Library: Policy

317:30-5-130. Inspections of care in Intermediate Care Facilities for the Mentally Retarded (ICF/MR)

Revised 5-27-97

The Oklahoma Health Care Authority (OHCA) is responsible for periodic inspections of care and services in each ICF/MR providing services for Title XIX applicants and recipients. The inspection of care reviews are made by the OHCA or its designated agent. The frequency of inspections is based on the quality of care and service being provided in a facility and the condition of recipients in the facility. However, the care and services provided to each recipient in the facility must be inspected at least annually. No notification of the time of the inspection will be given to the facility prior to the inspections.

(1) The purpose of periodic inspections is to determine:
- (A) The level of care required by each patient for whom Title XIX benefits have been requested or approved.
- (B) The adequacy of the services available in the particular facility to meet the current health, rehabilitative and social needs of each recipient in an ICF/MR and promote the maximum physical, mental, and psychosocial functioning of the recipient receiving care in such facility.
- (C) The necessity and desirability of the continued placement of each patient in such facility.
- (D) The feasibility of meeting the health care needs and the recipient's rehabilitative needs through alternative institutional or noninstitutional services.
- (E) If each recipient in an institution for the mentally retarded or persons with related conditions is receiving active treatment.
(2) Each applicant and recipient record will be reviewed for the purpose of determining adequacy of services, unmet needs and appropriateness of placement. Personal contact with and observation of each recipient will occur during the visit. This may necessitate observing recipients at sites outside of the facility.
- (A) Record reviews will include confirmation of whether:
  - (i) All required evaluations including medical, social and psychological are complete and current.
  - (ii) The habilitation plan is complete and current.
  - (iii) All ordered services are provided and properly recorded.
  - (iv) The attending physician reviews prescribed medications at least quarterly.
  - (v) Tests or observations of each recipient indicated by his medication regimen are made at appropriate times and properly recorded.
  - (vi) Physicians, nurse, and other professional progress notes are made as required and appear consistent with the observed condition of the recipient.
  - (vii) There is a habilitation plan to prevent regression and reflects progress toward meeting objectives of the plan.
  - (viii) All recipient needs are met by the facility or through arrangements with others.
  - (ix) The recipient needs continued placement in the facility or there is an appropriate plan to transfer the recipient to an alternate method of care.
- (B) Observations and personal contact with recipients will include confirmation of whether:
  - (i) The habilitation plans are followed.
  - (ii) All ordered services are provided.
  - (iii) The condition of the recipient is consistent with progress notes.
  - (iv) The recipient is clean and is receiving adequate hygiene services.
  - (v) The recipient is free of signs of malnutrition, dehydration and preventable injuries.
  - (vi) The recipient is receiving services to maintain maximum physical, mental, and psychosocial functioning.
  - (vii) The recipient needs any service that is not furnished by the facility or through arrangements with others.
(3) A full and complete report of observations, conclusions and recommendations are required concerning:
- (A) The adequacy, appropriateness, and quality of all services provided in the facility or through other arrangements, including physician services to recipients; and
- (B) Specific findings about individual recipients in the facility.
(4) The inspection report must include the dates of the inspection and the names and qualifications of the individuals conducting the inspection. A copy of each inspection report will be sent to:
- (A) The facility inspected;
- (B) The facility's utilization review committee;
- (C) The agency responsible for licensing, certification, or approval of the facility for purposes of Medicare and Medicaid; and
- (D) Other state agencies that use the information in the reports to perform their official function, including if inspection reports concern Institutions for Mental Diseases (IMDs), the appropriate State mental health authorities.
(5) The Oklahoma Health Care Authority will take corrective action as needed based on required reports and recommendations.