizing public
payment to the individual for the appropriate level of care for upon
admission to and for continued stay in an assisted living
facility ALF.
B. The assisted living facility ALF staff must
shall be knowledgeable of the criteria for level of care in an assisted
living facility ALF and is are responsible for discharge
of the resident discharging the individual whenever a resident
when the individual does not meet the criteria for level of care in an assisted
living facility ALF upon admission or at any later time.
C. The appropriate level of care must shall be
documented on the uniform assessment instrument UAI, and
completed in a manner consistent with the definitions of activities of daily
living ADLs and directions provided in the User's Manual: Virginia
Uniform Assessment Instrument as well as the requirements set forth in this
regulation.
D. During an inspection or review, staff from either the
department, DMAS, DSS or the local department of social services may
initiate a change in level of care for any assisted living facility resident
individual residing in the ALF for whom it is determined that the resident's
uniform assessment instrument UAI is not reflective of does
not reflect the resident's individual's current status.
22VAC40-745-60. Criteria for residential living care.
Individuals shall meet the criteria for residential
living as documented on the uniform assessment instrument UAI
when at least one of the following describes their functional capacity:
1. Rated dependent in only one of seven ADLs (i.e., bathing, dressing, toileting, transferring, bowel function, bladder function, and eating/feeding).
2. Rated dependent in one or more of four selected IADLs (i.e., meal preparation, housekeeping, laundry, and money management).
3. Rated dependent in medication administration.
22VAC40-745-70. Criteria for assisted living care.
Individuals shall meet the criteria for assisted living
as documented on the uniform assessment instrument UAI when at
least one of the following describes their capacity:
1. Rated dependent in two or more of seven ADLs.
2. Rated dependent in behavior pattern (i.e., abusive, aggressive, and disruptive).
22VAC40-745-80. Rating of levels of care on the uniform
assessment instrument UAI.
A. The rating of functional dependencies on the uniform
assessment instrument UAI must shall be based on the
individual's ability to function in a community environment.
B. For purposes of this regulation, The the
following abbreviations shall mean: D = dependent; and TD = totally dependent.
Mechanical help means equipment or a device or both are used; human help
includes supervision and physical assistance. Asterisks (*) denote dependence
in a particular function.
1. Activities of daily living.
a. Bathing.
(1) Without help
(2) Mechanical help only
(3) Human help only* (D)
(4) Mechanical help and human help* (D)
(5) Is performed by others* (TD)
b. Dressing.
(1) Without help
(2) Mechanical help only
(3) Human help only* (D)
(4) Mechanical help and human help* (D)
(5) Is performed by others* (TD)
(6) Is not performed* (TD)
c. Toileting.
(1) Without help
(2) Mechanical help only
(3) Human help only* (D)
(4) Mechanical help and human help* (D)
(5) Performed by others* (TD)
(6) Is not performed* (TD)
d. Transferring.
(1) Without help
(2) Mechanical help only
(3) Human help only* (D)
(4) Mechanical help and human help* (D)
(5) Is performed by others* (TD)
(6) Is not performed* (TD)
e. Bowel function.
(1) Continent
(2) Incontinent less than weekly
(3) Ostomy self-care
(4) Incontinent weekly or more* (D)
(5) Ostomy not self-care* (TD)
f. Bladder function.
(1) Continent
(2) Incontinent less than weekly
(3) External device, indwelling catheter, ostomy, self-care
(4) Incontinent weekly or more* (D)
(5) External device, not self-care* (TD)
(6) Indwelling catheter, not self-care* (TD)
(7) Ostomy, not self-care* (TD)
g. Eating/feeding.
(1) Without help
(2) Mechanical help only
(3) Human help only* (D)
(4) Mechanical help and human help* (D)
(5) Performed by others (includes spoon fed, syringe/tube fed, fed by IV)* (TD)
2. Behavior pattern.
a. Appropriate
b. Wandering/passive less than weekly
c. Wandering/passive weekly or more
d. Abusive/aggressive/disruptive less than weekly* (D)
e. Abusive/aggressive/disruptive weekly or more* (D)
3. Instrumental activities of daily living.
a. Meal preparation.
(1) No help needed
(2) Needs help* (D)
b. Housekeeping.
(1) No help needed
(2) Needs help* (D)
c. Laundry.
(1) No help needed
(2) Needs help* (D)
d. Money management.
(1) No help needed
(2) Needs help* (D)
4. Medication administration.
a. Without assistance
b. Administered/monitored by lay person* (D)
c. Administered/monitored by professional staff* (D)
22VAC40-745-90. Actions to be taken upon completion of the uniform
assessment instrument UAI.
A. Public pay individuals.
1. Upon completion of the uniform assessment instrument UAI
for admission, a significant change in the resident's individual's
condition, or the annual reassessment, the case manager or a qualified assessor
shall forward to the local department of social services financial
eligibility worker in the appropriate agency of jurisdiction, in the format
specified by the department, the effective date of admission or change in level
of care. Qualified assessors who may are authorized to perform
the annual reassessment or a change in level of care for public pay individuals
are employees of (i) local departments of social services; (ii) area agencies
on aging; (iii) centers for independent living; (iv) community services boards or
behavioral health authority; and (v) local departments of health, or an
independent physician to complete the uniform assessment instrument who
has a contract with DMAS to conduct assessments.
2. The completed uniform assessment instrument UAI,
the referral to the financial eligibility worker, and other relevant
data shall be maintained in the individual's record at the assisted
living facility ALF resident's record.
3. The annual reassessment shall be completed by the qualified
assessor conducting the initial assessment. If the original assessor is neither
willing nor able to complete the assessment and another assessor is not
available, the local department of social services where the resident individual
resides following placement in an assisted living facility in the ALF
shall be the assessor except that individuals who receive services from a
community service board or behavioral health authority shall be assessed and
reassessed by qualified assessors employed by the community services board or
behavioral health authority.
4. Clients of a community services board shall be assessed
and reassessed by qualified assessors employed by the community services board.
5. 4. The facility ALF shall provide
to notify the community services board or behavioral health
authority notification of uniform assessment instruments when UAIs
that indicate observed behaviors or patterns of behavior indicative of
mental illness, intellectual disability, substance abuse, or behavioral
disorders, pursuant to § 63.2-1805 B of the Code of Virginia.
B. For private pay residents individuals, the assisted
living facility ALF shall ensure that assessments for all residents
individuals at admission and at subsequent intervals are completed as
required in this chapter. The assisted living facility ALF shall
maintain in the resident's record the resident's the individual's
uniform assessment instrument UAI and other relevant data in
the individual's ALF record.
22VAC40-745-100. Targeted case management for auxiliary grant
recipients individuals receiving an Auxiliary Grant.
A. Targeted case management shall be limited to those residents
individuals who have multiple needs across multiple providers and this coordination
is beyond the scope of the assisted living facility ALF. It shall
be the responsibility of the assessor who identifies the individual's need for
residential care or assisted living care in an assisted living facility ALF
to assess the need for targeted case management services as defined in Part
IV (12VAC30-50-410 et seq.) of 12VAC30-50 12VAC30-50-470.
B. A case management agency must shall have
signed an agreement with DMAS to be reimbursed for the provision of targeted
case management services to auxiliary grant recipients for
individuals receiving an Auxiliary Grant.
C. The local department of social services where the adult
individual resides, following placement in an assisted living
facility admission to an ALF, shall be the case management agency
when there is no other qualified case management provider willing or able to
provide case management services.
D. A qualified case manager must shall possess a
combination of relevant work experience in human services or health care and
relevant education which indicates that the individual possesses the knowledge,
skills, and abilities at entry level as defined in Part IV (12VAC30-50-410
et seq.) of 12VAC30-50 12VAC30-50-470. This must be documented on
the case manager's job application form or supporting documentation or
observable in the job or promotion interview. When the provider agency is a
local department of social services, case managers shall meet the
qualifications for social work/social work supervisor classification as
specified in 22VAC40-670-20.
Part III
Resident Appeals
22VAC40-745-110. Resident appeals Appeals.
Assessors shall advise orally and in writing all applicants
to and residents of assisted living facilities public pay individuals
for which whom assessment or targeted case management services or
both are provided of the right to appeal the outcome of the assessment, the
annual reassessment, or determination of level of care. Applicants for
auxiliary grants An individual who are is denied an auxiliary
grant Auxiliary Grant because the assessor determines that they
the individual do does not require the minimum level of
services offered in the residential care level of care have
has the right to file an appeal with the department of under § 63.2-517
of the Code of Virginia. A determination that the individual does not meet the
criteria to receive assisted living level of care is an action which is
appealable to DMAS.
FORMS (22VAC40-745)
Private Pay Uniform Assessment Instrument (rev. 1/2010)
Virginia Uniform Assessment Instrument, UAI
DOCUMENTS INCORPORATED BY REFERENCE (22VAC40-745)
User's Manual: Virginia Uniform Assessment Instrument (UAI),
Commonwealth of Virginia, Revised April 1998 July 2005.