Long-Term Care Facilities - Virginia



I.         Federal

A.       Omnibus Budget Reconciliation Act (OBRA) (details)

B.       United States Code - Title 42 - Ch 7

Binding on CMS and states

Enforced thru CFR and CMS

1.       Medicare

a.        Subchapter XVIII - Part A

i.         SEC 1395I-3 QUALITY OF CARE


2.       Medicaid

a.        Subchapter XIX - Grants

i.         SEC 1396R REQUIREMENTS

C.       Code of Federal Regulations - Title 42 - Ch IV (CFR)

Enforced thru CMS

a.        Subchapter G (TOC)

i.         Part 483 REQUIREMENTS

ii.        Part 488 Survey, Certification, Enforcement

D.       Centers For Medicare and Medicaid Services (CMS)

1.       State Operations Manual (SOM)

a.        Chapter 5 Complaint Procedures

b.       Chapter 7 Facility Survey, Enforcement

c.        Chapter 8 State Standards, Certification

d.       APPENDIX PP GUIDELINES & F-TAGS  (749 page)

Most detailed guidance

2.       Resident Assessment Instrument  (RAI)

Consists of three parts:

a.        Resident Assessment Manual (1,517 pages)

b.       MINIMUM DATA SET (MDS)(data form)

c.        Care Area Assessment MDS-Sec V (CAA)(TOC)

(No mandated format or content)

3.       Facility Assessment

a.        Quality Indicator Survey (QIS)(annual inspection)

Utilizes computer program, onsite input

i.         Outline

ii.        Checklist

iii.      Surveyor Training Manual

b.       Pathways (checklists for 40 subjects)

c.        Quality of Care / Life Indicators (QCLIs)(coding)

4.       Policy & Memos

5.       Quarterly Provider Updates

II.        State

A.       Code of Virginia

1.       Title 32.1 Health

a.        Chapter 5 Facilities & Services (TOC)

i.         Art 1 Licensure and Inspection


2.       Title 54.1 Professions and Occupations,

a.        Chapter 30 Nursing (Registered, Practical, Aides)

b.       Chapter 31 Facility Administrators

B.       Virginia Administrative Code

1.       Title 12 Health

a.        Agency 5 Department of Health

i.         Chapter 215 Data Reporting

ii.        CHAPTER 371 LICENSURE  (TOC)

b.       Agency 30 Medical Assistance Serv. (Medicaid)

i.         Chapter 10 State Plan under Title XIX

ii.        Chapter 50 200 Speech, Hearing, Language

iii.      Chapter 50 270 Hospice

iv.      Chapter 50 320-360 P.A.C.E.

v.        Chapter 130 150 Mental Illness, Retardation

2.       Title 18 Professional and Occupational Licensing

a.        Agency 85 Board of Medicine

i.         Chapter 40 Respiratory Therapists

ii.        Chapter 80 Occupational Therapy

b.       Agency 90 Board of Nursing

i.         Chapter 19 Nursing

ii.        Chapter 21 Medication, Immunization


iv.      Chapter 30 Nurse Practitioners

v.        Chapter 50 Massage Therapists

vi.      Chapter 60 Medication Aides

c.        Agency 95 Board of Care Administrators

i.         Chapter 20 Nursing Home Administrators

d.       Agency 112 Board of Physical Therapy

i.         Chapter 20. Physical Therapy

e.       Agency 140 Board of Social Work

i.         Chapter 20 Social Work

III.      Facility

1.       Required policies and procedures