Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 130 - AMOUNT, DURATION AND SCOPE OF SELECTED SERVICES › Part III - Preadmission Screening and Annual Resident Review › Section 12VAC30-130-190 - Determinations and placement of individuals with MI or MR/RC

Current through Register Vol. 40, No. 24, July 15, 2024
A. If the MH/MRA
				  determines that a resident or applicant for admission to a NF requires a NF
				  level of services, the NF may admit or retain the individual. If the MH/MRA
				  determines that a resident or applicant for admission requires both a NF level
				  of services and specialized services for MI or MR/RC, the NF may admit or
				  retain the individual and the state must provide or arrange for the provision
				  of the specialized services needed by the individual while he resides in the
				  NF.
B. If the MH/MRA determines
				  that an applicant for admission to a NF does not require NF services, the
				  applicant cannot be admitted. NF services are not a covered Medicaid service
				  for that individual, and further screening is not required.
C. If the MH/MRA determines that a resident
				  requires neither the level of services by a NF nor specialized services for MI
				  or MR/RC, regardless of the length of stay in the facility, the state must (i)
				  arrange for the safe and orderly discharge of the resident from the facility;
				  and (ii) prepare and orient the resident for discharge.
D. For any resident who has continuously
				  resided in a NF for at least 30 months before the date of the determination,
				  and who requires only specialized services, the state must, in consultation
				  with the resident's family or legal representative and caregivers (i) offer the
				  resident the choice of remaining in the facility or of receiving services in an
				  alternative appropriate setting; (ii) inform the resident of the institutional
				  and noninstitutional alternatives available; (iii) clarify the effect on
				  eligibility for Medicaid services if the resident chooses to leave the
				  facility, including its effect on readmission to the facility or eligibility
				  for community-based services; and (iv) regardless of the resident's choice to
				  remain in the NF or to be discharged to a community setting, provide for, or
				  arrange for the provision of specialized services for the MI or MR.
E. For any resident who has not continuously
				  resided in a NF for at least 30 months before the date of the determination,
				  the state must, in consultation with the resident's family or legal
				  representative and caregivers (i) arrange for the safe and orderly discharge of
				  the resident from the facility; (ii) prepare and orient the resident for
				  discharge; and (iii) provide for, or arrange for the provision of, specialized
				  services for the MI or MR.
F. For
				  the purposes of establishing length of stay in a NF, the 30 months of
				  continuous residence in a NF or longer is calculated back from the date of the
				  first annual resident review determination which finds that the individual is
				  not in need of NF level of services. The 30 months of continuous residence in a
				  NF may include temporary absences for hospitalization and therapeutic leave and
				  may consist of consecutive residences in more than one NF.
G. Placement of an individual with MI or
				  MR/RC in a NF may be considered appropriate only when the individual's needs
				  are such that he or she meets the minimum standards for admission and his or
				  her needs for treatment do not exceed the level of services which can be
				  delivered in the NF to which the individual is admitted either through NF
				  services alone or, where necessary, through NF services supplemented by
				  specialized services provided by or arranged for by the state.
Statutory Authority
§ 32.1-325 of the Code of Virginia.