5101:3-3-32 Debt estimation methodology for change of operator, facility closure, voluntary termination, involuntary termination, or voluntary withdrawal for nursing facilities (NFs) and intermediate care facilities for the mentally retarded (ICFs-MR).

(A) The Ohio department of job and family services (ODJFS) shall use the debt estimation methodology set forth in this rule to estimate the exiting operator’s actual and potential debts to ODJFS and the United States centers for medicare and medicaid services (CMS) under the medicaid program.

(B) ODJFS shall total the value of all of the following that are determined applicable in calculating the debt estimate:

(1) Overpayments determined due to ODJFS pursuant to section 5111.27 of the Revised Code, including the following:

(a) Overpayments owed to ODJFS for adjudicated final fiscal audit periods.

(b) Overpayments identified in proposed adjudication orders that have been issued but not adjudicated.

(c) Overpayment amounts for any outstanding periods where a final fiscal audit has not yet been issued. Such amounts are estimated by generating preliminary reports of amounts owed by the exiting operator for the applicable periods.

(2) Monies owed to ODJFS and CMS resulting from penalties authorized by federal and state law, including but not limited to the following:

(a) Civil monetary penalties (CMPs) imposed pursuant to 42 C.F.R. 488.430.

(b) Penalties assessed pursuant to section 5111.28 of the Revised Code for lack of proper notice of a change of operator, facility closure, voluntary termination, or voluntary withdrawal from the medicaid program.

(d) Penalties assessed pursuant to rule 5101:3-3-22 of the Administrative Code when a provider fails to furnish invoices or other documentation that ODJFS requests during an audit.

(3) Interest monies owed to ODJFS pursuant to section 5111.28 of the Revised Code, and to CMS pursuant to 42 C.F.R. 488.442.

(4) Monies owed ODJFS and CMS pursuant to sections 5111.68 and 5111.685 of the Revised Code, including a final fiscal audit for the last fiscal year or portion thereof that the exiting operator participated in the medicaid program.

(5) Franchise permit fee (FPF) owed to ODJFS pursuant to section 3721.53 or 5112.33 of the Revised Code. FPF owed to ODJFS shall include unpaid FPF for the following:

(a) Amounts due for periods assessed or to be assessed but for which payment is not yet required pursuant to section 3721.53 or 5112.33 of the Revised Code.

(b) Amounts due that are certified to the Ohio attorney general’s office for collection, including penalties assessed pursuant to section 3721.54 or 5112.34 of the Revised Code for failure to pay the full amount when due.

(6) Monies owed for recapture of excess depreciation for ICFs-MR.

(7) Monies owed due to a credit balance.

(8) Monies owed pursuant to successor liability or assumption of liability agreements the exiting operator entered into.

(9) Other amounts ODJFS determines are applicable.

(C) The sum of the amounts determined owed, or estimated to be owed, to ODJFS and CMS pursuant to paragraphs (B)(1) to (B)(9) of this rule shall be the total estimated debt.

(D) ODJFS may release a portion of funds withheld pursuant to division (A) of section 5111.681 of the Revised Code if the funds withheld are materially greater than the debt calculated by the department in the initial debt summary report issued pursuant to section 5111.685 of the Revised Code.

Effective: 03/19/2012

R.C. 119.032 review dates: 12/15/2011 and 03/01/2017

Promulgated Under: 119.03

Statutory Authority: 5111.02, 5111.689

Rule Amplifies: 3721.53, 3721.54, 5111.27, 5111.28, 5111.68, 5111.681, 5111.683, 5111.685, 5112.33, 5112.34

Prior Effective Dates: 8/31/10 (Emer.), 11/29/10