Medicaid Quality Services to the Mentally Retarded Amendments of 1988

Medicaid Quality Services to the Mentally Retarded Amendments of 1988 - Title I: Optional Expansion of Community-Based Services - Amends title XIX (Medicaid) of the Social Security Act to expand the habilitation services which States are authorized to provide to individuals who would otherwise require Medicaid skilled nursing or intermediate care facility services to include services designed to assist individuals to engage in major life activities with other individuals, including employment and participation in community activities. Refers to the expanded services as "community habilitation services." Eliminates the restriction of the Medicaid waiver for community habilitation services to individuals who have been discharged from a skilled nursing or intermediate care facility.

Requires the Secretary to develop, by 1991, outcome-oriented instruments and methods for evaluating and assuring the quality of Medicaid community habilitation services. Prohibits States from paying for services which such instruments and methods find to be substandard.

Title II: Quality Assurance for Habilitation Facility Services - Defines a "habilitation facility" as an institution primarily engaged in providing health or habilitation services to mentally retarded individuals and not primarily for the care and treatment of mental diseases. Sets forth requirements for habilitation facilities, including requirements that such facilities: (1) promote maintenance or enhancement of the quality of life, self-determination, and independence of each client; (2) provide continuous active treatment which is coordinated and monitored by a qualified mental retardation professional; (3) provide such treatment in accordance with an individual program plan prepared and periodically reviewed and revised by an interdisciplinary team of professionals on the basis of an assessment of a client's developmental and behavioral management needs conducted upon the client's admission and at least annually thereafter; (4) not admit any new mentally retarded client on or after October 1, 1989, unless the State mental retardation or developmental disability authority has determined that the individual requires habilitation facility services; (5) provide physician services 24 hours a day, annual physical examinations, licensed nursing services, comprehensive dental diagnostic and treatment services, routine and emergency drugs and biologicals, professional program services to implement each client's active treatment plan, and meal services; (6) require a physician's supervision of each patient's care, have a physician available to furnish emergency medical care, and maintain clinical records on all clients; (7) protect specified client rights, including the right to appeal a transfer or discharge and receive post-discharge preparation and planning services; (8) provide applicants and residents with information regarding the Medicaid program and not require applicants to waive their rights to such benefits or have a third party guarantee payment to the facility as a condition of their admission; (9) protect a client's personal funds upon its acceptance of the client's authorization to hold such funds; (10) adopt certain measures to preserve facility safety and sanitation; and (11) meet such other conditions which the Secretary of Health and Human Services deems necessary for client health and safety. Sets forth the Secretary's responsibilities relating to habilitation facility requirements.

Makes the Secretary responsible for certifying that State habilitation facilities comply, and States responsible for certifying that other habilitation facilities comply, with Medicaid habilitation facility requirements. Requires each State to: (1) conduct periodic educational programs for habilitation facility staff and clients regarding the requirements imposed on such facilities; and (2) provide, through the State agency responsible for the certification of habilitation facilities, for the receipt, review, and investigation of allegations of client neglect and abuse and of misappropriation of client property by facility staff. Bases habilitation facility certification on an annual, unannounced survey. Directs the Secretary to: (1) develop and test a protocol for conducting surveys; (2) establish minimum qualifications for surveyors and train them in survey and certification techniques; and (3) conduct sample surveys of habilitation facilities, within two months of State surveys, to test the adequacy of State surveys, and reduce Federal payments for State Medicaid administrative costs if such State surveys prove inadequate. Authorizes the Secretary to conduct a special survey of a facility when there is reason to question its compliance with this Act.

Requires States to investigate complaints against a facility and monitor the compliance of a facility with this Act's requirements if the facility was previously found out of compliance or the State has reason to question its compliance.

Requires that: (1) certain information regarding habilitation facilities and their compliance with this Act's requirements be made available to the public; (2) the State agency responsible for the protection and advocacy system for the developmentally disabled and the guardians of facility clients be notified of a facility's noncompliance with this Act's requirements; and (3) survey results be posted in a place that is readily assessible to clients and their guardians. Gives State Medicaid fraud and abuse control units access to facility survey and certification information.

Requires that when the Secretary or a State determines that a habilitation facility's deficiencies immediately jeopardize residents' health and safety, immediate action be taken to remove the jeopardy and correct the deficiencies or such facility's participation in Medicaid be terminated. Directs the Secretary and States to apply certain other remedies where the health and safety of facility residents is not immediately jeopardized. Authorizes the imposition of civil money penalties against facilities found to be in compliance with this Act's requirements but to have been out of compliance previously. Provides that if a facility is out of compliance with any of this Act's requirements three months after having been found out of compliance with such requirements or on three consecutive annual surveys, Medicaid payments for newly admitted residents shall be denied, civil monetary penalties assessed and collected, and, in the latter case, on-site monitoring of the facility's compliance shall be established.

Provides that when a facility is found to have deficiencies relating to the facility's physical plant that do not immediately jeopardize the health or safety of its clients, the State may submit to the Secretary a written plan for permanently reducing the number of certified beds in such facility within 36 months of such finding and providing home and community-based services to clients who thereby cease to receive facility services. Requires that Medicaid-eligible clients be given the option of retaining facility services.

Requires the Secretary to report to the Congress annually on the extent to which habilitation facilities are complying with this Act's requirements and the number and type of enforcement actions taken by States and the Secretary.

Title III: Appropriate Placement for Mentally Retarded Individuals - Requires that State mental retardation or developmental disability authorities conduct preadmission and annual reviews of mentally retarded habilitation facility applicants and residents to determine whether they require facility services or community habilitation services. Directs that such preadmission and annual reviews be conducted in accordance with criteria to be developed by the Secretary by July 1, 1989. Requires States to provide for the active treatment of mentally retarded individuals who need such treatment but no longer need habilitation facility services. Requires States to establish an appeals procedure for individuals adversely affected by such preadmission and annual reviews.

Eliminates existing utilization review and penalty provisions directed at the provision of services in an intermediate care facility for the mentally retarded.

Title IV: Payment for Community Habilitation Services and Habilitation Facility Services - Covers the reasonable and adequate costs of community habilitation services and habilitation facility services.

Title V: Employee Protections and Miscellaneous - Provides employment protections for employees affected by habilitation facility bed reduction plans and the provision of community habilitation services.

Authorizes States to assign specific management functions relating to the provision of Medicaid services to the mentally retarded to State agencies responsible for developmentally disabled individuals.