Appendix F. HEAVY CARE/INTERMEDIATE SERVICES

I. Introduction.

The Department has developed criteria to be used in determining whether an applicant or recipient is medically eligible for the heavy care/intermediate level of care. To be determined medically eligible for the heavy care/intermediate level of care, a recipient shall meet the requirements in Section II. If any one of the requirements specified in Section II are not met, the recipient cannot be determined to be medically eligible for the heavy care/intermediate level of care.

II. Heavy care/intermediate services.

(a) Heavy care/intermediate services shall be provided in a dually certified skilled bed and are subject to the same limits on nursing hours as skilled care services.

(b) Heavy care/intermediate services are services provided to patients who are functionally impaired to the following extent with respect to the following activities of daily living:

(1) Eating—requires total care. Requires total care means that the individual must be hand fed by another person, is tube fed, or is in a feeding retraining program. Functional impairment shall be at level 3 or 4.

(2) Dressing—requires total care. Requires total care means that the individual must be dressed by another person. Functional impairment shall be at level 3.

(3) Continence of urine—is incontinent or has an indwelling bladder catheter. Incontinent means incontinent more than 50% of the time. Functional impairment shall be at level 3 or 4.

(4) Mental status—confused or speech-aphasic with behavioral problems. Confused means confused most of the time, semi-comatose or comatose. Functional impairment shall be at level 3, 4 or 5. Speech-aphasic with behavioral problems means unable to communicate for whatever reason. Functional impairment shall be at level 3 and there shall be behavioral problems.

(5) Mobility—wheelchair/mobile. Mobility includes those categories of mobility status which are wheelchair/mobile, cane/walker, chairbound or bedfast. Functional impairment shall be at level 2, 3, 4 or 5.

ITEM	LEVEL 1	LEVEL 2	LEVEL 3	LEVEL 4	LEVEL 5
Eating	Self	With Assistance	Total Care	Tube Fed
Bathing	Self	With Assistance	Total Care
Dressing	Self	With Assistance	Total Care
Continence of Urine	Continent	Occas. Incontinent	Incontinent	Catheter
Continence of Bowel	Continent	Occas. Incontinent	Incontinent	Colostomy
Mental Status	Clear	Occas. Confused	Confused	Semi Comatose	Comatose
Noisy	Never	Occasionally	Most of the Time
Combative	Never	Occasionally	Most of the Time
Withdrawn	Never	Occasionally	Most of the Time
Wanders	Never	Occasionally	Most of the Time
Suicidal	Never	Occasionally	Most of the Time
Mobility	Ambulatory	Wheelchair/Mobile	Cane/Walker/Asst.	Chairbound	Bedfast
Sight	Not Impaired	Impaired	Blind
Hearing	Not Impaired	Impaired	Deaf
Speech	Not Impaired	Impaired	Aphasic

(c) Documentation justifying the need for heavy care/intermediate services on an inpatient basis shall be recorded in the patient’s medical record at least monthly.

Source

The provisions of this Appendix F adopted December 24, 1988, effective January 1, 1989, 18 Pa.B. 5711; amended March 10, 1989, effective immediately and applies retroactively to February 23, 1988, 19 Pa.B. 999.

Cross References

This section cited in 55 Pa. Code § 1181.2 (relating to definitions); and 55 Pa. Code § 1181.54 (relating to payment conditions related to the recipient’s continued need for care).