§ 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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