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The purpose of this rule is to establish applicable compensation cost limits, the reasonable cost for compensation and compensation disallowances, and costs for duties that may be reported in the direct care cost center for administrators working in ICFs-MR. Paragraph (A) of this rule establishes the annual compensation cost limits for administrators. The compensation cost limit assumes that an administrator worked only in one facility for twelve consecutive months at forty hours per week. Paragraph (B) of this rule uses a “time slice” methodology to identify the hours an administrator works in a facility and related facilities. Time slices are subsequently used to determine the administrator coverage and appropriate compensation cost limits and reasonable compensation cost for each administrator. Paragraph (B)(1) of this rule establishes the coverage requirements, for ICFs-MR licensed by the Ohio department of health (ODH),depending on the ICF-MR’s bed size and any applicable disallowance for a facility not maintaining the appropriate administrator coverage. Paragraph (B)(2) of this rule calculates the reasonable cost for compensation and compensation disallowance if any for each administrator who’s compensation costs exceeds the applicable compensation cost limit, as determined under paragraphs (A) and (B) of this rule, adjusted for days worked in a calendar year and the percentage of time worked. Paragraph (B)(3) of this rule calculates a disallowance for a facility paying more than the cost of one full time administrator for the period. Paragraph (C) of this rule specifies direct care duties and associated costs that an administrator may report under the direct care cost center. The direct care costs reported by the administrator are not subject to the compensation cost limit.
(A) Compensation cost limits for administrators shall be based upon compensation costs for administrators who are non-owners or relatives of owners, as reported on the JFS 02524 Ohio department of job and family services medicaid ICF-MR cost report (Rev. 01/2007) from the calendar preceding the fiscal year in which the rate is paid. The compensation cost limits for administrators excluding owners or relatives of owners who are administrators are calculated as follows:
(1) The compensation cost limits for administrators are calculated from the following JFS 02524 excluding cost reports for providers of outlier services as specified in rules 5101:3-3-17.5 and 5101:3-3- 17.4 of the Administrative Code:
(a) Cost reports for ICFs-MR with a December thirty-first end date; and
(b) Desk reviewed and preliminarily determined to be allowable costs for ICFs-MR.
(2) For each individual non-owner administrator, calculate the hourly rate from the JFS 02524 schedule C-1 as follows:
(a) Calculate the number of days employed by subtracting the employment period beginning date from the employment period ending date. Add one day to the number of days calculated to account for total days worked as reported on the cost report; and
(b) Calculate the number of weeks worked by dividing the number of days employed by seven as calculated under paragraph (A)(2)(a) of this rule; and
(c) Calculate the weekly compensation amount by dividing the compensation amount as reported on the cost report by the number of weeks worked as calculated under paragraph (A)(2)(b) of this rule; and
(d) Calculate the hourly rate by dividing the weekly compensation amount as calculated under paragraph (A)(2)(c) of this rule by the weekly hours as reported on the cost report.
(3) Exclude any administrator’s hourly rate as calculated under paragraph (A)(2) of this rule that is less than the federal minimum wage rate in effect at the end of the cost reporting period.
(4) Excluding administrators as determined in paragraph (A)(3) of this rule, calculate the average annual facility administrator salary for each facility from the JFS 02524 schedule C-1 as follows:
(a) For each administrator calculate the hours worked by multiplying the weekly hours as reported on the cost report by the number of days employed as calculated under paragraph (A)(2)(a) of this rule; and
(b) For all administrators as reported for each facility total the following:
(i) Number of days employed as calculated under paragraph (A)(2)(a) of this rule; and
(ii) Compensation amounts as reported on the cost report; and
(iii) Hours worked as calculated under paragraph (A)(4)(a) of this rule; and
(c) Calculate a weighted facility average weekly hours by dividing the sum of the weighted weekly hours as calculated under paragraph (A)(4)(b)(iii) of this rule by the total number of days employed as calculated under paragraph (A)(4)(b)(i) of this rule; and
(d) Calculate the weighted facility compensation amount:
(i) If the weighted facility average weekly hours as calculated under paragraph (A)(4)(c) of this rule is less than thirty-five hours per week, multiply the total compensation amount as calculated under (A)(4)(b)(ii) of this rule by forty; or
(ii) If the weighted facility average weekly hours as calculated under paragraph (A)(4)(c) of this rule is thirty-five hours or more per week, multiply the total compensation amount as calculated under (A)(4)(b)(ii) of this rule by the weighted facility average weekly hours as calculated under paragraph (A)(4)(c) of this rule; and
(e) Calculate the total salary per year by dividing the weighted facility compensation amount as calculated under paragraph (A)(4)(d) of this rule by the weighted facility average weekly hours as calculated under paragraph (A)(4)(c) of this rule; and
(f) Calculate the average annual facility administrator salary by multiplying the total salary per year as calculated under paragraph (A)(4)(e) of this rule by the number of days in a calendar year and dividing the product by the total number of days employed as calculated under paragraph (A)(4)(b)(i) of this rule.
(5) Group the average annual facility administrator salary for each facility calculated in paragraph (A)(4) (f) of this rule into the following bed size categories based on certified bed size at the end of the cost reporting period:
(a) One to forty-nine; or
(b) Fifty to ninety-nine; or
(c) One hundred to one hundred forty-nine; or
(d) One hundred fifty or more.
(6) For each bed size category under paragraph (A)(5) of this rule calculate the compensation cost limit by summing the average annual facility administrator salary as calculated under paragraph (A)(4)(f) of this rule and dividing the total sum of all average annual facility administrator salary by the number of records summed.
(B) Reasonable costs for compensation and compensation disallowances for administrators are the facility’s desk reviewed, actual, allowable costs reported on the JFS 02524 subject to the applicable coverage requirements, compensation cost limits, and audit by the Ohio department of jobs and family services (ODJFS). The reasonable costs for compensation of administrators is calculated from the JFS 02524 as follows:
(1) The administrator coverage disallowance amount applies to ICFs-MR licensed by the ODH. For each individual administrator’s weekly hours reported on schedule C-1 of the JFS 02524 perform the following steps to determine the administrator coverage disallowance amount:
(a) General parameters.
(i) Facilities with a licensed bed capacity greater than ninety-nine are required to have at least thirty weekly hours of combined administrator coverage reported on schedule C-1 of the JFS 02524. The facility may employ more than one administrator to meet the minimum administrator coverage requirement. At least fifteen hours of the administrator’s time must be spent at the facility between the hours of six a.m. and six p.m. Monday through Friday.
(ii) Facilities with a licensed bed capacity of ninety-nine or less are required to have at least sixteen weekly hours of combined administrator coverage reported on schedule C-1 of the JFS 02524. The facility may employ more than one administrator to meet the minimum administrator coverage requirement. At least eight hours of the administrator’s time must be spent at the facility between the hours of six a.m. and six p.m. Monday through Friday.
(iii) In the event that a facility of one-hundred beds or more has a loss of an administrator, ODJFS will automatically waive the thirty-hour per week minimum administrator coverage requirement for up to a maximum of sixty calendar days per calendar year. ODJFS may waive the thirty-hour per week minimum administrator coverage requirement for longer than sixty days per calendar year if the facility demonstrates that it has been unable to hire an administrator despite diligent recruiting efforts. During any time period when the thirty-hour per week minimum administrator coverage requirement is waived, the sixteen hours per week minimum administrator coverage requirement of the ODH must still be met.
(iv) A facility may hold more than one medicaid provider agreement within the same physical structure. For these type facilities, without regard for provider number distribution, total the number of certified beds in the ICF-MR, then total the number of hours worked by the administrator(s) in the ICF-MR, to determine if the minimum administrator coverage requirement under paragraph (B)(1)(a) of this rule is met.
(b) Calculate the number of calendar days where the minimum administrator coverage requirement under paragraph (B)(1)(a) of this rule was not met by using the weekly hours as reported on schedule C-1 of the JFS 02524 and the employment period for each individual administrator as reported on schedule C-1 of the JFS 02524. Sum each administrator’s weekly hours for each calendar day of the cost reporting period. Determine each calendar day of the cost reporting period that does not meet the minimum administrator coverage requirement under paragraph (B)(1)(a) of this rule and total the number of calendar days that do not meet the minimum administrator coverage requirement.
(c) For each administrator reported on schedule C-1 of the JFS 02524 perform the following steps to determine the administrator coverage disallowance amount for not meeting the minimum administrator coverage requirements under paragraph (B)(1) of this rule:
(i) A minimum administrator coverage requirement time slice is defined as follows:
(a) The number of days employed except when there is an overlap of employment periods for administrators within the same facility; or
(b) When there is an overlap of employment periods for administrators within the same facility, the number of days within a time slice for each administrator is:
(i) The number of days employed for the overlap of an employment period when the administrators are working in the same facility during the same period of time.
(ii) The number of days employed preceding the overlapping employment period.
(iii) The number of days employed subsequent to the overlapping employment period.
(ii) For each minimum administrator coverage requirement time slice, calculate the following:
(a) Acquire the number of certified beds for the facility as of the end of the cost reporting period from schedule A, line 2, column 1 of the JFS 02524; and
(b) Calculate the total number of days employed for each 5101:3-3- 81.2 5 administrator by subtracting the beginning date from the ending date for each time slice and adding one; and
(c) Calculate the total number of days employed where the minimum administrator coverage requirement under paragraph (B)(1)(b) of this rule was not met; and
(d) Calculate the total number of waived days that are automatically provided under paragraph (B)(1)(a)(iii) of this rule that are applicable to each time slice; and
(e) Calculate the total number of additional waived days as determined under paragraph (B)(1)(a)(iii) of this rule that are applicable to the time slice period; and
(f) Calculate the total number of non-waived days by subtracting the waived days as calculated under paragraphs (B)(1)(c)(ii)(d) and (B)(1)(c)(ii)(e) of this rule from the total number of days employed within the time slice where the minimum administrator coverage requirement were not met under paragraph (B)(1)(c)(ii)(c) of this rule; and
(g) Calculate the percentage of time without minimum administrator coverage requirement by dividing the total number of non-waived days as calculated under paragraph (B)(1)(c)(ii)(f) of this rule by the number of days employed within a time slice as calculated under paragraph (B)(1)(c)(ii)(b) of this rule; and
(h) Calculate a daily salary amount for each administrator by dividing the compensation amount by the number of days employed as reported on schedule C-1 of the JFS 02524. For each time slice, calculate the prorated administrator compensation amount by multiplying the daily salary amount for each administrator by the number of days employed in each time slice as calculated under paragraph (B)(1)(c)(ii)(b) of this rule; and
(i) Calculate the administrator coverage disallowance amount by multiplying the prorated administrator compensation amount calculated under paragraph (B)(1)(c)(ii)(h) of this rule by the percentage of time without minimum administrator coverage requirement as calculated under paragraph (B)(1)(c)(ii)(g) of this rule.
(2) Reasonable costs for compensation and compensation disallowances for administrators are the facility’s desk reviewed, actual, allowable costs reported on schedule C-1 of the JFS 02524 subject to the applicable compensation cost limits and audit by ODJFS. For each individual administrator compensation reported on schedule C-1 of the JFS 02524 perform the following steps:
(a) An individual administrator compensation time slice is defined as follows:
(i) The number of days employed except when there is an overlap of an employment period for an administrator working in a related facility; or
(ii) When there is an overlap of an employment period for an administrator working in a related facility, the number of days within an individual administrator compensation time slice for the administrator is:
(a) The number of days employed for the overlap of an employment period when the administrator is working in the related facility during the same period of time.
(b) The number of days employed preceding the overlapping employment period.
(c) The number of days employed subsequent to the overlapping employment period.
(b) For each individual administrator compensation time slice, calculate the following:
(i) Acquire the number of certified beds for the facility as of the end of the cost reporting period from schedule A, line 2, column 1 of the JFS 02524; and
(ii) Acquire the number of certified beds for related facilities that the administrator worked in, during the individual administrator compensation time slice, as of the end of the cost reporting period from schedule A, line 2, column 1 of the JFS 02524; and
(iii) Calculate the total number of certified beds by adding the number of certified beds for the facility as determined under paragraph (B)(2)(b)(i) of this rule and the number of certified beds for any related facilities that the administrator worked in determined under paragraph (B)(2)(b)(ii) of this rule; and
(iv) Acquire the appropriate compensation cost limit as follows:
(a) If the administrator does not work in four or more related facilities, use the total number of certified beds determined under paragraph (B)(2)(b)(iii) of this rule to determine the appropriate compensation cost limit determined under paragraph (A)(6) of this rule; or
(b) If the administrator works in four or more related facilities, the compensation cost limit is the maximum for the bed size category determined under paragraph (A)(6) of this rule; and
(v) Acquire the allowance percentage from schedule C-1 of the JFS 02524 which shall not exceed one hundred-fifty per cent; and
(vi) Calculate the adjusted compensation cost limit by multiplying the compensation cost limit determined under paragraph (B)(2)(b)(iv) of this rule by the allowance percentage determined under paragraph (B)(2)(b)(v) of this rule; and
(vii) Calculate the total number of days employed for each administrator by subtracting the beginning date from the ending date for each time slice and adding one; and
(viii) Determine the total days in the calendar year; and
(ix) Calculate the per cent of days allowed by dividing the number of days in the individual administrator compensation time slice as calculated under paragraph (B)(2)(b)(vii) of this rule by the total days in the calendar year as determined under paragraph (B)(2)(b)(viii) of this rule; and
(x) Calculate the time slice adjusted compensation cost limit by multiplying the per cent of days allowed as calculated under paragraph (B)(2)(b)(ix) of this rule by the adjusted compensation as calculated under paragraph (B)(2)(b)(vi) of this rule; and
(xi) Acquire the weekly hours in the individual administrator compensation time slice for the appropriate time period from schedule C-1 of the JFS 02524; and
(xii) Acquire the related weekly hours in the individual administrator compensation time slice for the appropriate time period from the related facilities’ schedule C-1 of the JFS 02524; and
(xiii) Calculate the total weekly hours in the individual administrator compensation time slice by adding the weekly hours in the individual administrator compensation time slice as determined under paragraph (B)(2)(b)(xi) of this rule and the related weekly hours in the individual administrator compensation time slice as determined under paragraph (B)(2)(b)(xii) of this rule; and
(xiv) Calculate the maximum weekly hours:
(a) If the total weekly hours in the individual administrator compensation time slice as calculated under paragraph (B)(2)(b)(xiii) of this rule is less than thirty-five hours per week then the maximum weekly hours in the individual administrator compensation time slice is forty; or
(b) If the total weekly hours in the individual administrator compensation time slice as calculated under paragraph (B)(2)(b)(xiii) of this rule is greater than or equal to thirty-five hours per week then the maximum weekly hours in the individual administrator compensation time slice is the total weekly hours in the individual administrator compensation time slice; and
(xv) Calculate the hours allocation percentage by dividing weekly hours in the individual administrator compensation time slice as calculated under paragraph (B)(2)(b)(xi) of this rule by the maximum weekly hours as calculated under paragraph (B)(2)(b)(xiv) of this rule; and
(xvi) Calculate the final time slice adjusted compensation cost limit by multiplying the time slice adjusted compensation cost limit as calculated under paragraph (B)(2)(b)(x) of this rule by the hours allocation percentage as calculated under paragraph (B)(2)(b)(xv) of this rule; and
(xvii) Calculate a daily salary amount for each administrator by dividing the compensation amount by the number of days employed as reported on schedule C-1 of the JFS 02524. For each time slice, calculate the prorated administrator compensation amount by multiplying the daily salary amount for each administrator by the number of days employed in each time slice as calculated under paragraph (B)(2)(b)(vii) of this rule; and
(xviii) Acquire the administrator coverage disallowance amount applicable to this time slice as calculated under paragraph (B)(1)(c)(ii)(h) of this rule; and
(xix) Calculate the adjusted prorated administrator compensation amount by subtracting the administrator coverage disallowance amount as calculated under paragraph (B)(2)(b)(xviii) of this rule from the prorated administrator compensation amount as calculated under paragraph (B)(2)(b)(xvii) of this rule; and
(xx) Calculate the individual administrator compensation disallowance by subtracting the final time slice adjusted compensation cost limit as calculated under paragraph (B)(2)(b)(xvi) of this rule from the adjusted prorated administrator compensation amount as calculated under paragraph (B)(2)(b)(xix) of this rule. The result cannot be less than zero.
(xxi) Calculate the final adjusted prorated administrator compensation amount by subtracting the individual administrator compensation disallowance as calculated under paragraph (B)(2)(b)(xx) of this rule from the adjusted prorated administrator compensation amount as calculated under paragraph (B)(2)(b)(xix) of this rule.
(3) For each ICF-MR, determine the overall facility administrator aggregate compensation disallowance for reporting costs in excess of the adjusted compensation cost limit as follows:
(a) Acquire the number of certified beds for the facility as of the end of the cost reporting period from schedule A, line 2, column 1 of the JFS 02524; and
(b) Acquire the appropriate compensation cost limit for the bed size category using the total number of certified beds determined under paragraph (B)(3)(a) of this rule and the compensation cost limit determined under paragraph (A)(6) of this rule; and
(c) Establish the allowance percentage as one hundred-fifty per cent; and
(d) Calculate the adjusted compensation cost limit by multiplying the compensation cost limit determined under paragraph (B)(3)(b) of this rule by the allowance percentage determined under paragraph (B)(3)(c) of this rule; and
(e) Calculate the total administrator allowable compensation by summing the compensation reported on schedule C-1 of the JFS 02524 for all administrators and subtracting any disallowances calculated under paragraphs (B)(1)(c)(ii)(i) and (B)(2)(b)(xx) of this rule; and
(f) Calculate the overall facility administrator aggregate compensation disallowance by subtracting the adjusted compensation cost limit as calculated under paragraph (B)(3)(d) of this rule from the total administrator allowable compensation as calculated under paragraph (B)(3)(e) of this rule. The result cannot be less than zero.
(C) If an administrator works in one or more of the following direct care cost center positions, the compensation earned for performing such duties may be expensed directly to the direct care cost center. Compensation for an administrator performing a direct care cost center function is allowable only for duties which otherwise would require the employment of another individual. The portion of the individual’s total compensation paid by the ICF-MR that may be reported in the direct care cost center shall be determined by multiplying the total compensation by the percentage of time the individual spends performing the direct care duties. The ICF-MR must maintain records documenting the allocation of the individual’s time to these duties. Time studies conducted in accordance with the health care financing administration (HCFA) publication 15-1 (09/08/2005) shall be considered sufficient documentation of the allocation of time. If it is found that the ICF-MR has not sufficiently documented the allocation of time, the cost associated with the undocumented time will be reclassified back to the indirect cost center. Those direct care cost center functions are:
(1) Medical director;
(2) Director of nursing;
(3) Activities director;
(4) Registered nurse (RN);
(5) Licensed practical nurse (LPN);
(6) Recreational therapist;
(7) Psychologist;
(8) Respiratory therapist;
(9) Qualified mental retardation professional (QMRP);
(10) Licensed social worker/counselor;
(11) Chaplain;
(12) Charge nurse registered nurse;
(13) Charge nurse licensed practical nurse.
Effective: 07/01/2007
R.C. 119.032 review dates: 07/01/2012
Promulgated Under: 119.03
Statutory Authority: 5111.01, 5111.02
Rule Amplifies: 5111.241