Proposed Text
CHAPTER 200
REGULATIONS FOR RESPITE AND EMERGENCY CARE ADMISSION TO MENTAL
RETARDATION FACILITIES STATE TRAINING CENTERS
12VAC35-200-10. Definitions.
The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Applicant" means a person for whom respite care
or emergency care services are sought.
"Authorized representative" means a person permitted by law or regulations to authorize the disclosure of information or consent to treatment and services, including medical treatment, or for the participation in human research on behalf of an individual who lacks the mental capacity to make these decisions.
"Case management community services board (CSB)" or
"CSB" means a citizens board established pursuant to §37.1-195 §37.2-501
of the Code of Virginia that serves the area in which an adult resides or in
which a minor''s parent, guardian or legally authorized representative resides. The
case management CSB is responsible for case management, liaison with the
facility when an individual is admitted to a state training center, and
predischarge planning. If an individual, or the parents, guardian or legally
authorized representative on behalf of an individual, chooses to reside in a
different locality after discharge from the facility, the community services
board serving that locality becomes the case management CSB and works with the
original case management CSB, the individual receiving services and the state
facility to effect a smooth transition and discharge. For the purpose of
these regulations, CSB also includes a behavioral health authority established
pursuant to §37.2-602 of the Code of Virginia.
"Catastrophe" means an unexpected or imminent
change in an individual''s living situation or environment that poses a risk of
serious physical or emotional harm to that individual.
"Commissioner" means the Commissioner of the Department of Mental Health, Mental Retardation and Substance Abuse Services.
"Discharge plan" or "predischarge plan"
means a written plan prepared by the case management CSB in consultation with
the state facility pursuant to §37.1-197.1 §37.2-505 of the Code
of Virginia. This plan is prepared when the individual is admitted to the
facility and documents the planning for services after discharge.
"Emergency care admission" means the temporary
placement of an individual with mental retardation in a facility when immediate
care is necessary due to a catastrophe and no other community
alternatives are available. The total number of days that emergency or
respite care services, or both, are used shall not exceed 21 consecutive days
or 75 days in a calendar year. This emergency care is not intended as a means
of providing evaluation and program development services, nor is it intended to
be used to obtain treatment of medical or behavioral problems.
"Facility" means a state training center for individuals with mental retardation under the supervision and management of the Commissioner of the Department of Mental Health, Mental Retardation and Substance Abuse Services.
"Guardianship Guardian" means:
1. For minorsAn an adult who is either
appointed by the court as a legal guardian of said a minor or
exercises the rights and responsibilities of legal custody by delegation from a
biological or adoptive parent upon provisional adoption or otherwise by
operation of law.
2. For adultsa person appointed by the court who is
responsible for the personal affairs of an incapacitated adult under the order
of appointment. The responsibilities may include making decisions regarding the
individual''s support, care, health, safety, habilitation, education and
therapeutic treatment. Refer to definition of "incapacitated person"
at §37.1-134.6 §37.2-1000 of the Code of Virginia.
"Individual" means a person for whom respite or emergency services are sought.
"Least Less restrictive setting" means
the treatment and conditions of treatment that, separately or in
combination, are service location that is no more intrusive or
restrictive of freedom than reasonably necessary to achieve a substantial
therapeutic benefit and protection from harm (to self and others) based on an
individual''s needs.
"Legally authorized representative" means a
person permitted by law or regulations to give informed consent for disclosure
of information and give informed consent to treatment including medical
treatment on behalf of an individual who lacks the mental capacity to make
these decisions.
"Mental retardation" means the substantial
subaverage general intellectual functioning that originates during the
developmental period and is associated with impairment in adaptive behavior
a disability, originating before the age of 18 years, characterized
concurrently by (i) significantly subaverage intellectual functioning as
demonstrated by performance on a standardized measure of intellectual
functioning, administered in conformity with accepted professional practice,
that is at least two standard deviations below the mean; and (ii) significant
limitations in adaptive behavior as expressed in conceptual, social, and
practical adaptive skills.
"Respite care" means the placement of an
individual with mental retardation in a state facility when placement is solely
for the purpose of providing temporary care and supports to an
individual with mental retardation because of medical or other urgent
conditions of the caretaking person providing care. The total
number of days that respite or emergency care services, or both, are used is
not to exceed 21 consecutive days or 75 days in a calendar year. Respite care
services are not intended as a means of providing evaluations and program
development services, nor are they intended to be used to obtain treatment of
medical or behavioral problems or both.
Statutory Authority
§§37.1-10 and 37.1-65.2 of the Code of Virginia.
Historical Notes
Derived from VR470-07-02 §1, eff. December 20, 1980; amended, Virginia Register Volume 18, Issue 16, eff. May 22, 2002.
12VAC35-200-20. Respite care admission.
A. Applications for respite care in state facilities
shall be processed through the case management CSB. A parent, guardian, or legally
authorized representative seeking respite care services for an
individual with mental retardation shall apply first to the CSB that serves the
area where the applicant individual, or if a minor, his
parent, or guardian, or legally authorized representative
is currently residing. If the case management CSB determines that
respite care services for the applicant individual are not
available in the community, it shall forward an application to the facility
serving individuals with mental retardation from that geographic section of the
state in which the applicant individual or his parent, or
guardian, or legally authorized representative is currently residing.
The application shall include:
1. An application for services;
2. A medical history indicating the presence of any current medical problems as well as the presence of any known communicable disease. In all cases, the application shall include any currently prescribed medications as well as any known medication allergies;
3. A social history and current status;
4. A psychological evaluation that has been performed in
the past three years unless the facility director or designee determines that
sufficient information as to the applicant''s abilities and needs is included in
other reports received reflects the individual's current functioning;
5. A current individualized education plan for school aged applicants
individuals unless the facility director or designee determines that
sufficient information as to the applicant''s individual's
abilities and needs is included in other reports received;
6. A vocational assessment for adult applicants adults
unless the facility director or designee determines that sufficient information
as to the applicant''s individual's abilities and needs is
included in other reports received;
7. A statement from the case management CSB that
respite care services for the applicant individual are not
available in the community; and
8. A statement from the case management CSB that the
appropriate arrangements will be are being made to return the
individual to the CSB within the time frame required under this regulation;
and
9. A statement from the individual, a family member, or authorized representative specifically requesting services in the facility.
B. Determination of eligibility for respite care
services shall be based upon the following criteria:
1. The applicant individual has a primary
diagnosis of mental retardation and functions on a level that meets the
facility''s regular admission criteria;
2. The applicant''s individual's needs for
care and supervision are such that, in the event of a need for temporary
care, respite care services would not be available in a less restrictive
setting; and
3. The facility has appropriate resources to meet the care
and supervision needs of the applicant individual.
Within a reasonable time of the receipt of the completed
application By the end of the next working day following receipt of a
complete application package, the facility director, or his
designee, shall provide written notice of his decision to the case
management CSB. This notice shall state the reasons for the decision.
If it is determined that the applicant individual
is not eligible for respite care, the person seeking respite care
services may ask for reconsideration of the decision by submitting a written
request for such reconsideration to the commissioner. Upon receipt of such
request, the commissioner or designee shall notify the facility director
and the facility director shall forward the application packet and related
information to the commissioner or designee within 48 hours. The
commissioner or designee shall also provide an opportunity for
the person seeking respite care services to submit for
consideration any additional information or reasons as to why the admission
should be approved. The commissioner shall render a written decision on the
request for reconsideration within 10 days of the receipt of such request and
notify all involved parties. The commissioner''s decision shall be binding.
C. Respite care is shall be provided in state
facilities under the following conditions:
1. The length of the respite care stay at the facility
shall not exceed 21 consecutive days or a total of 75 days in a calendar
year the limits defined in §37.2-807 of the Code of Virginia;
2. Information on file at the facility is current;
3. 2. Space and adequate staff coverage are
available on a unit with an appropriate peer group for the applicant individual
and suitable resources to meet his care and supervision needs; and
4. 3. A physical examination performed by the facility''s
health service personnel at the time of the respite care admission has
determined that the applicant''s individual's health care needs
can be met by the facility''s resources during the scheduled respite care
stay.
If for any reason a person admitted for respite care
services is not discharged at the agreed upon time, the case management
CSB shall develop a an updated discharge plan as provided in §§37.1-98
and 37.1-197.1 §§37.2-837 and 37.2-505 of the Code of Virginia.
Respite care shall not be used as a mechanism to
circumvent the standard admissions procedures as provided in §37.1-65.1 §37.2-806
of the Code of Virginia. No person who is admitted to a training center in
response to under the provisions of this chapter shall, during the
time of such respite care admission, be eligible for admission to any
training center in response to §37.1-65.1 under §37.2-806 of the
Code of Virginia.
Statutory Authority
§§37.1-10 and 37.1-65.2 of the Code of Virginia.
Historical Notes
Derived from VR470-07-02 §2, eff. December 20, 1980; amended, Virginia Register Volume 18, Issue 16, eff. May 22, 2002.
12VAC35-200-30. Emergency care admission.
A. In the event of a catastrophe change in an
individual's circumstances necessitating immediate, short-term care for an
individual with mental retardation, emergency care admission may be
requested by a parent, guardian, or legally authorized representative by
calling the case management CSB. If the case management CSB
determines that respite care services for the applicant individual
are not available in the community, it may request an emergency admission to
the facility serving that geographic area in which the applicant individual,
or in case of a minor, his parent, or guardian, or
legally authorized representative resides.
The case management CSB shall make every effort to
obtain the same case information required for respite care admissions,
as described in 12VAC35-200-20 A, before assuming responsibility for the care
of the individual in need of emergency services. However, if the information is
not available, this requirement may temporarily be waived if, and only if,
arrangements have been made for receipt of the required information within 48
hours of the emergency care admission.
B. Acceptance for emergency care admissions admission
shall be based upon the following criteria:
1. A catastrophe change in the individual's
circumstances has occurred requiring immediate alternate arrangements to
protect the individual''s health and safety;
2. The individual has a primary diagnosis of mental
retardation and functions on a level that meets the facility''s regular
admissions criteria;
3. All other alternate care resources in the community have been explored and found to be unavailable;
4. Space is available on a unit with appropriate resources to
meet the individual''s care and supervision needs;
5. The facility''s health services personnel have determined that the individual''s health care needs can be met by the facility''s resources; and
6. The length of the emergency care stay at the
facility will not exceed 21 consecutive days or a total of 75 days in a
calendar year the limits defined in §37.2-807 of the Code of Virginia.
C. Within 24 hours of receiving a request for emergency care
admission, the facility director, or his designee, will inform
the case management CSB whether the applicant individual
is eligible for emergency care and whether the facility is able to provide
emergency care services.
If the facility is able to provide emergency care
services, arrangements shall be made to effect the admission as soon as
possible.
If the facility is unable to provide emergency care services
to an eligible applicant individual, the facility director or
designee shall provide written notice of this determination to the case
management CSB and may offer to try to obtain emergency care services
from another appropriate facility.
If for any reason a person admitted to a facility for
emergency care services is not discharged at the agreed upon
time, the case management CSB shall develop a discharge plan as provided
in §§37.1-98 and 37.1-197.1 §§37.2-505 and 37.2-837 of the Code
of Virginia.
Statutory Authority
§§37.1-10 and 37.1-65.2 of the Code of Virginia.
Historical Notes
Derived from VR470-07-02 §3, eff. December 20, 1980; amended, Virginia Register Volume 18, Issue 16, eff. May 22, 2002.