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Title: Section 400.12 - Level of care criteria

Effective Date


400.12 Level of care criteria

(a) New York State criteria for level of care. (1) Minimum qualification for residential health care facility care: The patient is qualified for residential health care facility care and such care is consistent with all applicable federal requirements as documented on the

patient screening instrument (SCREEN).

(2) Skilled nursing facility care. Patients in the following resource utilization groups meet the requirements for skilled nursing facility level of care:

Special Care A
Special Care B
Heavy Rehabilitation A
Heavy Rehabilitation B
Clinically Complex A
Clinically Complex B
Clinically Complex C
Clinically Complex D
Severe Behavioral A
Severe Behavioral B
Severe Behavioral C
Reduced Physical Functioning A
Reduced Physical Functioning B
Reduced Physical Functioning C
Reduced Physical Functioning D
Reduced Physical Functioning E

The SCREEN Form DOH 695 shall be maintained by the department, in such form and format as prescribed by the department in compliance with federal law, and shall be accessible at:


VOLUME C (Title 10)