How to Fill Out the Virginia UAI Form: Care Levels and Appeals

The Virginia UAI form, formally the Uniform Assessment Instrument, is a standardized evaluation of a person’s physical, mental, and social functioning used before admission to an assisted living facility, a nursing home, or a Medicaid home and community-based waiver such as CCC Plus.¹ If Medicaid or the Auxiliary Grant will pay for the care, you do not fill the form out yourself. You call your local Department of Social Services and request a Long-Term Services and Supports (LTSS) screening; a nurse and social worker then visit in person, complete the UAI, and submit it, generally within 30 calendar days of your request.²

Who Has to Be Assessed

Every person applying to or living in a Virginia assisted living facility must have a UAI on file, no matter who is paying.¹ The same requirement applies to anyone seeking Medicaid-funded nursing facility admission or Medicaid waiver services delivered at home.²

Who is allowed to complete the form depends on how the care is paid for.

For public pay, meaning Medicaid or Auxiliary Grant funding, a qualified assessor or case manager from a public human services agency has to complete the UAI. The local DSS benefits worker tells the applicant about the requirement before admission and helps coordinate the screening.³

For private pay, the assisted living facility can complete the UAI through trained staff, or an independent physician or public agency assessor can do it. The facility administrator or designee has to approve and sign the finished form. A private-pay resident can still ask a public agency assessor to complete the UAI if they prefer. The form must be completed no more than 90 days before admission, and if the person’s condition changes in a way that would affect the admission, a new assessment is required.¹

How to Request the Screening

Call your local Department of Social Services and ask for an LTSS screening. The same entry point applies whether you are pursuing nursing facility placement, an Auxiliary Grant-funded assisted living stay, or CCC Plus Waiver services in the home.⁴ If the person is currently in the hospital, a discharge planner can start the screening at the bedside instead.

After you make the request, the screening team has to contact you within seven calendar days to schedule the visit. The whole screening has to be completed and submitted within 30 calendar days of your request date.² Refusing the screening ends the process; Medicaid cannot determine eligibility for long-term services without it and will not pay for those services.

What the Assessment Covers

There are two versions of the UAI. A short form is used for assisted living assessments when the person meets a residential level of care. A full assessment, which adds several sections on top of the short form, is used for preadmission screening and whenever someone needs an assisted living level of care.⁵ The full form has four content areas: identification and background, functional status, physical health, and psychosocial status.

Activities of Daily Living

The functional status section rates seven activities of daily living: bathing, dressing, toileting, transferring between bed and chair, eating, continence, and walking or moving around.⁵ Each one is scored as independent, semi-dependent, or dependent. These scores feed directly into the care level determination, so specifics matter. “Needs someone to steady her getting in and out of the tub” is more useful than “needs help bathing.”

Instrumental Activities of Daily Living

Instrumental activities of daily living cover the more complex tasks of running a household: preparing meals, managing medications, housekeeping, laundry, and handling money.⁶ Someone who can dress and bathe alone but cannot safely manage pills or cooking may still need structured support.

Behavior and Cognition

The full assessment records wandering, agitation, resistance to care, and difficulty recognizing familiar people and places. Memory loss, confusion, and impaired judgment factor into the behavior pattern and orientation ratings, which weigh heavily in whether a person qualifies for nursing facility care.

Physical Health

This section captures current diagnoses, medications, vision and hearing, skin conditions including pressure sores, and whether the person’s medical or nursing needs go beyond basic assistance with daily activities. That threshold is met when the condition requires ongoing observation, when multiple interrelated conditions create a high risk of instability, or when at least one continuous medical or nursing service is needed.⁷

How to Prepare for the Visit

The screening team gathers information during a single face-to-face visit, so having documents and details ready makes the results faster and more accurate. Useful things to have on hand:

Current diagnoses, a full medication list with dosages, and records of recent hospitalizations or emergency visits.
Specific examples of what the person can and cannot do: how often incontinence occurs, whether they can get out of bed unassisted, how many falls in the last few months.
Any documentation of memory loss, wandering, agitation, or a formal dementia diagnosis, including caregiver notes on behavioral changes.
A picture of current care: who helps now, for how many hours a day, and where the gaps are.

Families sometimes understate difficulties out of habit or pride. That can produce a care level lower than the person actually needs. Be concrete, and describe bad days as well as good ones.

The Visit and Submission

For adults living in the community, a community-based team conducts the screening. The team consists of a nurse, social worker, or other state-designated assessor together with a physician, drawn from the local health department or local DSS.⁸ For someone already in the hospital, the hospital’s designated team handles it. For children, a DMAS designee does the assessment.

If the person is out of state or hazardous travel makes an in-person visit impossible, the screening can be done by video conferencing. In that case, the assessor has to review the UAI with the individual within seven working days of admission to confirm it is accurate.³

After the visit, the team enters the completed UAI and supporting forms into Virginia’s electronic Medicaid Long-Term Services (eMLS) system. You will then receive a notification letter along with the full screening packet. The packet contains the authorization form (DMAS-96) that confirms your approved level of care, the Level I PASRR screen, and documentation of the services you chose. Only that packet with the DMAS-96 authorizes services; the notification letter alone does not.²

For home and community-based waiver services, enrollment has to happen within one year of the screening. Miss that window and a new screening is required.²

Care Levels That Come Out of the UAI

The UAI produces a care level determination that controls what Medicaid will authorize. The two main outcomes are nursing facility level of care and assisted living level of care.

Nursing facility level of care requires both a functional threshold and a medical or nursing needs threshold. The functional threshold is met through specific combinations of ADL dependency ratings; one example is being rated dependent in at least two ADLs while also being semi-dependent or dependent in behavior pattern and orientation, and semi-dependent or dependent in joint motion, or dependent in medication administration. Another is dependency in five to seven ADLs together with dependency in mobility. Beyond that, the person also has to have medical or nursing needs that go past what basic ADL assistance and general supervision can address.⁷

Assisted living level of care means the person needs help with daily activities but not round-the-clock nursing supervision. This level supports placement in an assisted living facility, often paid for through the Auxiliary Grant program, which supplements income for people who receive or would qualify for Supplemental Security Income.⁹

One federal add-on runs alongside the UAI for nursing facility applicants. The Preadmission Screening and Resident Review (PASRR) Level I screen, built into Virginia’s LTSS packet, flags possible serious mental illness or intellectual disability; if either is flagged, a separate Level II evaluation follows to decide whether a nursing facility is the right setting.¹⁰

Reassessments

The UAI is not a one-time event. Virginia requires a reassessment at least once a year, and any time a significant change in the person’s condition occurs.³ A change is “significant” when it is expected to last 30 days or more and represents a meaningful shift in the person’s functional abilities or care needs.⁵

Reassessments can move the authorized care level in either direction. If you notice a lasting decline, such as more falls, worsening confusion, or new incontinence, contact the facility or case manager to request a reassessment rather than waiting for the annual review.

If You Disagree With the Care Level

Your notification letter has to include appeal rights.² Under federal Medicaid rules, any notice that denies, reduces, or terminates services must explain the reasons, provide access to the records and criteria used, and describe how to challenge the decision.¹¹

For CCC Plus enrollees, the path usually starts with an internal appeal through the managed care organization. If the MCO upholds the original decision, you can request a State Fair Hearing through DMAS within 120 days of the MCO’s final decision. DMAS generally issues a decision within 90 days, or within 72 hours if you request an expedited review because the standard timeline could jeopardize the person’s health. To keep services running during the appeal, you have to request the hearing within 10 days of the MCO’s decision and specifically ask that services continue. Appeals can be filed by email at appeals@dmas.virginia.gov, through the DMAS online appeals portal, by fax at (804) 452-5454, or by mail to the Appeals Division, Department of Medical Assistance Services, 600 E. Broad Street, Richmond, VA 23219.

1
Virginia Code Commission. Virginia Administrative Code 22VAC40-73-440 – Uniform Assessment Instrument (UAI)
2
Virginia Department of Medical Assistance Services. Screening Manual for Medicaid-Funded Long-Term Services and Supports (LTSS)
3
Virginia Code Commission. Virginia Administrative Code 22VAC30-110-20 – Individuals to Be Assessed
4
Virginia Medicaid. CCC Plus Waiver
5
Department for Aging and Rehabilitative Services. User’s Manual: UAI
6
Virginia Code Commission. Virginia Administrative Code 22VAC30-110 – Assessment in Assisted Living Facilities
7
Virginia Code Commission. Virginia Administrative Code 12VAC30-60-303 – Screening Criteria for Medicaid-Funded Long-Term Services and Supports
8
Virginia Regulatory Town Hall. Virginia Administrative Code 12VAC30-60 – Standards Established and Methods Used to Assure High Quality Care
9
Virginia Code Commission. Virginia Administrative Code 22VAC30-110 – Assessment in Assisted Living Facilities
10
Medicaid. Preadmission Screening and Resident Review
11
eCFR. Timely and Adequate Notice of Adverse Benefit Determination