405 IAC 1-3-2 Intermediate level of care criteria

Sec. 2. (a) Intermediate nursing care includes care for patients with long term illnesses or disabilities which are relatively stable, or care for patients nearing recovery and discharge who continue to require some professional medical or nursing supervision and attention. Intermediate care services encompass a range of services from those below skilled level services to those above room and board level services. The determination of the differences between the skilled and intermediate level of care is based upon the patient's condition, along with the complexity and range of medical services required by the patient on a daily basis. The provision of room, food, laundry, and supervision of activities of daily living do not, in and of themselves, qualify as intermediate care. (b) Intermediate care includes room, food, laundry, and professional supervision of activities for protection and safety, along with combinations of the following: (1) Assistance with ambulation. (2) Assistance with transfers and positioning. (3) Assistance with general bathing and hygiene. (4) Assistance with eating. (5) Assistance with dressing. (6) Assistance with toileting/incontinence care. (c) Intermediate services require some professional supervision, but may be performed by properly trained nonprofessional personnel. The following illustrated services are generally of a supportive nature and are less than skilled level services: (1) Administration of routine oral medications, eye drops, ointment, or any combination of all of these. (2) Injections which usually can be self-administered, such as the well-regulated diabetic who receives daily insulin injections. The administration of an occasional or PRN (as needed) intramuscular injection would be considered appropriate for intermediate level of care. (3) General maintenance care of colostomy or ileostomy, including cleaning colostomy, changing colostomy bags, or routine use of equipment. (4) Routine insertion and maintenance for patency of indwelling catheters. (5) Changes of dressings in noninfected, postoperative, or chronic conditions. (6) Prophylactic and palliative skin care, including bathing and application of medical creams or treatment of minor skin conditions. (7) Administration of oxygen, after initial phases for a stable, chronic condition. (8) Routine care of plaster cast and brace patients, including hip spica or body casts. (9) Heat as palliative treatment. (10) Provision and supervision of restorative measures. (11) Provision of skilled services or procedures when the resident's overall condition does not require the intensity of professional nursing services necessary for skilled level of care. (12) Twenty-four (24) hour a day supervision or direct assistance to maintain safety due to confusion or disorientation that is not related to, or a result of, mental illness. (d) Medicaid does not make reimbursement for services below the intermediate level of care.