Title of Regulation: 12VAC30-60. Standards Established and Methods Used to Assure High Quality Care (adding 12VAC30-60-361; repealing 12VAC30-60-360).

Statutory Authority: § 32.1-325 of the Code of Virginia; 42 USC § 1396 et seq.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: January 23, 2019.

Effective Date: February 7, 2019.

Agency Contact: Emily McClellan, Regulatory Supervisor, Policy Division, Department of Medical Assistance Services, 600 East Broad Street, Suite 1300, Richmond, VA 23219, telephone (804) 371-4300, FAX (804) 786-1680, or email emily.mcclellan@dmas.virginia.gov.

Basis: Section 32.1-325 of the Code of Virginia grants the Board of Medical Assistance Services the authority to administer and amend the State Plan for Medical Assistance. Section 32.1-324 of the Code of Virginia authorizes the Director of the Department of Medical Assistance Services (DMAS) to administer and amend the State Plan for Medical Assistance according to the board's requirements. The Medicaid authority as established by § 1902(a) of the Social Security Act (42 USC § 1396a) provides governing authority for payments for services.

Purpose: This regulatory action permits DMAS to replace the current Level of Functioning (LOF) survey instrument with the more current Virginia Individual Developmental Disability Eligibility Survey (VIDES) assessment. The purpose of this action is to implement the same screening standard to be applied to individuals for admission to an intermediate care facility for individuals with intellectual disability as is being used for screening such individuals for home and community based developmental disability waiver services. Using the same screening standard for all individuals, regardless of whether they seek institutional care or community care, ensures the uniformity and consistency of evaluation and treatment to protect the health and welfare of these vulnerable citizens.

Rationale for Using Fast-Track Rulemaking Process: This regulatory action is being promulgated as a noncontroversial fast-track rulemaking action since the use of the VIDES assessment instrument for waiver services, under the authority of a current emergency regulation, has been well received by the affected provider and citizen communities.

Substance: The section of the State Plan for Medical Assistance that is affected by this action is Standards Established and Methods Used to Assure High Quality of Care: Criteria for care in facilities for mentally retarded persons (12VAC30-60-360).

Current Policy: This section of the State Plan for Medical Assistance was implemented after the 1987 Omnibus Budget Reconciliation Act required that states specify standards for a level of functioning that individuals were required to meet for Medicaid to reimburse for intermediate care facilities for the mentally retarded (ICF/MR) services. With the exception of specifying that the Level of Functioning (LOF) survey also applied to individuals seeking waiver services in their communities, this section of the State Plan has not been substantially revised since it was originally promulgated.

The LOF survey assessed individuals in the following areas:

(i) Health status, as in medication administration, seizure control, handling diagnoses for disease control and care, direct service care for lesions or wound dressings, motor disabilities that interfere with activities of daily living, and nutritional issues (e.g., undernourishment, swallowing problems, obesity).

(ii) Communication, as in how often does the individual indicate wants by pointing or vocalization, use simple words or phrases, understand simple words or phrases, identify at least 10 things using the appropriate word, or speak in an understandable manner.

(iii) Task learning skills, as in paying attention to purposeful activities for five minutes, staying with a three-step task, telling time to the hour and understanding time intervals, counting more than 10 objects, writing or printing 10 words, or naming people or objects.

(iv) Personal or self-care, as in performing activities of daily living (e.g., eating, toileting, bathing, dressing).

(v) Mobility, as in moving around the environment, rising from sitting or lying down positions, and turning or repositioning in bed.

(vi) Behavior, as in engaging in self-destructive behavior, threatening physical harm to others, throwing things, damaging property, or responding in socially unacceptable manners.

(vii) Community living skills, as in preparing simple foods, caring for personal belongings and living space, performing laundry functions, counting money, using the telephone, being in the community without wandering off, and refraining from exhibiting unacceptable sexual behaviors in public.

The individual's level of functioning in each category indicate his areas of dependency. In some categories, dependency is rated by the degree of assistance required by the individual. In other categories, dependency is established by the frequency of a particular behavior or the individual's ability to perform a given task.

The formal name for ICF/MR institutions was changed by the U.S. Department of Health and Human Services Health Care Financing Administration (the Medicaid federal funding agency that preceded the current Centers for Medicare and Medicaid Services), to intermediate care facilities for individuals with intellectual disability (ICF/IID).

Recommendations: Beginning in 2013, DMAS, in collaboration with the Department of Behavioral Health and Developmental Services (DBHDS), began a major overhaul of its waiver programs for intellectually and developmentally disabled citizens, partially in response to the Department of Justice (DOJ) Settlement (court approved in 2012). These waivered programs were originally called the Individuals and Families with Developmental Disabilities (DD), the Intellectual Disabilities Waiver (ID), and the Day Support Waiver (DS). The DD waiver is being replaced with the Family and Individual Supports (FIS) waiver; the ID waiver is being replaced with the Community Living (CL) waiver; and the DS waiver is being replaced with the Building Independence (BI) waiver.

During the course of revamping these three waivers, DMAS and DBHDS replaced the outdated Level of Functioning (LOF) survey with the Virginia Individual Developmental Disability Eligibility Survey (VIDES). Adopting the use of the VIDES standards for individuals seeking institutional care in ICF/IIDs, as set out in this regulatory action, restores consistency to the standards applied to such individuals regardless of whether services are to be received in communities or institutions. The result will be that all such affected individuals will be evaluated by the same criteria.

In addition to the change in the survey tool, a new single point of referral for the screening process has been added to address concerns from the DOJ Settlement Agreement about consistency in screening and availability of community options.

The Virginia Individual Developmental Disabilities Eligibility Survey (VIDES) has three age-appropriate versions: VIDES for infants (children up to three years of age), VIDES for children (ages three through 18), and VIDES for adults (individuals 18 years of age and older).

The adult form assesses an individual's abilities, for example, in these areas:

(i) Health status, as in how often does the individual require support for medication administration, monitoring of seizures, or learning a prescribed regimen for a diagnosed chronic health care condition.

(ii) Communication, as in how often does the individual effectively share information, effectively communicate wants or needs; use at least simple words, phrases, or short sentences; ask for things using appropriate names; engage in purposeful activities; complete a multi-step task without reminders; or count more than 10 objects.

(iii) Task learning, as in how often does the individual engage in purposeful activities for at least five minutes, complete a multi-step task without reminders, tell time to the hour and understand time intervals, or count more than 10 objects.

(iv) Personal or self-care, as in with what type of assistance can the individual perform personal hygiene tasks, perform dining or eating functions, perform bathing or showering functions, and perform grooming tasks.

(v) Motor skills, as in with what type of assistance can the individual move safely about his environment, safely get in and out of bed, and demonstrate fine motor control or eye-hand coordination.

(vi) Behavior, as in how often does this individual engage in behavior that results in harm or injury to himself, demonstrate aggressive or threatening behavior toward other persons, engage in property destruction, or respond to others in a socially inappropriate manner.

(vii) Community living skills, as in with what type of assistance is the individual able to prepare simple foods, perform housecleaning and laundry tasks, identify and calculate the value of money, use the telephone, recognize and respond appropriately to dangerous situations, and remain safely in the community without wandering off.

(viii) Self direction skills, as in making and implementing daily personal decisions regarding daily schedule and time management; making and implementing major life decisions such as choice and type of living arrangements; demonstrating adequate social skills to establish or maintain interpersonal relationships; demonstrating the ability to cope with fears, anxieties, or frustrations; demonstrating the ability to manage personal finances; or demonstrating ability to protect self from exploitation.

The primary difference between the old LOF and the new VIDES is the addition of the self-direction section. This addition has resulted from recent federal emphasis on providing for and encouraging person-centered planning, activities, and program focus. Agencies that are charged with serving these individuals are now required to promote an individual's participation in developing that individual's own plan of care that must incorporate the individual's goals and objectives for life.

Issues: The advantages to the public and the Commonwealth are that consistent, person-centered functional standards will be applied to individuals who obtain care in their communities or in ICF/IID institutions. There are no disadvantages to the public or the Commonwealth in this action. Private businesses will only be affected to the degree that they are privately operated ICF/IIDs.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Medical Assistance Services proposes to replace the current Level of Functioning (LOF) survey standards with the new Virginia Individual Developmental Disabilities Eligibility Survey (VIDES) standards for individuals seeking care in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs).

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. The LOF survey has been a screening tool used to determine the level of care eligibility for certain mental health services since 1987. It assesses individuals in areas such as health status, communication, task learning, personal/self-care, mobility, behavior, and community living skills. Beginning in 2013, the Department of Medical Assistance Services (DMAS) in collaboration with the Department of Behavioral Health and Developmental Services (DBHDS), began a major overhaul of its waiver programs for intellectually and developmentally disabled citizens.

During the course of revamping the waiver programs that provided services in community settings,¹ DMAS and DBHDS replaced the outdated LOF survey with the Virginia Individual Developmental Disability Eligibility Survey (VIDES). The new VIDES survey assesses individuals in the same areas as the LOF survey but also includes an additional assessment on self-direction skills. Self-direction skills include making and implementing daily personal decisions regarding daily schedule and time management; making and implementing major life decisions such as choice and type of living arrangements; demonstrating adequate social skills to establish/maintain interpersonal relationships; demonstrating the ability to cope with fears, anxieties, or frustrations; demonstrating the ability to manage personal finances; and demonstrating ability to protect self from exploitation.

The added focus on self-direction has resulted from a recent federal emphasis on providing for and encouraging person-centered planning, activities, and program focus following the 1999 United States Supreme Court decision in Olmstead v. L.C., which requires that individuals with disabilities be served in the most integrated settings that are possible for their particular circumstances.² Agencies that are charged with serving these individuals are now required to promote individuals' participation in developing their own plans of care that must incorporate the individuals' goals and objectives for their lives.

Adopting the use of the VIDES standards for individuals seeking institutional care in ICF/IIDs restores consistency to the standards applied to such individuals regardless of whether services are to be received in communities or institutions. The expected result is that all such affected individuals will be evaluated by the same updated criteria as before the implementation of the new waiver designs.

DMAS does not expect the change in the survey to affect the number of individuals placed in ICF/IIDs. Thus, the proposed adoption of the VIDES survey should not create any significant financial impact on the Commonwealth. To the extent the new survey accommodates self-direction and updates screening standards with modern criteria, the proposed regulation should create a net benefit.

Businesses and Entities Affected. There are approximately 57 ICF/IIDs enrolled with DMAS. Some of these may be small businesses. These facilities have approximately 530-bed capacity.

Localities Particularly Affected. The proposed changes do not disproportionately affect any locality more than others.

Projected Impact on Employment. No impact on employment is expected.

Effects on the Use and Value of Private Property. No impact on the use and value of private property is expected.

Real Estate Development Costs. No impact on real estate development costs is expected.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. The proposed regulation does not impose costs and other effects on small businesses.

Alternative Method that Minimizes Adverse Impact. There is no adverse impact on small businesses.

Adverse Impacts:

Businesses. The proposed regulation does not adversely affect businesses.

Localities. The proposed regulation does not adversely affect localities.

Other Entities. The proposed regulation does not adversely affect other entities.

___________________________

¹These waivered programs were originally called the Individuals and Families with Developmental Disabilities (DD), the Intellectual Disabilities Waiver (ID), and the Day Support Waiver (DS). The DD waiver is being replaced with the Family and Individual Supports (FIS) waiver; the ID waiver is being replaced with the Community Living (CL) waiver; and the DS waiver is being replaced with the Building Independence (BI) waiver.

²527 U.S. 581 (1999).

Agency's Response to Economic Impact Analysis: The agency has reviewed the economic impact analysis prepared by the Department of Planning and Budget and raises no issues with this analysis.

Summary:

This regulatory action replaces the current Level of Functioning Survey standards with the Virginia Individual Developmental Disabilities Eligibility Survey (VIDES) standards for individuals seeking care in intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs). The Commonwealth has recently adopted the VIDES standards for the comparable level of functioning for waiver services in communities. By using the VIDES standards for institutional care in this action, the Commonwealth is restoring the consistency of functional standards for individuals regardless of whether they obtain their care in their communities or in ICF/IID institutions.

12VAC30-60-360. Criteria for care in facilities for mentally retarded persons. (Repealed.)

§ 4.0 Definitions. The following words and terms, when used in these criteria, shall have the following meaning, unless the context clearly indicated otherwise:

"no assistance" shall mean no help is needed.

"prompting/structuring" shall mean prior to the functioning, some verbal direction and/or some rearrangement of the environment is needed.

"supervision" shall mean that a helper must be present during the function and provide only verbal direction, general prompts, and/or guidance.

"some direct assistance" shall mean that helper must be present and provide some physical guidance/support (with or without verbal direction).

"total care" shall mean that a helper must perform all or nearly all of the functions.

"rarely" shall mean that a behavior occurs quarterly or less.

"sometimes" shall mean that a behavior occurs once a month or less.

"often" shall mean that a behavior occurs 2-3 times a month.

"regularly" shall mean that a behavior occurs weekly or more.

§ 4.1 Utilization Control regulations require that criteria be formulated for guidance for appropriate levels of services. Traditionally, care for the mentally retarded has been institutionally based; however, this level of care need not be confined to a specific setting. The habilitative and health needs of the client are the determining issues.

§ 4.2 The purpose of these regulations is to establish standard criteria to measure eligibility for Medicaid payment. Medicaid can pay for care only when the client is receiving appropriate services and when "active treatment" is being provided. An individual's need for care must meet these criteria before any authorization for payment by Medicaid will be made for either institutional or waivered rehabilitative services for the mentally retarded.

§ 4.3 Care in facilities for the mentally retarded requires planned programs for habilitative needs and/or health related services which exceed the level of room, board, and supervision of daily activities.

Such cases shall be combination of habilitative, rehabilitative, and health services directed toward increasing the functional capacity of the retarded person. Examples of services shall include training in the activities of daily living, task-learning skills, socially acceptable behaviors, basic community living programming, or health care and health maintenance. The overall objective of programming shall be the attainment of the optimal physical, intellectual, social, or task learning level which the person can presently or potentially achieve.

§ 4.4 The evaluation and re-evaluation for care in a facility for the mentally retarded shall be based on the needs of the person, the reasonable expectations of the resident's capabilities, the appropriateness of programming, whether progress is demonstrated from the training and, in an institution, whether the services could reasonably be provided in a less restrictive environment.

§ 4.5 Patient assessment criteria. The patient assessment criteria are divided into broad categories of needs, or services provided. These must be evaluated in detail to determine the abilities/skills which will be the basis for the development of a plan for care. The evaluation process will demonstrate a need for programming an array of skills and abilities or health care services. These have been organized in seven major categories. 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.

§ 4.6 The resident must meet the indicated dependency level in TWO OR MORE of categories 1 through 7.

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

2. Question "j" must be answered "yes."

B. Communication Skills - To meet this category three or more questions must be answered with a 3 or a 4.

C. Task Learning Skills - To meet this category three or more questions must be answered with a 3 or a 4.

D. Personal Care - To meet this category

1. Question "a" must be answered with a 4 or a 5, OR

2. Question "b" must be answered with a 4 or a 5, OR

3. Questions "c" and "d" must be answered with a 4 or a 5.

E. Mobility - To meet this category any one question must be answered with a 4 or a 5.

F. Behavior - To meet this category any one question must be answered with a 3 or a 4.

G. Community Living - To meet this category

1. Any two of the questions "b", "e", or "g" must be answered with a 4 or a 5, OR

2. Three or more questions must be answered with a 4 or a 5.

§ 4.7. Level of functioning survey.

A. HEALTH STATUS
How often is nursing care or nursing supervision by a licensed nurse required for the following? (Key:1=rarely, 2=sometimes, 3=often, and 4=regularly)
1. Medication administration and/or evaluation for effectiveness of a medication regimen?		1	2	3	4
2. Direct services: i.e., care for lesions, dressings, treatments, (other than shampoos, foot power, etc.)		1	2	3	4
3. Seizures control		1	2	3	4
4. Teaching diagnosed disease control and care, including diabetes		1	2	3	4
5. Management of care of diagnosed circulatory or respiratory problems		1	2	3	4
6. Motor disabilities which interfere with all activities of Daily Living - Bathing, Dressing, Mobility, Toileting, etc.		1	2	3	4
7. Observation for choking/aspiration while eating, drinking?		1	2	3	4
8. Supervision of use of adaptive equipment, i.e., special spoon, braces, etc.		1	2	3	4
9. Observation for nutritional problems (i.e., undernourishment, swallowing difficulties, obesity)		1	2	3	4
10. Is age 55 or older, has a diagnosis of a chronic disease and has been in an institution 20 years or more		1	2	3	4
B. COMMUNICATION
Using the Key 1=regularly, 2=often, 3=sometimes, 4=rarely, how often does this person
1. Indicate wants by pointing, vocal noises, or signs?		1	2	3	4
2. Use simple words, phrases, short sentences?		1	2	3	4
3. Ask for at least ten things using appropriate names?		1	2	3	4
4. Understand simple words, phrases or instructions containing prepositions: i.e., on in behind?		1	2	3	4
5. Speak in an easily understood manner?		1	2	3	4
6. Identify self, place of residence, and significant others?		1	2	3	4
C. TASK LEARNING SKILLS
How often does this person perform the following activities (Key: 1=regularly, 2=often, 3=sometimes, 4=rarely)
1. Pay attention to purposeful activities for 5 minutes?		1	2	3	4
2. Stay with a 3 step task for more than 15 minutes?		1	2	3	4
3. Tell time to the hour and understand time intervals?		1	2	3	4
4. Count more than 10 objects?		1	2	3	4
5. Do simple addition, subtraction?		1	2	3	4
6. Write or print ten words?		1	2	3	4
7. Discriminate shapes, sizes, or colors?		1	2	3	4
8. Name people or objects when describing pictures?		1	2	3	4
9. Discriminate between one, many, lot?		1	2	3	4
D. PERSONAL and SELF CARE
With what type of assistance can this person currently (Key: 1=No Assistance, 2=Prompting/Structures, 3=Supervision, 4=Some Direct Assistance, 5=Total Care)
1. Perform toileting functions: i.e., maintain bladder and bowel continence, clean self, etc.?	1	2	3	4	5
2. Perform eating/feeding functions: i.e., drinks liquids and eats with spoon or fork, etc.?	1	2	3	4	5
3. Perform bathing function: i.e., bathes, runs bath, dry self, etc.?	1	2	3	4	5
4. Dress self completely, i.e., including fastening, putting on clothes, etc.?	1	2	3	4	5
E. MOBILITY
With what type of assistance can this person currently (Key: 1=No Assistance, 2=Prompting/Structures, 3=Supervision, 4=Some Direct Assistance, 5=Total Care)
1. Move, (walking, wheeling) around environment?	1	2	3	4	5
2. Rise from lying down to sitting positons, sits without support?	1	2	3	4	5
3. Turn and position in bed, roll over?	1	2	3	4	5
F. BEHAVIOR
How often does this person (Key:1=Rarely, 2=Sometimes, 3=Often, and 4=Regularly)
1. Engage in self destructive behavior?		1	2	3	4
2. Threaten or do physical violence to others?		1	2	3	4
3. Throw things, damage property, have temper outbursts?		1	2	3	4
4. Respond to others in a socially unacceptable manner - (without undue anger, frustration, or hostility)		1	2	3	4
G. COMMUNITY LIVING SKILLS
With what type of assistance can this person currently (Key:1=No Assistance, 2=Prompting/Structures, 3=Supervision, 4=Some Direct Assistance, 5=Total Care)
1. Prepare simple foods requiring no mixing or cooking?	1	2	3	4	5
2. Take care of personal belongings, room (excluding vacuuming, ironing, clothes washing/drying, wet mopping)?	1	2	3	4	5
3. Add coins of various denominations up to one dollar?	1	2	3	4	5
4. Use the telephone to call home, doctor, fire, police?	1	2	3	4	5
5. Recognize survival signs/words: i.e., stop, go, traffic lights, police, men, women, restrooms, danger, etc.?	1	2	3	4	5
6. Refrain from exhibiting unacceptable sexual behavior in public?	1	2	3	4	5
7. Go around cottage, ward, building, without running away, wandering off, or becoming lost?	1	2	3	4	5
8. Make minor purchases, i.e., candy, soft drink, etc?	1	2	3	4	5

12VAC30-60-361. Criteria for supports and services in intermediate care facilities for individuals with intellectual disabilities.

A. This section establishes standard criteria that shall be met by individuals in order to receive Medicaid payment for care in intermediate care facilities for individuals with intellectual disabilities (ICF/IID). Once the individual has been screened and found to meet these criteria, Medicaid covers the costs of care only when the individual is receiving appropriate supports and services and when active treatment, as set forth in 42 CFR 483.440(a), is being provided.

B. Supports and services that are provided in facilities for individuals with developmental or intellectual disabilities for the purpose of claiming Medicaid reimbursement requires individualized, person-centered planned programs of supports and services to address habilitative needs or health needs, or both, as set forth in 42 CFR 483.21.

1. Such care may be a combination of habilitative, rehabilitative, and health services directed toward increasing or maintaining the highest mental, physical, and psychosocial skills and abilities of the individual. Individuals with degenerative conditions shall receive supports and services designed to retain skills and functioning and to prevent further regression to the extent possible. Examples of such care include (i) skill building in the activities of daily living, (ii) skill building in task-learning, (iii) learning socially acceptable behaviors, (iv) learning basic community living skills, (v) health care and health maintenance, and (vi) skill building in self direction.

2. The overall objective of facility based supports and services, as set out in the person-centered plan, shall be the attainment of the optimal physical, intellectual, social, or task learning level that the individual can presently or potentially achieve.

C. Level of dependency and level of functioning criteria.

1. An individual's need for care shall meet the level of functioning criteria in the Virginia Individual Developmental Disability Eligibility Survey (VIDES) before any authorization for payment by Medicaid will be made for institutional services.

2. The level of dependency in each category shall be indicated from the most dependent to the least dependent. In some categories, the dependency status shall be rated by the degree of assistance required, while in other categories, the dependency shall be established by the frequency of a behavior or the ability to perform a given task.

a. The adult-individual (18 years of age and older) shall demonstrate an overall total level for the VIDES assessment of dependency in three or more of the skills or statuses on the VIDES; to demonstrate a skill or exhibit a status, the individual shall meet the criteria for the dependency level set out for that skill or status in DMAS Form P237.

b. Children (ages three years through 17 years old) shall demonstrate an overall total level for the VIDES assessment of dependency in two or more areas for the VIDES specific for the child's age as set forth in DMAS Form P236.

c. Infants (younger than three years of age) shall demonstrate an overall total level for the VIDES assessment of dependency in two or more areas for the VIDES specific for the infant's age as set forth in DMAS Form P235.

D. Screening process for entrance into an ICF/IID shall be coordinated through DMAS or its designee.

1. ICF/IID screening requests:

a. DMAS or its designee shall accept requests for ICF/IID screenings and ensure that, within seven calendar days of referral, those screenings are scheduled.

b. DMAS or its designee shall accept requests for ICF/IID screenings and ensure that those who need emergency access are scheduled and screened within 48 hours. The criteria to determine the need for emergency access shall be one of the following:

(1) Child protective services has substantiated abuse or neglect against the primary caregiver and has removed the individual from the home, or for adults where (i) adult protective services has found that the individual needs and accepts protective services or (ii) abuse or neglect has not been founded, but corroborating information from other sources (agencies) indicate that there is an inherent risk present and there are no other caregivers available to provide support services to the individual.

(2) Death of primary caregiver or lack of alternative caregiver coupled with the individual's inability to care for himself and endangerment to self or others without supports.

c. The screening will be provided to the chosen ICF/IID during its assessment and admission process when requested by the facility.

d. Screenings by the DMAS designee shall be completed or approved prior to admission to an ICF/IID.

2. DMAS or its designee shall also explore and review more integrated community options with the individual and family or guardian at the time of screening and through the established review recommendations and procedures with DBHDS.

E. Upon admission to an ICF/IID, the facility shall perform an assessment of the individual consistent with 42 CFR 483.440.

F. The assessment and reassessment for determination of continued stay in the ICF/IID level of care shall be performed by the interdisciplinary team and be based on (i) the needs of the individual, (ii) the individual's capabilities, (iii) the appropriateness of services and supports to be provided, (iv) the progress the individual demonstrates from the skill building, and (v) whether the services and supports could reasonably be provided and are available in a less restrictive environment.

G. The individual assessment shall be evaluated in detail to determine the skills, abilities, and status that will be the basis for the development of an individual program plan (IPP). The assessment process shall indicate a need for an IPP that addresses the individual's skills, abilities, and need for health care services as set forth in 42 CFR 483.440.

FORMS (12VAC30-60)

Certificate of Medical Necessity -- Durable Medical Equipment and Supplies, DMAS 352 (rev. 8/95).

Request for Hospice Benefits, DMAS 420 (rev. 1/99).

Virginia Individual Developmental Disabilities Eligibility Survey - Infants' Version, P235 (eff. 3/2016)

Virginia Individual Developmental Disabilities Eligibility Survey - Children's Version, P236 (eff. 3/2016)

Virginia Individual Developmental Disabilities Eligibility Survey - Adults' Version, P237 (eff. 3/2016)