Level of Care Determinations for Members who are expected to always meet Nursing Facility Level of Care.
4.1.3.1 If the CONTRACTOR determines that the Member meets ongoing nursing facility level of care based on criteria prescribed by HSD and outlined in the Managed Care Policy Manual, the CONTRACTOR shall approve an ongoing NF LOC for the Member and will not annually assess the Member for NF LOC.
4.1.3.2 The CONTRACTOR is required to perform a CNA and develop an annual care plan for these Members as described in Sections 4.4.5 and 4.4.9.
4.1.3.3 The CONTRACTOR shall monitor the ongoing NF LOC status of Members, and report to HSD as required.
Level of Care Determinations. The Medical Director or designee, in consultation with the Village Director or designee, will determine your care needs, your appropriate level of care placement and whether such placement is temporary or permanent, in consultation with you, your family or responsible party and your physician.
Level of Care Determinations for Members who are expected to always meet NF LOC
4.1.3.1 If the CONTRACTOR determines that the Member meets ongoing NF LOC based on criteria prescribed by HCA and outlined in the Managed Care Policy Manual, the CONTRACTOR shall approve an ongoing NF LOC for the Member and will not annually assess the Member for NF LOC.
4.1.3.2 The CONTRACTOR is required to perform a CNA and develop an annual care plan for these Members as described in Sections 4.4.5 and 4.4.9 of this Agreement.
4.1.3.3 The CONTRACTOR shall monitor the ongoing NF LOC status of Members, and report to HCA as required.
Level of Care Determinations. Initial level of care determinations will be conducted by hospitals and local Pre-Admission Screening Teams that are contracted through the Virginia Departments of Health and Social Services. Participating Plans must ensure that Level of Care (LOC) annual reassessments are conducted timely for EDCD Waiver participants (minimum within 365 days of the last annual reassessment) Participating Plans will need to conduct annual face-to-face assessments (functional) for continued eligibility for the EDCD Waiver and establish criteria for reassessments resulting from a health status change (the triggering events that precipitate a need for reassessment, including a change in the ability to perform activities of daily living and instrumental activities of daily living). The LOC annual reassessment must include all the elements on the DMAS 99-C LOC Review Instrument for individuals who are in the EDCD Waiver who have a change in status (available at: xxxxx://xxx.xxxxxxxxxxxxxxxx.xxxx.xxxxxxxx.xxx/wps/portal). LOC annual reassessments for EDCD Waiver participants must be performed by providers with the following qualifications: (i) a registered nurse licensed in Virginia with at least one year of experience as an RN; (ii) a social worker; or (iii) an individual who holds at least a bachelor's degree in a health or human services field and has at least two years of experience working with individuals who are elderly and/or have disabilities. Participating Plans must ensure that LOC annual reassessments are conducted timely (minimum within one year of the last assessment) for nursing facility residents and work with nursing facilities to conduct these annual assessments (functional) for continued nursing facility placement. Participating Plans must communicate annual LOC reassessment data for EDCD Waiver participants and nursing facility residents to DMAS in a timely manner.
