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This rule establishes an administrative fee applicable to supplemental upper limit payments made to hospital providers, as authorized by section 5111.93 of the Revised Code.
(A) Definitions.
(1) “Hospital provider” means a hospital included in the definition of “public hospital” as described in rule 5101:3-2-50 of the Administrative Code or “state hospital” as defined in rule 5101:3-2-51 of the Administrative Code.
(2) “Supplemental upper limit payment” means the supplemental upper limit payment made to hospital providers as described in rules 5101:3-2-50 and 5101:3-2-51 of the Administrative Code.
(3) “Elected payment amount” means the total amount of funds paid to each hospital under the provisions of rules 5101:3-2-50 and 5101:3-2-51 of the Administrative Code.
(4) “Intergovernmental transfer” means the transfer of money from the hospital provider to the department as required for payment under the provisions of rules 5101:3-2-50 and 5101:3-2-51 of the Administrative Code.
(5) “Health care services administration fund” means the fund described under section 5111.94 of the Revised Code.
(B) Administrative fees.
For each supplemental upper limit payment made to hospital providers after the effective date of this rule, the department of job and family services shall collect or retain a fee equal to ten per cent of the federal financial participation included in the elected payment amount. Administrative fees described in this rule shall not be collected or retained for supplemental upper limit payments that would have been made to hospital providers prior to the effective date of this rule, but were delayed pending the centers for medicare and medicaid services approval of the state plan amendment authorizing the department to make supplemental upper limit payments.
(C) Calculation of administrative fee amounts.
Each hospital provider electing to receive supplemental upper limit payments shall calculate the fee amount by multiplying the difference between the elected payment amount and the required intergovernmental transfer by ten per cent. The product will be each hospital provider’s administrative fee for the supplemental upper limit payment.
(D) Payment of administrative fees.
(1) Each hospital provider that elects to receive supplemental upper limit payments shall make payments of fees determined in paragraph (C) of this rule to the department via electronic funds transfer. The fee payments must be made by the due date established by the department for the receipt of the required intergovernmental transfers for each supplemental upper limit payment, except for fee payment that would be due in calendar year 2003. For the fee payment that would be due in calendar year 2003, the administrative fee payment due date is extended to the due date established by the department for the receipt of the required intergovernmental transfer for the supplemental upper limit payment for the six-month payment period ending on December 31, 2003.
(2) If a hospital provider fails to make fee payments or remits the incorrect fee amount by the established due date, the department shall reduce the federal financial participation portion of the total payment amount by the amount of the past due fee, or the past due portion of the fee, prior to making the supplement upper limit payment. The department shall notify any hospital provider for which a fee adjustment is made.
(E) Deposits into the health care services administration fund.
All amounts received by the department under this rule shall be deposited into the state treasury to the credit of the health care services administration fund described under paragraph (A) of this rule. If the department applies the provisions of paragraph (D)(2) of this rule, the department shall transfer an amount equal to the past due fee or the past due portion of the fee for each hospital to which paragraph (D)(2) is applied, from fund 3F0, health care federal, to fund 5U3, health care services administration. This transfer shall be on the same day that elected payment amounts are made to hospital providers.
(F) The total supplemental upper limit payment paid to each hospital provider electing to receive supplemental upper limit payments shall be reported as a medicaid payment by each participating hospital provider, and shall include the administrative fee amounts.
HISTORY: Eff 9-1-03
Rule promulgated under: RC 119.03
Rule authorized by: RC 5111.93
Rule amplifies: RC 5111.01, 5111.02, 5111.93
R.C. 119.032 review dates: 09/01/2008