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The Pennsylvania Code website reflects the Pennsylvania Code changes effective through 53 Pa.B. 7346 (November 25, 2023).

55 Pa. Code § 6210.62. Level of care criteria.

§ 6210.62. Level of care criteria.

 (a)  There are three fundamental criteria which shall be met prior to an applicant or recipient qualifying for an ICF/ID level of care. The ICF/ID level of care shall be indicated only when the applicant or recipient:

   (1)  Requires active treatment.

   (2)  Has a diagnosis of an intellectual disability.

   (3)  Has been recommended for an ICF/ID level of care based on a medical evaluation.

 (b)  A physician shall certify the ICF/ID level of care on a form specified by the Department and that ICF/ID services are needed, for each applicant and current ICF/ID resident. Before the facility requests payment from MA, the certification shall have been made at the time of admission, or at the time a resident applied for assistance while in an ICF/ID.

 (c)  For purposes of an ICF/ORC, subsection (a)(2) means a diagnosis of other related condition.


   The provisions of this §  6210.62 amended under section 443.1(2) and (3) of the Human Services Code (62 P.S. §  443.1(2) and (3)).


   The provisions of this §  6210.62 amended June 17, 2016, effective June 18, 2016, 46 Pa.B. 3177. Immediately preceding text appears at serial page (276203).

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