Oklahoma Administrative Code › Title 340 - Department of Human Services › Chapter 100 - Developmental Disabilities Services › Subchapter 15 - Developmental Disabilities Services (DDS) Preadmission Screening and Resident Review (PASRR) › Section 340:100-15-1 - Nursing facility services for members with intellectual disability or related condition

Current through Vol. 41, No. 20, July 1, 2024
(a) The purpose of
				this Subchapter is to provide criteria by which Oklahoma Human Services,
				Developmental Disabilities Services, hereafter referred to as the Intellectual
				Disabilities (ID) Authority, determines the need for nursing facility services
				in contrast to other services and the need for specialized services for
				individuals with intellectual disabilities or related conditions. The
				provisions of this Subchapter apply to all Medicaid certified nursing
				facilities and to departmental staff responsible for evaluating individuals
				suspected of having intellectual disabilities or related conditions receiving
				or seeking to receive services in Medicaid certified nursing
				facilities.
(b) In order for the
				determination to be made that an individual with intellectual disabilities or
				related conditions needs services only available in a nursing facility but does
				not need specialized services, the individual must:
(1) require licensed nursing interventions at
				least once daily or require licensed nursing monitoring and observation on a
				frequent basis daily for maintenance of health or basic life support;
				and
(2) meets meet one or more of
				the following:
(A) be in a comatose
				state;
(B) require convalescent
				care;
(C) have a terminal
				illness;
(D) be at least 65 years
				of age, unless similar aging process characteristics are evident at age 50;
				or
(E) have a serious medical
				condition which requires on-going medical care and licensed nursing
				intervention services monitoring or observation. These conditions include but
				are not limited to:
(i) neurological
				disorders or malformations which includes muscle wasting diseases that are
				progressive, dementias, hydrocephalus, meningomyelocele, brain damage secondary
				to birth trauma, anoxia, cardiac arrest or other causes of cerebral anoxia that
				are severe enough to induce a comatose state. Cerebral or peripheral nerve
				damage secondary to central nervous system infection or trauma or other
				disorders or malfunctions inconsistent with normal functioning;
(ii) pulmonary disorder, with either
				congenital or acquired pulmonary disorders that leave the individual unable to
				adequately oxygenate, therefore, requiring respiratory support;
(iii) cardiac dysfunction or malformation
				which includes individuals with either congenital or acquired heart disease
				such as myocarditis, that are in persistent or intractable heart failure, have
				cardiac rhythms that are life threatening, are persistently cyanotic enough to
				require supplemental oxygen to survive or are otherwise liable to cardiac
				arrest, either primarily or secondarily. These individuals are identified by a
				physician as being unable to survive unless immediate skilled medical and
				nursing intervention is available;
(iv) circulatory dysfunction which includes
				individuals with either hypotension or hypertension with a central or unknown
				etiology that require frequent licensed nursing intervention or monitoring and
				medication or stimulation. It also includes individuals whose orthopedic or
				postural malformations require meticulous skin care;
(v) endocrine or metabolic disorder which
				includes individuals with hypothyroidism or hyperthyroidism, or diabetes with
				its associated problems including, but not limited to, circulation, skin care,
				infection, etc., aminoaciduria with secondary intellectual disabilities,
				glycogen storage disease or other abnormalities of lipid metabolism, and other
				genetic disorders limiting normal metabolism;
(vi) gastrointestinal disorder or malfunction
				which includes individuals with primary or secondary disorders of absorption of
				normal nutrients and vitamins that do not allow adequate calorie sustenance
				without supplementation by artificial means, those with congenital
				malformations of the gastrointestinal tract that require, despite surgical
				intervention, continuing supplementation with special diets and those whose
				nutritional requirements cannot be met without intravenous supplementation;
				or
(vii) renal and bladder
				dysfunction or malformation which includes individuals with severe polycystic
				kidney disease, hydronephrosis, those with kidney failure secondary to either
				congenital malformation, trauma or infection requiring frequent intravenous
				supplementation, and those in whom kidney or bladder malformations require
				surgical externalization with need for significant nursing and other
				management.