for Individuals with Intellectual Disabilities
Intermediate Care Facilities (ICF/IID)
Medicaid has the ability to cover institutions or group homes (four or more beds) for individuals with intellectual disabilities as an optional benefit. Currently, all 50 states have at least one intermediate care facility for individuals with intellectual disabilities (ICF/IID), and these facilities serve an ever-increasing number of individuals with intellectual disabilities and other related conditions.
States have undertaken extensive efforts to decrease institutionalization in ICF/IIDs and serve individuals in a home and community based setting that is integrated and person-centered. Whether states maintain the traditional ICF/IID services or want to transition clients to home-based settings, Myers and Stauffer has extensive experience with all phases of strategic planning, policy decisions, transition planning, and reimbursement models.
We provide the following services:
Audit and Attest
Bob Hicks, CPA
Our professionals are not just accountants and auditors, but also highly trained and knowledgeable health care professionals in areas including, but not limited to, claims, cost reports, the application of federal and state regulations, valuations, and asset tracing. Specific to ICF/IID providers, we have developed risk-based procedures and techniques to assist in identifying the allowable cost of providing ICF/IID services, including appropriate consideration of the various levels of day program services that an ICF/IID client may receive. Our services include:
- Develop cost reporting tools.
- Cost report collection.
- Web-based date exchanges for cost reports, supporting documentation, and related information.
- Cost report database management, analytics, and reporting systems.
- Audit and attest work programs and standardized work papers.
- Claims management and audit systems.
- Attest protocols compliant with state and federal definitions.
- Risk assessments to target audit work.
- Training programs for clients, providers, and other stakeholders.
Rate Setting and Reimbursement
Tara Clark, CPA
Our team partners with more than 23 state agency clients in the area of ICF/IID rate setting and recognize the importance of establishing the ICF/IID rates that meet state agency goals and objectives. We work with our clients to develop and implement accurate, transparent, and predictable payments that support the delivery of high quality, cost effective services and promote good health outcomes. Our services include:
- Cost report design.
- Web-based submission and communication system design (web-based portal) for cost report and documentation.
- Cost reporting tools development for state specific criteria.
- Cost report collection, database management and analytics.
- Cost report monitoring.
- ICF/IID rate setting.
- Cost settlement calculations and notice of program reimbursement.
- Add-on rate development for specific services.
- Quality incentive program/value-based purchasing/pay-for-performance program development and oversight.
Medicaid Financing and Reporting
Amy Perry, CPA
Our team, which includes former Centers for Medicare & Medicaid Services (CMS) analysts, possesses the experience and skillsets needed to address our clients’ federal reporting needs. We have helped states resolve issues effecting outstanding grant award finalizations as well as identify unclaimed federal funds prior to filing deadlines. Our ultimate goal is to provide our clients with the training, knowledge, tools, and skills necessary for state agency staff to fully manage the federal reporting process. Services include:
- Certified public expenditures (CPE) claims – reconcile claims to cost report data.
- Calculate fiscal impact estimates.
- Analyze upper payment limit (UPL) methodologies.
- Demonstrate federal UPL compliance, including calculations and narrative.
- Supplemental payment program design, calculations, and oversight.
- Provider tax program development, calculations, and compliance.
- Program financing consulting.
Legislation and Regulation
Amy Perry, CPA
Improving quality, outcomes, and patient experiences requires a fresh new perspective – a new way of thinking in an environment that has been traditionally under-funded and heavily utilized. We support our clients through the most significant period of change since the inception of the Medicare and Medicaid programs. Services include:
- Regulation and policy development support.
- Federal medical authorities consulting.
- State plan amendment.
- 1915(c)/(b), 1115, and 1132 waivers.
- Administrative code consulting.
- Public hearing and workgroup participation.
- Expert testimony.
- Analysis of programmatic and fiscal impact of proposed or passed legislation.
Ryan Farrell, CFE
Through our benefit/program integrity services, Myers and Stauffer is able to assist our government health care clients with the development, maintenance, and execution of organizational compliance plans designed to hold providers, clients, systems, and vendors accountable. We specialize in providing risk assessment, error rate measurement, loss prevention, and specialized auditing services to support public health care and social service agencies in traditional fee-for-service and capitated (e.g., managed care) systems. Our program integrity services include:
- Claims analysis.
- Post-pay claims audits – clinical and financial.
- Pre-pay claims audits – clinical and financial.
- Medicaid recovery audit contractor (RAC) services.
- Software modules for surveillance and utilization review subsystem (SURS), fraud and abuse detection services (FADS), and case tracking.
- Provider compliance.
- Payment system processing accuracy.
- Fraud, waste, and abuse detection (FWAD) litigation support.
Managed Care Oversight and Compliance
Mike Johnson, CPA, CFE
The extensive services offered by our highly skilled managed care team are generally focused on the oversight of health plans but can impact all provider types, including intermediate care facilities. These services include:
- Encounter data reconciliation and validation.
- Financial audits, performance audits, and program effectiveness audits.
- Network adequacy assessments and member access compliance.
- Readiness reviews.
- Claims payment and denial assessments, accuracy, and timeliness.
- Medical record review.
- Grievance and appeals analysis.
- Contract compliance.
- Other provider-specific issue review and resolution activities.