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 12VAC30-130-200 - PASARR evaluation criteria

Current through Register Vol. 40, No. 24, July 15, 2024
A. The state's
				  PASARR program must identify all individuals who are suspected of having MI or
				  MR/RC as defined herein. The identification function and determination that NF
				  criteria is met is termed Level I. Level II is the function of evaluating and
				  determining whether NF placement is appropriate to meet the individual's
				  MH/MR/RC needs and whether specialized services are needed.
B. Evaluations performed under PASARR and
				  PASARR notices must be adapted to the cultural background, language, ethnic
				  origin, and means of communication used by the individual being evaluated.
				  PASARR evaluations must involve the individual being evaluated, the
				  individual's legal representative, if one has been designated under state law,
				  and the individual's family if available and the individual or the legal
				  representative agrees to family participation. When parts of a PASARR
				  evaluation are performed by more than one evaluator, there must be
				  interdisciplinary coordination among the evaluators.
C. All information that is necessary for
				  determining whether it is appropriate for the individual with MI or MR/RC to be
				  placed in a NF or in another appropriate setting should be gathered throughout
				  all applicable portions of the PASARR evaluation. The determinations relating
				  to the need for NF level of care and specialized services are interrelated and
				  must be based upon a comprehensive analysis of all data concerning the
				  individual.
D. Evaluators may use
				  relevant evaluative data, obtained prior to initiation of preadmission
				  screening or annual resident review, if the data are considered valid and
				  accurate and reflect the current functional status of the individual. However,
				  in the case of individualized evaluations, the PASARR program may need to
				  gather additional information to supplement and verify the currency and
				  accuracy of existing data and to assess proper placement and
				  treatment.
E. For individualized
				  PASARR determinations, findings must be issued in the form of a written
				  evaluative report which (i) identifies the name and professional title of
				  person(s) who performed the evaluation(s) and the date on which each portion of
				  the evaluation was administered; (ii) provides a summary of the medical and
				  social history, including the positive traits or developmental strengths and
				  weaknesses or developmental needs of the evaluated individual; (iii) if NF
				  services are recommended, identifies the specific services which are required
				  to meet the evaluated individual's needs; (iv) if specialized services are not
				  recommended, identifies any specific MR/RC or MH services which are of a lesser
				  intensity than specialized services that are required to meet the evaluated
				  individual's needs; (v) if specialized services are recommended, identifies the
				  specific MR/RC or MH services required to meet the evaluated individual's
				  needs; and (vi) includes the basis for the report's conclusions.
F. For categorical PASARR determinations,
				  findings must be issued in the form of an abbreviated written evaluative report
				  which (i) identifies the name and professional title of the person applying the
				  categorical determination and the data on which the application was made; (ii)
				  explains the categorical determination(s) that has (have) been made; (iii)
				  identifies, to the extent possible, based on the available data, NF services,
				  including any mental health or specialized psychiatric rehabilitative services,
				  that may be needed; and (iv) includes the bases for the report's
				  conclusions.
G. For both
				  categorical and individualized determinations, findings of the evaluation must
				  correspond to the person's current functional status, mental health, and mental
				  retardation status as documented in medical and social history records.
				  Findings of the evaluation must be interpreted and explained to the individual
				  and, where applicable, to a legal representative designed under state law by
				  the assessment team or the MH/MRA. The evaluation report must be sent to the
				  individual and his legal representative, appropriate state authority in
				  sufficient time to meet the required time frames, admitting or retaining NF,
				  individual's attending physician, and the discharging hospital if the
				  individual is seeking NF admission from a hospital. The evaluation may be
				  terminated at any time during the evaluation that the individual being
				  evaluated does not have MI or MR/RC or has a primary diagnosis of dementia or a
				  nonprimary diagnosis of dementia without a primary diagnosis that is a serious
				  mental illness, and does not have a diagnosis of MR or a related
				  condition.
Statutory Authority
§ 32.1-325 of the Code of Virginia.