Subsection 144-101-II-50.01 - DEFINITIONS50.01-1Intermediate Care Facility for Persons with Mental Retardation (ICF-MR) is a facility that meets State licensing and Federal certification requirements for ICFs-MR. An ICF-MR provides, under an agreement with the Department of Health and Human Services (DHHS), health-related care and a rehabilitative services program for members with mental retardation or members with related conditions who do not require the degree of care and treatment that a hospital or skilled nursing facility is designed to provide, but require care and services above the level of room and board. There are two types of ICF's-MR: ICF-MR Nursing Facility and ICF-MR Group Home Facility. Both types must meet appropriate State licensing and Federal certification requirements.
A.ICF-MR Nursing Facility: To assist each member to reach his or her maximum level of functioning capabilities, an ICF-MR Nursing Facility provides, under an agreement with the Department of Health and Human Services, twenty-four (24) hours, seven (7) days a week, of licensed nurse supervision of coordinated health treatment and rehabilitative services for persons who have mental retardation or persons with related conditions (See Section 50.01-11 for definition of "persons with related conditions").B.ICF-MR Group Home Facility: An ICF-MR Group Home Facility provides a supportive and protective setting and twenty-four (24) hour, seven (7) days a week, of non-nursing supervision for persons who have mental retardation or persons with related conditions (See Section 50.01-11 for definition of "persons with related conditions"). The facility must assure the coordination of health and rehabilitative services to assist each member in reaching his or her maximum level of functioning capabilities.50.01-2 Active Treatment is a continuous aggressive and consistent program of specialized and generic training, treatment, health services and related services that are directed toward the member's acquisition of behaviors necessary to function with as much self-determination and independence as possible; and the prevention or deceleration of regression or loss of current optimal functional status.50.01-3Autistic disorder is a disorder that features the presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests. Autistic disorder is considered a related condition to mental retardation (see 50.01-11 for a definition of "Persons with Related Conditions).50.01-4Department is the State of Maine Department of Health and Human Services.50.01-5Distinct Part of a Larger Institution is when the Department certifies an ICF-MR as a distinct part of a larger institution. The following requirements must be met: A. The distinct part must meet all the requirements for an ICF-MR as stated in this Section and as specified in 42 CFR Part 483, subpart l.B. Is clearly an identifiable living unit, such as an entire ward, wing, floor or building, consists of all beds and related services in the unit, houses all members for whom payment is being made for ICF/MR services, and is approved in writing by the survey agency.C. The distinct part must separate costs related to ancillary services from costs related to routine services and must bill for the ancillary services according to the Billing Instructions for ICF-MR services, available at www.maine.gov/bms/index.shtml. These separate ancillary services may include, but are not limited to physical therapy, occupational therapy and speech and hearing services.50.01-6Extensive Assistance means that although the individual performed part of the activity over the last seven (7) days, or twenty-four (24) to forty-eight (48) hours if in a hospital setting, help of the following type(s) was provided: 1. Weight-bearing support three (3) or more times, or2. Full staff performance during part (but not all) of the last seven (7) days.50.01-7Functionally Significant Improvement is the demonstrable, measurable increase in the member's ability to perform specific tasks or motions that contribute to independence outside the therapeutic environment.50.01-8 Individual Program Plan (IPP) is a detailed annual written plan developed by the member and an Interdisciplinary Team, based on a comprehensive functional assessment, outlining the member's specific needs for training, treatment, education, and rehabilitative services along with the methods to be utilized in providing them. This includes but is not limited to the Person Centered Plan (PCP).50.01-9Interdisciplinary Team (IDT) is a team of professionals, paraprofessionals, and non-professionals who represent the disciplines of service areas that are relevant to the identification of the member's needs as described in the comprehensive functional assessment, and who have the expertise to design effective programs to meet those needs.50.01-10Person Centered Plan (PCP) is a process where the needs and desires of the member are articulated and identified with as much involvement of the person as possible. This is included in the IPP.50.01-11Persons with Related Conditions are individuals who have a severe, chronic disability that meets all of the following conditions. The disability must:A. Be attributable to cerebral palsy or epilepsy; or to any other condition, other than mental illness, found to be closely related to mental retardation, because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of mentally retarded persons, and requires treatment or services similar to those required for these persons; andB. Be manifested before the person reaches age twenty-two (22); andC. Be likely to continue indefinitely; andD. Result in substantial functional limitations in three (3) or more of the following areas of major life activity: 2. understanding and use of language.6. capacity for independent living.50.01-12Rehabilitation Potential is the physician's documented expectation of measurable functionally significant improvement in the member's condition in a reasonable, predictable period of time as the result of the prescribed treatment plan. The physician's documentation of rehabilitation potential must include the reasons used to support the physician's expectation and must follow guidelines detailed in MaineCare Benefits Manual (MBM), Chapter II, Section 90, Physician Services.50.01-13Rehabilitative Services are any medical or remedial services recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under State law, for maximum reduction of physical or mental disability and restoration of a recipient to his/her best possible functional level. Rehabilitative services include services that were historically referred to as habilitation services, which are services that are provided in order to assist an individual to acquire a variety of skills including, but not limited to, dressing, bathing, toileting and social development. Rehabilitative services are meant to raise the level of physical, mental, and independent living skills necessary for the client to be able to function in the community.50.01-14Utilization Review is the evaluation of the necessity, appropriateness, and efficiency of the use of services, procedures, and facilities by each participating ICF-MR. It includes a review of the appropriateness of admissions, services ordered and provided, and discharge practices. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-50, subsec. 144-101-II-50.01