An Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD) is a residential facility that:
Plan of Care
Each recipient must have an individual service plan (ISP) developed by an interdisciplinary team with representation from the professions, disciplines or service areas specific to the individual needs and program design. This plan must be based on the results of a comprehensive functional assessment as defined by federal regulations. This plan must state the objectives needed to meet the recipients needs as identified by the comprehensive assessment and document a sequenced plan for meeting the objectives. The objectives must:
The plan must describe relevant interventions to support the recipient toward independence. The interventions must:
The plan must be completed within 30 days after admission. The Qualified Developmental Disability Professional (QDDP) must review the plan when the recipient (not an all-inclusive list):
The plan must be reviewed and documented by the interdisciplinary team, per case management guidelines.
The ICF/DD is to provide outcome-based services in response to the needs of a person as identified in the Individual Service Plan. Services must be based on the needs, preferences and goals of the individual and be consistent with the principles of the least restrictive environment and self-determination. The ICF/DD must make available to each person:
A physician must certify the need for a certified NF, certified boarding care facility, or ICF/DD. A Physician Certification form (DHS-1503) must be completed in the following instances:
The initial utilization review date for a recipient must be established at the time of admission and documented on the Physician Certification (DHS1503). The initial utilization review date for an MA applicant must be established when notified of MA eligibility. The Utilization Review Group documentation must indicate the recipient was reviewed at least every six months, or more often if the group deems it necessary. Each time a Physician Certification (DHS1503) is required, the utilization review process must be re-established.
Each recipient must have a medical evaluation whenever a Physician Certification (DHS1503) is required. The minimum requirements of this evaluation include all of the following:
In the situation where a recipient is readmitted from a hospital stay or unauthorized leave, providers must document the review and any update of the evaluation.
Roles and Responsibilities
The state (DHS), counties and ICF/DD facilities all share responsibilities. The counties handle case management and logistical issues related to the facilities. More information on these roles and responsibilities of the parties may be found in the following sections of the ICF/DD System Manual:
Each ICF/DD provider agency is responsible to meet all federal, state and local requirements. ICF/DDs must:
Providers serving MHCP recipients who reside in an ICF/DD must:
For additional information, refer to:
Exemption: An SNF, ICF or ICF/DD that is operated, listed, and certified as a Christian Science sanatorium by the First Church of Christ Scientist, of Boston, Massachusetts, is not subject to the federal regulations for utilization control in order to receive MA payments for the cost of recipient care.
MHCP recipients must be actively enrolled in either Medical Assistance (MA, Programs NM and IM) or Emergency Medical Assistance (EMA), or be eligible under the DD waiver program.
MA-eligible recipients must reside in a certified bed that matches their certified level of care. Eligibility for ICF/DD services is determined through a screening process. Refer to Admission to an ICF/DD. Minnesota Department of Health (MDH) certifies an ICF/DD to provide health or rehabilitative services for persons who:
Medical Assistance (MA) will cover the cost of care for a recipient who resides in a licensed ICF/DD, certified Nursing Facility (NF), or a certified Boarding Care Home (BCH), if the recipient:
MHCP covers room and board care for an MA recipient in an ICF/DD. Items/services usually included in the per diem (not an all-inclusive list):
Alternative service options for persons who live in an ICF/DD provide flexibility and the choice to select and use the program option that best meets the persons needs as identified in the Individual Service Plan (ISP). Current options for persons include:
The ICF/DD and DT&H provider are required to provide active treatment and meet all federal regulations that govern a person who resided in an ICF/DD, no matter which of the options above, is used.
The Services During the Day Option for persons who live in an ICF/DD provides an option for services other than DT&H. It provides the flexibility and choice to select the program option that best meets the recipients needs as identified in the Individual Service Plan (ISP). Services or supports provided using this option enables the recipient to fully integrate into the community. Services during the day may include a variety of supports to enable the recipient to exercise choices for community integration and inclusion activities. Services during the day may include but are not limited to: supported work, support during community activities, community volunteer programs, adult day care, recreational activities, and other individualized supports. Services during the day must comply with active treatment requirements for recipients residing in an ICF/DD. Services during the day can be provided by any of the following:
Services may not be provided by the residential service provider, unless the recipient or their legal representative is:
A recipient can receive services during the day from someone other than the ICF/DD when that is the choice of the recipient or their legally authorized representative. The ICF/DD where the recipient lives is responsible to arrange, oversee and bill for the services provided. The ICF/DD will pay the provider of the service at a rate that does not exceed the rate approved by DHS. The application for this option is available in Services During the Day Options for persons living in ICF/DD facilities. MA eligible residents of ICF/DDs and Nursing Facilities (NFs) who also meet hospice service eligibility may elect to receive hospice services where they live. Refer to the Hospice Services section.
DT&H facilities are licensed supports to provide recipients with help to develop and maintain life skills, participate in community life and engage in proactive and satisfying activities of their own choosing. Services include:
A recipient cannot attend both a DT&H and Services During the Day on the same day. Only one of these two services may be billed for one person on any given day of the week.
ICF/DD Non - DT&H Service
ICF/DD recipients have a choice of day services as do persons who receive a home and community-based waiver. The active treatment criteria for persons who reside in an ICF/DD remains in place, no matter which option is chosen.
MA covers the majority of costs incurred while in an ICF/DD. However a resident may be responsible for some non-covered MA services, such as:
Refer to Admission to an ICF/DD
Refer to Preadmission Screening
On the DD screening document, code current services as ICF/DD community #28 with a risk status of 01: Person is at risk of ICF/DD placement.
Authorizations through Service Agreements are required for the following:
Refer to the ICF/DD Systems Manual for:
DHS governs the authorization of special needs rate exceptions for very dependent persons with special needs residing in an ICF/DD. Once a request is approved, a vendor and recipient specific service agreement and approval letter are generated and sent to the provider. Billing codes on the approved service agreement are as follows:
Special Needs Rate Exceptions for the Developmental Disabilities (DD) Waiver
The county cannot negotiate an individual rate for a recipient that is different from the established DT&H rates unless authorization is received from DHS in accordance with Rule 186 criteria. Recipients who receive a rate exception are considered to have the same level of need as recipients who reside in an ICF/DD. There is allowance for additional dollars to be available a maximum of 12 months to allow a recipient to continue to receive DT&H services.
MHCP grants final approval and will override the rate file on the service agreement for the person who receives the special needs rate exception. Counties do not have the ability to override the rate file.
Active Treatment: Refers to aggressive, consistent implementation of a program of specialized and generic training, treatment and health services. Active treatment does not include services to maintain generally independent recipients able to function with little supervision or in the absence of a continuous active treatment program.
Day Training and Habilitation Services (DT&H): These are services related to a person's employment or work, self-care, communication skills, socialization, community orientation, transportation needs, emotional development, development of adaptive behavior, cognitive development, and physical mobility. It includes training, supervision assistance, and other support activities designed and implemented in accordance with a persons individual service plan to help that person attain and maintain the highest level of independence, productivity, and integration into the community where the person lives and works. The ISP for each person requiring a 24-hour plan of care must provide services during the day outside the residence unless otherwise specified in their plan.
Developmental Disability (DD): Severe, chronic disability attributable to mental/physical impairment, which manifests before age 22 years and is likely to continue indefinitely. The disability results in substantial limitations in three or more of the following areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living and economic self-sufficiency as well as the continuous need for individually planned and coordinated services.
Developmental Disabilities (DD) Waiver: The DD Waiver provides funding for home and community-based services for children and adults with developmental disabilities. Assessed waiver service needs, as identified in the persons service plan, may be provided in a persons own home, in his/her biological or adoptive familys home, in a relatives home (e.g., sibling, aunt, grandparent, etc.), in a family foster care home or corporate foster care home.
Facility with Distinct Part Certification: Sections of the facility certified as psychiatric, NF, or ICF/DD; must admit and care for those MA recipients certified as requiring the same level of care as the bed certification.
Individual Service Plan (ISP): Each person with developmental disabilities or a related condition, who is receiving services, must have an ISP. The ISP is developed after an assessment of the persons preferences, functional skills and need for services and supports is completed before services are authorized. The ISP is based on the service recommendations from the completed assessment(s) and the service needs identified by the team.
Intermediate Care Facility for Persons with Developmental Disabilities (ICF/DD): Residential facility licensed as a health care institution and certified by the Minnesota Department of Health to provide health or rehabilitative services for persons with developmental disabilities or a related condition who require active treatment.
Leave Day: An overnight absence of more than 23 hours. After the first 23 hours, additional leave days are accumulated each time the clock passes midnight. Absence must be for hospital or therapeutic cause.
Level of Care (LOC): Care and services associated with a particular facility type, for example:
An LOC must be determined for all persons seeking a Medicaid waiver. It is an eligibility requirement for its receipt and identifies the type of waiver and services available to eligible recipients.
Long Term Care (LTC): Services received in a nursing facility, an intermediate care facility for persons with developmental disabilities (ICF/DD), or a swing bed when the individual in the facility is screened or certified as requiring the services provided in the facility.
LTC Facility: A residential facility certified by the MDH as a skilled nursing facility or as an intermediate care facility, including an ICF/DD.
DD Conversion: A recipient in an existing ICF/DD bed is provided home and community-based services and the ICF/DD bed the recipient previously occupied is decertified and removed from the community ICF/DD system.
Qualified Developmental Disability Professional (QDDP): Individual qualified to work as an expert with persons with developmental disabilities. The QDDP has a four-year college degree in an area related to developmental disabilities and a minimum of one-year experience working in that field.
Regional Treatment Center (RTC): State facility for treating persons with mental illness, developmental disabilities or chemical dependency that is under the direct administrative authority of the Commissioner.
Reserved Bed: The same bed that a recipient occupied before leaving the facility for hospital leave or therapeutic leave, or an appropriately certified bed if the recipient's physical condition upon returning to the facility prohibits access to the bed he/she occupied before the leave. It is commonly referred to as a bed hold.
Residential Care Services: Supportive and health supervision services provided in a licensed residential setting as identified in an Individual Service Plan.
Services During the Day: Services or supports provided to a person that enables the person to be fully integrated into the community. These may include a variety of supports to enable the person to exercise choices for community integration and inclusion activities. Services during the day may include, but are not limited to: supported work, support during community activities, community volunteer activities, adult daycare, recreational activities and other individualized integrated supports.
Therapeutic Leave: Absence of a recipient from an ICF/DD for a non-medical purpose with the expectation the recipient will return to the facility. The recipient may be at any of the following:
Utilization Review: A review of the use of medical resources at a medical facility for purposes of cost control
Waivered Service: Home or community-based service authorized and defined in the Minnesota state plan for the provision of medical assistance services. Waivered services include, at a minimum, case management, family training and support, developmental training homes, supervised living arrangements, semi-independent living services, respite care, and training and habilitation services.
MS 252.282 Local System Needs Planning
MS 256B.092 County of Financial Responsibility
MS 256B.27, subd.1 MA Reports and Audits
MS 256B.0625, subd.2 MA Covered Services
MS 256B.0926 Admission Review Team
MS 256B.48 Conditions for Participation
MS 256B.501 Community-Based Service Rates
MS 256B.501, subd.8; 8a Payment for persons with special needs for crisis intervention services
MS 256B.5011 ICF/DD Reimbursement
MS 256B.5012 ICF/DD Payment System
MS 256B.5013 Payment Rate Adjustments
MS 256B.5014 Financial Reporting
MS 256B.5015 Pass-Through of Other Services Costs
Minnesota Rules 4665.0500 Building Classification
Minnesota Rules 9510.1020 to 9510.1140 Rule 186 Definitions and Appeals
Minnesota Rules 9549.0060, subp.11 Capacity
Minnesota Rules 9549.0070 Payment Rate
Minnesota Rules 9553.0010 to 9553.0080 Costs/Payment Rate
42CFR440 Services: General Provisions
42CFR441 Services: Requirements and Limits Applicable to Specific Services
42CFR442 Standards for Payment to Nursing Facilities and ICF/DDs