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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
11/21/2024

12VAC30-130-450. Patient assessment criteria.

A. The evaluation process will demonstrate a need for programming an array of skills and abilities or health care services. These have been organized into seven major categories. The level of functioning in each category is graded from the most dependent to the least dependent. In some categories, the dependency status is rated by the degree of assistance required. In other categories, the dependency is established by the frequency of a behavior or ability to perform a given task.

The resident must meet the indicated dependency level in two or more of the categories 1 through 7.

1. Health status. To meet this category:

a. Two or more questions must be answered with a "4," or

b. Question 10 must be answered "yes".

2. Communication skills. To meet this category:

a. Three or more questions must be answered with a "3" or "4".

3. Task learning skills. To meet this category:

a. Three or more questions must be answered with a "3" or "4".

4. Personal care. To meet this category:

a. Question No. 1 must be answered with a "4" or "5", or

b. Question No. 2 must be answered with a "4" or "5", or

c. Questions No. 3 and 4 must be answered with a "4" or "5".

5. Mobility. To meet this category:

a. Any one question must be answered with a "4" or "5".

6. Behavior. To meet this category:

a. Any one question must be answered with a "3" or "4".

7. Community living. To meet this category:

a. Any two of the questions numbers 2, 5, or 7 must be answered with a "4" or "5", or

b. Three or more of questions 1 through 8 must be answered with a "4" or "5".

Statutory Authority

§ 32.1-325 of the Code of Virginia.

Historical Notes

Derived from VR460-04-8.2 § 3, eff. December 26, 1985.

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