Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 50 - Home and Community-Based Waiver Services › Subchapter 1 - Medically Fragile Waiver Services › Section 317:50-1-2 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words and terms when used in this subchapter
				  shall have the following meaning, unless the context clearly indicates
				  otherwise:
"ADL"
means the activities of daily living.
				  Activities of daily living are activities that reflect the member's ability to
				  perform self-care tasks essential for sustaining health and safety such
				  as:
(A) bathing,
(B) eating,
(C) dressing,
(D) grooming,
(E) transferring (includes getting in and out of a tub, bed
				  to chair, etc.),
(F) mobility,
(G) toileting, and
(H) bowel/bladder control.
"Cognitive Impairment"
means that the person, as
				  determined by the clinical judgment of the Long Term Care Nurse or the
				  information obtained in the Uniform Comprehensive Assessment Test Tool (UCAT)
				  assessment does not have the capability to think, reason, remember or learn
				  required task for self-care, communicating needs, directing care givers and/or
				  using appropriate judgment for maintenance of their own health or safety. The
				  clinical judgment of cognitive impairment is based on mental status
				  questionnaire performance in combination with a more general evaluation of
				  cognitive function from interaction with the person during the UCAT
				  assessment.
"Developmental Disability"
means a severe,
				  chronic disability of an individual that:
(A) is attributable to a mental or physical impairment or
				  combination of mental and physical impairments;
(B) is manifested before the individual attains age
				  22;
(C) is likely to continue indefinitely;
(D) results in substantial functional limitations in three or
				  more of the following areas of major life activity:
(i) self-care;
(ii) receptive and expressive language;
(iii) learning;
(iv) mobility;
(v) self-direction;
(vi) capacity for independent living; and
(vii) economic self-sufficiency; and
(E) reflects the individual's need for a combination and
				  sequence of special, interdisciplinary, or generic services, supports, or other
				  assistance that is of lifelong or extended duration and is individually planned
				  and coordinated.
"IADL"
means the instrumental activities of
				  daily living.
"Instrumental activities of daily living"
means
				  those activities that reflect the member's ability to perform household chores
				  and tasks within the community essential for sustaining health and safety such
				  as:
(A) shopping,
(B) cooking,
(C) cleaning,
(D) managing money,
(E) using a telephone,
(F) doing laundry,
(G) taking medication, and
(H) accessing transportation.
"Intellectual Disability"
means that the person
				  has, as determined by a Preadmission Screening Resident Review level II
				  evaluation, substantial limitations in functional ability due to significantly
				  sub-average intellectual functioning related to an event occurring before the
				  age of eighteen (18).
"Level of Care Services"
To be eligible for
				  level of care services, meeting the minimum Uniform Comprehensive Assessment
				  Test criteria established for skilled nursing facility or hospital level of
				  care demonstrates the individual must:
(A) require a treatment plan involving the planning and
				  administration of services that require the skills of licensed or otherwise
				  certified technical or professional personnel, and are provided directly or
				  under the supervision of such personnel;
(B) have a physical impairment or combination of physical,
				  mental and/or functional impairments;
(C) require professional nursing supervision (medication,
				  hygiene and/or dietary assistance);
(D) lack the ability to adequately and appropriately care for
				  self or communicate needs to others;
(E) require medical care and treatment in order to minimize
				  physical health regression or deterioration;
(F) require care that is not available through family and
				  friends, Medicare, Veterans Administration, or other federal entitlement
				  program with the exception of Indian Health Services; and
(G) require care that cannot be met through Medic-aid state
				  plan Services, including Personal Care, if financially eligible.
"MSQ"
means the mental status
				  questionnaire.
"Progressive degenerative disease process that responds
				  to treatment"
means a process such as, but not limited to, Multiple
				  Sclerosis (MS), Parkinson's Disease, Human Immunodeficiency Virus (HIV), or
				  Acquired Immunodeficiency Syndrome (AIDS), that, untreated, systematically
				  impairs normal body function which leads to acute illness and/or disability but
				  that reacts positively to a medically prescribed treatment intervention
				  (usually medication) which arrests or significantly delays the destructive
				  action of the process.
Added at 27 Ok Reg 2769,
				  eff 8-1-10 (emergency); Added at 28 Ok Reg 1589, eff 6-25-11; Amended at 29 Ok
				  Reg 1212, eff 6-25-12