Rhode Island Code of Regulations › Title 210 - Executive Office of Health and Human Services › Chapter 50 - Medicaid Long-Term Services and Supports › Subchapter 10 - Home and Community Based LTSS › Part 2 - Self-Directed Care › Section 210-RICR-50-10-2.15 - Personal Choice Assessments and Budget Development Tables

Current through June 14, 2024
A. Six (6) Levels of Assistance:
Independent
LTSS beneficiary is independent in completing the
								  task safely.
Set-Up
LTSS beneficiary requires brief supervision,
								  cueing, reminder and/or set- up assistance to perform the task.
Minimum
LTSS beneficiary is actively involved in the
								  activity, requires some hands- on assistance for completion, thoroughness or
								  safety. Needs verbal or physical assistance with twenty-five (25%) of the
								  task.
Moderate
LTSS beneficiary requires extensive hands-on
								  assistance but is able to assist in the process. Needs verbal or physical
								  assistance with fifty percent (50%) of the task.
Extensive
LTSS beneficiary requires verbal or physical
								  assistance with seventy-five percent (75%) of the task.
Total Assistance
LTSS beneficiary cannot participate or assist in
								  the activity and requires one hundred percent (100%) assistance with the
								  task.
Not Applicable
This task does not apply to this LTSS
								  beneficiary.
B.
				  Functional Characteristics for Each ADL/IADL:
ADL/IADL
Functional Characteristics
Bowel
Behavioral Issues, Limited ROM, Spasticity/Muscle
								  Tone
Dressing
Behavioral Issues, Limited ROM, Spasticity/Muscle
								  Tone
Eating
Behavioral Issues, Fine Motor Deficit,
								  Spasticity/Muscle Tone
Grooming
Cognitive, Limited ROM, Spasticity/Muscle
								  Tone
Mobility
Balance Problems, Decreased Endurance, Pain,
								  Spasticity/Muscle Tone
Shower
Balance Problems, Behavioral Issues, Limited ROM,
								  Spasticity/Muscle Tone
Skin Care
Open Wound
Sponge Bath
Behavioral Issues, Limited ROM, Spasticity/Muscle
								  Tone
Transfers
Balance Problem, Limited ROM, Spasticity/Muscle
								  Tone
Tub Bath
Balance Problem, Behavioral Issues, Limited ROM,
								  Spasticity/Muscle Tone
Urinary/Menses
Behavioral Issues, Limited ROM, Spasticity/Muscle
								  Tone
Communications
No Functional Characteristics
Housework
LTSS beneficiary Lives Alone
Meal Preparation
No Functional Characteristics
Shopping
No Functional Characteristics
C.
				  Activity and Time Allotments, in minutes:
Activity
Unit Time
Functional Time
Sponge Bath
30
45
Shower
20
40
Tub Bath
40
45
Dressing
15
20
Eating
20
40
Mobility
10
10
Urinary/Menses
10
15
Transfers
5
10
Grooming
8
8
Skin Care
10
10
Bowel
30
50
Meal Preparation
25
25
House Work
12.5
25
Communications
15
15
Shopping
60
60
Medications
2
5
D.
				  ADL Multipliers:
Level of Assistance
Sponge Bath
Shower
Tub Bath
Dressing
Eating
Mobility
Urinary Menses
Transfers
Grooming
Skin Care
Bowel
Total Assist
1
1
1
1
1
1
1
1
1
1
1
Maximum Assist
.75
.75
.75
.75
.75
1
.75
1
.75
1
.75
Moderate Assist
.5
.5
.5
.5
.5
.75
.5
.75
.5
.75
.5
Minimum
Assistance
.25
.25
.25
.25
.25
.75
.25
.75
.25
.25
.25
Set-Up Assistance
.15
.15
.15
.15
.15
.20
.15
.20
.15
.20
.15
Independent
0
0
0
0
0
0
0
0
0
0
0
E.
				  IADL Multipliers:
Level of Assistance
Meal Preparation
Housework
Communications
Shopping
Total Assist
1
1
1
1
Maximum Assist
1
1
1
1
Moderate Assist
.75
.75
.75
1
Minimum
Assistance
.5
.5
.5
1
Set-Up Assistance
.25
.25
.25
1
Independent
0
0
0
0