Virginia Administrative Code › Title 12 - HEALTH › Agency 30 - DEPARTMENT OF MEDICAL ASSISTANCE SERVICES › Chapter 130 - AMOUNT, DURATION AND SCOPE OF SELECTED SERVICES › Part II - Long-Stay Acute Care Hospitals › Section 12VAC30-130-130 - Long-stay acute care hospital requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. A coordinated multidisciplinary team
				  approach shall be implemented to meet the needs of the resident. Based on the
				  physician's plan of care, the interdisciplinary team should include, but is not
				  necessarily limited to, nurses, social workers, activity coordinators,
				  dieticians, rehabilitative therapists, and any direct care staff.
B. The long-stay acute care hospital shall
				  provide for the educational and habilitative needs of residents age 21 or
				  younger. These services must be age appropriate, must meet state educational
				  requirements, and must be appropriate to the child's cognitive level. Services
				  must be individualized to meet the specific needs of the child and must be
				  provided in an organized manner which encourages the child to participate.
				  Services may include but are not limited to school, active treatment for mental
				  retardation, habilitative therapies, social skills and leisure activities.
				  Therapeutic leisure activities must be provided daily.
C. The long-stay acute care hospital shall
				  provide an acceptable plan for assuring that residents requiring long-stay
				  acute hospital care are afforded the same opportunity for participating in
				  integrated facility activities as the other facility residents.
D. Nonemergency transportation shall be
				  provided so that residents may participate in community activities sponsored by
				  the facility or community activities in which the facility is providing
				  transportation for other facility residents.
E. The long-stay acute care hospital shall
				  coordinate discharge planning for the resident utilizing all available
				  resources in an effort to assist the resident to maximize his potential for
				  independence and self-sufficiency and to assure that services are being
				  provided by the most effective level of care.
F. The long-stay acute care hospital shall
				  provide family or caregiver training in the skills necessary for the care of
				  the resident in the community, should the resident or the resident's caregiver
				  so desire.
G. The long-stay acute
				  care hospital shall provide all necessary durable medical equipment to sustain
				  life or monitor vital signs and to carry out a plan of care designed by the
				  physician. This equipment may include but is not limited to mechanical
				  ventilator, apnea monitor, etc.
H.
				  The long-stay acute care hospital shall provide utilization review activities
				  as follows:
1. Purpose. The objective of the
				  utilization review mechanism is the maintenance of high-quality patient care
				  and the most efficient utilization of resources through an educational approach
				  involving the study of patient care as well as to ensure that inpatient care is
				  provided only when medically necessary and that the care meets quality
				  standards.
a. In addition to the
				  certification by the resident's physician, the hospital shall have a
				  utilization review plan which provides for review of all Medicaid patient stays
				  and medical care evaluation studies of admissions, durations of stay, and
				  professional services rendered.
b.
				  Effective utilization review shall be maintained on a continuing basis to
				  ensure the medical necessity of the services for which the program pays and to
				  promote the most efficient use of available health facilities and
				  services.