5101:3-28-10 Federally qualified health centers (FQHCs): prospective payment system cost report.

(A) If the following situations apply to an FQHC, thea JFS 03421 (rev. 07/2001) cost report(s) must be filed with the department:

(1) An entity is newly- qualified as an FQHC on or after July 1, 2001 as described in rule 5101:3-28-01 of the Administrative Code;

(2) An existing FQHC has added a service that has changed in scope because the FQHC began providing a new category of service as defined in paragraph (B) of rule 5101:3-28-09 of the Administrative Code; and

(3) An FQHC has requested that the department review a request for a change in scope of service as described in paragraph (C) of rule 5101:3-28-09 of the Administrative Code.

(B) Filing requirements

(1) If a cost report is required because the FQHC meets the condition described in paragraph (A)(1) of this rule, the cost report must be filed within ninety days after the close of one full year of operation of the new FQHC. The cost report shall be filed in accordance with the instructions specified for the JFS 03421 and must cover the period beginning the first day of the first full month after the new FQHC became qualified as an FQHC.

(2) If a cost report is required because the FQHC has added a new category of service as described in paragraph (A)(2) of this rule, the cost report shall be filed within ninety days after the close of one full year of operation of the new FQHC. The cost report shall be filed in accordance with the instructions specified for the JFS 03421 and shall cover the period beginning on the first day of the first full month after the new category of services was added.

(3) If cost reports are required because the FQHC meets the condition described in paragraph (A)(3) of this rule, two cost reports must be filed.

(a) The first cost report shall be filed in accordance with the instructions specified for the JFS 03421 and shall cover the twelve month period ending the last day of the last month before the service changed in scope and shall be submitted to the department, with all required documentation, within ninety days after the close of the twelve month period.

(b) The second cost report shall be filed in accordance with the instructions specified for the JFS 03421 and shall cover the twelve month period beginning on the first day of the first full month after the service that has changed in scope began operation and shall be submitted to the department with all required documentation within ninety days after the close of the twelve month period.

(C) Failure to file complete and accurate cost reports within the time frames established in paragraph (B) of this rule will result in the department making no adjustments to the rate(s) for a service that the FQHC claims has changed in scope of service. No extensions will be granted for cost report filings.

(D) The cost report form, JFS 03421, to be submitted by the FQHC shall be supplied by the department. The FQHC must request the cost report software from the department by contacting the manager of financial operations within the bureau of health plan policy in the office of medicaid.

(E) The FQHC must complete and return the cost report to the department within the time frames stated in paragraph (B) of this rule.

Effective: 07/01/2006
R.C. 119.032 review dates: 03/09/2006 and 07/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 10/25/01