TITLE 40
Human services

CHAPTER 40-8.10
Long Term Care Service Reform for Medicaid Eligible Individuals

SECTION 40-8.10-3


§ 40-8.10-3 Levels of care.

(a) The secretary of the executive office of health and human services shall coordinate responsibilities for long-term care assessment in accordance with the provisions of this chapter. Importance shall be placed upon the proper and consistent determination of levels of care across the state departments for each long-term care setting, including behavioral health residential treatment facilities, long-term care hospitals, intermediate care facilities, and/or skilled nursing facilities. Specialized plans of care that meet the needs of the individual Medicaid recipients shall be coordinated and consistent across all state departments. The development of care plans shall be person-centered and shall support individual self-determination, family involvement, when appropriate, individual choice and interdepartmental collaboration.

(b) Levels of care for long-term care institutions (behavioral health residential treatment facilities, long-term care hospitals, intermediate care facilities and/or skilled nursing facilities), for which alternative community-based services and supports are available, shall be established pursuant to the § 40-8.9-9. The structure of the three (3) levels of care is as follows:

(i) Highest level of care. Individuals who are determined, based on medical need, to require the institutional level of care will have the choice to receive services in a long-term care institution or in a home and community-based setting.

(ii) High level of care. Individuals who are determined, based on medical need, to benefit from home and community-based services.

(iii) Preventive level of care. Individuals who do not presently need an institutional level of care but who need services targeted at preventing admission, re-admissions or reducing lengths of stay in an institution.

(c) Determinations of levels of care and the provision of long term care health services shall be determined in accordance with this section and shall be in accordance with the applicable provisions of § 40-8.9-9.

History of Section.
(P.L. 2009, ch. 68, art. 23, § 9; P.L. 2015, ch. 141, art. 5, § 17.)