ICFs/IID – Citations and Description

2130 - ICFs/IID – Citations and Description (Rev. 91, Issued: 09-27-13, Effective: 09-27-13, Implementation: 09-27-13) 2130A - Citations (Rev. 91, Issued: 09-27-13, Effective: 09-27-13, Implementation: 09-27-13) An ICF/IID is defined in §1905(d) of the Act. The ICF/IID CoPs appear in 42 CFR Part 483 Subpart I. Regulatory requirements for ICF/IID services which appear in 42 CFR 435, Subpart K (Federal Financial Participation) and Part 440 Subpart A (Definitions), augment the CoPs listed in 42 CFR Part 483. 2130B - Definitions (Rev. 91, Issued: 09-27-13, Effective: 09-27-13, Implementation: 09-27-13) An ICF/IID is an institution that meets Federal CoPs and has as its primary purpose the provision of health or rehabilitation services to individuals with intellectual disabilities or related conditions receiving care and services under the Medicaid program. The ICF/IID CoPs recognize the developmental, social, and behavioral needs of individuals with intellectual disabilities who live in residential settings by requiring that each individual both require and receive active treatment for the ICF/IID care to be eligible for Medicaid funding. Active treatment means the aggressive, consistent implementation of a program of specialized and generic training, treatment, health, and related services directed toward the acquisition of the behaviors necessary for the individual to function with as much self- determination and independence as possible. It includes the prevention or deceleration of regression or loss of current optimal functional status. An injury should be reported as an “injury of unknown source” when: 1. The source of the injury was not witnessed by any person and the source of the injury could not be explained by the client; and 2. The injury raises suspicions of possible abuse or neglect because of the extent of the injury or the location of the injury (e.g., the injury is located in an area not generally vulnerable to trauma) or the number of injuries observed at one particular point in time or the incidence of injuries over time. The definition of “immediately” means there should be no delay between staff awareness of the allegation and reporting to the administrator or other officials in accordance with State law unless the situation is unstable at the time the allegation comes to the attention of the staff. In this case, reporting should occur as soon as the safety of all clients is assured and all necessary emergency measures have been taken. Section 42 CFR § 483.420(d)(2) of the ICFs/IID regulations addresses the obligation of the facility staff to report allegations of mistreatment, neglect or abuse, and injuries of unknown source immediately to the administrator of the facility or to other officials in accordance with State law through established procedures. An injury should be reported as an “injury of unknown source” when: 1. The source of the injury was not witnessed by any person and the source of the injury could not be explained by the client; and 2. The injury raises suspicions of possible abuse or neglect because of the extent of the injury or the location of the injury (e.g., the injury is located in an area not generally vulnerable to trauma) or the number of injuries observed at one particular point in time or the incidence of injuries over time. It is important to note that members of the ICF/IID population are a mobile population and lead active lives. Therefore, they experience normal day-to-day bumps and minor abrasions as they go about their lives. These minor occurrences which are not of serious consequence to the individual and do not present as a suspicious or repetitive injury (as discussed above) should be recorded by the facility staff once they are aware of them and follow-up should be conducted as indicated. For injuries that do not rise to the level of reportable “injuries of unknown source”, the facility should follow its policies and procedures for incident recording, investigation, and tracking. 42 CFR § 483.420(d)(2) further requires that allegations of mistreatment, neglect or abuse and injuries of unknown source must be, “reported immediately to the administrator or to other officials in accordance with State law, through established procedures”. For the purpose of this regulation “immediately” means there should be no delay between staff awareness of the allegation and reporting to the administrator or other officials in accordance with State law unless the situation is unstable at the time the allegation comes to the attention of the staff. In this case, reporting should occur as soon as the safety of all clients is assured and all necessary emergency measures have been taken. This reporting must be done on a 24/7 basis. Conformity with this definition will necessitate that the facility administration have procedures in place to receive reports, even on off-duty hours (e.g., electronic mail, answering machine, voice mail, and fax). It is critical that the administrator, as designated by the Governing Body under 42 CFR § 483.410(a)(2)-(3), be notified of such occurrences as quickly as possible to ensure the safety of all residents. There must also be evidence that the information was received, in a timely manner, by that facility administrator. When the administrator is not on duty, the facility policies and procedures should detail who (either by name or title) will be acting in the administrator’s absence. The person(s) acting for the administrator must have the authority to immediately take whatever corrective action is necessary to ensure client health and safety. For example if an employee is to be removed from client contact pending an investigation, the acting administrator must have the authority to take this action without approval from another official. CMS expects that such reporting is always made to the administrator of the facility (unless the administrator is suspected to be involved in the mistreatment, neglect or injury) and that the administrator then ensures that the appropriate State officials are notified. In any instance where a staff member is concerned that the administrator of the facility may have been involved in an incident of mistreatment, neglect, abuse or injury, the staff member should follow the facility policy for reporting to the appropriate person above the level of the administrator. The facility should have a written policy that directs the staff in these situations.