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

(A) An intermediate care facility, group, or association may request a reconsideration of a prospective intermediate care facility rate on the basis of a possible error in the calculation of the rate as follows:

(1) A request for reconsideration of a prospective rate on the basis of a possible error in the calculation of the rate shall be filed with the department no more than thirty days after the later of the initial payment of the rate or the receipt of the rate setting calculation.

(2) The request for a reconsideration of a prospective rate on the basis of a possible error in the calculation of the rate shall be filed in accordance with the following procedures:

(a) 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; and

(b) The request shall indicate that it is a request for rate reconsideration due to a possible error in the calculation of the rate; and

(c) The request shall include a detailed explanation of the possible error and the proposed corrected calculation; and

(d) The request shall include references to the relevant sections of the Revised Code and/or paragraphs of the Administrative Code as appropriate.

(3) The department shall respond in writing within sixty days of receiving a written request for reconsideration of a prospective rate due to a possible error in the calculation of the rate. If the department requests additional information to determine whether a rate adjustment is warranted, the intermediate care facility shall respond in writing and shall provide additional supporting documentation no more than thirty days after the receipt of the request for additional information. The department shall respond in writing within sixty days of receiving the additional information to the request for reconsideration of a prospective rate due to a possible error in the calculation of the rate.

(4) If a rate adjustment is warranted as the result of a reconsideration of a prospective rate due to a possible error in calculation, the adjustment shall be implemented retroactively to the initial service date for which the rate is effective.

(B) The department's decision at the conclusion of the rate reconsideration process shall not be subject to any administrative proceedings under Chapter 119. or any other provision 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