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VIRGINIA DEPARTMENT OF MEDICAL ASSISTANCE SERVICES NURSING FACILITY ADMISSION, DISCHARGE or LEVEL OF

VIRGINIA DEPARTMENT OF MEDICAL ASSISTANCE SERVICES NURSING FACILITY ADMISSION, DISCHARGE or LEVEL OF 2026

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The document is a form from the Virginia Department of Medical Assistance Services used for communication between nursing facilities and health plans regarding the admission, discharge, or level of care change for Commonwealth Coordinated Care Plus (CCC Plus) members. It includes sections for identification information, reasons for submission, provider summaries, and certification of the individual's status. The form ensures compliance with Medicaid requirements and confidentiality regulations.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date the form is completed in the designated field.
Select the reason for submission by checking the appropriate box: Admission, Discharge, or Level of Care Change.
Fill in the individual's identification information including first name, middle initial, last name, birthdate, gender, Medicaid number, and social security number.
Provide the nursing facility's name and address along with its NPI number.
Enter the admission and discharge dates for the individual as applicable.
Complete the health plan information including name and fax number.
Answer all questions regarding level of care and prior providers as indicated on the form.
Sign and date the form at the bottom to certify that all information is accurate before submitting it via fax to the health plan.

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Versions	Form popularity	Fillable & printable
2019	4 Satisfied (46 Votes)
2019	4.7 Satisfied (33 Votes)

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Who regulates skilled nursing facilities in Virginia?

Division of Long-Term Care Services. The Division of Long Term Care Services is responsible for the licensing and monitoring of nursing homes within state licensing laws and regulations through conducting regular, on-site inspections.

What triggers a level 2 pasrr?

Level 2 care includes Intensive Outpatient (IOP), followed closely by Partial Hospitalization Program (PHP). Usually PHP and IOP programs are both provided at the same location. This may be separate or attached to another level of care.

What is a Level 2 background screening clearance?

Level 2 Background Check Fingerprinting This process involves submitting your fingerprints to be checked against national databases, including the FBIs records. This ensures a thorough review of your criminal history and helps identify any potential issues that might not be visible through other checks.

Does Virginia Medicaid cover skilled nursing facilities?

Virginia Medicaid Long-Term Care Definition Specifically, long-term care Medicaid is covered. In addition to nursing home care, Virginia Medicaid pays for many non-medical support services that help frail seniors remain living in their homes.

What does LTSS screening determine?

LTSS screening means the process to (i) evaluate the functional, nursing, and social supports of individuals referred for screening for certain long-term care services and supports requiring nursing facility eligibility; (ii) assist individuals in determining what specific services the individual needs; (iii) evaluate

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