La. Admin. Code tit. 50 § II-10339

Current through Register Vol. 50, No. 11, November 20, 2024

Section II-10339 - Client Health and Habilitative Services

A.Intermediate Care Facilities for the Mentally Retarded (ICF/MR) are defined as intermediate care facilities whose primary purpose is to provide health or habilitative services for mentally retarded individuals or persons with related conditions and meet the standards in 42 CFR 442 and 483.400.

B. The following health and habilitative services must be provided to all clients.

1. Active Treatment Services. The facility must provide or arrange for each client to receive a continuous active treatment program consisting of needed interventions and services in sufficient number and frequency to support the achievement of the objectives identified in the Individual Habilitation Plan (IHP). These services include but are not limited to occupational, speech, physical and recreational therapies; psychological, psychiatric, audiology, social work, special education, dietary and rehabilitation counseling.

NOTE: Supplies, equipment, etc. needed to meet the goals of the IHP cannot be charged to the client or their responsible parties.

2. Active Treatment Components

a. Individual Habilitation Plan. Each client must have an Individual Habilitation Plan developed by an interdisciplinary team that represents the professions, disciplines or service areas that are relevant to identifying the client's needs as described by the programs that meet those needs.

i. The facility must document in the Individual Habilitation Plan (IHP) the presence, or the reason for absence, at the individual's staffing conference of the client, family members and relevant disciplines, professions or service areas as identified in the comprehensive functional assessment.

ii. Within 30 days after admission, the interdisciplinary team must do assessments or reassessments as needed to supplement the preliminary evaluation conducted prior to admission.

iii. The comprehensive functional assessment must take into consideration the client's age and the implications for active treatment at each stage as applicable. It must contain the following components:

(a). the presenting problems and disabilities and where possible, their causes including diagnosis, symptoms, complaints and complications;

(b). the client's specific developmental strengths;

(c). the client's specific developmental and behavioral management needs;

(d). an identification of the client's needs for services without regard to the actual availability of the services.

iv. The comprehensive functional assessment must cover the following developmental areas:

(a). physical development and health;

(b). nutritional status;

(c). sensorimotor development;

(d). affective development;

(e). speech and language development;

(f). auditory functioning;

(g). cognitive development;

(h). social development;

(i). adaptive behaviors or independent living skills necessary for the client to be able to function in the community;

(j). vocational skills as applicable;

(k). psychological development.

b. Specific Objectives. Within 30 days after admission, the interdisciplinary team must prepare for each client an IHP that states specific objectives necessary to meet the client's needs, as identified by the comprehensive functional assessment, and states the plan for achieving these objectives.

i. Components for these objectives must be:

(a). stated separately, in terms of a single behavioral outcome;

(b). be assigned projected completion dates;

(c). be expressed in behavioral terms that provide measurable indices of performance;

(d). be organized to reflect a developmental disability;

(e). be assigned priorities.

ii. A copy of each client's Individual Habilitation Plan must be made available to all relevant staff, including staff of other agencies who work with the client, the client, parents if the client is a minor, or legal guardian. The Individual's Habilitation Plan must be implemented within 14calendar days of its development.

iii. The facility must develop and make available to relevant staff an active treatment schedule that outlines the current active treatment program.

iv. Each written training program designed to implement these objectives in the Individual Habilitation Plan must specify:

(a). the methods to be used;

(b). the schedule for use of the methods;

(c). the person responsible for the program;

(d). the type of data and frequency of data collection necessary to be able to assess progress toward the desired objectives;

(e). the inappropriate client behavior(s), if applicable; and

(f). a provision for the appropriate expression and the replacement of inappropriate behavior, if applicable, with behavior that is adaptive or appropriate.

v. The IHP must also:

(a). describe relevant interventions to support the individual toward independence;

(b). identify the location where program strategy information (which must be accessible to any person responsible for implementation) can be found;

(c). include, for those clients who lack them, training in personal skills essential for privacy and independence (including skills and activities of daily living) until it has been demonstrated that the client is developmentally incapable of applying them;

(d). plans for discharge.

vi. The IHP must identify mechanical supports, if needed, to achieve proper body position, balance, or alignment. This plan must specify:

(a). the reason for each support;

(b). the situation in which each is to be applied;

(c). a schedule for the use of each support.

vii. Clients who have multiple disabling conditions must be provided the opportunity to spend a major portion of each working day out of bed and outside the bedroom area, moving about by various methods and devices whenever possible.

viii. The IHP must include opportunities for client choice and self management.

c. Documentation. The facility must document data relevant to the accomplishment of the criteria specified in the client's Individual Habilitation Plan objectives. This data must meet certain criteria.

i. Data must be documented in measurable outcomes;

ii. Significant events related to the client's Individual Habilitation Plan and assessment and that contribute to an overall understanding of his ongoing level and quality of function must be documented;

iii. The Individual Habilitation Plan must be reviewed by a qualified mental retardation professional at least quarterly or as needed and revised as necessary, including but not limited to situations in which the client:

(a). has successfully completed an objective or objectives identified in the Individual Habilitation Plan;

(b). is regressing or losing skills;

(c). is failing to progress toward identified objectives after reasonable efforts have been made;

(d). is being considered for training toward new objectives.

iv. At least annually, the comprehensive assessment of each client must be reviewed by the interdisciplinary team for relevancy and updated as needed. The Individual Habilitation Plan must be revised as needed or at least by the 365th day after the last review.

NOTE: For admission requirements, refer to §10301, Participation.

3. Health Services

a. Physician Services. The health care of each client shall be under the continuing supervision of a Louisiana licensed physician. The facility must ensure the availability of physician services 24 hours a day. The facility must provide or obtain preventive and general medical care plus annual physical examinations of each client.

i. The client, the family or the responsible party shall be allowed a choice of physicians.

ii. If the client does not have a personal physician, the ICF/MR shall provide referrals to physicians in the area, identifying physicians that participate in the Medicaid Program.

NOTE: The cost of physician services cannot be charged to the client or their responsible parties.

b. Nursing Services. The facility must provide each client nursing services as prescribed by a physician or as identified by the Individual Habilitation Plan and client needs.

NOTE: The cost for nursing services cannot be charged to the client or their legal representative.

i. Nursing services must include:

(a). the development, with a physician, of a medical care plan of treatment for a client when the physician has determined that an individual client requires such a plan;

(b). twenty-four-hour nursing service as indicated by the medical care plan or other nursing care as prescribed by the physician or as identified by client needs;

(c). review of individual client health status on a quarterly or more frequent basis;

(d). training clients and staff as needed in appropriate health and hygiene methods and self-administration of medications;

(e). notify the physician of any changes in the client's health status.

ii. If the facility utilizes only licensed practical nurses to provide health services, it must have a formal arrangement with a registered nurse licensed to practice in Louisiana to be available for verbal or on-site consultation to the licensed practical nurse.

c. Dental Services. The facility must provide or arrange for comprehensive diagnostic and treatment services for each client from qualified personnel, including licensed dentists and dental hygienists either through organized dental services in-house or through arrangement. The facility must ensure that dental treatment services include dental care needed for relief of pain and infections, restoration of teeth and maintenance of dental health. The facility must ensure the availability of emergency treatment on a 24-hour per day basis by a licensed dentist.

NOTE: The cost for these dental services cannot be charged to the client or their responsible party.

d. Pharmaceutical Services. The facility must provide or arrange for the provision of routine and emergency drugs and biologicals to its clients. Drugs and biologicals may be obtained from community or contract pharmacists or the facility may maintain a licensed pharmacy.

i. Routine administration of medications shall be done at the facility where the client resides. Clients may not be transported elsewhere for the sole purpose of medication administration.

ii. The ICF/MR shall neither expect, nor require, any provider to give a discount or rebate for prescription services rendered by the pharmacists.

iii. The ICF/MR shall order at least a one month supply of medications from a pharmacy of the client's, family's, or responsible party's choice. Less than a month's supply is ordered only when the attending physician specifies that a smaller quantity of medication is necessary for a special medical reason.

iv. The ICF/MR Chief Executive Officer or the authorized representative shall certify receipt of prescribed medications by signing and dating the pharmacy billing.

NOTE: The costs for drugs and biologicals cannot be charged to the client, family or responsible party including any additional charges for the use of the unit dose or blister pack system of packing and storing medications.

v. Aids and Equipment. The facility must furnish, maintain in good repair, and teach clients to use and to make informed choices about the use of dentures, eyeglasses, hearing and other communication aids, braces, and other devices identified by the interdisciplinary team as needed by the client.

NOTE: The costs for aids and equipment cannot be charged to the clients or their legal representatives.

e. Nutritional Services. The facility must provide a nourishing, well-balanced diet for each client, including modified and specially prescribed diets. The nutritional component must be under the guidance of a licensed dietitian.

NOTE: Nutritional services are included in the per diem rate. Residents of ICF/MR facilities are not eligible for Food Stamps, Commodities, or other subsidized food programs.

f. Clothing. The facility should provide adequate seasonal clothing for the client. Adequate is defined as a seven-day supply in good repair and properly fitting. Work uniforms or special clothing/equipment for training will be provided in addition to the seven-day supply.

i. The facility must maintain a current clothing inventory for each client.

ii. A client with adequate clothing may purchase additional clothing using his/her personal funds if he/she desires.

iii. If a client desires to purchase a certain brand, the client has the right to use his/her personal funds in this manner; however, the client must be made aware of what the facility is providing prior to making his/her decision.

NOTE: For more information on services that must be provided by the ICF/MR facility or may be purchased by the client, see §10307, Payment.

La. Admin. Code tit. 50, § II-10339

Promulgated by the Department of Health and Human Resources, Office of Family Security, LR 13:578 (October 1987), amended by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 25:691 (April 1999).

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153.