A. As used in this section, “acute care hospital” 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.

Ask a legal question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

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 within 30 days or the individual has requested enrollment in a program of all-inclusive care for the elderly (PACE) as defined in § 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’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’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’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’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 § 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’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’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 home 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.

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.