La. Admin. Code tit. 50 § VII-30103
AAMR - American Association of Mental Retardation (formerly the AAMD C American Association of Mental Deficiency).
Abuse - the infliction of physical or mental injury to a client or causing a client's deterioration to such an extent that his/her health, moral or emotional well-being is endangered. Examples include, but are not limited to: sexual abuse, exploitation or extortion of funds or other things of value.
Active Treatment - an aggressive and consistent program of specialized and generic training, treatment, health and related services directed toward the acquisition of behaviors necessary for the client to function with as much self determination and independence as possible and the prevention and deceleration of regression or loss of current optimal functional status.
Acuity Factor - an adjustment factor which will modify the direct care portion of the Inventory for Client and Agency Planning (ICAP) rate based on the ICAP level for each resident.
Adaptive Behavior - the effectiveness or degree with which the individual meets the standards of personal independence and social responsibility expected for his age and cultural group. Since these exceptions vary for different age groups, deficits in adaptive behavior will vary at different ages.
Administrative and Operating Costs - include:
Agency - see Medicaid Agency.
Ambulatory - an ability to walk about.
ANSI - American National Standards Institute.
Applicant - an individual whose written application for Medicaid has been submitted to the agency but whose eligibility has not yet been determined.
ART - accredited record technician.
Attending Physician - a physician currently licensed by the Louisiana State Board of Medical Examiners, designated by the client, family, agency, or responsible party as responsible for the direction of overall medical care of the client.
Autism - a condition characterized by disturbance in the rate of appearance and sequencing of developmental milestones:
BHSF - Bureau of Health Services Financing. See Health Services Financing.
Board Certified Social Worker (BCSW) - a person holding a Master of Social Work (MSW) degree who is licensed by the Louisiana State Board of Certified Social Work Examiners.
Capacity for Independent Living - the ability to maintain a full and varied life in one's own home and community.
Capital Costs - include:
Care Related Costs - include in-house and contractual salaries, benefits, taxes, and supplies that help support direct care but do not directly involve caring for the patient and ensuring their well being (e.g., dietary and educational). Care related costs would also include personal items, such as clothing, personal hygiene items (soap, toothpaste, etc), hair grooming, etc.
Cerebral Palsy - a permanently disabling condition resulting from damage to the developing brain, which may occur before, during or after birth and results in loss or impairment of control over voluntary muscles.
Certification - a determination made by the Department of Health and Hospitals (DHH) that an ICF/MR meets the necessary requirements to participate in Louisiana as a provider of Title XIX (Medicaid) Services.
Change in Ownership (CHOW) - any change in the legal entity responsible for the operation of an ICF/MR.
Chief Executive Officer (CEO) - an individual licensed, currently registered, and engaged in the day to day administration/management of an ICF/MR.
Client - an applicant for or recipient of Title XIX (Medicaid) ICF/MR services.
Code of Federal Regulations (CFR) - the regulations published by the federal government. Section 42 includes regulations for ICF/MRs.
Comprehensive Functional Assessment - identifies the client's need for services and provides specific information about the client's ability to function in different environments, specific skills or lack of skills, and how function can be improved, either through training, environmental adaptations, or provision of adaptive, assistive, supportive, orthotic, or prosthetic equipment.
Developmental Disabilities (DD) - severe, chronic disabilities which are attributable to mental retardation, cerebral palsy, autism, epilepsy or any other condition, other than mental illness, found to be closely related to mental retardation. This condition results in an impairment of general intellectual functioning or adaptive behavior similar to that of mental retardation, and requires treatment or services similar to those required for MR/DD are manifested before the person reaches age 22 and are likely to continue indefinitely.
Developmental Period - a period from birth to before a person reaches age 22.
DHH - Department of Health and Hospitals or its designee.
DHHS - the federal Department of Health and Human Services in Washington, D.C.
Direct Care Costs - consist of all costs related to the direct care interaction with the patient. Direct care costs include:
Dual Diagnosis - clients who carry diagnoses of both mental retardation and mental illness.
Enrollment - process of executing a contract with a licensed and certified ICF/MR provider for participation in the Medical Assistance Program. Enrollment includes the execution of the provider agreement and assignment of the provider number used for payment.
Epilepsy - disorder of the central nervous system which is characterized by repeated seizures which are produced by uncontrolled electrical discharges in the brain.
Facility - an intermediate care facility for the mentally retarded and developmentally disabled.
Fiscal Intermediary - the private fiscal agent with which DHH contracts to operate the Medicaid Management Information System. It processes the Title XIX (Medicaid) claims for services provided under the Medical Assistance Program and issues appropriate payment(s).
General Intellectual Functioning - results obtained by assessment with one or more of the individually administered general intelligence tests developed for that purpose.
HCFA - Health Care Financing Administration.
Health Services Financing, Bureau of (BHSF) - a division of DHH responsible for administering, overseeing, and monitoring the state's Medicaid Program.
HSS - Health Standards Section within BHSF, the section responsible for licensing, certifying and enrolling ICFs/MR.
ICAP - Inventory for Client and Agency Planning. A standardized instrument for assessing adaptive and maladaptive behavior and includes an overall service score. This ICAP service score combines adaptive and maladaptive behavior scores to indicate the overall level of care, supervision or training required.
ICAP Service Level - ranges from 1 to 9 and indicates the service need intensity. The lower the score the greater is the client need.
ICAP Service Score - indicates the level of service intensity required by an individual, considering both adaptive and maladaptive behavior.
NOTE: The relationship between the service level and service score for ICAP support levels is as follows:
ICAP Relationship Graph | ||
ICAP Service Level | ICAP Service Score | ICAP Support Levels |
Pervasive+ | ||
1 | 1-19 | Pervasive |
2 | 20-29 | |
3 | 30-39 | Extensive |
4 | 40-49 | |
5 | 50-59 | Limited |
6 | 60-69 | |
7 | 70-79 | Intermittent |
8 | 80-89 | |
9 | 90+ | |
Index Factor - this factor will be based on the Skilled Nursing Home without Capital Market Basket Index published by Data Resources Incorporated or a comparable index if this index ceases to be published.
Individual Habilitation Plan (IHP) - the written ongoing program of services developed for each client by an interdisciplinary team in order for that client to achieve or maintain his/her potential. The plan contains specific, measurable goals, objectives and provides for data collection.
Individual Plan of Care (IPC) - same as Individual Habilitation Plan.
Individual Program Plan (IPP) - same as Individual Habilitation Plan.
Individual Service Plan (ISP) - same as Individual Habilitation Plan.
Interdisciplinary Team (IDT) - a group of individuals representing the different disciplines in the formulation of a client's individual habilitation plan. That team meets at least annually to develop and review the plans, more frequently if necessary.
Intermediate Care Facility for the Mentally Retarded and Developmentally Disabled (ICF/MR) - same as facility for the mentally retarded or persons with related conditions.
Learning - general cognitive competence-the ability to acquire new behaviors, perceptions, and information and to apply previous experiences in new situations.
Legal Status - a designation indicative of an individual's competency to manage their affairs.
Level of Care (LOC) - service needs of the client based upon his/her comprehensive functional status.
Licensed - a determination by the Louisiana Department of Health and Hospitals, Bureau of Health Service Financing, that an ICF/MR meets the state requirements to participate in Louisiana as a provider of ICF/MR services.
Living Unit - a place where a client lives including sleeping, training, dining and activity areas.
LPN - licensed practical nurse.
LSC - life safety code.
LTC - long term care.
Major Life Activities - any one of the following activities or abilities:
Measurable Outcomes - a standard or goal by which performance is measured and evaluated.
Mechanical Support - a device used to achieve proper body position or balance.
Medicaid - medical assistance provided according to the State Plan approved under Title XIX of the Social Security Act.
Medicaid Agency - the single state agency responsible for the administration of the Medical Assistance Program (Title XIX). In Louisiana, the Department of Health and Hospitals is the single state agency.
Medicaid Management Information System (MMIS) - the computerized claims processing and information retrieval system which includes all ICF/MR providers eligible for participation in the Medical Assistance Program. This system is an organized method for payment for claims for all Title XIX Services.
Medical Assistance Program (MAP) - another name for the Medicaid Program.
Medicare - the federally administered Health Insurance program for the aged, blind and disabled under the Title XVIII of the Social Security Act.
Medicare Part A - the hospital insurance program authorized under Part A of Title XVIII of the Social Security Act.
Medicare Part B - the supplementary medical insurance program authorized under Part B of Title XVIII of the Social Security Act.
Mental Retardation (MR) - significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior, and manifested during the developmental period.
NOTE: It shall be emphasized that a finding of low I.Q. is never by itself sufficient to make the diagnosis of mental retardation or in evaluating its severity. A low I.Q. shall serve only to help in making a clinical judgment regarding the client's adaptive behavioral capacity. This judgment also includes present functioning, including academic and vocational achievement, motor skills, and social and emotional maturity.
Mobil Nonambulatory - the inability to walk without assistance, but the ability to move from place to place with the use of a device such as a walker, crutches, wheelchair or wheeled platform.
Mobility - motor development and ability to:
Neglect - the failure to provide proper or necessary medical care, nutrition or other care necessary for a client's well being.
New Facility - an ICF/MR newly opened or recently began participating in the Medical Assistance Program.
Nonambulatory - the inability to walk without assistance.
Nursing Facility or Facility - health care facilities such as a private home, institution, building, residence, or other place which provides maintenance, personal care, or nursing services for persons who are unable to properly care for themselves because of illness, physical infirmity or age. These facilities serve two or more persons who are not related by blood or marriage to the operator and may be operated for profit or nonprofit.
Office for Citizens with Developmental Disabilities (OCDD) - the office within DHH responsible for programs serving the MR/DD population.
Operational - admission of at least one client, completion of functional assessments(s) and development of individual program plan(s) for the client(s); and implementation of the program plan(s) in order that the facility actually demonstrate the ability, knowledge, and competence to provide active treatment.
Overall Plan of Care (OPC) - see Individual Habilitation Plan.
Pass through Cost Component - includes the provider fee.
Peer Group - the administrative and operating per diem rate and the capital per diem rate are tiered based on peer group size. Peer groups are as follows:
Provider - any individual or entity enrolled to furnish Medicaid services under a provider agreement with the Medicaid agency.
Qualified Mental Retardation Professional (QMRP) - a person who has specialized training and at least one year or more of experience in treating and/or working directly with and in direct contact with the mentally retarded clients. To qualify as a QMRP, a person must meet the requirements of 42 CFR 483.430.
Rate Year - a one-year period corresponding to the state fiscal year from July 1 through June 30.
Rebasing - recalculation of the per diem rate components using the latest available audited or desk reviewed cost reports.
Recipient - an individual who has been determined eligible for Medicaid.
Registered Nurse (RN) - a nurse currently registered and licensed by the Louisiana State Board of Nursing.
Representative Payee - a person designated by the Social Security Administration to receive and disburse benefits in the best interest of and according to the needs of the beneficiary.
Responsible Party - a person authorized by the client, agency or sponsor to act as an official delegate or agent in dealing with the Department of Health and Hospitals and/or the ICF/MR.
Self-Care - daily activities which enable a person to meet basic life needs for food, hygiene, appearance and health.
Self-Direction - management and control over one's social and personal life and the ability to make decisions that affect and protect one's own interests. A substantial functional limitation in self-direction would require a person to need assistance in making independent decisions concerning social and individual activities and/or in handling personal finances and/or in protecting his own self-interest.
Significant Assistance - help needed at least one-half of the time for one activity or a need for some help in more than one-half of all activities normally required for self-care.
Significantly Sub-Average - for purposes of certification for ICF/MR an I.Q. score of below 70 on the Wechsler, Standford-Binet, Cattell, or comparable test will be considered to establish significantly sub-average intellectual functioning.
SNF - Skilled Nursing Facility.
Sponsor - an adult relative, friend, or guardian of the client who has a legitimate interest in or responsibility for the client's welfare. Preferably, this person is designated on the admission forms as "responsible party."
Substantial Functional Limitation - a condition that limits a person from performing normal life activities or makes it unsafe for a person to live alone to such an extent that assistance, supervision, or presence of a second person is required more than half of the time.
Support Levels - describe the levels of support needed by individuals with mental retardation and other developmental disabilities. The five descriptive levels of service intensity using the ICAP assessment are summarized in Subparagraphs a-e below.
Title XIX - see Medicaid.
Training and Habilitation Services - services intended to aid the intellectual, sensorimotor and emotional development of a client as part of overall plans to help the individual function at the greatest physical, intellectual, social and vocational level he/she can presently or potentially achieve.
Understanding and Use of Language - communication involving both verbal and nonverbal behavior enabling the individual both to understand others and to express ideas and information to others.
La. Admin. Code tit. 50, § VII-30103