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/ID 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
Updated news for Pennsylvania Non-state operated ICF/ID:
Tentative Cost Settlements
The ICF/ID tentative cost settlements are completed through FY 2013-14. No further tentative cost settlements are being done at this time (March 2017) due to a staff shortage and higher priorities..
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 DHS (DPW) issues the settlement notice?
ZERO PERCENT INFLATIONARY INCREASE:
ODP has provided no inflationary increase in the ratesetting methodology since FY 2007-2008. Many believe this is in contradiction to the ICF/ID regulations, at least through June 30, 2011, 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. Some providers who appealed the lack of an inflationary increase in FY 2008-09 through FY 2010-2011 won their appeals.
The inflationary increase was eliminated in revised regulations, which were promulgated in June 2012, retroactive to July 1, 2011. The regulations are retroactive to July 1, 2011. These regulations were promulgated the same time as the Chapter 51 regulations and some consider them to be invalid due to manner in which they were established and implemented.
If you wish to file an appeal of the "zero" inflationary increase, or the lack of a COLA, your appeal must be filed within thirty days of the date of the rate letter. In the past, some providers have appealed the ODP rate correspondence, and some have appealed the Office of Long Term Living (OLTL) rate letter, and some have appealed both/all. In more recent years, the Department stopped issuing the OLTL letters, and the notice of appeal is now in the budget approval letters. You should consult legal counsel regarding when and what to appeal.
Importantly, note that your appeal must be timely filed (within 30 days) of the document to which you are appealing.
Keeping up with deadlines:
MR46 Cost Reports are due September 30th for the fiscal year that ended on the preceding June 30th. September 30 is a regulatroy deadlines, and ODP does not typically allow extensions. If you are unable to submit your cost report by the deadline, submit it as soon as possible thereafter.
Requests for waiver of the standard interim rate are due October 31st for the fiscal year which began on the preceding July 1st. The October 31st deadline is now written into the revised ICF/ID regulations that were promulgated in May 2012, retroactive to July 1, 2011. You may also submit requests throughout the fiscal year based on the waiver condition of an unforeseen circumstance.
Contact AZTAC as soon as possible if you need us to prepare any 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 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 described to be 30 days, but there may be times when you need to submit a request beyond the 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/ID 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 typically 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.