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The impact of a focused drug regimen review process based on clear objectives and of interdisciplinary team cooperation is described. By shifting from a pharmacy departmental focus, which was primarily on drug distribution activities, to a broader agenda that promotes pharmacists as clinicians, inroads were made in reducing medication doses per resident, decreasing nursing time spent in medication administration, and decreasing pharmacy expenses in this residential facility for the developmentally disabled.

Regulations and voluntary standards within the context of organizational design and mission as well as leadership in management for quality were discussed. Rules and regulations are closely associated with the structure and mission of the organization. Altering them may require fundamental redesign of organizational structure and purpose. Likewise, alterations in organizational design can change the need for rules and regulations. In addition, standards do not automatically yield quality. Rather, they define expected levels of performance from individuals, programs, and the organization. The senior management of organizations is responsible for exercising the leadership in managing for quality.

A redesigned psychotropic drug review service was needed for our 650-bed intermediate care facility for the mentally retarded (ICF/MR). A committee consisting of a client's rights monitor, pharmacist, and psychologist prepared the necessary policy and procedure as well as data collection sheets. Meetings are now conducted in a semiformal fashion, with each discipline contributing in tis area of expertise. Since the inception of the restructured psychotropic drug review service, psychotropic medication dosages (neuroleptic agents only) have decreased at a projected annual rate of 17% and there have been no significant withdrawal reactions. This dosage decrease has saved the institution approximately $2800 to $3200 in medication costs after a 10-month period.

This regulation would authorize intermediate care facilities for the mentally retarded (ICFs/MR) to negotiate revisions to their 1977 plans of correction for Life Safety Code, living, dining, and therapy area deficiencies under certain circumstances. Under this proposed regulation, the Secretary would be authorized to approve revised plans of correction from facilities which have completed at least 25 percent of their original plans of correction under 42 CFR 442.115 (c) and (d) and which propose to phase out an increased number of previously certified beds not already schedules for phase out under the existing plan of correction. The timetable for the phase out and the actual number of beds to be phased out will be negotiated with target figures established for each six-month period of the plan, with the total time for the plan not to exceed five years from the effective data of the final rule. Facilities would still be required to meet the July 18, 1982 deadline currently established in 42 CFR 442,115(b) for those aspects of existing plans of correction which include construction or renovation of units which will remain in use after planned phase out is completed. The intent of this regulation is to stimulate an overall reduction in the number of certified beds in large residential facilities, while forestalling further expenditures of capital funds for the renovation of existing facilities or the construction of new units where an expanded phase out of units is feasible.

Participants in the Medicaid program are faced with an increasingly stringent regulatory environment at both the federal and state levels. This article suggests operational strategies for ensuring providers against the decertification of their programs. These strategies include corrective action planning, monitoring, implementation, and preparation for survey.

This regulation amends 42 CFR 442.115 to authorize a State survey agency, in specified circumstances to certify an intermediate care facility for the mentally retarded for participation in the Medicaid program when the facility has not met the July 18, 1980 compliance deadline provided in 42 CFR 442.115(a). The regulation would permit plans to correct certain deficiencies by July 18, 1982 based on the length of time needed to complete the plan. It would also allow extensions beyond either the 1980 or 1982 deadline where, under limited circumstances a delay has been caused by litigation. We are publishing this regulation as a final rule because of the need to protect facilities from disruption of Federal funding where the criteria for an extension of the deadline are satisfied, including the assurance that the health and safety of the residents will not be jeopardized by the granting of an extension. However, we are providing a comment period and will make any further revisions we find necessary based upon comments we receive.

This rule revises teh format, location and content of the standards for intermediate care facilities for the mentally retarded and persons with related conditions (ICFs/MR). (The standards are those requirements that ICFs/MR must meet in order to participate in the Medicaid program). The new format will be that of "conditions of participation" and will make the regulations for ICFs/MR consistent with the organization of the Medicare and Medicaid regulations for skilled nursing facilities. The new location will be under a new Part 483, "Conditions of participation for long term care facilities". Revisions to the content of the regulations are designed in increase the focus on the provision of active treatment services for clients. Clarify Federal requirements, and maintain essential client protections. The major outcome of these regulations will be to align Federal standards with contemporary care practices for residential care services for persons with mental retardation or other developmental disabilities. We also are making several technical changes and cross-references to achieve consistency with other existing regulations.