Current through Register Vol. 47, No. 6, September 18, 2024
The specialized license is for residential care facilities
which serve persons with intellectual disabilities, chronic mental illness and
other developmental disabilities having five or fewer residents as specified in
Iowa Code section
225C.26. The facility is
exempt from Iowa Code section
135.63.
For this specialized license, all rules of 481-Chapter 63 apply except those
which are deleted or amended, as indicated in subsequent rules.
(1) The provider may apply for a specialized
license from the department of inspections and appeals. Before the license is
granted, the provider shall meet all of the following requirements:
a. Compliance with program requirements
pursuant to Iowa Code chapter 135C and administrative rules relating to
residential care facilities adopted by the state board of health, or standards
adopted by the Accreditation Council for Services for Persons with Mental
Retardation and Other Developmental Disabilities (1984). The program of care
shall emphasize an age-appropriate and least restrictive program.
b . The facility shall be located in areas
zoned for single- or multiple-family housing, or be located in an
unincorporated area, and shall be constructed in compliance with applicable
local housing codes and rules adopted for this classification of license by the
state fire marshal. (II, III)
c.
The facility shall be appropriately accessible to residents who have
disabilities. (II, III)
d. Written
plans shall demonstrate that the facility meets the needs of the residents
pursuant to individual program plans meeting age-appropriate and least
restrictive program requirements. (II)
e. Written plans shall demonstrate the
residents have reasonable access to employment for job-related training,
education, generic community resources, or integrated opportunities to promote
community interaction. (II)
f.
Unless documented as appropriate within the residents' individual program
plans, populations with primary diagnosis of chronic mental illness or
intellectual disability/developmental disability may not be residents of the
same specialized license facility. (II, III)
(2) The housing for persons with intellectual
disabilities, chronic mental illness, and other developmental disabilities,
developed pursuant to this rule shall be eligible for funding utilized by
licensed residential care facilities for the intellectually disabled.
(3) Rescinded IAB 6/27/90, effective
8/1/90.
(4) Rescinded IAB 6/27/90,
effective 8/1/90.
(5) The director
of the department of inspections and appeals shall appoint a specialized
license committee not to exceed nine members. This committee shall monitor the
program rules and procedures adopted for this classification of
license.
(6) All conditions and
criteria in 481-Chapter 63 apply to the specialized license with the exception
of the following deletions:
481-63.7
(135C), 63.8(2)"b ," 63.8(7)"b,"
63.13(1)"i," 63.18(1)"b" (9),
63.19(1)"a," "b," "c,"
63.19(2)"c"(1),"e," "g," 63.19(4)"a,"
"b," "c," "g" "h," "i, " "I, " "n, " "p, " "q, " "r, " "t,"
63.19(5)"b,"
"c, " "d" 63.21(1), (2),
(3)"a" to"e," (4) "a,"
"b,"
"c"(1) to (3), "d, " "e,
" 63.21(5)"c," 63.23(3)"c,"
63.23(4)"c, " "d" 63.24(1), (7), (10), 63.25(10)"b,
" 63.26(1) to (4), (6) "b," 63.27(3) to (5),
63.28(1)"a, " "b, " "f, " "g, " "k, " "I, " "m, " "o,"
63.28(2)"c," 63.28(3)"a, " "d, " "e, " "f" (3),
"g"(2), 63.28(5)"b,"
"i," 63.28(9),
63.29(1), (4), (5), 63.33(6) "i."
(7) The following rules in Chapter 63 are
amended for this specialized license as follows:
1. 63.3(1) "a" and
63.3(2)-Delete all references to 481-Chapter 60.
2. 63.8(1) "a" -Add "or
qualified mental health professional (III)" after "qualified intellectual
disabilities professional". (III)
3. 63.8(2)-Add "For purposes of the
specialized license, the administrator may act as an administrator for not more
than three residential care facilities for the intellectually disabled, chronic
mentally ill, and developmentally disabled." (II)
4. 63.9(1)-Add "For purposes of the
specialized license there shall be written personnel policies in all facilities
to include hours of work and attendance at the education program."
(III)
5. 63.11(1)
"a" -Delete the words "a managerial role of in line
2.
6. 63.11(2) "b"
-Delete the second sentence and "with 15 or less beds" in the third
sentence.
7. 63.14(5)
"b" -Add "or guardian" after "resident" in the first
line.
8. 63.17(1)-Add a new
paragraph: "v. Current Individual Program Plans (IPP)".
9. 63.17(5) "a" -Add "For
the specialized license, a job description shall be in the individual's
personnel file." (III)
10. 63.19(2)
"b" -Delete from the end "Recommended daily dietary allowances
are:" Also delete subparagraphs (1) to (5).
11. 63.19(2) "f" -Delete the
second sentence.
12. 63.19(3)
"e" -Delete "for a minimum of a one-week period" in the first
line.
13. 63.19(4)
"m" -Delete "smooth, washable," in the second line.
14. 63.19(4) "o" -Delete the
second sentence.
15. 63.19(4)
"s" -Add "and rinse" after "wash" in the first line and then
delete the rest of the sentence after "(60°C)".
16. 63.19(4) "w" -Change
"or" to "and" in the first line and delete ",washing, sanitizing, and
air-drying".
17. 63.19(5)
"b" -Delete the second sentence.
18. 63.19(5) "f"-Add "during
food preparation" after "kitchen".
19. 63.24(9)-Change "nonslip" to
"slip-resistant" in the first sentence.
20. 63.25(1)-Delete the second
sentence.
21. 63.28(1)
"j" -Change "on both sides" in the first line to "on at least
one side".
22. 63.28(4)
"n" -Change to read "Bedrooms shall have a minimum of 60
square feet for double, 80 square feet for single, and 100 square feet physical
(wheelchair)." (III)
23. 63.28(4)
"o "-Change "four" to "two".
24. 63.28(5) "c" -Amend to
read: "Minimum numbers of toilets and bath facilities shall be one for each
five residents." (III)
25. 63.28(5)
"d" -Amend to read: "There shall be a minimum of one bathroom
with tub or shower, toilet stool, and lavatory on each floor in the multistory
buildings." (III)
26. 63.28(5)
"e" -Amend to read: "Grab bars shall be provided as needed."
(III)
27. 63.33(8)-Change any
reference of "responsible party" to "legal guardian".
28. 63.33(8) "c" -Delete "in
the case of a confused or intellectually disabled resident". Change any
reference of "responsible party" to "legal guardian".
29. 63.33(8) "d" -Change any
reference of "responsible party" to "legal guardian".
30. 63.46(1)-Change any reference of
"responsible party" to "legal guardian" and delete the rest of the paragraph
after "state law".
(8)
"Qualified mental health professional" is a person who:
a. Holds a master's degree from an accredited
educational institution with coursework relevant to the position for which the
person is hired;
b. Has at least
two years' relevant experience supervised by a qualified mental health
professional in assessing mental health problems and needs of persons in
providing appropriate mental health services for those persons;
c. Holds a current Iowa license when required
by Iowa licensure law.
(9) "Intellectual disabilities" as used in
this chapter shall also include the chronically mentally ill and the
developmentally disabled for purposes of this specialized license.
a. For the specialized license, "persons with
intellectual disabilities" means persons with significantly subaverage general
intellectual functioning existing concurrently with deficits in adaptive
behavior, manifested during the developmental period.
(1) "General intellectual functioning" is
defined as the results obtained by assessment with one or more of the
individually administered general intelligence tests developed for the purpose
of assessing intellectual functioning;
(2) "Significantly subaverage functioning" is
defined as approximately 70 IQ or below;
(3) "Adaptive behavior" is defined as the
effectiveness or degree with which individuals meet the standards of personal
independence and social responsibility expected for age and cultural
group;
(4) "Developmental period"
is defined as the period of time between conception and the eighteenth
birthday.
b. For the
specialized license, "persons with developmental disabilities" means persons
with a severe, chronic disability which:
(1)
Is attributable to mental or physical impairment, or a combination of physical
and mental impairments;
(2) Is
manifested before the person attains the age of 22;
(3) Is likely to continue
indefinitely;
(4) Results in
substantial functional limitations in three or more of the following areas of
life activity; self-care, receptive and expressive language, learning,
mobility, self-direction, capacity for independent living and economic
self-sufficiency; and
(5) Reflects
the person's need for a combination and sequence of services which are of
lifelong or extended duration.
c. For the specialized license, "persons with
chronic mental illness" means adults aged 18 or older, with persistent mental
or emotional disorders that seriously impair their functioning relative to such
primary aspects of daily living as personal relations, living arrangement or
employment. Persons with chronic mental illness typically meet at least one of
the following criteria:
(1) Have undergone
psychiatric treatment more intensive than outpatient care more than once in a
lifetime (e.g., emergency services, alternative home care, partial
hospitalization or in-patient hospitalization);
(2) Have experienced a single episode of
continuous, structured supportive residential care other than hospitalization.
In addition, such persons typically meet at least two of the
following criteria, on a continuing or intermittent basis for at least two
years:
1. Are unemployed, or employed
in a sheltered setting, or have markedly limited skills and a poor work
history;
2. Require financial
assistance for out-of-hospital maintenance and may be unable to procure this
assistance without help;
3. Show
severe inability to establish or maintain a personal social support
system;
4. Require help in basic
living skills;
5. Exhibit
inappropriate social behavior which results in demand for intervention by the
mental health or judicial system.
In atypical instances chronically mentally ill persons may
vary from the above criteria.
(10) For the specialized license,
there shall be implemented an individual program plan (IPP) of goals and
objectives for each resident developed using evaluations, assessments and
progress reports. (II)
(11) For the
specialized license, "age-appropriate" shall mean activities, settings,
personal appearance and possessions commensurate with the person's
chronological age.
(12) For the
specialized license, "least restrictive" shall mean the availability to the
person of programs, services and settings that give the greatest opportunity
for human development and to associate with and become part of the general
society.
(13) "Individual program
plan" shall be a written plan for the provision of services to the person and,
when appropriate, to the person's family, that is developed and implemented,
using an interdisciplinary process, which identifies the person's and, when
appropriate, the person's family's functional status, strengths, and needs, and
service activities designed to enable a person to maintain or move toward
independent functioning. The plan is developed in accordance with the
developmental model, which is a service approach that recognizes and assumes
the potential for positive change, growth, and sequential development in all
people. (II)
a. An individual program plan
shall be developed and implemented for each individual accepted for service,
regardless of the individual's chronological age or developmental level. (I,
II)
b. The interdisciplinary team
shall develop the plan. (II) For the purpose of the specialized license, the
team shall include:
(1) The person, the
person's legal guardian, and the person's family unless the family's
participation is contrary to the wishes of the adult person who has not been
legally determined to be incompetent; (II, III)
(2) The service coordinator or case manager;
(II, III)
(3) All current service
providers; and (II, III)
(4) Other
persons whose appropriateness may be identified through the diagnosis and
evaluation or current reevaluation. (III)
c. The person or the person's legal guardian
has the ultimate authority to accept or reject the plan unless otherwise
determined by court. (III)
d. The
resident and the facility retain the rights of appeal and due process from the
interdisciplinary team decisions. (II, III)
(14) Goals and objectives shall be stated
separately and a time frame shall be specified for their achievement. (II, III)
a. Each individual enrolled shall have an
individual program plan. (II)
b.
The initial individual program plan shall be developed within 30 calendar days
after the individual is enrolled in this service. (II)
c. The individual program shall be developed
by an appropriately constituted interdisciplinary team. (II)
d. The individual program plan shall state
specific objectives to reach identified goals and shall identify the
individuals responsible for implementation. (II, III)
e. Goals and objectives shall be stated
separately. (II, III)
f. Goals and
objectives shall be assigned projected evaluation completion dates and shall be
reviewed at least annually. (II, III)
g. Goals and objectives shall be expressed in
behavioral terms that provide measurable indices of progress. (II)
h. Goals and objectives shall be sequenced
with a developmental progression appropriate to the individual. (II,
III)
i. Goals and objectives of the
individual program plans shall be assigned priorities by the interdisciplinary
team and implemented with documentation of needed resources. (II,
III)
j. The individual program plan
shall be written in terms that are understandable to all concerned. (II, III)
(15) Where
implementation is a shared responsibility, the individual program plan shall
identify the agencies or persons responsible for delivering the services
required. (III)
(16) A review of
the individual program plan shall be made at least quarterly by a member or
members of the individual's interdisciplinary team, as determined by the team,
in order to ensure the continuing implemented appropriateness of the plan and
any necessary action to be initiated. (II)
a.
Problems or changes that call for review of the individual program plan by the
team shall be indicated. (II)
b.
The team shall be convened at least annually to review the individual program
plan where problems or changes that call for review by the team are indicated.
(II, III)
c. The team review shall
assess the individual's response to activities designed to achieve the
objective stated in the individual program plan. (II, III)
d. The team review shall modify activities or
objectives as necessary. (II, III)
e. The team review shall determine the
services that are needed. (II, III)
f. The team review shall include
consideration of the advisability of continued enrollment or alternative
placements. (II, III)
