ICF/MR is a funding stream defined in Title XIX of the Social SecurityAct (Medicaid), which is designed to provide "active treatment services" to pesons who are diagnosed with mental retardation or persons wtih other related conditions. 

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/MR 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.

 

ICF/MR Assessment annoucement of amount, methodology, and aggregate impact in the Pennsylvania Bulletin dated February 25, 2005.

 

Following are just a few of the things you should know/understand if you are fiscally or programmatically responsibile for a Pennsylania non-state operated ICF/MR.   AZTAC can come to your agency and provide training on all of these topics.

• Ratesetting Methodology
• Tentative and Final Cost Settlements 
• Audits, recommended and final setllements
• ICF/MR Assessment
• Waiver Requests
• Inflationary increases
• Depreciation threshholds
• 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/MR programs in Pennsylvania

ICF/MR programs in other states

ICF/MR Task Force

 

Updated news for Pennsylvania Non-state operated ICF/MR:

Tentative Cost Settlements 

ODP has recently 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 beginning to catch 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.

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.  Since this would be an "unforeseen circumstance," the request must be submitted within 30 days.   Contact Mary Anne Haschert at AZTAC to discuss further. 

ZERO PERCENT INFLATIONARY INCREASE:   

ODP provided no inflationary increase in the ratesetting methodology for FY 2008-09, FY 2009-2010, or FY 2010-11.  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.

 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 shoud 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 2010-2011 MR46 Cost Reports are due September 30, 2011.    Contact AZTAC if you need us to prepare your MR46's for FY 20.   

FY 2011-2012  Waiver Requests are expected to be due October 31, 2011.
Waiver requests will likely be due by October 31, 2011 and may be retroactive to July 1, 2011.  When submitting a waiver submission after the October 31st deadline, ODP expects your request to be submitted within 30 days. 

Contact AZTAC as soon as possible if you need us to prepare your FY 2011-2012 waiver submissions.  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 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. 

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.

ICF/MR Assessments
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.

Deadlines
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.