§1396r–3 Correction and reduction plans for intermediate care facilities for mentally retarded

Summary

If a facility for people with intellectual disabilities has serious problems that do not immediately threaten residents, the State can do one of two things. The State can send, within the number of days the Secretary sets, a written correction plan that shows how the facility already meets rules and sets timetables to fix staffing and building problems within 6 months. Or the State can send, within that same time plus 35 days, a written plan to permanently cut certified beds over up to 36 months so unsafe buildings can be emptied and staffing fixed. Before sending a cutback plan, the State must hold a hearing at the facility at least 35 days beforehand with notice to staff, residents, families, and the public, must show it has provided similar home and community services before, and must promise to meet the detailed requirements below. A cutback plan must list how many residents will get home or community services, their needs, and a schedule in 6-month steps across the 36 months; explain how residents are chosen and how services will be built; describe protections for health and welfare including consumer and provider input and required State licensing and certification; let eligible residents choose another setting (or another part of the facility) to keep their medical-assistance eligibility; say how residents who remain will get active treatment and be kept safe; keep the staff-to-resident ratio at whichever is higher—the ratio the Secretary requires or the ratio that existed when the problems were found; and protect employees by preserving rights and benefits, offering training, reassigning staff to community jobs where possible, and making maximum efforts to keep them employed (but not guaranteeing jobs). The Secretary must allow at least 30 days for public comment before approving a cutback plan. If more than 15 cutback plans are approved in one fiscal year, any approvals beyond the first 15 must be for facilities where fixing the problems would cost $2,000,000 or more. If a State fails to fix problems after a 6-month correction plan, the Secretary may end the facility’s provider agreement. For cutback plans, if the State fails during any 6-month check, the Secretary must end the provider agreement or, if the State tried in good faith, reduce federal payments by 5 percent of the cost of care for all eligible people in the facility for each month of failure. These rules apply only to correction or cutback plans the Secretary approved by January 1, 1990.