405 IAC 5-13-7 Admission and placement; large private and small ICFs/IID

Sec. 7. (a) Admissions to large private and small ICFs/IID shall be based upon a determination of the need for such care by the office. The interdisciplinary professional team from the proposed placement facility shall review a comprehensive evaluation covering physical, emotional, social, and cognitive factors, as required by federal law, to ensure the facility can meet the needs of the member. (b) The interdisciplinary professional team includes a physician, a certified social worker, and other professionals, one (1) of whom is a qualified intellectual disability professional. (c) A qualified intellectual disability professional is a person as defined in 42 CFR 483.430. (d) The following guidelines are applicable for admission and readmission of a member to a large private or small ICF/IID: (1) The office must authorize Medicaid payment for each member in the large private and small ICF/IID. This process must be completed prior to the first Medicaid payment. Determination of appropriate reimbursement is based on the documentation required by this subsection. (2) Admission to all large private and small ICF/IID facilities requires diagnostic evaluation, including social and psychological components. (3) The ICF/IID must submit a form approved by the office, completed by the physician, for each Medicaid applicant or member for whom services are required. The need for care and placement during any payment period must be included in the medical evaluation. The payment period will not be approved for any period of time that precedes the date the physician signs the Form 450B certifying the need for ICF/IID services. (4) Both member and provider must have been eligible to participate in Medicaid during any period for which Medicaid reimbursement is requested. (5) A physician must certify the patient's need for ICF/IID care at the time of admission. The first recertification must take place within twelve (12) months from the date of admission certification. Subsequent recertifications must occur annually thereafter, or more often, as determined by the interdisciplinary team. (6) The certification must specify the level of care required by the member, and the recertification must clearly indicate the need for care to continue at this level. The certification must be signed by the physician and dated at the time of signature. Subsequent recertifications must be signed by a physician, a physician assistant, or a nurse practitioner and dated at the time of signature. (A STAMPED SIGNATURE WILL NOT BE ACCEPTED.) (7) The admission certification and the three (3) latest recertifications must be kept in the member's active medical record. All other recertification must be kept on file in the facility and be available for review purposes. (8) Pursuant to 42 CFR 483.440(c)(3), the interdisciplinary professional team must, within thirty (30) days after admission, review and update the preadmission evaluation. (9) The individual program plan must be reviewed at least by the qualified intellectual disability professional and revised as necessary as required by 42 CFR 483.440(f). (10) At least annually, the comprehensive functional assessment of each individual must be reviewed by the interdisciplinary team for relevancy and updated as needed in accordance with 42 CFR 483.440(f)(2).