C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-96, app 144-101-II-#1
ADL = Activities of Daily Living APPENDIX #1 TASK TIME ALLOWANCES | ||||
Activity | Definitions | Time Estimates | Considerations | |
Bed Mobility | How person moves to and from lying position, turns side to side and positions body while in bed. | 5 - 10 minutes | Positioning supports, cognition, pain, disability level | |
Transfer | How person moves between surfaces - to/from: bed, chair, wheelchair, standing position (EXCLUDE to/from bath/toilet). | 5 - 10 minutes up to 15 minutes | Use of slide board, gait belt, swivel aid, supervision needed, positioning after transfer, cognition Mechanical lift transfer | |
Locomotion | How person moves between locations in his/her room and other areas on same floor. If in wheel- chair, self-sufficiency once in chair. | 5 - 15 minutes (Document time and number of times done in POC) | Disability level, type of aids used, cognition, pain | |
Dressing & Undressing | How person puts on, fastens and takes off all items of street clothing, including donning/removing prosthesis. | 20 - 45 minutes | Supervision, disability, cognition, pain, type of clothing, type of prosthesis | |
Eating | How person eats and drinks (regardless of skill) | 5 minutes 30 minutes 30 minutes | Set up, cut food and place utensils Individual is fed Supervision of activity due to swallowing, chewing, cognition issues | |
Toilet Use | How person uses the toilet room (or commode, bedpan, urinal); transfers on/off toilet, cleanses, changes pad, manages ostomy or catheter and adjusts clothes. | 5 -15 minutes/use | Bowel, bladder program, ostomy regimen, catheter regimen, cognition | |
Personal Hygiene | How person maintains personal hygiene. (EXCLUDE baths and showers) | Washing face, hands, perineum, combing hair, shaving and brushing teeth Shampoo (only if done separately) Nail Care | 20 min/day 15 min up to 3 times/week 20 min/week | Disability level, pain, cognition, adaptive equipment. |
Walking | a. How person walks for exercise only b. How person walks around own room c. How person walks within home d. How person walks outside | Document time and number of times in POC, and level of assistance needed. | Disability, cognition, pain, mode of ambulation (cane), prosthesis needed for walking | |
Bathing | How person takes full-body bath/shower, sponge bath (EXCLUDE washing of back, hair), and transfers in/out of tub/shower | 15 - 30 minutes | If shower used and shampoo done then consider as part of activity, cognition | |
Task time allowances are used for the authorization of covered services under this Section. Refer to Section 96.04(C).
These allowances reflect the time normally allowed to accomplish the listed tasks. The Authorized Entity and PDN provider will use these allowances when authorizing a Member's authorized plan of care. If these times are not sufficient when considered in light of a Member's unique circumstances as identified by the Authorized Entity, the Authorized Entity may make an appropriate adjustment as long as the authorized hours do not exceed the limits established for the Member's level of care.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-96, app 144-101-II-#1