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R-15-98E

INTERMEDIATE CARE FACILITY SERVICES FOR DEVELOPMENTALLY
 DISABLED (ICF/DD) AND INTERMEDIATE CARE FACILITIES FOR
 DEVELOPMENTALLY DISABLED HABILITATIVE (ICF/DDH)

I. Criteria for Determining Admission to ICFs/DD

Criteria for admissions to ICFs/DD are contained in state regulations (Title 22. CCR, Section 51343) and are applied on a statewide basis. The criteria for admission are as follows:

A. To qualify for ICF/DD services, persons shall meet the definition for developmental disability as defined in Title 22. CCR. Section 51 164.

B. Services are limited to those persons who require and will benefit horn services provided pursuant to the provisions of Sections 76301 through 76413. In determining the need for ICF/DD services, the following criteria shall be considered:

1. The complexity of the patient's medical problems is such that the patient requires skilled nursing care or observation on an ongoing intermittent basis and 24-hour supervision to meet the patient's health needs.

2. Medications may be mainly supportive or stabilizing but still require professional nurse observation for response and effect on an intermittent basis.

3. The extent of the patient's psychosocial and developmental service needs shall be determined.

4. The patient's need for specialized developmental, training, and habilitative program services which are not available through other levels of care shall be determined.

5. The extent to which provision of specialized developmental, training and habilitative program services shall be determined as to how they can reasonably be expected to result in a higher level of functioning and lessening dependence on others in carrying out daily living activities.

6 The patient shall have a qualifying developmental deficit in either a self-help area or social-emotional area as follows:
a. A qualifying developmental deficit shall be determined in the self-help skill area if the patient has two moderate or severe skill task impairments from a combination of the following defined assessment items:
(1) Eating
(a) Does not feed self, requires assistance.
(b) Attempts to feed self with fingers or spoon, but may require assistance.

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(2) Toileting
(a) Not toilet trained or habit trained.
(b) Is habit trained.
(c) Indicates need to toilet self, but requires assistance.
(d) Goes to toilet by self, but requires assistance to complete toileting.

(3) Bladder Control
(a) No bladder control.
(b) Some bladder control, occasional accidents during waking hours (once a week or more)
(c) Wets bed at night.

(4) Dressing
(a) Does not dress.
(b) Puts on some clothes by self, or assists when being dressed.

b. A qualifying developmental deficit shall be determined in the social-emotional area if the patient exhibits two moderate or severe impairments from a combination of the following defined assessment items:

(1) Social behavior. including but not limited to stealing, excessive screaming. teasing. lying, hugging, etc.
(a) Participation in group activities is often prevented or disrupted by unacceptable social behavior.

(2) Aggression
(a) Has had violent episodes which have caused serious physical injury in past year.
(b) Has had violent episodes which have caused minor physical injury in past year.
(c) Has not caused physical injury in past year, but often resorts to verbal abuse and threats.

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(3) Self-injurious behavior, including but not limited to biting, scratching, putting inappropriate objects into ear, mouth, etc.
(a) Self-injurious behavior causes severe injury which requires physician attention at least once per year.
(b) Self-injurious behavior requires first aid at least once a month or self injurious behavior which requires physician attention at least once per year.

(4) Smearing
(a) Smears at every opportunity.
(b) Smears at least once a week.
(c) Smears but does so infrequently

(5) Destruction of Property
(a) Serious property damage has occurred at least once in the past year.
(b) Minor properly damage has occurred twice or more in the past year.

(6) Running or Wandering Away
Running or wandering away occurs at least monthly unless prevented.

(7) Temper Tantrums or Emotional Outbursts
Temper tantrums are displayed at least once a month.

II. Criteria for Determining admission to ICFs/DDH
Criteria for admission to ICFs/DDH are contained in state regulations (Title 22, CCR, Section 51343) and are applied on a statewide basis.

A. To qualify for ICF/DDH services, persons shall meet the definition for developmental disability as defined in Tine 22, CCR, Section 51164.

B. Services are limited to those persons who require and will benefit from services provided pursuant to the provisions of Title 22, CCR, Sections 76853 through 76906.

C. In determining the need for ICF/DDH services, the criteria in Part I, ICF/DD Services, apply except that patients shall not have any of the following developmental deficits in the socio emotional area:

1. Aggression-has had violent episodes which have caused serious physical injury in past year.

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2. Self-injurious behavior-causes severe injury which requires physician attention at least once per year.

3. Smearing-smears at every opportunity.

D. Patients shall not be admitted to or approved for services if these patients:

1. Have decubitus ulcers.

2. Require restraints, except as provided in Title 22, CCR, Sections 76867 and 76868.

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Manuarl of Criteria, Intermediate Care Facility Services for Developmentally Disabled and Intermediate Care Facilities for Developmentally Disabled Habilitative