Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 5 - MEDICAID SERVICES › Rule 13 - Intermediate Care Facilities for the Mentally Retarded › Section 13-7 - Admission and placement; large private and small ICFs/IID

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC
				  12-15-21-3
Affected: IC 12-13-7-3; IC 12-15
Sec. 7.
(a)
				Admissions to large private and small ICFs/IID shall be based upon a
				determination of the need for such care by the office. The interdisciplinary
				professional team from the proposed placement facility shall review a
				comprehensive evaluation covering physical, emotional, social, and cognitive
				factors, as required by federal law, to ensure the facility can meet the needs
				of the member.
(b) The
				interdisciplinary professional team includes a physician, a certified social
				worker, and other professionals, one (1) of whom is a qualified intellectual
				disability professional.
(c) A
				qualified intellectual disability professional is a person as defined in
				42 CFR
				483.430.
(d) The following guidelines are applicable
				for admission and readmission of a member to a large private or small ICF/IID:
(1) The office must authorize Medicaid
				payment for each member in the large private and small ICF/IID. This process
				must be completed prior to the first Medicaid payment. Determination of
				appropriate reimbursement is based on the documentation required by this
				subsection.
(2) Admission to all
				large private and small ICF/IID facilities requires diagnostic evaluation,
				including social and psychological components.
(3) The ICF/IID must submit a form approved
				by the office, completed by the physician, for each Medicaid applicant or
				member for whom services are required. The need for care and placement during
				any payment period must be included in the medical evaluation. The payment
				period will not be approved for any period of time that precedes the date the
				physician signs the Form 450B certifying the need for ICF/IID
				services.
(4) Both member and
				provider must have been eligible to participate in Medicaid during any period
				for which Medicaid reimbursement is requested.
(5) A physician must certify the patient's
				need for ICF/IID care at the time of admission. The first recertification must
				take place within twelve (12) months from the date of admission certification.
				Subsequent recertifications must occur annually thereafter, or more often, as
				determined by the interdisciplinary team.
(6) The certification must specify the level
				of care required by the member, and the recertification must clearly indicate
				the need for care to continue at this level. The certification must be signed
				by the physician and dated at the time of signature. Subsequent
				recertifications must be signed by a physician, a physician assistant, or a
				nurse practitioner and dated at the time of signature. (A STAMPED SIGNATURE
				WILL NOT BE ACCEPTED.)
(7) The
				admission certification and the three (3) latest recertifications must be kept
				in the member's active medical record. All other recertification must be kept
				on file in the facility and be available for review purposes.
(8) Pursuant to
				42 CFR
				483.440(c)(3), the
				interdisciplinary professional team must, within thirty (30) days after
				admission, review and update the preadmission evaluation.
(9) The individual program plan must be
				reviewed at least by the qualified intellectual disability professional and
				revised as necessary as required by
				42 CFR
				483.440(f).
(10) At least annually, the comprehensive
				functional assessment of each individual must be reviewed by the
				interdisciplinary team for relevancy and updated as needed in accordance with
				42 CFR
				483.440(f)(2).