Administrative Code

Virginia Administrative Code
11/30/2021

Part II. Assessment Services

22VAC30-110-20. Individuals to be assessed.

A. All individuals applying to or residing in an ALF shall be assessed face-to-face using the UAI prior to admission, at least annually, and whenever there is a significant change in the individual's condition.

1. When the qualified assessor or case manager and individual are unable to be in the same physical space to conduct an assessment due to the individual's location in another state or due to hazardous travel conditions for the qualified assessor or case manager, the use of video conferencing to conduct the assessment shall be permitted.

2. The appropriate qualified assessor or case manager shall review the assessment with the adult within seven working days of admission to the ALF to ensure all assessment information is accurate.

B. For private pay individuals, qualified staff of the ALF or an independent physician may complete the UAI. Qualified staff are ALF employees who have successfully completed department designated training course on the UAI for either public or private pay assessments. The ALF maintains documentation of the completed training. The administrator or the administrator's designated representative shall approve and sign the completed UAI for private pay individuals. A private pay individual may request the assessment be completed by a qualified public human services agency assessor. When a public human services agency assessor completes the UAI for a private pay individual, the agency may determine and charge a fee for private pay assessments that may not exceed the amount DMAS reimburses for public pay assessments.

C. For public pay individuals, the UAI shall be completed by a case manager or a qualified assessor to determine the need for residential care or assisted living care services. The assessor is qualified to complete the assessment if the assessor has completed the department designated training course on the UAI. Assessors who prior to January 1, 2004, routinely completed UAIs as part of their job descriptions may be deemed to be qualified assessors without the completion of the training course. Qualified assessors who may initially authorize ALF services for public pay individuals are employees of:

1. Local departments;

2. Area agencies on aging;

3. Centers for independent living;

4. Community services boards or behavioral health authorities;

5. Local departments of health;

6. State facilities operated by the Department of Behavioral Health and Developmental Services;

7. Acute-care hospitals;

8. Department of Corrections; and

9. Independent physicians who have a signed provider agreement with DMAS to conduct ALF assessments.

D. For public pay individuals, the ALF shall coordinate with the qualified assessor or case manager to ensure that the UAI is completed as required. If the individual has not been assessed, the local department benefits worker shall inform the individual or the individual's legal representative of the need to be assessed prior to admission. If the individual has not applied for an auxiliary grant, the qualified assessor or case manager conducting the assessment shall inform the individual or the individual's legal representative of the need to submit an application for an auxiliary grant.

Statutory Authority

§§ 51.5-131 and 51.5-146 of the Code of Virginia.

Historical Notes

Former 22VAC40-745-20, derived from VR615-46-02 § 2.1, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 1, eff. November 1, 2006; amended and renumbered as 22VAC30-110-20, Virginia Register Volume 30, Issue 1, eff. October 9, 2013; amended, Virginia Register Volume 31, Issue 11, eff. February 25, 2015; Volume 37, Issue 19, eff. June 9, 2021.

22VAC30-110-30. Determination of services to be provided.

A. The assessment shall be conducted using the UAI. The UAI is comprised of a short assessment and a full assessment. The short assessment is designed to briefly assess the individual's need for appropriate level of care and services and to determine if a full assessment is needed.

B. The following sections of the UAI shall be completed as follows:

1. For private pay individuals, the assessment shall include sections related to identification and background, functional status, which includes ADLs, continence, ambulation, IADLs, medication administration, and behavior pattern. The private pay or public pay UAI may be used.

2. For public pay individuals, the short form of the UAI shall be completed. The short form consists of sections related to identification and background, and functional status (i.e., the first four pages of the UAI), plus sections on medication administration, and behavior pattern. If, upon assessment, it is determined that the individual is dependent in at least two ADLs or is dependent in behavior, then the full assessment shall be completed.

3. For private pay and public pay individuals, the prohibited conditions section shall be completed.

C. The UAI shall be completed within 90 days prior to the date of admission to the ALF. If there has been a significant change in the individual's condition since the completion of the UAI that would affect the admission to an ALF, a new UAI shall be completed as specified in 22VAC30-110-20.

D. When an individual moves to an ALF from another ALF, a new UAI is not required except that a new UAI shall be completed whenever there is a significant change in the individual's condition or the most recent UAI was completed more than 12 months ago.

E. In emergency placements, the UAI shall be completed within seven working days from the date of placement. An emergency placement shall occur only when the emergency is documented and approved by (i) a local department adult protective services worker for public pay individuals or by (ii) a local department adult protective services worker or independent physician for private pay individuals.

F. The UAI shall be completed annually on all individuals residing in ALFs and whenever there is a significant change in the individual's condition.

G. The ALF shall provide an area for assessments and reassessment to be conducted that ensures the individual's privacy and protects confidentiality.

H. At the request of the ALF, the individual residing in the ALF, the individual's legal representative, the individual's physician, the Virginia Department of Social Services, or the local department, an independent assessment using the UAI shall be completed to determine whether the individual's care needs are being met in the current ALF. An independent assessment is an assessment that is completed by an entity other than the original assessor. The ALF shall assist the individual in obtaining the independent assessment as requested. If the request is for a private pay individual, the entity requesting the independent assessment shall be responsible for paying for the assessment.

I. The assessor shall consult with other appropriate human service professionals as needed to complete the assessment.

J. Qualified assessors who are employees of local departments shall enter ALF assessments in the department designated case management system.

K. DMAS shall reimburse for completion of assessments and authorization of ALF placement for public pay individuals pursuant to this section.

Statutory Authority

§§ 51.5-131 and 51.5-146 of the Code of Virginia.

Historical Notes

Former 22VAC40-745-30, derived from VR615-46-02 § 2.2, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 1, eff. November 1, 2006; amended and renumbered as 22VAC30-110-30, Virginia Register Volume 30, Issue 1, eff. October 9, 2013; amended, Virginia Register Volume 31, Issue 11, eff. February 25, 2015; Volume 37, Issue 19, eff. June 9, 2021.

22VAC30-110-40. Discharge.

A. ALF staff shall assist the individual and the individual's legal representative in the discharge or transfer process. For public pay individuals, ALF staff shall provide written notification of the individual's date and place of discharge or of the individual's death to the local department benefits worker in the jurisdiction responsible for authorizing the auxiliary grant and the qualified assessor or case manager who conducted the most recent assessment. The ALF shall make these notifications at least 14 calendar days prior to the individual's planned discharge or within five calendar days after the individual's death. In the event of an emergency discharge as specified in 22VAC40-73-430, the notification shall be made as rapidly as possible, but must be made by close of the day following the emergency discharge.

B. Upon issuing a notice of summary order of suspension to an ALF, the Commissioner of the Virginia Department of Social Services or his designee shall contact the appropriate local department to develop a relocation plan. Individuals residing in an ALF whose license has been summarily suspended pursuant to § 63.2-1709 of the Code of Virginia shall be relocated as soon as possible to reduce the risk to their health, safety, and welfare. New assessments of the individuals who are relocating are not required, pursuant to 22VAC30-110-30 D.

Statutory Authority

§§ 51.5-131 and 51.5-146 of the Code of Virginia.

Historical Notes

Former 22VAC40-745-40, derived from VR615-46-02 § 2.3, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 1, eff. November 1, 2006; amended and renumbered as 22VAC30-110-40, Virginia Register Volume 30, Issue 1, eff. October 9, 2013; amended, Virginia Register Volume 31, Issue 11, eff. February 25, 2015; Volume 37, Issue 19, eff. June 9, 2021.

22VAC30-110-50. Authorization of services to be provided.

A. The qualified assessor or case manager is responsible for authorizing public payment to the individual for the appropriate level of care upon admission to and for continued stay in an ALF.

B. The ALF staff shall be knowledgeable of the criteria for level of care in an ALF and are responsible for discharging the individual when the individual does not meet the criteria for level of care in an ALF upon admission or at any later time.

C. The appropriate level of care shall be documented on the UAI, and the UAI shall be completed in a manner consistent with this chapter. The User's Manual: Virginia Uniform Assessment Instrument is the department-designated handbook containing procedures that may be used in completing the UAI.

D. During an inspection or review, staff from the Virginia Department of Social Services or the local department may initiate a change in level of care for any individual residing in the ALF for whom it is determined that the UAI does not reflect the individual's current status.

Statutory Authority

§§ 51.5-131 and 51.5-146 of the Code of Virginia.

Historical Notes

Former 22VAC40-745-50, derived from VR615-46-02 § 2.4, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 1, eff. November 1, 2006; amended and renumbered as 22VAC30-110-50, Virginia Register Volume 30, Issue 1, eff. October 9, 2013; amended, Virginia Register Volume 31, Issue 11, eff. February 25, 2015; Volume 37, Issue 19, eff. June 9, 2021.

22VAC30-110-60. Criteria for residential living care.

Individuals shall meet the criteria for residential living as documented on the UAI when at least one of the following describes their functional capacity:

1. Rated dependent in only one of seven ADLs (i.e., bathing, dressing, toileting, transferring, bowel function, bladder function, and eating/feeding).

2. Rated dependent in one or more of four selected IADLs (i.e., meal preparation, housekeeping, laundry, and money management).

3. Rated dependent in medication administration.

Statutory Authority

§ 51.5-131 of the Code of Virginia.

Historical Notes

Former 22VAC40-745-60, derived from VR615-46-02 § 2.5, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 1, eff. November 1, 2006; renumbered as 22VAC30-110-60, Virginia Register Volume 30, Issue 1, eff. October 9, 2013; amended, Virginia Register Volume 31, Issue 11, eff. February 25, 2015.

22VAC30-110-70. Criteria for assisted living care.

Individuals shall meet the criteria for assisted living as documented on the UAI when at least one of the following describes their capacity:

1. Rated dependent in two or more of seven ADLs.

2. Rated dependent in behavior pattern (i.e., abusive, aggressive, and disruptive).

Statutory Authority

§ 51.5-131 of the Code of Virginia.

Historical Notes

Former 22VAC40-745-70, derived from VR615-46-02 § 2.6, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 1, eff. November 1, 2006; renumbered as 22VAC30-110-70, Virginia Register Volume 30, Issue 1, eff. October 9, 2013; amended, Virginia Register Volume 31, Issue 11, eff. February 25, 2015.

22VAC30-110-80. Rating of levels of care on the uniform assessment instrument.

A. The rating of functional dependencies on the UAI shall be based on the individual's ability to function in a community environment.

B. For purposes of this chapter, the following abbreviations shall mean: D = dependent; and TD = totally dependent. Mechanical help means equipment or a device or both are used; human help includes supervision and physical assistance. Asterisks (*) denote dependence in a particular function.

1. Activities of daily living.

a. Bathing.

(1) Without help

(2) Mechanical help only

(3) Human help only* (D)

(4) Mechanical help and human help* (D)

(5) Performed by others* (TD)

b. Dressing.

(1) Without help

(2) Mechanical help only

(3) Human help only* (D)

(4) Mechanical help and human help* (D)

(5) Performed by others* (TD)

(6) Is not performed* (TD)

c. Toileting.

(1) Without help

(2) Mechanical help only

(3) Human help only* (D)

(4) Mechanical help and human help* (D)

(5) Performed by others* (TD)

(6) Is not performed* (TD)

d. Transferring.

(1) Without help

(2) Mechanical help only

(3) Human help only* (D)

(4) Mechanical help and human help* (D)

(5) Performed by others* (TD)

(6) Is not performed* (TD)

e. Bowel function.

(1) Continent

(2) Incontinent less than weekly

(3) Ostomy self-care

(4) Incontinent weekly or more* (D)

(5) Ostomy not self-care* (TD)

f. Bladder function.

(1) Continent

(2) Incontinent less than weekly

(3) External device, indwelling catheter, ostomy, self-care

(4) Incontinent weekly or more* (D)

(5) External device, not self-care* (TD)

(6) Indwelling catheter, not self-care* (TD)

(7) Ostomy, not self-care* (TD)

g. Eating/feeding.

(1) Without help

(2) Mechanical help only

(3) Human help only* (D)

(4) Mechanical help and human help* (D)

(5) Performed by others (includes spoon fed, syringe/tube fed, fed by IV)* (TD)

2. Behavior pattern.

a. Appropriate

b. Wandering/passive less than weekly

c. Wandering/passive weekly or more

d. Abusive/aggressive/disruptive less than weekly* (D)

e. Abusive/aggressive/disruptive weekly or more* (D)

3. Instrumental activities of daily living.

a. Meal preparation.

(1) No help needed

(2) Needs help* (D)

b. Housekeeping.

(1) No help needed

(2) Needs help* (D)

c. Laundry.

(1) No help needed

(2) Needs help* (D)

d. Money management.

(1) No help needed

(2) Needs help* (D)

4. Medication administration.

a. Without assistance

b. Administered/monitored by lay person* (D)

c. Administered/monitored by professional staff* (D)

Statutory Authority

§§ 51.5-131 and 51.5-146 of the Code of Virginia.

Historical Notes

Former 22VAC40-745-80, derived from VR615-46-02 § 2.8, eff. February 1, 1996; renumbered as 22VAC30-110-80, Virginia Register Volume 30, Issue 1, eff. October 9, 2013; amended, Virginia Register Volume 31, Issue 11, eff. February 25, 2015; Volume 37, Issue 19, eff. June 9, 2021.

22VAC30-110-90. Actions to be taken upon completion of the uniform assessment instrument.

A. Actions to be taken upon completion of the uniform assessment instrument for public pay individuals.

1. Upon completion of the UAI for initial assessment for admission, a significant change in the individual's condition, or the annual reassessment, the case manager or a qualified assessor shall forward to the local department benefits worker in the appropriate agency of jurisdiction, in the format specified by the department, the effective date of admission or change in level of care. Qualified assessors who are authorized to perform the annual reassessment or a change in level of care for public pay individuals are employees of (i) local departments; (ii) area agencies on aging; (iii) centers for independent living; (iv) community services boards or behavioral health authority; and (v) local departments of health, or an independent physician who has a signed provider agreement with DMAS to conduct assessments.

2. A completed copy of the UAI, the referral to the local department benefits worker, and other relevant data shall be maintained in the individual's record at the ALF.

3. The annual reassessment shall be completed by the qualified assessor or case manager conducting the initial assessment. If the original assessor is neither willing nor able to complete the assessment and another assessor is not available, the local department where the individual resides shall be the assessor, except that individuals who receive services from a community service board or behavioral health authority shall be assessed and reassessed by qualified assessors employed by the community services board or behavioral health authority.

4. The earliest date that an annual reassessment may be completed is 60 calendar days prior to the annual reassessment due date.

5. After the annual reassessment has been completed, if the individual still meets either residential or assisted living level of care, the qualified assessor or case manager shall offer the individual the choice, based on availability, of housing option pursuant to § 51.5-160 of the Code of Virginia.

6. The ALF shall notify the community services board or behavioral health authority when UAIs indicate observed behaviors or patterns of behavior indicative of mental illness, intellectual disability, substance abuse, or behavioral disorders, pursuant to § 63.2-1805 B of the Code of Virginia.

B. Actions to be taken upon completion of the uniform assessment instrument for private pay individuals, the ALF shall ensure that assessments for all individuals at admission and at subsequent intervals are completed as required in this chapter. The ALF shall maintain the individual's UAI and other relevant data in the individual's ALF record.

Statutory Authority

§§ 51.5-131 and 51.5-146 of the Code of Virginia.

Historical Notes

Former 22VAC40-745-90, derived from VR615-46-02 § 2.8, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 1, eff. November 1, 2006; Volume 28, Issue 23, eff. August 15, 2012; renumbered as 22VAC30-110-90, Virginia Register Volume 30, Issue 1, eff. October 10, 2013; amended, Virginia Register Volume 31, Issue 11, eff. February 25, 2015; Volume 37, Issue 19, eff. June 9, 2021.

22VAC30-110-100. Targeted case management for individuals receiving an auxiliary grant.

A. Targeted case management shall be limited to those individuals who have multiple needs across multiple providers and this coordination is beyond the scope of the ALF. It shall be the responsibility of the qualified assessor or case manager who identifies the individual's need for residential care or assisted living care in an ALF to assess the need for targeted case management as defined in 12VAC30-50-470.

B. A case management agency shall have signed a provider agreement with DMAS to be reimbursed for the provision of targeted case management for individuals receiving an auxiliary grant.

C. The local department where the individual resides, following admission to an ALF, shall be the case management agency when there is no other qualified case management provider willing or able to provide case management.

D. A qualified case manager shall possess a combination of relevant work experience in human services or health care and relevant education which indicates that the individual possesses the knowledge, skills, and abilities at entry level as defined in 12VAC30-50-470. This must be documented on the case manager's job application form or supporting documentation. When the provider agency is a local department, case managers shall meet the qualifications for family services occupational group as specified in 22VAC40-670-20.

Statutory Authority

§§ 51.5-131 and 51.5-146 of the Code of Virginia.

Historical Notes

Former 22VAC40-745-100, derived from VR615-46-02 § 2.8, eff. February 1, 1996; amended, Virginia Register Volume 23, Issue 1, eff. November 1, 2006; Volume 28, Issue 23, eff. August 15, 2012; amended and renumbered as 22VAC30-110-100, Virginia Register Volume 30, Issue 1, eff. October 9, 2013; amended, Virginia Register Volume 31, Issue 11, eff. February 25, 2015; Volume 37, Issue 19, eff. June 9, 2021.

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