6513.1 In addition to the patient specific per diem rate described in § 6501.2, DHCF shall pay an additional per diem amount for any day that a resident qualifies as a bariatric resident pursuant to the requirements set forth in § 6513.2.

6513.2 A bariatric resident is defined as one who:

1. (a) Has a body mass index (BMI) of forty (40) or higher; and
2. (b) Requires the assistance of two or more staff for three (3) or more Activities of Daily Living (ADL) during the most recent MDS assessment period.

6513.3 Reimbursement for bariatric residents shall be prior authorized by DHCF. The following documentation is required for authorization:

1. (a) Medical records including MDS documenting the resident's height, weight and calculation of BMI; and
2. (b) A description of the resident's ADL assistance needs, including the relevant section of the most recent MDS assessment demonstrating the need for assistance of two or more staff for three (3) or more ADLs.

SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006); as amended by Final Rulemaking published at 66 DCR 13663 (October 18, 2019).