N.C. Division of Health Service Regulation

Procedure to Establish an Intermediate Care Facility for the Mentally Retarded (ICF/MR)

Contacts: For questions regarding any part of this process, please contact the appropriate sections of the N.C. Division of Health Service Regulation:

Certificate of Need Section	(919) 855-3873
Construction Section	(919) 855-3893
Medical Facilities Planning Section	(919) 855-3865
Mental Health Licensure and Certification Section	(919) 855-3795

Step	Process followed
1.0	Check the Medical Facilities Plan: Medical Facilities Planning Section
1.1	Applicants can find the number of additional ICF/MR beds needed each year in the State Medical Facilities Plan, which also specifies the areas of the state where they are needed.
1.2	Applicants can also find the certificate of need review schedule and deadline for submittal of applications for ICF/MR beds in the State Medical Facilities Plan. No one may develop a new ICF/MR, relocate an existing ICF/MR bed, or increase the number of ICF/MR beds in an existing ICF/MR without first obtaining a certificate of need.
2.0	Obtain a Certificate of Need: Certificate of Need Section
2.1	The applicant submits a certificate of need application for the proposed project according to the review schedule outlined in the State Medical Facilities Plan. If the applicant is leasing the facility, both the prospective owner/lessor and the lessee of the facility must submit a joint application. Applications will not be accepted if there is not a review scheduled for the county in which beds are proposed to be located.
2.2	Applicants must attend a public hearing conducted by the Certificate of Need (CON) Section to present the application and respond to public comment.
2.3	The CON Section decides to approve or disapprove an application within 150 days of the beginning of the review period.
2.4	A certificate of need is issued 35 days after the date of approval if a petition for a contested case hearing is not filed.
3.0	Apply for license: Mental Health Licensure and Certification Section
3.1	After a certificate of need is issued, the applicant contacts the Mental Health Licensure and Certification Section for information about licensing.
3.2	The applicant submits floor plans, the completed license application, and any other information needed by the Mental Health Licensure and Certification Section.
3.3	The Mental Health Licensure and Certification Section submits the floor plans and the application to the Construction Section.
4.0	Construction and Life Safety Approval: Construction Section
4.1	The Construction Section reviews the facility’s plans and application, and writes the applicant with requirements or review comments and instructions.
4.2	As the project nears completion, the applicant notifies the Mental Health Licensure and Certification Section to schedule an inspection pending Construction Section approval.
4.3	At least two weeks before construction is complete, the applicant sends a letter to the Construction Section requesting a final construction inspection with project information and local approvals. The facility must be ready with all systems operational and all construction completed by the final construction inspection date. The Construction Section does not do punchlist inspections; they are the responsibility of the designer, contractor, and owner.
4.4	The Construction Section reviews the local approvals. If the documents are acceptable, the Construction Section sends an approval transmittal form to the Mental Health Licensure and Certification Section for purpose of licensure and to Life Safety Code Surveyors to alert them of a pending request for certification for Medicare/Medicaid.
4.5	For a Medicaid/Medicare certification, the Life Safety Code Surveyors from the Construction Section schedule a visit to the facility and notify the applicant of the scheduled inspection date.
4.6	The Life Safety Code Surveyors inspect the facility and, if acceptable, notify the ICF/MR Branch that the facility is ready for an initial certification survey.
4.7	After the initial Life Safety Code survey, Life Safety Code Surveyors may notify the applicant of additional building modifications that may be required because of resident evacuation ratings prepared by the ICF/MR Branch.
5.0	Obtain a license: Mental Health Licensure and Certification Section
5.1	The applicant contacts the Mental Health Licensure and Certification Section to schedule a licensure inspection visit.
5.2	Mental Health Licensure and Certification Section completes their inspection and issues a license if the facility is acceptable for licensure.
6.0	Obtain certification: ICF/MR Branch
6.1	After the facility is licensed and has clients, the applicant contacts the Branch to request, in writing, an initial certification survey.
6.2	Within 3 weeks of approval by the Life Safety Code staff of the Construction Section, the Branch conducts the initial certification survey. During this survey, resident evacuation ratings are completed and then forwarded to the Life Safety Code surveyors for review (refer to step 4.7 above).
6.3	Certification is recommended based on one of the following: the last date of the initial certification survey or the life safety code survey or the last date of an acceptable plan of correction from either of these surveys.
6.4	The Branch forwards all information to the NC Division of Medical Assistance and to the Atlanta Health Care Financing Administration (HCFA) Regional Office for approval.
6.5	The NC Division of Medical Assistance and HCFA assign the provider numbers.

Step

Process followed

1.0

Check the Medical Facilities Plan: Medical Facilities Planning Section

1.1

Applicants can find the number of additional ICF/MR beds needed each year in the State Medical Facilities Plan, which also specifies the areas of the state where they are needed.

1.2

Applicants can also find the certificate of need review schedule and deadline for submittal of applications for ICF/MR beds in the State Medical Facilities Plan. No one may develop a new ICF/MR, relocate an existing ICF/MR bed, or increase the number of ICF/MR beds in an existing ICF/MR without first obtaining a certificate of need.

2.0

Obtain a Certificate of Need: Certificate of Need Section

2.1

The applicant submits a certificate of need application for the proposed project according to the review schedule outlined in the State Medical Facilities Plan. If the applicant is leasing the facility, both the prospective owner/lessor and the lessee of the facility must submit a joint application. Applications will not be accepted if there is not a review scheduled for the county in which beds are proposed to be located.

2.2

Applicants must attend a public hearing conducted by the Certificate of Need (CON) Section to present the application and respond to public comment.

2.3

The CON Section decides to approve or disapprove an application within 150 days of the beginning of the review period.

2.4

A certificate of need is issued 35 days after the date of approval if a petition for a contested case hearing is not filed.

3.0

Apply for license: Mental Health Licensure and Certification Section

3.1

After a certificate of need is issued, the applicant contacts the Mental Health Licensure and Certification Section for information about licensing.

3.2

The applicant submits floor plans, the completed license application, and any other information needed by the Mental Health Licensure and Certification Section.

3.3

The Mental Health Licensure and Certification Section submits the floor plans and the application to the Construction Section.

4.0

Construction and Life Safety Approval: Construction Section

4.1

The Construction Section reviews the facility’s plans and application, and writes the applicant with requirements or review comments and instructions.

4.2

As the project nears completion, the applicant notifies the Mental Health Licensure and Certification Section to schedule an inspection pending Construction Section approval.

4.3

At least two weeks before construction is complete, the applicant sends a letter to the Construction Section requesting a final construction inspection with project information and local approvals. The facility must be ready with all systems operational and all construction completed by the final construction inspection date. The Construction Section does not do punchlist inspections; they are the responsibility of the designer, contractor, and owner.

4.4

The Construction Section reviews the local approvals. If the documents are acceptable, the Construction Section sends an approval transmittal form to the Mental Health Licensure and Certification Section for purpose of licensure and to Life Safety Code Surveyors to alert them of a pending request for certification for Medicare/Medicaid.

4.5

For a Medicaid/Medicare certification, the Life Safety Code Surveyors from the Construction Section schedule a visit to the facility and notify the applicant of the scheduled inspection date.

4.6

The Life Safety Code Surveyors inspect the facility and, if acceptable, notify the ICF/MR Branch that the facility is ready for an initial certification survey.

4.7

After the initial Life Safety Code survey, Life Safety Code Surveyors may notify the applicant of additional building modifications that may be required because of resident evacuation ratings prepared by the ICF/MR Branch.

5.0

Obtain a license: Mental Health Licensure and Certification Section

5.1

The applicant contacts the Mental Health Licensure and Certification Section to schedule a licensure inspection visit.

5.2

Mental Health Licensure and Certification Section completes their inspection and issues a license if the facility is acceptable for licensure.

6.0

Obtain certification: ICF/MR Branch

6.1

After the facility is licensed and has clients, the applicant contacts the Branch to request, in writing, an initial certification survey.

6.2

Within 3 weeks of approval by the Life Safety Code staff of the Construction Section, the Branch conducts the initial certification survey. During this survey, resident evacuation ratings are completed and then forwarded to the Life Safety Code surveyors for review (refer to step 4.7 above).

6.3

Certification is recommended based on one of the following: the last date of the initial certification survey or the life safety code survey or the last date of an acceptable plan of correction from either of these surveys.

6.4

The Branch forwards all information to the NC Division of Medical Assistance and to the Atlanta Health Care Financing Administration (HCFA) Regional Office for approval.

6.5

The NC Division of Medical Assistance and HCFA assign the provider numbers.

This page last updated on April 12, 2004