Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part VII - Long Term Care › Subpart 3 - Intermediate Care Facilities for Persons with Intellectual Disabilities › Chapter 301 - General Provisions › Section VII-30103 - Definitions and Acronyms Specific to Mental Retardation and Other Developmental Disabilities

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Definitions regarding Mental Retardation are adopted from the American
				  Association on Mental Deficiency
Manual on Terminology and
				  Classification in Mental Retardation
, 1977 Edition.
B. Definitions for Developmental Disabilities
				  are taken from the 1983 amended R.S. 28:330-444 based on Public Law 95-602.
C. All clients must meet the criteria for
				  mental retardation and other developmental disabilities in order to qualify for
				  Title XIX reimbursement for ICF/MR services.
AAMR
- American Association of Mental
					 Retardation (formerly the AAMD C American Association of Mental
					 Deficiency).
Abuse
- the infliction of physical or
					 mental injury to a client or causing a client's deterioration to such an extent
					 that his/her health, moral or emotional well-being is endangered. Examples
					 include, but are not limited to: sexual abuse, exploitation or extortion of
					 funds or other things of value.
Active Treatment
- an aggressive and
					 consistent program of specialized and generic training, treatment, health and
					 related services directed toward the acquisition of behaviors necessary for the
					 client to function with as much self determination and independence as possible
					 and the prevention and deceleration of regression or loss of current optimal
					 functional status.
Acuity Factor
- an adjustment factor which
					 will modify the direct care portion of the Inventory for Client and Agency
					 Planning (ICAP) rate based on the ICAP level for each resident.
Adaptive Behavior
- the effectiveness or
					 degree with which the individual meets the standards of personal independence
					 and social responsibility expected for his age and cultural group. Since these
					 exceptions vary for different age groups, deficits in adaptive behavior will
					 vary at different ages.
Administrative and Operating Costs
-
					 include:
a. in-house and contractual
				  salaries;
b. benefits;
c. taxes for administration and plant
				  operation maintenance staff;
d.
				  utilities;
e. accounting;
f. insurances;
g. maintenance staff;
h. maintenance supplies;
i. laundry and linen;
j. housekeeping; and
k. other administrative type
				  expenditures.
Agency
- see Medicaid Agency.
Ambulatory
- an ability to walk
					 about.
ANSI
- American National Standards
					 Institute.
Applicant
- an individual whose written
					 application for Medicaid has been submitted to the agency but whose eligibility
					 has not yet been determined.
ART
- accredited record technician.
Attending Physician
- a physician
					 currently licensed by the Louisiana State Board of Medical Examiners,
					 designated by the client, family, agency, or responsible party as responsible
					 for the direction of overall medical care of the client.
Autism
- a condition characterized by
					 disturbance in the rate of appearance and sequencing of developmental
					 milestones:
a. abnormal responses to
				  sensations;
b. delayed or absent
				  speech and language skills while specific thinking capabilities may be present;
				  and
c. abnormal ways of relating to
				  people and things.
BHSF
- Bureau of Health Services
					 Financing. See
Health Services Financing
.
Board Certified Social Worker (BCSW)
- a
					 person holding a Master of Social Work (MSW) degree who is licensed by the
					 Louisiana State Board of Certified Social Work Examiners.
Capacity for Independent Living
- the
					 ability to maintain a full and varied life in one's own home and
					 community.
Capital Costs - include:
a. depreciation;
b. interest expense on capital
				  assets;
c. leasing
				  expenses;
d. property taxes;
				  and
e. other expenses related to
				  capital assets.
Care Related Costs
- include in-house and
					 contractual salaries, benefits, taxes, and supplies that help support direct
					 care but do not directly involve caring for the patient and ensuring their well
					 being (e.g., dietary and educational). Care related costs would also include
					 personal items, such as clothing, personal hygiene items (soap, toothpaste,
					 etc), hair grooming, etc.
Cerebral Palsy
- a permanently disabling
					 condition resulting from damage to the developing brain, which may occur
					 before, during or after birth and results in loss or impairment of control over
					 voluntary muscles.
Certification
- a determination made by
					 the Department of Health and Hospitals (DHH) that an ICF/MR meets the necessary
					 requirements to participate in Louisiana as a provider of Title XIX (Medicaid)
					 Services.
Change in Ownership (CHOW)
- any change in
					 the legal entity responsible for the operation of an ICF/MR.
Chief Executive Officer (CEO)
- an
					 individual licensed, currently registered, and engaged in the day to day
					 administration/management of an ICF/MR.
Client
- an applicant for or recipient of
					 Title XIX (Medicaid) ICF/MR services.
Code of Federal Regulations (CFR)
- the
					 regulations published by the federal government. Section 42 includes
					 regulations for ICF/MRs.
Comprehensive Functional Assessment
-
					 identifies the client's need for services and provides specific information
					 about the client's ability to function in different environments, specific
					 skills or lack of skills, and how function can be improved, either through
					 training, environmental adaptations, or provision of adaptive, assistive,
					 supportive, orthotic, or prosthetic equipment.
Developmental Disabilities (DD)
- severe,
					 chronic disabilities which are attributable to mental retardation, cerebral
					 palsy, autism, epilepsy or any other condition, other than mental illness,
					 found to be closely related to mental retardation. This condition results in an
					 impairment of general intellectual functioning or adaptive behavior similar to
					 that of mental retardation, and requires treatment or services similar to those
					 required for MR/DD are manifested before the person reaches age 22 and are
					 likely to continue indefinitely.
Developmental Period
- a period from birth
					 to before a person reaches age 22.
DHH
-
Department of
					 Health and Hospitals or its designee.
DHHS
- the federal Department of Health
					 and Human Services in Washington, D.C.
Direct Care Costs
- consist of all costs
					 related to the direct care interaction with the patient.
Direct care
					 costs
include:
a. in-house
				  and contractual salaries;
b.
				  benefits; and
c. taxes for all
				  positions directly related to patient care, including:
i. medical;
ii. nursing;
iii. therapeutic and training;
iv. ancillary in-house services;
				  and
v. recreational.
Dual Diagnosis
- clients who carry
					 diagnoses of both mental retardation and mental illness.
Enrollment
- process of executing a
					 contract with a licensed and certified ICF/MR provider for participation in the
					 Medical Assistance Program. Enrollment includes the execution of the provider
					 agreement and assignment of the provider number used for payment.
Epilepsy
- disorder of the central nervous
					 system which is characterized by repeated seizures which are produced by
					 uncontrolled electrical discharges in the brain.
Facility
- an intermediate care facility
					 for the mentally retarded and developmentally disabled.
Fiscal Intermediary
- the private fiscal
					 agent with which DHH contracts to operate the Medicaid Management Information
					 System. It processes the Title XIX (Medicaid) claims for services provided
					 under the Medical Assistance Program and issues appropriate payment(s).
General Intellectual Functioning
- results
					 obtained by assessment with one or more of the individually administered
					 general intelligence tests developed for that purpose.
HCFA
- Health Care Financing
					 Administration.
Health Services Financing, Bureau of
					 (BHSF)
- a division of DHH responsible for administering, overseeing,
					 and monitoring the state's Medicaid Program.
HSS
- Health Standards Section within
					 BHSF, the section responsible for licensing, certifying and enrolling
					 ICFs/MR.
ICAP
- Inventory for Client and
					 Agency Planning.
A standardized instrument for assessing adaptive and
					 maladaptive behavior and includes an overall service score. This ICAP service
					 score combines adaptive and maladaptive behavior scores to indicate the overall
					 level of care, supervision or training required.
ICAP Service Level
-
					 r
anges from 1 to 9 and indicates the service need intensity. The lower
					 the score the greater is the client need.
ICAP Service Score
-
indicates the level of service intensity required by an individual,
					 considering both adaptive and maladaptive behavior.
NOTE: The relationship between the service level and
					 service score for ICAP support levels is as follows:
ICAP Relationship Graph
ICAP Service Level
ICAP Service Score
ICAP Support Levels
Pervasive+
1
1-19
Pervasive
2
20-29
3
30-39
Extensive
4
40-49
5
50-59
Limited
6
60-69
7
70-79
Intermittent
8
80-89
9
90+
Index Factor
- this factor will be based
					 on the
Skilled Nursing Home without Capital Market Basket
					 Index
published by Data Resources Incorporated or a comparable index
					 if this index ceases to be published.
Individual Habilitation Plan (IHP)
- the
					 written ongoing program of services developed for each client by an
					 interdisciplinary team in order for that client to achieve or maintain his/her
					 potential. The plan contains specific, measurable goals, objectives and
					 provides for data collection.
Individual Plan of Care
(IPC) - same as
					 Individual Habilitation Plan.
Individual Program Plan
(IPP) - same as
					 Individual Habilitation Plan.
Individual Service Plan
(ISP) - same as
					 Individual Habilitation Plan.
Interdisciplinary Team (IDT)
- a group of
					 individuals representing the different disciplines in the formulation of a
					 client's individual habilitation plan. That team meets at least annually to
					 develop and review the plans, more frequently if necessary.
Intermediate Care Facility for the Mentally
					 Retarded and Developmentally Disabled
(ICF/MR) - same as facility for
					 the mentally retarded or persons with related conditions.
I.Q. - Intelligence
				  Quotient.
Learning
- general cognitive
					 competence-the ability to acquire new behaviors, perceptions, and information
					 and to apply previous experiences in new situations.
Legal Status
- a designation indicative of
					 an individual's competency to manage their affairs.
Level of Care (LOC)
- service needs of the
					 client based upon his/her comprehensive functional status.
Licensed
- a determination by the
					 Louisiana Department of Health and Hospitals, Bureau of Health Service
					 Financing, that an ICF/MR meets the state requirements to participate in
					 Louisiana as a provider of ICF/MR services.
Living Unit
- a place where a client lives
					 including sleeping, training, dining and activity areas.
LPN
- licensed practical nurse.
LSC
- life safety code.
LTC
- long term care.
Major Life Activities
- any one of the
					 following activities or abilities:
a.
				  self-care;
b. understanding and use
				  of language;
c. learning;
d. mobility;
e. self-direction;
f. capacity for independent living.
Measurable Outcomes
- a standard or goal
					 by which performance is measured and evaluated.
Mechanical Support
- a device used to
					 achieve proper body position or balance.
Medicaid
- medical assistance provided
					 according to the State Plan approved under Title XIX of the Social Security
					 Act.
Medicaid Agency
- the single state agency
					 responsible for the administration of the Medical Assistance Program (Title
					 XIX). In Louisiana, the Department of Health and Hospitals is the single state
					 agency.
Medicaid Management Information System
					 (MMIS)
- the computerized claims processing and information retrieval
					 system which includes all ICF/MR providers eligible for participation in the
					 Medical Assistance Program. This system is an organized method for payment for
					 claims for all Title XIX Services.
Medical Assistance Program (MAP)
- another
					 name for the Medicaid Program.
Medicare
- the federally administered
					 Health Insurance program for the aged, blind and disabled under the Title XVIII
					 of the Social Security Act.
Medicare Part A
- the hospital insurance
					 program authorized under Part A of Title XVIII of the Social Security
					 Act.
Medicare Part B
- the supplementary
					 medical insurance program authorized under Part B of Title XVIII of the Social
					 Security Act.
Mental Retardation (MR)
- significantly
					 subaverage general intellectual functioning existing concurrently with deficits
					 in adaptive behavior, and manifested during the developmental period.
NOTE: It shall be emphasized that a finding of low I.Q. is
					 never by itself sufficient to make the diagnosis of mental retardation or in
					 evaluating its severity. A low I.Q. shall serve only to help in making a
					 clinical judgment regarding the client's adaptive behavioral capacity. This
					 judgment also includes present functioning, including academic and vocational
					 achievement, motor skills, and social and emotional maturity.
Mobil Nonambulatory
- the inability to
					 walk without assistance, but the ability to move from place to place with the
					 use of a device such as a walker, crutches, wheelchair or wheeled
					 platform.
Mobility
- motor development and ability
					 to:
a. use fine and gross motor
				  skills;
b. move the extremities at
				  will.
Neglect
- the failure to provide proper or
					 necessary medical care, nutrition or other care necessary for a client's well
					 being.
New Facility
- an ICF/MR newly opened or
					 recently began participating in the Medical Assistance Program.
Nonambulatory
- the inability to walk
					 without assistance.
Nursing Facility or Facility
- health care
					 facilities such as a private home, institution, building, residence, or other
					 place which provides maintenance, personal care, or nursing services for
					 persons who are unable to properly care for themselves because of illness,
					 physical infirmity or age. These facilities serve two or more persons who are
					 not related by blood or marriage to the operator and may be operated for profit
					 or nonprofit.
Office for Citizens with Developmental Disabilities
					 (OCDD)
- the office within DHH responsible for programs serving the
					 MR/DD population.
Operational
- admission of at least one
					 client, completion of functional assessments(s) and development of individual
					 program plan(s) for the client(s); and implementation of the program plan(s) in
					 order that the facility actually demonstrate the ability, knowledge, and
					 competence to provide active treatment.
Overall Plan of Care
(OPC) - see
					 Individual Habilitation Plan.
Pass through Cost Component
- includes the
					 provider fee.
Peer Group
- the administrative and
					 operating per diem rate and the capital per diem rate are tiered based on peer
					 group size. Peer groups are as follows:
a. 1-8 beds;
b. 9-15 beds;
c. 16-32 beds;
d. 33 or more beds.
Provider
- any individual or entity
					 enrolled to furnish Medicaid services under a provider agreement with the
					 Medicaid agency.
Qualified Mental Retardation Professional
					 (QMRP)
- a person who has specialized training and at least one year
					 or more of experience in treating and/or working directly with and in direct
					 contact with the mentally retarded clients. To qualify as a QMRP, a person must
					 meet the requirements of
					 42
					 CFR 483.430.
Rate Year
- a one-year period
					 corresponding to the state fiscal year from July 1 through June 30.
Rebasing
- recalculation of the per diem
					 rate components using the latest available audited or desk reviewed cost
					 reports.
Recipient
- an individual who has been
					 determined eligible for Medicaid.
Registered Nurse (RN)
- a nurse currently
					 registered and licensed by the Louisiana State Board of Nursing.
Representative Payee
- a person designated
					 by the Social Security Administration to receive and disburse benefits in the
					 best interest of and according to the needs of the beneficiary.
Responsible Party
- a person authorized by
					 the client, agency or sponsor to act as an official delegate or agent in
					 dealing with the Department of Health and Hospitals and/or the ICF/MR.
Self-Care
- daily activities which enable
					 a person to meet basic life needs for food, hygiene, appearance and
					 health.
Self-Direction
- management and control
					 over one's social and personal life and the ability to make decisions that
					 affect and protect one's own interests. A substantial functional limitation in
					 self-direction would require a person to need assistance in making independent
					 decisions concerning social and individual activities and/or in handling
					 personal finances and/or in protecting his own self-interest.
Significant Assistance
- help needed at
					 least one-half of the time for one activity or a need for some help in more
					 than one-half of all activities normally required for self-care.
Significantly Sub-Average
- for purposes
					 of certification for ICF/MR an I.Q. score of below 70 on the Wechsler,
					 Standford-Binet, Cattell, or comparable test will be considered to establish
					 significantly sub-average intellectual functioning.
SNF
- Skilled Nursing Facility.
Sponsor
- an adult relative, friend, or
					 guardian of the client who has a legitimate interest in or responsibility for
					 the client's welfare. Preferably, this person is designated on the admission
					 forms as "responsible party."
Substantial Functional Limitation
- a
					 condition that limits a person from performing normal life activities or makes
					 it unsafe for a person to live alone to such an extent that assistance,
					 supervision, or presence of a second person is required more than half of the
					 time.
Support Levels
-
					 d
escribe the levels of support needed by individuals with mental
					 retardation and other developmental disabilities. The five descriptive levels
					 of service intensity using the ICAP assessment are summarized in Subparagraphs
					 a-e below.
a. Intermittent - supports
				  on an as needed basis. Characterized as episodic in nature, the person does not
				  always need the support(s), or short-term supports needed during life-span
				  transition (e.g., job loss or an acute medical crisis). Intermittent supports
				  may be high or low intensity when provided.
b. Limited - supports characterized by
				  consistency over time, time-limited but not of an intermittent nature, may
				  require fewer staff members and less costs than more intense levels of support
				  (e.g., time-limited employment training or transitional supports during the
				  school to adult provided period).
c. Extensive - supports characterized by
				  regular involvement (e.g., daily) in at least some environment (such as work or
				  home) and not time-limited (e.g., long term support and long-term home living
				  support).
d. Pervasive - supports
				  characterized by their constancy, high intensity; provided across environments;
				  potential life-sustaining nature. Pervasive supports typically involve more
				  staff members and intrusiveness than do extensive or time-limited
				  supports.
e. Pervasive Plus - a
				  time-limited specific assignment to supplement required Level of Need services
				  or staff to provide life sustaining complex medical care or to supplement
				  required direct care staff due to dangerous life threatening behavior so
				  serious that it could cause serious physical injury to self or others and
				  requires additional trained support staff to be at "arms length" during waking
				  hours.