                                 CODE OF VIRGINIA

LONG-TERM SERVICES AND SUPPORTS SCREENING REQUIRED (§ 32.1-330)

A. As used in this section, &#8220;acute care hospital&#8221; includes an acute
care hospital, a rehabilitation hospital, a rehabilitation unit in an acute care
hospital, or a psychiatric unit in an acute care hospital.

B. Every individual who applies for or requests community or institutional
long-term services and supports as defined in the state plan for medical
assistance services may choose to receive services in a community or
institutional setting. Every individual who applies for or requests community or
institutional long-term services and supports shall be afforded the opportunity
to choose the setting and provider of long-term services and supports.

C. Every individual who applies for or requests community or institutional
long-term services and supports shall be screened prior to, or in the situations
described in subsection F within three business days of, initiation of such
community or institutional long-term services and supports to determine his need
for long-term services and supports, including nursing facility services as
defined in the state plan for medical assistance services. The type of long-term
services and supports screening performed shall not limit the long-term services
and supports settings or providers for which the individual is eligible.

D. Except as otherwise provided in this subsection, if an individual who applies
for or requests long-term services and supports as defined in the state plan for
medical assistance services is residing in a community setting at the time of
such application or request, the screening for long-term services and supports
required pursuant to subsection C shall be completed by a long-term services and
supports screening team that includes a nurse, social worker or other assessor
designated by the Department who is an employee of the Department of Health or
the local department of social services and a physician who is employed or
engaged by the Department of Health. To the extent such screening team
determines it is unable to complete the long-term services and supports
screening within 30 days and the individual is in imminent need of nursing
facility placement, such screening team shall confer as to which entity can most
expeditiously conduct the long-term services and supports screening. The nursing
facility screening team as described in subsection F shall be authorized to
conduct such screening if it is determined that it is the most expeditious
option. To the extent such screening team determines it is unable to complete
the long-term services and supports screening within 30 days or the individual
has requested enrollment in a program of all-inclusive care for the elderly
(PACE) as defined in &#xA7; 32.1-330.3, such screening team shall confer as to
which entity can most expeditiously conduct the long-term services and supports
screening. Qualified staff of the PACE program shall be organized to conduct
such screening if it is determined that it is the most expeditious option.

E. If an individual who applies for or requests long-term services and supports
as defined in the state plan for medical assistance services is receiving
inpatient services in an acute care hospital at the time of such application or
request and will immediately begin receiving long-term services and supports as
defined in the state plan for medical assistance services pursuant to a
discharge order from an acute care hospital, the screening for long-term
services and supports required pursuant to subsection C shall be completed by
the acute care hospital in accordance with the screening requirements
established by the Department. Any individual receiving inpatient services in an
acute care hospital discharged to a nursing facility for skilled care only is
not required to be screened prior to discharge from the hospital unless the
individual requests the screening.

F. If an individual who applies for or requests long-term services and supports
as defined in the state plan for medical assistance services is receiving
skilled nursing services in a nursing facility, or in the situation described in
subsection D where the nursing facility screening team is authorized to conduct
the long-term services and supports screening, the Department shall require
qualified staff of the nursing facility to conduct the long-term services and
supports screening prior to or within three business days of initiation of
long-term services and supports and in accordance with the requirements
established by the Department, with the results certified by a physician prior
to or within three business days of initiation of long-term services and
supports under the state plan for medical assistance services.

G. If an individual is admitted to a nursing facility and such individual was
not screened but is subsequently determined to have been required to be screened
prior to admission to the nursing facility, then the qualified staff designated
in subsection F may conduct a screening after admission. Coverage of
institutional long-term services and supports under this subsection by the
Commonwealth&#8217;s program of medical assistance services indicated by the
screening shall not begin until six months after the initial admission to the
nursing facility. During this six-month period, the nursing home in which the
individual resides shall be responsible for all costs indicated for
institutional long-term services and supports that would otherwise have been
covered by the Commonwealth&#8217;s program of medical assistance services,
without accessing patient funds. Six months after the date of admission to the
nursing facility, and as indicated through the eligibility determination, the
Commonwealth&#8217;s program of medical assistance services shall assume
coverage of such services. To the extent that sufficient evidence is provided to
indicate that the admission without screening was of no fault of the nursing
facility, the Department shall begin coverage of institutional long-term
services and supports under this subsection by the Commonwealth&#8217;s program
of medical assistance services immediately upon the completion of the functional
screening indicating nursing facility level of care pending the financial
eligibility determination.

H. If an individual seeks enrollment in a program of all-inclusive care for the
elderly (PACE) as defined in &#xA7; 32.1-330.3, qualified staff of the PACE
program may conduct the long-term services and supports screening in accordance
with the requirements established by the Department, with the results certified
by the PACE program&#8217;s physician prior to the initiation of long-term
services and supports under the state plan for medical assistance services. If a
PACE program is unable to complete the long-term services and supports screening
of an individual, the screening teams described in subsection D or the acute
care hospital described in subsection E shall conduct the screening.

I. In any jurisdiction in which a long-term services and supports screening team
described in subsection D or the acute care hospital described in subsection E
has failed or is unable to perform the long-term services and supports
screenings required by subsection D or E within 30 days of receipt of the
individual&#8217;s application or request for long-term services and supports
under the state plan, the Department shall enter into contracts with other
public or private entities to conduct such long-term services and supports
screenings in addition to or in lieu of the long-term services and supports
screening teams described in subsection D or the acute care hospitals described
in subsection E. This subsection shall not apply to the specific circumstances
outlined in subsection D where the qualified staff of a nursing facility or PACE
program agree to conduct such screening.

J. The Department shall require all individuals who perform long-term services
and supports screenings pursuant to this section to receive training on and be
certified in the use of the long-term services and supports screening tool for
eligibility for community or institutional long-term services and supports
provided in accordance with the state plan for medical assistance services prior
to conducting such long-term services and supports screenings.

K. The Department shall report annually by August 1 to the Governor and the
Chairmen of the House Committee on Health and Human Services and the Senate
Committee on Education and Health regarding (i) the number of long-term services
and supports screenings for eligibility for community and institutional
long-term services and supports conducted pursuant to this section and (ii) the
number of cases in which the Department or the public or private entity with
which the Department has entered into a contract to conduct such long-term
services and supports screenings fails to complete such long-term services and
supports screenings within 30 days.

HISTORY: 1984, c. 781; 1990, c. 716; 2003, c. 480; 2014, cc. 285, 413; 2015, c.
542; 2017, c. 749; 2019, c. 430; 2020, cc. 304, 365; 2023, cc. 184, 185; 2024,
cc. 24, 48, 152, 517.