22VAC40-745 Assessment in Assisted Living Facilities

REGULATIONS

Vol. 29 Iss. 7 - December 03, 2012

TITLE 22. SOCIAL SERVICES

STATE BOARD OF SOCIAL SERVICES

Chapter 745

Proposed Regulation

Title of Regulation: 22VAC40-745. Assessment in Assisted Living Facilities (amending 22VAC40-745-10 through 22VAC40-745-110).

Statutory Authority: §§ 63.2-217, 63.2-800, and 63.2-1732 of the Code of Virginia.

Public Hearing Information:

December 12, 2012 - 4 p.m. - Henrico Department of Social Services, 8600 Dixon Powers Drive, Henrico, VA

Public Comment Deadline: February 1, 2013.

Agency Contact: Karin Clark, Regulatory Coordinator, Department of Social Services, 801 East Main Street, Room 1507, Richmond, VA 23219, telephone [phone], FAX [phone], TTY [phone], or email [e-mail].

Basis: Section 63.2-217 of the Code of Virginia provides general authority for the State Board of Social Services to adopt regulations as may be necessary or desirable to carry out the purpose of Title 63.2 of the Code of Virginia. Section 63.2-800 of the Code of Virginia requires the board to promulgate regulations specific to the Auxiliary Grant Program, which includes assessments on persons residing in assisted living facilities. Section 63.2-1732 of the Code of Virginia authorizes the board to adopt regulations to carry out the provisions of Subtitle IV of Title 63.2 of the Code of Virginia and to protect residents of assisted living facilities (ALFs) and promote their highest level of functioning.

Purpose: The proposed regulatory action is necessary to ensure that regulation content addresses the assessment of individuals applying to or residing in ALFs. Conformity across regulations and clarity in regulation content are essential to ensuring that the individual's health and safety needs are best met in an ALF setting and that the assessment process occurs in a timely and appropriate manner.

Substance: The majority of changes are technical, such as clarifying definitions and other regulation text to comport with DSS licensing regulations and using acronyms to replace certain terms. Regulation content is amended to clarify the intent. The regulation also incorporates person-centered language by replacing terms such as resident and applicant.

Issues: The amendments to the regulation ensure that an auxiliary grant payment to an individual in an assisted living facility (ALF) is approved only after a qualified assessor has determined the individual meets residential or assisted living level of care.

The amendments to the regulation clarify but do not increase ALF staffs' or qualified assessors' assessment responsibilities. The regulatory action comports the regulation content with Department of Social Services licensing regulations. Clarifying regulation content ensures that the assessment process is understood by ALF providers, assessors, and individuals who reside in ALFs.

The regulatory action incorporates person-centered language such as individual and removes terms such as applicant and recipient.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The State Board of Social Services (Board) proposes to amend its regulations that govern assessment of potential residents (and re-assessment of current residents) of assisted living facilities to make definitions and regulatory language consistent with assisted living facility licensure regulations (22VAC40 -72).

Result of Analysis. Benefits likely outweigh costs for all proposed changes.

Estimated Economic Impact. The Board's regulations governing assessment in assisted living facilities set the rules for assessment of individuals who may be entering assisted living facilities, as well as re-assessment of individuals who are already residents of assisted living facilities, and set qualifying criteria for individuals who conduct assessments. The Board now proposes to amend these regulations for clarification and so that they comport with current assisted living facility licensure regulations.

The Board, for instance, proposes to remove references to "applicant" and "resident" and replace them with "individual" and also proposes to add language that clarifies when information about auxiliary grants must be given. All of the changes that are proposed for these regulations will either clarify the requirements of the regulations or harmonize the language used with that in the licensure regulations but will not change any current practices. Consequently, no affected entity is likely to incur any costs on account of these regulatory changes. The clarity that these changes bring will, however, benefit individuals who found the language differences between the regulations confusing.

Businesses and Entities Affected. These proposed regulatory changes will affect all 550 licensed assisted living facilities in the Commonwealth as well as all 120 local Departments of Social Services.

Localities Particularly Affected. No locality will be particularly affected by this proposed regulatory action.

Projected Impact on Employment. This proposed regulatory action is unlikely to have any effect on employment in the Commonwealth.

Effects on the Use and Value of Private Property. These proposed regulatory changes are unlikely to affect the use or value of private property in the Commonwealth.

Small Businesses: Costs and Other Effects. No small business is likely to incur any costs on account of this regulatory action.

Small Businesses: Alternative Method that Minimizes Adverse Impact. No small business is likely to incur any costs on account of this regulatory action.

Real Estate Development Costs. This regulatory action will likely have no effect on real estate development costs in the Commonwealth.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 36 (06). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to Economic Impact Analysis: The Department of Social Services concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

The proposed amendments include (i) revised definitions and text to comport with current Department of Social Services licensing regulations, (ii) clarification of regulation content related to assessment of individuals applying to or residing in ALFs, determination of services to be provided, and discharge or transition, and (iii) incorporation of person-centered language throughout the regulation.

Part I
Definitions

22VAC40-745-10. Definitions.

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise:

"Activities of daily living (ADLs)" or "ADLs" means bathing, dressing, toileting, transferring, bowel control, bladder control, and eating/feeding. A person's An individual's degree of independence in performing these activities is a part of determining appropriate level of care and services.

"Applicant" means an adult planning to reside in an assisted living facility.

"Administrator" means the licensee or person designated by the licensee who (i) is responsible for the general administration and management of an assisted living facility and who oversees the day-to-day operation of the facility, including compliance with all regulations for assisted living facilities and (ii) meets the requirements of 22VAC40-72.

"Assessment" means a standardized approach using common definitions to gather sufficient information about applicants to and residents of assisted living facilities an individual applying to or residing in an assisted living facility to determine the need for appropriate level of care and services.

"Assisted living care" means a level of service provided by an assisted living facility for adults to individuals who may have physical or mental impairments and require at least moderate assistance with the activities of daily living. Moderate assistance means dependency in two or more of the activities of daily living. Included in this level of service are individuals who are dependent in behavior pattern (i.e., abusive, aggressive, disruptive) as documented on the uniform assessment instrument.

"Assisted living facility (ALF)" or "ALF" means any public or private assisted living facility ALF that is required to be licensed as an assisted living facility ALF by the Department of Social Services under Chapter 17 (§ 63.2-1700 et seq.) of Title 63.2 of the Code of Virginia, specifically, any congregate residential setting that provides or coordinates personal and health care services, 24-hour supervision, and assistance (scheduled and unscheduled) for the maintenance or care of four or more adults who are aged, infirm or disabled and who are cared for in a primarily residential setting, except (i) a facility or portion of a facility licensed by the State Board of Health or the Department of Behavioral Health and Developmental Services, but including any portion of such facility not so licensed; (ii) the home or residence of an individual who cares for or maintains only persons related to him by blood or marriage; (iii) a facility or portion of a facility serving infirm or disabled persons between the ages of 18 and 21, or 22 if enrolled in an educational program for the handicapped pursuant to § 22.1-214 of the Code of Virginia, when such facility is licensed by the department as a children's residential facility under Chapter 17 (§ 63.2-1700 et seq.) of Title 63.2 of the Code of Virginia, but including any portion of the facility not so licensed; and (iv) any housing project for persons 62 years of age or older or the disabled that provides no more than basic coordination of care services and is funded by the U.S. Department of Housing and Urban Development, by the U.S. Department of Agriculture, or by the Virginia Housing Development Authority. Included in this definition are any two or more places, establishments or institutions owned or operated by a single entity and providing maintenance or care to a combined total of four or more aged, infirm or disabled adults. Maintenance or care means the protection, general supervision and oversight of the physical and mental well-being of an aged, infirm or disabled individual. Assuming responsibility for the well-being of individuals, either directly or through contracted agents, is considered general supervision and oversight.

"Assisted living facility administrator" means any individual charged with the general administration of an assisted living facility, regardless of whether he has an ownership interest in the facility and meets the requirements of 22VAC40-72.

"Auxiliary Grants Program" means a state and locally funded assistance program to supplement the income of a an individual who is receiving Supplemental Security Income (SSI) recipient or adult an individual who would be eligible for SSI except for excess income, and who resides in an assisted living facility ALF with an approved rate.

"Case management" means multiple functions designed to link individuals to appropriate services. Case management may include a variety of common components such as initial screening of need, comprehensive assessment of needs, development and implementation of a plan of care, service monitoring, and follow-up.

"Case management agency" means a public human service agency which employs a case manager or contracts for case management.

"Case manager" means an employee of a public human services agency who is qualified to perform assessments and designated to develop and coordinate plans of care.

"Consultation" means the process of seeking and receiving information and guidance from appropriate human services agencies and other professionals when assessment data indicate certain social, physical and mental health conditions.

"Department" or "DSS" means the Virginia Department of Social Services.

"Dependent" means, for activities of daily living (ADLs) ADLs and instrumental activities of daily living (IADLs), the individual needs the assistance of another person or needs the assistance of another person and equipment or device to safely complete the activity. For medication administration, dependent means the individual needs to have medications administered or monitored by another person or professional staff. For behavior pattern, dependent means the person's individual's behavior is aggressive, abusive, or disruptive.

"Discharge" means the movement of a resident out of process that ends an individual's stay in the assisted living facility ALF.

"Emergency placement" means the temporary status of an individual in an assisted living facility ALF when the person's individual's health and safety would be jeopardized by not permitting entry into the facility until requirements for admission have been met.

"Facility" means an assisted living facility ALF.

"Independent physician" means a physician who is chosen by the resident of an individual residing in the assisted living facility ALF and who has no financial interest in the assisted living facility ALF, directly or indirectly, as an owner, officer, or employee or as an independent contractor with the facility.

"Instrumental activities of daily living (IADLs)" or "IADLs" means for the purposes of this chapter, meal preparation, housekeeping, laundry, and money management. A person's An individual's degree of independence in performing these activities is a part of determining appropriate level of care and services.

"Maximum physical assistance" means that an individual has a rating of total dependence in four or more of the seven activities of daily living as documented on the uniform assessment instrument.

"Medication administration" means for purposes of this regulation, assessing the degree of assistance required an individual requires to take medications and is a part of determining the need for in order to determine the individual's appropriate level of care and services.

"Private pay" means that a resident of an individual residing in an assisted living facility is not eligible for benefits under the Auxiliary Grants Program.

"Prohibited conditions" means physical or mental health conditions or care needs as described in § 63.2-1805 of the Code of Virginia. An ALF shall not admit or allow the continued residence of an individual with a prohibited condition. Prohibited conditions include, but are not limited to, an individual who requires maximum physical assistance as documented on the uniform assessment instrument and meets nursing facility level of care criteria as defined in the State Plan for Medical Assistance. Unless the individual's independent physician determines otherwise, an individual who requires maximum physical assistance and meets nursing facility level of care criteria as defined on the State Plan for Medical Assistance shall not be admitted to or continue to reside in an ALF.

"Public human services agency" means an agency established or authorized by the General Assembly under Chapters 2 and 3 (§§ 63.2-203 et seq. and 63.2-300 et seq.) of Title 63.2, Chapter 14 (§ 51.5-116 et seq.) of Title 51.5, Chapters 1 and 5 (§§ 37.2-100 et seq. and 37.2-500 et seq.) of Title 37.2, or Article 5 (§ 32.1-30 et seq.) of Chapter 1 of Title 32.1, or hospitals operated by the state under Chapters 6.1 and 9 (§§ 23-50.4 et seq. and 23-62 et seq.) of Title 23 of the Code of Virginia and supported wholly or principally by public funds, including but not limited to funds provided expressly for the purposes of case management.

"Public pay" means that a resident of an individual residing in an assisted living facility ALF is eligible for benefits under the Auxiliary Grants Program.

"Qualified assessor" means an individual a person who is authorized to perform an assessment, reassessment, or change in level of care for an applicant to or resident of an assisted living facility individual who is seeking admission to an ALF or who resides in an ALF. For public pay individuals, a qualified assessor is an employee of a public human services agency who is trained in the completion of the uniform assessment instrument and is authorized to approve placement for an individual who is seeking admission to or residing in an ALF. For private pay individuals, a qualified assessor is staff of the assisted living facility ALF trained in the completion of the uniform assessment instrument or an independent private physician or a qualified assessor for public pay individuals.

"Reassessment" means an update of information on the uniform assessment instrument at any time after the initial assessment. In addition to a periodic an annual reassessment, a reassessment should shall be completed whenever there is a significant change in the resident's individual's condition.

"Resident" means an individual who resides in an assisted living facility.

"Residential living care" means a level of service provided by an assisted living facility ALF for adults individuals who may have physical or mental impairments and require only minimal assistance with the activities of daily living. Minimal assistance means dependency in only one activity of daily living ADL or dependency in one or more of the selected instrumental activities of daily living IADLs as documented on the uniform assessment instrument. Included in this level of service are individuals who are dependent in medication administration as documented on the uniform assessment instrument. This The definition of residential living care includes independent living facilities that voluntarily become licensed the services provided by the ALF to individuals who are assessed as capable of maintaining themselves in an independent living status.

"Significant change" means a change in a resident's an individual's condition that is expected to last longer than 30 days. It does not include short-term changes that resolve with or without intervention, a short-term acute illness or episodic event, or a well-established, predictive, cyclic pattern of clinical signs and symptoms associated with a previously diagnosed condition where an appropriate course of treatment is in progress.

"Targeted case management" means the provision of ongoing case management services by an employee of a public human services agency contracting with the Department of Medical Assistance Services to an auxiliary grant resident of individual who is receiving an auxiliary grant in an assisted living facility ALF who meets the criteria set forth in 12VAC30-50-470.

"Total dependence" means the individual is entirely unable to participate in the performance of an activity of daily living ADL.

"Uniform assessment instrument" or "UAI" means the department-designated assessment form. There is an alternate version of the uniform assessment instrument which that may be used for private pay residents; social individuals paying privately. Social and financial information which that is not relevant because of the resident's individual's payment status is not included on this the private pay version.

"User's Manual: Virginia Uniform Assessment Instrument" means the department-designated handbook containing common definitions and procedures for completing the department-designated assessment form.

"Virginia Department of Medical Assistance Services (DMAS)" or "DMAS" means the single state agency designated to administer the Medical Assistance Services Program in Virginia.

Part II
Assessment Services

22VAC40-745-20. Persons Individuals to be assessed.

A. All residents of and applicants to assisted living facilities must individuals applying to or residing in an ALF shall be assessed face-to-face using the uniform assessment instrument UAI prior to admission, at least annually, and whenever there is a significant change in the resident's individual's condition.

B. For private pay individuals, qualified staff of the assisted living facility ALF or an independent private physician may complete the uniform assessment instrument UAI. Qualified staff of the assisted living facility are ALF employees of the facility who have successfully completed state-approved training on the uniform assessment instrument UAI for either public or private pay assessments. The assisted living facility ALF maintains documentation of the completed training. The administrator or the administrator's designated representative must shall approve and sign the completed uniform assessment instrument UAI for private pay individuals. A private pay individual may request the assessment be completed by a qualified public human services agency assessor. When a public human services agency assessor completes the uniform assessment instrument UAI for a private pay individual, the agency may determine and charge a fee for private pay applicants and residents; the fee assessments that may not exceed the fee paid by amount DMAS reimburses for public pay applicants and residents assessments.

C. For public pay individuals, a uniform assessment instrument the UAI shall be completed by a case manager or a qualified assessor to determine the need for residential care or assisted living care services. The assessor is qualified to complete the assessment if the assessor has completed a state-approved training course on the state-designated uniform assessment instrument UAI. Public human services agency assessors Assessors who prior to January 1, 2004, routinely complete, completed UAIs as part of their job descriptions, uniform assessment instruments for applicants to or residents of assisted living facilities prior to January 1, 2004, may be deemed to be qualified assessors without the completion of the training course. Qualified assessors who may initially authorize assisted living facility ALF services for public pay individuals are employees of (i) local departments of social services; (ii) area agencies on aging; (iii) centers for independent living; (iv) community services boards; (v) local departments of health; (vi) state facilities operated by the Department of Mental Health, Mental Retardation and Substance Abuse Services, (vii) acute-care hospitals, and (viii) Department of Corrections Community Release Units; and independent physicians.

1. Local departments of social services;

2. Area agencies on aging;

3. Centers for independent living;

4. Community services boards or behavioral health authorities;

5. Local departments of health;

6. State facilities operated by the Department of Behavioral Health and Developmental Services;

7. Acute-care hospitals;

8. Department of Corrections Community Release Units; and

9. Independent physicians who have a contract with DMAS to conduct ALF assessments.

D. The assisted living facility must For public pay individuals, the ALF shall coordinate with the assessor to ensure that the uniform assessment instrument UAI is completed as required. If the individual has not been assessed, the local department of social services eligibility worker shall inform the individual or the individual's legal representative of the need to be assessed by a qualified assessor prior to admission. If the individual has not applied for an auxiliary grant, the qualified assessor conducting the assessment shall inform the individual or the individual's legal representative of the need to submit an application for an auxiliary grant.

22VAC40-745-30. Determination of services to be provided.

A. The assessment shall be conducted with the department-designated uniform assessment instrument which using the UAI that sets forth a resident's an individual's care needs. The uniform assessment instrument UAI is designed to be a comprehensive, accurate, standardized, and reproducible assessment of individuals seeking or receiving long-term care services. The uniform assessment instrument 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. The uniform assessment instrument shall contain the following items: Full name of the individual; social security number; current address; date of birth; sex; marital status; racial/ethnic background; education; method for communication of needs; primary caregiver or emergency contact or both; usual living arrangements; problems with physical environmental; use of current formal services; annual income; sources of income; legal representatives; benefits or entitlements received; types of health insurance; performance on functional status which includes ADLs, continence, ambulation and IADLs; physician information; admissions to hospitals, nursing facilities or assisted living facilities for medical or rehabilitation reasons; advance directives; diagnoses and medication profile; sensory functioning; joint motion; presence of fractures/dislocations; missing limbs or paralysis/paresis; nutrition; smoking history; use of rehabilitation therapies; presence of pressure ulcers; need for special medical procedures; need for ongoing medical/nursing needs; orientation; memory and judgment; behavior pattern; life stressors; emotional status; social history which includes activities, religious involvement; contact with family and friends; hospitalization for emotional problems; use of alcohol or drugs; assessment of caregivers; and an assessment summary.

B. Sections The following sections of the uniform assessment instrument which must UAI shall be completed are as follows:

1. The assessment for private pay individuals shall include the following portions of the uniform assessment instrument: name of the individual; social security number; current address; birthdate; sex; marital status; performance on 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. In lieu of completing selected parts of the department-designated uniform assessment instrument, the alternate uniform assessment instrument developed for private pay applicants and residents The private pay or public pay UAI may be used.

2. For public pay individuals, the short form of the uniform assessment instrument 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 activities of daily living ADLs or is dependent in behavior, then the full assessment must shall be completed.

C. 1. The uniform assessment instrument UAI shall be completed within 90 days prior to the date of admission to the assisted living facility ALF. If there has been a significant change in the individual's condition since the completion of the uniform assessment instrument which UAI that would affect the admission to an assisted living facility ALF, a new uniform assessment instrument UAI shall be completed as specified in 22VAC40-745-20.

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

3. E. In emergency placements, the uniform assessment instrument must 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.

D. F. The uniform assessment instrument UAI shall be completed at least annually on all residents of assisted living facilities individuals residing in ALFs. Uniform assessment instruments UAIs shall be completed as needed whenever there is a significant change in the resident's individual's condition. All uniform assessment instruments UAIs shall be completed as required by 22VAC40-745-20. The ALF shall provide an area for assessments and reassessment to be conducted that ensures the individual's privacy and protects confidentiality.

E. G. At the request of the assisted living facility ALF, the resident individual residing in the ALF, the resident's individual's legal representative, the resident's individual's physician, DSS, or the local department of social services, an independent assessment using the uniform assessment instrument UAI shall be completed to determine whether the resident's individual's care needs are being met in the current placement ALF. An independent assessment is an assessment that is completed by an entity other than the original assessor. The assisted living facility ALF shall assist the resident individual in obtaining the independent assessment as requested. If the request is for a private pay resident individual, and the independent assessment confirms that the resident's placement is appropriate, then the entity requesting the independent assessment shall be responsible for payment of paying for the assessment, if applicable.

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

G. I. DMAS shall reimburse for completion of assessments and authorization of assisted living facility ALF placement for public pay applicants and residents individuals pursuant to this section.

22VAC40-745-40. Discharge.

A. Discharge is the process that ends the stay in an assisted living facility. Staff of the assisted living facility must plan for post-discharge services when the public pay resident is returned to a home-based placement, a nursing facility, or other placement ALF staff shall assist the individual and legal representative in the discharge or transfer process. Assisted living facility For public pay individuals, ALF staff shall notify in writing provide written notification of the individual's date and place of discharge or of the individual's death to the local department of social services financial eligibility worker in the jurisdiction responsible for authorizing the auxiliary grant and the public human services agency qualified assessor of the date and place of discharge as well as when a resident dies who conducted the most recent assessment. The assisted living facility must ALF shall make these notifications at least 14 calendar days prior to the resident's individual's planned discharge or within five calendar days after the individual's death of the resident. In the event of an emergency discharge as defined by 22VAC40-71-160 specified in 22VAC40-72-420, the notification shall be made as rapidly as possible, but must be made by close of business on the day following the emergency discharge.

B. Upon issuing a notice of summary order of suspension to an assisted living facility ALF, the Commissioner of the Virginia Department of Social Services or his designee shall contact the appropriate local department of social services to develop a relocation plan. The residents of an assisted living facility Individuals residing in an ALF whose license has been summarily suspended pursuant to § 63.2-1709 of the Code of Virginia shall be relocated as soon as possible to reduce the risk of jeopardizing the to their health, safety, and welfare of residents. An assessment of the relocated resident is New assessments of the individuals who are relocating are not required, pursuant to 22VAC40-745-30 C 3 22VAC40-745-30 D.

22VAC40-745-50. Authorization of services to be provided.

A. The assessor is responsible for authorizing public payment to the individual for the appropriate level of care for upon admission to and for continued stay in an assisted living facility ALF.

B. The assisted living facility must ALF staff shall be knowledgeable of the criteria for level of care in an assisted living facility ALF and is are responsible for discharge of the resident whenever a resident discharging the individual when the individual does not meet the criteria for level of care in an assisted living facility ALF upon admission or at any later time.

C. The appropriate level of care must shall be documented on the uniform assessment instrument UAI, and completed in a manner consistent with the definitions of activities of daily living ADLs and directions provided in the User's Manual: Virginia Uniform Assessment Instrument as well as the requirements set forth in this chapter.

D. During an inspection or review, staff from either the department, DMAS, DSS or the local department of social services may initiate a change in level of care for any assisted living facility resident individual residing in the ALF for whom it is determined that the resident's uniform assessment instrument is not reflective of UAI does not reflect the resident's individual's current status.

22VAC40-745-60. Criteria for residential living care.

Individuals shall meet the criteria for residential living as documented on the uniform assessment instrument UAI when at least one of the following describes their functional capacity:

1. Rated dependent in only one of seven ADLs (i.e., bathing, dressing, toileting, transferring, bowel function, bladder function, and eating/feeding).

2. Rated dependent in one or more of four selected IADLs (i.e., meal preparation, housekeeping, laundry, and money management).

3. Rated dependent in medication administration.

22VAC40-745-70. Criteria for assisted living care.

Individuals shall meet the criteria for assisted living as documented on the uniform assessment instrument UAI when at least one of the following describes their capacity:

1. Rated dependent in two or more of seven ADLs.

2. Rated dependent in behavior pattern (i.e., abusive, aggressive, and disruptive).

22VAC40-745-80. Rating of levels of care on the uniform assessment instrument.

A. The rating of functional dependencies on the uniform assessment instrument must UAI shall be based on the individual's ability to function in a community environment.

B. The For purposes of this chapter, the following abbreviations shall mean: D = dependent; and TD = totally dependent. Mechanical help means equipment or a device or both are used; human help includes supervision and physical assistance. Asterisks (*) denote dependence in a particular function.

1. Activities of daily living.

a. Bathing.

(1) Without help

(2) Mechanical help only

(3) Human help only* (D)

(4) Mechanical help and human help* (D)

(5) Is performed by others* (TD)

b. Dressing.

(1) Without help

(2) Mechanical help only

(3) Human help only* (D)

(4) Mechanical help and human help* (D)

(5) Is performed by others* (TD)

(6) Is not performed* (TD)

c. Toileting.

(1) Without help

(2) Mechanical help only

(3) Human help only* (D)

(4) Mechanical help and human help* (D)

(5) Performed by others* (TD)

(6) Is not performed* (TD)

d. Transferring.

(1) Without help

(2) Mechanical help only

(3) Human help only* (D)

(4) Mechanical help and human help* (D)

(5) Is performed by others* (TD)

(6) Is not performed* (TD)

e. Bowel function.

(1) Continent

(2) Incontinent less than weekly

(3) Ostomy self-care

(4) Incontinent weekly or more* (D)

(5) Ostomy not self-care* (TD)

f. Bladder function.

(1) Continent

(2) Incontinent less than weekly

(3) External device, indwelling catheter, ostomy, self-care

(4) Incontinent weekly or more* (D)

(5) External device, not self-care* (TD)

(6) Indwelling catheter, not self-care* (TD)

(7) Ostomy, not self-care* (TD)

g. Eating/feeding.

(1) Without help

(2) Mechanical help only

(3) Human help only* (D)

(4) Mechanical help and human help* (D)

(5) Performed by others (includes spoon fed, syringe/tube fed, fed by IV)* (TD)

2. Behavior pattern.

a. Appropriate

b. Wandering/passive less than weekly

c. Wandering/passive weekly or more

d. Abusive/aggressive/disruptive less than weekly* (D)

e. Abusive/aggressive/disruptive weekly or more* (D)

3. Instrumental activities of daily living.

a. Meal preparation.

(1) No help needed

(2) Needs help* (D)

b. Housekeeping.

(1) No help needed

(2) Needs help* (D)

c. Laundry.

(1) No help needed

(2) Needs help* (D)

d. Money management.

(1) No help needed

(2) Needs help* (D)

4. Medication administration.

a. Without assistance

b. Administered/monitored by lay person* (D)

c. Administered/monitored by professional staff* (D)

22VAC40-745-90. Actions to be taken upon completion of the uniform assessment instrument.

A. Public pay individuals.

1. Upon completion of the uniform assessment instrument UAI for admission, a significant change in the resident's individual's condition, or the annual reassessment, the case manager or a qualified assessor shall forward to the local department of social services financial eligibility worker in the appropriate agency of jurisdiction, in the format specified by the department, the effective date of admission or change in level of care. Qualified assessors who may are authorized to perform the annual reassessment or a change in level of care for public pay individuals are employees of (i) local departments of social services; (ii) area agencies on aging; (iii) centers for independent living; (iv) community services boards or behavioral health authority; and (v) local departments of health, or an independent physician to complete the uniform assessment instrument who has a contract with DMAS to conduct assessments.

2. The completed uniform assessment instrument UAI, the referral to the financial eligibility worker, and other relevant data shall be maintained in the individual's record at the assisted living facility resident's record ALF.

3. The annual reassessment shall be completed by the qualified assessor conducting the initial assessment. If the original assessor is neither willing nor able to complete the assessment and another assessor is not available, the local department of social services where the resident individual resides following placement in an assisted living facility in the ALF shall be the assessor, except that individuals who receive services from a community service board or behavioral health authority shall be assessed and reassessed by qualified assessors employed by the community services board or behavioral health authority.

4. Clients of a community services board shall be assessed and reassessed by qualified assessors employed by the community services board.

5. 4. The facility ALF shall provide to notify the community services board or behavioral health authority notification of uniform assessment instruments that when UAIs indicate observed behaviors or patterns of behavior indicative of mental illness, intellectual disability, substance abuse, or behavioral disorders, pursuant to § 63.2-1805 B of the Code of Virginia.

B. For private pay residents individuals, the assisted living facility ALF shall ensure that assessments for all residents individuals at admission and at subsequent intervals are completed as required in this chapter. The assisted living facility ALF shall maintain in the resident's record the resident's uniform assessment instrument the individual's UAI and other relevant data in the individual's ALF record.

22VAC40-745-100. Targeted case management for auxiliary grant recipients individuals receiving an auxiliary grant.

A. Targeted case management shall be limited to those residents individuals who have multiple needs across multiple providers and this coordination is beyond the scope of the assisted living facility ALF. It shall be the responsibility of the assessor who identifies the individual's need for residential care or assisted living care in an assisted living facility ALF to assess the need for targeted case management services as defined in Part IV (12VAC30-50-410 et seq.) of 12VAC30-50 12VAC30-50-470.

B. A case management agency must shall have signed an agreement with DMAS to be reimbursed for the provision of targeted case management services to auxiliary grant recipients for individuals receiving an auxiliary grant.

C. The local department of social services where the adult individual resides, following placement in an assisted living facility admission to an ALF, shall be the case management agency when there is no other qualified case management provider willing or able to provide case management services.

D. A qualified case manager must shall possess a combination of relevant work experience in human services or health care and relevant education which indicates that the individual possesses the knowledge, skills, and abilities at entry level as defined in Part IV (12VAC30-50-410 et seq.) of 12VAC30-50 12VAC30-50-470. This must be documented on the case manager's job application form or supporting documentation or observable in the job or promotion interview. When the provider agency is a local department of social services, case managers shall meet the qualifications for social work/social work supervisor classification as specified in 22VAC40-670 22VAC40-670-20.

Part III
Resident Appeals

22VAC40-745-110. Resident appeals Appeals.

Assessors shall advise orally and in writing all applicants to and residents of assisted living facilities public pay individuals for which whom assessment or targeted case management services or both are provided of the right to appeal the outcome of the assessment, the annual reassessment, or determination of level of care. Applicants for auxiliary grants An individual who are is denied an auxiliary grant because the assessor determines that they do the individual does not require the minimum level of services offered in the residential care level have of care has the right to file an appeal with the department of under § 63.2-517 of the Code of Virginia. A determination that the individual does not meet the criteria to receive assisted living level of care is an action which is appealable to DMAS.

NOTICE: The following forms used in administering the regulation were filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name to access a form. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, General Assembly Building, 2nd Floor, Richmond, Virginia 23219.

FORMS (22VAC40-745)

Virginia Uniform Assessment Instrument for Private Pay Residents of Assisted Living Facilities (rev. 1/10).

Virginia Uniform Assessment Instrument, UAI (1994).

DOCUMENTS INCORPORATED BY REFERENCE (22VAC40-745)

User's Manual: Virginia Uniform Assessment Instrument (UAI), Commonwealth of Virginia, Revised April 1998.

User's Manual: Virginia Uniform Assessment Instrument (UAI), Commonwealth of Virginia (rev. 7/05).

VA.R. Doc. No. R11-2585; Filed November 5, 2012, 12:54 p.m.