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The Georgia
Medical Care Foundation determines whether the child meets the Level of
Care. The following page is a list of criteria that they use to see if the
child qualifies.
You need to be sure to document the type of assistance the child needs that
fits into the Intermediate Level of Care Criteria.
The child must need monitoring and overall management of a medical condition
under the direction of a licensed physician.
In addition they must need one other service in Column A and at least one
item from Column B or Column C.
Be sure to specify the child’s need for assistance in daily living
activities. If the family was not providing that support, someone else would
have to.
I always found it helpful to have these criteria so that I was aware of what
they were looking for. Be sure to spell it out clearly in the individual
habilitation plan.
Intermediate Level of Care Criteria
1. Intermediate care services may be provided to an individual with a stable
medical condition requiring intermittent skilled nursing services under the
direction of a licensed physician (Column A Medial Status) AND a mental or
functional impairment that would prevent self-execution of the required
nursing care (Column B and C Mental Status, Functional Status).
2. Special attention should be given to cases where psychiatric treatment is
involved. A patient is not considered appropriate for intermediate care
services when the primary diagnosis or the primary needs of the patient are
psychiatric rather than medical. This individual must also have medical care
needs that meet the criteria for intermediate care facility placement. In
some cases a patient suffering from mental illness may need the type of
services which constitute intermediate care because the mental condition is
secondary to another more acute medical disorder.
3. Requirements: One condition must exist form Column A (medical status),
one from Column B (mental status) or C (functional status) with the
exception of #5, Column C.
COLUMN A
Medical Status
1. Requires monitoring and overall management of a medical condition(s)
under the direction of a licensed physician.
In addition to the criteria listed immediately above, the patient’s specific
medical condition must require any of the following plus one item from
Column B OR C.
2. Nutritional management; which may include therapeutic diets or
maintenance of hydration status.
3. Maintenance and preventive skin care and treatment of skin conditions,
such as cuts, abrasions, or healing decubiti.
4. Catheter care such as catheter change and irrigation
5. Therapy services such as oxygen therapy, physical therapy, speech
therapy, occupation therapy (less than five(5) times weekly).
6. Restorative nursing services such as range of motion exercises and bowel
and bladder training.
7. Monitoring of vital signs and laboratory studies of weights.
8. Management and administration of medications including injections.
COLUMN B
Mental Status
The mental status must be such that the cognitive loss is more than
occasional forgetfulness.
1. Documented short or long-term memory deficits with etiologic diagnosis.
Cognitive loss addressed on MDS/care plan for continued placement.
2. Documented moderately or severely impaired cognitive skills with
etiologic diagnosis for daily decision making. Cognitive loss addressed on
MDS/care plan for continued placement.
3. Problem behavior, i.e., wandering, verbal abuse, physically and/or
socially disruptive or inappropriate behavior requiring appropriate
supervision or intervention.
4. Undetermined cognitive patterns which cannot be assessed by a mental
status exam, for example, due to aphasia.
COLUMN C
Functional Status
One of the following conditions must exist (with the exception of #5).
1. Transfer and locomotion performance of resident requires
limited/extensive assistance by staff through help or one person physical
assist.
2. Assistance with feeding. Continuous stand-by supervision, encouragement
or cueing required and set-up help of meals.
3. Requires direct assistance of another person to maintain continence.
4. Documented communication deficits in making self understood or
understanding others. Deficits must be addressed in medical record with
etiologic diagnosis addressed on MDS/care plan for continued placement.
5. Direct stand-by supervision or cueing with one person physical assistance
from staff to complete dressing and personal hygiene. (If this is the only
evaluation of care identified, another deficit in functional status is
required.)
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A special needs
trust is the only estate planning option that protects assets, enables the
beneficiary to receive goods and services from the estate, and still
preserves eligibility for government benefits. |
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