Waiver and/or Variance of ICF/IID Requirements

2140 - Waiver and/or Variance of ICF/IID Requirements (Rev. 91, Issued: 09-27-13, Effective: 09-27-13, Implementation: 09-27-13) 2140A - ICF/IID Room Size and Occupancy (Rev. 91, Issued: 09-27-13, Effective: 09-27-13, Implementation: 09-27-13) No waivers are available to an ICF/IID to change the square footage requirements for bedrooms. 42 CFR Part 483.470(b) allows as little as 80 square feet for individual bedrooms and 60 square feet for multiple individual bedrooms. However, the SA may grant a variance to the requirement in 42 CFR Part 483.470(b)(iii) of no more than four individuals per room if a physician who meets the qualifications for a qualified intellectual disabilities professional in 42 CFR Part 483.430(a) and is also a member of the individual’s interdisciplinary team has justified, in writing, in each IPP, the following: • How the individual is so medically impaired as to require direct and continuous monitoring during sleeping hours; • Whether the individual is on a medical care plan, as described in 42 CFR Part 483.460(a)(2); • The extent of life support services needed to meet the individual’s medical needs; and • The specific reason why housing the individual in a room of four or fewer individuals would not meet the individual’s medical needs. The variance must not adversely affect the health or safety of the individual. The variance must assure that the minimum square footage requirements specified in 42 CFR Part 483.470(b) have been met. The variance expires unless renewed each time the ICF/IID is certified. It is not meant to justify the long-term continued use of open wards or nominally partitioned wards for housing individuals. The only acceptable reason for individuals being housed in bedrooms serving more than 4 individuals is that the individual is in very fragile health and needs extensive life support services, such as posturing for clearing the airway, monitoring for uncontrolled seizures, etc. Each individual placed in the grouping must have such a high level of medical monitoring need as to require supervision which is possible only through the use of bedrooms housing more than four individuals. 2140B - Waiver of LSC (Rev. 1, 05-21-04) See §2472.