ICF/DD-H vs. ICF/DD-N vs. ICF/DD-CN

ICF/DD-H (Habilitative)

24-hour personal care, habilitation, developmental and supportive health services for people with developmental disabilities who have intermittent, recurring nursing needs and are certified by a physician as not needing continuous skilled nursing. 4 to 15 beds. (HSC §1250(e))

ICF/DD-N (Nursing)

24-hour personal care, developmental services and nursing supervision for people with developmental disabilities who have intermittent, recurring needs for skilled nursing but don't need continuous skilled nursing. It must serve medically fragile people, or people with significant developmental delay. 4 to 15 beds. (HSC §1250(h))

ICF/DD-CN (Continuous Nursing)

A "homelike" facility for medically fragile people with developmental disabilities who are certified as needing continuous skilled nursing. 4 to 8 beds. (HSC §1250(m))

ICF/DD

24-hour care, habilitation and developmental services for people whose primary need is developmental services and who have a recurring but intermittent need for skilled nursing. These are larger facilities. (HSC §1250(g))

ICF

Inpatient care for people who need recurring skilled nursing supervision but not continuous skilled nursing. In CDPH's listing these are distinct parts of state hospitals and veterans homes. (HSC §1250(d))

Medi-Cal's coverage rules spell out who qualifies for each level of care.

ICF/DD-H (22 CCR §51343.1): a developmental disability; skilled nursing needed on an ongoing but intermittent basis, with needs that are predictable and can be scheduled in advance; and two or more deficits in self-help (eating, toileting, bladder control, dressing) or social-emotional skills. People with extreme aggression or self-injury, any pressure sore (decubitus ulcer) or an active reportable communicable disease aren't candidates.

ICF/DD-N (22 CCR §51343.2): a developmental disability or significant delay; a need for 24-hour nursing supervision, with a stable condition that a physician certifies doesn't need continuous skilled nursing; deficits in self-help, motor or social-emotional skills; and intermittent skilled nursing such as G-tube or NG feeding, tracheostomy care and suctioning, oxygen, catheterization, wound care or repositioning to prevent skin breakdown.

In practice, a DD-H home serves people whose main need is developmental and habilitative programming with light, scheduled nursing; a DD-N home serves medically fragile people who still receive active treatment.

• ICF/DD-H has its own state regulations: Title 22, Division 5, Chapter 8.5 (§76800 and following).
• ICF/DD-N has no current state chapter. Its old regulations were repealed in 1993, and under HSC §1275.3(d) DD-N homes follow the federal ICF/IID standards (42 CFR 483.400–480) until new state rules are adopted.
• ICF/DD-CN licensing begins, by statute, upon adoption of licensing regulations under §1275.3. The Department of Health Care Services runs the program as Developmentally Disabled Continuous Nursing Care (DD-CNC).
• Every certified type must also meet the federal Conditions of Participation for ICF/IID, which is what the federal surveys on this site check.

• DD-H: a registered nurse, employed or under contract, on site at least 1 hour per client per week (22 CCR §76878).
• DD-N: licensed nursing hours every day. In homes with 4 to 7 residents, the Department of Developmental Services' staffing schedule requires at least 8 hours a day of LVN or psychiatric technician time.
• DD-CN: continuous skilled nursing, by definition.

CDPH's facility listing is the source for the counts on this site's Dashboard and county pages. Most California ICFs are small DD-H and DD-N homes; the median ICF has 6 beds, while a handful of large ICF/DD and ICF units hold about half of all ICF beds.

You can filter Facility Search by type, for example every ICF/DD-N.