Intermediate Care Facilities for the Intellectually ...

Intermediate Care

Facilities for the

Intellectually Disabled

(ICF/ID)

Provider Manual

Iowa

Department

of Human

Services

Provider

Page

Intermediate Care Facilities for the

Intellectually Disabled (ICF/ID)

Date

1

May 1, 2014

TABLE OF CONTENTS

Chapter I. General Program Policies

Chapter II. Member Eligibility

Chapter III. Provider-Specific Policies

Chapter IV. Billing Iowa Medicaid

Appendix

III. Provider-Specific Policies

Iowa

Department

of Human

Services

Provider and Chapter

Page

Intermediate Care Facilities for the

Intellectually Disabled (ICF/ID)

Date

Chapter III. Provider-Specific Policies

1

May 1, 2014

TABLE OF CONTENTS

Page

CHAPTER III. PROVIDER-SPECIFIC POLICIES .................................................. 1

A.

INTERMEDIATE CARE FACILITIES ELIGIBLE TO PARTICIPATE ........................... 1

B.

ADMINISTRATION ......................................................................................

1. Governing Body ..................................................................................

2. Records .............................................................................................

a. Personal Needs Accounts ..............................................................

b. Resident Records .........................................................................

3. Services Provided Under Agreements with Outside Sources .......................

C.

APPEALS OF ADVERSE ACTIONS .................................................................. 5

D.

ARRANGEMENTS MADE WITH THE RESIDENT................................................. 6

1. Financial Participation .......................................................................... 6

2. Personal Needs Allowance .................................................................... 8

3. Medicare, Veterans, and Similar Benefits ................................................ 9

4. Resident Care Agreement ................................................................... 10

E.

AUDITS OF BILLING AND HANDLING OF RESIDENT FUNDS ............................. 11

F.

CERTIFICATION PROCESS .......................................................................... 12

1. Certification of Need........................................................................... 12

a. Inclusion in the Community .......................................................... 12

b. Family-Scale Size ....................................................................... 12

c. Location in Community Residential Neighborhood ............................ 12

2. License............................................................................................. 13

3. Provider Agreements .......................................................................... 14

4. Survey and Certification...................................................................... 15

G.

MEDICAID ELIGIBILITY .............................................................................. 17

1. Application Procedure ......................................................................... 17

2. Continued Stay Reviews ..................................................................... 18

3. Eligibility for Services ......................................................................... 18

a. Placement Approved ................................................................... 19

b. Placement Not Approved .............................................................. 20

1

1

2

3

4

5

Iowa

Department

of Human

Services

Provider and Chapter

Page

Intermediate Care Facilities for the

Intellectually Disabled (ICF/ID)

Date

Chapter III. Provider-Specific Policies

2

May 1, 2014

Page

H.

PHYSICAL ENVIRONMENT........................................................................... 20

1. Bedrooms ......................................................................................... 20

2. Disaster Plans and Drills ..................................................................... 21

3. Resident Bathrooms ........................................................................... 22

4. Safety .............................................................................................. 22

I.

PROTECTION OF RESIDENTS¡¯ RIGHTS.......................................................... 24

1. Communication with Residents, Parents, and Guardians .......................... 25

2. Health Care Services .......................................................................... 26

a. Dental Services .......................................................................... 26

b. Dietetic Services ......................................................................... 27

c. Laboratory Services .................................................................... 28

d. Pharmacy Services...................................................................... 29

e. Physician Services ...................................................................... 31

f. Nursing Services......................................................................... 32

3. Management of Inappropriate Resident Behavior .................................... 33

a. Drug Usage................................................................................ 34

b. Oversight Committee .................................................................. 34

c. Physical Restraints ...................................................................... 35

d. Time-Out Rooms ........................................................................ 36

4. Safeguarding Personal Property ........................................................... 36

5. Staff Treatment of Residents ............................................................... 37

J.

PROVISION OF SERVICES .......................................................................... 38

1. Individual Program Plan ...................................................................... 38

a. Program Implementation ............................................................. 40

b. Program Monitoring and Change ................................................... 40

2. Resident Assessment.......................................................................... 41

3. Staff Conduct Toward Residents ........................................................... 41

K.

RESIDENT ADMISSIONS ............................................................................ 42

L.

STAFF ..................................................................................................... 44

1. Direct Care Staff ................................................................................ 44

2. Nursing Staff ..................................................................................... 45

3. Professional Program Staff .................................................................. 45

4. Qualified Intellectual Disability Professional ........................................... 47

5. Staff Training Program ....................................................................... 47

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