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Effective: December 1, 2006 |
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12.15.05ar1 - TEFRA Level of Care Determination (Archive) |
Archived: June 1, 2015 |
All TEFRA option referrals to the State Medical Review Team (SMRT) are reviewed to determine:
l If the child is considered disabled according to the Social Security standards, and
l If the child's needs meet the level of care requirements.
Workers should not attempt to determine which children may or may not meet the TEFRA level of care criteria. The following information about the level of care types is provided to assist workers in identifying children who may need a referral, and determining which corresponding documentation request form should be given to them as part of the TEFRA referral process.
Nursing Facility Level of Care - Physical Disability.
ICF/DD Level of Care - Developmental Disability.
Nursing Facility Level of Care - Mental Health Disability.
Nursing Facility Level of Care - Physical Disability
The child requires a nursing facility level of care as determined by the Long-Term Care Consultation (LTCC) and the home care independent rating document adjusted to address age-appropriate standards for children under 18 years of age. That is, the child requires nursing care which is appropriate if the child is in active restorative treatment, is in need of special treatments provided or supervised by a licensed nurse, or has unpredictable episodes of active disease processes requiring immediate judgment by a licensed nurse.
See Required Documentation - Physical Disability (DHS-3854) for further information.
ICF/DD Level of Care - Developmental Disability
The child needs a level of care provided in an Intermediate Care Facility for the Developmentally Disabled (ICF/DD) . That is, the child needs a 24-hour plan of care for persons with developmental disabilities, and the specialized services provided in an ICF/DD. See Required Documentation - Developmental Disability (DHS-3855) for further information.
Nursing Facility Level of Care - Mental Health Disability
The child needs a level of care provided in a nursing facility if a child with a mental illness or disorder diagnosis requires 24-hour monitoring or supervision and has a plan of mental health treatment because of specific symptoms or functional impairments associated with a serious mental illness or disorder diagnosis. See Required Documentation - Mental Health Disability (DHS-3856) for further information.
For more information, see: