405 IAC 1-1-11 Intermediate care for the mentally retarded; eligibility

Sec. 11. Intermediate Care for the Mentally Retarded (ICF/MR) is to be provided for persons in an institution which meets the Federal certification standards to participate as an eligible Medicaid provider. Intermediate care services are designed for persons who are mentally retarded or with certain other conditions as specified herein. The services and/or treatment programs are delivered on an in-patient basis and under the direction and supervision of the required professional staff. Admissions to Intermediate Care Facilities for the Mentally Retarded must be based upon a determination of the need for such care by an interdisciplinary professional team. Approval by the State Department of Public Welfare–Medicaid Division, must be received by the ICF/MR institution prior to admission, or in cases of those individuals who make application while in the institution, prior to payment for that service. Intermediate Care for the Mentally Retarded (ICF/MR) will be provided by the Medicaid program, for eligible persons who must meet these two conditions: (1) Patient or resident has a diagnosis of mental retardation or related conditions of epilepsy, cerebral palsy, or other developmental disability found to be closely related to mental retardation or to require treatment similar to that required for mentally retarded individuals. (a) Patient or resident may be severely or profoundly retarded, moderately retarded, severely physically handicapped, aggressive, assaultive, security risk, or manifesting severe hyperactive or psychotic-like behavior. (b) Patient or resident may be moderately retarded and may require habit training, training and guidance in the activities of daily living, and development of self-help skills for maximum independence and as needed by the patient or resident. (c) Patient or resident may be in vocational training programs or adults who work in sheltered workshops. (2) Patient or resident must have a comprehensive evaluation covering physical, emotional, social and cognitive factors conducted by an interdisciplinary professional team. In addition to the above required conditions, eligible persons may require any of the following professional services: (1) Patient or resident may require professional medical supervision for the administration of medicines and/or treatments. (2) Physician services. (3) Dental services. (4) Nursing services. (5) Pharmacy services. (6) Training and habilitation. (7) Modified or special diets to meet nutritional needs. (8) Physical therapy services. (9) Speech pathology and audiological services. (10) Occupational therapy services. (11) Recreational therapy services. (12) Psychological services. (13) Social services.