Section 30. Determination of services to be provided

A. The assessment shall be conducted using the UAI that sets forth an individual's care needs. The UAI is designed to be a comprehensive, accurate, standardized, and reproducible assessment of individuals seeking or receiving long-term care services. The UAI is comprised of a short assessment and a full assessment. The short assessment is designed to briefly assess the individual's need for appropriate level of care and services and to determine if a full assessment is needed.

B. The following sections of the UAI shall be completed as follows:

1. For private pay individuals, the assessment shall include sections related to identification and background, functional status, which includes ADLs, continence, ambulation, IADLs, medication administration, and behavior pattern. The private pay or public pay UAI may be used.

2. For public pay individuals, the short form of the UAI shall be completed. The short form consists of sections related to identification and background, and functional status (i.e., the first four pages of the UAI), plus sections on medication administration, and behavior pattern. If, upon assessment, it is determined that the individual is dependent in at least two ADLs or is dependent in behavior, then the full assessment shall be completed.

C. The UAI shall be completed within 90 days prior to the date of admission to the ALF. If there has been a significant change in the individual's condition since the completion of the UAI that would affect the admission to an ALF, a new UAI shall be completed as specified in 22VAC30-110-20.

D. When an individual moves to an ALF from another ALF, a new UAI is not required except that a new UAI shall be completed whenever there is a significant change in the individual's condition or the assessment was completed more than 12 months ago.

E. In emergency placements, the UAI shall be completed within seven working days from the date of placement. An emergency placement shall occur only when the emergency is documented and approved by a Virginia adult protective services worker for public pay individuals or by a Virginia adult protective services worker or independent physician for private pay individuals.

F. The UAI shall be completed annually on all individuals residing in ALFs. UAIs shall be completed whenever there is a significant change in the individual's condition. All UAIs shall be completed as required by 22VAC30-110-20. The ALF shall provide an area for assessments and reassessment to be conducted that ensures the individual's privacy and protects confidentiality.

G. At the request of the ALF, the individual residing in the ALF, the individual's legal representative, the individual's physician, the Department of Social Services, or the local department of social services, an independent assessment using the UAI shall be completed to determine whether the individual's care needs are being met in the current ALF. An independent assessment is an assessment that is completed by an entity other than the original assessor. The ALF shall assist the individual in obtaining the independent assessment as requested. If the request is for a private pay individual, the entity requesting the independent assessment shall be responsible for paying for the assessment.

H. The assessor shall consult with other appropriate human service professionals as needed to complete the assessment.

I. DMAS shall reimburse for completion of assessments and authorization of ALF placement for public pay individuals pursuant to this section.

Historical Notes

Former 22VAC40-745-30, derived from VR615-46-02 § 2.2, eff. February 1, 1996; amended, Volume 23, Issue 01, eff. November 1, 2006; amended and renumbered as 22VAC30-110-30, Virginia Register Volume 30, Issue 01, eff. October 9, 2013; amended, Virginia Register Volume 31, Issue 11, eff. February 25, 2015.

Statutory Authority

§ 51.5-131 of the Code of Virginia.