Stable medical condition without cognitive loss or functional impairment insufficient to qualify for SOURCE.

Topic: Health Law, Decided by: Judge Malihi 
Docket Number: ***** , Decision Date: December 19, 2013 
Attachment: Click here to download the decision. 

The Department of Community Health (DCH) correctly determined that Petitioner does not meet the minimal requirements to qualify for intermediate nursing home level of care under the Service Options Using Resources in Community Environments Program (SOURCE).  In order to meet the level of care necessary to qualify for SOURCE, the individual must meet the qualifications in Column A in Appendix I of the SOURCE Manual, regarding Medical Status, plus at least one item from Column B, regarding Mental Status, or Column C, regarding Functional Status.  Petitioner has a stable medical condition requiring intermittent skilled nursing, as required by Column A.  He does not, however, meet the remaining columns.  First, while he occasionally forgets to take his medications, it does not rise to the level of cognitive loss.  Second, while Petitioner does require limited assistance to dress and bathe, he must require more in order to qualify under the functional impairment column.  Set-up assistance with transfer and locomotion does not constitute direct physical assistance.  Furthermore, Petitioner is able to manage without help for the majority of the week.

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