Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 10. State Plan under Title XIX of the Social Security Act Medical Assistance Program; General Provisions

12VAC30-10-800. Survey and certification process.

A. The state assures that the requirements of § 1919(a)(1)(A) through (C) and § 1919(g)(2)(A) through (E)(iii) of the Act which relate to the survey and certification of non-state owned facilities based on the requirements of § 1919(b), (c) and (d) of the Act, are met.

B. The state conducts periodic education programs for staff and residents (and their representatives). 12VAC30-20-272 describes the survey and certification educational program.

C. The state provides for a process for the receipt and timely review and investigation of allegations of neglect and abuse and misappropriation of resident property by a nurse aide of a resident in a nursing facility or by another individual used by the facility. 12VAC30-20-274 describes the state's process.

D. The state agency responsible for surveys and certification of nursing facilities conducts the process for the receipt and timely review and investigation of allegations of neglect and abuse and misappropriation of resident property.

E. The state assures that a nurse aide, found to have neglected or abused a resident or misappropriated resident property in a facility, is notified of the finding. The name and finding is placed on the nurse aide registry.

F. The state notifies the appropriate licensure authority of any licensed individual found to have neglected or abused a resident or misappropriated resident property in a facility.

G. The state has procedures, as provided for at § 1919(g)(2)(A)(i), for the scheduling and conduct of standard surveys to assure that the state has taken all reasonable steps to avoid giving notice through the scheduling procedures and the conduct of the surveys themselves. 12VAC30-20-275 describes the state's procedures.

H. The state assures that each facility shall have a standard survey which includes (for a case-mix stratified sample of residents) a survey of the quality of care furnished, as measured by indicators of medical, nursing and rehabilitative care, dietary and nutritional services, activities and social participation, and sanitation, infection control, and the physical environment, written plans of care and audit of resident's assessments, and a review of the compliance with resident's rights not later than 15 months after the date of the previous standard survey.

I. The state assures that the statewide average interval between standard surveys of nursing facilities does not exceed 12 months.

J. The state may conduct a special standard or special abbreviated standard survey within two months of any change of ownership, administration, management, or director of nursing of the nursing facility to determine whether the change has resulted in any decline in the quality of care furnished by the facility.

K. The state conducts extended surveys immediately or, if not practicable, not later than two weeks following a completed standard survey in a nursing facility which is found to have provided substandard care or in any other facility at the secretary's or state's discretion.

L. The state conducts standard and extended surveys based upon a protocol, i.e., survey forms, methods, procedures and guidelines developed by HCFA, using individuals in the survey team who meet minimum qualifications established by the secretary.

M. The state provides for programs to measure and reduce inconsistency in the application of survey results among surveyors. 12VAC30-20-277 describes the state's programs.

N. The state issues a multidisciplinary team of professionals including a registered professional nurse.

O. The state assures that members of a survey team do not serve (or have not served within the previous two years) as a member of the staff or consultant to the nursing facility or has no personal or familial financial interest in the facility being surveyed.

P. The state assures that no individual shall serve as a member of any survey team unless the individual has successfully completed a training and test program in survey and certification techniques approved by the secretary.

Q. The state maintains procedures and adequate staff to investigate complaints of violations of requirements by nursing facilities and onsite monitoring. 12VAC30-20-278 describes the state's complaint procedures.

R. The state makes available to the public information respecting surveys and certification of nursing facilities including statements of deficiencies, plans of correction, copies of cost reports, statements of ownership and the information disclosed under § 1126 of the Act.

S. The state notifies the state long-term care ombudsman of the state's finding of noncompliance with any the requirements of subsection B, C, and D or of any adverse actions taken against a nursing facility.

T. If the state finds substandard quality of care in a facility, the state notifies the attending physician of each resident with respect to which such finding is made and the nursing facility administrator licensing board.

U. The state provides the state Medicaid fraud and abuse agency access to all information concerning survey and certification actions.

Statutory Authority

§ 32.1-325 of the Code of Virginia; §§ 1919(g)(1) through (2) and 1919(g)(4) through (5) of the Act, P.L. 100-203 (§ 4212(a)).

Historical Notes

Derived from VR460-01-79.21, eff. November 15, 1995.

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