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 intellectual disabilities 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 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 an interesting read.
Proposed regulations published in Pennsylvania Bulletin, dated December 26, 1992.
Final regulations published in Pennsylvania Bulletin, dated October 29, 1994.
Revised regulations were again published in June 2012, retroactive to July 1, 2011, 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 (cost of living adjustment)
- provision to allow the Department to apply a RAF (rate adjustment factor)
- 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.
- Standard Interim Rate Methodology
- Tentative and Final Cost Settlements
- Audits, recommended and final settlements
- ICF/ID Assessment
- Waiver Requests
- Inflationary increases
- Depreciation thresholds
- Waiver of Minimum Occupancy
- ID46 Cost Reports
- ID47 Budgets
- 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 2016-17.
When you receive a tentative cost settlement, send 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.
Draft recommended settlements and Final recommended settlements (formerly BFO audits) are now being issued for FY 2013-2014. Final cost settlements for FY 2013-2014 will follow the final recommended settlement. You should send all these documents to AZTAC for review so that we can be sure they are calculated correctly.
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 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 they may be invalid due to manner in which they were established and implemented. The Chapter 51 regulations are now obsolete and have been replaced with the Chapter 6100 regulations.
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 setting letter from ODP. 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. Eventually, 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 ICF/ID deadlines:
ID46 Cost Reports are due September 30th for the fiscal year that ended on the preceding June 30th. This is a postmarked deadline. Always retain proof of submission. September 30 is a regulatroy deadline, 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. If September 30th falls on a weekend, the due date is the next business day, per revised ID46 instructions issued in July 2017 and August 2018.
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. This is a postmarked deadline. Always retain proof of submission. 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" . ODP had previously described "immediately" to be 30 days, but there may be times when you need to submit a request beyond the 30 days. Also, ODP has permitted waiver submissions throughout the year for the last several years. 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 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.