Regulating professional services in ICFs/MR: remembering the past and looking to the future.

Generally, our society regulates from a standpoint of failure in the system. When the field of mental retardation could not adequately monitor its own professional practices, litigation and legislation brought the onset of government intervention. Historically, consensus building has been the method by which standards emerge and then become adopted into regulation. Yet at best, this practice results in "opinions" as to how quality should be defined. The Health Care Financing Administration's experience in regulating and enforcing has resulted in an emphasis on the outcomes of services received by individuals. Though difficult, it challenges professionals to begin defining accountable measures of "quality" over time.