Cal. Code Regs. Tit. 22, § 51120 - Intermediate Care Services
(a) Intermediate care services means services
provided in hospitals, skilled nursing facilities or intermediate care
facilities to patients who:
(1) Require
protective and supportive care, because of mental or physical conditions or
both, above the level of board and care.
(2) Do not require continuous supervision of
care by a licensed registered or vocational nurse except for brief spells of
illness.
(3) Do not have an
illness, injury, or disability for which hospital or skilled nursing facility
services are required.
(b) With respect to services furnished to
individuals under age 65, intermediate care services may include services in a
public institution (or distinct part thereof) for mentally retarded or persons
with related conditions only if:
(1) The
primary purpose of such institution (or distinct part thereof) is to provide a
program of health or rehabilitative services for mentally retarded individuals
and such institutions meet standards as may be prescribed by the United States
Department of Health and Human Services.
(2) The mentally retarded individual with
respect to whom a request for payment is made has been determined to need and
is receiving active treatment under such a program.
(3) Payment for intermediate care services to
any such institution (or distinct part thereof) will not be used to displace
with Federal funds any non-Federal expenditures that are already being made for
mentally retarded persons.
(c) Intermediate care services do not
include:
(1) Services rendered in accordance
with Section
51305, Physician Services; 51306,
Optometry Services; 51307, Dental Services; 51308, Chiropractic Services;
51309, Psychology, Physical Therapy, Occupational Therapy, Speech Therapy, and
Audiology Services; 51310, Podiatry Services; 51311, Laboratory, Radiological,
and Radioisotope Services; 51312, Prayer or Spiritual Healing; 51313,
Pharmaceutical Services and Prescribed Drugs; 51314, Rehabilitation Center
Outpatient Services; 51315, Prosthetic and Orthotic Appliances; 51317,
Eyeglasses, Prosthetic Eyes, and Other Eye Appliances; 51319, Hearing Aids;
51320, Medical Supplies; 51321, Durable Medical Equipment, except as provided
in Section
51321(h) (4);
51323, Medical Transportation Services; 51325, Blood and Blood Derivatives;
51326, Nurse Anesthetist Services; 51327, Inpatient Hospital Services; 51328,
Outpatient Heroin Detoxification Services; 51330, Chronic Hemodialysis;
51330.1, Renal Homotransplantation; 51331, Hospital Outpatient Department
Services and Organized Outpatient Clinic Services; 51337, Home Health Agency
Services; 51340, Early and Periodic Screening Services; and 51341, Short-Doyle
Medi-Cal Provider Services.
(2)
Other equipment and supplies for which prior authorizations have been granted
to other providers by the Medi-Cal Consultant and which are therefore
separately billed by other providers of services; nor
(3) Personal care items and services not
reimbursable by the California Medical Assistance Program as a medical care
service but for which a personal and incidental allowance is
provided.
Notes
2. Certificate of Compliance filed 7-27-72 (Register 72, No. 31).
3. Amendment of subsections (a) and (c)(1) filed 8-8-78; effective thirtieth day thereafter (Register 78, No. 32).
4. Amendment of subsections (a) and (b)(1) filed 6-22-87; operative 7-22-87 (Register 87, No. 27).
Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14110 and 14132, Welfare and Institutions Code.
2. Certificate of Compliance filed 7-27-72 (Register 72, No. 31).
3. Amendment of subsections (a) and (c)(1) filed 8-8-78; effective thirtieth day thereafter (Register 78, No. 32).
4. Amendment of subsections (a) and (b)(1) filed 6-22-87; operative 7-22-87 (Register 87, No. 27).
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