Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 00 - Long-Term Services › Part 5 - "Medicaid Long-Term Services and Supports: Functional/Clinical Eligibility" (210-RICR-50-00-5) › Section 210-RICR-50-00-5.3 - Definitions

Current through June 14, 2024
A. For the purposes of this Part, the
				  following definitions apply:
"Activities of daily living" or "ADLs" means the routine
					 activities that people tend do every day without needing assistance. There are
					 six basic ADLs: eating, bathing, dressing, toileting, transferring, and
					 mobility and ambulation. The need for assistance with medication management and
					 personal hygiene is also considered an ADL.
2. "Community supported living services for
				  I/DD" means one or more of the home and community-based Medicaid LTSS services
				  and supports identified in §50-10-1 provided to assist an intellectually/
				  developmentally disabled person with the activities of daily living in a
				  setting such as primary residence, the home of another, a BHDDH group home, or
				  other community living setting arrangement where such services and supports are
				  available.
3. "Department of
				  Behavioral Healthcare, Hospitals, and Developmental Disabilities" or "BHDDH"
				  means the entity within the executive branch of Rhode Island State government
				  that serves as the mental health authority and administers LTSS programs funded
				  in whole or in part by Medicaid for persons with intellectual or developmental
				  disabilities and serious mental/behavioral health needs.
4. "Department of Children, Youth and
				  Families" or "DCYF" means the State agency responsible for administering child
				  protective and behavioral health services for children and youth, and their
				  families, who are at-risk for or in the care and custody of the State,
				  including several LTSS programs funded in part by Medicaid and CHIP.
5. "Department of Human Services" or "DHS"
				  means the State agency that has been delegated responsibility for processing
				  Medicaid LTSS eligibility through and providing functional assessments and case
				  management services to certain applicants and beneficiaries in accordance with
				  the terms and conditions of an interagency agreement with the EOHHS.
6. "Division of Elderly Affairs" or "DEA"
				  means the unit within the DHS with responsibility for administering the State's
				  HCBS co-pay program for persons who do not qualify for Medicaid LTSS as well as
				  conducting assessments for certain Medicaid HCBS programs under RI General Laws
				  and the terms and conditions of an interagency agreement with the EOHHS, the
				  Medicaid Single State Agency in Rhode Island.
7. "Executive Office of Health and Human
				  Services" or "EOHHS" means the entity within the executive branch of Rhode
				  Island state government that is designated as the Medicaid Single State Agency
				  in RI General Laws and the Medicaid State Plan and that, in this capacity, is
				  responsible for overseeing the administration of all Medicaid-funded LTSS in
				  collaboration with the health and human services agencies under the office's
				  jurisdiction.
8. "Functional
				  disability" means a deficit or deficits in the capacity to perform the
				  activities of daily living and/or the instrumental activities of daily living
				  of sufficient magnitude that alone, or in conjunction with certain health
				  conditions, constitutes a need for the level of care LTSS typically provided in
				  an institutional setting.
9.
				  "Instrumental activities of daily living" or "IADLs" means the skills a person
				  needs to live safely and successfully in a residential setting of choice
				  without outside supports. Such skills include, but are not limited to, using
				  the telephone, traveling, shopping, preparing meals, doing housework, taking
				  medications properly, and managing money.
10. "Level of care" means the amount of
				  services and supports necessary to meet a person's needs. When associated with
				  a licensed health care institution, the term refers to the set of services and
				  supports the institution is authorized and typically provides to people with a
				  specific range of needs.
11.
				  "Minimum Data Set" or "MDS" means a component of the federally mandated process
				  for clinical assessment of all residents in Medicare or Medicaid certified
				  nursing homes. This process provides a comprehensive assessment of each
				  resident's functional capabilities and helps nursing home staff identify health
				  problems.
12. "Needs-based
				  criteria" means the health and functional status factors used in the
				  determination of LTSS functional/clinical eligibility to assess a person's need
				  for the level of care provided in a nursing facility, ICF/ID, or certain
				  hospital settings.