As used in this subpart:

1. (1)

   1. (A) “Eating” means the intake of nourishment and fluid, excluding tube feeding and total parenteral (outside the intestines) nutrition.
   2. (B) This definition does not include meal preparation;
2. (2) “Extensive assistance” means that the individual would not be able to perform or complete the activity of daily living without another person to aid in performing the complete task by providing weight-bearing assistance;

3. (3) “Licensed medical professional” means a licensed:

   1. (A) Nurse;
   2. (B) Physician;
   3. (C) Physical therapist; or
   4. (D) Occupational therapist;
4. (4) “Limited assistance” means that the individual would not be able to perform or complete the activity of daily living three (3) or more times per week without another person to aid in performing the complete task by guiding or maneuvering the limbs of the individual or by other nonweight bearing assistance;
5. (5) “Locomotion” means the act of moving from one (1) location to another, regardless of whether the movement is accomplished with aids or devices;

6. (6)

   1. (A) “Mental retardation” means a level of retardation as described in the American Association on Mental Retardation's Manual on Classification on Mental Retardation.
   2. (B) For further clarification, see 42 C.F.R. §§ 483.100 – 102, Subpart C, Preadmission Screening and Annual Review of Mentally Ill and Mentally Retarded Individuals;

7. (7)

   1. (A) “Serious mental illness or disorder” means:

      1. (i) Schizophrenia, mood, paranoid, panic, or other severe anxiety disorder;
      2. (ii) Somatoform disorder;
      3. (iii) Personality disorder; or
      4. (iv) Other psychotic disorder.
   2. (B) For further clarification, see 42 C.F.R. §§ 483.100 – 102, Subpart C, Preadmission Screening and Annual Review of Mentally Ill and Mentally Retarded Individuals;

8. (8)

   1. (A) “Skilled level of care” means:

      1. (i) The following services when delivered by licensed medical personnel in accordance with a medical care plan requiring a continuing assessment of needs and monitoring of response to plan of care; and
      2. (ii) Such services are required on a twenty-four-hour per day basis.

   2. (B) The services must be reasonable and necessary to the treatment of the individual's illness or injury, i.e., be consistent with the nature and severity of the individual's illness or injury, the individual's particular medical needs, accepted standards of medical practice, and in terms of duration and amount:

      1. (i) Intermuscular or subcutaneous injections if the use of licensed medical personnel is necessary to teach an individual or the individual's caregiver the procedure;
      2. (ii) Intravenous injections and hypodermoclysis or intravenous feedings;
      3. (iii) Levin tubes and nasogastric tubes;
      4. (iv) Nasopharyngeal and tracheostomy aspiration;
      5. (v) Application of dressings involving prescription medication and aseptic techniques;
      6. (vi) Treatment of Stage III or Stage IV decubitus ulcers or other widespread skin disorders that are in Stage III or Stage IV;
      7. (vii) Heat treatments which have been specifically ordered by a physician as a part of active treatment and which require observation by nurses to adequately evaluate the individual's progress;
      8. (viii) Initial phases of a regimen involving administration of medical gases;
      9. (ix) Rehabilitation procedures, including the related teaching and adaptive aspects of nursing/therapies, that are part of active treatment, to obtain a specific goal and not as maintenance of existing function;
      10. (x) Ventilator care and maintenance; and
      11. (xi) The insertion, removal, and maintenance of gastrostomy feeding tubes;
9. (9) “Substantial supervision” means the prompting, reminding, or guidance of another person to perform the task;

10. (10) “Toileting” means the act of voiding of the individual's bowels or bladder, and includes:

    1. (A) The use of a:

       1. (i) Toilet;
       2. (ii) Commode;
       3. (iii) Bedpan; or
       4. (iv) Urinal;

    2. (B) Transfers on and off a:

       1. (i) Toilet;
       2. (ii) Commode;
       3. (iii) Bedpan; or
       4. (iv) Urinal;
    3. (C) The cleansing of the individual after the act;
    4. (D) Changes of incontinence devices such as pads or diapers;
    5. (E) Management of ostomy or catheters; and
    6. (F) Adjustment to clothing;
11. (11) “Total dependence” means the individual needs another person to completely and totally perform the task for the individual; and

12. (12) “Transferring” means the act of an individual in moving from one (1) surface to another, and includes transfers to and from:

    1. (A) Bed;
    2. (B) Wheelchairs;
    3. (C) Walkers and other locomotive aids; and
    4. (D) Chairs.