405 IAC 5-13-7 - Admission and placement; large private and small ICFs/IID
Authority: IC 12-15-1-10; IC 12-15-1-15; IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-13-7-3; IC 12-15
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).
Notes
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