The Intermediate Care Facility (ICF) level of care is a specialized form of residential support designed for individuals who require comprehensive health and rehabilitative services in a structured, long-term setting. This support is primarily associated with Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), regulated under federal law and the Medicaid program. The ICF level of care is distinct because it moves beyond simple custodial support, mandating a program of services aimed at maximizing a person’s independence and functional abilities. It serves as a placement for those whose needs exceed a typical residential home but are not as medically intensive as those requiring a hospital or Skilled Nursing Facility.
Defining Intermediate Care Facilities
An Intermediate Care Facility is a residential facility certified by state and federal governments to provide comprehensive services to its residents. These facilities provide ongoing evaluation, planning, and integration of various health and rehabilitative services. ICFs can range in size from large, campus-style settings to smaller, community-based homes, often referred to as ICF/IIDs. These smaller settings typically house between four and 16 residents and are integrated into neighborhoods to promote community living and inclusion.
Federal regulations require that ICFs provide 24-hour supervision, supportive care, and nursing oversight under the direction of a physician. The facility’s purpose is to offer health and rehabilitative services, not just room and board, for individuals with long-term needs. Since 1971, this type of facility has been recognized as an optional benefit under the federal Medicaid program, which established the standards for care and facility operation.
Target Population and Eligibility
The ICF level of care is for individuals with intellectual disabilities (ID) or related developmental disabilities (DD) that began before the age of 22. These related conditions are defined functionally, meaning they must cause significant limitations in at least three major life activities, such as:
- Self-care.
- Language.
- Learning.
- Mobility.
- Economic self-sufficiency.
To be eligible, an individual must demonstrate a need for the intensive, continuous services that characterize this level of care.
A formal assessment must determine that the individual requires 24-hour support and would benefit from the facility’s specialized programming. Eligibility is tied to the requirement for “Active Treatment,” the core service provided in an ICF/IID setting. The individual’s condition must also be likely to continue indefinitely, establishing the need for long-term support rather than short-term rehabilitation.
Components of the Level of Care
The mandate for “Active Treatment” dictates the philosophy and structure of all services provided in an ICF. Active Treatment is not passive maintenance of an individual’s current status but involves the implementation of specialized training and therapies. The goal is to ensure that residents acquire the behaviors and skills necessary to function with the greatest possible self-determination and independence.
This continuous program is developed by an interdisciplinary team, which includes professionals such as:
- Physicians.
- Therapists.
- Social workers.
- Direct care staff.
Each resident receives an Individualized Support Plan (ISP) that outlines specific, measurable objectives designed to promote developmental progression. Services focus on skill development in areas such as communication, self-care, social interaction, and daily living tasks, like dressing and meal preparation.
Active Treatment incorporates necessary health services, including medical care, dental services, and medication management, all integrated into the individualized plan. Behavior support is also a component, implementing strategies to help residents adapt to their environment and develop positive coping mechanisms. Habilitation is central, meaning the facility helps the person to develop, maintain, or improve skills and functioning that were never fully acquired.
Distinguishing ICF from Other Care Settings
The ICF level of care is positioned within the continuum of long-term care, between general residential homes and medical facilities. Unlike a general residential care home, which provides assistance with daily living, an ICF is a certified health facility subject to federal standards and oversight. General residential homes typically lack the mandatory Active Treatment component and the required staffing levels of licensed professionals.
Skilled Nursing Facilities (SNFs) focus on intensive medical needs and rehabilitation that requires the daily services of licensed nurses or therapists, often for short-term recovery following an acute illness. ICFs provide ongoing nursing and supportive care on a less than continuous skilled nursing basis. Their focus is long-term habilitative training rather than acute medical rehabilitation. While ICF residents may have complex medical needs, the facility’s structure is built around comprehensive developmental services, which fundamentally differs from the medically-focused SNF model.
Funding and Regulatory Oversight
ICF services are funded through Medicaid, a joint federal and state program. The federal government establishes the standards and regulations, while state governments administer the program, determine eligibility criteria, and license the facilities. This partnership ensures that all ICFs adhere to a baseline set of requirements, regardless of location.
To receive Medicaid funding, an ICF must be certified by the Centers for Medicare and Medicaid Services (CMS) and comply with federal standards. These standards cover eight areas, including:
- Facility management.
- Client protections.
- Staffing.
- Health care services.
- The provision of Active Treatment.
Federal surveys and certification processes are regularly conducted to ensure that facilities maintain compliance and that the mandated level of care is consistently delivered.