What is an Intermediate Care Facility (ICF)?

An immediate care facility (ICF) provides long-term nursing and supportive care to individuals who are unable to care for themselves due to a mental disability or declining health. ICF residents are cared for by skilled nurses under the supervision and direction of a physician, but ICF’s provide less nursing care than medical facilities such as skilled nursing facilities (SNF’s). Yet ICF’s provide more care than assisted living facilities, so they occupy a middle ground between SNF’s and assisted living facilities.


Typically, ICF’s are small and have an average of 8-15 residents. The services provided by a particular ICF depend on factors such as the residents’ needs and the facility’s size, but generally ICF nurses and other staff provide their residents with a variety assistance, including getting dressed, bathing, hygiene, using the bathroom, mobility, housekeeping, laundry, medication distribution and administration, and transportation to appointments. Besides nurses, some ICF’s have contracts with occupational therapists, physical therapists, social workers, and dieticians, who visit the facility and provide their specialized services to ICF residents.


Unlike SNF’s, ICF’s don’t provide medical services, so they aren’t eligible for reimbursement through Medicare. However, residents may be able to pay for their IFC stay using long-term care insurance and Medicaid if they are eligible. Otherwise, IFC residents must pay out-of-pocket for their stay and care.


Medicaid provides an optional ICF benefit to Individuals with Intellectual Disabilities known as an “ICFs/IID benefit” that was created by the Social Security Act to pay for certain “institutions” that provide “active treatment.” The ICFs/IID optional Medicaid benefit is designed to incentivize states to provide comprehensive and individualized health care and rehabilitation services to individuals with intellectual disabilities, and in doing so support these individuals’ functional status and independence. Although the ICFs/IID Medicaid benefit is optional all states provide it, and the benefit is often used by states as an alternative to home and community-based services waivers for individuals with intellectual disabilities.


ICF’s are licensed and regulated by states, which conduct surveys of ICF’s much like they do for SNF’s in order to ensure compliance with relevant healthcare rules and regulations. When a new ICF wants to open its doors it must undergo a licensing process, after which it must undergo a periodic certification process in order to ensure the facility satisfies federal standards for participation in the state’s Medicaid program and stays in continuous compliance with all federal and state regulations. Otherwise, the facility’s certification and Medicaid payments could be jeopardized.

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