Fiscal Year 2023 ICF and MC/DD 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 ICF or MC/DD 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 State Plan Amendment by the federal Centers for Medicare and Medicaid Services (CMS), facilities licensed by the Department of Public Health under the ID/DD Community Care Act as ID/DD facilities and under the MC/DD Act as MC/DD facilities, shall increase wages as follows:
    • Effective January 1, 2023, as previously approved by federal CMS, for all direct support personnel and all other frontline personnel who work in residential and community day services/developmental training settings and are not subject to the Bureau of Labor Statistics’ mean hourly wage increases, 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 aide base wages, with the remaining $0.50 (50%) to be used flexibly for base wage increases to the rate methodology for aides; and
    • Effective January 1, 2023, as previously approved by federal CMS, for non-executive direct care staff, excluding aides, to the federal Department of Labor Statistics’ mean hourly wage based on the same or similar occupation title.
  • Any wage increases provided to direct support personnel in residential and community day services settings 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 aide wage increase requirements effective January 1, 2023 (subject to federal CMS approval) 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 ICF or MC/DD provider:
ICF provider
MC/DD provider

Authorized Agency Representative Name: [Authorized Agency Representative Name]