CMS Updates QMRP to QIDP

The enactment of Rosa’s Law on October 5, 2010 changed all references to “mental retardation” in Federal law to “intellectual disability” and changed all references to a “mentally retarded individual” to “an individual with an intellectual disability.” These changes were codified in regulation by the Centers for Medicare & Medicaid Services (CMS) on May 16, 2012.
The attached letter implements revised Nomenclature for Qualified Mental Retardation Professional (QMRP). Previous nomenclature for a QMRP, as referenced at 42 CFR 483.430(a), is changed to Qualified Intellectual Disabilities Professional (QIDP).


CMS S&C Letter on Use of Audio Devices

CMS has released new guidance on the use of Audio recording devices in common areas of an ICF/IID facility. The guidance is similar to previously released information on the use of video cameras:

“The…  regulations do not unilaterally prohibit the use of audio surveillance devices within the ICF/IID. There may be instances where the use of audio surveillance devices may be helpful in ensuring that the clients are free from physical, verbal, sexual or psychological abuse, mistreatment or punishment. However, great care must be exercised to prevent any unintended violation of an individual’s rights and privacy when such equipment is used in the facility.”

Please see the link below for the full letter from CMS:


CMS Issues Changes to ICF Program

CMS Issues Changes to ICF Program – More than a Name Change

On May 11, 2012 CMS issued a letter regarding the Publication of Final Rule “Medicare and Medicaid Program; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction CMS-9070-F”.  These rules will take effect on July 16, 2012 and have a direct impact for ICF/IID (formerly ICF/MR) providers.

Name Change: Based on Rosa’s Law (2010), Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) will now reflect nationwide changes and be referred to as Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID).

Elimination of 12 month Time Limited Agreement: The rule eliminates the mandatory 12 month ICF/IID annual survey and replaces the requirement with an open ended agreement which, consistent with nursing facilities (NFs), would remain in effect until the Secretary or a State determines that the ICF/IID no longer meets the conditions of participation for ICF/IIDs. Instead ICFs/IID must be surveyed, on average, every 12 months with a maximum 15-month survey interval.

Complaint Surveys Can be Combined with Annual before the end of 12 months: Complaint surveys that result in an abbreviated survey 10 or 11 months into the facility’s certification period, can now be expanded for the purpose of completing the requirements of annual certification at the same time.

Some ICFs/IDD may be surveyed more frequently: The proposed change allows states greater latitude to survey poor performing facilities more frequently and high quality facilities less frequently, as long as the overall time-frames are observed. Each ICF/IDD will be surveyed at least once every 15 months, and facilities must be surveyed an average of every 12 months. This means that if some facilities are surveyed only after 12 months but before the end of 15 months from the last survey, other facilities in the state must be surveyed more frequently than 12 months.

For further information, download the letter which includes links to the rules and additional information.

Link: CMS Letter SC12-29

Background Paper – Informed Consent/Guardianship

Resource materials from the recent National Association of QMRP presentation Making a Difference: Washington D.C.’s Efforts to Promote Alternatives to Guardianship by Catherine Hayes and Tina Campanella.

Background Paper – Informed Consent/Guardianship Project is a short paper which provides an overview of a project undertaken by the Quality Trust, representatives of the Washington D.C. government, provider and advocacy groups who came together in 2003 to form a workgroup to discuss guardianship and informed consent concerns for people being supported by the service system in Washington D.C. Goals of the workgroup include identifying and promoting alternatives to full guardianship that will decrease the number of individuals at risk of losing their rights through a full guardianship and developing training and resource materials.


CMS Survey and Certification Letters Released between 2009 and 2011

CMS continues to post Survey and Certification Guidance letters that provide clarification in a number of areas. Since 2009, four letters have been released, with the most recent letter released on 7/29/11. These letters include:

• Clarification of Protection of Client’s Rights at 42 CFR §483.420(a)(4) – Ensure Right to Manage Financial Affairs

• Clarification of Self-Administration of Medications at 42 CFR §483.460(k)(4) – Intermediate Care Facilities for the Mentally Retarded (ICFs/MR)

• Clarification of Reporting Mistreatment, Neglect and Abuse and Injuries of Unknown Source at 42 CFR § 483.420(d)(2) –Intermediate Care Facilities for the Mentally Retarded (ICFs/MR)

• The Use of Video Cameras in Common Areas in Intermediate Care Facilities for the Mentally Retarded (ICFs/MR)

Please click on the link to download a file containing all four letters.

These letters have been developed and reviewed over the past few years, and represent needed clarification for the ICF/MR provider community. As further guidance is developed and released, H&W will be posting additional information on this important topic.

CMS Publishes New Survey Guidelines for ICF/IID

Click here to download 2015 Update to SOM Appendix J ICF IG

 Click here to download new Exhibit 355 to SOM Appendix J

The new Interpretive Guidelines for ICF/IID regulations have been implemented and are effective as of April 27, 2015. click on the link above to download the new Appendix J to the State Operations Manual. Some changes have been made to this posting from the Advance Copy previously released in January 2015. No guidance revisions were made to W115, W118, W139, W161, W162, W175-W178, W188, W226, W265, W357, W364, W377-W382, W387-W391, W409-W413, W418, W432-W434, W452, W453, or W471. The probes and procedures previously contained under the guidance have been placed into a State Operations Manual (SOM) Exhibit. New exhibit 355 is being added to SOM Appendix J containing surveyor probes and procedures previously in Appendix J, Part II – Interpretive Guidelines for ICF/IID. The probes and procedures provide surveyors with additional clarification, beyond the guidance in Appendix J, in interpreting the regulation text.

H&W is developing a document that will illustrate the changes from the previous IGs and give guidance to providers on the new expectations, including additional policies and procedures that are outlined in the updated IGs. Look for emails and announcements when these offerings become available in the near future. Please assure that we have your updated email information.