ICF/ID is a funding stream defined in Title XIX of the Social Security Act (Medicaid), which is designed to provide "active treatment services" to persons who are diagnosed with mental retardation or persons with other related conditions.
ICF/ID (formerly ICF/MR) Regulations
55 Pa. Code Title 55, Chapter 6210
55 Pa. Code Title 55, Chapter 6211
Code of Federal Regulations
The following documents are interesting to read, because they provide background and insight to the ICF/ID state regulations.
Original issue of ICF/MR regulations in the Pennsylvania Bulletin, dated May 4, 1985. These were the first promulgated regulations for the ICFs/MR in a newly designated Subchapter C of Chaper 1181 of the Pa. Code, Title 55. This was a few years in the making and the preamble text is very interesting to read.
Proposed regulations published in Pennsylvania Bulletin, dated December 26, 1992.
Final regulations published in Pennsylvania Bulletin, dated October 29, 1994.
Revised regulations were published in May 2012, but the PA Bulletin published only the revised segments and not the revised chapter in entirety. The primary changes to the ICF/ID regulations (Chapter 6211) were:
- removal of the inflationary increase in the ratesetting methodology
- provision for allowing (not guaranteeing) a COLA
- establish October 31 as the deadline for submission of requests for waiver of the standard interim rate
- change "ICF/MR" to "ICF/ID"
Following are just a few of the things you should know/understand if you are fiscally or programmatically responsible for a Pennsylania non-state operated ICF/ID. AZTAC can come to your agency and provide training on all of these topics or set up a customized webinar with you.
- Ratesetting Methodology
- Tentative and Final Cost Settlements
- Audits, recommended and final settlements
- ICF/MR Assessment
- Waiver Requests
- Inflationary increases
- Depreciation thresholds
- Waiver of Minimum Occupancy
- MR46 Cost Reports
- Budget Modification Requests
- Movement of Funds Requests
- 10% Budgetary Limitations
- 13% GA Limitation
- Mid-year waivers
- One-time-only costs
ICF/ID Task Force
To receive ICF/ID information, sign up for the ODP Non State ICF/ID List Serve as follows:
Your agency may add as many staff to this list serve as you wish. Please use the link identified below to add additional members of your staff to this list serve:
This list serve will be used for general information, Task Force Meeting Announcements and other important information which is not provider specific. Please be aware that you may be receiving information through this list serve.
If you have any questions concerning this list serve, please contact Mr. Joshua Kauffman of the ODP staff at firstname.lastname@example.org.
Updated news for Pennsylvania Non-state operated ICF/ID:
Tentative Cost Settlements
ODP has been issuing tentative cost settlements for several fiscal years. There has been a "backlog" due to issues since the implementation of PROMISe. Prior to PROMISe, tentative cost settlements were issued approximately six months after submitting your MR46 cost report. ODP is now catching up and has been issuing settlements for prior years.
When you receive a tentative, fax a copy to AZTAC for review. Catching mistakes in these calculations can save your organization a lot of money, but it is critical to respond in a timely manner. Also be sure that the tentative settlement is correctly reflected in your final cost settlement, which might occur several years later.
Many providers report that they don't like being surprised about money they have to pay back for a settlement applicable to several years ago. Did you know that you can pre-calculate each year's tentative settlement and put paybacks into reserve until DPW issues the settlement notice?
Electricity increases in Pennsylvania. Many areas of Pennsylvania are experiencing increased expenses for electricity due to the expiration of rate caps. Some areas of Pennslyvania experienced increases in January 2010, and others had increases effective January 2011. If you are unable to absorb these increases within your approved funding level, you may submit a waiver request. You should shop around for lower prices, and be prepared to include that justification in your waiver submission. AZTAC can help you prepare the waiver submission for these expenses.
ZERO PERCENT INFLATIONARY INCREASE:
ODP provided no inflationary increase in the ratesetting methodology for FY 2008-09, FY 2009-2010, FY 2010-11, or FY 2011-12. Many believe this is in contradiction to the ICF/MR regulations, which states that an inflationary increase will be provided (based on an index such as the CPI-W). The only other fiscal year that no inflationary increase was provided was FY 1996-1997. UPDATE: The inflationary increase was eliminated in revised regulations, which were promulgated in May 2012. The regulations are retroactive to July 1, 2011. You should consult with your legal counsel regarding the viability of an appeal in FY 2011-12 for the inflationary increase.
If you wish to file an appeal of the "zero" inflationary increase, your appeal must be filed within thirty days of the date of the rate letter. Some providers appeal the ODP rate correspondence, some appeal the Bureau of Long Term Living rate letter, and some appeal both/all. You should consult legal counsel regarding when and what to appeal.
Providers do have an opportunity to request that their appeals be consolidated with other providers filing an appeal for the same reason--in this case, the "zero percent" inflationary increase. The first step is that each provider must file its own appeal, and after the appeals are timely filed and docketed, then a request can be made for consolidation. If you would like more information regarding this, contact Mary Anne Haschert at AZTAC. Importantly, note that your appeal must be timely filed (within 30 days).
Consolidation would not likely be beneficial to providers who are appealing other issues in addition to the zero percent inflationary increase.
Keeping up with deadlines:
FY 2011-2012 MR46 Cost Reports were due September 30, 2012. ODP issued new MR46 forms and instructions, primarily for the purpose of adding a new Schedule 12A for the purpose of itemizing day program expenses. The Schedule 12A will be "locked" to Schedule 12 and will control the costs that are reported for day program expenses. An issue that first arose in the review of FY 2010-11 cost reports was that ODP questioned many providers about the day program rates shown on Schedule 12 as they were compared to waiver-approved rates. (See AZTAC's Task Force notes from the December 14 ICF/ID Task Force meeting.) Note that these revisions to the MR46 cost report could result in a cost report that does not agree with your general ledger nor your independent audits.
FY 2012-13 Waiver Requests were due October 31, 2012.
The October 31st deadline is now written into the revised ICF/ID regulations that were promulgated in May 2012, retroactive to July 1, 2011.
Contact AZTAC as soon as possible if you need us to prepare any waiver submissions. When submitting a waiver submission after the October 31st deadline, ODP expects your request to be submitted within 30 days. When AZTAC prepares your waiver requests, we also take care of all of the followup questions, responses to ODP, revised budget, verification of calculations, etc. Please fax or email any correspondence you receive from the Department immediately, so that we may keep records for you. We maintain various year-to-year files, and we keep backups of all of your information. The more we do for you, the more we are able to help you reach adequate funding levels for your programs. It is important to monitor costs and funding throughout the entire year, not just at the deadlines.
Waiver Requests for Unforeseen Circumstance
Waiver requests for "unforeseen circumstance" can be submitted anytime during the fiscal year If you have an "unforeseen circumstance" which has caused significant costs that you cannot absorb within your funding level, you may submit a waiver request to ODP by the October 31st deadline and it can be retroactive to July 1, if applicable. However, if an unforeseen circumstance occurs after the October 31st deadline, waiver requests for "unforeseen circumstance" should be submitted "immediately" --which ODP has defined to be 30 days. Contact AZTAC as soon as you are aware of a problem that might result in an additional waiver request for "unforeseen circumstance."
For more information regarding the submission of waiver requests, click here.
The ICF/MR Assessment is a health-care related tax permitted by federal regulation and imposed by the Department of Public Welfare. In the rate setting process, the amount of annual assessment is added into your approved funding level, whether your funding level is determined by the standard interim rate methodology or the waiver of the standard interim rate methodology. The assessment is collected via quarterly payments. Although ODP will calculate these amounts for you, it is the provider's responsibility to sign off on them in a timely manner.
At the beginning of the fiscal year, ODP typically issues revised rate correspondence to all providers for the purpose of removing the prior year assessment and including the new year's assessment. This revised rate is effective on July 1 of the fiscal year to which the assessment applies. Even though the rate is effective on July 1 of a new fiscal year, it is still technically the previous year's rate---just changed for the assessment. You will see revised interim rates for the new fiscal after cost reports are filed and after waiver requests are reviewed. AZTAC can verify the calculations in the rate correspondence for you if you fax or email the document to us.
AZTAC tracks the ICF/MR assessments carefully. We can pre-calculate your assessment, and verify the quarterly reports from the ODP. Simply fax or email any correspondence that your receive from the Department, and we will verify the numbers for you.
The Movement of Funds deadline for each fiscal year is May 31.
The Budget Modification Request deadline for each fiscal year is June 30. Up to two budget modification requests may be submitted per year.
ODP does not permit any extension on these deadlines, unless your rate correspondence has been significantly delayed, in which case, the deadline is 30 days from the date of the rate correspondence.