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DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES AUXILIARY GRANT PROGRAM NON-FINANCIAL REQUIREMENTS 07/19 CHAPTER C, PAGE 22 Assessors use the “Uniform Assessment Instrument” (UAI) to record the outcomes of their assessments. Assessors use the “Medicaid Funded Long-term Care Service Authorization (DMAS-96)” to notify the eligibility worker of the results of the initial assessments and the “Eligibility Communication Document” to notify them of the results of the annual redeterminations. https://www.virginiamedicaid.dmas.virginia.gov https://fusion.dss.virginia.gov

6.2.4 Procedures 6.2.4.1 Intake The eligibility worker must have a copy of a “Medicaid Funded Long-term Care Service Authorization (DMAS-96)” in the case record to substantiate that the individual’s screening is in a current status. The worker does not need a copy of the UAI. 6.2.4.1.1 The DMAS 96 Must: • Be signed by the assessor. • For new residents, have been completed within 90 days prior to admission to the ALF. • State that the “Medicaid Authorization Level of Care” is “11 = ALF Residential Living”, “12 = ALF Regular Assisted Living”. 6.2.4.2 Ongoing The eligibility worker must have a copy of the “Eligibility Communication Document” in the case record to substantiate that the individual’s screening is in a current status. 6.2.4.2.1 “Eligibility Communication Document” Must: • Be signed by the person that conducted the assessment. • Have been completed within 12 months prior to the redetermination month. 6.2.5 Current Assessment Not On File