LTSS Screening Virginia — The UAI Assessment and How to Prepare

Before your parent can receive Medicaid-funded long-term care in Virginia — whether in a nursing home or through the CCC Plus waiver at home — they must pass a clinical screening that proves they need nursing facility level of care. This screening uses a standardized tool called the Uniform Assessment Instrument (UAI), and how your parent presents during the assessment directly affects whether they qualify.

What the LTSS Screening Is

The Long-Term Services and Supports (LTSS) screening, also called Pre-Admission Screening (PAS), is Virginia's clinical gatekeeping process. A two-person team — a social worker from the local Department of Social Services and a nurse from the local Health Department — conducts an in-person evaluation of your parent.

The screening can be requested through:

• The local DSS office
• The local Health Department
• A hospital discharge planner (if your parent is currently hospitalized)

If your parent is in the hospital after a fall, stroke, or acute medical event, ask the discharge planner to initiate the PAS before discharge. This is faster than requesting it independently and ensures clinical documentation from the hospital stay is immediately available to the screening team.

What the UAI Evaluates

The Uniform Assessment Instrument is a multi-page form that assesses your parent across several domains:

Activities of Daily Living (ADLs): The screener evaluates your parent's ability to perform bathing, dressing, toileting, transferring (moving from bed to chair), eating, and ambulation. For each ADL, they note whether your parent can perform it independently, needs hands-on assistance, or is fully dependent.

Cognitive function: The screener assesses orientation (does the parent know the date, where they are, who is around them), short-term memory, and decision-making ability. If your parent has a dementia diagnosis, bring the medical records — the screener will document the diagnosis but also observe behavior during the visit.

Medical conditions: Current diagnoses, medication management needs, and clinical stability. A parent who requires skilled nursing interventions (wound care, IV therapy, catheter management) has a stronger case for nursing facility level of care.

Behavioral issues: Wandering, aggression, resistance to care, and safety risks. For a parent with Alzheimer's or other dementia, these behavioral factors often determine whether home-based care is feasible or facility placement is necessary.

Sensory function: Vision, hearing, and speech limitations that affect the parent's ability to live independently.

How to Prepare for the Assessment

The screening is not a test your parent can study for, but how the family prepares matters enormously.

Document the worst days, not the best. The screener sees your parent for one visit — typically 60–90 minutes. If your parent has good days and bad days (common with dementia, Parkinson's, or chronic pain), the screener may catch them on a good day and underestimate their needs. Before the visit, write down specific incidents: falls in the last 6 months, times your parent left the stove on, wandering episodes, times they could not get out of bed without help.

Bring medical records. Hospital discharge summaries, the primary care physician's notes on functional limitations, specialist reports (neurologist for dementia, orthopedist for mobility issues), and any occupational or physical therapy evaluations. The screener relies partly on observation and partly on documentation.

Do not coach your parent to perform better. This is the most common mistake families make. A parent who insists they can bathe independently — when the family knows they have not bathed unassisted in months — may screen out of eligibility. Be honest with the screener about your parent's actual daily capabilities, even if it is uncomfortable to discuss in front of them.

Have the primary caregiver present. The person who provides daily care knows the parent's limitations better than anyone. The screener will interview both the parent and the caregiver.

What Happens After the Screening

If the screening confirms nursing facility level of care, the authorization is documented on Form DMAS-96. This clinical authorization is valid for:

• 180 days for community-based services (CCC Plus waiver)
• 365 days for institutional placement (nursing home)

If services do not begin within those windows, the screening expires and must be redone. Do not let the authorization lapse — if your parent is waiting for a Medicaid application to be processed, keep the timeline in mind.

If the screening finds that your parent does not meet nursing facility level of care, you can request a new screening if their condition deteriorates. There is no formal appeal process for the clinical screening itself, but a denial of Medicaid coverage based on the screening can be appealed through DMAS within 30 days.

The Virginia Medicaid Long-Term Care & Asset Protection Guide includes a UAI preparation checklist and documentation worksheet to help families present the most accurate picture of their parent's care needs during the screening.

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