Intermediate Care Facilities for Individuals with Mental Retardation

Intermediate Care Facilities for Individuals with Developmental Disabilities (ICF/MR) is a disability benefit that is offered through United States Medicaid funding. Section 1905(d) of the Social Security Act^[1] enacted benefits and made funding available for "institutions" (which consisted of 4 or more beds) for individuals with mental retardation or developmental disabilities (MR/DD), the Act states these facilities providing for the MR/DD population must provide adequate "active treatment," currently defined by Secretary of the U.S. Department of Health and Human Services.^[2]

Since the regulations creation there has been a major change in the stigma regarding the field of developmental disabilities. The Act places substantial emphasis on how MR/DD people living in their own homes, controlling their own lives while interacting with others and being an integrated part the home community has become beneficial. In 1999, the Supreme Court of the United States made an important ruling on this topic in Olmstead v. L.C. ^[3]

Background

The ICF/MR Program began in 1971 when legislation began federal funding for ICFs/MR as an optional, beneficial Medicaid service. Authorization for ICF/MR services were seen at the congressional level as an option under the state plan Medicaid services. This allowed states to receive matching federal funds for MR/DD institutional services.^[2] This program helped facilitate the act of deinstitutionalization. In which many developmental center institutions (such as Broadview Developmental Center) closed doors and their funding then shifted to community-based programs for those individuals with MR/DD (or mental retardation/developmental disabilities.)

It provided the first Medicaid long-term services and supports benefit specifically for persons with intellectual and developmental disabilities.^[4]

As of 2011, all 50 states within the U.S.A have at least one ICF/MR-based program providing for the MR/DD. Across the U.S., there are more than 7,000 ICFs/MR. Within these programs there are about 129,000 people with mental retardation and other related conditions receiving treatment. Most have other disabilities as well as mental retardation. While many of these individuals located in these facilities are non-ambulatory, have seizure disorders, behavior problems, mental illness, visual or hearing impairments, or a combination of the above they all still must qualify for Medicaid assistance financially to remain in practice.^[2]

In order to obtain Medicaid reimbursement, ICFs/MR must be certified and comply with state mandated standards of practice in eight areas, including management, client protections, facility staffing, active treatment services, client behavior and facility practices, health care services, physical environment and dietetic services.^[2] Upon successful auditing and submission of these eight areas, will then a service providing for MR/DD individuals be ICF/MR certified. The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) has issued regulations regarding seclusion and restraint. These regulations are called “Conditions of Participation (CoPs).” CoPs serve as the basis of survey activities for the purpose of determining whether a facility qualifies for a provider agreement under Medicare or Medicaid. There is a set of CoPs for each type of provider or supplier subject to certification. Providers must meet the applicable CoPs for them to be able to provide and continue to provide Medicare and Medicaid benefits.^[5]

Individual development

Operating ICFs/MR certified companies and organizations must recognize the developmental, cognitive, social, physical, and behavioral needs of individuals with mental retardation who live in their setting or environment by requiring that each individual with MR/DD receives active treatment in regards to appropriate habilitation of their functions to be eligible for Medicaid funding.^[6] Current ICFs/MR certified companies must submit to protocol and auditing procedures to ensure they receive said active treatment in order to obtain Medicaid funding through the subsequent state of audit.

Active treatment can be defined as the individualized implementation of a program of training, treatment, health, and related services directed toward the rehabilitation of the behaviors necessary for the MR/DD individual to function within the general scope of their being and independence as well as possible. This treatment can and should include prevention or deceleration (or regression) of current functional statuses.^[6] This can be facilitated through the development of goals, outings, and a behavioral support plan or Individual Service Plan established by their Qualified Mental Retardation Professional or QMRP.

Medicaid Home and Community Based Services

The Medicaid Home and Community Based Services (HCBS) was authorized in 1981 as an alternative to the institutional standards of the ICF/MR program. This service complimented ICF/MR by helping with the financial shift from institutions to community-based service. ^[4]

Medicaid, the nation’s primary health insurance program for persons with disabilities and low-income populations is provided for most people with significant disabilities who have greater medical needs and often require assistance with the activities of daily living throughout their lifetimes. It is overwhelmingly the largest funding source of both acute health care and long term services and supports for most of our constituents. Although Medicaid is a federal program, its benefits are defined and distributed at the state level.^[7]

Organizational options

The developmentally disabled can turn to certain organizations to aid in their search to gain information regarding the options for their care.

One option is VOR, www.vor.net, a national nonprofit organization advocating for high quality care and human rights for all people with intellectual and developmental disabilities. VOR is the only national advocacy organization that supports a spectrum of care options, including Intermediate Care Facilities (ICFs) for Persons with Mental Retardation (now called, ICFs for Persons with Intellectual Disabilities). VOR offers hope and support for people with intellectual and developmental disabilities, and their families, who are working to protect or secure necessary services. VOR advocates for appropriate care at all levels of government.

Another organization is the Arc of the United States, a grassroots organization serving people with intellectual and developmental disabilities.^[7]

The Arc, started in 1950 by a group of parents of disabled individuals and other citizens, to seek out options for individuals suffering from, what was known at the time as "mental retardation". At the outset, the organizations goal at this point was to alter perceptions of children with intellectual and developmental disabilities and to educate parents and others regarding the potential of people with intellectual and developmental disabilities. ^[7]

Since the beginning, The Arc has adapted to the changes that people with disabilities face across their life span. The Arc has seen several name changes, advocated for the passage of state and federal legislation on behalf of people with disabilities and established a network of state and local chapters that range from small voluntary groups to large, professional organizations.^[7]

State chapters of The Arc can be found in 39 states across the United States, with over 730 local chapters.^[7]

Renaming mental retardation

Professionals in the field of intellectual disability/mental retardation have raised discussion about the construct of disability, how intellectual disability fits within the general construct of disability, and the use of the term intellectual disability.^[8]

The term intellectual disability is being used instead of mental retardation is exemplified by organization names (e.g., International Association for the Scientific Study of Intellectual Disabilities, President's Committee for People With Intellectual Disabilities)and more recent published research. ^[8]

Presently, intellectual disability diagnosis covers the same population of individuals who were diagnosed previously with mental retardation in number, kind, level, type, and duration of the disability and the need of people with this disability for individualized services and supports. Simply, every individual who is or was eligible for a diagnosis of mental retardation is eligible for a diagnosis of intellectual disability. ^[8]

The concept of a disability is "focused on the expression of limitations in individual functioning within a social context and represents a substantial disadvantage to the individual. Disability has its genesis in a health condition that gives rise to impairments in body functions and structures, activity limitations, and participation restrictions within the context of personal and environmental factors." ^[8] This relates to the term intellectual disability evolved to "emphasize an ecological perspective that focuses on the person–environment interaction and recognizes that the systematic application of individualized supports can enhance human functioning." ^[8]

References

Policy sources