Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 30. Department of Medical Assistance Services
Chapter 130. Amount, Duration and Scope of Selected Services
8/9/2022

12VAC30-130-160. Level II determination.

A. For each resident of a NF who has a condition of MI or MR/RC, the MH/MRA, as appropriate, must determine whether the individual requires the level of services provided by a NF, an inpatient psychiatric hospital for individuals under age 21, an institution for mental disease (IMD) providing medical assistance to individuals age 65 and older, an intermediate care facility for the mentally retarded (ICF/MR), or specialized services for either MI or MR/RC.

B. When a Level II evaluation is required, a determination shall be made within an annual average of seven to nine working days of the referral for screening. The MH/MRA shall convey determinations verbally to NFs and the individual and confirm them in writing.

C. The MH/MRA shall notify in writing the following entities of a Level II determination:

1. The evaluated individual and his or her legal representative;

2. The admitting or retaining NF;

3. The individual or resident's attending physician; and

4. The discharging hospital.

D. Each notice described above shall include the following:

1. Whether a NF level of services is needed;

2. Whether specialized services are needed;

3. The placement options available to the individual; and

4. The rights of the individual to appeal the determination.

Statutory Authority

§ 32.1-325 of the Code of Virginia.

Historical Notes

Derived from VR460-04-4.3910 § 3, eff. June 1, 1994.

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