Section 6210.62. Level of care criteria

(a) There are three fundamental criteria which shall be met prior to an applicant or recipient qualifying for an ICF/MR level of care. The ICF/MR level of care shall be indicated only when the applicant or recipient:

(1) Requires active treatment.

(2) Has a diagnosis of mental retardation.

(3) Has been recommended for an ICF/MR level of care based on a medical evaluation.

(b) A physician shall certify the ICF/MR level of care on a form specified by the Department and that ICF/MR services are needed, for each applicant and current ICF/MR resident. Before the facility requests payment from MA, the certification shall have been made at the time of admission, or at the time a resident applied for assistance while in an ICF/MR.

(c) For purposes of an ICF/ORC, subsection (a)(2) means a diagnosis of other related condition.