US · guidance
CMS SOM App. J, Tag W489
§483.480(d)(5) Ensure that each client eats in an upright position, unless otherwise specified
by the interdisciplinary team or a physician.
Guidance §483.480(d)(5)
If a client eats in any position other than an upright position, the physician should document the
medical necessity for the position, and/or the IPP should include the program plan to teach the
client the physical skill necessary for eating upright.
This applies to all clients, including those fed by nasogastric tube or gastrostomy tube. The IPP
should identify the most appropriate position for the client to be positioned during mealtime, in
relation to the placement of the food contents.
Transmittals Issued for this Appendix
Rev # Issue Date Subject Impl Date CR#
R178SOMA.pdf 04/13/2018
Revisions to State
Operations Manual (SOM)
Appendix J, Part I – Survey
Protocol for Intermediate
Care Facilities for
Individuals with Intellectual
Disabilities (ICF/IID)
04/13/2018 N/A
R175SOMA 12/22/2017 Revisions to State Operations
Manual (SOM) Appendix J, Part II
– Interpretive Guidelines –
Responsibilities of Intermediate
Care Facilities for Individuals with
Intellectual Disabilities (ICF/IID)
12/22/2017 N/A
R162SOM 10/14/2016 Revisions to State Operations
Manual (SOM) Appendix J, Part II
– Interpretive Guidelines –
Responsibilities of Intermediate
Care Facilities for Individuals with
Intellectual Disabilities
10/14/2016 N/A
R158SOM 09/09/2016 Revisions to State Operations
Manual (SOM) Appendix J, Part II
– Interpretive Guidelines –
Responsibilities of Intermediate
Care Facilities for Individuals with
Intellectual Disabilities and Exhibit
355, Probes and Procedures for
Appendix J
09/09/2016 N/A
R144SOM 08/14/2015 Revisions to State Operations
Manual (SOM) Appendix J, Part II
– Interpretive Guidelines –
Responsibilities of Intermediate
Care Facilities for Individuals with
Intellectual Disabilities
08/14/2015 N/A
R135SOM 02/27/2015 Revisions to State Operations
Manual (SOM) Appendix J, Part II
04/27/2015 N/A
– Interpretive Guidelines –
Responsibilities of Intermediate
Care Facilities for Individuals with
Intellectual Disabilities revisions.
An addition of a New Exhibit to the
State Operations Manual (SOM) for
Intermediate Care Facilities for
Individuals with Intellectual
Disabilities (ICF/IID), Probes and
Procedures for Appendix J, Part II –
Interpretive Guidelines-Responsibilities of Intermediate
Care Facilities for Individuals with
Intellectual Disabilities
R94SOM 12/06/2013 State Operations Manual (SOM)
Appendix J, Guidance to Surveyors:
Intermediate Care Facilities for
Individuals with Intellectual
Disabilities, nomenclature
revisions
12/06/2013 N/A
R10SOM 08/12/2005 Revisions to Appendix J 08/12/2005 N/A
History
Rev. 135, Issued: 02-27-15, Effective: 04-27-15, Implementation: 04-27-15
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
dfe5277cfc8b3f1def99018ec6f958f1c236ec8b00da02abdcbd08ca80411af5
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