12VAC30-60-316: Criteria for continued nursing facility care using the Minimum Data Set (MDS)

Individuals may be considered appropriate for nursing facility care when one of the following describes their medical or nursing needs and functional capacity as recorded on the Minimum Data Set (MDS) of the Resident Assessment Instrument that is specified by the Commonwealth.

1. Functional capacity:

a. The individual meets criteria for two to four of the Activities of Daily Living, plus Behavior and Orientation; and Joint Motion;

b. The individual meets criteria for five to seven of the Activities of Daily Living and also for Locomotion; or

c. The individual meets criteria for two to seven of the Activities of Daily Living and also for Locomotion, and Behavior and Orientation. An individual in this category will not be appropriate for nursing facility care unless he also has a medical condition requiring treatment or observation by a nurse.

2. Medical or Nursing Needs: The individual has health needs which require medical or nursing supervision or care above the level which could be provided through assistance with activities of daily living, medication administration and general supervision and is not primarily for the care and treatment of mental diseases.