{"data":{"id":"us-va/12vac30-130-460","jurisdiction":"us-va","citation":"12VAC30-130-460","heading":"Directions for applying the criteria","body":"A. The references under the questions in the following categories indicate those items which are on the Behavior Development Survey (DMH 71 Revised 6/80). The absence of a reference indicates this question is not addressed on the BDS form. Some categories on the Behavior Development Survey are not incorporated since the information in that area of the evaluation will be reflected elsewhere in the criteria or the condition is not indicative of a functional deficit justifying a need for intermediate care.\n\nPATIENT ASSESSMENT CRITERIA.\n\n1. HEALTH STATUS -- To meet this category:\n\na.\n\nTwo or more questions must be answered with a 4, or Question   No. 10 must be answered yes.\n\nRarely\n\nSome-\n\ntimes\n\nOften\n\nRegu-\n\nlarly\n\nb.\n\nHow often is nursing care or nursing supervision by a licensed   nurse required for the following:\n\n1\n\n2\n\n3\n\n4\n\n1.\n\nMedication administration and/or evaluation for   effectiveness of a medication regime? ((70) Receiving Medications and History   of Seizures pg.4)\n\n1\n\n2\n\n3\n\n4\n\n2.\n\nDirect services: i.e., care for lesions, dressings,   treatments, (other than shampoos, foot powder, etc.)?\n\n1\n\n2\n\n3\n\n4\n\n3.\n\nSeizures control? ((68) History of seizures pg.4)\n\n1\n\n2\n\n3\n\n4\n\n4.\n\nTeaching diagnosed disease control and care, including   diabetes?\n\n1\n\n2\n\n3\n\n4\n\n5.\n\nManagement of care of diagnosed circulatory or respiratory   problems?\n\n1\n\n2\n\n3\n\n4\n\n6.\n\nMotor disabilities which interfere with all activities of   daily living--bathing, dressing, mobility, toileting, etc.?\n\n1\n\n2\n\n3\n\n4\n\n7.\n\nObservation for choking/aspiration while eating, drinking?\n\n1\n\n2\n\n3\n\n4\n\n8.\n\nSupervision for use of adaptive equipment, i.e., special   spoon, braces, etc.? (physical aids pg.4)\n\n1\n\n2\n\n3\n\n4\n\n9.\n\nObservation for nutritional problems (i.e.,   undernourishment, swallowing difficulties, obesity)?\n\n1\n\n2\n\n3\n\n4\n\n10.\n\nIs age 55 or older, has a diagnosis of a chronic disease and   has been in an institution 20 years or more?\n\nyes\n\nno\n\n2. COMMUNICATION -- To meet this category:\n\na.\n\nThree or more questions must be answered with a 3 or a 4.\n\nNo assis-tance\n\nPrompt-ing/\n\nStruc-turing\n\nSuper-vision\n\nSome Direct Assis-tance\n\nTotal\n\nAssis-tance\n\nb.\n\nHow often does this person:\n\n1.\n\nIndicate wants by pointing, vocal noises, or signs? ((62)(c)   Preverbal Expression pg.2)\n\n1\n\n2\n\n3\n\n4\n\n2.\n\nUse simple words, phrases short sentences? ((67) Sentences   pg.2)\n\n1\n\n2\n\n3\n\n4\n\n3.\n\nAsk for at least ten things using appropriate names? ((67)   Vocabulary pg.1)\n\n1\n\n2\n\n3\n\n4\n\n4.\n\nUnderstand simple words, phrases or instructions containing   prepositions: i.e., on in behind? ((27) Complex Instructions pg.3)\n\n1\n\n2\n\n3\n\n4\n\n5.\n\nSpeak in an easily understood manner? ((66) Speech pg.1)\n\n1\n\n2\n\n3\n\n4\n\n6.\n\nIdentify self, place of residence, and significant other,   ((47) Awareness of Others, pg.3)\n\n1\n\n2\n\n3\n\n4\n\n3. TASK LEARNING SKILLS -- To meet this category:\n\na.\n\nThree or more questions must be answered with a 3 or a 4.\n\nRegu-\n\nlarly\n\nOften\n\nSome-times\n\nRarely\n\nb.\n\nHow often does this person:\n\n1.\n\nPay attention to purposeful activities for 5 minutes?   ((42)(2) Attention pg.3)\n\n1\n\n2\n\n3\n\n4\n\n2.\n\nStay with a three-step task for more than 15 mintues? ((42)   (5) Attention pg. 3)\n\n1\n\n2\n\n3\n\n4\n\n3.\n\nTell time to the hour and understand time intervals? ((33)   (b) Time pg. 3)\n\n1\n\n2\n\n3\n\n4\n\n4.\n\nCount more than 10 objects? ((31) (5) Numbers pg.3)\n\n1\n\n2\n\n3\n\n4\n\n5.\n\nDo simple addition, subtraction ((31) (6)Numbers pg.3)\n\n1\n\n2\n\n3\n\n4\n\n6.\n\nWrite or print ten words? ((59) (3) Writing pg. 2)\n\n1\n\n2\n\n3\n\n4\n\n7.\n\nDiscriminate shapes, sizes, or colors?\n\n1\n\n2\n\n3\n\n4\n\n8.\n\nName people or objects when describing pictures? ((67) (4) Vocabulary   pg. 1)\n\n1\n\n2\n\n3\n\n4\n\n9.\n\nDiscriminate between one, many, lot? ((31) (2) Numbers pg.   3)\n\n1\n\n2\n\n3\n\n4\n\n4. PERSONAL/SELF CARE -- To meet this category:\n\na.\n\nQuestion No. 1 must be answered with a 4 or a 5, or\n\nb.\n\nQuestion No. 2 must be answered with a 4 or a 5, or\n\nc.\n\nQuestions No. 3 and 4 must be answered with a 4 or a 5?\n\nNOTE: The yes or no questions are for the purpose of   identification of needs to be included in the plan of care. Questions   answered yes or no are not part of the scale.\n\nNo Assis-tance\n\nPrompt-ing/\n\nStruc-turing\n\nSuper-vision\n\nSome Direct Assis-tance\n\nTotal\n\nAssis-tance\n\nd.\n\nWith what type of assistance can this person currently:\n\n1.\n\nPerform toileting functions: i.e., maintain bladder and bowel   continence, clean self? etc. ((31)(5) Toilet Training pg. 1)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n(a) has toileting accidents more than twice a day? ((31)(2)   Toilet Training pg. 1)\n\nyes\n\nno\n\n(b) has toileting accidents at night?\n\nyes\n\nno\n\n(c) Flushes toilet, pulls up clothes? ((36) Self Care at   Toilet pg. 2)\n\nyes\n\nno\n\n2.\n\nPerform eating/feeding functions: i.e., drinks liquids and   eats with spoon or fork, etc? ((28)(3) Use of Table Utensils pg. 1)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n(a) Feeds self with spoon neatly? ((28)(3) Use of Table   Utensils)\n\nyes\n\nno\n\n(b) Spilling? ((3) (3) Drinking pg. 1)\n\nyes\n\nno\n\n3.\n\nPerform bathing functions (i.e., bathe, runs bath, dry self,   etc.)? ((44)(5) Bathing pg. 2)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n(a) Washes hands and face with soap? ((39) (40) Washes Hands   and Face pg. 2)\n\nyes\n\nno\n\n(b) Dries hands and face? ((42) Washes Hands and Face pg. 2)\n\nyes\n\nno\n\n(c) Care for hair, nails, beard?\n\nyes\n\nno\n\n4.\n\nDress self completely i.e., including fastening, putting on   clothes, etc. ((5) (6) Dressing pg. 2)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n(a) Dresses upper body, but needs help with fastening?\n\nyes\n\nno\n\n(b) Dresses self but needs assistance with pulling, or\n\nyes\n\nno\n\n(c) Putting on most clothing, fastening, shoes? ((50) (3)   Dressing (52) Shoes pg. 2)\n\nyes\n\nno\n\n5. MOBILITY -- To meet this category:\n\na.\n\nAny one question must be answered with a 4 or a 5.\n\nNOTE: The yes or no questions are for the purpose of   identification of needs to be included in the plan of care. Questions   answered yes or no are not part of the scale.\n\nNo Assis-tance\n\nPrompt-ing/\n\nStruc-turing\n\nSuper-vision\n\nSome Direct Assis-tance\n\nTotal\n\nAssis-tance\n\nb.\n\nWith what type of assistance can this person currently:\n\n1.\n\nMove (walking, wheeling) around environment? ((59)   Ambulation pg. 1,(79) Physical Aids pg. 4)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n(a) Walk with assistive device, person? ((59) Ambulation pg.   1, Physical Aids pg. 4)\n\nyes\n\nno\n\n(b) Walk on level ground for 50 yards with or without   assistive device? ((73, 74, 76) Physical Aids, pg. 4)\n\nyes\n\nno\n\n(c) Transfer to/from a wheelchair? ((75) Physical Aids pg. 4)\n\nyes\n\nno\n\n2.\n\nRise from lying down to sitting positions, sits without   support? ((27) Body Balance pg. 1)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n3.\n\nTurn and position in bed, roll over?\n\n1\n\n2\n\n3\n\n4\n\n5\n\n6. BEHAVIOR -- To meet this category:\n\na.\n\nAny one question must be answered with a 3 or a 4.\n\nRarely\n\nSome-times\n\nOften\n\nRegu-\n\nlarly\n\nb.\n\nHow often does this person:\n\n1.\n\nEngage in self-destructive behavior? ((61) Maladaptive   Behavior pg. 4)\n\n1\n\n2\n\n3\n\n4\n\n2.\n\nThreaten or do physical violence to others? ((52) Maladaptive   Behavior pg. 4)\n\n1\n\n2\n\n3\n\n4\n\n3.\n\nThrow things, damage property, have temper outbursts? ((53,   55) Maladaptive Behavior pg. 4)\n\n1\n\n2\n\n3\n\n4\n\n4.\n\nRespond to others in a socially unacceptable manner (without   undue anger, frustration or hostility)? ((50) Interactions with Others pg. 3)\n\n1\n\n2\n\n3\n\n4\n\n7. COMMUNITY LIVING SKILLS -- To meet this category:\n\na.\n\nAny two of questions 2, 5, or 7 must be answered with a 4 or   a 5, or\n\nb.\n\nThree or more of questions 1 through 8 must be answered with   a 4 or a 5.\n\nNo Assis-tance\n\nPrompt-ing/\n\nStruc-turing\n\nSuper-vision\n\nSome Direct Assis-tance\n\nTotal\n\nAssis-tance\n\nc.\n\nWith what type of assistance would this person currently be   able to:\n\n1.\n\nPrepare simple foods requiring no mixing or cooking? ((38)   Food Preparation pg. 3)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n2.\n\nTake care of personal belongings, room (excluding vacuuming,   ironing, clothes washing/drying, wet mopping)? ((43) Personal Belongings pg.   3)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n3.\n\nAdd coins of various demonima1 nations up to one dollar?   ((57) Money Handling pg. 2)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n4.\n\nUse the telephone to call home, doctor, fire, police?\n\n1\n\n2\n\n3\n\n4\n\n5\n\n5.\n\nRecognize survival signs/words: i.e., stop, go, traffic lights,   police, men, women, restrooms, danger, etc.? ((68) Reading pg. 2)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n6.\n\nRefrain from exhibiting unacceptable sexual behavior in   public? ((63, 64, 65) Maladaptive Behavior pg. 4)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n7.\n\nGo around cottage, ward, building, without running away,   wandering off, or becoming lost? ((56) Sense of Direction pg. 2, (57)   Maladaptive Behavior pg. 4)\n\n1\n\n2\n\n3\n\n4\n\n5\n\n8.\n\nMake minor purchases i.e., candy, soft drink, etc.? ((58, 4)   Purchasing pg. 2)\n\n1\n\n2\n\n3\n\n4\n\n5","path":["Title 12. Health","Agency 30. Department of Medical Assistance Services","Chapter 130. Amount, Duration and Scope of Selected Services","Part VI. Criteria for Intermediate Care for Mentally Retarded Persons"],"source_url":"https://law.lis.virginia.gov/admincode/title12/agency30/chapter130/section460/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:51:13Z","sha256":"53be877545563e938e807191eac0ab5181c0d516dab000b3b89d914d4b48f8d7","source_id":"us-va-vac","stale":false,"prev":"us-va/12vac30-130-450","next":"us-va/12vac30-130-600"},"notice":"GroundRules: Original legal text. Not legal advice."}