Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 120. Waivered Services
8/8/2020

12VAC30-120-1650. Payment for Services.

A. DMAS shall pay the facility a per diem fee for each individual using the AAL Waiver who has been enrolled in and authorized to receive assisted living services. Except for 14 days of leave each calendar year as described in subsection C of this section, payment of the per diem fee is limited to the days in which the individual is physically present in the facility.

B. The services that are provided as a part of the Auxiliary Grant rate pursuant to 22VAC40-25-40 will not be included for payment from the waiver.

C. Periods of absence from the assisted living facility.

1. An assisted living facility AAL Waiver bed may be held for leave when the individual's ISP provides for such leave. Leave includes visits with relatives and friends or admission to a rehabilitation center for up to seven consecutive days for an evaluation. Leave shall not include periods of absence due to an admission to a hospital or nursing facility.

2. Leave shall be limited to 14 cumulative days in any 12-month period. Leave is individual specific and is counted from the first occurrence of overnight leave that an individual takes. From that date, an individual has 14 days of leave available during the next 365 days.

3. After the 14 days of leave have been exhausted and during periods of absence due to a hospital or nursing facility admission, the assisted living facility may choose to hold the bed for the individual, but DMAS shall not pay for the service. The individual or the individual's authorized representative may choose to pay to hold the bed by paying the assisted living facility directly using other funds. The rate shall be negotiated between the individual's authorized representative and the assisted living facility, but shall not exceed the auxiliary grant rate in effect at the time of the individual's absence.

4. During periods of absence for any reason, DMAS shall hold the waiver slot for the individual for a total of 30 consecutive days. If the individual's absence exceeds 30 days, DMAS shall terminate AAL Waiver services and assign the slot to the next individual on the waiting list.

Statutory Authority

§§ 32.1-324 and 32.1-325 of the Code of Virginia.

Historical Notes

Derived from Volume 23, Issue 20, eff. July 11, 2007; amended, Virginia Register Volume 28, Issue 20, eff. July 5, 2012.

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