Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part II - Nursing Facilities › Subpart 3 - Standards for Payment › Chapter 103 - Standards for Payment for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) › Subchapter F - Health Services › Section II-10339 - Client Health and Habilitative Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
Intermediate Care Facilities for
					 the Mentally Retarded (ICF/MR)
are defined as intermediate care
					 facilities whose primary purpose is to provide health or habilitative services
					 for mentally retarded individuals or persons with related conditions and meet
					 the standards in 42 CFR 442 and
					 483.400.
B. The following health and habilitative
					 services must be provided to all clients.
1.
					 Active Treatment Services. The facility must provide or arrange for each client
					 to receive a continuous active treatment program consisting of needed
					 interventions and services in sufficient number and frequency to support the
					 achievement of the objectives identified in the Individual Habilitation Plan
					 (IHP). These services include but are not limited to occupational, speech,
					 physical and recreational therapies; psychological, psychiatric, audiology,
					 social work, special education, dietary and rehabilitation counseling.
NOTE: Supplies, equipment, etc. needed to meet the goals
						of the IHP cannot be charged to the client or their responsible parties.
2. Active Treatment Components
a. Individual Habilitation Plan. Each client
					 must have an Individual Habilitation Plan developed by an interdisciplinary
					 team that represents the professions, disciplines or service areas that are
					 relevant to identifying the client's needs as described by the programs that
					 meet those needs.
i. The facility must
					 document in the Individual Habilitation Plan (IHP) the presence, or the reason
					 for absence, at the individual's staffing conference of the client, family
					 members and relevant disciplines, professions or service areas as identified in
					 the comprehensive functional assessment.
ii. Within 30 days after admission, the
					 interdisciplinary team must do assessments or reassessments as needed to
					 supplement the preliminary evaluation conducted prior to admission.
iii. The comprehensive functional assessment
					 must take into consideration the client's age and the implications for active
					 treatment at each stage as applicable. It must contain the following
					 components:
(a). the presenting problems and
					 disabilities and where possible, their causes including diagnosis, symptoms,
					 complaints and complications;
(b).
					 the client's specific developmental strengths;
(c). the client's specific developmental and
					 behavioral management needs;
(d).
					 an identification of the client's needs for services without regard to the
					 actual availability of the services.
iv. The comprehensive functional assessment
					 must cover the following developmental areas:
(a). physical development and
					 health;
(b). nutritional
					 status;
(c). sensorimotor
					 development;
(d). affective
					 development;
(e). speech and
					 language development;
(f). auditory
					 functioning;
(g). cognitive
					 development;
(h). social
					 development;
(i). adaptive
					 behaviors or independent living skills necessary for the client to be able to
					 function in the community;
(j).
					 vocational skills as applicable;
(k). psychological development.
b. Specific Objectives.
					 Within 30 days after admission, the interdisciplinary team must prepare for
					 each client an IHP that states specific objectives necessary to meet the
					 client's needs, as identified by the comprehensive functional assessment, and
					 states the plan for achieving these objectives.
i. Components for these objectives must be:
(a). stated separately, in terms of a single
					 behavioral outcome;
(b). be
					 assigned projected completion dates;
(c). be expressed in behavioral terms that
					 provide measurable indices of performance;
(d). be organized to reflect a developmental
					 disability;
(e). be assigned
					 priorities.
ii. A copy
					 of each client's Individual Habilitation Plan must be made available to all
					 relevant staff, including staff of other agencies who work with the client, the
					 client, parents if the client is a minor, or legal guardian. The Individual's
					 Habilitation Plan must be implemented within 14calendar days of its
					 development.
iii. The facility must
					 develop and make available to relevant staff an active treatment schedule that
					 outlines the current active treatment program.
iv. Each written training program designed to
					 implement these objectives in the Individual Habilitation Plan must specify:
(a). the methods to be used;
(b). the schedule for use of the
					 methods;
(c). the person
					 responsible for the program;
(d).
					 the type of data and frequency of data collection necessary to be able to
					 assess progress toward the desired objectives;
(e). the inappropriate client behavior(s), if
					 applicable; and
(f). a provision
					 for the appropriate expression and the replacement of inappropriate behavior,
					 if applicable, with behavior that is adaptive or appropriate.
v. The IHP must also:
(a). describe relevant interventions to
					 support the individual toward independence;
(b). identify the location where program
					 strategy information (which must be accessible to any person responsible for
					 implementation) can be found;
(c).
					 include, for those clients who lack them, training in personal skills essential
					 for privacy and independence (including skills and activities of daily living)
					 until it has been demonstrated that the client is developmentally incapable of
					 applying them;
(d). plans for
					 discharge.
vi. The IHP
					 must identify mechanical supports, if needed, to achieve proper body position,
					 balance, or alignment. This plan must specify:
(a). the reason for each support;
(b). the situation in which each is to be
					 applied;
(c). a schedule for the
					 use of each support.
vii. Clients who have multiple disabling
					 conditions must be provided the opportunity to spend a major portion of each
					 working day out of bed and outside the bedroom area, moving about by various
					 methods and devices whenever possible.
viii. The IHP must include opportunities for
					 client choice and self management.
c. Documentation. The facility must document
					 data relevant to the accomplishment of the criteria specified in the client's
					 Individual Habilitation Plan objectives. This data must meet certain criteria.
i. Data must be documented in measurable
					 outcomes;
ii. Significant events
					 related to the client's Individual Habilitation Plan and assessment and that
					 contribute to an overall understanding of his ongoing level and quality of
					 function must be documented;
iii.
					 The Individual Habilitation Plan must be reviewed by a qualified mental
					 retardation professional at least quarterly or as needed and revised as
					 necessary, including but not limited to situations in which the client:
(a). has successfully completed an objective
					 or objectives identified in the Individual Habilitation Plan;
(b). is regressing or losing
					 skills;
(c). is failing to progress
					 toward identified objectives after reasonable efforts have been made;
(d). is being considered for training toward
					 new objectives.
iv. At
					 least annually, the comprehensive assessment of each client must be reviewed by
					 the interdisciplinary team for relevancy and updated as needed. The Individual
					 Habilitation Plan must be revised as needed or at least by the 365th day after
					 the last review.