Title of Regulation: 12VAC30-60. Standards Established and Methods Used to Assure High Quality Care (amending 12VAC30-60-306).

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

Effective Date: December 25, 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.

Background: Federal law requires that individuals seeking nursing facility placement be screened prior to admission in order to determine if the nursing facility placement is medically appropriate. For a hospital discharging a Medicaid member to a nursing facility, Virginia regulations currently permit up to three days after a Medicaid member's discharge for the hospital to submit the required nursing facility screening forms via the electronic screening portal. This three-day period creates potential lag between the Medicaid member's hospital discharge and admission to a nursing facility.

Summary:

The amendment removes the option for a hospital to take three days to complete the required screening of a Medicaid member prior to a member's admission to a nursing facility so that the nursing facility can directly admit Medicaid members and fully comply with federal screening requirements.

12VAC30-60-306. Submission of screenings.

A. The screening entity shall complete and submit the following forms to DMAS electronically via ePAS:

1. DMAS-95 - MI/IDD/RC (Supplemental Assessment Process Form Level I), as appropriate;

2. DMAS-96 (Medicaid-Funded Long-Term Care Service Authorization Form);

3. DMAS-97 (Individual Choice - Institutional Care or Waiver Services), as applicable;

4. UAI (Uniform Assessment Instrument);

5. DMAS-108 (Tech Waiver Adult Referral); and

6. DMAS-109 (Tech Waiver Pediatric Referral).

B. For screenings performed in the community, the screening entity shall submit to DMAS via ePAS each screening form listed in subsection A of this section within 30 days of the individual's request date for screening.

C. For screenings performed in a hospital, the hospital team shall submit to DMAS via ePAS each screening form listed in subsection A of this section, which shall be completed prior to the individual's discharge. For individuals who will be admitted to a Medicare-funded skilled NF or to a Medicare-funded rehabilitation hospital (or rehabilitation unit) directly upon discharge from the hospital, the hospital screener shall have up to an additional three days post-discharge to submit the screening forms via ePAS.