​ICF Conversion Process

 ICF Conversion Process (PDF)

A provider who is interested in learning more about the voluntary conversion program being offered by DODD should contact Ann Weisent at Ann.Weisent@dodd.ohio.gov or 614-949-8792, or Josh Anderson at Joshua.Anderson@dodd.ohio.gov or 614-387-0576.  A core team of DODD staff are willing to meet with interested providers to answer any questions providers might have during their consideration of participating in the voluntary conversion program.

Prior to making a final decision to participate in this program, private providers should contact their local County Board to inform them of their interest in the program.  The provider and County Board will need to work together to create preliminary Ohio Developmental Disabilities Profiles (ODDP) for individuals who are interested in receiving Home and Community-Based Services (HCBS) waivers.

Once a provider makes the decision to participate in the voluntary conversion process:

The ICF-IID operator provides 90-day written notice of intent to convert ICF-IID beds to waiver to the Directors of the Ohio Department of Health (ODH) and DODD. The notice shall contain how many beds will be converted, how many will remain ICF, a statement that the provider has analyzed the financial impact of the proposal and the quality of care of the remaining individuals will not be adversely impacted, ODDP scores/expected funding ranges of transitioning individual(s), Acuity Assessment Instrument (AAI) levels for day programming, as well as intended timeframes for conversion. 

Notices should be sent to:

  • Richard Hodges, Director,  Ohio Department of Health, 246 N. High St., Columbus, Ohio 43215
  • John Martin, Director, DODD, 30 E. Broad St., Columbus, Ohio  43215

    Per Section 5124.62 of the Ohio Revised Code (ORC), the Director of DODD shall approve conversions of ICF-IID beds to HCBS. If the Director of DODD does not approve the proposed conversion, the decision is final and the process ends. 

    Upon approval for ICF Conversion to IO Waiver:

    DODD will send a letter to the ICF-IID provider, the Director of ODH, and the local County Board informing them that the request to convert ICF-IID beds to waiver has been approved. 
  1. Upon approval of the conversion plan, the provider shall give all residents of the facility at least 30 days' notice of the intent to convert some/all beds to waiver. Each resident shall be informed they may do either of the following:  1) the individual may continue to receive ICF-IID services from any willing provider, or 2) the individual may seek HCBS instead of ICF-IID services from any willing provider if eligible and a slot is available. Documentation of notification shall remain available for review by the Office of Provider Standards and Review (OPSR) upon request.
  2. The ICF operator contacts OPSR to complete the Development Application. 
    1. If the operator determines that they want to license the setting in which the new waiver slots will be located, OPSR works with the provider to complete the facility licensing process (approximately 60 day process) which includes:
      1. Notification of local authorities per statute
      2. Completion of required inspection
        1. Building
        2. Water
        3. Sewer
        4. Fire
      3. Feasibility Review
    2. If the operator determines that they do not want to license the setting in which the new waiver slots will be located, OPSR issues a new license, effective the date of the individual's enrollment on the waiver decreasing the capacity of the facility and the bed is surrendered.
    3. OPSR obtains required signatures for Development application/process.
    4. If a full conversion, the provider/operator will work with the Ohio Department of Medicaid (ODM) to follow the closure process. OPSR issues closure letter which notifies ODH and ODM of facility closure and relinquishment of ICF-IID beds. ODH terminates ICF certification and notifies ODM to terminate the Medicaid Provider Agreement. Operator complies with statutory requirements regarding voluntary termination (5124.50 to 5124.53) and Ohio Administrative Code (OAC) 5123:2-3-05.
    5. If a partial conversion, OPSR issues development change letter which notifies ODH and ODM of a decrease in the facility capacity and the relinquishment of a determined number of ICF-IID beds. ODH reduces the ICF's certified capacity and notifies ODM to amend the Medicaid Provider Agreement to reflect reduced capacity. DODD issues new license with reduced capacity.  Operator complies with OAC 5123:2-3-05.
  3. DODD will pay for the waiver services for the transitioning individual. Additional funding may be available to support the conversion of ICF beds, but each case will be reviewed separately based on the specific circumstances of the providers, County Boards and individuals involved, as well as availability of additional funds.
  4. DODD commits to a continuing allocation to the County Board should/when the individual dis-enrolls from the waiver. The continuing amount will be determined by a review of the previous 12 months of state funded waiver payments for the individual. Subject to review and with the discretion of DODD, the continuing allocation amount may be pro-rated if the transitioned individual has not been served on the waiver for at least 12 consecutive months prior to dis-enrollment. This amount will be permanently added to the County Board allocation to maintain residential capacity of the county. The County Board will be responsible for notifying Charles Flowers at Charles.flowers@dodd.ohio.gov in the Division of Medicaid Development and Administration within 90 days when an individual dis-enrolls.
  5. Once the County Board is notified of the provider's intent to participate in the voluntary conversion program, the County Board will assign a Service and Support Administrator (SSA) to the individual considering conversion. The County Board also must be comfortable that they can ensure health and safety. The process should include a discharge plan that specifies the individuals' choice of HCBS provider and anticipated move date. 
  6. When the County Board is ready to begin the process of enrolling the individual on the waiver, they should notify Ann Weisent at Ann.Weisent@dodd.ohio.gov. The notification should be developed with the provider and include the individual's name, projected DDP range, Acuity Score, current living arrangement, proposed living arrangement, and anticipated date of enrollment.
  7. A waiver allocation letter will be forwarded via email to the County Board Superintendent and/or SSA Director from the Division of Medicaid Developmental and Administration acknowledging the utilization of ICF conversion to fund the requested waiver, and copy the provider/operator. 
  8. After the waiver allocation letter is received, the provider and County Board together finalize the ODDP and develop an Individual Service Plan (ISP).
  9.  Upon receipt of the approval letter from the Division of Medicaid Development and Administration, the County Board places the individual(s) on the IO Waiting List and selects XICF Priority Code only. Then the County Board places the individual on the Preliminary Implementation Component Tool (PICT). Based on the Waiting List Record, the enrollment reason will auto populate with XICF. Once the PICT is completed, the County Board shall email Waivercapacity-support@list.dodd.ohio.gov to inform DODD the PICT record is submitted. (There is no separate/additional waiver subtype for this process). The match source code will be XICF. ICF Conversion waivers count toward a County Board's IO Waiver floor. The Department will review the PICT and notify the County Board of the approval via email. Once the County Board receives this email, the may begin the normal waiver enrollment process. Once enrolled, the County Board submits the PAWS plan for the individual using XICF as the Match Source. The County Board must submit the plan using our direct entry application, and NOT the XML upload. Please note, if the individual is to receive HPC services in 15-minute units, the "DC Add On" box in PAWS must be checked in order for the provider to be reimbursed properly. The County Board will communicate any anticipated delays in the enrollment process to the Provider/Operator.

General Items to keep In Mind

The Department strongly suggests utilization of Home Choice option for start-up costs. There is $2,000 available for one-time start-up costs, and $5,000 community transition funding for the SSA's transition coordination. An additional $500 also is available for pre-transition transportation. This option is available only to individuals who are currently residing in an institutional setting and will be moving to a community setting housing four or fewer individuals. An individual receiving a state-funded waiver through conversion of a vacant ICF bed is NOT eligible for Home Choice if they are currently residing in a community setting (i.e.; own home, family home, etc.). See ODM's website for additional information about the Home Choice program.

There is a $0.52 per unit rate incentive for waiver providers who serve individuals moving to a waiver as a result of this conversion initiative. This rate incentive is available for a one year period from the time of conversion.

Also, ICF-IID providers who participate in this voluntary conversion process will be eligible for a semi-annual reassessment of their franchise fees based on bed reductions resulting from conversion efforts.