With the general provision included in the 2026 Appropriations Act (Item 291 PPPPP) for the proposed action to impact “any other provider rates” community ICF-IIDs are included.  These programs are funded in accordance with 12VAC20-90-10 #6 which states:

6. Reimbursement to Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) shall be retrospective on the basis of reasonable costs in accordance with Medicare principles of reimbursement. Nonstate facilities shall be limited to a ceiling based on the highest as filed rate paid to an ICF/IID institution in state fiscal year 2012 and annually adjusted thereafter with the application of the NF inflation factor, as set out in 12VAC30-90-41 B.

This is particularly troublesome for two reasons:

• These programs are, by design, small (with two exceptions for long standing legacy programs, they are 12 beds or fewer and many are 6 beds or fewer); 38 homes for 262 adults are managed by CSBs, 24 homes for 138 children and/or adults are managed by private providers.  Small settings are far more susceptible  to dramatic fluctuations in cost because the cost is distributed over a far smaller number of individuals.  A vacancy in even one bed for a portion of the year can make the program unsustainable if it is providing complex medical care.

• With the impending, planned closure of Hiram Davis Medical Center in Petersburg, that has become a needed resource for individuals with IID with complex medical needs; putting community resources that can care for this population at even greater risk of being unsustainable is not a good policy choice.

We feel strongly, that to ensure that the level of care and support can be maintained for an extremely compromised population, that the language of 12VAC20-90-10 #6 cited above should be modified to eliminate the reference to state fiscal year 2012.  That is not, however, the issue raised by this notice.