SECTION 317:35-5-4.2. Determining nursing facility level of care for TEFRA children

  In order to determine nursing facility level of care for TEFRA children:

(1)   The child must be age 18 years or younger and expected to meet the following criteria for a minimum of 30 days.

(A)   The child must:

(i)   have a long-term medical or physical condition which significantly diminishes his/her functional capacity;

(ii)   require health-related services that are so inherently complex that it can only be safely and effectively provided by technical or professional medical personnel, such as a registered nurse, licensed practical nurse, etc., and are ordinarily provided in a nursing facility. Without these services, the child is at risk of being institutionalized within a nursing facility; and

(iii)   the services needed are above general supervision but can be provided safely in the child's home. The services are usually required 24 hours per day and are ordinarily provided in a nursing facility inpatient basis (see 42 CFR 409.31-409.34 for the types of services and service frequencies that would be normally considered as nursing facility level of care).

(B)   The service(s) needed has been ordered by a physician.

(2)   The services needed by the child must be greater than the services provided by an ICF/IID and less than those provided in a hospital.

[Source: Added at 32 Ok Reg 1118, eff 8-27-15]