Intermediate Care Facility - Individuals with Intellectual Disabilities (ICF-IID) Cost Report

For information on NC Medicaid requirements to follow when preparing cost reporting forms, download the “Guidance for Cost Report Preparation” document below.

Cost reports must be filed by the due date listed below. NC Medicaid does not plan to grant extensions except in the case of natural disasters (e.g., fires and floods.) Medicaid does not normally permit amended cost reports except under certain circumstances.

ICF-IID Facility FYE June 30, 2023

• Guidance for Cost Report Preparation for ICF-IID Group Home FYE June 30, 2023
• FY2023 ICF-IID Provider Health Care Assessment Tax Schedules

ICF-IID Facility FYE June 30, 2022

• FY2022 ICF-IID Provider Health Care Assessment Tax Schedules

Chart of Accounts

• Chart of Accounts for ICF/IID Facilities

Cost Limitations for ICF-IID Cost Reports for fiscal year ended June 30, 2023

Medical Director: $250 per bed annually

Management Fees: $7.13 per patient day

Capital/Lease Costs: $6,546 annually per bed

Director's Fees: $2,400 annually or $200 per meeting

Owner or Administrator Salary:

• $57,570 (1-50 beds)
• $69,912 (51-99 beds)
• $74,024 (100-149 beds)
• $79,660 (150-199 beds)
• $90,469 (200-249 beds)

ICF-IID Baseline Payroll Template (NC Session Law 2021-180)

Contact

NC Medicaid Finance Section
Phone: 919-527-7171
Fax: 919-716-0600
Email: Medicaid.LTCCostReport@dhhs.nc.gov