Chapter 5123:2-7 Intermediate Care Facilities

5123:2-7-01 [Rescinded] Intermediate care facilities - definitions.

Effective: 7/8/2018
Five Year Review (FYR) Dates: 4/23/2018
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5111.226, 5111.02
Rule Amplifies: 5111.02 , 5123.04, 5111.226
Prior Effective Dates: 01/10/2013

5123:2-7-02 Intermediate care facilities - provider agreements.

(A) For the purposes of this rule, the following definitions shall apply:

(1) "Closure" means the discontinuance of the use of the building or part of the building that houses the intermediate care facility, and that results in the relocation of the facility's residents who continue to require intermediate care facility services.

(a) A facility's closure occurs regardless of whether there is a replacement of the facility whereby the operator completely or partially replaces the facility's physical plant through the construction of a new physical plant or the transfer of the facility's license from one physical plant location to another.

(b) Facility closure occurs regardless of whether residents of the closing facility elect to be relocated to the operator's replacement facility or to another intermediate care facility.

(c) A facility closure occurs regardless of action taken by the Ohio department of health related to the facility's certification under Title XIX of the Social Security Act, 79 stat. 286 (1965), 42 U.S.C. 1396, that may result in the transfer of part of the facility's survey findings to a replacement facility, or related to retention of a license as a residential facility under Chapter 5123. of the Revised Code.

(d) The last effective date of the provider agreement of a closed facility will be the date of the relocation of the last resident.

(2) "Operator" means the individual, partnership, association, trust, corporation, or other legal entity that operates an intermediate care facility.

(3) "Reasonable assurance period" means a certain period of time, determined by the centers for medicare and medicaid services, for which a long-term care facility operator whose provider agreement has been involuntarily terminated is required to operate without recurrence of the deficiencies that were the basis for termination. Participation in the medicare and medicaid programs may resume only following that period. If corrections were made before submission of a new request for participation, the period of compliance before the new request is counted as part of the period.

(4) "Voluntary withdrawal" means the operator elects to voluntarily terminate from the medicaid program.

(B) Each intermediate care facility shall have a medicaid provider agreement with the Ohio office of medical assistance. Execution and maintenance of a provider agreement between the Ohio office of medical assistance and the operator of an intermediate care facility is also contingent upon compliance with requirements set forth in this rule.

(C) An intermediate care facility shall:

(1) Execute the provider agreement in the format provided by the Ohio office of medical assistance.

(2) Apply for and maintain a valid license to operate.

(3) Comply with the provider agreement and all applicable federal, state, and local laws and rules.

(4) Keep records and file cost reports as required by rule 5123:2-7-12 of the Administrative Code.

(5) Open all records relating to the costs of its services for inspection and audit by the department and the Ohio office of medical assistance and otherwise comply with rule 5123:2-7-12 of the Administrative Code.

(6) Supply to the department and the Ohio office of medical assistance such information as the department or the Ohio office of medical assistance requires concerning services to individuals who have applied for or been determined to be eligible for medicaid.

(7) Provide the following necessary information to process records for payment and adjustment:

(a) Submit Ohio office of medical assistance form 09401, "Facility CDJFS Transmittal" (revised April 2011), to the county department of job and family services for any information regarding a specific resident for maintenance of current and accurate records; and

(b) Submit Ohio office of medical assistance form 09400, "Nursing Facility Payment and Adjustment Authorization" (revised October 2012), to the Ohio office of medical assistance to initiate, terminate, or adjust medicaid payment for a specific resident as required.

(8) Permit access to the facility and its records for inspection by the department, the Ohio office of medical assistance, the Ohio department of health, the county department of job and family services, and any other state or local government entity having authority to inspect, to the extent of that entity's authority.

(9) In the case of a change of operator as defined in section 5111.65 of the Revised Code, adhere to the following procedures.

(a) The exiting operator or owner and entering operator must provide a written notice to the department and the Ohio office of medical assistance, as provided in section 5111.67 of the Revised Code, at least forty-five days prior to the effective date of any actions that constitute a change of operator for the intermediate care facility, but at least ninety days if residents are to be relocated. An exiting operator that does not give proper notice is subject to the penalties specified in section 5111.28 of the Revised Code.

(b) The entering operator must submit documentation of any transaction (e.g., sales agreement, contract, or lease) as requested by the department or the Ohio office of medical assistance to determine whether a change of operator has occurred as specified in section 5111.67 of the Revised Code.

(c) The entering operator shall submit an application for participation in the medicaid program and a written statement of intent to abide by rules of the department and the Ohio office of medical assistance, the provisions of the assigned provider agreement, and any existing centers for medicare and medicaid services form CMS-2567, "Statement of Deficiencies and Plan of Correction" (revised February 1999), submitted by the exiting operator.

(d) An entering operator is subject to the same survey findings as the exiting operator unless the entering operator does not accept assignment of the exiting operator's provider agreement. Refusal to accept assignment results in termination of certification on the last day of the exiting operator's participation in medicaid. An entering operator who refuses assignment may reapply for medicaid participation and must undergo a complete initial certification survey by the Ohio department of health. There may be gaps in medicaid coverage at the facility.

(10) Comply with Title VI of the Civil Rights Act, 42 U.S.C. 2000 d(1964), Title VII of the Civil Rights Act, 42 U.S.C. 2000 e(1991), and Public Law 101-336 (the Americans with Disabilities Act of 1990), 42 U.S.C. 12101(2008), and shall not discriminate against any resident on the basis of race, color, age, sex, creed, national origin, or disability.

(11) Provide notice to the department within five days of any bankruptcy or receivership pertaining to the provider. All requests shall be in writing and shall be mailed to "Ohio Department of Developmental Disabilities, Division of Medicaid Development and Administration, 30 East Broad Street, 13th Floor, Columbus, Ohio 43215-3414" or faxed to (614) 466-0652.

(12) Provide the department, the Ohio office of medical assistance, the resident or guardian, and anyone designated by the resident or guardian written notice at least ninety days prior to a closure or voluntary withdrawal from the medicaid program. An intermediate care facility that does not issue the proper notice is subject to the penalties specified in section 5111.28 of the Revised Code.

(D) An intermediate care facility shall not:

(1) Charge fees for the application process of a medicaid individual or applicant.

(2) Charge a medicaid individual an admission fee.

(3) Charge a medicaid individual an advance deposit.

(4) Directly bill its residents for or directly pass through to its residents the franchise permit fee.

(5) Require a third party to accept personal responsibility for paying the facility charges out of his or her own funds. However, the facility may require a representative who has legal access to an individual's income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the individual's income or resources if the individual's medicaid application is denied and if the individual's cost of care is not being paid by medicare or another third-party payor. A third-party guarantee is not the same as a third-party payor (i.e., an insurance company), and this provision does not preclude the facility from obtaining information about medicare and medicaid eligibility or the availability of private insurance. The prohibition against third-party guarantees applies to all individuals and prospective individuals in all intermediate care facilities regardless of payment source. This provision does not prohibit a third party from voluntarily making payment on behalf of an individual.

(E) Effective dates of provider agreements

(1) Effective dates of initial provider agreements generally are assigned by the state survey agency on the basis of findings of compliance or substantial compliance with standards of certification.

(2) If a provider agreement is involuntarily terminated by the centers for medicare and medicaid services as the result of a look behind survey, re-entry into the medicaid program requires satisfaction of the reasonable assurance period as set forth in the "Medicaid State Operations Manual," chapter 2, section 2016F (October 1, 2010).

(F) Conditional provider agreements and cancellation clauses

(1) If the state survey agency determines that an intermediate care facility is in substantial compliance with medicaid standards but has deficiencies that must be corrected, the Ohio office of medical assistance may execute a conditional provider agreement for a term of up to twelve full calendar months, subject to an automatic cancellation clause.

(2) The intermediate care facility must correct deficiencies within sixty days following the scheduled date of correction as established by the state survey agency.

(3) If deficiencies are corrected before the cancellation date, the state survey agency may rescind the cancellation notice, and shall notify the department and the Ohio office of medical assistance in writing of its decision.

(4) If deficiencies are not corrected before the cancellation date, the state survey agency may propose termination of the provider agreement.

(5) If deficiencies are not corrected, the Ohio office of medical assistance may cancel the provider agreement in accordance with section 5111.06 of the Revised Code, unless one of the following occurs:

(a) The state survey agency finds that all required corrections have been made and notifies the department and the Ohio office of medical assistance; or

(b) The state survey agency determines that substantial progress has been made in carrying out a plan of correction that has been submitted to and accepted by the state survey agency.

(G) At the request of the department or upon its own initiative, the Ohio office of medical assistance may terminate, suspend, or not enter into the provider agreement upon thirty days written notice to the provider for violations of Chapter 5111. of the Revised Code; Chapters 5101:3-1, 5101:3-3, and 5123:2-7 of the Administrative Code; and if applicable, subject to Chapter 119. of the Revised Code.

(1) In accordance with section 5111.22 of the Revised Code, a provider agreement may be terminated, denied, or not renewed if the Ohio office of medical assistance determines such an agreement is not in the best interests of the state or medicaid recipients. Best interests include, but are not limited to:

(a) The provider has not fully and accurately disclosed information as required by the provider agreement or any rule contained in division 5101:3 or 5123:2 of the Administrative Code;

(b) The provider has failed to abide by or to have the capacity to comply with the terms and conditions of the provider agreement and/or rules and regulations promulgated by the department or the Ohio office of medical assistance;

(c) The provider has been found liable by a court for negligent performance of professional duties;

(d) The provider has failed to file cost reports as required by rule 5123:2-7-12 of the Administrative Code;

(e) The provider has made false statements or has altered records, documents, or charts. Alteration does not include properly documented correction of records;

(f) The provider has failed to cooperate or provide requested records or documentation for purposes of an audit or review of any provider activity by any federal, state, or local agency;

(g) The provider has been found in violation of section 504 of the Rehabilitation Act of 1973, the Civil Rights Act of 1964, or Public Law 101-336 (the Americans with Disabilities Act of 1990) in relation to the employment of individuals, the provision of services, or the purchase of goods and services;

(h) The attorney general, auditor of state, or any board, bureau, commission, or agency has recommended termination of the provider agreement where the reason for the request bears a reasonable relationship to the administration of the medicaid program or the integrity of state and/or federal funds;

(i) The provider has violated the prohibition against billing medicaid residents for covered services or factoring as found in rule 5101:3-1-13.1 or 5101:3-1-23 of the Administrative Code;

(j) The facility has been found by the Ohio department of health during a survey of the facility to have an emergency that is the result of a determination that there is noncompliance at the condition of participation level that constitutes immediate jeopardy; and

(k) The provider fails to pay the full amount of a franchise permit fee pursuant to section 5112.341 of the Revised Code.

(2) The Ohio office of medical assistance shall terminate, deny, or not renew a provider agreement when any of the situations set forth in division (D) of section 5111.06 of the Revised Code occur.

(3) Notices and termination orders shall comply with provisions set forth in section 5111.06 of the Revised Code.

(H) The county department of job and family services shall use the Ohio office of medical assistance form 09401, "Facility CDJFS Transmittal" (revised April 2011), to communicate information regarding a specific individual.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-03 Intermediate care facilities - institutions eligible to participate in medicaid.

(A) For the purposes of this rule, the following definitions shall apply:

(1) "Certification" means the process by which the state survey agency certifies its findings to the federal centers for medicare and medicaid services or the Ohio office of medical assistance with respect to a facility's compliance with health and safety requirements of divisions (a), (b), (c), and (d) of section 1919 of the Social Security Act, 42 U.S.C. 1396 r(1999).

(2) "Certified beds" mean beds that are counted in a provider facility that meets medicaid standards. A count of facility beds may differ depending on whether the count is used for certification, licensure, eligibility for medicaid payment formulas, eligibility for waivers, or other purposes.

(3) "Distinct part" means a portion of an institution or institutional complex that is certified to provide intermediate care facility services. A distinct part shall be physically distinguishable from the larger institution and fiscally separate for cost reporting purposes. A distinct part must meet the requirements of 42 C.F.R. 440.150(1994).

(4) "Facility" means the entity subject to certification and approval in order for the provider to be approved for medicaid payment. A facility may be an entire institution or may be a distinct part of an institution.

(5) "Intermediate care facility services" means those services provided to eligible individuals requiring a level of care and active treatment as set forth and defined in rule 5101:3-3-07 of the Administrative Code and that are available in facilities certified as intermediate care facilities by the Ohio department of health or by the state survey agency of another state.

(B) Requirements for participation

To participate in the Ohio medicaid program and receive payment for intermediate care facility services provided to eligible residents, operators shall meet all of the following requirements:

(1) Operate a facility that meets the licensure, registration, and other applicable state standards as set forth in this rule; and

(2) Operate a facility certified by the Ohio department of health or by the state survey agency of another state as being in compliance with applicable federal regulations for medicaid participation as an intermediate care facility with a minimum of four intermediate care facility certified beds, as set forth in this rule; and

(3) Operate a facility for which the provider has a medicaid provider agreement with the Ohio office of medical assistance.

(C) Qualified types of Ohio intermediate care facilities

To be eligible for certification a facility shall qualify as one of the following:

(1) A residential facility licensed by the department in accordance with section 5123.19 of the Revised Code and rules adopted pursuant to Chapter 5123. of the Revised Code, with an operator who has received development approval to operate the residential facility as an intermediate care facility under one of the following conditions:

(a) An operator has requested a new residential facility license and obtained development approval from the department pursuant to rule 5123:2-3-26 of the Administrative Code to operate the facility as an intermediate care facility; or

(b) An operator of an existing residential facility who has received development approval to operate a facility other than an intermediate care facility, and has submitted a new request for development approval that specifies the plan to modify the type or source of funding for the facility, and has received development approval from the department pursuant to rule 5123:2-3-26 of the Administrative Code to operate the facility as an intermediate care facility.

(2) As described in section 5123.192 of the Revised Code, a nursing home or portion of a nursing home licensed by the Ohio department of health that holds beds initially certified as intermediate care facility beds before June 30, 1987, that continue to be certified as intermediate care facility beds.

(3) A county home, county nursing home, or district home operated in compliance with Chapter 5155. of the Revised Code that was certified as an intermediate care facility before January 20, 2005.

(D) Certification of intermediate care facilities and beds subject to certification survey

(1) Certification

A facility's certification as an intermediate care facility by the Ohio department of health or by the state survey agency of another state governs the types of services the facility may provide.

(2) Provider agreements

A provider agreement with an Ohio intermediate care facility shall include any part of the facility that meets standards for certification of compliance with federal and state laws for participation in the medicaid program.

(3) Emergency services

(a) Waiver of licensed capacity.

(i) To accommodate persons in emergency need of services, the department may issue to the operator of a licensed residential facility a waiver of licensed capacity.

(ii) A waiver of licensed capacity is time-limited and temporarily permits the operator to exceed the maximum number of licensed beds.

(b) Institutional respite care.

(i) A waiver of licensed capacity may be made specifically in order to provide institutional respite care as a prior authorized service to persons enrolled in a home and community based services waiver in accordance with division 5101:3 of the Administrative Code.

(ii) Beds designated for institutional respite care for persons enrolled in home and community-based services waivers shall not be included in the provider agreement.

(4) Beds subject to certification survey

(a) All beds in a medicaid-participating intermediate care facility that are not designated for institutional respite care for persons enrolled in a home and community-based services waiver shall be surveyed to determine compliance with the applicable certification standards.

(b) If the beds are certifiable, they shall be included in the provider agreement.

(c) Beds authorized through a waiver of residential facility licensed capacity in accordance with rule 5123:2-3-26 of the Administrative Code that are used to provide intermediate care facility services shall be included in the provider agreement.

(d) The only other basis for allowing nonparticipation of a portion of an Ohio intermediate care facility is certification of noncompliance by the Ohio department of health.

(E) Requirements for out-of-state providers of intermediate care facility services

(1) To participate in the Ohio medicaid program and receive payment for intermediate care facility services to eligible Ohio residents, an operator of a facility located outside Ohio shall meet all of the following requirements in its state of origin:

(a) The operator of the facility shall hold a valid state-required license, registration, or equivalent from the respective state that specifies the level(s) of care the facility is qualified to provide; and

(b) The operator of the facility shall hold a valid and current medicaid provider agreement from the respective state as an intermediate care facility provider type.

(2) Additionally, out-of-state providers shall meet the following Ohio requirements:

(a) The operator of the facility shall have a current, completed, and signed Ohio office of medical assistance form 03623 on file with the Ohio office of medical assistance; and

(b) The operator of the facility shall obtain resident-specific and date-specific prior authorization in accordance with rule 5101:3-1-11 of the Administrative Code.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-04 Intermediate care facilities - payment during the Ohio office of medical assistance administrative appeals process for termination of a provider agreement.

(A) When the Ohio office of medical assistance is required to provide an adjudicatory hearing pursuant to Chapter 119. of the Revised Code, payment shall continue for medicaid-covered services provided to eligible residents during the appeal of and the proposed termination of an intermediate care facility provider agreement. Payment shall not be made under this provision for services rendered on or after the effective date of the issuance of a final order of adjudication pursuant to Chapter 119. of the Revised Code, except as provided in paragraph (B) of this rule.

(B) Payment may be provided up to thirty days following the effective date of termination of an intermediate care facility provider agreement or after an administrative hearing decision that upholds the termination action. Payment will be available if both of the following conditions are met:

(1) Payment is for residents admitted to the intermediate care facility before the effective date of termination; and

(2) The intermediate care facility cooperates with federal, state, and local entities in the effort to transfer residents to other facilities or community programs that can meet the residents' needs.

(C) When the Ohio office of medical assistance acts under instructions from the United States department of health and human services, payment ends on the termination date specified by that agency.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-05 Intermediate care facilities - payment during the state survey agency's administrative appeals process for termination or non-renewal of medicaid certification.

(A) For the purposes of this rule, the following definitions shall apply:

(1) "Effective date of termination" means the date set by the state survey agency or the United States department of health and human services for the termination of certification.

(2) "Informal reconsideration" is the process by which intermediate care facilities may refute in writing, prior to the termination or non-renewal of medicaid certification, the state survey agency's findings on which the termination or non-renewal is based. The facility must receive a written response to the informal reconsideration request which either affirms or reverses the survey decisions. Informal reconsideration is a process independent of the formal appeal. The facility may or may not choose to utilize informal reconsideration.

(B) When medicaid certification is either terminated or not renewed, the Ohio office of medical assistance must terminate the medicaid provider agreement.

(C) In addition to or in conjunction with the appeals process, the intermediate care facility may request informal reconsideration. If informal reconsideration results in an affirmation of the original survey findings, the appeals process moves forward to the administrative hearing if one was requested. If informal reconsideration results in a reversal of the original survey findings, the state survey agency's termination or non-renewal action, based on those original findings, is dismissed.

(D) Payment during the appeals process

(1) During the appeals process provided by the state survey agency for the proposed termination or non-renewal of medicaid certification, payment under regulations for covered services provided to eligible residents shall continue through the earlier of the following:

(a) The date of issuance of a final order of adjudication that upholds the state survey agency's termination or non-renewal action; or

(b) The one hundred twentieth day after the effective date of termination of the intermediate care facility's provider agreement.

(2) Payment may be provided up to an additional thirty days following either the cessation of payment on the one hundred twentieth day post termination or non-renewal; or after the issuance of an adjudication order that upholds the termination or non-renewal action. Payment will be available if both of the following conditions are met:

(a) Payment is for residents admitted to the intermediate care facility before the effective date of termination or non-renewal; and

(b) The intermediate care facility cooperates with the state, local, and federal entities in the effort to transfer residents to other facilities or community programs that can meet the residents' needs.

(E) When the Ohio office of medical assistance acts under instructions from the United States department of health and human services, payment ends on the termination date specified by that agency.

(F) When the state survey agency certifies that there is jeopardy to residents' health and safety by issuing an order under Chapter 5111. of the Revised Code, or when it fails to certify that there is no jeopardy, payment will end on the effective date of termination.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-06 [Rescinded] Intermediate care facilities - level of care review process.

Effective: 7/1/2015
Five Year Review (FYR) Dates: 04/14/2015
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04
Prior Effective Dates: 01/10/2013

5123:2-7-07 Intermediate care facilities - resource assessment notice.

(A) General The Ohio office of medical assistance form 04080, "Medicaid Resource Assessment Notice" (revised October 2005), shall conform to all conditions set forth in rule 5101:1-39-35 of the Administrative Code.

(B) Notification

(1) All intermediate care facilities shall furnish written notice at the time of admission to all individuals with a spouse living in the community of the individual's right to have a resource assessment performed by the county department of job and family services. This includes individuals who, at the time of admission, are eligible for the medicare program, or who are covered by a private third party payer.

(2) The intermediate care facility shall do all of the following:

(a) Give a copy of the resource assessment notice to the resident's family member, legal guardian, or authorized agent; and

(b) Send a copy of the signed resource assessment notice to the county department of job and family services within five working days; and

(c) Post an unsigned copy of the resource assessment notice in a prominent, publicly accessible place within the facility.

(C) Record retention

An intermediate care facility shall keep a signed copy of the resource assessment notice in a resident's record as long as he or she is a resident of the facility. This copy shall be made available upon request to the department, the Ohio office of medical assistance, the county department of job and family services, and the Ohio department of health.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-08 Intermediate care facilities for individuals with intellectual disabilities - bed-hold days.

(A) Purpose

This rule establishes requirements and procedures for an intermediate care facility for individuals with intellectual disabilities (ICFIID) to be reimbursed for reserving a bed for a resident who is temporarily absent.

(B) Definitions

For the purposes of this rule, the following definitions shall apply:

(1) "Admission" occurs when an individual who was not being counted in the census of any Ohio medicaid-certified ICFIID becomes a resident of an ICFIID. An admission may be a new admission or a return admission after a discharge.

(2) "Bed-hold day" means a day for which a bed is reserved for a resident of an ICFIID through medicaid reimbursement while the resident is temporarily absent from the ICFIID for hospitalization, therapeutic leave, or a visit with friends or relatives. Reimbursement for bed-hold days may be made only if the resident has the intent and ability or may have cause to return to the same ICFIID. A resident on bed-hold day status is not considered discharged because the ICFIID is reimbursed to hold the bed while the resident is on temporary leave.

(3) "Business day" means a day of the week, excluding Saturday, Sunday, or a legal holiday as defined in section 1.14 of the Revised Code.

(4) "Department" means the Ohio department of developmental disabilities.

(5) "Discharge" means the full release of a resident from an ICFIID so that he or she is no longer counted in the ICFIID's census. Reasons for discharge include, but are not limited to, the resident's move to another ICFIID, decision to reside in a community-based setting, or death. The day of discharge is not counted as a bed-hold day or an occupied day except when discharge and admission occur on the same day, in which case the day is considered a day of admission and counts as one occupied day.

(6) "Home and community-based services" has the same meaning as in section 5123.01 of the Revised Code.

(7) "Hospital" has the same meaning as in rule 3701-59-01 of the Administrative Code.

(8) "Hospitalization" means a resident is temporarily absent from an ICFIID for the purpose of receiving services or being treated in a hospital.

(9) "Institution for mental disease" has the same meaning as in rule 5160-3-16.4 of the Administrative Code.

(10) "Occupied day" means either:

(a) A day of admission; or

(b) A day during which a medicaid-eligible resident's stay in an ICFIID is eight or more hours. A day begins at twelve a.m. and ends at eleven fifty-nine p.m.

(11) "Readmission" occurs when a resident returns to the same ICFIID following use of bed-hold days.

(12) "Skilled nursing facility" means a nursing facility certified to participate in the medicare program.

(13) "Therapeutic leave" means a resident is temporarily absent from an ICFIID, and is in a residential setting other than a long-term care facility, hospital, or other entity eligible to receive federal, state, or county funds to maintain a resident, for the purpose of receiving a regimen of therapeutic services or visiting a potential new residential setting.

(C) Prohibition of preadmission bed-hold payment

(1) The department shall not make payment to an ICFIID to reserve a bed for a medicaid-eligible prospective resident.

(2) An ICFIID shall not accept preadmission payment to reserve a bed from a medicaid-eligible prospective resident or from any other source on the prospective resident's behalf as a precondition for admission.

(D) Limits and reimbursement for bed-hold days

(1) For a medicaid-eligible resident of an ICFIID, except those excluded in accordance with paragraph (H) of this rule, the department may reimburse the ICFIID to reserve a bed only for as long as the resident has a developmental disabilities level of care determination and intends or may have cause to return to the same ICFIID, but not for more than thirty days in any calendar year unless additional days have been authorized by the department in accordance with paragraph (E) of this rule.

(2) Reimbursement for bed-hold days shall be paid at one hundred per cent of the ICFIID's per diem rate.

(3) Reimbursement for bed-hold days may be made for the following reasons:

(a) Hospitalization

Bed-hold days used for hospitalization may be reimbursed only until:

(i) The day the resident's anticipated level of care at time of discharge from the hospital changes to a level of care that the ICFIID is not certified to provide;

(ii) The day the resident is discharged from the hospital, including discharge resulting in transfer to the ICFIID, a nursing facility, or a skilled nursing facility;

(iii) The day the resident decides to go to another ICFIID upon discharge from the hospital and notifies the first ICFIID; or

(iv) The day the hospitalized resident dies.

(b) Therapeutic leave

(i) A plan to use bed-hold days for therapeutic leave for the purpose of receiving a regimen of therapeutic services must be approved in advance by the resident's primary physician and documented in the resident's medical record. The documentation shall be available for viewing by the department.

(ii) A plan to use bed-hold days for therapeutic leave for the purpose of visiting a potential new residential setting must be approved in advance by the resident's primary physician or a qualified intellectual disability professional and documented in the resident's medical record or individual plan. The documentation shall be available for viewing by the department.

(iii) An ICFIID shall make arrangements for the resident to receive required care and services while on approved therapeutic leave. Medicaid funding, however, shall not be used for state plan home health services, durable medical equipment, and/or private duty nursing on days for which the ICFIID receives reimbursement for bed-hold days.

(c) Visit with friends or relatives

(i) A plan to use bed-hold days to visit with friends or relatives must be approved in advance by the resident's primary physician or a qualified intellectual disability professional and documented in the resident's medical record or individual plan. The documentation shall be available for viewing by the department.

(ii) An ICFIID shall make arrangements for the resident to receive required care and services while on approved visits. Medicaid funding, however, shall not be used for state plan home health services, durable medical equipment, and/or private duty nursing on days for which the ICFIID receives reimbursement for bed-hold days.

(iii) The number of days per visit is flexible within the maximum bed-hold days, allowing for differences in the resident's physical condition, the type of visit, and travel time.

(4) The number and frequency of bed-hold days used shall be considered in evaluating the continuing need of a resident for care in an ICFIID.

(E) Requests for additional bed-hold days

(1) Additional bed-hold days beyond the original thirty days in a calendar year require prior authorization except in the event of emergency hospitalization. In the event of emergency hospitalization, authorization may be requested after the fact if the request is submitted within one business day of the first day of hospitalization. A maximum of thirty additional consecutive bed-hold days may be authorized per request.

(2) An ICFIID shall submit a request for additional bed-hold days to the department electronically via the department's website. The request shall be consistent with the goals of the resident's individual plan and medical records, and shall include:

(a) Reason for bed-hold days (i.e., hospitalization, therapeutic leave, or visit with friends or relatives);

(b) Projected dates of absence; and

(c) Projected date of return.

(3) The department shall review the request for additional bed-hold days and send notice within five business days of approval or denial to the ICFIID.

(a) When a request is approved, the notice shall specify the time period during which the bed-hold days may be used.

(b) When a request is denied, the notice shall specify the reason for denial and explain the individual's right to a state hearing in accordance with section 5101.35 of the Revised Code.

(4) The department shall review prior authorization requests on a case-by-case basis. Conditions under which prior authorization may be denied include, but are not limited to, visits with friends or relatives exceeding thirty consecutive days or forty-five total days in a calendar year.

(5) An approved request for additional bed-hold days is for the specified period of time only. Unused bed-hold days from an approved request shall not be used at a later time. A new prior authorization request must be submitted if additional bed-hold days are required during that same calendar year.

(6) Bed-hold days beyond the original thirty days used without prior authorization may result in an adjustment to the ICFIID's reimbursement.

(F) Readmission

An ICFIID shall readmit a resident upon depletion of approved bed-hold days or at any time prior to depletion of approved bed-hold days upon the resident's request for readmission.

(G) Residents eligible for bed-hold days

(1) Medicaid reimbursement for bed-hold days is available under the provisions specified in this rule if a resident:

(a) Is eligible for medicaid services and has met the patient liability and financial eligibility requirements set forth in rule 5160:1-3-04.3 of the Administrative Code;

(b) Requires a developmental disabilities level of care; and

(c) Is not excluded in accordance with paragraph (H) of this rule.

(2) If a resident meets all of the criteria in paragraph (G)(1) of this rule and is pending approval of a medicaid application and requires bed-hold days, medicaid reimbursement shall be made retroactive to the date the resident became medicaid-eligible and approved for medicaid vendor reimbursement through the date the resident returns from a leave or until the maximum number of bed-hold days are exhausted.

(H) Exclusions

Bed-hold days are not available to a medicaid-eligible resident of an ICFIID who is:

(1) Enrolled in a medicare or medicaid hospice program;

(2) Over age twenty-one and under age sixty-five and becomes a patient of an institution for mental disease;

(3) Enrolled in a home and community-based services waiver;

(4) In a period of restricted medicaid coverage because of an improper transfer of resources as set forth in rule 5160:1-3-07.2 of the Administrative Code; or

(5) Relocating due to anticipated closure of an ICFIID, an ICFIID's voluntary withdrawal from participation in the medicaid program, or other events that result in termination of an ICFIID's medicaid provider agreement except when the ICFIID becomes a downsized ICFIID as defined in section 5124.01 of the Revised Code or converts beds from ICFIID services to home and community-based services in accordance with section 5124.60 or 5124.61 of the Revised Code. No span of bed-hold days shall be approved that ends on an ICFIID's date of closure or termination from participation in the medicaid program.

(I) Compliance

(1) Without limiting such other remedies provided by law for noncompliance with this rule:

(a) The Ohio department of medicaid may terminate the ICFIID's provider agreement; or

(b) The department may require the ICFIID to submit and implement a corrective action plan on a schedule specified by the department.

(2) An ICFIID shall cooperate with any investigation and shall provide copies of any records requested by the department or the Ohio department of medicaid.

Replaces: 5123:2-7-08

Effective: 7/1/2016
Five Year Review (FYR) Dates: 07/01/2021
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5124.02, 5124.03, 5124.34, 5164.02
Rule Amplifies: 5123.04, 5124.02, 5124.03, 5124.34, 5164.02
Prior Effective Dates: 01/10/2013

5123:2-7-09 Intermediate care facilities - personal needs allowance accounts and other resident funds.

(A) For the purposes of this rule, the following definitions shall apply:

(1) "Interest-bearing" means a rate of return equal to or above the passbook savings rate at local banking institutions in the area.

(2) "Intermediate care facility for individuals with intellectual disabilities" (or "intermediate care facility") means an intermediate care facility for the mentally retarded certified as in compliance with applicable standards for the medicaid program by the director of health in accordance with Title XIX of the Social Security Act, 79 Stat. 286 (1965), 42 U.S.C. 1396, other than a state-operated intermediate care facility.

(3) "Letters of administration," also known as "letters testamentary," means court papers allowing a person to take charge of the property of a deceased person in order to distribute it.

(4) "Personal needs allowance" has the same meaning as in rule 5101:1-39-24 of the Administrative Code.

(5) "Personal needs allowance account" means an account or petty cash fund that holds the money of a resident of an intermediate care facility and is managed for the resident by the intermediate care facility.

(6) "Surety bond" means an agreement between the principal (i.e., the intermediate care facility), the surety (i.e., the insurance company), and the obligee (i.e., the resident and/or the department acting on behalf of the resident), wherein the principal and the surety agree to compensate the obligee for any loss of the obligee's funds that the principal holds, safeguards, manages, and accounts for. The purpose of a surety bond is to guarantee that an intermediate care facility will pay a resident, or the department on behalf of the resident, for losses occurring from any failure by the intermediate care facility to hold, safeguard, manage, and account for the resident's funds, including losses occurred as a result of acts of error or negligence, incompetence, or dishonesty. The principal assumes the responsibility to compensate the obligee for the amount of the loss up to the entire amount of the surety bond. This paragraph does not require an intermediate care facility to change the obligee from the Ohio office of medical assistance to the department if the surety bond was in effect on the effective date of this rule unless after that date the intermediate care facility makes a change in the surety bond.

(B) Personal needs allowance account

(1) A medicaid resident who receives care in an intermediate care facility is eligible to retain a personal needs allowance account in the amount set forth in rule 5101:1-39-24 of the Administrative Code for the purchase of items and services of his or her choice in accordance with 42 C.F.R. 483.420(1991). In addition, an intermediate care facility licensed by the Ohio department of health shall comply with section 3721.15 of the Revised Code.

(2) A personal needs allowance account is the exclusive property of the resident, who may use the funds in the account as he or she chooses to meet personal needs.

(C) Management of personal funds

(1) An intermediate care facility shall allow residents to manage their financial affairs and teach them to do so to the extent of their capabilities in accordance with 42 C.F.R. 483.420(1991). In addition, an intermediate care facility licensed by the Ohio department of health shall comply with section 3721.15 of the Revised Code.

(2) An intermediate care facility shall not require a resident to deposit his or her personal needs allowance funds with the intermediate care facility. However, if a resident requests assistance from the intermediate care facility staff in managing his or her personal needs allowance account, the request shall be in writing.

(3) Upon written request from a resident, an intermediate care facility shall hold, safeguard, manage, and account for the resident's personal needs allowance funds deposited with the intermediate care facility.

(4) Upon written request from a resident, an intermediate care facility shall furnish written information about the resident's account to the resident or the resident's representative.

(5) An intermediate care facility shall explain both verbally and in writing to a resident or the resident's representative that personal needs allowance funds are for the resident to use as he or she chooses. If a representative is the payee for the resident's personal needs allowance account, the representative shall be responsible for ensuring that the money is used to meet the personal needs of the resident.

(D) Deposit of personal needs allowance account funds and interest earned by intermediate care facilities licensed by the Ohio department health

(1) If a resident's personal needs allowance account funds are one hundred dollars or less, an intermediate care facility licensed by the Ohio department of health may deposit the funds in an interest-bearing account, a non-interest-bearing account, or a petty cash fund.

(2) If a resident's personal needs allowance account funds are in excess of one hundred dollars, an intermediate care facility licensed by the Ohio department of health shall deposit the funds in an interest-bearing account (or accounts) that is separate from any of the intermediate care facility's operating accounts within five banking days from the date the balance exceeds one hundred dollars.

(3) An intermediate care facility licensed by the Ohio department of health shall credit any interest earned on a resident's personal needs allowance funds to the resident's personal needs allowance account. If pooled accounts are used, the intermediate care facility shall prorate interest per resident on the basis of actual earnings or end-of-quarter balance.

(4) An intermediate care facility licensed by the Ohio department of health shall not charge a resident a fee for managing the resident's personal needs allowance account. Banks, however, may charge the resident a fee for handling the account.

(E) Accounting and records

(1) An intermediate care facility shall establish and maintain a system that ensures full and complete accounting of each resident's funds.

(2) An intermediate care facility shall not combine a resident's personal needs allowance funds with any of the provider's funds or with the funds of any individual other than another resident of the intermediate care facility.

(3) An intermediate care facility shall furnish a resident with access to petty cash (less than fifty dollars) on an ongoing basis and shall arrange for the resident to access larger funds (fifty dollars or more). The provider shall give the resident a receipt for every transaction.

(4) An intermediate care facility shall obtain a resident's signature upon receipt by the resident of money from his or her personal needs allowance account. If the resident is unable to sign his or her name, he or she shall acknowledge receipt of the money by marking an "X." Two persons shall verify through signature that they have witnessed the resident's action. Personal needs allowance funds shall not be withdrawn or utilized by the intermediate care facility for any purpose other than that requested by the resident to whom the fund belongs.

(5) An intermediate care facility shall maintain a detailed ledger account of revenue and expenses for each personal needs allowance account managed by the intermediate care facility. The ledger account shall meet all of the following criteria:

(a) Specify all funds received by or deposited with the intermediate care facility. For personal needs allowance account funds deposited in banks, monies shall be credited to the resident's bank account within three business days;

(b) Specify the dates and reasons for all expenditures;

(c) Specify at all times the balance due the resident, including interest earned as last reported by the bank to the intermediate care facility; and

(d) Be available to the resident or the resident's representative for review.

(6) Upon request, an intermediate care facility shall furnish receipts to a resident or the resident's representative for purchases made with the resident's personal needs allowance funds.

(7) Within thirty days after the end of the quarter, an intermediate care facility shall furnish a written quarterly statement to each resident or resident's representative of all financial transactions made by the intermediate care facility on the resident's behalf.

(F) Notification of certain balances and transactions that may affect medicaid eligibility

(1) Notice to resident

(a) An intermediate care facility shall give written notification to each resident who receives medicaid benefits and whose personal funds are managed by the intermediate care facility when the amount in the resident's personal needs allowance account reaches two hundred dollars less than the resource limits set forth in rules 5101:1-39-01.1 and 5101:1-39-05 of the Administrative Code.

(b) The notice shall inform the resident that he or she may lose medicaid eligibility if the amount in his or her personal needs allowance account, in addition to the value of his or her other nonexempt resources, reaches his or her resource limit amount.

(c) A copy of the notice shall be retained in the resident's file.

(2) Notice to the county department of job and family services

An intermediate care facility shall report to the county department of job and family services any personal needs allowance account balance in excess of the resource limit. The county department of job and family services shall apply the excess amount to the routine cost of the resident's intermediate care facility care according to rule 5101:1-38-20 of the Administrative Code.

(3) If a resident is considering using personal needs allowance funds to purchase life insurance, grave space, a burial account, or other item that may be considered a countable resource, the intermediate care facility shall refer the resident or the resident's representative to the county department of job and family services for an explanation of the effect the purchase may have on the resident's medicaid eligibility.

(G) Release of funds upon discharge

Upon discharge of a resident, an intermediate care facility shall release all the resident's personal needs allowance account funds, up to and including the resource limit amount.

(H) Conveyance of funds upon death for an intermediate care facility licensed by the Ohio department of health

(1) First thirty days

An intermediate care facility licensed by the Ohio department of health shall not retain the money in a resident's personal needs allowance account beyond thirty days following the resident's death if letters testamentary or letters of administration are issued, or an application for release from administration is filed under section 2113.03 of the Revised Code concerning the resident's estate within that thirty-day period. In these circumstances, the intermediate care facility licensed by the Ohio department of health shall transfer the resident's personal needs allowance account funds and a final accounting of those funds to the administrator, executor, commissioner, or person who filed the application for release from administration. If these conditions for release are not met, the intermediate care facility shall follow paragraph (H)(2) or (H)(3) of this rule.

(2) First sixty days

If, within sixty days after a resident's death, letters testamentary or letters of administration are issued, or an application for release from administration is filed under section 2113.03 of the Revised Code concerning the resident's estate, the intermediate care facility licensed by the Ohio department of health shall transfer the resident's personal needs allowance account funds and a final accounting of those funds to the administrator, executor, commissioner, or person who filed the application for release from administration.

(3) After sixty days

(a) If, within sixty days after a resident's death, letters testamentary or letters of administration concerning the resident's estate are not issued, or an application for release from administration is not filed under section 2113.03 of the Revised Code concerning the resident's estate, and if the resident was a recipient of medicaid benefits, the intermediate care facility licensed by the Ohio department of health shall transfer the resident's personal needs allowance account funds to the Ohio office of medical assistance no earlier than sixty and no later than ninety days after the resident's death, with the exception listed in paragraph (H)(3)(c) of this rule.

(b) Personal needs allowance account funds transferred to the Ohio office of medical assistance shall be paid by check or money order made payable to "Attorney General of Ohio" and shall be accompanied by a completed Ohio office of medical assistance form 09405, "Personal Needs Allowance Account Remittance Notice" (revised July 2005). The payment and completed form 09405 shall be mailed to the Ohio attorney general's office.

(c) If funeral or burial expenses for a deceased resident have not been paid and the only resource left to pay those expenses are the resident's personal needs allowance account funds, or all other resources of the resident are inadequate to pay the full amount, the resident's personal needs allowance account funds shall be used to pay the expenses.

(d) If, sixty-one or more days after a resident dies, letters testamentary or letters of administration are issued, or an application for release from administration under section 2113.03 of the Revised Code is filed concerning the resident's estate, the Ohio office of medical assistance shall transfer the resident's personal needs allowance account funds to the administrator, executor, commissioner, or person who filed the application for release from administration, unless the Ohio office of medical assistance is entitled to recover the money under section 5111.11 of the Revised Code.

(I) Conveyance of funds upon death for an intermediate care facility licensed by the department

For an intermediate care facility licensed by the department, conveyance of funds upon death shall be in accordance with rule 5123:2-3-14 of the Administrative Code.

(J) Financial security for an intermediate care facility licensed by the Ohio department of health

An intermediate care facility licensed by the Ohio department of health shall purchase a surety bond or provide other necessary assurances to the director of the department to ensure the security of all resident funds deposited with and managed by the intermediate care facility.

(1) Surety bond.

(a) A surety bond shall be executed by a licensed surety company pursuant to Chapters 1301., 1341., and 3929. of the Revised Code.

(b) At a minimum, surety bond coverage shall protect at all times the full amount of resident funds deposited with the intermediate care facility, including interest earned and refundable deposit fees.

(c) The surety bond shall provide for repayment of funds lost due to any failure of the intermediate care facility, whether by commission, bankruptcy, omission, or otherwise, to hold, safeguard, manage, and account for resident funds.

(d) Except as provided in paragraph (J)(1)(f) of this rule, the surety bond shall designate either the resident, or the department on behalf of the resident, as the obligee.

(e) If an entity purchases a surety bond that covers more than one of its facilities, the surety bond shall protect the full amount of all resident funds on deposit in all the entity's facilities.

(f) Paragraph (J)(1)(d) of this rule does not require an intermediate care facility to change the obligee from the Ohio office of medical assistance to the department if the surety bond was in effect on the effective date of this rule unless after that date the intermediate care facility makes a change in the surety bond.

(2) Reasonable alternative to the surety bond

An intermediate care facility electing not to purchase a surety bond shall submit a proposal for an alternative to the department for approval. A reasonable alternative to the surety bond shall provide protection equivalent to that afforded by a surety bond. Neither self insurance nor deposit of funds in bank accounts protected by the federal deposit insurance corporation or a similar entity are acceptable alternatives to a surety bond. An acceptable alternative shall meet all of the following criteria:

(a) At a minimum, protect at all times the full amount of resident funds deposited with the intermediate care facility, including interest earned and refundable deposit fees;

(b) Except as provided in paragraph (J)(2)(f) of this rule, designate either the department or the residents of the intermediate care facility as the entity or entities that will collect payment for lost funds;

(c) Guarantee repayment of funds lost due to any failure of the intermediate care facility, whether by commission, bankruptcy, omission, or otherwise, to hold, safeguard, manage, and account for resident funds;

(d) Be managed by a third party unrelated in any other way to the intermediate care facility or its management; and

(e) Not name the intermediate care facility as a beneficiary.

(f) Paragraph (J)(2)(b) of this rule does not require an intermediate care facility to change the designee from the Ohio office of medical assistance to the department if the alternative to the surety bond was in effect on the effective date of this rule unless after that date the intermediate care facility makes a change in the alternative.

(K) Limitations on charges to the personal needs allowance account

(1) An intermediate care facility shall not charge a resident's personal needs allowance account for items and services that the intermediate care facility is required to furnish in order to participate in the medicaid program, and that are included in medicaid payments made to the intermediate care facility.

(2) An intermediate care facility shall inform each medicaid eligible resident of the medicaid program's coverage and limitations.

(3) Items and services that may not be purchased with personal needs allowance account funds include, but are not limited to, the following:

(a) Nursing services;

(b) Dietary services;

(c) Activities programs;

(d) Room and bed maintenance services;

(e) Routine personal hygiene items and services required to meet the needs of the resident, including but not limited to hair hygiene supplies, comb, brush, bath soap, disinfecting soap or specialized cleansing agents when indicated to treat special skin problems or to fight infection, razor, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, moisturizing lotion, tissues, cotton balls, deodorant, incontinence care supplies, sanitary napkins and related supplies, towels, washcloths, hospital gowns, over the counter drugs, hair and nail hygiene services, bathing, and basic personal laundry;

(f) Medically related social services;

(g) Medical supplies such as irrigation trays, catheters, drainage bags, syringes, and needles;

(h) Durable medical equipment;

(i) Air conditioners or charges to resident for the use of electricity; (j) Therapy or podiatry services; and

(k) Charges for telephone consultation by physicians or other personnel.

(L) Resident requests for items and services (1) A resident's personal needs allowance account funds may be used to purchase only those items and services requested by the resident, even if the items or services are requested by a physician.

(2) When a resident requests an item or service for which a charge to the resident's personal needs allowance account will be made, the intermediate care facility shall inform the resident that there will be a charge and the amount of the charge.

(3) An intermediate care facility shall not require a resident to request an item or service as a condition for admission to or continued stay in the intermediate care facility.

(M) Items and services that may be charged to the personal needs allowance account

(1) An intermediate care facility shall accept medicaid payment as payment in full for items and services that are covered by the medicaid program. If a resident clearly expresses a desire for a particular brand or item not available from the intermediate care facility, the resident's personal needs allowance funds may be used as long as a comparable item of reasonable quality is available from the provider at no charge. The intermediate care facility may charge the resident only the difference in cost between the available item and the resident's preferred item.

(2) Items and services that may be charged to a resident's personal needs allowance account include, but are not limited to, the following:

(a) Telephone;

(b) Television or radio for personal use;

(c) Personal comfort items, including smoking materials, notions, novelties, and confections;

(d) Cosmetics and grooming items and services in excess of those for which payment is made under the medicaid program;

(e) Personal reading material;

(f) Stationary or stamps;

(g) Personal clothing;

(h) Specialty laundry services such as dry cleaning, mending, or hand-washing;

(i) Flowers or plants;

(j) Gifts purchased on behalf of a resident;

(k) Non-covered special care services such as privately hired nurses or nurse aides;

(l) Social events or entertainment offered outside the scope of the facility's activities program;

(m) Private rooms, except when therapeutically required for infection control or similar reasons;

(n) Specially prepared or alternative food instead of food generally prepared by the facility; and

(o) Burial plots.

(N) Monitoring The county department of job and family services is responsible for monitoring personal needs allowance accounts. At least once a quarter, a designated county department of job and family services employee shall determine if an intermediate care facility is following the provisions of this rule, and shall report any questions concerning inappropriate use or inadequate record keeping of personal needs allowance funds to the department and to the Ohio department of health for further action. Inappropriate use of personal needs allowance account funds by a payee or an intermediate care facility does not, however, reduce the scope or duration of medicaid benefits for a medicaid recipient.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-10 [Rescinded] Intermediate care facilities - outlier services for behavioral redirection and medical monitoring.

Effective: 7/8/2018
Five Year Review (FYR) Dates: 4/23/2018
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5111.226, 5111.02
Rule Amplifies: 5111.02 , 5123.04, 5111.226
Prior Effective Dates: 01/10/2013

5123:2-7-11 Intermediate care facilities for individuals with intellectual disabilities - relationship of other covered medicaid services.

(A) Purpose

This rule identifies covered services generally available to individuals who are eligible for medicaid and describes the relationship of such services to those provided to residents of an intermediate care facility for individuals with intellectual disabilities (ICFIID) other than a state-operated ICFIID. Reimbursement of services through the "ICFIID cost report mechanism" referenced in this rule is governed by rule 5123:2-7-12 of the Administrative Code.

(B) Dental services

All covered dental services provided by licensed dentists are reimbursed directly to the provider of the dental services in accordance with Chapter 5160-5 of the Administrative Code. Personal hygiene services provided by staff or contracted personnel of the ICFIID are reimbursed through the ICFIID cost report mechanism.

(C) Laboratory and x-ray services

Costs incurred for the purchase and administration of tuberculin tests, and for drawing specimens and forwarding specimens to a laboratory, are reimbursed through the ICFIID cost report mechanism. All laboratory and x-ray procedures covered under the medicaid program are reimbursed directly to the laboratory or x-ray provider in accordance with Chapter 5160-11 of the Administrative Code.

(D) Medical supplier services

(1) Medical supplier services that are reimbursed through the ICFIID cost report mechanism include:

(a) Costs incurred for "needed medical and program supplies," defined as items that have a very limited life expectancy. Such items include atomizers, nebulizers, bed pans, catheters, electric pads, hypodermic needles, syringes, incontinence pads, splints, and disposable ventilator circuits.

(b) Costs incurred for the purchase and repair of "needed medical equipment," defined as items that can stand repeated use, are primarily and customarily used to serve a medical purpose, are not useful to a person in the absence of illness or injury, and are appropriate for use in the ICFIID. Such items include hospital beds, wheelchairs, and intermittent positive-pressure breathing machines, except as noted in paragraph (D)(2) of this rule.

(c) Costs of equipment associated with oxygen administration such as carts, regulators, humidifiers, cannulas, masks, and demurrage.

(2) Medical supplier services that are reimbursed directly to the medical supplier provider in accordance with Chapter 5160-10 of the Administrative Code include:

(a) Certain durable medical equipment items, specifically, ventilators and custom-made wheelchairs that have parts which are actually molded to fit the resident.

(b) "Prostheses," defined as devices that replace all or part of a body organ to prevent or correct physical deformity or malfunction. Such devices include artificial arms or legs, electro-larynxes, and breast prostheses.

(c) "Orthoses," defined as devices that assist in correcting or strengthening a distorted part. Such devices include arm braces, hearing aids and batteries, abdominal binders, and corsets.

(d) Contents of oxygen cylinders or tanks including liquid oxygen, except emergency stand-by oxygen which is reimbursed through the ICFIID cost report mechanism.

(e) Oxygen-producing machines (concentrators) for specific use by an individual resident.

(E) Pharmaceuticals

(1) Over-the-counter drugs covered in accordance with rule 5160-9-03 of the Administrative Code and nutritional supplements are reimbursed through the ICFIID cost report mechanism.

(2) Pharmaceuticals reimbursed directly to the pharmacy provider are subject to the limitations in Chapter 5160-9 of the Administrative Code, the limitations established by the Ohio state board of pharmacy, and the following conditions:

(a) When new prescriptions are necessary following expiration of the last refill, the new prescription may be ordered only after the physician examines the resident.

(b) A copy of all records regarding prescribed drugs for a resident of an ICFIID shall be retained by the dispensing pharmacy for at least six years. A receipt for drugs delivered to an ICFIID shall be signed by a representative of the ICFIID at the time of delivery and a copy retained by the pharmacy.

(F) Therapy services

(1) Costs incurred for physical therapy, occupational therapy, speech therapy, and audiology services provided by licensed therapists or therapy assistants that are covered for residents of an ICFIID by medicaid are reimbursed through the ICFIID cost report mechanism.

(2) Costs incurred for psychology services provided by licensed psychologists or psychology assistants that are covered for residents of an ICFIID by medicaid are reimbursed through the ICFIID cost report mechanism. No reimbursement for psychology services shall be made to a provider other than the ICFIID or a community mental health center certified by the Ohio department of mental health and addiction services. Services provided by an employee of the community mental health center shall be billed directly to medicaid by the community mental health center.

(3) Costs incurred for respiratory therapy services provided by licensed respiratory care professionals that are covered for residents of an ICFIID by medicaid are reimbursed through the ICFIID cost report mechanism. No reimbursement for respiratory therapy services shall be made to a provider other than the ICFIID.

(4) Reasonable costs for rehabilitative, restorative, or maintenance therapy services rendered to residents of an ICFIID by staff or contracted personnel of the ICFIID and the overhead costs to support the provision of such services are reimbursed through the ICFIID cost report mechanism.

(G) Physician services

(1) A physician may be directly reimbursed for providing the following services to a resident of an ICFIID:

(a) All covered diagnostic and treatment services in accordance with Chapter 5160-4 of the Administrative Code.

(b) All medically necessary physician visits in accordance with rule 5160-4-06 of the Administrative Code.

(c) All required physician visits as described in this rule when the services are billed in accordance with rule 5160-4-06 of the Administrative Code.

(i) Physician visits provided to a resident of an ICFIID are considered timely if they occur no later than ten calendar days after the date the visit was requested.

(ii) For reimbursement of the required physician visits, the physician shall:

(a) Review the resident's total program of care including medications and treatments at each visit required by this rule;

(b) Write, sign, and date progress notes at each visit;

(c) Sign all orders; and

(d) Personally visit the resident except as provided in paragraph (G)(1)(c)(iii) of this rule.

(iii) At the option of the physician, required visits after the initial visit may be delegated in accordance with paragraph (G)(1)(c)(iv) of this rule and alternate between physician and visits by a physician assistant or certified nurse practitioner.

(iv) A physician may delegate tasks to a physician assistant (in accordance with Chapter 4730. of the Revised Code and Chapter 4730-1 of the Administrative Code) or a certified nurse practitioner (in accordance with Chapter 4723. of the Revised Code and Chapter 4723-4 of the Administrative Code) provided the physician assistant or certified nurse practitioner is acting within the scope of his or her practice and is under supervision and employment of the billing physician. A physician may not delegate a task when regulations specify that the physician must perform it personally or when delegation is prohibited by state law or the ICFIID's policies.

(2) Services directly reimbursed to the physician shall be:

(a) Based on medical necessity, as defined in rule 5160-1-01 of the Administrative Code, and requested by the resident of the ICFIID with the exception of the required visits described in paragraph (G)(1)(c) of this rule.

(b) Documented by entries in the resident's medical record along with any symptoms and findings. Each entry shall be signed and dated by the physician.

(3) Services provided in the capacity of overall medical direction are reimbursed only to an ICFIID and may not be directly reimbursed to a physician.

(H) Podiatry services

Covered services provided by licensed podiatrists are reimbursed directly to the authorized podiatric provider in accordance with Chapter 5160-7 of the Administrative Code.

(I) Transportation services

Costs incurred by the ICFIID for transporting residents by means other than covered ambulance or ambulette services are reimbursed through the ICFIID cost report mechanism. Payment is made directly to authorized providers for covered ambulance and ambulette services as set forth in Chapter 5160-15 of the Administrative Code.

(J) Vision care services

All covered vision care services, including examinations, dispensing, and the fitting of eyeglasses, are reimbursed directly to authorized vision care providers in accordance with Chapter 5160-6 of the Administrative Code.

Replaces: 5123:2-7-11

Effective: 7/1/2017
Five Year Review (FYR) Dates: 07/01/2022
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5124.03
Rule Amplifies: 5123.04, 5124.03
Prior Effective Dates: 01/10/2013

5123:2-7-12 [Rescinded] Intermediate care facilities for individuals with intellectual disabilities - cost report and chart of accounts.

Effective: 7/8/2018
Five Year Review (FYR) Dates: 4/23/2018
Promulgated Under: 119.03
Statutory Authority: 5164.02, 5124.03, 5123.04
Rule Amplifies: 5124.101, 5124.10 , 5124.03, 5124.02, 5123.04 , 5124.61, 5124.60, 5124.522
Prior Effective Dates: 01/10/2013, 01/01/2017, 02/15/2018

5123:2-7-13 Intermediate care facilities - rate recalculations, interest on overpayments, penalties, repayment of overpayments, and deposit of repayment of overpayments.

(A) If a provider properly amends its medicaid cost report under rule 5123:2-7-12 of the Administrative Code, the Ohio office of medical assistance makes a finding based on an audit under section 5111.27 of the Revised Code, or the department makes a finding based on an exception review of resident assessment information conducted under section 5111.27 of the Revised Code after the effective date of the rate for direct care costs that is based on the assessment information any of which results in a determination that the provider has received a higher rate than it was entitled to receive, the department shall recalculate the provider's rate using the revised information. The department shall apply the recalculated rate to the periods when the provider received the incorrect rate to determine the amount of the overpayment. The provider shall refund the amount of the overpayment. In addition to requiring a refund under this rule, the department may charge the provider interest at the applicable rate specified in this rule from the time the overpayment was made.

(1) The interest shall be no greater than two times the average bank prime rate if the overpayment was equal to or less than one per cent of the total medicaid payments to the provider for the fiscal year for which the incorrect information was used to establish a rate.

(2) The interest shall be no greater than two and one-half times the average bank prime rate if the overpayment was greater than one per cent of the total medicaid payments to the provider for the fiscal year for which the incorrect information was used to establish a rate.

(3) The department shall determine the average bank prime rate using statistical release H.15, "Selected Interest Rates," a weekly publication of the federal reserve board (available at www.federalreserve.gov/releases/H15/), or any successor publication. If statistical release H.15, or its successor ceases to contain the bank prime rate information or ceases to be published, the department shall request a written statement of the average bank prime rate from the federal reserve bank of Cleveland or the federal reserve board.

(B) The department also may impose the following penalties and fines:

(1) If a provider does not furnish invoices or other documentation that the Ohio office of medical assistance requests during an audit within sixty days after the request, no more than the greater of one thousand dollars per audit or twenty-five per cent of the cumulative amount by which the costs for which documentation was not furnished increased the total medicaid payments to the provider during the fiscal year for which the costs were used to establish a rate.

(2) If an owner or operator fails to provide notice of facility closure, voluntary withdrawal or voluntary termination of participation in the medicaid program, or change of operator as required by the Revised Code, no more than the current average bank prime rate plus four per cent of the last two monthly payments.

(C) If the provider continues to participate in the medicaid program, the Ohio office of medical assistance shall deduct any amount that the provider is required to refund under this rule, and the amount of any interest charged or penalty imposed under this rule, from the next available payment from the department to the provider. The department and the provider may enter into an agreement under which the amount, together with interest, is deducted in installments from payments from the department to the provider.

(D) The Ohio office of medical assistance shall transmit all refunds and penalties issued under this rule to the treasurer of state for deposit in the general revenue fund.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-14 Intermediate care facilities - debt estimation, debt summary report, and successor liability agreements for change of operator, facility closure, voluntary termination, involuntary termination, or voluntary withdrawal.

(A) Debt estimation

(1) The Ohio office of medical assistance shall use the debt estimation methodology set forth in this rule to estimate the exiting operator's actual and potential debts to the department and the centers for medicare and medicaid services under the medicaid program.

(2) The Ohio office of medical assistance shall total the value of all of the following that are determined applicable in calculating the debt estimate:

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

(i) Overpayments owed for adjudicated final fiscal audit periods.

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

(iii) 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.

(b) Monies owed to the department and the centers for medicare and medicaid services resulting from penalties authorized by federal and state law, including but not limited to the following:

(i) 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.

(ii) Late cost report filing penalties assessed pursuant to rule 5123:2-7-12 of the Administrative Code.

(iii) Penalties assessed pursuant to rule 5123:2-7-13 of the Administrative Code when a provider fails to furnish invoices or other documentation that the Ohio office of medical assistance requests during an audit.

(c) Interest monies owed to the department pursuant to section 5111.28 of the Revised Code, and to the centers for medicare and medicaid services pursuant to 42 C.F.R. 488.442(2011).

(d) Monies owed to the department and the centers for medicare and medicaid services 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.

(e) Franchise permit fee owed to the department pursuant to section 3721.53 or 5112.33 of the Revised Code which shall include unpaid franchise permit fee for the following:

(i) 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.

(ii) 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.

(f) Monies owed for recapture of excess depreciation.

(g) Monies owed due to a credit balance.

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

(i) Other amounts the department determines are applicable.

(3) The sum of the amounts determined owed, or estimated to be owed, to the department and the centers for medicare and medicaid services pursuant to paragraphs (A)(2)(a) to (A)(2)(i) of this rule shall be the total estimated debt.

(4) The Ohio office of medical assistance 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.

(B) Provision of debt estimate

For the purposes of division (C) of section 5111.68 of the Revised Code, the debt estimate is considered provided by the Ohio office of medical assistance on the date of mailing or date of personal service.

(C) Initial debt summary report

(1) Whenever the Ohio office of medical assistance issues an initial debt summary report pursuant to section 5111.685 of the Revised Code, the Ohio office of medical assistance shall give notice to the affected party informing the affected party of the affected party's right to request a review. Notice shall be given by registered mail, return receipt requested, and shall include:

(a) A statement informing the affected party that the affected party is entitled to request a review of the initial debt summary report.

(b) A statement informing the affected party that if a request for review of the initial debt summary report is not submitted on or before thirty days after the mailing of the initial debt summary report, the initial debt summary report becomes the final debt summary report thirty-one days after the mailing of the initial debt summary report, and that the affected party may request, in accordance with Chapter 119. of the Revised Code, an adjudication hearing regarding a finding in the final debt summary report that pertains to an audit or alleged overpayment made under the medicaid program to the exiting operator. The adjudication shall be consolidated with any other uncompleted adjudication that concerns a matter addressed in the final debt summary report.

(2) The Ohio office of medical assistance shall also mail a copy of the notice to the affected party's attorney or other representative of record. To qualify as an attorney or representative of record, the affected party or the attorney or representative must notify the Ohio office of medical assistance, in writing, that the attorney or representative is to be designated the attorney or representative of record for purposes of receiving notice of an initial debt summary report. The notification must include the address where the Ohio office of medical assistance should mail the notice to the attorney or representative of record. The mailing of notice to the affected party's attorney or representative is not deemed to perfect service of the notice. Failure to mail a copy of the notice to the attorney or representative of record will not result in failure of otherwise perfected service upon the affected party. In those instances where an affected party is a corporation doing business in Ohio or is incorporated in Ohio, the mailing of notice to the corporation's statutory agent pursuant to sections 1701.07 and 1703.19 of the Revised Code will perfect service.

(3) When any notice of an initial debt summary report is sent by registered mail pursuant to this rule is returned because the affected party fails to claim the notice, the Ohio office of medical assistance shall send the notice by ordinary mail to the affected party at the affected party's last known address and shall obtain a certificate of mailing. Service by ordinary mail is complete when the certificate of mailing is obtained unless the notice is returned showing failure of delivery.

(4) If any notice of an initial debt summary report is sent by registered or ordinary mail is returned for failure of delivery, the Ohio office of medical assistance shall make personal delivery of the notice by an employee or agent of the Ohio office of medical assistance. An employee or agent of the Ohio office of medical assistance may make personal delivery of the notice upon a party at any time.

(5) Refusal of delivery of an initial debt summary report by personal service or by mail is not failure of delivery and service is deemed to be complete at the time of personal refusal or at the time of receipt by the Ohio office of medical assistance of the refused mail as demonstrated by the Ohio office of medical assistance time and date stamp. Failure of delivery occurs only when a mailed notice is returned by the postal authorities marked undeliverable, address or addressee unknown, or forwarding address unknown or expired.

(6) Any request for a review made as the result of notice of an initial debt summary report issued pursuant to this rule must be made in writing and mailed or delivered to the Ohio office of medical assistance office and address identified in the initial debt summary report within thirty calendar days of the following, as applicable:

(a) The time of mailing the notice if notice is given pursuant to paragraph (C)(1) of this rule.

(b) The date that service is complete if notice is given pursuant to paragraph (C)(3) or (C)(5) of this rule.

(c) The date of personal service.

(7) If a request for review is mailed to the Ohio office of medical assistance office and address identified in the initial debt summary report, the request is deemed to have been made as follows:

(a) If the request is mailed by certified mail, as of the date stamped by the United States postal service on its receipt form.

(b) If the request is mailed by regular United States mail, as of the date of the postmark appearing upon the envelope containing the request.

(c) If the request is mailed by regular United States mail and the postmark is illegible or fails to appear on the envelope, as of the date of its receipt by the Ohio office of medical assistance office identified in the initial debt summary report as evidenced by that office's time stamp.

(8) If a request for review is made by facsimile transmission or by electronic mail to the office identified in the initial debt summary report, the request is deemed to have been made as of the date of its receipt as evidenced by the receipt date generated by the facsimile transmission or the date of receipt shown in the source code of the electronic mail received by the office identified in the initial debt summary report.

(9) If a request for review is mailed, personally delivered, made by facsimile transmission, or made by electronic mail to a party or address other than the proper office identified in the initial debt summary report, the request is deemed to have been made as of the date of its receipt by the office identified in the initial debt summary report as evidenced by that office's time stamp.

(10) If a request for review is personally delivered to the office identified in the initial debt summary report, the request is deemed to have been made as of the date of its receipt as evidenced by that office's time stamp.

(11) All requests for review must clearly identify both the affected party involved and the initial debt summary report that is being contested.

(D) Revised debt summary report

(1) Whenever the Ohio office of medical assistance issues a revised debt summary report pursuant to section 5111.685 of the Revised Code, the Ohio office of medical assistance shall give notice to the affected party informing the affected party of the affected party's right to submit additional information. Notice shall be given by registered mail, return receipt requested, and shall include:

(a) A statement informing the affected party that the affected party is entitled to submit additional information.

(b) A statement informing the affected party that if additional information is not submitted on or before thirty days after the mailing of the revised debt summary report, the revised debt summary report becomes the final debt summary report thirty-one days after the mailing of the revised debt summary report, and that the affected party may request, in accordance with Chapter 119. of the Revised Code, an adjudication hearing regarding a finding in the final debt summary report that pertains to an audit or alleged overpayment made under the medicaid program to the exiting operator. The adjudication shall be consolidated with any other uncompleted adjudication that concerns a matter addressed in the final debt summary report.

(2) The Ohio office of medical assistance shall also mail a copy of the notice to the affected party's attorney or other representative of record. To qualify as an attorney or representative of record, the affected party or the attorney or representative must notify the Ohio office of medical assistance, in writing, that the attorney or representative is to be designated the attorney or representative of record for purposes of receiving notice of a revised debt summary report. The notification must include the address where the Ohio office of medical assistance should mail the notice to the attorney or representative of record. The mailing of notice to the affected party's attorney or representative is not deemed to perfect service of the notice. Failure to mail a copy of the notice to the attorney or representative of record will not result in failure of otherwise perfected service upon the affected party. In those instances where an affected party is a corporation doing business in Ohio or is incorporated in Ohio, the mailing of notice to the corporation's statutory agent pursuant to sections 1701.07 and 1703.19 of the Revised Code will perfect service.

(3) When any notice of a revised debt summary report is sent by registered mail pursuant to this rule is returned because the affected party fails to claim the notice, the Ohio office of medical assistance shall send the notice by ordinary mail to the affected party at the affected party's last known address and shall obtain a certificate of mailing. Service by ordinary mail is complete when the certificate of mailing is obtained unless the notice is returned showing failure of delivery.

(4) If any notice of a revised debt summary report sent by registered or ordinary mail is returned for failure of delivery, the Ohio office of medical assistance shall make personal delivery of the notice by an employee or agent of the Ohio office of medical assistance. An employee or agent of the Ohio office of medical assistance may make personal delivery of the notice upon a party at any time.

(5) Refusal of delivery of a revised debt summary report by personal service or by mail is not failure of delivery and service is deemed to be complete at the time of personal refusal or at the time of receipt by the Ohio office of medical assistance of the refused mail as demonstrated by the Ohio office of medical assistance time and date stamp. Failure of delivery occurs only when a mailed notice is returned by the postal authorities marked undeliverable, address or addressee unknown, or forwarding address unknown or expired.

(6) Any submission of additional information made as the result of notice of a revised debt summary report issued pursuant to this rule must be made in writing and mailed or delivered to the Ohio office of medical assistance office and address identified in the revised debt summary report within thirty calendar days of the following, as applicable:

(a) The time of mailing the notice if notice is given pursuant to paragraph (D)(1) of this rule.

(b) The date that service is complete if notice is given pursuant to paragraph (D)(3) or (D)(5) of this rule.

(c) The date of personal service.

(7) If a submission of additional information is mailed to the Ohio office of medical assistance office and address identified in the revised debt summary report, the request is deemed to have been made as follows:

(a) If the submission of additional information is mailed by certified mail, as of the date stamped by the United States postal service on its receipt form.

(b) If the submission of additional information is mailed by regular United States mail, as of the date of the postmark appearing upon the envelope containing the request.

(c) If the submission of additional information is mailed by regular United States mail and the postmark is illegible or fails to appear on the envelope, as of the date of its receipt by the Ohio office of medical assistance office identified in the revised debt summary report as evidenced by that office's time stamp.

(8) If a submission of additional information is made by facsimile transmission or by electronic mail to the office identified in the revised debt summary report, the submission is deemed to have been made as of the date of its receipt as evidenced by the receipt date generated by the facsimile transmission or the date of receipt shown in the source code of the electronic mail received by the office identified in the revised debt summary report.

(9) If a submission of additional information is mailed, personally delivered, made by facsimile transmission, or made by electronic mail to a party or address other than the proper office identified in the revised debt summary report, the request is deemed to have been made as of the date of its receipt by the office identified in the revised debt summary report as evidenced by that office's time stamp.

(10) If a submission of additional information is personally delivered to the office identified in the revised debt summary report, the request is deemed to have been made as of the date of its receipt as evidenced by that office's time stamp.

(11) All submissions of additional information must clearly identify both the affected party involved and the revised debt summary report that is being contested.

(E) Final debt summary report

Rule 5101:6-50-03 of the Administrative Code shall apply if a party timely submits a request for review, and additional information in response to a revised debt summary report, and the Ohio office of medical assistance issues a final debt summary report pursuant to section 5111.685 of the Revised Code. An adjudication on a final debt summary report shall be conducted only with respect to findings in the final debt summary report that pertain to an audit or alleged overpayment made under the medicaid program to the exiting operator. The adjudication shall be consolidated with any other uncompleted adjudication that concerns a matter addressed in the final debt summary report.

(F) Computation of time deadlines

Section 1.14 of the Revised Code controls the computing of time deadlines imposed by this rule. The time within which an act is required by law to be completed is computed by excluding the first day and including the last day. When the last day falls on a Saturday, Sunday, or legal holiday, the act may be completed on the next succeeding day that is not a Saturday, Sunday, or legal holiday. When the last day to perform an act that is required by law is to be performed in a public office and that public office is closed to the public for the entire day, the act may be performed on the next succeeding day that is not a Saturday, Sunday, or legal holiday.

(G) Successor liability agreements

(1) Successor liability agreements entered into pursuant to section 5111.681 of the Revised Code are subject to approval by the Ohio office of medical assistance.

(2) Successor liability agreements must be signed by the exiting operator, the Ohio office of medical assistance, and the entity assuming liability pursuant to section 5111.681 of the Revised Code.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-15 Intermediate care facilities for individuals with intellectual disabilities - claim submission, payment, and adjustment process.

(A) Purpose

This rule establishes procedures for an intermediate care facility for individuals with intellectual disabilities (ICFIID) to submit claims and be paid for services rendered.

(B) Exchanging information regarding residents of an ICFIID

(1) Notification of change in income

An ICFIID shall notify the department in a format prescribed by the department and notify the county department of job and family services via email of a change in the income of a medicaid-eligible resident within five calendar days following the ICFIID's awareness of the change in income.

(2) Notification of death

An ICFIID shall notify the department in a format prescribed by the department and notify the county department of job and family services via email of the death of a medicaid-eligible resident within five calendar days following the resident's death. Within ten calendar days of receipt of the notification, the county department of job and family services shall terminate medicaid eligibility.

(C) Submission of claims for services included in the ICFIID per diem rate

(1) An ICFIID shall submit claims for payment for services that are included in the ICFIID per diem rate either directly or as a trading partner as defined in rule 5160-1-20 of the Administrative Code or through another trading partner. The ICFIID shall be a medicaid provider in an active enrollment status for all dates within the claim span.

(2) The ICFIID shall electronically submit claims for payment, including adjustments, for services that are included in the ICFIID per diem rate in one of the following formats:

(a) Electronic data interchange, in accordance with standards established under 45 C.F.R. 160, 45 C.F.R. 162, and 45 C.F.R. 164 as in effect on the effective date of this rule, using the 837 health care claim institutional (837I) electronic format (2015), which is available at the national uniform billing committee website (http://nubc.org/subscriber/index.dhtml ); or

(b) The medicaid information technology system web portal.

(3) Claim submissions shall comply with the UB-04 national uniform billing data specifications and be submitted in accordance with the correct national coding initiative and coding standards as set forth in the following guides and as described in 45 C.F.R. 162.1000 and 45 C.F.R. 162.1002 as in effect on the effective date of this rule:

(a) Healthcare common procedure coding system;

(b) Current procedure terminology codebook; and

(c) International classification of diseases codebook.

(4) Trading partners who submit electronic data interchange claim transactions shall follow the requirements set forth in paragraph (H) of rule 5160-1-19 of the Administrative Code.

(5) Claim submissions shall comply with the current version of the claim transaction requirements in this rule and as specified in the Ohio department of medicaid 8371 companion guide (May 12, 2014), which is available at the Ohio department of medicaid website (http://medicaid.ohio.gov/providers/mits/hipaa5010implementation. aspx).

(6) A single claim shall include days of service provided, including qualifying leave days, for a single resident within a single calendar month and shall not cross calendar months. If an ICFIID determines that a claim that has been paid should have included additional per diem service days, the ICFIID shall timely submit an adjustment claim correcting the entire calendar month's claim information.

(7) When a medicaid-eligible resident of an ICFIID has a patient liability obligation, the entire monthly amount of patient liability, as determined in accordance with rule 5160:1-3-04.3 of the Administrative Code, shall be reported by the ICFIID on the resident's monthly claim. When a resident is admitted, discharged, transfers to another facility, or switches from medicare to medicaid mid-month, the entire monthly amount of patient liability shall be reported on the claim for that month. The patient liability shall be applied as an offset against the amount medicaid would otherwise reimburse for the claim. When the patient liability exceeds the amount medicaid would reimburse, the claim shall be processed with a payment of zero dollars.

(8) The treatment of lump sum payments and their disposition regarding medicaid eligibility are addressed in rule 5160:1-3-05.8 of the Administrative Code; if however, the county department of job and family services and the medicaid-eligible resident determine that the lump sum shall be assigned to the ICFIID as payment for past per diem services received by the resident, the ICFIID shall submit adjustment claims for as many prior months as necessary to fully offset the amount of the lump sum payment that was assigned to the ICFIID. When there are lump sum monies remaining after adjusting all prior payments, the ICFIID shall apply the remaining lump sum balance to current and future claims. When the resident is discharged or passes away prior to exhausting the lump sum payment, the ICFIID shall return the balance to the individual or the individual's estate.

(9) Timely filing requirements

(a) Original claim submission

(i) A claim must be received by the Ohio department of medicaid within three hundred sixty-five calendar days of the actual date of service.

(ii) A claim received beyond three hundred sixty-five calendar days of the actual date of service shall be denied except when the provisions of paragraph (C)(10) of this rule apply.

(iii) For purposes of this rule, the date of receipt shall be determined by the date the claim is received in the medicaid information technology system web portal or the date the claim is received via electronic data interchange.

(b) Resubmission of a denied claim

(i) A claim denied by the Ohio department of medicaid may be resubmitted for payment but the resubmission must be received by the Ohio department of medicaid no later than the later of the following dates:

(a) Three hundred sixty-five calendar days from the actual date of service; or

(b) One hundred eighty calendar days from the date the claim was denied, even if this date is beyond three hundred sixty-five calendar days from the actual date of service.

(ii) A resubmitted claim received beyond seven hundred thirty calendar days from the actual date of service shall be denied.

(c) Adjustment to a previously paid claim, including a claim paid at zero dollars

(i) When an ICFIID identifies an underpaid claim, the ICFIID shall submit an adjustment to the Ohio department of medicaid within one hundred eighty calendar days of the date the underpaid claim was paid by the Ohio department of medicaid.

(ii) When an ICFIID identifies an overpaid claim, the ICFIID shall submit an adjustment to the Ohio department of medicaid within sixty calendar days of identifying the overpayment. The Ohio department of medicaid shall not accept a check from the ICFIID in lieu of a claim adjustment in this situation.

(iii) When the Ohio department of medicaid identifies the need for an ICFIID to adjust a claim, it shall notify the ICFIID to make the adjustment. The ICFIID shall make the adjustment within sixty calendar days of notification. If the ICFIID fails to make the adjustment, the Ohio department of medicaid shall either make the adjustment or void the claim as is appropriate for the fact pattern.

(iv) If within sixty calendar days of the date the Ohio department of medicaid processes an adjustment, there are no outgoing payments for the ICFIID against which the adjustment can be made, the Ohio department of medicaid shall issue an invoice to the ICFIID for the resulting credit balance. The ICFIID shall seek reconsideration or remit payment to the Ohio department of medicaid within sixty calendar days of the date of the invoice. The ICFIID shall include a copy of the invoice with the payment. If the ICFIID fails to include a copy of the invoice or remit full payment, the unpaid balance shall be certified to the Ohio attorney general for collection.

(d) A claim with prior payment by medicare or another insurance plan shall be submitted by the ICFIID within one hundred eighty calendar days from the date medicare or other insurance plan paid the claim to the ICFIID.

(10) Exceptions to filing timelines

(a) When submission of a claim is delayed due to the pendency of either an administrative hearing decision by the Ohio department of job and family services or an eligibility determination by a county department of job and family services, the claim must be received within one hundred eighty calendar days of the date of the administrative hearing decision or eligibility determination. The ICFIID shall maintain all documentation supporting the information on the claim and shall produce the documentation upon request. In no case shall a delay in processing eligibility information under rule 5160:1-2-11 of the Administrative Code be a basis for denial of payment under this provision.

(b) When a claim cannot be submitted to the Ohio department of medicaid within three hundred sixty-five calendar days of the actual date of service due to coordination of benefits delays with medicare and/or other insurance plans, the claim must be received by the Ohio department of medicaid within one hundred eighty calendar days from the date medicare or other insurance plan paid the claim.

(D) Submission of claims for services not included in the ICFIID per diem rate

An ICFIID shall submit medicare crossover claims and claims for medicaid reimbursement for allowable services that are not included in the ICFIID per diem rate in accordance with the requirements set forth in rule 5160-1-19 of the Administrative Code.

Replaces: 5123:2-7-15

Effective: 7/1/2017
Five Year Review (FYR) Dates: 07/01/2022
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5124.03
Rule Amplifies: 5123.04, 5124.03
Prior Effective Dates: 01/10/2013, 07/01/2015

5123:2-7-16 [Rescinded] Intermediate care facilities - chart of accounts.

Effective: 2/15/2018
Five Year Review (FYR) Dates: 11/30/2017
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5111.226, 5111.02
Rule Amplifies: 5111.02 , 5123.04, 5111.226
Prior Effective Dates: 01/10/2013

5123:2-7-17 Intermediate care facilities - leased staff services.

(A) "Leased staff services" means services provided by staff who are furnished to an intermediate care facility by a leasing firm under contract with the intermediate care facility.

(B) Costs related to leased staff services are reimbursable as other/contracted costs if all of the following apply:

(1) The intermediate care facility has contracted for leased staff services through an established staff leasing firm. An established staff leasing firm is one that is, and over a period of time has been, in the business of leasing staff in a variety of industries. Individuals with a variety of skills are generally included in the contractual agreement between the intermediate care facility and the staff leasing firm.

(2) The leased staff are present in the intermediate care facility on a consistent basis. It is the responsibility of the provider to maintain documentation showing continuity in staff.

(3) The contract between the intermediate care facility and the staff leasing firm is for a period of one year or more.

(4) The intermediate care facility maintains control over the day-to-day management of leased staff.

(C) Staff leasing arrangements are reimbursable through the medicaid cost reporting mechanism in the following manner:

(1) The wage component of fees paid to the staff leasing firm are reported in the direct care, indirect care, and other protected cost centers in other/contract wages (column 2) of the medicaid cost report for the applicable accounts as defined in rule 5123:2-7-16 of the Administrative Code.

(2) The payroll taxes and employee benefits portion of fees paid to the staff leasing firm are reported in the direct care, indirect care, and other protected cost centers in other/contract wages (column 2) of the medicaid cost report for the applicable accounts as defined in rule 5123:2-7-16 of the Administrative Code on the basis of dollars allocated to the appropriate employee benefit and payroll accounts.

(3) The payroll administration portion of fees paid to the staff leasing firm not identified as wages or benefits are reported in account 7305, administrative and general services, other indirect care (column 2) of the medicaid cost report as defined in rule 5123:2-7-16 of the Administrative Code. Payroll administration fees paid to a staff leasing firm meeting the definition of a related party as defined in rule 5123:2-7-01 of the Administrative Code are not reimbursable beyond those expenses that would be reimbursable if incurred by the provider itself.

(D) It is the provider's responsibility to maintain adequate documentation of the staff leasing costs.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.20, 5111.226, 5123.04
Rule Amplifies: 5111.20, 5111.226, 5123.04

5123:2-7-18 Intermediate care facilities - capital asset and depreciation guidelines.

(A) A per diem for depreciation on buildings, components, and equipment used in the provision of patient care that are not reimbursable by medicaid directly to the medical equipment supplier in accordance with rule 5101:3-3-19 of the Administrative Code is an allowable cost.

(B) For purposes of determining if an expenditure should be capitalized, the following guidelines are utilized:

(1) Any expenditure for an item that costs five hundred dollars or more and has a useful life of two or more years per item must be capitalized and depreciated over the asset's useful life.

(2) A provider may use a capitalization policy less than five hundred dollars per item, but is required to obtain prior approval from the department if the provider wishes to change its capitalization policy from its initial capitalization policy.

(C) All capital assets shall be depreciated using the straight-line method of depreciation.

(D) For purposes of determining the useful life of a capital asset, intermediate care facilities shall use the table as set forth in the appendix to this rule or a different useful life if approved by the department. If a capital asset is not reflected on the table as set forth in the appendix to this rule, the internal revenue service publication 946, "How to Depreciate Property" (revised 2011), available at http://www.irs.gov/publications/p946/index.html, shall be used for purposes of determining the useful life of that capital asset.

(E) The following depreciation conventions shall be used to calculate depreciation expense:

(1) In the month that a capital asset is placed into service, no depreciation expense is recognized as an allowable expense. A full month's depreciation expense is recognized in the month following the month the asset is placed into service.

(2) In the month that the capital asset is disposed, if the capital asset is not fully depreciated, the allowable depreciation expense is recognized as it is defined in section 132 of the centers for medicare and medicaid services publication 15-1, "Provider Reimbursement Manual" (revised January 2005), available at http://www.cms.hhs.gov/manuals. At no time shall an asset be depreciated more than its adjusted basis.

(F) Providers shall maintain detailed depreciation schedules to verify each individual capital asset placed in service.

Click to view Appendix

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-19 [Rescinded] Intermediate care facilities - nonreimbursable costs.

Effective: 1/1/2017
Five Year Review (FYR) Dates: 10/14/2016
Promulgated Under: 119.03
Statutory Authority: 5111.20, 5111.226, 5123.04
Rule Amplifies: 5111.20, 5111.226, 5123.04
Prior Effective Dates: 01/10/2013

5123:2-7-20 [Rescinded] Intermediate care facilities - resident assessment classification and case mix payment system.

Effective: 7/8/2018
Five Year Review (FYR) Dates: 4/23/2018
Promulgated Under: 119.03
Statutory Authority: 5162.021, 5124.193, 5124.192, 5124.19 , 5124.03, 5124.02, 5123.04
Rule Amplifies: 5123.04, 5162.021, 5124.193, 5124.192, 5124.191, 5124.19 , 5124.03, 5124.02
Prior Effective Dates: 01/10/2013, 10/01/2013, 06/26/2014, 10/01/2014

5123:2-7-21 Intermediate care facilities - compensation cost limits, reasonable costs for compensation, and compensation disallowances if any for owners and relatives of owners.

(A) Compensation cost limits for owners and relatives of owners shall be based upon compensation costs for individuals who hold comparable positions but who are not owners or relatives of owners, as reported on the intermediate care facility cost report from the calendar year preceding the fiscal year in which the rate is paid. As used in this rule, "comparable position" means the position that is held by the owner or owner's relative, if that position is listed separately on the intermediate care facility cost report, or if the position is not listed separately, the group of positions that is listed on the cost report and that includes the position held by the owner or the owner's relative. The compensation cost limits for owners and relatives of owners who function in positions listed on attachment 6 of the intermediate care facility cost report shall be based upon the wage and hour equivalents which are calculated as follows:

(1) The compensation cost limits for owners and relatives of owners are calculated from the following intermediate care facility cost reports excluding cost reports for providers of outlier services as specified in rule 5123:2-7-10 of the Administrative Code:

(a) Cost reports for intermediate care facilities with a December thirty-first end date; and

(b) Desk-reviewed and preliminarily determined to be allowable costs for intermediate care facilities.

(2) For each wage and hour chart of account number from attachment 6 of the intermediate care facility cost report, calculate the compensation cost limits as follows:

(a) Calculate the total non-owner wages paid by summing the total non-owner wages paid (column E) for all providers that have amounts reported in columns (E) and (H) of attachment 6.

(b) Calculate the total non-owner hours paid by summing the total non-owner hours paid (column H) for all providers that have amounts reported in columns (E) and (H) of attachment 6.

(c) Calculate the average hourly rate by dividing the total non-owner wages paid as calculated under paragraph (A)(2)(a) of this rule by the total non-owner hours paid as calculated under paragraph (A)(2)(b) of this rule.

(d) Calculate the compensation cost limit by multiplying the average hourly rate as calculated under paragraph (A)(2)(c) of this rule by two thousand eighty hours.

(B) Compensation cost limits for an owner or an owner's relative who serves the intermediate care facility in a capacity such as corporate officer, for which no comparable position or group of positions is listed on attachment 6 shall be based upon the civil service equivalents. Compensation for owners and relatives of owners that are corporate officers is allowable for managerial, administrative, professional, and other services related to the operation of the facility and rendered in connection with patient care. The compensation cost limit for owners and relatives of owners who function in corporate positions shall be based upon the civil service equivalents as listed below and in the case of a proprietor or a partner, one of the below listed civil service equivalents shall be applied based upon the duties performed:

(1) Corporate president (a) Business administrator 3, class number 63317 for facilities with a combined bed total of one to ninety-nine; or

(b) Business administrator 4, class number 63318 for facilities with a combined bed total of one hundred to one hundred ninety-nine; or

(c) Fiscal officer 4, class number 66538 for facilities with a combined bed total of two hundred to two hundred ninety-nine; or

(d) Director 1, class number 61111 for facilities with a combined bed total of three hundred to five hundred ninety-nine; or

(e) Director 2, class number 61112 for facilities with a combined bed total of six hundred to one thousand one hundred ninety-nine; or

(f) Director 3, class number 61113 for facilities with a combined bed total of one thousand two hundred or more.

(2) Corporate vice-president (a) Program administrator 2, class number 63123 for facilities with a combined bed total of one to ninety-nine; or

(b) Program administrator 3, class number 63124 for facilities with a combined bed total of one hundred to one hundred ninety-nine; or

(c) Assistant director 1, class number 61211 for facilities with a combined bed total of two hundred to two hundred ninety-nine; or

(d) Assistant director 2, class number 61212 for facilities with a combined bed total of three hundred to five hundred ninety-nine; or

(e) Assistant director 3, class number 61213 for facilities with a combined bed total of six hundred to one thousand one hundred ninety-nine; or

(f) Assistant director 4, class number 61214 for facilities with a combined bed total of one thousand two hundred or more.

(3) Corporate treasurer (a) Fiscal specialist 1, class number 66531 for facilities with a combined bed total of one to ninety-nine; or

(b) Fiscal specialist 2, class number 66532 for facilities with a combined bed total of one hundred to one hundred ninety-nine; or

(c) Fiscal officer 1, class number 66535 for facilities with a combined bed total of two hundred to two hundred ninety-nine; or

(d) Fiscal officer 2, class number 66536 for facilities with a combined bed total of three hundred to five hundred ninety-nine; or

(e) Fiscal officer 3, class number 66537 for facilities with a combined bed total of six hundred to one thousand one hundred ninety-nine; or

(f) Fiscal officer 4, class number 66538 for facilities with a combined bed total of one thousand two hundred or more.

(4) Board secretary/member (a) Administrative professional 1, class number 16871 for facilities with a combined bed total of one to ninety-nine; or

(b) Office manager, class number 16821 for facilities with a combined bed total of one hundred to one hundred ninety-nine; or

(c) Administrative professional 4, class number 16874 for facilities with a combined bed total of two hundred to two hundred ninety-nine; or

(d) Program administrator 2, class number 63123 for facilities with a combined bed total of three hundred to five hundred ninety-nine; or

(e) Board/commission secretary 1, class number 62111 for facilities with a combined bed total of six hundred to one thousand one hundred ninety-nine; or

(f) Board/commission secretary 2, class number 62112 for facilities with a combined bed total of one thousand two hundred or more.

(5) For those owners and relatives of owners who serve the intermediate care facility in the capacity of a corporate officer, proprietor, or partner as specified under paragraphs (B)(1) to (B)(4) of this rule, the formula for determining the compensation cost limits is as follows:

(a) The civil service equivalent hourly rate as published by the Ohio department of administrative services for those positions specified under paragraphs (B)(1) to (B)(4) of this rule will be multiplied by two thousand eighty hours to arrive at an annual salary screen for each step in the position. If the civil service equivalent hourly rate changes during the reporting period, the civil service equivalent hourly rate will be the hourly rate that is in effect at the end of the cost reporting period.

(b) The appropriate job step within those civil service classifications as specified under paragraphs (B)(1) to (B)(4) of this rule will be based upon the owner's years of service in the health care field plus one.

(C) Reasonable costs for compensation and compensation disallowances for owners and relatives of owners are the facility's desk-reviewed, actual, allowable costs reported on schedule C-2 of the intermediate care facility cost report subject to the applicable compensation cost limits and audit by the Ohio office of medical assistance. For each owner or relative of an owner that has reported compensation on schedule C-2 of the intermediate care facility cost report shall perform the following steps.

(1) An owner and relative of an owner time slice is defined as follows:

(a) The number of days employed except when there is an overlap of an employment period for an owner or relative of an owner working in a related facility and the functions have the same position number; or

(b) When there is an overlap of an employment period for an owner or relative of an owner working in a related facility and the functions have the same position number, the number of days within an owner or relative of an owner compensation time slice for the individual is:

(i) The number of days employed for the overlap of an employment period when the individual is working in the related facility during the same period of time.

(ii) The number of days employed for the overlap of an employment period when the individual is working in the related facility during the same period of time.

(iii) The number of days employed subsequent to the overlapping employment period.

(2) For each owner and relative of an owner compensation 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 intermediate care facility cost report; and

(b) Acquire the number of certified beds from the intermediate care facility cost report for related facilities, as of the end of the cost reporting period; and

(c) Calculate the total number of certified beds by adding the number of certified beds for the facility as determined under paragraph (C)(2)(a) of this rule and the number of certified beds for any related facilities as determined under paragraph (C)(2)(b) of this rule.

(d) For owners and relatives of owners who received compensation as a corporate officer, acquire the appropriate corporate duty job step as calculated under paragraph (B)(5)(b) of this rule; and

(e) Determine the applicable compensation cost limit based on the position the owner or relative of an owner worked as follows:

(i) For owners and relatives of owners that are performing duties that are included on attachment 6 of the intermediate care facility cost report acquire the appropriate compensation cost limit as calculated under paragraph (A)(2)(d) of this rule subject to the following criteria:

(a) Compensation is allowable only for duties performed by owners which otherwise would require the employment of another individual.

(b) In order to qualify as a supervisor for positions listed on attachment 6 of the intermediate care facility cost report, the supervisor must supervise at least two individuals in facilities with fifty beds or more. In facilities with less than fifty beds, a supervisor may supervise one individual; or

(ii) For owners and relatives of owners who performed duties which otherwise would have required the employment of another individual and received compensation as a corporate officer, acquire the appropriate compensation cost limit as calculated under paragraph (B)(5) of this rule; and

(iii) For purposes of determining the compensation cost limits, owners and relatives of owners, are overtime exempt. There shall be no upward adjustment to the applicable compensation cost limit to accommodate circumstances where such individuals work in excess of forty hours per week.

(f) Calculate the number of days in the time slice for each individual by subtracting the beginning date from the ending date for each time slice and adding one; and

(g) Determine the total days in the calendar year; and

(h) Calculate the per cent of days allowed by dividing the number of days in the time slice as calculated under paragraph (C)(2)(f) of this rule by the total days in the calendar year as determined under paragraph (C)(2)(g) of this rule; and

(i) Calculate the time slice adjusted compensation cost limit by multiplying the per cent of days allowed as calculated under paragraph (C)(2)(h) of this rule by the adjusted compensation as calculated under paragraph (C)(2)(e) of this rule.

(j) Acquire the weekly hours in the time slice for the appropriate time period from schedule C-2 of the intermediate care facility cost report; and

(k) Acquire the related weekly hours in the time slice for the appropriate time period from the related facilities' schedule C-2 of the intermediate care facility cost report; and

(l) Calculate the total weekly hours in the time slice by adding the weekly hours in the time slice as determined under paragraph (C)(2)(j) of this rule and the related weekly hours in the time slice as determined under paragraph(C)(2)(k) of this rule; and

(m) Calculate the maximum weekly hours:

(i) If the total weekly hours in the time slice as calculated under paragraph (C)(2)(l) of this rule is less than thirty-five hours per week then the maximum weekly hours in the time slice is forty; or

(ii) If the total weekly hours in the time slice as calculated under paragraph (C)(2)(l) of this rule is greater than or equal to thirty-five hours per week then the maximum weekly hours in the time slice is the total weekly hours in the time slice; and

(n) Calculate the hours allocation percentage by dividing the weekly hours in the time slice as calculated under paragraph (C)(2)(j) of this rule by the maximum weekly hours as calculated under paragraph (C)(2)(m) of this rule; and

(o) Calculate the final time slice adjusted compensation cost limit by multiplying the time slice adjusted compensation cost limit as calculated under paragraph (C)(2)(i) of this rule by the hours allocation percentage as calculated under paragraph (C)(2)(n) of this rule.

(p) Calculate a daily salary amount for each owner and relative of an owner by dividing the compensation amount by the number of days employed as reported on schedule C-2 of the intermediate care facility cost report. For each time slice, calculate the prorated owner and relative of an owner compensation amount by multiplying the daily salary amount for each owner and relative of an owner by the number of days in the time slice as calculated under paragraph (C)(2)(f) of this rule.

(q) Calculate the owner and relative of an owner compensation disallowance amount by subtracting the final time slice adjusted compensation cost limit as calculated under paragraph (C)(2)(o) of this rule from the prorated owner and relative of an owner compensation amount as calculated under paragraph (C)(2)(p) of this rule. The result cannot be less than zero.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-22 Intermediate care facilities - compensation cost limits, reasonable costs for compensation, and compensation disallowances if any for administrators.

(A) Compensation cost limits for administrators shall be based upon compensation costs for administrators who are not owners or relatives of owners, as reported on the intermediate care facility cost report from the calendar year preceding the fiscal year in which the rate is paid. The compensation cost limits for administrators, excluding owners and relatives of owners who are administrators, are calculated as follows:

(1) The compensation cost limits for administrators are calculated from the following intermediate care facility cost reports excluding cost reports for providers of outlier services as specified in rule 5123:2-7-10 of the Administrative Code:

(a) Cost reports for intermediate care facilities with a December thirty-first end date; and

(b) Desk-reviewed and preliminarily determined to be allowable costs for intermediate care facilities.

(2) For each administrator, calculate the hourly rate from schedule C-1 of the intermediate care facility cost report 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 schedule C-1 of the intermediate care facility cost report 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 paragraph (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 paragraph (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 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 schedule C-1 of the intermediate care facility cost report subject to the applicable compensation cost limits and audit by the Ohio office of medical assistance.

(1) For each individual administrator compensation reported on schedule C-1 of the intermediate care facility cost report 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 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 intermediate care facility cost report; 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 intermediate care facility cost report; and

(iii) Calculate the total number of certified beds by adding the number of certified beds for the facility as determined under paragraph (B)(1)(b)(i) of this rule and the number of certified beds for any related facilities that the administrator worked in determined under paragraph (B)(1)(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)(1)(b)(ii) 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 intermediate care facility cost report 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)(1)(b)(iv) of this rule by the allowance percentage determined under paragraph (B)(1)(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)(1)(b)(vii) of this rule by the total days in the calendar year as determined under paragraph (B)(1)(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)(1)(b)(ix) of this rule by the adjusted compensation as calculated under paragraph (B)(1)(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 intermediate care facility cost report; 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 intermediate care facility cost report; 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)(1)(b)(xi) of this rule and the related weekly hours in the individual administrator compensation time slice as determined under paragraph (B)(1)(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)(1)(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)(1)(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)(1)(b)(xi) of this rule by the maximum weekly hours as calculated under paragraph (B)(1)(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)(1)(b)(x) of this rule by the hours allocation percentage as calculated under paragraph (B)(1)(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 intermediate care facility cost report. 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)(b)(vii) of this rule; and

(xviii) Calculate the individual administrator compensation disallowance by subtracting the final time slice adjusted compensation cost limit as calculated under paragraph (B)(1)(b)(xvi) of this rule from the adjusted prorated administrator compensation amount as calculated under paragraph (B)(1)(b)(xvii) of this rule. The result cannot be less than zero.

(xix) Calculate the final adjusted prorated administrator compensation amount by subtracting the individual administrator compensation disallowance as calculated under paragraph (B)(1)(b)(xviii) of this rule from the adjusted prorated administrator compensation amount as calculated under paragraph (B)(1)(b)(xvii) of this rule.

(2) For each intermediate care facility, 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 intermediate care facility cost report; and

(b) Acquire the appropriate compensation cost limit for the bed size category using the total number of certified beds determined under paragraph (B)(2)(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)(2)(b) of this rule by the allowance percentage determined under paragraph (B)(2)(c) of this rule; and

(e) Calculate the total administrator allowable compensation by summing the compensation reported on schedule C-1 of the intermediate care facility cost report for all administrators and subtracting any disallowances calculated under paragraph (B)(1)(b)(xviii) 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)(2)(d) of this rule from the total administrator allowable compensation as calculated under paragraph (B)(2)(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 intermediate care facility 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 intermediate care facility must maintain records documenting the allocation of the individual's time to these duties. Time studies conducted in accordance with the centers for medicare and medicaid services publication 15-1, "Provider Reimbursement Manual" (revised January 2005), available at http://www.cms.hhs.gov/manuals, shall be considered sufficient documentation of the allocation of time. If it is found that the intermediate care facility 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;

(5) Licensed practical nurse;

(6) Recreational therapist;

(7) Psychologist;

(8) Respiratory therapist;

(9) Qualified intellectual disabilities professional;

(10) Licensed social worker/counselor;

(11) Chaplain;

(12) Charge nurse - registered nurse; and

(13) Charge nurse - licensed practical nurse.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-23 Intermediate care facilities - method for establishing the other protected costs component of the prospective rate.

(A) Each eligible intermediate care facility shall be paid a per diem for each resident for other protected costs. This component of the rate will be established prospectively each fiscal year for each facility. This per diem shall be calculated by dividing the desk-reviewed, actual, allowable other protected costs total except for the franchise permit fee (account number 6091) by the inpatient days. This information will come from the year-end cost report preceding the fiscal year in which the rate will be paid. This per diem will then be inflated by the estimated inflation rate as calculated under paragraph (B) of this rule and added to the per diem for the franchise permit fee as calculated under paragraph (C) of this rule to determine the total other protected cost component of the prospective rate.

(B) The department shall estimate the rate of inflation for the eighteen-month period using the consumer price index for all urban consumers for nonprescription drugs and the consumer price index for all urban consumers for medical supplies, as published by the United States bureau of labor statistics. The estimated inflation rate is calculated by taking the value of the indexes as of the thirty-first day of December in the fiscal year the rate will be paid, divided by the value of the indexes as of the first day of July in the immediately preceding calendar year. If the estimated inflation rate for the eighteen-month period is different from the actual inflation rate for that period, the difference shall be added to or subtracted from the inflation rate estimated for the following fiscal year.

(C) Notwithstanding the methodology of reimbursement for other protected costs, as set forth under rule 5123:2-7-16 of the Administrative Code, the franchise permit fee rate in the amount equal to the assessment specified in section 5112.30 of the Revised Code will be included in the other protected cost center per diem rate for each intermediate care facility subject to the franchise permit fee assessment as specified in section 5112.31 of the Revised Code. The intermediate care facility will not receive reimbursement for the franchise permit fee if there is no assessment. The franchise permit fee rate is not subject to the inflation factor that is allowed for costs reported in the other protected cost center under paragraph (B) of this rule.

Effective: 01/10/2013
R.C. 119.032 review dates: 01/10/2018
Promulgated Under: 119.03
Statutory Authority: 5111.02, 5111.226, 5123.04
Rule Amplifies: 5111.02, 5111.226, 5123.04

5123:2-7-24 [Rescinded] Intermediate care facilities - cost of ownership, efficiency incentive, and reporting of accumulated depreciation.

Effective: 7/8/2018
Five Year Review (FYR) Dates: 4/23/2018
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5111.226, 5111.02
Rule Amplifies: 5111.02 , 5123.04, 5111.226
Prior Effective Dates: 01/10/2013

5123:2-7-25 [Rescinded] Intermediate care facilities - nonextensive renovation.

Effective: 7/8/2018
Five Year Review (FYR) Dates: 4/23/2018
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5111.226, 5111.02
Rule Amplifies: 5111.02 , 5123.04, 5111.226
Prior Effective Dates: 01/10/2013

5123:2-7-26 [Rescinded] Intermediate care facilities - active treatment day programming.

Effective: 7/8/2018
Five Year Review (FYR) Dates: 4/23/2018
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5111.226, 5111.02
Rule Amplifies: 5111.02 , 5123.04, 5111.226
Prior Effective Dates: 01/10/2013

5123:2-7-27 [Rescinded] Intermediate care facilities - prospective rate reconsideration on the basis of possible calculation errors.

Effective: 7/8/2018
Five Year Review (FYR) Dates: 4/23/2018
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5111.226, 5111.02
Rule Amplifies: 5111.02 , 5123.04, 5111.226
Prior Effective Dates: 01/10/2013

5123:2-7-28 [Rescinded] Intermediate care facilities - prospective rate reconsideration on the basis of extreme hardship upon admission of a resident from a state-operated developmental center.

Effective: 7/8/2018
Five Year Review (FYR) Dates: 4/23/2018
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5111.226, 5111.02
Rule Amplifies: 5111.02 , 5123.04, 5111.226
Prior Effective Dates: 01/10/2013

5123:2-7-29 Intermediate care facilities for individuals with intellectual disabilities - ventilator services.

(A) Purpose

This rule sets forth requirements for an intermediate care facility for individuals with intellectual disabilities (ICFIID) to provide and be reimbursed for providing services to residents who are dependent on invasive mechanical ventilators.

(B) Definitions

(1) "Adult" means a person twenty-two years of age or older.

(2) "Business day" means a day of the week, excluding Saturday, Sunday, or a legal holiday as defined in section 1.14 of the Revised Code.

(3) "Department" means the Ohio department of developmental disabilities.

(4) "Designated outlier coordinator" means a department staff member who coordinates the general operations of the ICFIID outlier services program. The designated outlier coordinator works with providers of outlier services, individuals requesting and receiving outlier services, other persons whom individuals have identified, other service agencies, and other department staff. The designated outlier coordinator's duties include, but are not limited to:

(a) Assisting with the initial approval and ongoing monitoring of an ICFIID providing outlier services;

(b) Coordinating the processing of pre-admission and continued stay prior authorization requests for individuals; and

(c) Reviewing assessments, individual plans, day programming plans, staffing plans, and other documents.

(5) "Individual plan" means a written description of the services to be provided to an individual, developed by an interdisciplinary team that represents the professions, disciplines, or service areas that are relevant to identifying the individual's needs, as described by the comprehensive functional assessments.

(6) "Invasive mechanical ventilator" means a ventilator that is interfaced directly with the individual via an artificial airway (e.g., tracheostomy tube). Invasive mechanical ventilators (volume and/or pressure) are life support devices designed specifically for invasive mechanical ventilation applications and must accommodate direct current backup power supply and include disconnect, high pressure, low pressure, and power loss alarms.

(7) "Nurse" means a person authorized by Chapter 4723. of the Revised Code to engage in the practice of nursing as a registered nurse or a licensed practical nurse.

(8) "Outlier services" means those clusters of services that have been determined by the department to require reimbursement rates established pursuant to section 5124.152 of the Revised Code when delivered by qualified providers to individuals who have been prior-authorized to receive a category of service identified as an outlier service by the department as set forth in Chapter 5123:2-7 of the Administrative Code.

(9) "Pediatric ventilator services" means services provided by an ICFIID in accordance with rule 5123:2-7-29 of the Administrative Code as it existed on the day immediately prior to the effective date of this rule.

(10) "Physician" means a person authorized by Chapter 4731. of the Revised Code to practice medicine and surgery, osteopathic medicine and surgery, or podiatric medicine and surgery.

(11) "Plan of correction" means a corrective action plan prepared by an ICFIID in response to deficiencies cited by the department or the Ohio department of health. The plan shall conform to regulations and guidelines and include information that describes how the deficiency will be corrected, when it will be corrected, how other residents that may be affected by the deficiency will be identified, and how the ICFIID will ensure that compliance is maintained upon correction.

(12) "Prior authorization assessment for ventilator services" means an evaluation to determine if an individual meets the eligibility criteria to receive ventilator services set forth in paragraphs (C)(3) to (C)(6) of this rule that shall take place only after the individual is determined to meet the financial eligibility and level of care requirements set forth in paragraphs (C)(1) and (C)(2) of this rule.

(13) "Prior authorization for ventilator services" means department approval obtained by an ICFIID to provide ventilator services to a specific individual for specific time-limited initial or continued stay periods. Prior authorization for ventilator services shall be required for the ICFIID to be authorized by the department to provide ventilator services and to receive reimbursement for services rendered to the individual. Reimbursement may be denied for any service not rendered in accordance with Chapters 5160-3 and 5123:2-7 of the Administrative Code.

(14) "Registered nurse" has the same meaning as in section 4723.01 of the Revised Code.

(15) "Respiratory care professional" means a person who is licensed under Chapter 4761. of the Revised Code to practice the full range of respiratory care services described in division (A) of section 4761.01 of the Revised Code.

(16) "Ventilator services" means services provided by an ICFIID that holds an effective provider agreement with the Ohio department of medicaid and that is approved by the department to deliver outlier services to individuals who are dependent on invasive mechanical ventilators.

(C) Individual eligibility criteria

To receive prior authorization for ventilator services, an individual shall:

(1) Have been determined by the county department of job and family services to meet the medicaid financial eligibility standards for institutional care.

(2) Have obtained a developmental disabilities level of care determination from the department within the last thirty calendar days, or, at the time of prior authorization assessment for ventilator services, be determined by the department to meet the criteria for a developmental disabilities level of care in accordance with rule 5123:2-8-01 of the Administrative Code.

(3) Require the use of an invasive mechanical ventilator.

(4) Have been either:

(a) An adult resident of an ICFIID approved to provide pediatric ventilator services on the day immediately prior to the effective day of this rule; or

(b) An inpatient, for at least ninety days within the past twelve months, in an acute care hospital for treatment of a life-threatening or complex medical condition. If the individual has been an inpatient in an acute care hospital for treatment of a life-threatening or complex medical condition within the past twelve months but for less than ninety days, an ICFIID may submit to the department, and the department may approve, a written request to waive the ninety-day requirement. The request shall include a description of the clinical services the individual continues to require and an attestation by the ICFIID that it is able to meet the individual's needs.

(5) Have achieved a stabilized medical condition so that the immediate services of an acute care hospital, including daily physician visits, are not medically necessary.

(6) Require monitoring by a nurse twenty-four hours per day and professional assessment by a registered nurse on a daily basis.

(D) ICFIID eligibility criteria

(1) An ICFIID shall complete and submit to the department an application for approval to provide ventilator services. The application is available at the department's website (http://dodd.ohio.gov/). The ICFIID shall provide any additional information requested by the department and may be subject to documentation review and on-site visits by department personnel.

(2) In order to be approved to provide ventilator services and qualify for enhanced payment for provision of ventilator services to prior-authorized individuals, an ICFIID shall:

(a) Be an Ohio medicaid-certified ICFIID and agree to cooperate with the department's oversight of ventilator services;

(b) Meet the requirements set forth in rule 5123:2-7-02 of the Administrative Code in order to obtain and maintain a provider agreement.

(c) Fully meet all standards for residential facilities licensed in accordance with section 5123.19 of the Revised Code or have an approved and implemented plan of correction and have not demonstrated a pattern of repeat deficiencies.

(d) Fully meet all standards for Ohio medicaid ICFIID certification or meet the medicaid program requirements of a facility for which the Ohio department of health found deficiencies, have an approved and implemented plan of correction, and have not demonstrated a pattern of repeat deficiencies.

(e) Have:

(i) An emergency action plan in place in the event of a power failure;

(ii) An on-site backup generator service for all equipment including suction lines, oxygen lines, and emergency power to ventilators;

(iii) Sufficient backup ventilators on-site and available in the event of mechanical failure as well as any other equipment necessary to meet the needs of individuals in the event of an emergency; and

(iv) An emergency response plan in place in the event of natural or human-made disasters that provides for the safe transport of individuals to a safe area with appropriate resources available to ensure the health and safety of the individuals.

(f) Schedule direct care staff to ensure that adequately trained staff are present and on duty twenty-four hours per day, every day of the year. Staffing shall be sufficient to ensure that urgent, emergent, and routine resident needs are identified appropriately and in a timely manner and are met through the implementation of intervention strategies reflected in each resident's individual plan. Absences of staff for breaks and meals shall not compromise this staffing arrangement.

(g) Ensure that staff who manage ventilator services have evidence of at least two years of work experience with individuals who have complex medical conditions.

(h) Address through staff training programs, the specific medical domains a staff member must master for a thorough understanding and demonstration of competency in order to meet the specialized needs of residents requiring ventilator services. Initial and continuing direct care staff training shall include:

(i) Orientation to the ICFIID's status as a provider of ventilator services, including the individual eligibility criteria set forth in paragraph (C) of this rule and the ICFIID eligibility criteria set forth in paragraph (D) of this rule;

(ii) Information about the specific health care needs of the current residents of the ICFIID who receive ventilator services;

(iii) Accepted best practices and innovative approaches to meet residents' needs;

(iv) Training to ensure nursing care competence for residents, including specialized training on developmental needs that improve an individual's overall functional status; and

(v) Due to the increased risk of infection for residents of ICFIID who receive ventilator services, steps to be taken to minimize risk of transmission of contagious or infectious diseases.

(i) Agree to furnish or arrange to have furnished all medically necessary services to individuals who are dependent on invasive mechanical ventilators, regardless of whether the services are reimbursable through the ICFIID cost report mechanism or directly to the provider of such services.

(i) The ICFIID shall ensure that physician services are available twenty-four hours per day.

(ii) A physician shall complete an assessment of the individual at least once every thirty calendar days for the first ninety calendar days and at least once every ninety calendar days thereafter if the individual maintains a stable status with no acute complications related to ventilator support. If acute care needs requiring hospitalization present upon return to the ICFIID, a physician shall complete an assessment of the individual at least once every thirty calendar days for the first ninety calendar days and at least once every ninety calendar days thereafter.

(iii) The ICFIID shall ensure that respiratory care services are available twenty-four hours per day. Medically necessary respiratory care services shall be provided by a respiratory care professional or by a nurse who the ICFIID has determined has the training, knowledge, skill, and ability to complete the services in coordination with the respiratory care professional, and as ordered by a physician.

(iv) The ICFIID, in consultation with a physician and a respiratory care professional, shall develop a facility plan for providing care to individuals who are dependent on invasive mechanical ventilators. The plan shall address maintenance of ventilators, required modification and maintenance of facilities, and special accommodations required to ensure that all needs, including but not limited to, hygiene, bathing, dietary, social, and transportation, of individuals who are dependent on invasive mechanical ventilators, are met.

(v) The ICFIID shall ensure that services by registered nurses are available twenty-four hours per day.

(vi) Nursing care and any personal care that may be required for the health, safety, and wellbeing of the individuals served shall be available twenty-four hours per day. Nursing personnel shall be sufficient to ensure prompt recognition of any adverse change in an individual's condition and to facilitate nursing, medical, or other appropriate interventions, up to and including transfers to an acute care hospital.

(vii) The need for physical, occupational, and/or speech therapy services shall be assessed and services shall be provided as needed by therapists licensed to practice in Ohio.

(viii) If an individual is receiving enteral feedings and there is a complication of medical status secondary to the nutritional status, a dietary consultation by a person licensed to practice dietetics in Ohio shall be made available to that individual.

(j) Prior to admission of an individual who requires ventilator services, arrange for a suitable school or day program for the individual and submit the plan for such program to the designated outlier coordinator or other department designee.

(k) Prior to admission of an individual who requires ventilator services, develop and submit to the designated outlier coordinator or other department designee accurate assessments or reassessments by an interdisciplinary team that address the individual's health, social, psychological, educational, vocational, and chemical dependency needs. Health information shall include a copy of the medical assessment completed by a physician who has knowledge of and experience with the individual and shall include a clinical summary, need for invasive mechanical ventilation (including viability and plan for weaning), detailed therapy assessment with recommended therapy plan, medication needs, and any other medical information relevant to the individual's care needs.

(l) Ensure that a registered nurse submits a written summary of clinical status to the primary care physician on a monthly basis. The physician shall review and sign the summary and place it in the individual's medical record.

(m) Due to the complex and intensive needs of individuals who require ventilator services, develop a transitional plan prior to admission of an individual to ensure that the ICFIID is able to meet the individual's health, safety, and behavioral support needs from the day of admission. The transitional plan shall address major concerns and shall be provided to the designated outlier coordinator or other department designee upon request.

(n) Within thirty calendar days after admission, develop accurate assessments or reassessments by an interdisciplinary team that address the individual's health, social, psychological, educational, vocational, and chemical dependency needs in order to supplement the preliminary evaluation described in paragraph (D)(2)(k) of this rule, which was conducted prior to admission. The ICFIID shall provide the assessments or reassessments to the designated outlier coordinator or other department designee upon request.

(o) Develop a comprehensive individual plan within thirty calendar days of an individual's admission, with input from the individual, the individual's parent, the individual's guardian, or other person whom the individual has identified, as applicable. The ICFIID shall provide a copy of the individual plan to the designated outlier coordinator or other department designee upon request.

(i) The individual plan shall be reviewed by the appropriate program staff at least quarterly and revised as necessary with input from the individual, the individual's parent, the individual's guardian, or other person whom the individual has identified, as applicable.

(ii) The ICFIID shall notify the designated outlier coordinator or other department designee whenever an individual experiences a significant change in medical status, including hospitalization.

(iii) The ICFIID shall prepare a quarterly report in a format approved by the department that summarizes the resident's individual plan, progress, changes in treatment, current status relative to discharge goals, and any updates to the discharge plan, including referrals made and anticipated time frames. The ICFIID shall provide a copy of the quarterly report to the designated outlier coordinator or other department designee upon request.

(iv) The designated outlier coordinator or other department designee may visit the ICFIID at any time. The ICFIID shall provide any documents or information requested by the designated outlier coordinator or other department designee.

(p) Within thirty calendar days after admission, develop a written discharge plan with the interdisciplinary team in conjunction with the individual and others concerned with the individual's welfare. The discharge plan shall include a description of targeted medical/health status indicators that would signify the resident could be safely discharged. The ICFIID shall provide a copy of the discharge plan to the designated outlier coordinator or other department designee upon request.

(q) Accept payment for the provision of services at the non-outlier ICFIID reimbursement rate if prior authorization for ventilator services requested for an individual already residing in the ICFIID is denied.

(E) Outlier per diem rate

(1) An ICFIID's per diem rate shall be set in accordance with Chapter 5124. of the Revised Code and applicable rules in Chapter 5123:2-7 of the Administrative Code. An outlier per diem rate for ventilator services, determined and applied in accordance with paragraph (H) of this rule, shall be added to the ICFIID's per diem rate.

(2) With the exception of any specific items that are direct-billed in accordance with rule 5123:2-7-11 of the Administrative Code, the ICFIID shall agree to accept as payment in full the per diem rate established for ventilator services in accordance with this rule, and to make no additional charge to the individual, to any member of the individual's family, or to any other source for covered ventilator services.

(F) Prior authorization for services

(1) Payment for ventilator services covered by the medicaid program shall be available only upon prior authorization by the department for each individual in accordance with the procedures set forth in this rule. The prior authorization procedures set forth in this rule are in addition to the developmental disabilities level of care review process set forth in rule 5123:2-8-01 of the Administrative Code.

(a) Unless the individual is seeking a change of payer, prior authorization for ventilator services shall occur prior to admission to the ICFIID.

(b) In the case of requests for continued stay, prior authorization for ventilator services shall occur no later than the final day of the previously authorized ventilator services stay.

(2) A request for prior authorization for ventilator services shall be submitted to the department in writing via email to cr-icf@dodd.ohio.gov.

(3) It is the responsibility of the ICFIID to ensure that all required information is provided to the department as requested. An initial request for prior authorization for ventilator services is considered complete when:

(a) A request has been accurately completed and submitted via email to cr-icf@dodd.ohio.gov;

(b) A developmental disabilities level of care has been issued in accordance with rule 5123:2-8-01 of the Administrative Code and a determination regarding the feasibility of community-based care has been made; and

(c) The designated outlier coordinator has received supporting documentation exhibiting evidence that the applicant meets the eligibility criteria set forth in paragraphs (C)(3) to (C)(6) of this rule. The ICFIID shall retain a duplicate copy of all submitted documentation. Supporting documentation may include, but is not limited to, the preliminary evaluation, assessments, and transitional plan required prior to admission as set forth in paragraph (D) of this rule.

(4) The department's determination shall be based on the completed initial stay request and any additional information or documentation necessary to make the determination of eligibility for ventilator services, which may include a face-to-face visit by at least one department representative with the individual and, if applicable, the individual's parent, the individual's guardian, or other person whom the individual has identified and, to the extent possible, the individual's formal and informal care givers, to review and discuss the individual's care needs and preferences.

(5) Based upon a comparison of the individual's condition, service needs, and the requested placement site with the eligibility criteria set forth in paragraph (C) of this rule, the department shall conduct a review of the application, assessment report, and supporting documentation about the individual's condition and service needs to determine whether the individual is eligible for ventilator services.

(6) The department shall issue a notice of determination within thirty calendar days of receipt of a complete request for prior authorization indicating approval or denial of the request to the individual, the individual's parent, the individual's guardian, or other person whom the individual has identified, as applicable, and the ICFIID. The department shall send a copy of the notice to the county department of job and family services to be maintained in the individual's case record.

(a) When a request for prior authorization for ventilator services is denied, notice shall specify the reason for denial and explain the individual's right to a state hearing in accordance with section 5101.35 of the Revised Code.

(b) When a request for prior authorization for ventilator services is approved, the notice shall include an assigned prior authorization number, the number of days for which ventilator services are authorized, and the date on which payment is authorized to begin. The notice shall also include the name, location, and phone number of the department staff member who is assigned to monitor the individual's progress at the ICFIID.

(i) Individuals who are determined to have met the eligibility criteria set forth in paragraph (C) of this rule may be approved for an initial stay of a maximum of one hundred eighty-four days. The number of days prior-authorized for each eligible individual shall be based upon the submitted application materials, consultation with the individual's attending physician, and/or any additional consultations or materials required by the assessor to make a reasonable estimation regarding the individual's probable need for ventilator services.

(ii) Continued stay determinations shall be based on reports from the ICFIID submitted to the designated outlier coordinator regarding critical events and the status of the individual's condition and discharge planning options, face-to-face assessments conducted by the department, and/or other information determined by the department. When the department determines that the individual continues to meet the eligibility criteria set forth in paragraph (C) of this rule, and the ICFIID submits a request for continued stay in accordance with paragraph (F)(8) of this rule, continued stays may be approved for maximum increments of one hundred eighty-four days.

(c) Reimbursement for ventilator services shall be limited to services approved as indicated in the approval letter.

(7) An individual is expected to be discharged to the setting specified in the individual's discharge plan at the end of the prior-authorized initial or continued stay, and progress toward that end shall be monitored by the department or its designee throughout the individual's stay in the ICFIID.

(8) Ventilator services may be extended beyond the previously approved length of stay if the ICFIID submits a written request to the department proving that it is not possible to implement the individual's discharge plan. Such requests shall be submitted at least thirty calendar days prior to the last day of the previously authorized stay, unless there is a significant change of circumstances within the week preceding the expected discharge date that prevents implementation of the discharge plan.

(G) Payment authorization

The payment authorization date shall be one of the following, but shall not be earlier than the effective date of the individual's developmental disabilities level of care determination:

(1) The date of admission to the ICFIID; or

(2) The date of prior authorization for ventilator services approval, if the individual was already a resident of an ICFIID that provides ventilator services but was using another payer source.

(H) Initial and subsequent contracted rates

(1) The department shall establish the initial and subsequent contracted rates in accordance with Chapter 5124. of the Revised Code. All rate adjustments determined in accordance with this rule shall be effective on the payment authorization date determined in accordance with paragraph (G) of this rule through the date of discharge from the ICFIID or until the date the individual no longer meets the eligibility criteria set forth in paragraph (C) of this rule.

(2) An ICFIID may bill the ventilator services revenue code for each individual whose initial or continued stay prior authorization has been approved in accordance with paragraph (F) of this rule.

(3) An ICFIID shall not bill the ventilator services revenue code for individuals who are using bed-hold days in accordance with rule 5123:2-7-08 of the Administrative Code.

(4) The ICFIID shall be responsible for contacting the designated outlier coordinator no later than by the close of the next business day following the discharge of an individual or point at which the individual no longer meets the eligibility criteria established in paragraph (C) of this rule to ensure processing time for recalculation and application of the ventilator services outlier per diem rate to the ICFIID per diem rate.

(5) The ventilator services outlier per diem rate will be specific to the individual approved to receive ventilator services in the amount of three hundred dollars.

(I) Implementation of this rule

For purposes of implementation and notwithstanding other provisions of this rule:

(1) A resident of an ICFIID who was receiving pediatric ventilator services on the day immediately prior to the effective date of this rule shall be deemed by the department to be prior-authorized to receive ventilator services in accordance with this rule.

(2) An ICFIID that was approved to provide pediatric ventilator services on the day immediately prior to the effective date of this rule shall be deemed by the department to be approved to provide ventilator services in accordance with this rule.

(3) An ICFIID that was approved to provide pediatric ventilator services on the day immediately prior to the effective date of this rule, seeking to secure prior authorization for ventilator services on behalf of an adult individual who was a resident of the ICFIID on the day immediately prior to the effective date of this rule, shall submit to the department in writing via email to cr-icf@dodd.ohio.gov:

(a) The individual's comprehensive individual plan which includes a suitable day program, developed with input from the individual, the individual's guardian, or other person whom the individual has identified, as applicable.

(b) Accurate assessments or reassessments by an interdisciplinary team that address the individual's health, social, psychological, educational, vocational, and chemical dependency needs. Health information shall include a copy of the medical assessment completed by a physician who has knowledge of and experience with the individual and shall include a clinical summary, need for invasive mechanical ventilation (including viability and plan for weaning), detailed therapy assessment with recommended therapy plan, medication needs, and any other medical information relevant to the individual's care needs.

(c) A written discharge plan developed with the interdisciplinary team in conjunction with the individual and others concerned with the individual's welfare. The discharge plan shall include a description of targeted medical/health status indicators that would signify the resident could be safely discharged.

(d) Other documents or information requested by the department for purposes of making a determination.

(4) The department shall issue a notice of determination within ten calendar days of receipt of a complete request for prior authorization submitted in accordance with paragraph (I)(3) of this rule. When the department determines the individual is eligible for ventilator services, the payment authorization date shall be the date of prior authorization for ventilator services approval.

Replaces: 5123:2-7-29

Effective: 1/18/2018
Five Year Review (FYR) Dates: 01/18/2023
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5124.03, 5124.152
Rule Amplifies: 5123.04, 5124.03, 5124.15 , 5124.152 , 5124.25, 5162.021
Prior Effective Dates: 10/01/2013, 02/16/2017

5123:2-7-30 [Rescinded] Intermediate care facilities - exception review process.

Effective: 7/8/2018
Five Year Review (FYR) Dates: 4/23/2018
Promulgated Under: 119.03
Statutory Authority: 5162.021, 5124.193, 5124.03, 5124.02, 5123.04
Rule Amplifies: 5123.04 , 5162.021, 5124.193, 5124.03, 5124.02
Prior Effective Dates: 10/01/2013

5123:2-7-31 Intermediate care facilities for individuals with intellectual disabilities - recoupment of downsizing incentive.

(A) Purpose

This rule establishes a process for the recoupment of a downsizing incentive from an intermediate care facility for individuals with intellectual disabilities (ICFIID) when the ICFIID obtained department approval to become a downsized ICFIID pursuant to section 5124.39 of the Revised Code and does not become a downsized ICFIID on or before July 1, 2018.

(B) Definitions

(1) "Department" means the Ohio department of developmental disabilities.

(2) "Downsized ICFIID" has the same meaning as in section 5124.01 of the Revised Code.

(3) "Intermediate care facility for individuals with intellectual disabilities" has the same meaning as in section 5124.01 of the Revised Code.

(C) Amount of recoupment

(1) On or before January 1, 2018, the department shall survey each ICFIID with an approved downsizing plan to determine if the ICFIID will in fact become a downsized ICFIID on or before July 1, 2018. An ICFIID shall respond to the department in writing on or before February 1, 2018.

(2) When the department determines that the ICFIID will not become a downsized ICFIID on or before July 1, 2018, the department shall calculate the amount of the recoupment in accordance with division (A)(1) of section 5124.39 of the Revised Code and send notice to the ICFIID by registered mail, return receipt requested, of the amount due.

(3) The amount of the recoupment calculated in accordance with paragraph (C)(2) of this rule shall be due and payable as of July 1, 2018.

(D) Interest

(1) Except as provided in paragraph (D)(2) of this rule, the department shall charge interest on the amount of the recoupment that is equal to the current average bank prime rate as determined pursuant to section 5124.43 of the Revised Code. Interest on the amount shall begin to accrue from the date the rate was calculated based on the ICFIID's approved downsizing plan.

(2) The department shall not charge interest on the amount of the recoupment when:

(a) An ICFIID voluntarily repays the amount determined by the department to be subject to recoupment; or

(b) An ICFIID voluntarily repays the amount determined by the department to be subject to recoupment when it reports to the department in writing on or before February 1, 2018 that it will not become a downsized ICFIID on or before July 1, 2018, and notifies the department of the method of repayment in accordance with paragraph (E)(2) of this rule.

(E) Payment methods

(1) On or before July 1, 2018, an ICFIID subject to recoupment shall notify the department in writing of the desired method by which to make the repayment.

(2) The repayment may be made:

(a) In a lump sum payment to the department;

(b) In a single deduction from the ICFIID's next scheduled medicaid payment as long as the deduction will equal the total amount due to the department;

(c) Pursuant to a written agreement between the department and the ICFIID, in installment payments to the department for a period not to exceed six months; or

(d) Pursuant to a written agreement between the department and the ICFIID, in installment deductions from the ICFIID's next scheduled medicaid payments for a period not to exceed six months.

(3) The department's decision to allow or disallow repayment by the methods described in paragraphs (E)(2)(c) and (E)(2)(d) of this rule is final and not subject to appeal.

(F) Request for exemption from recoupment

(1) On or before July 1, 2018, an ICFIID subject to recoupment may request in writing that the department exempt it from recoupment by providing proof to the department that:

(a) The ICFIID made a good faith effort to become a downsized ICFIID in accordance with its approved plan by July 1, 2018, but was unable to complete the downsizing for reasons beyond the ICFIID's control; and

(b) The ICFIID provides the department with a plan and timeline to ensure that the ICFIID becomes a downsized ICFIID within a reasonable period of time after July 1, 2018.

(2) The department shall consider all of the information submitted by the ICFIID and issue a written decision regarding the exemption from recoupment within thirty calendar days of receiving the request.

(3) Subject to the provisions of paragraph (H) of this rule, the department's decision to allow or disallow the request for exemption from recoupment is final and not subject to further appeal.

(G) Nonconformity with terms of exemption from recoupment

If an ICFIID receives an exemption from recoupment in accordance with paragraph (F) of this rule and fails to become a downsized ICFIID on or before the date set forth in the approved exemption:

(1) The department shall calculate the amount of the recoupment in accordance with division (A)(1) of section 5124.39 of the Revised Code and send notice to the ICFIID by registered mail, return receipt requested, of the amount due.

(2) The amount of the recoupment calculated in accordance with paragraph (G)(1) of this rule shall be due and payable no later than ten calendar days after the ICFIID receives notice of the amount due.

(3) The department shall charge interest on the amount of the recoupment that is equal to the current average bank prime rate as determined pursuant to section 5124.43 of the Revised Code. Interest on the amount shall begin to accrue from the date the rate was calculated based on the ICFIID's original approved downsizing plan.

(4) Paragraph (D)(2) of this rule shall not apply.

(H) Request for reconsideration

(1) An ICFIID may submit a written request for reconsideration to the department no later than ten calendar days after it receives the notice of recoupment pursuant to paragraph (C) or (G) of this rule. The request for reconsideration may ask the department to reconsider that the ICFIID is subject to recoupment or may ask the department to reconsider the amount of the recoupment.

(2) The department shall consider all of the information submitted by the ICFIID and issue a written decision regarding reconsideration within thirty calendar days of receiving the request.

(3) The department's decision regarding the request for reconsideration is final and not subject to further appeal.

Effective: 7/1/2017
Five Year Review (FYR) Dates: 07/01/2022
Promulgated Under: 119.03
Statutory Authority: 5123.04, 5124.03, 5124.39
Rule Amplifies: 5123.04, 5124.03, 5124.39

5123:2-7-32 Intermediate care facilities for individuals with intellectual disabilities - administration of the Ohio developmental disabilities profile.

(A) Purpose

This rule sets forth a requirement and process for administration of the Ohio developmental disabilities profile to residents of an intermediate care facility for individuals with intellectual disabilities (ICFIID).

(B) Definitions of terms used in this rule

(1) "Certified assessor" means a person authorized by the department to administer the Ohio developmental disabilities profile. In order to become a certified assessor, a person shall complete training conducted or approved by the department and successfully perform a post-training demonstration.

(2) "Department" means the Ohio department of developmental disabilities.

(3) "Intermediate care facility for individuals with intellectual disabilities" has the same meaning as in section 5124.01 of the Revised Code.

(4) "Ohio developmental disabilities profile" means the instrument used to assess the needs and circumstances of an individual with developmental disabilities relative to other individuals with developmental disabilities.

(5) "Reporting period" means one of the four quarters of the calendar year, that is:

(a) January through March;

(b) April through June;

(c) July through September; or

(d) October through December.

(6) "Reporting period end date" means the last day of the last month in a reporting period.

(7) "Significant change of condition" means that the individual has experienced a change in physical or mental condition or functional abilities which may result in a change in the individual's support needs.

(C) Administration of the Ohio developmental disabilities profile

(1) Only a certified assessor may administer the Ohio developmental disabilities profile or attest that the most recent Ohio developmental disabilities profile is still valid for a resident of an ICFIID.

(2) A certified assessor of the department shall administer the Ohio developmental disabilities profile to a new resident of an ICFIID (other than a resident who transfers from another ICFIID) within thirty calendar days of the resident's admission, regardless of the resident's payment source or anticipated length of stay. Within seven calendar days of administration of the Ohio developmental disabilities profile, the department shall electronically notify the ICFIID of the results.

(3) When a resident of an ICFIID transfers to another ICFIID, the resident's most recent Ohio developmental disabilities profile shall transfer with the resident.

(4) When a resident of an ICFIID, regardless of the resident's payment source or anticipated length of stay, experiences a significant change of condition, a certified assessor of the ICFIID shall administer the Ohio developmental disabilities profile and electronically submit the results to the department with supporting documentation for the significant change of condition within fifteen calendar days of the significant change of condition. Within seven calendar days of receipt of the ICFIID's electronic submission, the department shall make a determination on a question-by-question basis and electronically notify the ICFIID that:

(a) The department accepts the results of the Ohio developmental disabilities profile administered by the ICFIID;

(b) The department requires additional supporting documentation to make a determination which shall be submitted by the ICFIID within seven calendar days; or

(c) The department does not accept the results of the Ohio developmental disabilities profile administered by the ICFIID with the department's rationale for not accepting the results.

(5) An ICFIID that disputes the results of an Ohio developmental disabilities profile administered by the department in accordance with paragraph (C)(2) of this rule or the department's determination in accordance with paragraph (C)(4)(c) of this rule may submit a request for reconsideration within fifteen calendar days of receiving notification of the results or determination. The ICFIID shall electronically submit the request for reconsideration to the department with a detailed explanation of why the ICFIID disputes the results or determination, relevant supporting documentation, and a proposed resolution. When an ICFIID submits a request for reconsideration in response to the department's determination in accordance with paragraph (C)(4)(c) of this rule, a certified assessor of the department shall re-administer the entire Ohio developmental disabilities profile to the resident. The department shall electronically respond to the ICFIID within fifteen calendar days of receiving the request for reconsideration. The department's decision regarding a request for reconsideration is final and not subject to further appeal.

(D) Quarterly certification of Ohio developmental disabilities profile data

(1) For each reporting period, a certified assessor of the ICFIID shall attest that the most recent Ohio developmental disabilities profile is still valid for each resident of the ICFIID on the reporting period end date, regardless of a resident's payment source or anticipated length of stay.

(a) The following shall be considered residents of the ICFIID on the reporting period end date:

(i) Residents admitted or transferred to the ICFIID prior to or on the reporting period end date and physically residing in the ICFIID on the reporting period end date; and

(ii) Residents temporarily absent on the reporting period end date but for whom the ICFIID 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 in accordance with rule 5123:2-7-08 of the Administrative Code.

(b) The following shall not be considered residents of the ICFIID on the reporting period end date:

(i) Residents discharged from the ICFIID prior to or on the reporting period end date;

(ii) Residents transferred to another ICFIID prior to or on the reporting period end date; and

(iii) Residents who die prior to or on the reporting period end date.

(2) A certified assessor of the ICFIID shall electronically certify the Ohio developmental disabilities profile data on behalf of the entire ICFIID no later than fifteen calendar days following the reporting period end date. The certification shall include the name of the certified assessor who verified that an Ohio developmental disabilities profile has been administered and attested that the most recent Ohio developmental disabilities profile is still valid for each resident of the ICFIID on the reporting period end date and the name and contact information of a staff member should department staff have questions about the data.

(E) Summary and correction of Ohio developmental disabilities profile data

(1) The department shall electronically notify an ICFIID of a missing or incomplete certification of Ohio developmental disabilities profile.

(2) The department shall process and summarize the ICFIID's Ohio developmental disabilities profile data for the reporting period and electronically provide a summary of the data to the ICFIID.

(3) An ICFIID may correct errors or omissions identified by either the department or the ICFIID by electronically submitting corrections along with an amended certification of Ohio developmental disabilities profile data no later than forty-five calendar days following the reporting period end date. Timeliness of the submission shall be determined by the electronic submission date.

(4) An ICFIID shall ensure that corrections made to the Ohio developmental disabilities profile data submitted to the department are consistent with the Ohio developmental disabilities profiles maintained at the ICFIID.

Effective: 9/15/2017
Five Year Review (FYR) Dates: 09/15/2022
Promulgated Under: 119.03
Statutory Authority: Section 261.170 of House Bill 49 of the 132nd General Assembly, 5124.03, 5123.04
Rule Amplifies: 5123.04 , Section 261.170 of House Bill 49 of the 132nd General Assembly, 5124.03