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Intermediate Care Facilities for Persons with Mental Retardation or Developmental Disabilities

Definition:

See definition of "long-term care facility."

Intermediate care facilities for persons with mental retardation or developmental disabilities (ICFs/MR or DD) provide "intermediate developmental disability care," defined as "the provision of nursing care services, health-related services, and social services for persons with developmental disabilities, as defined in 53-20-102(5), MCA, or for individuals with related problems" (50-5-101(30), Montana Code Annotated [MCA]). These residential facilities provide room and board, a planned program of care, supervision on a continuous 24 hour-a-day basis, and active treatment for residents of the facility.

"Active treatment" means that "each client must receive a continuous active treatment program, which includes aggressive, consistent implementation of a program of specialized and generic training, treatment, health services and related services...that is directed toward- (I) The acquisition of the behaviors necessary for the client to function with as much self determination and independence as possible; and (ii) The prevention or deceleration of regression or loss of current optimal functional status" (Code of Federal Regulations [CFR] 42§483.440).

The CFR also states that "an institution for the mentally retarded is not an institution for mental diseases." "Institution for the mentally retarded with related conditions" means an "institution (or distinct part of an institution) that - (a) is primarily for the diagnosis, treatment, or rehabilitation" of persons with mental retardation "or persons with related conditions; and (b) provides, in a protected residential setting, ongoing evaluation, planning, 24-hour supervision, coordination, and integration of health or rehabilitative services to help each individual function at his greatest ability" (CFR 42§435.1009).

"Developmental disability" means "a disability attributable to mental retardation, cerebral palsy, epilepsy, autism, or any other neurologically handicapping condition closely related to mental retardation and requiring treatment similar to that required by" persons with mental retardation "if the disability originated before the person attained age 18, has continued or can be expected to continue indefinitely, and constituted a substantial handicap for the person" (Administrative Rules of Montana [ARM] 46.8.100). Current law allows only those individuals who have been found to have a serious developmental disability and to be 18 years of age or older to be admitted to a state-operated ICF/MR or DD (53-20-125(1), MCA).

"Seriously developmentally disabled" means "a person who: a) is developmentally disabled; b) is impaired in cognitive functioning; c) has behaviors that pose an imminent risk of serious harm to self or others, or self-help deficits so severe as to require total care or near total care and because of those behaviors or deficits, cannot safely and effectively be habilitated in community-based services" (53-20-102(15), MCA).

"Community-based facilities or community-based services means those services and facilities which are available for the evaluation, treatment, and habilitation of persons with developmental disabilities in a community setting, including but not limited to outpatient facilities, special education services, group homes, foster homes, day-care facilities, sheltered workshops, and other community-based services and facilities" (53-20-102(2), MCA, ARM 46.8.706(4)). A community home for individuals with developmental disabilities is defined as a "family-oriented residence or home designed to provide facilities for two to eight persons with developmental disabilities, established as an alternative to existing state institutions" (53-20-302, MCA).

The most common configuration of an ICF/MR or DD includes at least two sites: the residential program site and the day training habilitation program site. ICFs/MR or DD must also provide primary medical services as part of the treatment model.

Goal:

ICF/MR or DD services should be regarded as an effective means of treatment for those individuals who have a serious developmental disability and who cannot be safely and effectively habilitated or served through less restrictive community-based services and facilities.

Objectives:

  1. To limit ICF/MR or DD services to those persons who are determined to be seriously developmentally disabled by providing services funded through Medicaid's Home and Community-Based (HCB) Waiver program.
  2. To promote the accessibility and availability of appropriate community-based services throughout Montana to individuals with developmental disabilities as an alternative to ICFs/MR or DD.
  3. To coordinate any planning efforts towards the development and delivery of services for people with developmental disabilities with planning efforts of the Office of Public Instruction (OPI), and Department of Public Health and Human Services (DPHHS) divisions and programs, including the Disability Services Division (DSD) and the Developmental Disabilities Planning and Advisory Council (DDPAC), as well as local agencies providing or affiliated with such services.
  4. To advocate for the expansion of community services funded through the HCB Waiver program to serve additional people with developmental disabilities who would otherwise require institutionalization or other ICF/MR or DD services, and to deinstitutionalize those people who are inappropriately receiving care in an ICF/MR or DD.
  5. To maintain or reduce the current number of licensed and certified ICF/MR or DD beds

Certificate of Need Guidelines:

As outlined in 50-5-304, MCA, any applicant seeking to establish an ICF/MR or DD should address the review criteria in its CON application, including an evaluation of the proposal with the guidelines established in this section. The review criteria consider consistency with this State Health Care Facilities Plan, but also allow consideration of additional data and information.

  1. No new ICFs/MR or DD will be approved, nor will any expansion of existing ICFs/MR or DD be approved. See Guideline #3.
  2. If a community home seeks to obtain a license to operate under the provisions of 53-20-205, MCA, it is not subject to Certificate of Need (CON) review. However, any HCB Waiver-funded community home under construction should meet the physical plant requirements for ICFs/MR or DD, or should be able to do so with only minor physical modifications.
  3. The establishment of any new ICF/MR or DD should not be authorized unless the HCB Waiver program ceases to exist. Should this occur, the following CON guidelines will take effect.
    1. Applicants must have documentation from the DSD that there are individuals who need and want the services which would be provided by the proposed facility.
    2. An applicant must demonstrate that existing services are not meeting the demand for appropriate services to persons with developmental disabilities. Proposals for new ICFs/MR or DD will only be approved if there are specific local conditions which require such development.
    3. Proposals to add beds to existing ICFs/MR or DD shall be subject to the bed need methodology for long-term care beds contained in this plan (see the Nursing Home Services component). State-owned facilities are exempt from CON review (50-5-309, MCA).
    4. The maximum number of individuals to be served in a proposed new ICF/MR or DD should be six. The facility should be located in a residential area and the structure should blend with other homes in the neighborhood. Programming should be directed toward maximum community involvement and participation of the individuals served.
    5. CON proposals for ICFs/MR or DD must demonstrate there is a qualified professional work force available to staff such a facility.
    6. Existing HCB Waiver-funded facilities should not be required to undergo CON review to convert to ICFs/MR or DD, in the event that HCB Waiver funding is terminated, but would be required to submit a letter of intent informing DPHHS of the conversion.

Need Methodology for ICFs/MR:

See Nursing Home Services component (only applicable if HCB Waiver ceases to exist).

Discussion:

One of the most sensitive issues in determining service needs for Montana's citizens with developmental disabilities relates to the role of institutional care in an ICF/MR or DD. As cited previously, Montana law limits placement in a state-operated ICF/MR or DD to those persons who are "seriously developmentally disabled." It is necessary to maintain institutional services in the form of ICFs/MR or DD since the resources currently available for community-based services may not be sufficient to serve an individual who is found to have serious developmental disabilities.

In Montana, the development of community-based services began around 1974 with a movement toward deinstitutionalization. This move has been mandated by legislative action and supported by federal monies, with the intention of providing improved services which are available in community settings where groups are smaller and services are more individualized than were previously available in large institutions. Montana law supports community-based services by mandating that services for persons with developmental disabilities be provided in the least restrictive environment according to their individual habilitation needs (53-20-148, MCA).

Community-based services, available through the HCB Waiver program are a cost-effective alternative for serving those individuals who would otherwise require institutionalization or other ICF/MR or DD services. The needs of the great majority of Montana's residents with developmental disabilities can best be met in a community-based environment. Most community-based providers are qualified to participate in the waiver program.

The cost of serving people in the HCB Waiver program is less expensive than serving people in ICFs/MR or DD. Of even greater importance than the cost savings, however, the flexibility of the HCB Waiver program allows more personalized services and more accommodation to individual choices. The opportunity to use and take part in a variety of integrated activities and to become part of communities can reduce the isolation of individuals with developmental disabilities, and hopefully improve their quality of life.

There is presently one facility in Montana that is certified as ICF/MR and one ICF/DD (Table 1). The current bed capacity of 68 is believed to be sufficient to serve individuals who have serious developmental disabilities.

TABLE 1 Effective Date: July 2011

ICF/MR and ICF/DD

Montana Developmental Center (MR)
Boulder, MT
Licensed & Certified

56

Montana Developmental Center (DD)
Boulder, MT
Licensed only

 12

Statewide Total 

68

Information taken from the DPHHS
Quality Assurance Division Licensure Bureau's
Health Care Facilities List

The most recent listing of ICFs/MR or DD can be obtained from the department's web page http://www.dphhs.mt.gov or by contacting the Licensure Bureau, 2401 Colonial Drive, 2nd Floor, PO Box 202953, Helena, Montana 59620-2953, (406) 444-0596.

Page last updated: 07/31/2013