C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER G—STANDARDS AND CERTIFICATION › PART 483—REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES › Subpart I—Conditions of Participation for Intermediate Care Facilities for Individuals with Intellectual Disabilities

42 C.F.R. § 483.420

Condition of participation: Client protections

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(a) Standard: Protection of clients' rights. The facility must ensure the rights of all clients. Therefore, the facility must—

(1) Inform each client, parent (if the client is a minor), or legal guardian, of the client's rights and the rules of the facility;

(2) Inform each client, parent (if the client is a minor), or legal guardian, of the client's medical condition, developmental and behavioral status, attendant risks of treatment, and of the right to refuse treatment;

(3) Allow and encourage individual clients to exercise their rights as clients of the facility, and as citizens of the United States, including the right to file complaints, and the right to due process;

(4) Allow individual clients to manage their financial affairs and teach them to do so to the extent of their capabilities;

(5) Ensure that clients are not subjected to physical, verbal, sexual or psychological abuse or punishment;

(6) Ensure that clients are free from unnecessary drugs and physical restraints and are provided active treatment to reduce dependency on drugs and physical restraints;

(7) Provide each client with the opportunity for personal privacy and ensure privacy during treatment and care of personal needs;

(8) Ensure that clients are not compelled to perform services for the facility and ensure that clients who do work for the facility are compensated for their efforts at prevailing wages and commensurate with their abilities;

(9) Ensure clients the opportunity to communicate, associate and meet privately with individuals of their choice, and to send and receive unopened mail;

(10) Ensure that clients have access to telephones with privacy for incoming and outgoing local and long distance calls except as contraindicated by factors identified within their individual program plans;

(11) Ensure clients the opportunity to participate in social, religious, and community group activities;

(12) Ensure that clients have the right to retain and use appropriate personal possessions and clothing, and ensure that each client is dressed in his or her own clothing each day; and

(13) Permit a husband and wife who both reside in the facility to share a room.

(b) Standard: Client finances. (1) The facility must establish and maintain a system that—

(i) Assures a full and complete accounting of clients' personal funds entrusted to the facility on behalf of clients; and

(ii) Precludes any commingling of client funds with facility funds or with the funds of any person other than another client.

(2) The client's financial record must be available on request to the client, parents (if the client is a minor) or legal guardian.

(c) Standard: Communication with clients, parents, and guardians. The facility must—

(1) Promote participation of parents (if the client is a minor) and legal guardians in the process of providing active treatment to a client unless their participation is unobtainable or inappropriate;

(2) Answer communications from clients' families and friends promptly and appropriately;

(3) Promote visits by individuals with a relationship to the client (such as family, close friends, legal guardians and advocates) at any reasonable hour, without prior notice, consistent with the right of that client's and other clients' privacy, unless the interdisciplinary team determines that the visit would not be appropriate;

(4) Promote visits by parents or guardians to any area of the facility that provides direct client care services to the client, consistent with the right of that client's and other clients' privacy;

(5) Promote frequent and informal leaves from the facility for visits, trips, or vacations; and

(6) Notify promptly the client's parents or guardian of any significant incidents, or changes in the client's condition including, but not limited to, serious illness, accident, death, abuse, or unauthorized absence.

(d) Standard: Staff treatment of clients. (1) The facility must develop and implement written policies and procedures that prohibit mistreatment, neglect or abuse of the client.

(i) Staff of the facility must not use physical, verbal, sexual or psychological abuse or punishment.

(ii) Staff must not punish a client by withholding food or hydration that contributes to a nutritionally adequate diet.

(iii) The facility must prohibit the employment of individuals with a conviction or prior employment history of child or client abuse, neglect or mistreatment.

(2) The facility must ensure that all allegations of mistreatment, neglect or abuse, as well as injuries of unknown source, are reported immediately to the administrator or to other officials in accordance with State law through established procedures.

(3) The facility must have evidence that all alleged violations are thoroughly investigated and must prevent further potential abuse while the investigation is in progress.

(4) The results of all investigations must be reported to the administrator or designated representative or to other officials in accordance with State law within five working days of the incident and, if the alleged violation is verified, appropriate corrective action must be taken.

Notes of Decisions
Cited in 10 cases (1 in the last 5 years), 1990–2021 · leading case: Texas Home Mgmt., Inc. v. Peavy, 89 S.W.3d 30 (Tex. 2002).
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Texas Home Mgmt., Inc. v. Peavy, 89 S.W.3d 30 (Tex. 2002). · cites it 6× “42 C.F.R. § 483.420 (c)(5) ("The facility must promote frequent and informal leaves from the facility for visits, trips, or vacations.”
T.M. v. Elwyn, Inc., 950 A.2d 1050 (Pa. Super. Ct. 2008). · cites it 4× “The information which must be produced pursuant to this order includes, but is not limited to, the kind required to be kept for all of Elwyn's clients and reported pursuant to 42 C.F.R. § 483.420 pertaining to the protection of clients' rights.”
Jackson Ex Rel. Jackson v. Fort Stanton Hosp. & Training Sch., 757 F. Supp. 1243 (D.N.M. 1990). · cites it 3× “440(c)(5); failing to enable residents to retain and use appropriate personal possessions, as required by 42 C.F.R. § 483.420 (a)(12); failing to implement procedures that prohibit physical, verbal, sexual and psychological abuse or punishment, as required by 42 C.”
Texas Home Mgmt., Inc. v. Texas Dep't of Mental Health & Mental Retardation, 953 S.W.2d 1 (Tex. App. 1997). · cites it 4× “MHMR adopted the surveyors' finding that Appleby Home violated the condition of participation set out in 42 CFR § 483.420 by (1) failing to protect two of its residents from the physical abuse of B.”
Maioriello v. New York State Off. for People with Developmental Disabilities, 272 F. Supp. 3d 307 (N.D.N.Y. 2017). “) Specifically, Plaintiff’s denial is once again based on arguments that are irrelevant to whether the above quoted language from 42 C.F.R. § 483.420 is accurate and/or valid.”
Legacy Healthcare, Inc. v. Barnes & Thornburg, 837 N.E.2d 619 (Ind. Ct. App. 2005). “found, based on W149 [standard of participation 42 CFR § 483.420 (d)(1) (Staff Treatment of Clients) ] that immediate jeopardy exists' and that ISDH 'has made a final determination that your certification for participation in the Medicaid program .”
Oakwood Cmty. Ctr. icf/mr v. Sebelius, 723 F. Supp. 2d 937 (E.D. Ky. 2010). · cites it 4× “[Id] See 42 C.F.R. §§ 483.420 & 483.430. The Secretary, through the Centers for Medicare and Medicaid Services (“CMS”), accepted the OIG survey findings, including OIG’s recommendation to terminate Oakwood’s provider agreement effective September 14, 2005.”
Thrower v. Pennsylvania, 873 F. Supp. 2d 651 (W.D. Pa. 2012). “, 42 C.F.R. § 483.420 (“The facility must ensure the rights of all clients.”
Dreyer v. Idaho Dep't of Health & Welfare (D. Idaho 2021). · cites it 5× “For example, in Count IV of the Complaint, Plaintiffs allege Defendants acted wrongfully by violating 42 C.F.R. §483.420 , which has absolutely no correlation to Congress’s mandate in Section 1396a(a)(31).”
United States v. Arkansas, 794 F. Supp. 2d 935 (E.D. Ark. 2011). “See' 42 C.F.R. § 483.420 (a)(6) (2011) (requiring facilities to ensure that residents are free from unnecessary restraints and are provided active treatment to reduce the need for physical restraints); 42 C.”
— 42 C.F.R. § 483.420(c)(5) — 1 case
Texas Home Mgmt., Inc. v. Peavy, 89 S.W.3d 30 (Tex. 2002). “42 C.F.R. § 483.420 (c)(5) ("The facility must promote frequent and informal leaves from the facility for visits, trips, or vacations.”
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