CHAPTER 65INTERMEDIATE CARE FACILITIESFOR PERSONS WITH MENTAL ILLNESS (ICF/PMI)48165.1(135C) Definitions. For the purposes of these rules, the following terms shall have the meaning indicated in this chapter. The definitions set out in Iowa Code section 135C.1 shall be considered incorporated verbatim in the rules. The use of the words “shall” and “must” indicate these standards are mandatory.
"Academic services" means those activities provided to assist a person to acquire general information and skills which establish the basis for subsequent acquisition and application of knowledge.
"Activity coordinator" means a person who has completed the state-approved activity coordinator’s course.
"Age appropriate" means those activities, settings, and personal appearance and possessions commensurate with the person’s chronological age.
"Chronic mental illness" (see the definition of “Mental illness”).
"Commission" means the mental health and disability services commission.
"Community living training services" are those activities provided to assist a person to acquire or sustain the knowledge and skills essential to independent functioning to the person’s maximum potential in the physical and social environment. These services may focus on the following areas:
- Independent living skills which include those skills necessary to sustain oneself in the physical environment and are essential to the management of one’s personal property and business. This includes self-advocacy skills.
- Socialization skills which include self-awareness and self-control, social responsiveness, group participation, social amenities and interpersonal skills.
- Communication skills which include expressive and receptive skills in verbal and nonverbal language, including reading and writing.
- Leisure time and recreational skills which include the skills necessary for a person to use leisure time in a manner which is satisfying and constructive to the person.
- Parenting skills which include those skills necessary to meet the needs of the person’s child. This service is designed to assist the person with mental illness to acquire or sustain the skills necessary for parenting.
"Department" means the Iowa department of inspections and appeals.
"Dependent adult abuse" is as defined in rule 481—52.1(235E).
"Diagnosis" means the investigation and analysis of the cause or nature of a person’s condition, situation or problem.
"Direct care staff" means those staff persons who provide a homelike environment for the residents and assist or supervise the resident in meeting the goals in the resident’s program plan.
"Evaluation services" means those activities designed to identify a person’s current functioning level and those factors which are barriers to maintaining the current level or achieving a higher level of functioning.
"Exploitation" means the act or process of taking unfair advantage of a resident, or the resident’s physical or financial resources for one’s own personal or pecuniary profit by the use of undue influence, harassment, duress, deception, false representation or false pretenses.
"Goals" means general statements of attainable expected accomplishments to be achieved in meeting identified needs.
"Incident" means all accidental, purposeful, or other occurrences within the facility or on the premises affecting residents, visitors, or employees whether there is apparent injury or where hidden injury may have occurred.
"Individual program plan (IPP)" means a written plan for the provision of services to the resident that is developed and implemented using an interdisciplinary process that is based on the resident’s functional status, strengths, and needs and that identifies service activities designed to enable a person to maintain or move toward independent functioning. The plan identifies a continuum of development and outlines progressive steps and anticipated outcomes of services.
"Informed consent" means an agreement by a person, or by the person’s legally authorized representative, based upon an understanding of:
- A full explanation of the procedures to be followed including an identification of those that are and are not experimental;
- A description of the attendant discomforts, risks, and benefits to be expected; and
- A disclosure of appropriate alternative procedures that would be advantageous for the person.
"Interdisciplinary process" means an approach to assessment, individual program planning, and service implementation in which planning participants function as a team. Each participant utilizing the skills, competencies, insights and perspectives provided by the participant’s training and experience focuses on identifying the service needs of the resident and the resident’s family. The purpose of the process is for participants to review and discuss, face-to-face, all information and recommendations and to reach decisions as a team. Participants share all information and recommendations, and develop as a team, a single, integrated individual program plan to meet the resident’s needs and, when appropriate, the resident’s family’s needs.
"Interdisciplinary team" means the group of persons who develop a single, integrated individual program plan to meet a resident’s needs for services. The interdisciplinary team consists of, at a minimum, the resident, the resident’s legal guardian, if applicable, the resident’s advocate, if desired by the resident, a referral agency representative, other appropriate staff members, the resident’s attending psychiatrist and QMHP, other providers of services, and other persons relevant to the resident’s needs.
"Least restrictive environment" means the environment in which the interventions in the lives of people with mental illness can be carried out with a minimum of limitation, intrusion, disruption, and departure from commonly accepted patterns of living.It is the environment which allows residents to participate, to the maximum extent possible, in everyday life and to have control over the decisions that affect them. It is an environment that provides needed supports which do not interfere with personal liberty and do not unduly interfere with a person’s access to the normal events of life.
"Legal services" means those activities designed to assist the person in exercising constitutional and legislatively enacted rights.
"Level of functioning" means a person’s current physiological and psychological status and current academic, community living, self-care and vocational skills.
"Mechanical restraint" means a device applied to a person’s limbs, head or body which restricts a person’s movement and includes, but is not limited to, leather straps, leather cuffs, camisoles or handcuffs.
"Mental abuse" means, but is not limited to, humiliation, harassment, and threats of punishment or deprivation.
"Mental health counselor" means a person who is certified or eligible for certification as a mental health counselor by the National Academy of Certified Clinical Mental Health Counselors.
"Mental health, mental retardation commission" means the commission described in Iowa Code section 225C.5.
"Mental illness" means a substantial disorder of thought or mood which significantly impairs judgment, behavior, or the capacity to recognize reality or the ability to cope with the ordinary demands of life. Mental illnesses include the organic and functional psychoses, neuroses, personality disorders, alcoholism and drug dependence, behavioral disorders and other disorders as defined by the current edition of “American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.” Mental illness is chronic when it is of long duration or marked by frequent recurrences.
"Normalization" means helping persons, in accordance with their needs and preferences, to achieve a lifestyle that is consistent with the norms and patterns of general society in ways which incorporate the age-appropriate and least restrictive principles.
"Objectives" means specific, time-limited, and measurable statements showing outcomes or accomplishments necessary to progress toward the goal.
"Physical abuse" means, but is not limited to, corporal punishment and the use of restraints as punishment.
"Physical injury" means damage to any bodily tissue to the extent the tissue must undergo a healing process in order to be restored to a sound and healthy condition. It may also mean damage to the extent the bodily tissue cannot be restored to a sound and healthy condition, or results in the death of the resident whose bodily tissue sustained the damage.
"Physical or physiological treatment" means those activities designed to prevent, halt, control, relieve, or reverse symptoms or conditions which interfere with the physical or physiological functioning of the human body.
"Physical restraint" means a technique involving the use of one or more of a staff person’s arms, legs, hands or other body areas to restrict or control the movements of a resident. This does not include the use of mechanical restraint.
"Physician" means a person who is currently licensed in Iowa to practice medicine and surgery, osteopathic medicine and surgery, or osteopathy.
"Primary care provider" means any of the following who provide primary care and meet certification standards:
- A physician who is a family or general practitioner or an internist.
- An advanced registered nurse practitioner.
- A physician assistant.
"Program" means a set of related resources and services directed to the accomplishment of a fixed set of goals and objectives for any of the following:
- Special target populations;
- The population of a specified geographic area(s);
- A specified purpose; and
- A person.
"Psychiatric nurse" means a person who meets the requirements of certified psychiatric-mental health nurse practitioner pursuant to 655—Chapter 7, Iowa Administrative Code, or is eligible for certification.
"Psychiatrist" means a doctor of medicine or osteopathic medicine and surgery who is certified by the American Board of Psychiatry and Neurology or who is eligible for certification.
"Psychologist" means a person who is licensed to practice psychology in the state of Iowa, or is certified by the Iowa department of education as a school psychologist, or is eligible for certification.
"Psychotherapeutic treatment" means those activities designed to assist a person in the identification or modification of beliefs, emotions, attitudes, or behaviors in order to maintain or improve the person’s functioning in response to the physical, emotional and social environment.
"Qualified mental health professional (QMHP)" means a person who:
- Holds at least a master’s degree in a mental health field, including but not limited to: psychology, counseling and guidance, nursing and social work; or is a doctor of medicine (M.D.) or a doctor of osteopathic medicine and surgery (D.O.); and
- Holds a current Iowa license when required by the Iowa licensure law; and
- Has at least two years of postdegree experience, supervised by a mental health professional, in assessing mental problems and needs of individuals and in providing appropriate mental health services for those individuals. See rule 481—65.4(135C) for variance procedures.
"Resident" means a person who has been admitted to the facility to receive care and services.
"Seclusion" means the isolation of the resident in a locked room which cannot be opened by the resident.
"Self-care training services" means those activities provided to assist a person to acquire or sustain the knowledge, habits and skills essential to the daily needs of the person. The activities focus on personal hygiene, general health maintenance, mobility skills and other activities of daily living.
"Service" means a set of interrelated activities provided to a resident pursuant to the IPP.
"Sexual abuse" means, but is not limited to, the exposing of pubes to a resident, the exposure of a resident’s genitals, pubes, breasts or buttocks for sexual satisfaction, fondling or touching the inner thigh, groin, buttocks, anus or breast of a resident or the clothing covering these areas, sexually suggestive comments or remarks made to a resident, a genital to genital or rectal, or oral to genital or rectal contact, or the commission of a sexual offense under Iowa Code chapter 709 or Iowa Code section 726.2.
"Social worker" means a person who is licensed to practice social work in the state of Iowa, or who is eligible for licensure.
"Support services" means those activities provided to or on behalf of a person in the areas of personal care and assistance and property maintenance in order to allow a person to live in the least restrictive environment.
"Transportation services" means those activities designed to assist a person to travel from one place to another to obtain services or carry out life’s activities.
"Verbal abuse" means, but is not limited to, the use of derogatory terms or names, undue voice volume and rude comments, orders or responses to residents.
"Vocational training services" means those activities designed to familiarize a person with production or employment requirements and to maintain or develop the person’s ability to function in a work setting. This service includes programming which allows or promotes the development of skills, attitudes and personal attributes appropriate to the work setting.
"Work" means any activity during which a resident provides goods or services for wages.
"Written, in writing or recorded" means that an account or entry is made in a permanent form.Related ARC(s): 0766C, 1204C, 1752C48165.2(135C) Application for license. In order to obtain an initial license for an ICF/PMI, the applicant must comply with the rules and standards contained in Iowa Code chapter 135C and the standards in 481—Chapter 61. Variances from Chapter 61 regulations are allowed under rule 481—61.2(135C). An application must be submitted to the department which states the type and category of license for which the facility is applying. 65.2(1) Each application shall include: a. A floor plan of each floor of the facility drawn on 8½- × 11-inch paper showing room areas in proportion, room dimensions, room numbers for all rooms, including bathroom, and designation of the use to which room will be put and window and door location; b. A photograph of the front and side elevation of the facility; c. The statutory fee for an intermediate care facility license; d. Evidence of a certificate signed by the state fire marshal or deputy state fire marshal as to compliance with fire safety rules. 65.2(2) A résumé of care with a narrative which includes the following information shall be submitted: a. The purpose of the facility; b. A description of the target population and limitations on resident eligibility; c. An identification and description of the services the facility will provide. This shall include at least specific and measurable goals and objectives for each service available in the facility and a description of the resources needed to provide each service including staff, physical facilities and funds; d. A description of the human service system available in the area, including, but not limited to, social, public health, visiting nurse, vocational training, employment services, sheltered living arrangements, and services of private agencies; and e. A description of working relationships with the human service agencies when applicable which shall include at least how the facility will coordinate with: (1) The department of human services to facilitate continuity of care and coordination of services to residents; and (2) Other agencies to identify unnecessary duplication of services and plan for development and coordination of needed services. 65.2(3) In order to obtain a renewal or change of ownership license of the ICF/PMI the applicant must: a. Submit to the department the completed application form 30 days prior to annual license renewal or change of ownership date of the ICF/PMI license; b. Submit the statutory license fee for an ICF/PMI with the application for renewal or change of ownership; c. Have an approved current certificate signed by the state fire marshal or deputy state fire marshal as to compliance with fire safety rules; and d. Submit documentation of review of résumé of care pursuant to subrule 65.2(1), paragraph “a,” and a copy of any revisions to the plan.This rule is intended to implement Iowa Code sections 135C.7 and 135C.9.Related ARC(s): 1205C48165.3(135C) Licenses for distinct parts. Separate licenses may be issued for distinct parts which are clearly identifiable parts of a health care facility, containing contiguous rooms in a separate wing or building or on a separate floor of the facility, which provide care and services of separate categories.The following requirements shall be met for a separate licensing of a distinct part:
- The distinct part shall serve only residents who require the category of care and services immediately available to them within that part. (III)
- The distinct part shall meet all the standards, rules and regulations pertaining to the category for which a license is being sought.
- The distinct part must be operationally and financially feasible.
- A separate personal care staff with qualifications appropriate to the care and services being rendered must be regularly assigned and working in the distinct part under responsible management. (III)
- Separately licensed distinct parts may have certain services such as management, building maintenance, laundry and dietary in common with each other.
- The need for a variance has been established consistent with the résumé of care or the resident’s individual program plan.
- There is no danger to the health, safety, welfare or rights of any resident.
- The variance will apply only to a specific intermediate care facility for the mentally ill.
- No resident shall be admitted or retained who is in need of greater services than the facility can provide. (II, III)
- Residents shall be admitted only on a written order signed by a physician. (II, III)
- A preplacement visit shall be completed prior to admission, except in case of an emergency admission or readmission, to familiarize the applicant with the facility and services offered. The policies and procedures may allow for waiving the requirement at the request of a person seeking admission when the completion of the visit would create a hardship for the person seeking admission. If the distance to be traveled makes it impossible to complete the visit in an eight-hour day, this may be considered to create a hardship. (III)
- Prior to admission of an applicant, the facility shall obtain sufficient information to determine if its program is appropriate and adequate to meet the person’s needs. (III)
- Admission criteria shall include, but not be limited to, age, sex, current diagnosis from an American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, substance abuse, dual diagnosis and criteria that are consistent with the résumé of care. (III)
- Each facility shall maintain a waiting list with selection priorities identified. (III)
- No ICF/PMI may admit more residents than the number of beds for which it is licensed. (II, III)
- There shall be a written, organized orientation program for all residents which shall be planned and implemented to resolve or reduce personal, family, business, and emotional problems that may interfere with the health care, recovery, and rehabilitation of the individual and which shall be available for review by the department. (III)
- Infants and children under the age of 18 shall not be admitted as residents to an ICF/PMI for adults unless given prior written approval by the department. A distinct part of an ICF/PMI, segregated from the adult section, may be established based on a résumé of care submitted by the licensee or applicant which is commensurate with the needs of the residents of the health care facility and has received the department’s review and approval. (III)
- Within 30 days of a resident’s admission to a health care facility receiving reimbursement through the medical assistance program under Iowa Code chapter 249A, the facility shall ask the resident or the resident’s personal representative whether the resident is a veteran and shall document the response. If the facility determines that the resident is a potential veteran, the facility shall report the resident’s name along with the names of the resident’s spouse and any dependent children, as well as the name of the contact person for this information, to the Iowa department of veterans affairs. Where appropriate, the facility may also report such information to the Iowa department of human services.
- Directed to maximizing the growth and development of the individual by incorporating a hierarchy of available alternative methods that emphasize positive approaches; (II, III)
- Available in each program area and living unit; (II, III)
- Available to individuals and their families; (II, III) and
- Developed with the participation, as appropriate, of individuals served. (II, III)
- Type I is physical restraint which uses equipment to promote the safety of the individual. It is not applied directly to a person. Examples: divided doors and side rails.
- Type II is mechanical restraint applied to someone’s body. A device is applied to the body to promote safety of the individual. Examples: vests or soft tie devices, hand socks, geriatric chairs.
- Type III is mechanical restraint applied to any part of the body which inhibits only the movement of that part of the body. Examples: wrist, ankle or leg restraints and waist straps.
- Medication orders shall be correctly implemented by qualified personnel. (II)
- Qualified staff shall ensure that residents are able to take their own medication. (I, II)
- Each physician order allowing a resident to self-administer medications shall specify whether this self-medication shall be without supervision or under the supervision of qualified staff as defined in 65.17(2). (I, II)
- The person responsible for planning menus and monitoring the kitchens in each facility shall have completed training, approved by the department, in sanitation and food preparation. (III)
- In facilities licensed for over 15 beds, food service personnel shall be on duty during a 12-hour span extending from the preparation of breakfast through supper. (III)
- There shall be written work schedules and time schedules covering each type of job in the food service department for facilities over 15 beds. These work and time schedules shall be posted or kept in a notebook which is available for use in the food service area. (III)