This checklist is adapted from the long-term care facility admission criteria in the Alabama Administrative Code. To meet the NF LOC to be admitted to the E&D, ACT, TA, or SAIL Waivers, the applicant must meet at least two of the criteria from Sections (a) through (k) of the following list. (And remember, for the TA and SAIL Waivers, the individual must meet additional program criteria as described earlier in this manual.)
New admissions and re-determinations must meet two of the criteria listed in A-K. Supporting documentation must be submitted with the application. The medical form of the level of care application must be signed by the physician, a nurse practitioner, or a physician assistant.
Medicaid recipients who have had no break in institutional care since their discharge from a nursing facility and residents who are re-admitted to a nursing facility within 30 days of their discharge to the community only need to meet one of the following criteria.
(a) Individual requires daily administration of medications
(b) Individual requires restorative nursing procedures (such as gait training or bowel and bladder training), as long as the individual has the potential to restore those abilities and can benefit from the training on a daily basis
(c) Individual requires aspiration/suctioning to maintain a clear airway
(d) Individual has an indwelling tube or stoma, such as a:
- Tracheotomy
- Central Venous Line c Port
- Fistula
- Colostomy
- Gastrostomy
- Ileostomy
(e) Individual requires tube feeding or total parenteral nutrition (TPN)
(f) Individual requires care of extensive pressure ulcers/bedsores or other widespread skin disorders
(g) Individual requires regular, continuing observation of unstable medical conditions, which can only be provided by or under the direction of a registered nurse
(h) Individual uses oxygen
(i) Individual requires regular sterile or medicated dressing changes
(j) Individual is a comatose patient
(k) Individual requires assistance with at least one of the following activities of daily living (ADLs) on a regular basis:
–Transfer: needs regular physical assistance with transfer to and from bed, chair, and toilet
–Mobility: requires regular physical assistance with ambulating with a mobility aid (e.g., a walker or cane), or with a wheelchair if unable to ambulate.
–Eating: requires g-tube feedings or physical assistance from another person to place food into the mouth.
–Toileting: requires regular physical assistance to use the toilet or to perform incontinence care, ostomy care, or indwelling catheter care.
–Expressive and Receptive Communication: cannot reliably communicate basic needs and wants, use verbal or written language, or understand and follow simple instructions and commands without continual intervention.
–Orientation: disoriented to person (e.g., does not remember their own name or recognize immediate family members) or to place (e.g., does not know what their residence is).
–Medication Administration: incapable of administering prescribed medications even with limited assistance, such as reminding the individual to take their medications or handing the individual their medications.
–Behavior: requires persistent intervention due to a persistent pattern of dementia-related behavioral problems.
–Skilled Nursing or Rehabilitative Services: requires more intense daily skilled nursing or rehabilitative services than would be provided through a daily home health visit.
Criterion K should reflect the individual’s capabilities on an ongoing basis and not isolated, exceptional, or infrequent limitations of function in a generally independent individual who is able to function with minimal supervision or assistance. Multiple items being met under (K) will still count as one criterion.
For assistance on better understanding Medicaid Waivers in Alabama, please reach out to Disability Advocacy Solutions.
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