37.40.205    PREADMISSION SCREENING, NURSING FACILITY SERVICES

(1) For elderly persons and physically disabled persons, the need for nursing facility service will be determined based upon the following criteria:

(a) The services of a skilled nursing facility (SNF) are needed when a person meets the criteria for skilled care as defined by Title XVIII of the Social Security Act.

(b) The services of an intermediate care facility (ICF) are needed when a person:

(i) does not qualify for skilled nursing facility care; and

(ii) is determined by the department or its designee to need care at a level higher than personal care;

(c) In order to receive home and community services, an applicant must be determined to be at risk of or require care at the intermediate level as determined by the department or its designee through a functional rating of the person. The need for such care is indicated when the person:

(i) is able to ambulate (walk or wheel) to a dining room or equivalent;

(ii) is capable of self care with minimal assistance;

(iii) has four or fewer problems determined to be low level by the department or its designee; and

(iv) requires no more than one-hour of nursing care per 24 hours.

(d) A candidate for discharge is a person who has two or less problems. This criteria does not apply to persons with a diagnosis of mental illness or mental retardation.

(2) For mentally retarded persons applying for the home and community services program, the appropriate nursing facility services will be determined based upon the following criteria:

(a) The services of an intermediate care facility for the mentally retarded (ICF/MR) are needed when a mentally retarded person:

(i) has severe medical problems requiring substantial care, but not to the extent that habilitation is impossible;

(ii) has extreme deficits in self-care and daily living skills which require intensive training; or

(iii) has significant maladaptive social and/or interpersonal behavior patterns which require an on-going, supervised program of intervention.

(b) Skilled nursing facility (SNF) level of care is needed when a person with mental retardation meets the requirements for SNF services as found in (1) (a) of this rule.

History: Sec. 53-2-201, 53-6-113 and 53-6-402, MCA; IMP, Sec. 53-2-201, 53-6-101, 53-6-111 and 53-6-402, MCA; EMERG, NEW, 1989 MAR p. 439, Eff. 4/14/89; TRANS, from SRS, 2000 MAR p. 489.