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and/or have been determined to need specialized services for serious mental illness. 2. “Institution for Mental Disease” or “IMD” means a hospital, nursing facility, or other institution of more than sixteen (16) beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services. A facility is considered an IMD if its overall character is that of a facility established and maintained primarily for the care and treatment of individuals with mental diseases, whether or not it is licensed as such. Provided however, an intermediate care facility for individuals with intellectual disabilities shall not be considered an IMD. 3. “Mental diseases” means diseases listed as mental disorders in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), incorporated herein by reference (not including any later editions thereof), with the exception of intellectual disabilities, senility, and organic brain syndrome. This publication is available at: http://www.cdc.gov/nchs/icd/icd10cm.htm. 7.4 IMD Determination Review Process A. EOHHS shall make the final determination as to whether any hospital, nursing facility, or other institution of more than sixteen (16) beds is an IMD and excluded from the Medicaid program. EOHHS shall identify: 1. Facilities that are at risk of becoming IMDs; 2. The course of action to be taken when such facilities have been identified as at risk of becoming an IMD; and 3. The course of action to be taken if a facility is identified as an IMD. B. Medicaid payment is not available for services provided to individuals in an IMD who are age twenty-one (21) and over, and under age sixty-five (65), except as permitted in 42 C.F.R. § 438.6(e) and in the Section 1115 Waiver Demonstration. C. All Medicaid certified providers with more than sixteen (16) beds shall bi-annually complete and submit to EOHHS an IMD compliance self-assessment reporting tool and attestation of compliance to Medicaid. Specifically: 1. All hospitals on or before May 1, 2020, and bi-annually on December 1st and May 1st thereafter, shall submit an IMD compliance self-assessment reporting tool and attestation of compliance to EOHHS. 2. All other Medicaid certified providers with more than sixteen (16) beds shall submit an IMD compliance self-assessment reporting tool and