Fiscal Year 2023 Waiver Wage Attestation Form (7/1/2022 to 6/30/2023)

Enter applicable agency information in the data fields below.  All data fields are required to be filled out.  The form below will self-populate the fields from the information entered in the data fields.

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Type of Waiver-funded provider (Please check all that apply):

I, [Authorized Agency Representative], as the [Title of Authorized Agency Representative] of [Agency Name], certify that [Agency Name] has administered all State Fiscal Year 2023 legislatively and/or administratively mandated wage increases to benefit direct care staff as prescribed below.

For State Fiscal Year 2023:

  • Pursuant to Public Act 102-0699 and as previously approved via waiver amendment by the federal Centers for Medicare and Medicaid Services (CMS), providers of community-based services and supports to individuals with intellectual and developmental disabilities shall increase wages as follows:
    • Effective January 1, 2023, as previously approved by federal CMS, for Direct Support Professionals (DSPs), by $1.00 per hour, with at least $0.50 (50%) of those funds to be provided for a $0.50 per hour direct increase to all DSP wages, with the remaining $0.50 (50%) to be used flexibly for wage increases for DSPs and other frontline staff not covered by the federal Department of Labor Bureau of Labor Statistics’ mean hourly wage increases; and
    • Effective January 1, 2023, as previously approved by federal CMS approval, for non-executive direct care staff, excluding DSPs, to the federal Department of Labor Statistics’ mean hourly wage based on the same or similar occupation title.
  • Any increases provided to DSP wages between July 1, 2022, and December 31, 2022, that a provider voluntarily provided or was mandated to provide based on local minimum wage requirements, will be inclusive towards the DSP wage increase requirements effective January 1, 2023 (as federal CMS approved) so long as the increase follows the above language from Public Act 102-0699.

Agency Name: [Agency Name]

Agency FEIN: [Agency FEIN]

Agency Address: [Agency Address]

Type of Waiver-funded provider:
24-hour CILA provider
Enhanced Residential (37U)
Intermittent CILA provider
Host Family CILA provider

Authorized Agency Representative Name: [Authorized Agency Representative Name]