5160-16-06 Rural health clinics (RHCs): prospective payment system (PPS).

(A) Section 702 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 requires states to establish a new medicaid prospective payment system (PPS) for RHCs. This rule addresses how the department complies with BIPA requirements.

(B) Definitions:

(1) "Base rate" is the initial PPS rate assigned to an RHC.

(2) For the purposes of Chapter 5101:3-16 of the Administrative Code, "change in scope of service" is defined in accordance with paragraph (A)(1)(b) of rule 5101:3-28-09 of the Administrative Code. For the purposes of Chapter 5101:3-16 of the Administrative Code, references to federally qualified health centers in paragraph (B) of rule 5101:3-28-09 of the Administrative Code also apply to RHCs.

(C) Establishment of PPS rates for RHCs:

(1) For RHCs in operation during their fiscal year 1999, the base rate is the average of that RHC's medicare reimbursement rate per visit for its fiscal years 1999 and 2000.

(2) For RHCs beginning operation after their fiscal year 2000, the base rate is the same as the rate(s) established for other RHCs in the nearest adjacent area that are similar in size, caseload, and scope of services. If there is not an RHC in an adjacent area that is similar in size, caseload, and scope of services, the state-wide sixtieth percentile rate will be assigned to the new RHC as the start-up PPS rate.

(3) On October 1 of each subsequent year of operation, all PPS rates in effect for RHCs on September 30th will be increased by the percentage increase in the latest available medicare economic index (MEI).

(D) An RHC may request a PPS rate review upon incurring a change in scope of services. Provisions regarding review of change of scope of service for federally qualified health centers (FQHCs) in paragraph (C) of rule 5101:3-28-09alsoapply to RHCs, with the exception that RHCs shall utilize the independent rural health clinic and freestanding federally qualified health center cost report form(CMS-222-92), dated 1/2005, for the purpose of filing cost reports, rather that the JFS 03421, as described in paragraph (C)(7)(e) of rule 5101:3-28-09 of the Administrative Code.

Effective: 07/01/2006
R.C. 119.032 review dates: 03/30/2006 and 07/01/2011
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 10/15/01