Current through all regulations passed and filed through September 16, 2024
(A)
This rule describes the criteria for an individual to
meet the nursing facility (NF)-based level of care. The NF-based level of care
includes the intermediate and skilled levels of care. An individual is
determined to meet the NF-based level of care when the individual meets the
criteria as described in paragraphs (B) to (D) of this rule.
(B)
The criteria for
the intermediate 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, exceed the criteria for the protective
level of care, as described in paragraph (B)(3) of rule 5101:3-3-06 of the
Administrative Code.
(2)
The individual's LTSS needs are less than the criteria
for the skilled level of care, as described in paragraph (D)(4) of this
rule.
(3)
The individual's LTSS needs do not meet the criteria
for the ICF-MR-based level of care, as defined in rule 5101:3-3-05 of the
Administrative Code.
(4)
The individual has a need for a minimum of one of the
following:
(a)
Assistance, as defined in rule 5101:3-3-05 of the Administrative Code, with the
completion of a minimum of two activities 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;
(b)
Assistance with the completion of a minimum of one ADL
as described in paragraph (C) of this rule, and assistance with medication
administration, as defined in rule 5101:3-3-05 of the Administrative
Code;
(c)
A minimum of one skilled nursing service or skilled
rehabilitation service, as defined in rule 5101:3-3-05 of the Administrative
Code; or
(d)
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.
(C)
For the purposes
of meeting the criteria described in paragraph (B)(4) of this rule, an
individual has a need in an ADL when:
(1)
The individual
requires assistance with mobility in at least one of the following three
components:
(a)
Bed mobility;
(b)
Locomotion;
or
(c)
Transfer.
(2)
The individual
requires assistance with bathing.
(3)
The individual
requires assistance with grooming in all of the following three
components:
(a)
Oral hygiene;
(b)
Hair care;
and
(c)
Nail care.
(4)
The individual
requires assistance with 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 assistance with 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 assistance with eating.
(D)
The criteria for the skilled level of care is met
when:
(1)
The
individual's LTSS needs exceed the criteria for the protective level of care,
as described in paragraph (B)(3) of rule 5101:3-3-06 of the Administrative
Code.
(2)
The individual's LTSS needs exceed the criteria for
the intermediate level of care as described in paragraph (B)(4) of this
rule.
(3)
The individual's LTSS needs exceed the criteria for
the ICF-MR-based level of care.
(4)
The individual
requires a minimum of one of the following:
(a)
One skilled
nursing service within the day on no less than seven days per week; or
(b)
One
skilled rehabilitation service within the day on no less than five days per
week.
(5)
The individual has an unstable medical condition, as
defined in rule 5101:3-3-05 of the Administrative Code.
(E)
When
an individual meets the criteria for a skilled level of care, as described in
paragraph (D) of this rule, the individual may request placement in an
intermediate care facility for persons with mental retardation (ICF-MR) that
provides services to individuals who have a skilled level of care. When an
individual with a skilled level of care requests placement in an ICF-MR, the
following requirements apply:
(1)
The individual may be determined to meet the criteria
for the ICF-MR-based level of care; and
(2)
The ICF-MR must
provide written certification that the services provided in the facility are
appropriate to meet the needs of an individual who meets the criteria for a
skilled level of care.
Replaces: Part of 5101:3-3-05, 5101:3-3-06
