Intermediate Care Facilities (ICF/IID

Updated: October 2026

Purpose

ND Medicaid covers services provided by Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) that are certified, licensed, and enrolled with ND Medicaid.

Applicability

Eligible Providers

To receive payment from ND Medicaid, the eligible servicing and billing providers must be enrolled with ND Medicaid on the date of service, and their National Provider Identifiers (NPIs) must be active in their Medicaid enrollment records. Servicing providers acting as a locum tenens provider must be enrolled with ND Medicaid, and services they provide must be billed with their NPI. Please refer to provider enrollment for additional details on enrollment eligibility and supporting documentation requirements.

Eligible Members

Providers are responsible for verifying a member’s eligibility before providing services. Eligibility can be verified using the ND Medicaid MMIS Portal or through the Automated Voice Response System by dialing 1.877.328.7098.

Level of Care

ND Medicaid will not cover ICF/IID services unless the member meets ICF/IID level of care criteria.

See 42 CFR §440.150.

Individuals with related conditions means someone who has a severe, chronic disability that meets all the following conditions:

It is attributable to
- Cerebral palsy or epilepsy; or
- Any other condition, other than mental illness, found to be closely related to Intellectual Disability because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of intellectually disabled persons, and requires treatment or services similar to those required for these persons.
It is manifested before the person reaches age 22.
It is likely to continue indefinitely.
It results in substantial functional limitations in three or more of the following areas of major life activity:
- Self-care.
- Understanding and use of language.
- Learning.
- Mobility.
- Self-direction.
- Capacity for independent living.

See 42 CFR §435.1010.

Refer to the Member Eligibility Manual for additional information regarding eligibility including information regarding limited coverage categories.

Covered Services and Limits

General Provider Policies

The General Provider Policies details basic coverage requirements for all services. Basic coverage requirements include:

The provider must be enrolled in ND Medicaid;
Services must be medically necessary;
The member must be eligible on the date of service; and
If applicable, the service has an approved service authorization.

The Procedure Code Look-up Tool can be used to identify if a procedure code is covered by ND Medicaid along with code specific details such as ORP requirements, Service Authorization requirements, and current rates.

Limits on Leave Days

Hospital Leave

ND Medicaid will cover a maximum of 15 days per occurrence for hospital leave. The purpose of the hospital leave policy is to ensure that a bed is available when a member returns to the facility. A facility may not bill for hospital leave days when it is known that the member will not return to the facility.

Once the facility accepts payment for hospital leave on behalf of a member, then the facility must still bill ND Medicaid for hospital leave days beyond the 15th day that the resident's bed was held. Any days exceeding the 15-day limit are noncovered days.

Therapeutic Leave

ND Medicaid will cover a maximum of 30 therapeutic leave days per member per calendar year.

Once the facility accepts payment for therapeutic leave on behalf of a member, then the facility must still bill ND Medicaid for therapeutic leave days beyond the 30th day that the resident's bed was held. Any days exceeding the 30-day limit are noncovered days.

Service Authorization Requirements

No service authorization required.

Noncovered Services

General Noncovered Services

The Noncovered Services Policy contains a general list of services that are not covered by North Dakota Medicaid.

ICF/IID Non-Covered Services

The following services are not included in the ICF/IID per diem payment. The services may be separately billed to North Dakota Medicaid by the provider furnishing the service:

Prescription drugs, except vaccines;
Physician services for direct resident care;
Laboratory and radiology services performed outside of facility;
Mental health services;
Dental services; and
Prosthetic devices and prosthetic supplies provided for an individual resident which are prescribed by a doctor.

Documentation Requirements

General Requirements

Providers must keep legible medical and financial records that fully justify and disclose the extent of services provided and billed to ND Medicaid. Records must be retained for at least 7 years after the last date the claim was paid or denied. Providers must follow the documentation requirements in the Provider Requirements Policy.

Reimbursement Methodology and Claim Instructions

Timely Filing

ND Medicaid must receive an original Medicaid primary claim within one hundred eighty (180) days from the date of service. The time limit may be waived or extended by ND Medicaid in certain circumstances. The Timely Filing Policy contains additional information.

Third-Party Liability

Medicaid members may have one or more additional source of coverage for health services. ND Medicaid is generally the payer of last resort. Providers must pursue the availability of third-party payment sources. The Third Party Liability Policy contains additional information.

Client Share (Recipient Liability)

Client share (recipient liability) is the monthly amount a member must pay toward the cost of medical services before the Medicaid program will pay for services received. The Client Share Policy contains additional information.

Reimbursement

A claim for services must be submitted at the provider’s usual and customary charge. Payment for services is limited to the lesser of the provider’s usual and customary charge or the ND Medicaid calculated reimbursement.

Claim Form

ICF Services must be billed using the UB 04 claim form or 837i. Detailed claim instructions are available on the ND Medicaid Provider Guidelines, Policies & Manual webpage.

Claim Requirements

A member on medical or therapeutic leave on the last day of the month whose bed is being held by the facility is “Still a Patient”.

The number of billed units must include the date of discharge or death.

ICF/IID claims must be submitted to ND Medicaid using the following Revenue Codes when billing for:

Revenue Code 0110 – In-House Medicaid Days
Revenue Code 0180 – Therapeutic Leave Days
Revenue Code 0185 – Hospital Leave Days

A facility must submit a claim for every month a member is in the facility, even if insurance has paid for the services. This allows the system to apply recipient liability towards other claims. The claim should be submitted immediately after the month is over. Do not bill more than one calendar month per claim.

ND Medicaid cannot make any payment for ICF/IID services to the ICF/IID provider if a member has elected hospice care. The hospice provider is paid the rate applicable to the member and is responsible for paying the facility for services provided to the member. Once a member has elected hospice benefits, the ICF/IID provider may not submit a claim for services provided while the member is on hospice.

Definitions

ICF/IID services – those items and services provided in an ICF for individuals with intellectual disability or individuals with related conditions. The primary purpose of an ICF is to furnish health or rehabilitative services.

References

Contact

Medical Services
600 East Boulevard Ave
Bismarck, ND 58505-0250
Phone: (701) 328-2310
Email: dhsmedicalservices@nd.gov