Fla. Admin. Code Ann. R. 59G-4.180 - Intermediate Care Services
(1)
Purpose. This rule establishes the level of care criteria that must be met in
order for nursing and rehabilitation services to qualify as intermediate care
services and clarifies the criteria that must be met in order for such services
to qualify as an intermediate level I or intermediate level II service under
Medicaid.
(2) Definitions as used
in this section.
(a) Intermediate care
nursing home resident. A Medicaid nursing home applicant or recipient who
requires intermediate care services including 24-hour observation and care and
the constant availability of medical and nursing treatment and care, but not to
the degree of care and treatment provided in a hospital or that which meets the
criteria for skilled nursing services.
(b) Rehabilitation services. Individualized
activities or exercises prescribed by health care professionals that are
designed to restore the recipient to self-sufficiency or to maintain the
recipient at the highest attainable functional level.
(c) Routine. The administration of
medications, treatments, or services in accordance with an established or
predetermined schedule and performed for individuals whose medical needs are
stabilized or chronic.
(3) Intermediate Services criteria.
(a) To be classified as requiring
intermediate care services, level I or level II in the community or in a
nursing facility, the applicant or recipient must require the type of medical,
nursing or rehabilitation services specified in this subsection.
(b) Intermediate Care Services. To be
classified as intermediate care services, the nursing or rehabilitation service
must be:
1. Ordered by and remain under the
supervision of a physician;
2.
Medically necessary and provided to an applicant or recipient whose health
status and medical needs are of sufficient seriousness as to require nursing
management, periodic assessment, planning or intervention by licensed nursing
or other health professionals;
3.
Required to be performed under the supervision of licensed nursing or other
health professionals;
4. Necessary
to achieve the medically desired results and to ensure the comfort and safety
of the applicant or recipient;
5.
Required on a daily or intermittent basis;
6. Reasonable and necessary to the treatment
of a specific documented medical disorder, disease or impairment; and
7. Consistent with the nature and severity of
the individual's condition or the disease state or stage.
(c) When determining whether intermediate
care services are required, consideration shall be given to the nature of the
services prescribed and to which level of nursing or other health care
personnel meets the qualifications necessary to provide such services, the
availability and accessibility of community or alternative resources, and how
the recipient's, applicant's or resident's needs can be most effectively and
efficiently met.
(d) The amount of
care required shall not be a primary factor in determining whether or not an
applicant or resident requires intermediate care services.
(e) To qualify for placement in a nursing
facility, the applicant or recipient must require intermediate care services
including 24 hour observation and care and the constant availability of medical
and nursing treatment and care, but not to the degree of care and services
provided in a hospital or that meets the criteria for skilled
services.
(4)
Intermediate Care Services Level I.
(a)
Intermediate care service level I is extensive health related care and service
required by an individual who is incapacitated mentally or
physically.
(b) Examples of
services that qualify as intermediate care services level I:
1. Administration of routine or stabilized
dosages of oral medication, eye drops or ointments;
2. Routine administration of intramuscular or
subcutaneous medication and observation of the individual's response and side
effects;
3. Administration and
adjustment of medication for pain and the monitoring of results and side
effects;
4. Routine administration
of insulin to a diabetic resident whose condition is stable, but who is unable
to self-administer due to physical, mental or medical reasons;
5. Routine oral suctioning;
6. Tracheostomy care when the individual's
condition is stable, but the individual is unable to care for the tracheostomy
due to physical, mental or medical reasons;
7. Routine intermittent positive pressure
breathing (IPPB) therapy after a regimen of therapy has been established or
therapy is performed by the resident with nursing supervision;
8. Routine care of stoma and surrounding skin
in the presence of colostomy, gastrostomy or ileostomy, excluding the initial
period of training, teaching or intensive care, and special problems, for
example, bleeding, severe diarrhea, or stricture;
9. Routine care of a supra-pubic catheter,
excluding special care in cases of hemorrhage, frequent obstruction, frequent
changes;
10. Routine services to
maintain satisfactory functioning of indwelling bladder catheters, including
routine insertion of catheter and, excluding special care in cases of
infection, hemorrhage, frequent obstruction, frequent changes of the catheter,
irrigations more than two times daily, or the use of special medications for
irrigation and instillation;
11.
Changes of dressings, sterile or aseptic, for noninfected postoperative or
chronic conditions;
12.
Prophylactic and palliative skin care, including bathing and application of
creams, or treatment of minor and noninfected skin problems;
13. Routine care of the incontinent resident,
including the use of diapers and protective sheets;
14. General maintenance care in connection
with a plaster cast;
15. Routine
care in connection with temporary casts, splints, braces or similar devices,
excluding observing for circulatory or skin changes in unstable
cases;
16. Decubitus care involving
superficial, noninfected lesions and preventive measures when a resident is
susceptible to decubitic formation;
17. Bowel and bladder control training and
maintenance after a successful program has been established;
18. Care of a resident with an amputation or
a fracture requiring routine care of a stabilized condition and reinforcement
of an established rehabilitation plan;
19. Use of heat as a palliative and comfort
measure, such as whirlpool and hydrocollator, including the use of special
baths with whirl-type action when not required to be performed by a physical
therapist or licensed nurse;
20.
Routine administration of medical gases after a regimen of therapy has been
established by a physician and is administered by the resident;
21. Assistance or supervision in dressing,
eating and toileting;
22. Periodic
positioning or repositioning;
23.
General supervision of exercises which have been taught to the resident,
including the carrying out of a maintenance program, for example, the
performance of repetitive exercises required to maintain functions in paralyzed
extremities, assisted walking, and similar procedures;
24. Administration of oxygen on an emergency
or short-term basis;
25.
Rehabilitative restorative care, passive range of motion (ROM)
exercise;
26. Routine use of
physical restraints or protective devices; and
27. Routine dietary management.
(c) Intermediate care services
level II is limited health related care and services required by an individual
who is mildly incapacitated or ill to a degree to require medical supervision.
Individuals requiring this level of care shall:
1. Be ambulatory, with or without assistive
devices,
2. Demonstrate
independence in activities of daily living, and
3. Not require the administration of
psychotropic drugs on a daily or intermittent basis or exhibit periods of
disruptive or disorganized behavior requiring 24-hour nursing
supervision.
(d)
Examples of services, in addition to medical supervision, that qualify as
intermediate care level II:
1. Administration
of routine oral medication;
2.
Assistance with mobilization, helping a resident maintain balance when
transferring from bed to chair and providing necessary help when climbing steps
or manipulating wheelchair in difficult places;
3. Assistance with bathing, that is,
assembling towels, soap, and other necessary supplies, helping the recipient in
and out of the bathtub or shower, turning the water on and off, adjusting water
temperature, washing and drying portions of the body which are difficult for
the recipient to reach and being available while the recipient is bathing
himself;
4. Assistance with
dressing, that is, helping the recipient to choose and to put on appropriate
clean clothing, and fastening hooks, buttons, zippers and ties;
5. Assistance with meals, that is, helping
with cutting up food and pouring beverages;
6. Assistance with grooming, that is, helping
the recipient to shave, wash, comb and curl hair, and to clean and file
fingernails and toenails. Fingernails or toenails should not be cut by the
recipient unless approved by the physician;
7. Provision of social and leisure services
which are arranged for and individually designed to reduce isolation and
withdrawal and to enhance communication and social skills;
8. Self-administration of medical gases, oral
medications, subcutaneous medication after a regimen of therapy has been
established and self-administration approved by the physician;
9. Ongoing medical and social evaluations to
determine the point when a recipient's progress has reached the stage at which
medical and related needs can be met appropriately outside of the nursing
facility or through alternative placement or services;
10. Application of dressings and treatments
prescribed by the physician for small or superficial areas requiring a
dressing;
11. Application of
elastic stockings, when prescribed, if the recipient cannot manage
independently;
12. Administration
of oxygen or intermittent positive pressure breathing when prescribed by the
physician and performed by the recipient;
13. Assistance with colostomy care, that is,
helping the recipient care for permanent colostomy which the recipient
ordinarily cares for;
14. Routine
measurement and recording of vital signs and weights, including being alert to
symptoms and readings corresponding to abnormal conditions of the
residents;
15. Routine restorative
and rehabilitation procedures, that is, the encouragement and incorporation of
range of motion exercises in the daily activities schedule.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.