HAR §17-1737-30. Content of ICF-MR services

(a) Long-term institutional services shall be provided by freestanding or distinct part ICF-MR facilities that shall meet the eligibility requirements specified in chapters 17-1736 and 17-1739. (b) ICF-MR facilities shall provide inpatient or authorized community-based services designed primarily for the treatment and rehabilitation of the mentally retarded or persons with related conditions. (c) ICF-MR services shall include but not be limited to: (1) Twenty-four hour supervision of mentally retarded individuals or persons with related conditions in a protected residential setting; (2) A continuous active treatment program which includes aggressive, consistent implementation of a program of specialized and generic training, treatment health services and related services described in this subsection, that is directed towards: (A) The acquisition of the behaviors necessary for the client to function with as much self-determination and independence as possible; and (B) The prevention or deceleration of regression or loss of current optimal functional status. Active treatment does not include services to maintain generally independent clients who are able to function with little supervision or in the absence of a continuous active treatment program; (3) Interventions to manage inappropriate client behavior that are employed with sufficient safeguards and supervision to ensure that the safety, welfare and civil and human rights of clients are adequately protected; (4) Sufficient direct care staff to manage and supervise clients in accordance with their individual program plans, to respond to injuries and symptom of illness and to handle emergencies in each defined residential living unit; UNOFFICIAL 1737-29 (5) Preventive and general medical care as well as annual physical exams of each client that include: (A) Evaluation of vision and hearing; (B) Immunizations, using as a guide the recommendations of the Public Health Service Advisory Committee on Immunization Practices or of the Committee on the Control of Infectious Diseases of the American Academy of Pediatrics; (C) Routine screening lab exams and special studies; and (D) TB control, appropriate to the facility's population, and in accordance with the recommendations of the American College of Chest Physicians or the section of diseases of the American Academy of Pediatrics, or both; (6) Licensed nursing services sufficient to care for clients health needs, including those clients with medical care plans; (7) Provision of or arrangements for comprehensive dental diagnostic services and comprehensive dental treatment services that include: (A) The availability of emergency dental treatment on a twenty-four hours a day basis by a licensed dentist; and (B) Dental care needed for relief of pain and infections, restoration of teeth, and maintenance of dental health; (8) Provision of or arrangements for routine and emergency drugs and biologicals that are administered in compliance with physician's orders; (9) At least three meals a day that comprise a nourishing, well-balanced diet including modified and specially prescribed diets; (10) Physician services available twenty-four hours a day to: (A) Develop and maintain, in coordination with licensed nursing personnel, a medical care plan of treatment for a client if the physician determines that an individual client requires twenty-four hours licensed nursing care; and UNOFFICIAL 1737-30 (B) Participate in establishing an initial individual program plan for a newly admitted client; and (11) Provision of necessary services, including emergency and other health care through contractual agreements which shall: (A) Stipulate the responsibilities, functions, objectives, service fee, and other terms agreed to by the ICF-MR and the provider; and (B) Provide that the ICF-MR is responsible for assuring that the outside services meet the standards for quality of services. [Eff 08/01/94; am 02/10/97 ] (Auth: HRS §346- 14; Pub. L. No. 100-203; 42 C.F.R. §§430.10, 431.10, 483.400) (Imp: Pub. L. No. 100-203; 42 C.F.R. §§483.400; 483.480) §17-1737-31 Determining the applicant's or recipient's need for long-term institutional services. (a) The provision for the determination of need for admission to a long-term institution are based on a physician's and other appropriate health care professional's assessment of the applicant's or recipient's condition and recommendation of the applicant's or recipient's need for a specific acuity level (or level of medical care). (b) Their recommendation of the applicant's or recipient's need for a specific acuity level (or level of medical care) shall be based on the following criteria: (1) Acuity Level A recipient requires licensed nursing and ancillary nursing personnel services on a regular and long-term basis to maintain, improve, or safeguard health, or to minimize disability or pain. The services provided shall be beyond room, board, and personal care services available in personal care home, and shall: (A) Be available to recipients who require assistance with the normal activities of daily living twenty-four hours a day; (B) Be ordered by a physician and shall be provided under the direction of the attending physician or staff physician; (C) Be planned, provided, and maintained by licensed and ancillary nursing personnel UNOFFICIAL 1737-31 and other professional personnel, in accordance with a written resident care plan; (D) Be provided on an inpatient basis only after consideration of the recipient's condition and the feasibility and availability of utilizing more economical alternative facilities and services have been ruled out; and (E) Be less than twenty-four hours of skilled nursing or regular rehabilitation services; (2) Acuity Level B recipient shall: (A) Be evaluated by an interdisciplinary professional team, who shall recommend admission based on their evaluation, which shall be completed not more than three months prior to admission, or before the ICF-MR requests payment for a client applying for medicaid after admission; (B) Be diagnosed as mentally retarded or with other related conditions; and (C) Require the medical care and special services that are appropriately obtained from an ICF-MR as described in section 17-1737-30; and (3) Acuity Level C recipient requires skilled nursing services provided directly or under the general supervision of registered professional nurses on a twenty-four hour basis, rehabilitation services, or both and shall: (A) Be provided on a seven-days a week basis, except rehabilitation services may be needed by the recipient and provided on a five-days a week basis; and (B) Include subparagraphs (1)(A),(B),(C), and (D). [Eff 08/01/94 ] (Auth: HRS §§346-14, 346-49; Pub. L. No. 100- 203; 42 C.F.R. §§430.10, 431.10) (Imp: Pub. L. No. 100-203; 42 C.F.R. §§435.1009, 440.40, 440.150, 456.270, 456.271, 456.370, 483.30, 483.440) §17-1737-32 Authorization for admission to a NF or ICF-MR. (a) Authorization by the department for the recommended acuity level (or level of medical care) UNOFFICIAL 1737-32 required by an applicant or recipient shall be in accordance with the provisions of chapter 1739 and section 17-1737-31. (b) Authorization granted by the department for admission to a NF or ICF-MR shall be based on the determination that the applicant or recipient requires the services stipulated in sections 17-1737-29 and 17- 1737-30. [Eff 08/01/94; am 02/10/97 ] (Auth: HRS §§346-14, 346-49; 42 C.F.R. §§430.10, 431.10, 435.1009) (Imp: 42 C.F.R. §§435.1009, 440.150, 456.271, 456.370, 483.440) §17-1737-33 Preadmission screening and resident review (PASRR). The state PASRR program shall require that: (1) NFs shall not admit, on or after January 1, 1989, any new resident with: (A) "Mental illness" as defined in section 17-1737-27 unless the state mental health authority has determined, based on an independent physical and mental evaluation performed by a person or entity other than the state mental health authority, prior to admission, whether: (i) Because of the physical and mental condition of the individual, the individual requires the level of services provided by a NF; and (ii) If the individual requires such level of services, the individual requires active treatment for mental illness; or (B) "Mental retardation" or "persons with related conditions" as defined in section 17-1737-27 unless the state mental retardation/developmental disability authority has determined prior to admission whether: (i) Because of the physical and mental condition of the individual, the individual requires the level of services provided by a NF; and (ii) If the individual requires such level of services, the individual requires active treatment for mental retardation; UNOFFICIAL 1737-33 (2) For those residents who entered the NF prior to January 1, 1989, and were identified with a diagnosis of: (A) "Mental illness" as defined in section 17-1737-27, the state mental health authority shall determine whether, because of the resident's physical and mental condition, the resident requires: (i) The level of services provided by a NF; and (ii) Active treatment for mental illness; or (B) "Mental retardation" or identified as "persons with related conditions" as defined in section 17-1737-27, the state mental retardation/developmental disability authority shall determine whether because of the resident's physical and mental condition, the resident requires: (i) The level of services provided by a NF; and (ii) Specialized services for mental retardation or related conditions in an ICF-MR; (3) The nursing facility shall notify the State mental health authority or the State mental retardation or developmental disabilities authority within twenty-one days after a significant change in the physical or mental condition of a resident who meets criteria for mental illness or mental retardation. For an individual with mental illness, if their condition worsens notification must be made to the State mental health authority within twenty-one days. For individuals with mental retardation, if their condition improves where the individual may benefit from specialized services, notification to the State mental retardation or developmental disabilities authority must be made within twenty-one days. [Eff 08/01/94; am 08/25/07 ] (Auth: HRS §346-14; 42 C.F.R. §§430.10, 431.10; Pub. L. No. 100-203) (Imp: Pub. L. No. 100-203; 42 C.F.R. §483.20)