Agencies | Governor
Virginia Regulatory Town Hall

Proposed Text


Establish Adult Services Standards
Stage: Proposed



22VAC40-775-10. 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" or "ADLs" means bathing, dressing, toileting, transferring, eating/feeding, and bowel and bladder continence.  An individual's degree of independence in performing these activities is a part of determining an individual's service needs.

"Adult" means any individual age 18 or over, or under 18 if legally emancipated.

"Adult services" means services that are provided to adults with an impairment.

"Adult services worker" means an employee of the local department of social services who provides adult services to eligible adults in the locality.

"Adult with an impairment" means an adult whose physical or mental capacity is diminished to the extent that he needs counseling or supervisory assistance or assistance with ADLs or instrumental activities of daily living.

"Chore services" means non-routine, heavy home maintenance services provided to adults who are unable to perform such tasks.  Chore services shall be provided to adults living in an independent situation who are responsible for maintenance of their residence and who have no one available to provide this service without cost.  Chore services include minor repair work on furniture and appliances in the adult's home; carrying coal, wood or water; chopping wood; removing snow; yard maintenance; and painting.

 "Companion services" means services provided by an individual or an agency provider to an adult who is unable to care for himself without assistance and where there is no one available to provide the needed services without cost.  Companion services include light housekeeping, companionship, shopping, meal preparation, transportation, household management, and assistance with ADLs.

"Department" means the Virginia Department of Social Services.

"Home-based services" means companion, chore, and homemaker services that allow individuals to attain or maintain self-care and are likely to increase self-sufficiency.

"Homemaker services" means services performed by an individual or agency provider who provides the adult instruction in or performs activities to maintain a household.  Homemaker services include personal care, home management, household maintenance, nutrition, consumer education, or hygiene education.

"Instrumental activities of daily living" or "IADLs" means tasks such as meal preparation, shopping, housekeeping, money management, transportation, using the telephone, home maintenance, and laundry. An individual's degree of independence in performing these activities is a part of determining an individual's service needs.

"Local board" means the local board of social services representing one or more counties or cities.

"Local department" means the local department of social services of any county or city in this Commonwealth.

"Public assistance" means Temporary Assistance for Needy Families (TANF), auxiliary grants, medical assistance, energy assistance, supplemental nutritional assistance program, employment services, child care, and general relief.

"Social services" means foster care, adoption, adoption assistance, adult services, adult protective services, child protective services, domestic violence services, or any other services program implemented in accordance with regulations adopted by the State Board of Social Services.

"Social supports" means individuals who routinely provide assistance or support to the adult.

"State board" means the State Board of Social Services.


22VAC40-775-20. Philosophy.

The following principles are inherent to the provision of Adult Services:

A.  The adult services worker is an advocate for the adult.

B. The least-restrictive and least-intrusive intervention necessary to stabilize the situation is the most appropriate.

C. The adult is the focus of service delivery, and the adult services worker shall preserve, respect, and protect the adult's right to self-determination even if other individuals request that the local department intervene.

D. The adult has the right to make decisions on his own behalf until he delegates that responsibility voluntarily or the court grants that responsibility to another individual.

E.  Adult services are designed to strengthen the adult's family and social supports.

F.  A multi-disciplinary approach to service delivery provides the most effective method to develop or enhance the adult's support system and address the adult's needs.


22VAC40-775-30. Intake services.

A.  Intake services are designed to provide a timely, coordinated method for the adult to access needed services or to obtain sufficient information about other community resources.

B.  Intake services provide an initial access point for services provided to the adult by the local department and shall be provided in accordance with current laws, regulations, and guidance.

C.  Intake services may include information and referral, initial assessment, crisis intervention, and assistance with other needs as indicated by the adult's situation or initial assessment.


22VAC40-775-40. Individuals served.

A.    Individuals required to be served:

1.    Any adult with an impairment who is living in the community and is in need of preadmission screening for Medicaid-funded nursing facility placement or home and community-based waiver services pursuant to § 32.1-330 of the Code of Virginia.

2.  An adult with an impairment who is in need of an assisted living facility assessment pursuant to 63.2-1804 of the Code of Virginia.

3.  An adult with an impairment who meets the financial eligibility criteria as defined in 22VAC40-780-40 or 22VAC40-780-50 and who is in need of home-based services, pursuant to § 63.2-1600 of the Code of Virginia.

B. Individuals encouraged to be served to the extent funds are available.

1.  Any adult with an impairment who, upon emancipation from a local department's custody, is assessed to be in need of services.

2.   Any adult with an impairment who is in need of community-based services to avoid institutionalization and who requests services.

C.  Adults to be served at the option of the local department include any adult who requests and is in need of services.


22VAC40-775-50. Service provision.

A. A service application shall be submitted to the local department. The service application shall indicate what services the adult is requesting.

B. Determinations for service eligibility and financial eligibility are separate processes and shall be pursued simultaneously. Eligibility shall be determined as promptly as possible.  The local department shall notify the adult promptly of its decision whether services can be provided, but no later than 45 days after the application is received by the local department.

C. Service eligibility.  The adult services worker shall assess the adult's need for the requested services. Home-based services are available to adults who do not reside in an institution including but not limited to a nursing facility, assisted living facility, or hospital.

D. Financial eligibility. The adult services worker shall determine the adult's financial eligibility for services. 

1. The local department, upon the decision of the local board, may choose to offer services to adults under universal access pursuant to 22VAC40-780-60.

2. Income maintenance.  Adults who meet the category of income maintenance are eligible pursuant to 22VAC40-780-40.  The adult services worker shall verify the adult's income.

3.  Eligibility based on income. Adults, who are not eligible for services under the eligibility categories of universal access or income maintenance, shall be evaluated by the adult services worker to determine eligibility for the category of eligibility based on income are eligible pursuant to 22VAC40-780-50.  The adult's income, not resources, is counted in determining if an individual meets this eligibility category.  The local board shall determine the percentage of income on the state median income chart that the local department shall use when determining eligibility in this category.  The adult services worker shall verify the adult's income. Income from the following resources shall be disregarded when determining financial eligibility for services in this category:

a. Home produce utilized by the adult for his own consumption;

b. The value of food benefits under the Supplemental Nutrition Assistance Program;

c. The value of foods donated under the United States Department of Agriculture Commodity Distribution Program, including those furnished through the school meal programs;

d. Benefits received under Title VII, Nutrition Program for the Elderly, of the Older Americans Act of 1965, as amended (42 USC §§ 3001 et seq.);

e. Grants or loans to any undergraduate students for educational purposes made or insured under any program administered by the United States Secretary of Education;

f. A scholarship or grant obtained and used under conditions which preclude its use for current living costs;

g. Training allowance provided by the Department of Rehabilitative Services for persons participating in Rehabilitative Services Programs;

h. Payments to VISTA volunteers;

i. The Veterans Administration educational amount for the caretaker 18 or older when used specifically for educational purposes. Any additional money included in the benefit amount for dependents is to be counted as income;

j. Income tax refunds including earned income tax credit advance payments and refunds;

k. Payments made under the Energy Assistance Program;

l. The value of supplemental food assistance received under the Child Nutrition Act of 1966 (42 USC §§ 1771-1789). This includes all school meals programs; the Women, Infants and Children program, and the Child Care Food program;

m. All federal, state, local government rent and housing subsidies and utility payments;

n. Funds distributed to, or held in trust for, members of any Indian tribe under Public Laws 92-254, 93-134, 94-540, 97-458, 98-64, 98-123, or 98-124. Additionally, interest and investment income accrued on such funds while held in trust, and purchases made with such interest and investment income;

o. All bona fide loans.  The loan may be for any purpose and may be from a private individual as well as from a commercial institution.  The amount disregarded is limited to the principal of the loan;

p. Monetary gifts for special occasions such as the adult's birthday, Christmas, or graduations;

q. Withdrawals of bank deposits;

r. Payments to vendors for services provided to the adult; and

s. Lump sum insurance payments.

E. A service case shall be opened based on the adult's eligibility, assessment of need, and the availability and intent to deliver the service.

F.  To the extent that resources are available, a variety of activities or interventions may be utilized during the provision of services to the adult.  These interventions may include, but are not limited to, referral to public assistance programs and other resources, service planning, case management, emergency assistance, home-based services, and other activities to assist the adult.

G. The activities or interventions described in this section may be provided directly by local department staff or volunteers, purchased from approved providers, or provided through referral to community resources.

H. The adult services worker and the adult and the adult's family or social supports, if applicable, shall collaborate to evaluate progress towards meeting the goals and objectives of the services.


22VAC40-775-60. Responsibilities of the adult services worker.

A.   The adult services worker shall comply with all relevant laws, regulations, and department guidance regarding the provision of services to adults.

B.   The adult services worker shall develop a service plan with the adult and his family and social supports, as applicable, for services to be provided, resources to be used to meet the presenting concern, and target dates.  Service plans shall meet the requirements of department guidance.

C.  The adult services worker shall provide notification of a change in the adult's eligibility for services or other change in case status as required by department guidance.