Nebraska Administrative Code › Topic - HEALTH AND HUMAN SERVICES SYSTEM › Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES › Chapter 31 - SERVICES IN AN INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES (ICF/DD) › Section 471-31-004 - SERVICE REQUIREMENTS

Current through June 17, 2024
004.01
GENERAL REQUIREMENTS.
004.01(A)
MEDICAL
  NECESSITY.
Intermediate care facility for individuals with
  developmental disabilities (ICF/DD) services must meet the medical necessity
  requirements in 471 NAC 1, and each client must be determined to meet level of
  care criteria outlined in this chapter.
004.01(B)
PRIOR
  AUTHORIZATION.
Medicaid pays for intermediate care facility for
  individuals with developmental disabilities (ICF/DD) services only when prior
  authorized. Each admission must be separately prior authorized.
004.01(C)
ADMISSION
  PROCESS.
For all clients seeking Medicaid payment for intermediate
  care facility for individuals with developmental disabilities (ICF/DD)
  services, the facility must complete a pre-admission evaluation to determine if
  the client is Medicaid eligible or has applied for Medicaid, has been diagnosed
  with an intellectual disability or related condition and whether the facility
  can provide services to meet the client's needs. In addition, the facility must
  determine that the client needs and will benefit from active treatment. The
  facility must conduct or obtain the following as part of the pre-admission
  evaluation:
(1) Current and comprehensive
  physician's examination:
(2) A
  current dental examination completed within 12 months before admission or
  within one month after the date of admission:
(3) Current and comprehensive functional
  assessments conducted on the day of and no more than three months prior to the
  admission:
(4) Psychological
  evaluation which includes the client's diagnoses, must be completed on or no
  more than three months prior to admission:
(5) The most recent individual program plan
  and if school age, the most recent individual education plan. Must have been
  implemented within the previous twelve months:
(6) Current, within the previous twelve
  months, habilitative training records:
(7) Current medical records:
(8) Physician certification for the client's
  need of intermediate care facility for individuals with developmental
  disabilities (ICF/DD) level of care. Must be signed by the physician:
(9) Physician plan of care, as required by
  42 CFR
  456.380: and
(10) Independent qualified intellectual
  disabilities professional (QIDP) assessment
004.01(C)(i)
EVALUATIONS.
Evaluations conducted must meet
  requirements found at
  42 CFR
  456.370(c). All evaluations,
  assessments, and records obtained must be current with the client's needs at
  the time of the admission process as required at
  42 CFR
  456.370(a) and (b).
004.01(C)(ii)
ADMISSION DETERMINATION.
The facility will review the
  preadmission evaluation and hold a pre-admission meeting with the client,
  guardian, and interdisciplinary team (IDT) to determine admission. Personnel
  from outside the facility that previously provided services to the client
  should be encouraged to attend, as well. The purpose of the pre-admission
  meeting is to:
(a) Summarize in writing the
  findings from the individual functional assessments:
(b) Determine the clients needs without
  regard to the intermediate care facility for individuals with developmental
  disabilities (ICF/DD)'s ability to meet those needs;
(c) Determine whether or not the intermediate
  care facility for individuals with developmental disabilities (ICF/DD) level of
  care is appropriate and meets the client's needs. If the interdisciplinary team
  (IDT) determines that intermediate care facility for individuals with
  developmental disabilities (ICF/DD) services are not appropriate to meet the
  client's needs, the intermediate care facility for individuals with
  developmental disabilities (ICF/DD) must refer the client and legal guardian to
  the Department of Health and Human Services' Developmental Disabilities
  Division, Service Coordination (DDD SC) to determine the availability of
  alternative services;
(d) Determine
  if the client will be admitted to the intermediate care facility for
  individuals with developmental disabilities (ICF/DD): and
(e) Develop the pre-admission plan if the
  client is to be admitted.
004.01(C)(iii)(1)
ALTERNATIVES.
The intermediate care facility for
  individuals with developmental disabilities (ICF/DD), Medicaid, the client,
  family, guardian, attending physician, and intermediate care facility for
  individuals with developmental disabilities (iCF/DD)'s interdisciplinary team
  (IDT) staff must cooperatively explore alternatives available through Medicaid
  programs based on the client's total needs.
004.01(C)(iii)
PRE-ADMISSION
  PLAN.
The pre-admission plan is the individual program plan (IPP)
  for the first 30 days after the client is admitted to the intermediate care
  facility for individuals with developmental disabilities (ICF/DD). The plan
  must:
(1) Include the client's name, date of
  birth, and guardianship status;
(2)
  Document the interdisciplinary team (IDT)'s rationale for admitting the
  client:
(3) Identify additional
  needed evaluations:
(4) Identify
  the client's skills and skill deficits:
(5) Identify baselines which are conducted to
  determine training needs:
(6)
  Identify the client's current medical and nutritional status:
(7) Specify the care, services, and referral
  for additional evaluations to be provided for the first 30 days or until the
  post-admission evaluation is established;
(8) Include programs and services to be
  continued from other programs: and
(9) Include a plan to explore alternative,
  less restrictive services on an ongoing basis.
004.01(C)(iv)
PHYSICIAN'S
  ADMISSION HISTORY AND PHYSICAL.
When the client is admitted to the
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD), the facility must ensure that:
(1)
  The client has a physical examination within 48 hours, two working days, after
  admission, unless an examination was performed within thirty days before
  admission: and
(2) The history and
  physical is documented on Form DM-5 or attached to Form DM-5.
004.01(C)(v)
PHYSICIAN'S INITIAL CERTIFICATION (FORM DM-5 OR FORM
  MC-9NF).
The physician's certification on Form DM-5. Form MC-9NF,
  or Nursing Facility Leyel Of Care Determination Form, must be signed within the
  following time frame:
(a) For clients already
  eligible for Medicaid at the time of admission. Form DM-5. Form MC-9NF, or
  Nursing Facility Level Of Care Determination Form must be signed and dated
  within 30 days before the date of admission, or within 48 hours (two working
  days) after the date of admission: or
(b) For clients not already determined to be
  eligible for Medicaid at the time of admission. Form DM-5. Form MC-9NF or
  Nursing Facility Level Of Care Determination Form must be signed and dated
  within 30 days before or within 48 hours (two working days) after the date the
  client's eligibility is determined.
004.01(C)(v)(1)
ELIGIBILITY
  DETERMINATION.
The date of eligibility for intermediate care
  facility for individuals with developmental disabilities (ICF/DD) services is
  defined as the actual date the eligibility determination is made not
  necessarily the effective date of Medicaid eligibility. The following
  circumstances impact Medicaid coverage of intermediate care facility for
  individuals with developmental disabilities (CF/DD) services:
(a) if Form DM-5, Form MC-9NF, or Nursing
  Facility Level of Care Determination Form, is signed and dated more than 30
  days before the date of eligibility determination, the facility must provide
  Medicaid with a new or updated Form DM-5, Form MC-9NF. or Nursing Facility
  Level of Care Determination Form before Medicaid authorizes payment to the
  facility;
(b) If Form DM-5, Form
  MC-9NF. or the Nursing Facility Level of Care Determination Form is signed and
  dated more than 48 hours two working days after admission or eligibility
  determination, the earliest that payment to the facility could be effective is
  the date Form DM-5. Form MC-9NF. or the Nursing Facility Level Of Care
  Determination Form, is signed and dated. Holidays and weekends are not counted
  if they fall within the 48-hourtime period; and
(c) If the date of Form DM-5. Form MC-9NF. or
  the Nursing Facility Level of Care Determination Form falls within the required
  time frame. Medicaid may authorize payment to be effective on the date of
  admission or the medical eligibility effective date.
004.01(C)(v)(2)
SIGNATURE
  REQUIREMENTS.
Form DM-5 must be signed and dated by a physician,
  if a physician signature stamp is used, the physician must initial the stamped
  signature. Physician's assistant or registered nurse signature or initials are
  not acceptable.
004.01(C)(v)(3)
RECORD RETENTION.
Forms DM-5, MC-9NF, or the Nursing
  Facility Level of Care Determination Form must be maintained in the client's
  medical record in the facility where the client resides.
004.01(C)(vi)
EMERGENCY
  ADMISSIONS.
In the case of an emergency admission, the
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD) facility will follow the admission process according to this chapter.
  The facility must hold the pre-admission meeting on the day the client enters
  the facility and will document the reason for the admission. However, the
  facility is given seyen calendar days to complete the needed assessments to
  verify the client's need for intermediate care facility for individuals with
  developmental disabilities (ICF/DD) level of care, health and nutritional
  needs, skills and skill deficits and training needs.
004.01(C)(vii)
ADMISSION
  NOTIFICATION.
The intermediate care facility for individuals with
  developmental disabilities (ICF/DD) must notify Medicaid within 10 days of
  admitting a client into the intermediate care facility for individuals with
  developmental disabilities (iCF/DD).
004.01(D)
LEVEL OF
  CARE.
004.01(D)(i)
INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH DEVELOPMENTAL
  DISABILITIES (ICF/DD) LEVEL OF CARE CRITERIA.
Medicaid applies the
  following criteria to determine the appropriateness of intermediate care
  facility for individuals with developmental disabilities (ICF/DD) services on
  admission and at each subsequent review:
(1)
  The individual has a diagnosis of an intellectual disability or a related
  condition, which has been confirmed by prior diagnostic evaluations and
  standardized tests and sources independent of the intermediate care facility
  for individuals with developmental disabilities (ICF/DD): and
(2) The individual can benefit from active
  treatment as defined in
  42 CFR
  483.440(a) and 471 NAC
  31-002. In addition, the following
  criteria apply:
(a) The individual has a
  related condition and the independent qualified intellectual disabilities
  professional (QIDP) assessment identifies the related condition has resulted in
  substantial functional limitations in three or more of the following areas of
  major life skills: self-care, receptive and expressive language, learning,
  mobility, self-direction, or capacity for independent living. These substantial
  functional limitations indicate that the individual needs a combination of
  individually planned and coordinated special interdisciplinary care, a
  continuous active treatment program, treatment, and other services which are
  lifelong or of extended duration: and
(b) A Medicaid-eligible individual has a dual
  diagnosis of developmental disability or a related condition and a mental
  illness. The developmental disability or related condition has been verified as
  the primary diagnosis by both an independent qualified intellectual
  disabilities professional (QIDP) and a mental health professional in which
  their scope of practice allows them to diagnose mental illness: and:
(i) Historically there is evidence of missed
  developmental stages, due to developmental disability or a related
  condition:
(ii) There is remission
  in the mental illness and it does not interfere with intellectual functioning
  and participation in training programs: and
(iii) The diagnosis of developmental
  disability or a related condition takes precedence over the diagnosis of mental
  illness:
(c) When the
  individual does not have substantial functional limitations in self-care
  skills, the individual must have substantial functional limitations in at least
  the life skill area for capacity for independent living along with two other
  life skill areas.
004.01(D)(ii)
APPROVAL OF THE
  INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES
  (ICF/DD) LEVEL OF CARE.
The intermediate care facility for
  individuals with developmental disabilities (ICF/DD), after determining to
  admit the client, must submit the following to the Medicaid review team to
  request approval for Medicaid payment of intermediate care facility for
  individuals with developmental disabilities (ICF/DD) level of care for the
  client:
(a) Completed Form MC-9NF, or Nursing
  Facility Level of Care Determination Form;
(b) The physician's examination or completed
  Form DM-5. The physician who conducted the examination must sign and date Form
  DM-5 with the physician's determination of level of care indicated. If the
  physician's examination is submitted instead of Form DM-5, it must include a
  clear indication that the physician conducting the examination certifies the
  client requires intermediate care facility for individuals with developmental
  disabilities (ICF/DD) level of care;
(c) A current dental examination, completed
  within 12 months before admission or within one month after the date of
  admission:
(d) Completed Form
  DM-5-DD-LTC as instructed in Appendix 471-000-5;
(e) The independent qualified intellectual
  disabilities professional (QIDP) assessment:
(f) The individual program plan (IPP) and
  individualized educational plan (lEP), if school-aged, from the previous
  provider:
(g) Mental health
  evaluation performed by a mental health professional:
(h) The pre-admission evaluation:
  and
(i) For out-of-state
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD) verification that the client's needs cannot be met by a Nebraska
  provider. Exceptions may be made by the department in its own discretion for
  this requirement.
004.01(D)(ii)(1)
ONSITE OBSERVATIONS.
When Medicaid receives all
  required documentation, Medicaid reviews all submitted documentation and
  determines whether the intermediate care facility for individuals with
  developmental disabilities (ICF/DD) level of care is appropriate, in the event
  Medicaid determines the documentation available for review does not provide
  adeguate information to make a determination of whether the intermediate care
  facility for individuals with developmental disabilities (ICF/DD) level of care
  is appropriate, Medicaid may conduct onsite observations of the client at the
  facility, interview facility staff, or request additional information from the
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD) facility. If additional information is needed, the intermediate care
  facility for individuals with developmental disabilities (ICF/DD) must provide
  the necessary information upon the request of Medicaid. Medicaid will notify
  the intermediate care facility for individuals with developmental disabilities
  (ICF/DD) of any decision, and will notify the client as well as the parent or
  guardian of an adverse decision.
004.01(D)(iii)
INAPPROPRIATE
  LEVEL OF CARE.
On admission, and at each subsequent review, the
  facility must ensure which services provided in the intermediate care facility
  for individuals with developmental disabilities (ICF/DD) are the least
  restrictive alternative. The following do not meet criteria for intermediate
  care facility for individuals with developmental disabilities (ICF/DD)
  services:
(a) Mental illness is the primary
  barrier to independent living within a normalized environment; or
(b) The intermediate care facility for
  individuals with developmental disabilities (ICF/DD) level of care is not the
  least restrictive alternative, including when the client:
(i) Exhibits skills and needs comparable to
  those of persons with similar needs living independently or semi-independently
  in the community;
(ii) Exhibits
  skills and needs comparable to those of persons at nursing facility (NF) level
  of care; or
(iii) Is able to
  function with little supervision or in the absence of a continuous active
  treatment program.
004.01(D)(iii)(1)
INITIAL
  REVIEW.
For those clients who, at the time of initial review, are
  found to be inappropriate for intermediate care facility for individuals with
  developmental disabilities (ICF/DD) care, Medicaid limits Medicaid coverage to
  a maximum of 30 days, beginning with the day Medicaid determines that the level
  of care is inappropriate.
004.01(D)(iii)(2)
CLIENT RESIDING
  AT THE FACILITY.
For those clients who, while residing at an
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD), are found to be inappropriate for intermediate care facility for
  individuals with developmental disabilities (ICF/DD) care in accordance with
  the provisions of this chapter below, Medicaid limits Medicaid coverage to a
  maximum of 60 days, beginning with the day the recommendation becomes final.
004.01(D)(iii)(2)(a)
DEPARTMENT
  RECOMMENDATION.
After Medicaid reviews the client's health,
  habiiitative, and social needs and determines the client no longer meets
  criteria for intermediate care facility for individuals with developmental
  disabilities (ICF/DD) level of care according to this chapter, the following
  process will take place:
(i) Medicaid will
  send a notification letter to the client's attending physician and the
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD)'s qualified intellectual disabilities professional (QIDP) giving them
  an opportunity to respond. Based on the responses, Medicaid may take the
  following actions:
(1) If appropriate
  justification for continued intermediate care facility for individuals with
  developmental disabilities (ICF/DD) care is provided within the time frames
  specified in the letter of notification, the recommendation may be withdrawn;
  or
(2) In the absence of
  appropriate or timely justification, the recommendation becomes
  final;
(ii) Once the
  responses of the attending physician and intermediate care facility for
  individuals with developmental disabilities (ICF/DD) qualified intelIectual
  disabilities professional (QIDP) have been reviewed, Medicaid will send written
  notification of the decision to the intermediate care facility for individuals
  with developmental disabilities (ICF/DD), the attending physician, and the
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD)'s qualified intellectual disabilities professional (QIDP):
  and
(iii) If the recommendation is
  upheld, the intermediate care facility for individuals with developmental
  disabilities (ICF/DD) must document a specific and appropriate discharge plan
  in compliance with
  42 CFR
  483.440(b) to assist the
  client in preparing for alternate arrangements.
004.01(D)(iii)(2)(b)
INTERMEDIATE
  CARE FACILITY FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES (ICF/DD)
  RECOMMENDATION.
Intermediate care facility for individuals with
  developmental disabilities (ICF/DD) staff must submit requests for a change of
  level of care between reviews to Medicaid in writing along with supporting
  documentation. If the client needs to be discharged to an alternative setting:
(i) The intermediate care facility for
  individuals with developmental disabilities (ICF/DD) must notify the
  individual, family or legal guardian, and the Department of Health and Human
  Services' Developmental Disabilities Division, Service Coordination (DDD SC) of
  the recommendation:
(ii) The
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD) must assist the client, family, or legal guardian in seeking
  appropriate alternatives;
(iii) The
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD) must document which other alternatives were explored and the
  responses:
(iv) The present
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD) must provide services to meet the needs of the client and must refer
  to appropriate agencies for services until the expiration of the 60 day
  coverage period or until an appropriate alternative is available, whichever
  comes first;
(v) The intermediate
  care facility for individuals with developmental disabilities (ICF/DD), and
  others involved, must make available to the Medicaid review team the
  documentation of active exploration for appropriate alternatives: and
(vi) Upon receipt of all the necessary
  information, the intermediate care facility for individuals with developmental
  disabilities (ICF/DD) must document a specific and appropriate discharge plan
  in compliance with
  42 CFR
  483.440(b) to assist the
  client in preparing for alternate arrangements.
004.01(D)(iii)(2)(c)
ADDITIONAL
  RECOMMENDATIONS.
In the event that any State or Federal survey or
  certification agency determines a client no longer needs or benefits from
  intermediate care facility for individuals with developmental disabilities
  (ICF/DD) services, Medicaid will follow the process outlined in 471 NAC
  31-004.01(DXiii)(2)(a).
004.01(D)(iv)
INTERMEDIATE CARE
  FACILITY FOR iNDIVIDUALS WITH DEVELOPMENTAL DISABILITIES (ICF/DD) LEVEL OF CARE
  CONTINUANCE.
A client who currently resides in an intermediate
  care facility for individuals with developmental disabilities (ICF/DD) who has
  been determined inappropriate for that level of care may be approved by the
  Medicaid review team to continue at the intermediate care facility for
  individuals with developmental disabilities (ICF/DD) level of care, for a
  limited period of time. The continuance may be approved when the intermediate
  care facility for individuals with developmental disabilities (ICF/DD) presents
  written documentation of its ongoing efforts to obtain an appropriate
  alternative living situation for the client.
004.01(E)
OUT-OF-STATE
  SERVICES.
Medicaid covers out-of-state intermediate care facility
  for individuals with developmental disabilities (ICF/DD) services in accordance
  with 471 NAC 1. Evidence must be provided that the client's needs cannot be met
  by providers in Nebraska, Out-of-State services may also be permitted by
  department discretion in cases where the client's current living situation is
  bordering an out-of-state community where an appropriate provider is
  located.
004.01(F)
INDEPENDENT QUALIFIED INTELLECTUAL DISABILITIES PROFESSIONAL (QIDP)
  ASSESSMENT.
The intermediate care facility for individuals with
  developmental disabilities (ICF/DD) facility must ensure an independent
  qualified intellectual disabilities professional (QIDP) assessment is completed
  for all clients during the admission process. The facility is responsible for
  securing the qualified intellectual disabilities professional (QIDP), including
  payment for such services. An individual program plan (IPP) is acceptable in
  lieu of the independent qualified intellectual disabilities professional (QIDP)
  assessment as long as the individual program plan (IPP) provides accurate and
  current information regarding the client's strengths and needs. The Individual
  Program Plan (IPP) cannot have an implementation date of more than 12 months
  prior to the client's admission to the facility. The facility must ensure:
(1) The qualified intellectual disabilities
  professional (QIDP) is not associated with the facility in any
  manner;
(2) The qualified
  intellectual disabilities professional (QIDP) meets requirements at 42 CFR
  480.430 to be considered a qualified intellectual disabilities professional
  (QIDP);
(3) The qualified
  intellectual disabilities professional (QIDP) assessment is completed no later
  than the date of and, no more than three months prior to, the client's
  admission to the facility; and
(4)
  The independent qualified intellectual disabilities professional (QIDP)
  completes the assessment in accordance with requirements at 471 NAC
  31-004.01(F)(i).
004.01(F)(i)
QUALIFIED INTELLECTUAL DISABILITIES PROFESSIONAL (QIDP) ASSESSMENT
  PROCESS.
To ensure completion of an accurate, comprehensive
  assessment, the qualified intellectual disabilities professional (QIDP) must:
(1) Interview and conduct observations of the
  client in their living environment, and vocational environment, if
  possible;
(2) Conduct a functional
  and complete assessment of skills, using an appropriate standardized assessment
  tool, in order to identify the client's present skills and skill-deficit
  areas;
(3) Review records to verify
  the diagnosis of an intellectual disability or related condition, including the
  most recent psychological assessment, as well as medical records:
(4) Review of available, relevant client
  records, including medical and programming records, to aid in determining the
  client's skills, skill-deficits, training needs, and possible assessment
  needs.
(5) Submit a written report
  to the facility which summarizes the results of the qualified intellectual
  disabilities professional (QIDP) assessment The written report must include the
  following:
(a) The client's name, age, and
  date of birth:
(b) The client's
  current address or place of residence:
(c) The client's guardianship
  status:
(d) The client's current
  diagnosis and physical disabilities:
(e) Sources of information gathered to
  complete the assessment:
(f) Any
  independent assessments or evaluations conducted as part of the assessment
  process:
(g) Datefs) the assessment
  was conducted, as well as the date of the written report:
(h) A narrative summarizing the client's
  skills and skill-deficits, including use of adaptive equipment, with regard to:
(i) Self-care:
(ii) Communication, receptive and
  expressive:
(iii) Learning
  abilities:
(iv) Mobility:
(v) Self-direction, adaptive skills,
  including but not limited to behavior, social skills and decision-making
  skills:
(vi) Independent living
  skills, including but not limited to money-handling, daily household tasks, and
  community access:
(vii) Vocational
  skills: and
(viii) Recommendations
  for each skill area for training, treatment needs, further assessment and
  evaluation needs, needed adaptive equipment, and possible needs for additional
  services. The recommendations must be determined without regard to the
  availability of services:
(I) Summary of progress, or lack of progress,
  in previous service settings:
(k)
  The qualified intellectual disabilities professional (QIDP)'s determination of
  the type of service setting needed to meet the client's treatment needs. This
  determination must not identify a specific facility or provider: and
(I) The qualified intellectual disabilities
  professional (QIDP)'s name, signature, and address.
004.01(G)
INDIVIDUAL PROGRAM PLAN (IPP).
Within 30 days of a
  client's admission to the intermediate care facility for individuals with
  developmental disabilities (ICF/DD), the interdisciplinary team (IDT) must
  prepare an individual program plan (IPP). The individual program plan (IPP)
  must specify long-term goals, short-term objectives, and services to address
  prioritized needs in a continuum of development: outlining projected
  progressive, sequential, steps and the developmental consequences, outcomes, of
  training programs and services. Additionally, the individual program plan (IPP)
  must address therapeutic leave. Long-term goals and short-term objectives for
  all formal training to be provided are based on identified needs. Objectives
  must be person-centered, stated in specific, observable, and measurable terms
  so the level of skill Acquisition can be assessed. The long-term goal must be
  the culmination of its short-term objectives. Each client's individual program
  plan (IPP), functional assessments, and nursing plan of care must be made
  available to ail relevant staff and the interdisciplinary team (IDT). As soon
  as the interdisciplinary team (IDT) has formulated a client's individual
  program plan (IPP), each client must 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 program plan (IPP).
004.01(G)(i)
REVIEW AND REVISION OF THE INDIVIDUAL PROGRAM PLAN
  (IPP).
The interdisciplinary team (IDT) must review each
  individual program plan (IPP) at least quarterly, and revise each individual
  program plan (IPP) as needed. At least annually, the Interdisciplinary Team
  (IDT) reviews and updates each client's individual program plan (IPP),
  including ongoing exploration of alternatives. Each interdisciplinary team
  (IDT) member's assessment must be completed before this annual review. The
  revisions of the individual program plan (IPP) are based on current needs as
  identified by the comprehensive functional assessments and the client's
  response to training, as required by
  42 CFR
  456.380(c) and
  483.440.
  The qualified intellectual disabilities professional (QIDP) and other
  interdisciplinary team (IDT) members must each routinely review aspects of the
  client's active treatment process to determine if the client's needs are
  effectively addressed and if revisions are needed.
004.01(H)
BED
  HOLDING.
Medicaid covers a reserved bed in an intermediate care
  facility for individuals with developmental disabilities (ICF/DD) during a
  client's absence, due to hospitalization for an acute condition, and for
  therapeutically indicated home visits. Coverage of bed holding is subject to
  the following conditions:
(1) A held bed must
  be vacant and counted in the census. The census must not exceed licensed
  capacity;
(2) Hospital bed holding
  is limited to reimbursement for 15 days per hospitalization:
(3) Therapeutic leave bed holding is limited
  to reimbursement for 36 days per calendar year, even if the client has a stay
  in more than one intermediate care facility for individuals with developmental
  disabilities (ICF/DD) during the calendar year. Bed holding days are prorated
  when a client is admitted after January 1: and
(4) Facility staff must work with the client
  as well as parent or guardian to plan the use of the allowed 36 days of
  therapeutic leave for the calendar year.
004.01(H)(i)
SPECIAL
  LIMIT.
When the limitation for therapeutic leave interferes with
  an approved therapeutic or habilitative program, the intermediate care facility
  for individuals with developmental disabilities (ICF/DD) may submit a request
  for special limits of up to an additional six days per calendar year to
  Medicaid. Requests for special limits must include:
(1) The number of leave days
  requested:
(2) The need for
  additional therapeutic bed holding days;
(3) The physician's orders; and
(4) The individual program plan
  (IPP).