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Ohio Laws and Rules
(A) All ICFs-MR shall submit to the Ohio department of job and family services (ODJFS) a quarterly case mix assessment, using the JFS 02221 “Individual Assessment Form Answer Sheet” (rev.6/03), for each resident of a medicaid certified ICF-MR bed, regardless of payment source or anticipated length of stay, to reflect the resident’s condition on the reporting period end date, which is the last day of the calendar quarter. The ICF-MR shall follow the instructions in the JFS 02220 “Ohio ICF-MR Individual Assessment Form” (rev. 4/07) when completing the JFS 02221.
(1) For purposes of this rule, the following residents shall be considered residents of a medicaid certified bed on the reporting period end date:
(a) Residents admitted to the ICF-MR prior to the reporting period end date and physically residing in the ICF-MR on the reporting period end date; and
(b) Residents admitted to the ICF-MR on the reporting period end date from a non-ICF-MR setting (home, hospital, adult care facility, rest home, nursing facility (NF)); and
(c) Residents transferred or admitted into the ICF-MR from another ICF-MR on the reporting period end date; and
(d) Residents temporarily absent on the reporting period end date but for which the facility is receiving payment, from any source, to hold a bed for the resident during a hospital stay, visit with friends or relatives, or participation in therapeutic programs outside the facility; and
(2) The following residents shall not be considered residents of a medicaid certified bed as of the reporting period end date:
(a) Residents discharged from the ICF-MR prior to or on the reporting period end date; and
(b) Residents transferred to another ICF-MR prior to or on the reporting period end date; and
(c) Residents who die prior to or on the reporting period end date.
(B) ICF-MR providers shall complete and submit a signed JFS 02222 “ICF-MR Certification Form” (rev. 3/07) with the quarterly submission of JFS 02221 data identifying the name of the ICF-MR, its provider number, the total number of beds the provider has certified by the Ohio department of health (ODH) for medicaid, and total number of residents in the ICF-MR as of the reporting period end date for whom the provider must submit a JFS 02221 form pursuant to paragraph (A)(1) of this rule.
(C) The JFS 02222 certification form and a copy of the JFS 02221 assessment data forms, in the formats approved by ODJFS, shall be submitted to ODJFS postmarked no later than the fifteenth day of the month following the reporting period end date. The providers shall retain the original JFS 02221 assessment data forms in the resident’s record.
(1) If the data is submitted to ODJFS in paper format, the copies of the ODJFS 02221 assessment data forms must be legible and photo-copied single-sided. All of the copies of the JFS 02221 assessment data forms from the same provider number shall be banded together with the provider’s JFS 02222 certification form and submitted at the same time in one box or envelope.
(2) If the data is submitted to ODJFS in an electronic format, a paper copy of the JFS 02222 certification form must accompany the electronic data. The electronic data must be submitted in the exact record layout provided in the ODJFS free software. The data in electronic format must be identified with the facility name and medicaid provider number.
(D) Effective December 31, 2007 all ICFs-MR must submit the JFS 02221 assessment data electronically. After that date, ODJFS will not accept JFS 02221 assessment data in a paper format. A paper copy of the JFS 02222 certification form must still accompany the electronic data.
Replaces: 5101:3-3-75
Effective: 07/01/2007
R.C. 119.032 review dates: 07/01/2012
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.23
Prior Effective Dates: 10/1/92 (Emer.), 12/31/92, 9/30/93 (Emer.), 1/1/94, 1/13/02, 2/2/06