5101:3-3-24 Prospective rate reconsideration for nursing facilities (NFs) for possible calculation errors.

(A) A facility, group, or association may request a reconsideration of a prospective NF rate on the basis of a possible error in the calculation of the rate as follows;

(1) A request for reconsideration of a prospective rate on the basis of a possible error in the calculation of the rate shall be filed with the Ohio department of job and family services (ODJFS) no more than thirty days after the later of the initial payment of the rate or the receipt of the rate-setting calculation.

(2) The request for a reconsideration of a prospective rate on the basis of a possible error in the calculation of the rate shall be filed in accordance with the following procedures:

(a) The request for rate reconsideration shall be in writing; and

(b) The request shall be addressed to "Ohio Department of Jobs and Family Services, Bureau of Long Term Care Facilities, Reimbursement Section, 30 East Broad Street, 33rd Floor, Columbus, Ohio 43215-3414"; and

(c) The request shall indicate that it is a request for rate reconsideration due to a possible error in the calculation of the rate; and

(d) The request shall include a detailed explanation of the possible error and the proposed corrected calculation; and

(e) The request shall include references to the relevant sections of the Revised Code and/or paragraphs of the Administrative Code as appropriate.

(3) ODJFS shall respond in writing within sixty days of receiving each written request for reconsideration of a prospective rate due to a possible error in the calculation of the rate. If ODJFS requests-additional information to determine whether a rate adjustment is warranted, the NF shall respond in writing and shall provide additional supporting documentation no more than thirty days after the receipt of the request for additional information. ODJFS shall respond in writing within sixty days of receiving the additional information to the request for reconsideration of a prospective rate due to a possible error in the calculation of the rate.

(4) If a rate adjustment is warranted as the result of a reconsideration of a prospective rate due to a possible error in calculation, the adjustment shall be implemented retroactively to the initial service date for which the rate is effective.

(B) ODJFS's decision at the conclusion of the rate reconsideration process shall not be subject to any administrative proceedings under Chapter 119. or any other provision of the Revised Code.

Effective: 07/01/2006
R.C. 119.032 review dates: 07/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02 , 5111.29
Rule Amplifies: 5111.29