§ 10 CCR 2505-10-8.402 - ADMISSION PROCEDURES FOR LONG-TERM CARE

  1. § 10 CCR 2505-10-8.402.10 - ADMISSION PROCEDURES FOR CLASS I NURSING FACILITIES
  2. § 10 CCR 2505-10-8.402.30 - ADMISSION PROCEDURES FOR HOME AND COMMUNITY BASED SERVICES
  3. § 10 CCR 2505-10-8.402.40 - ADMISSION TO NURSING FACILITY WITH REFERRAL FOR COMMUNITY SERVICES
  4. § 10 CCR 2505-10-8.402.50 - DENIALS (ALL TARGET GROUPS)
  5. § 10 CCR 2505-10-8.402.60 - CONTINUED STAY REVIEWS: SKILLED AND MAINTENANCE SERVICES

Current through Register Vol. 44, No. 18, September 25, 2021

8.402.01 PRE-ADMISSION REVIEW When a physician or designee wishes to obtain skilled or maintenance services for a client, he/she shall contact the regional URC. The URC will request and record information about the client's condition and the proposed treatment plan.

In order to promote the most appropriate placement of individuals with intellectual or developmental disabilities when skilled or maintenance services are sought, the physician shall, unless an emergency admission is required, refer the client to theCommunity Centered Board (CCB) where the client resides. Class I services shall be authorized by the URC only when the following requirements have been met:

a. The CCB determines, in collaboration with the physician and the client or the client's designated representative, that Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) services or services available through Home and Community Based Services for individuals with Developmental Disabilities (HCBS-DD) are not appropriate to meet the health care needs of the client.
b. ICF/IID or HCBS-DD services are not available if such services are appropriate.
c. The physician and the client or the client's designated representative choose Class I services in preference to services available specifically for individuals with intellectual or developmental disabilities, and the client meets the level of care criteria for these services.

Referrals by physicians of individuals with intellectual or developmental disabilities for Class I services without review by the CCB will not be certified by the URC for Medicaid reimbursement. Clients for whom ICF/IID or HCBS-DD services are appropriate as defined in Section 8.401.18, subject to the physician's and the client's or the client's designated representative concurrence, shall be referred immediately to the URC and to the appropriate Community Centered Board under the provisions at Section 8.405.

8.402.02 After reviewing the information taken from the physician or his designee, the URC shall assign a target group designation based upon the primary reason for which long-term care services are needed. The URC shall follow the target group designations established at Section 8.402.32(A) through 8.402.32(D).

Notes

38 CR 07, April 10, 2015, effective 5/1/2015 43 CR 23, December 10, 2020, effective 12/30/2020

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