Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-3 - Long-Term Care Facilities; Nursing Facilities; Intermediate Care Facilities for the Individuals with Intellectual Disabilities
Section 5160-3-06 - Criteria for the protective level of care
Universal Citation: OH Admin Code 5160-3-06
Current through all regulations passed and filed through September 16, 2024
(A) This rule describes the criteria for an individual to meet the protective level of care.
(B) The criteria for the protective level of care is met when:
(1)
The
individual's needs for long-term services and supports (LTSS), as defined in
rule 5101:3-3-05 of the Administrative Code, are less than the criteria for the
intermediate or skilled levels of care, as described in paragraphs (B)(4), (C),
and (D)(4) of rule 5101:3-3-08 of the Administrative Code.
(2)
The individual's
LTSS needs are less than the criteria for the ICF-MR-based level of care, as
defined in rule 5101:3-3-05 of the Administrative Code.
(3)
The individual
has a need for:
(a)
Less than twenty-four hour support, as defined in rule
5101:3-3-05 of the Administrative Code, in order to prevent harm due to a
cognitive impairment, as diagnosed by a physician or other licensed health
professional acting within his or her applicable scope of practice, as defined
by law; or
(b)
Supervision, as defined in rule 5101:3-3-05 of the
Administrative Code, of one activity of daily living (ADL), as defined in rule
5101:3-3-05 of the Administrative Code and as described in paragraph (C) of
this rule, or supervision of medication administration, as defined in rule
5101:3-3-05 of the Administrative Code; and
(c)
Assistance, as
defined in rule 5101:3-3-05 of the Administrative Code, with three instrumental
activities of daily living (IADL), as defined in rule 5101:3-3-05 of the
Administrative Code and as described in paragraph (D) of this rule.
(C) For the purposes of meeting the criteria described in paragraph (B)(3) of this rule, an individual has a need in an ADL when:
(1)
The individual
requires supervision of mobility in at least one of the following three
components:
(a)
Bed mobility;
(b)
Locomotion;
or
(c)
Transfer.
(2)
The individual
requires supervision of bathing.
(3)
The individual
requires supervision of grooming in all of the following three
components:
(a)
Oral hygiene;
(b)
Hair care;
and
(c)
Nail care.
(4)
The individual
requires supervision of toileting in at least one of the following four
components:
(a)
Using a commode, bedpan, or urinal;
(b)
Changing
incontinence supplies or feminine hygiene products;
(c)
Cleansing self;
or
(d)
Managing an ostomy or catheter.
(5)
The
individual requires supervision of dressing in at least one of the following
two components:
(a)
Putting on and taking off an item of clothing or
prosthesis; or
(b)
Fastening and unfastening an item of clothing or
prosthesis.
(6)
The individual requires supervision of eating.
(D) For the purposes of meeting the criteria described in paragraph (B)(3) of this rule, an individual has a need in an IADL when:
(1)
The individual
requires assistance with meal preparation.
(2)
The individual
requires assistance with environmental management in all of the following three
components:
(a)
Heavy chores;
(b)
House cleaning;
and
(c)
Yard work and/or maintenance.
(3)
The
individual requires assistance with personal laundry.
(4)
The individual
requires assistance with community access in at least one of the following
three components:
(a)
Accessing transportation;
(b)
Handling
finances; or
(c)
Telephoning.
(5)
The individual
requires assistance with shopping.
Replaces: Part of 5101:3-3-08
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