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    v1.0.30
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyConnecticut DSS ICF/IID Rate Update | OpenPayer
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    DraftConnecticut Department of Social ServicesPolicy 26-AE

    Private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) Reimbursement

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    This proposed Connecticut Medicaid State Plan Amendment governs reimbursement methodology and rate adjustments for private ICF/IIDs during SFY 2027, including standard rate increases, capital improvement adjustments, available-appropriation limits, and federal Upper Payment Limit requirements.

    Policy Summary
    PayerConnecticut Department of Social Services
    PolicyPrivate ICF/IID Reimbursement
    Policy CodePolicy 26-AE
    Change TypeReimbursement methodology and rate adjustment
    Effective DateJuly 1, 2026
    Next Review DateNot specified
    Key ActionFacilities seeking a capital-improvement rate increase must obtain approval from the Department of Developmental Services in consultation with DSS.
    SourceLink
    POLICY UPDATE CHANGES

    For SFY 2027, each private ICF/IID will receive a rate increase of 5.8 percent over the facility rate in effect for the period ending June 30, 2026.

    A facility may receive an additional rate increase for a capital improvement approved by the Department of Developmental Services in consultation with DSS when the improvement supports resident health or safety.

    5.8%SFY 2027 facility rate increase
    $2.28MSFY 2027 projected expenditure increase

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    $2.48MSFY 2028 projected expenditure increase
    2%One-time supplemental payment
    2%April-June 2026 additional increase

    SFY 2027 ICF/IID Reimbursement

    SFY 2027 ICF/IID reimbursement

    SFY 2027 private ICF/IID reimbursement is determined under the following rate and exception rules.

    ALL of the following

    • The facility is a private Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID).
    • For the fiscal year ending June 30, 2027, the facility rate is 5.8 percent greater than the rate in effect for the period ending June 30, 2026.
    • If interim rate status or an agreement with DSS would result in a lower rate effective July 1, 2026, the lower rate is issued instead.

      Exception to the standard SFY 2027 rate increase.

    A facility may receive an additional rate increase for a capital improvement approved by the Department of Developmental Services in consultation with DSS when the improvement supports resident health or safety during SFY 2027.

    The increase is payable only to the extent that it is within available appropriations.

    Rate Methodology and Payment Limits

    SFY 2027 standard rate increase
    Increase5.8% greater than the facility rate in effect for the period ending June 30, 2026
    Effective periodFor the fiscal year ending June 30, 2027
    ExceptionA facility that would otherwise receive a lower rate effective July 1, 2026, due to interim rate status or an agreement with the Department shall be issued the lower rate
    One-time supplemental payment
    Payment amount2% of the calculated rate based on 2024 cost report filings, before any add-ons, multiplied by the total number of actual Medicaid days
    Payment datesMay 1, 2026, through May 15, 2026

    Facility Requirements and Rate Calculation

    Billing Rule

    Capital Improvement Rate Increase

    A facility may receive a SFY 2027 rate increase for a capital improvement only when the improvement is approved by the Department of Developmental Services in consultation with the Department of Social Services and supports the health or safety of residents. The increase is limited to available appropriations.

    Billing Rule

    Rate Calculation Basis

    Calculate applicable payment amounts using the 2024 cost report filings before any add-ons, in accordance with the policy’s rate rules. This basis applies to the one-time supplemental payment for May 1–15, 2026, and the additional rate increase for April 1–June 30, 2026; SFY 2027 rates are based on the rate in effect for the period ending June 30, 2026, subject to the stated interim-rate or Department-agreement exception.

    • For May 1–15, 2026, multiply 2% of the calculated rate based on the 2024 cost report filings, before add-ons, by actual Medicaid days for dates of service July 1, 2025, through March 31, 2026.

    Upper Payment Limit

    Upper Payment Limit (UPL)
    DefinitionA federally required limit on Medicaid payment
    Calculation methodCalculated using federally specified Medicare cost principles
    Federal financial participationFederal financial participation is not available for Medicaid payments above the limit
    Policy Summary
    PayerConnecticut Department of Social Services
    PolicyPrivate ICF/IID Reimbursement
    Policy CodePolicy 26-AE
    Change TypeReimbursement methodology and rate adjustment
    Effective DateJuly 1, 2026
    Next Review DateNot specified
    Key ActionFacilities seeking a capital-improvement rate increase must obtain approval from the Department of Developmental Services in consultation with DSS.
    SourceLink
    On This Page
    SFY 2027 ICF/IID ReimbursementRate Methodology and Payment LimitsFacility Requirements and Rate CalculationUpper Payment Limit
    Medicaid-day period
    Dates of service July 1, 2025, through March 31, 2026
    April–June 2026 additional increase
    Additional increase2% of the calculated rate based on 2024 cost report filings, before any add-ons
    Effective periodApril 1, 2026, through June 30, 2026
    Rate applicationThe calculated 2% amount is added to the rate in effect as of March 31, 2026
    Federal Upper Payment Limit
    Payment limitMedicaid payments to ICF/IIDs must remain within the federally calculated Upper Payment Limit
    UPL basisThe limit is calculated using federally specified Medicare cost principles
    Potential SPA changesOne or more portions of the State Plan Amendment may be modified or removed as necessary to remain within the UPL
  1. For April 1–June 30, 2026, add 2% of the calculated rate based on the 2024 cost report filings, before add-ons, to the rate in effect March 31, 2026.