12VAC30-60-313: Individuals determined to not meet criteria for Medicaid-funded long-term services and supports

Notwithstanding 12VAC30-60-302 E, an individual shall be determined not to meet the level of care for Medicaid-funded LTSS when there is no LTSS screening or MDS to document the individual meets the medical or nursing, functional, or risk criteria or when one of the following specific care needs solely describes the individual's condition:

1. The individual requires minimal assistance with ADLs, including those individuals whose only need in all areas of functional capacity is for prompting to complete the activity;

2. The individual independently uses mechanical devices such as a wheelchair, walker, crutch, or cane;

3. The individual requires limited diets such as a mechanically altered, low-salt, low-residue, diabetic, reducing, or other restrictive diets;

4. The individual requires medications that can be independently self-administered or administered by the caregiver;

5. The individual requires protection to prevent the individual from obtaining alcohol or drugs or to address a social or environmental problem;

6. The individual requires minimal staff observation or assistance for confusion, memory impairment, or poor judgment; or

7. The individual's primary need is for behavioral management that can be provided in a community-based setting.