Please accept these comments to the Emergency/NOIRA stage for the pre-admission screening regulations on behalf of the Virginia Health Care Association-Virginia Center for Assisted Living (VHCA-VCAL), our members’ 30,000 employees, and the 29,000 residents served in our over 280 nursing centers and assisted living facilities. VHCA-VCAL is proud of our role as the Commonwealth’s largest association representing long term care. Our strength, effectiveness, and integrity are significantly enhanced by the diversity of our membership, which includes proprietary, non-profit, and government-operated facilities dedicated to providing the highest quality of care.

Our only comment on the draft regulations is to seek clarification to the new 12VAC30-60-315 language.  This new section provides for community based and nursing facility service providers to conduct ongoing determinations that individuals meet functional needs for Medicaid LTSS.  However, this section also specifies that individuals enrolled in MCOs responsible for the provision of LTSS also conduct such evaluations.  For community providers (DMAS 99 LOC) and nursing facilities (MDS), there are parameters provided to guide these evaluations; for MCO, there are no such parameters other than “qualified MCO staff”.  

Further, as the Commonwealth moves to managed long term services and supports (MLTSS) in the near future, a high percentage (if not all) individuals qualified for LTSS in the community or in a nursing facility will also be enrolled in a MCO; there is no delineation of dual responsibility and hierarchy of the determination of ongoing need.  As written, both the provider and the MCO are responsible for the assessment.  Where there is disagreement, it is not clear which assessment prevails.  This needs to be corrected prior to the launch of MLTSS, and we believe should be delegated to the clinical expertise of the providers who see the patient on a daily basis.

Thank you for the opportunity to comment.  Please direct any questions to Steve Ford, SVP, Policy and Reimbursement, at steve.ford@vhca.org  or (804) 212-1695.