Chapter 5124. INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES SERVICES
As used in this
chapter:
| (A) |
"Addition" means an increase in an ICF/IID's square
footage. |
| (B) |
"Affiliated
operator" means an operator affiliated with either of the following:
| (1) |
The
exiting operator for whom the affiliated operator is to assume liability for
the entire amount of the exiting operator's debt under the medicaid program or
the portion of the debt that represents the franchise permit fee the exiting
operator owes; |
| (2) |
The entering
operator involved in the change of operator with the exiting operator specified
in division (B)(1) of this section. |
|
| (C) |
"Allowable
costs" means an ICF/IID's costs that the department of developmental
disabilities determines are reasonable. Fines paid under section
5124.99
of the Revised Code are not allowable costs. |
| (D) |
"Capital costs"
means an ICF/IID's costs of ownership and costs of nonextensive
renovation. |
| (E) |
"Case-mix score"
means the measure determined under section
5124.192,
5124.193,
or 5124.197 of the Revised Code of the relative direct-care resources
needed to provide care and habilitation to an ICF/IID resident. |
| (F) |
"Change of
operator" means an entering operator becoming the operator of an ICF/IID in the
place of the exiting operator.
| (1) |
Actions that
constitute a change of operator include the following:
| (a) |
A
change in an exiting operator's form of legal organization, including the
formation of a partnership or corporation from a sole proprietorship; |
| (b) |
A
transfer of all the exiting operator's ownership interest in the operation of
the ICF/IID to the entering operator, regardless of whether ownership of any or
all of the real property or personal property associated with the ICF/IID is
also transferred; |
| (c) |
A lease of
the ICF/IID to the entering operator or the exiting operator's termination of
the exiting operator's lease; |
| (d) |
If
the exiting operator is a partnership, dissolution of the
partnership; |
| (e) |
If the
exiting operator is a partnership, a change in composition of the partnership
unless both of the following apply:
| (i) |
The
change in composition does not cause the partnership's dissolution under state
law. |
| (ii) |
The partners
agree that the change in composition does not constitute a change in
operator. |
|
| (f) |
If the
operator is a corporation, dissolution of the corporation, a merger of the
corporation into another corporation that is the survivor of the merger, or a
consolidation of one or more other corporations to form a new
corporation. |
|
| (2) |
The
following, alone, do not constitute a change of operator:
| (a) |
A
contract for an entity to manage an ICF/IID as the operator's agent, subject to
the operator's approval of daily operating and management decisions; |
| (b) |
A
change of ownership, lease, or termination of a lease of real property or
personal property associated with an ICF/IID if an entering operator does not
become the operator in place of an exiting operator; |
| (c) |
If
the operator is a corporation, a change of one or more members of the
corporation's governing body or transfer of ownership of one or more shares of
the corporation's stock, if the same corporation continues to be the
operator. |
|
|
| (G) |
"Cost center"
means the following:
| (4) |
Other
protected costs. |
|
| (H) |
| (1) |
Except as provided in division (H)(2) of this section,
"cost report year" means the calendar year immediately preceding the calendar
year in which a fiscal year for which a medicaid payment rate determination is
made begins. |
| (2) |
When a cost report the department of developmental
disabilities accepts under division (A) or (C)(1)(b) of section
5124.101
of the Revised Code is used in determining an ICF/IID's medicaid payment rate,
"cost report year" means the period that the cost report
covers. |
|
| (I) |
Costs of nonextensive renovations" means the following:
| (1) |
For the purpose of determining an ICF/IID's per
medicaid day capital component rate under section
5124.17
of the Revised Code, the actual expense incurred by the ICF/IID for
depreciation or amortization and interest on renovations approved by the
department of developmental disabilities as nonextensive
renovations; |
| (2) |
For the purpose of determining an ICF/IID's per
medicaid day payment rate for reasonable capital costs under section 5124.171
of the Revised Code, the actual expense incurred by
the
ICF/IID for depreciation or amortization and interest on renovations that are
not extensive renovations. |
|
| (J) |
| (1) |
"Costs of ownership" means the actual expenses incurred by an ICF/IID for all
of the following:
| (a) |
Subject to
division (J)(2) of this section, depreciation and interest on
any capital assets that cost five hundred dollars or more per item, including
the following:
| (ii) |
Building
improvements that are not approved as nonextensive renovations
for the
purpose of section
5124.17 or 5124.171 of the Revised Code; |
| (iv) |
Transportation equipment;
|
| (v) |
For the purpose of determining an ICF/IID's per
medicaid day payment rate for reasonable capital costs under section 5124.171
of the Revised Code, extensive renovations. |
|
| (b) |
Amortization and interest on land improvements and leasehold
improvements; |
| (c) |
Amortization
of financing costs; |
| (d) |
Except as
provided in division (BB) of this section, lease and rent of land,
building, and equipment. |
|
| (2) |
The
costs of capital assets of less than five hundred dollars per item may be
considered costs of ownership in accordance with an ICF/IID provider's
practice. |
|
| (K) |
| (1) |
"Date of
licensure" means the following:
| (a) |
In the case
of an ICF/IID that was originally licensed as a nursing home under Chapter
3721. of the Revised Code, the date that it was originally so licensed,
regardless that it was subsequently licensed as a residential facility under
section
5123.19
of the Revised Code; |
| (b) |
In the case
of an ICF/IID that was originally licensed as a residential facility under
section
5123.19
of the Revised Code, the date it was originally so licensed; |
| (c) |
In
the case of an ICF/IID that was not required by law to be licensed as a nursing
home or residential facility when it was originally operated as a residential
facility, the date it first was operated as a residential facility, regardless
of the date the ICF/IID was first licensed as a nursing home or residential
facility. |
|
| (2) |
If, after an
ICF/IID's original date of licensure, more residential facility beds are added
to the ICF/IID or all or part of the ICF/IID undergoes an extensive renovation,
the ICF/IID has a different date of licensure for the additional beds or
extensively renovated portion of the ICF/IID. This does not apply, however, to
additional beds when both of the following apply:
| (a) |
The
additional beds are located in a part of the ICF/IID that was constructed at
the same time as the continuing beds already located in that part of the
ICF/IID. |
| (b) |
The part of
the ICF/IID in which the additional beds are located was constructed as part of
the ICF/IID at a time when the ICF/IID was not required by law to be licensed
as a nursing home or residential facility. |
|
| (3) |
The
definition of "date of licensure" in this section applies in determinations of
ICFs/IID's medicaid payment rates but does not apply in determinations of
ICFs/IID's franchise permit fees under sections
5168.60
to
5168.71
of the Revised Code. |
|
| (L) |
"Desk-reviewed"
means that an ICF/IID's costs as reported on a cost report filed under section
5124.10 or
5124.101
of the Revised Code have been subjected to a desk review under section
5124.108 of the
Revised Code and preliminarily determined to be allowable costs. |
| (M) |
"Developmental
center" means a residential facility that is maintained and operated by the
department of developmental disabilities. |
| (N) |
"Direct care
costs" means all of the following costs incurred by an ICF/IID:
| (1) |
Costs for registered nurses, licensed practical nurses, and nurse aides
employed by the ICF/IID; |
| (2) |
Costs for direct care staff, administrative nursing staff, medical directors,
respiratory therapists, physical therapists, physical therapy assistants,
occupational therapists, occupational therapy assistants, speech therapists,
audiologists, habilitation staff (including habilitation supervisors),
qualified intellectual disability professionals, program directors, social
services staff, activities staff, psychologists, psychology assistants, social workers,
counselors, and other persons holding degrees qualifying them to provide
therapy; |
| (3) |
Costs of
purchased nursing services; |
| (4) |
Costs of training and staff development, employee benefits, payroll taxes, and
workers' compensation premiums or costs for self-insurance claims and related
costs as specified in rules adopted under section
5124.03 of the Revised
Code, for personnel listed in divisions (N)(1), (2), and
(3) of this section; |
| (5) |
Costs of
quality assurance; |
| (6) |
Costs of
consulting and management fees related to direct care; |
| (7) |
Allocated direct care home office costs; |
| (8) |
Costs of off-site day programming, including day
programming that is provided in an area that is not certified by the director
of health as an ICF/HD under Title XIX and regardless of either of the
following:
| (a) |
Whether or not the area in which the day programming
is provided is less than two hundred feet away from the
ICF/IID; |
| (b) |
Whether or not the day programming is provided by an
individual or organization that is a related party to the ICF/IID
provider. |
|
| (9) |
Costs of other direct-care resources that are specified as direct care costs in
rules adopted under section
5124.03 of the Revised
Code. |
|
| (O) |
"Downsized ICF/IID" means an ICF/IID that
permanently reduced its medicaid-certified capacity pursuant to a plan approved
by the department of developmental disabilities under section
5123.042
of the Revised Code. |
| (P) |
"Effective date of a change of operator" means the
day the entering operator becomes the operator of the ICF/IID. |
| (Q) |
"Effective date
of a facility closure" means the last day that the last of the residents of the
ICF/IID resides in the ICF/IID. |
| (R) |
"Effective date
of an involuntary termination" means the date the department of medicaid
terminates the operator's provider agreement for the ICF/IID or the last day
that such a provider agreement is in effect when the department cancels or
refuses to revalidate it. |
| (S) |
"Effective date
of a voluntary termination" means the day the ICF/IID ceases to accept medicaid
recipients. |
| (T) |
"Entering
operator" means the person or government entity that will become the operator
of an ICF/IID when a change of operator occurs or following an involuntary
termination. |
| (U) |
"Exiting
operator" means any of the following:
| (1) |
An
operator that will cease to be the operator of an ICF/IID on the effective date
of a change of operator; |
| (2) |
An
operator that will cease to be the operator of an ICF/IID on the effective date
of a facility closure; |
| (3) |
An operator
of an ICF/IID that is undergoing or has undergone a voluntary
termination; |
| (4) |
An operator
of an ICF/IID that is undergoing or has undergone an involuntary
termination. |
|
| (V) |
| (1) |
For
the purpose of determining an ICF/IID's per medicaid day payment rate for
reasonable capital costs under section 5124.171 of the Revised Code,
"extensive renovation" means the following:
| (a) |
An
ICF/IID's betterment, improvement, or restoration to which both of the
following apply:
| (i) |
It was
started before July 1, 1993. |
| (ii) |
It
meets the definition of "extensive renovation" established in rules that were
adopted by the director of job and family services and in effect on December
22, 1992. |
|
| (b) |
An ICF/IID's
betterment, improvement, or restoration to which all of the following apply:
| (i) |
It
was started on or after July 1, 1993. |
| (ii) |
Except as provided in division (V)(2) of this section, it costs more than sixty-five
per cent and not more than eighty-five per cent of the cost of constructing a
new bed. |
| (iii) |
It extends
the useful life of the assets for at least ten years. |
|
|
| (2) |
The
department of developmental disabilities may treat a renovation that costs more
than eighty-five per cent of the cost of constructing new beds as an extensive
renovation if the department determines that the renovation is more prudent
than construction of new beds. |
| (3) |
For
the purpose of division (V)(1)(b)(ii) of this section, the cost of
constructing a new bed shall be considered to be forty thousand dollars,
adjusted for the estimated rate of inflation from January 1, 1993, to the end
of the calendar year during which the extensive renovation is completed, using
the consumer price index for shelter costs for all urban consumers for the
north central region, as published by the United States bureau of labor
statistics. |
|
| (W) |
| (1) |
Subject to
divisions (W)(2) and (3) of this section, "facility closure"
means either of the following:
| (a) |
Discontinuance of the use of the building, or part of the building, that houses
the facility as an ICF/IID that results in the relocation of all of the
facility's residents; |
| (b) |
Conversion of
the building, or part of the building, that houses an ICF/IID to a different
use with any necessary license or other approval needed for that use being
obtained and one or more of the facility's residents remaining in the facility
to receive services under the new use. |
|
| (2) |
A
facility closure occurs regardless of any of the following:
| (a) |
The
operator completely or partially replacing the ICF/IID by constructing a new
ICF/IID or transferring the ICF/IID's license to another ICF/IID; |
| (b) |
The
ICF/IID's residents relocating to another of the operator's ICFs/IID; |
| (c) |
Any
action the department of health takes regarding the ICF/IID's medicaid
certification that may result in the transfer of part of the ICF/IID's survey
findings to another of the operator's ICFs/IID; |
| (d) |
Any
action the department of developmental disabilities takes regarding the
ICF/IID's license under section
5123.19
of the Revised Code. |
|
| (3) |
A
facility closure does not occur if all of the ICF/IID's residents are relocated
due to an emergency evacuation and one or more of the residents return to a
medicaid-certified bed in the ICF/IID not later than thirty days after the
evacuation occurs. |
|
| (X) |
"Fiscal year"
means the fiscal year of this state, as specified in section
9.34
of the Revised Code. |
| (Y) |
"Franchise permit fee" means the fee imposed by
sections
5168.60
to
5168.71
of the Revised Code. |
| (Z) |
"Home and community-based services" has the same
meaning as in section
5123.01
of the Revised Code. |
| (AA) |
"ICF/IID services" has the same meaning as in
42 C.F.R 440.150. |
| (BB) |
| (1) |
"Indirect care costs" means all reasonable costs incurred by an ICF/IID other
than capital costs, direct care costs, and other protected costs. "Indirect
care costs" includes costs of habilitation supplies, pharmacy consultants,
medical and habilitation records, program supplies, incontinence supplies,
food, enterals, dietary supplies and personnel, laundry, housekeeping,
security, administration, liability insurance, bookkeeping, purchasing
department, human resources, communications, travel, dues, license fees,
subscriptions, home office costs not otherwise allocated, legal services,
accounting services, minor equipment, maintenance and repair expenses,
help-wanted advertising, informational advertising, start-up costs,
organizational expenses, other interest, property insurance, employee training
and staff development, employee benefits, payroll taxes, and workers'
compensation premiums or costs for self-insurance claims and related costs, as
specified in rules adopted under section
5124.03 of the Revised
Code, for personnel listed in this division. Notwithstanding division
(J) of
this section, "indirect care costs" also means the cost of equipment, including
vehicles, acquired by operating lease executed before December 1, 1992, if the
costs are reported as administrative and general costs on the ICF/IID's cost
report for the cost reporting period ending December 31, 1992. |
| (2) |
For
the purpose of division (BB)(1) of
this section, an operating lease shall be construed in accordance with
generally accepted accounting principles. |
|
| (CC) |
"Inpatient
days" means both of the following:
| (1) |
All days
during which a resident, regardless of payment source, occupies a bed in an
ICF/IID that is included in the ICF/IID's medicaid-certified
capacity; |
| (2) |
All days for
which payment is made under section
5124.34
of the Revised Code. |
|
| (DD) |
"Intermediate
care facility for individuals with intellectual disabilities" and "ICF/IID"
mean an intermediate care facility for the mentally retarded as defined in the
"Social Security Act," section 1905(d),
42 U.S.C. 1396d (d). |
| (EE) |
"Involuntary
termination" means the department of medicaid's termination of, cancellation
of, or refusal to revalidate the operator's provider agreement for the ICF/IID
when such action is not taken at the operator's request. |
| (FF) |
"Maintenance
and repair expenses" means, except as provided in division
(XX)(2)(b) of this section, expenditures that are
necessary and proper to maintain an asset in a normally efficient working
condition and that do not extend the useful life of the asset two years or
more. "Maintenance and repair expenses" includes the costs of ordinary repairs
such as painting and wallpapering. |
| (GG) |
"Medicaid-certified capacity" means the number of an ICF/IID's beds that are
certified for participation in medicaid as ICF/IID beds. |
| (HH) |
"Medicaid
days" means both of the following:
| (1) |
All days
during which a resident who is a medicaid recipient eligible for ICF/IID
services occupies a bed in an ICF/IID that is included in the ICF/IID's
medicaid-certified capacity; |
| (2) |
All
days for which payment is made under section
5124.34
of the Revised Code. |
|
| (II) |
| (1) |
"New
ICF/IID" means an ICF/IID for which the provider obtains an initial provider
agreement following the director of health's medicaid certification of the
ICF/IID, including such an ICF/IID that replaces one or more ICFs/IID for which
a provider previously held a provider agreement. |
| (2) |
"New
ICF/IID" does not mean either of the following:
| (a) |
An
ICF/IID for which the entering operator seeks a provider agreement pursuant to
section
5124.511
or
5124.512
or (pursuant to section
5124.515
) section
5124.07
of the Revised Code; |
| (b) |
A downsized
ICF/IID or partially converted ICF/IID. |
|
|
| (JJ) |
"Nursing home"
has the same meaning as in section
3721.01
of the Revised Code. |
| (KK) |
"Operator" means the person or government entity
responsible for the daily operating and management decisions for an
ICF/IID. |
| (LL) |
"Other
protected costs" means costs incurred by an ICF/IID for medical supplies; real
estate, franchise, and property taxes; natural gas, fuel oil, water,
electricity, sewage, and refuse and hazardous medical waste collection;
allocated other protected home office costs; and any additional costs defined
as other protected costs in rules adopted under section
5124.03 of the Revised
Code. |
| (MM) |
| (1) |
"Owner" means any person or government entity that has at least five per cent
ownership or interest, either directly, indirectly, or in any combination, in
any of the following regarding an ICF/IID:
| (a) |
The
land on which the ICF/IID is located; |
| (b) |
The
structure in which the ICF/IID is located; |
| (c) |
Any
mortgage, contract for deed, or other obligation secured in whole or in part by
the land or structure on or in which the ICF/IID is located; |
| (d) |
Any
lease or sublease of the land or structure on or in which the ICF/IID is
located. |
|
| (2) |
"Owner" does
not mean a holder of a debenture or bond related to an ICF/IID and purchased at
public issue or a regulated lender that has made a loan related to the ICF/IID
unless the holder or lender operates the ICF/IID directly or through a
subsidiary. |
|
| (NN) |
"Partially converted ICF/IID" means an ICF/IID
that converted some, but not all, of its beds to providing home and
community-based services under the individual options waiver pursuant to
section
5124.60
or
5124.61
of the Revised Code. |
| (OO) |
| (1) |
For the purpose of the total per medicaid day payment
rate determined for an ICF/IID under division (B) of section
5124.15 of the
Revised Code and the initial total per medicaid day payment rate determined for
a new ICF/IID under section
5124.151
of the Revised Code:
| (a) |
"Peer group 1-A" means each ICF/IID with a
medicaid-certified capacity exceeding sixteen. |
| (b) |
"Peer group 2-A" means each ICF/IID with a
medicaid-certified capacity exceeding eight but not exceeding
sixteen. |
| (c) |
"Peer group 3-A" means each ICF/IID with a
medicaid-certified capacity of seven or eight. |
| (d) |
"Peer group 4-A" means each ICF/IID with a
medicaid-certified capacity not exceeding six, other than an ICF/IID that is in
peer group 5-A. |
| (e) |
"Peer group 5-A" means each ICF/IID to which all of
the following apply:
| (i) |
The ICF/IID is first certified as an ICF/IID after
July 1, 2014. |
| (ii) |
The ICF/IID has a medicaid-certified capacity not
exceeding six. |
| (iii) |
The ICF/IID has a contract with the department of
developmental disabilities that is for fifteen years and includes a provision
for the department to approve all admissions to. and discharges from, the
ICF/IID. |
| (iv) |
The ICF/IID's residents are admitted to the ICF/IID
directly from a developmental center or have been determined by the department
to be at risk of admission to a developmental center. |
|
|
| (2) |
For the purpose of the total per medicaid day payment
rate determined for an ICF/IID under division (C) of section
5124.15 of the
Revised Code:
| (a) |
"Peer group
1-B" means each ICF/IID with a medicaid-certified
capacity exceeding eight. |
| (b) |
"Peer group
2-B" means each ICF/IID with a medicaid-certified
capacity not exceeding eight, other than an ICF/IID that is in peer group
3. |
| (c) |
"Peer group
3-B" means each ICF/IID to which all of the
following apply:
| (i) |
The ICF/IID is
first certified as an ICF/IID after July 1, 2014; |
| (ii) |
The ICF/IID has
a medicaid-certified capacity not exceeding six; |
| (iii) |
The ICF/IID
has a contract with the department of developmental disabilities that is for
fifteen years and includes a provision for the department to approve all
admissions to, and discharges from, the ICF/IID; |
| (iv) |
The ICF/UD's
residents are admitted to the ICF/IID directly from a developmental center or
have been determined by the department to be at risk of admission to a
developmental center. |
|
|
|
| (PP) |
| (1) |
Except as provided in divisions (PP)(2) and (3) of this section, "per diem"
means an ICF/IID's desk-reviewed, actual, allowable costs in a given cost
center in a cost reporting period, divided by the facility's inpatient days for
that cost reporting period. |
| (2) |
When
determining capital costs for the purpose of section 5124.171 of the Revised Code, "per
diem" means an ICF/IID's actual, allowable capital costs in a cost reporting
period divided by the greater of the facility's inpatient days for that period
or the number of inpatient days the ICF/IID would have had during that period
if its occupancy rate had been ninety-five per cent. |
| (3) |
When
determining indirect care costs for the purpose of section
5124.21 or 5124.211 of the Revised Code, "per diem" means
an ICF/IID's actual, allowable indirect care costs in a cost reporting period
divided by the greater of the ICF/IID's inpatient days for that period or the
number of inpatient days the ICF/IID would have had during that period if its
occupancy rate had been eighty-five per cent. |
|
| (QQ) |
"Provider" means an operator with a valid provider agreement. |
| (RR) |
"Provider agreement" means a provider agreement, as defined in section
5164.01 of the
Revised Code, that is between the department of medicaid and the operator of an
ICF/IID for the provision of ICF/IID services under the medicaid
program. |
| (SS) |
"Purchased
nursing services" means services that are provided in an ICF/IID by registered
nurses, licensed practical nurses, or nurse aides who are not employees of the
ICF/IID. |
| (TT) |
"Reasonable"
means that a cost is an actual cost that is appropriate and helpful to develop
and maintain the operation of resident care facilities and activities,
including normal standby costs, and that does not exceed what a prudent buyer
pays for a given item or services. Reasonable costs may vary from provider to
provider and from time to time for the same provider. |
| (UU) |
"Related party" means an individual or organization that, to a significant
extent, has common ownership with, is associated or affiliated with, has
control of, or is controlled by, a provider.
| (1) |
An
individual who is a relative of an owner is a related party. |
| (2) |
Common ownership exists when an individual or individuals possess significant
ownership or equity in both the provider and the other organization.
Significant ownership or equity exists when an individual or individuals
possess five per cent ownership or equity in both the provider and a supplier.
Significant ownership or equity is presumed to exist when an individual or
individuals possess ten per cent ownership or equity in both the provider and
another organization from which the provider purchases or leases real
property. |
| (3) |
Control
exists when an individual or organization has the power, directly or
indirectly, to significantly influence or direct the actions or policies of an
organization. |
| (4) |
An individual
or organization that supplies goods or services to a provider shall not be
considered a related party if all of the following conditions are met:
| (a) |
The
supplier is a separate bona fide organization. |
| (b) |
A
substantial part of the supplier's business activity of the type carried on
with the provider is transacted with others than the provider and there is an
open, competitive market for the types of goods or services the supplier
furnishes. |
| (c) |
The types of
goods or services are commonly obtained by other ICFs/IID from outside
organizations and are not a basic element of resident care ordinarily furnished
directly to residents by the ICFs/IID. |
| (d) |
The
charge to the provider is in line with the charge for the goods or services in
the open market and no more than the charge made under comparable circumstances
to others by the supplier. |
|
|
| (VV) |
"Relative of owner" means an individual who is related to an owner of an
ICF/IID by one of the following relationships:
| (2) |
Natural
parent, child, or sibling; |
| (3) |
Adopted parent, child, or sibling; |
| (4) |
Stepparent, stepchild, stepbrother, or stepsister; |
| (5) |
Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or
sister-in-law; |
| (6) |
Grandparent
or grandchild; |
| (7) |
Foster
caregiver, foster child, foster brother, or foster sister. |
|
| (WW) |
For the purpose of determining an ICF/IID's per
medicaid day capital component rate under section
5124.17
of the Revised Code, "renovation" means an ICF/IID's betterment, improvement,
or restoration, other than an addition, through a capital
expenditure. |
| (XX) |
| (1) |
For
the purpose of determining an ICF/IID's per medicaid day payment rate for
reasonable capital costs under section 5124.171 of the Revised Code,
"renovation" means the following:
| (a) |
An
ICF/IID's betterment, improvement, or restoration to which both of the
following apply:
| (i) |
It was
started before July 1, 1993. |
| (ii) |
It
meets the definition of "renovation" established in rules that were adopted by
the director of job and family services and in effect on December 22,
1992. |
|
| (b) |
An ICF/IID's
betterment, improvement, or restoration to which both of the following apply:
| (i) |
It
was started on or after July 1, 1993. |
| (ii) |
It
betters, improves, or restores the ICF/IID beyond its current functional
capacity through a structural change that costs at least five hundred dollars
per bed. |
|
|
| (2) |
For the purpose
of division (XX)(1) of this section, a renovation started on or after
July 1, 1993, may include both of the following:
| (a) |
A
betterment, improvement, restoration, or replacement of assets that are affixed
to a building and have a useful life of at least five years; |
| (b) |
Costs that otherwise would be considered maintenance and repair expenses if
they are an integral part of the structural change that makes up the renovation
project. |
|
| (3) |
For
the purpose of division (XX)(1) of this section, "renovation" does not
mean construction of additional space for beds that will be added to an
ICF/IID's licensed capacity or medicaid-certified capacity. |
|
| (YY) |
"Residential
facility" has the same meaning as in section
5123.19
of the Revised Code. |
| (ZZ) |
"Secondary building"
means a building or part of a building, other than an ICF/IID. in which the
owner of one or more ICFs/IID has administrative work regarding the ICFs/IID
performed or records regarding the ICFs/IID stored. |
| (AAA) |
"Sponsor" means an adult relative, friend, or guardian of an ICF/IID resident
who has an interest or responsibility in the resident's welfare. |
| (BBB) |
"Title XIX"
means Title XIX of the "Social Security Act,"
42 U.S.C. 1396, et seq. |
| (CCC) |
"Title XVII"
means Title XVIII of the "Social Security Act,"
42 U.S.C. 1395, et seq. |
| (DDD) |
"Voluntary
termination" means an operator's voluntary election to terminate the
participation of an ICF/IID in the medicaid program but to continue to provide
service of the type provided by a residential facility as defined in section
5123.19
of the Revised Code. |
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of medicaid shall enter
into a contract with the department of developmental disabilities under section
5162.35 of the Revised Code that provides for the
department of developmental disabilities to assume the powers and duties of the
department of medicaid with regard to the medicaid program's
coverage of ICF/IID services
. The contract shall include a schedule for the
assumption of the powers and duties. The contract may
provide for the department of medicaid to perform one or more duties of the
department of developmental disabilities under sections 5124.50 to 5124.53 of
the Revised Code. Except as otherwise authorized by the United States
secretary of health and human services, no provision of the contract may
violate a federal law or regulation governing the medicaid program.
Renumbered from § 5111.226 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Added by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
To the extent authorized by rules authorized by
section 5162.021 of the Revised Code, the director of developmental
disabilities shall adopt rules in accordance with Chapter 119. of the Revised
Code as necessary to implement this chapter.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The medicaid program shall cover ICF/IID services when
all of the following apply:
| (A) |
The ICF/IID services are provided to a medicaid
recipient eligible for the services. |
| (B) |
The ICF/IID services are provided by an ICF/IID for
which the provider has a valid provider agreement. |
| (C) |
Federal financial participation is available for the
ICF/IID services. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Subject to section 5124.072 of the Revised Code, an
ICF/IID operator is eligible to enter into a provider agreement for an ICF/IID
if all of the following apply:
| (1) |
The ICF/IID is certified by the director of health for
participation in medicaid; |
| (2) |
The ICF/IID is licensed by the director of
developmental disabilities as a residential facility; |
| (3) |
Subject to division (B) of this section, the operator
and ICF/IID comply with all applicable state and federal statutes and
rules. |
|
| (B) |
A state rule that requires an ICF/IID operator to have
received approval of a plan for the proposed ICF/IID pursuant to section
5123.042 of the Revised Code as a condition of the operator being eligible to
receive medicaid payments for ICF/IID services the ICF/IID provides does not
apply if, under former section 5123.193 of the Revised Code as enacted by Am.
Sub. H.B. 1 of the 128th general assembly or section 5123.197 of the Revised
Code, a residential facility license was obtained or modified for the ICF/IID
without obtaining approval of such a plan. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Except as provided in section 5124.072 of the Revised
Code, the department of medicaid shall enter into a provider agreement with an
ICF/IID operator who applies, and is eligible, for the provider
agreement. |
| (B) |
A provider agreement
shall require the department of developmental disabilities, pursuant to its
agreement with the department of medicaid under section 5124.02 of the Revised
Code, to make medicaid payments to the provider in accordance with this chapter
for ICF/IID services the ICF/IID provides to its residents who are medicaid
recipients eligible for ICF/IID services. |
| (C) |
A provider agreement shall require the provider to do
all of the following:
| (1) |
Maintain eligibility for
the provider agreement as provided in section 5124.06 of the Revised
Code; |
| (2) |
Keep records relating to
a cost reporting period for the greater of seven years after the cost report is
filed or, if the department of developmental disabilities issues an audit
report in accordance with section 5124.109 of the Revised Code, six years after
all appeal rights relating to the audit report are exhausted; |
| (3) |
File reports as the department of developmental
disabilities requires; |
| (4) |
Open all records relating to the costs of the
ICF/IID's services for inspection and audit by the department of developmental
disabilities; |
| (5) |
Open its premises for inspection by the department of
developmental disabilities, department of health, and any other state or local
authority having authority to inspect; |
| (6) |
Supply to the department of developmental disabilities
such information as it requires concerning the ICF/IID's services to residents
who are, or are eligible to be, medicaid recipients; |
| (7) |
Comply with section 5124.08 of the Revised Code. |
|
| (D) |
A provider agreement may
contain other provisions that are consistent with law and considered necessary
by the department of medicaid or the department of developmental
disabilities. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
An ICF/IID operator may enter into provider agreements
for more than one ICF/IID.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of medicaid shall not revalidate an
ICF/IID provider agreement if the provider fails to maintain eligibility for
the provider agreement as provided in section 5124.06 of the Revised
Code.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Every provider agreement with an ICF/IID provider
shall do both of the following:
| (1) |
Except as provided by division (B) of this section,
include any part of the ICF/IID that meets federal and state standards for
medicaid certification; |
| (2) |
Prohibit the provider from doing either of the
following:
| (a) |
Discriminating against a
resident on the basis of race, color, sex, creed, or national origin; |
| (b) |
Subject to division (D)
of this section, failing or refusing to do either of the following:
| (i) |
Admit as a resident of the ICF/IID an individual
because the individual is, or may (as a resident of the ICF/IID) become, a
medicaid recipient if less than eighty per cent of the ICF/IID's residents are
medicaid recipients; |
| (ii) |
Retain as a resident of
the ICF/IID an individual because the individual is, or may (as a resident of
the ICF/IID) become, a medicaid recipient. |
|
|
|
| (B) |
Unless otherwise required
by federal law, an ICF/IID bed is not required to be included in a provider
agreement if the bed is designated for respite care under a medicaid waiver
component operated pursuant to a waiver sought under section 5166.20 of the
Revised Code. |
| (C) |
For the purpose of division (A)(2)(b)(ii) of this
section, a medicaid recipient who is a resident of an ICF/IID shall be
considered a resident of the ICF/IID during any hospital stays totaling less
than twenty-five days during any twelve-month period. A medicaid recipient
identified by the department of developmental disabilities or its designee as
requiring the level of care of an ICF/IID shall not be subject to a maximum
period of absences during which the recipient is considered to be an ICF/IID
resident if prior authorization of the department for visits with relatives and
friends and participation in therapeutic programs is obtained in accordance
with rules adopted under section 5124.03 of the Revised Code. |
| (D) |
Nothing in this section shall bar a provider from
doing any of the following:
| (1) |
If the provider is a religious organization operating
a religious or denominational ICF/IID, giving preference to persons of the same
religion or denomination; |
| (2) |
Giving preference to persons with whom the provider
has contracted to provide continuing care; |
| (3) |
Retaining residents who have resided in the provider's
ICF/IID for not less than one year as private pay residents and who
subsequently become medicaid recipients but refusing to admit as a resident an
individual who is, or may (as a resident of the ICF/IID) become, a medicaid
recipient, if all of the following apply:
| (a) |
The provider does not refuse to retain a resident who
has resided in the provider's ICF/IID for not less than one year as a private
pay resident because the resident becomes a medicaid recipient, except as
necessary to comply with division (D)(3)(b) of this section. |
| (b) |
The number of medicaid recipients retained under
division (D)(3) of this section does not at any time exceed ten per cent of all
the ICF/IID's residents. |
| (c) |
On July 1, 1980, all the ICF/IID's residents were
private pay residents. |
|
|
| (E) |
No provider shall violate the provider agreement
obligations imposed by this section. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
An ICF/IID resident has a cause of action against the
provider of the ICF/IID for breach of the provider agreement obligations or
other duties imposed by section 5124.08 of the Revised Code. The action may be
commenced by the resident, or on the resident's behalf by the resident's
sponsor, by the filing of a civil action in the court of common pleas of the
county in which the ICF/IID is located or in the court of common pleas of
Franklin county.
If a court of common pleas finds that a provider has
breached a provider agreement obligation or other duty imposed by section
5124.08 of the Revised Code, the court may do one or more of the
following:
| (A) |
Enjoin the provider from
engaging in the practice; |
| (B) |
Order such affirmative relief as may be
necessary; |
| (C) |
Award to a resident and a
sponsor that brings the action on behalf of a resident actual damages, costs,
and reasonable attorney's fees. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Except as provided in division (D) of this section
and divisions (C)(2) and (4) of section
5124.101 of the Revised Code,
each ICF/IID provider shall file with the department of developmental
disabilities an annual cost report for each of the provider's ICFs/IID for
which the provider has a valid provider agreement. The cost report for a year
shall cover the calendar year or portion of the calendar year during which the
ICF/IID participated in the medicaid program. Except as provided in division
(E) of this section, the cost report is due not later than ninety days after
the end of the calendar year, or portion of the calendar year, that the cost
report covers. |
| (B) |
| (1) |
If an ICF/IID undergoes a change of provider that
the department determines, in accordance with rules adopted under section
5124.03 of the Revised Code, is
not an arms length transaction, the new provider shall file the ICF/IID's cost
report in accordance with division (A) of this section and the cost report
shall cover the portion of the calendar year during which the new provider
operated the ICF/IID and the portion of the calendar year during which the
previous provider operated the ICF/IID. |
| (2) |
If an ICF/IID undergoes a change of provider that
the department determines, in accordance with rules adopted under section
5124.03 of the Revised Code, is
an arms length transaction, the new provider shall file with the department a
cost report for the ICF/IID not later than, except as provided in division (E)
of this section, ninety days after the end of the ICF/IID's first three full
calendar months of operation under the new provider. The cost report shall
cover the period that begins with the ICF/IID's first day of operation under
the new provider and ends on the first day of the month immediately following
the first three full months of operation under the new provider. |
|
| (C) |
If the medicaid payment rate for a new ICF/IID was
most recently determined in accordance with section
5124.151 of the Revised Code,
the provider shall file with the department a cost report for the new ICF/IID
not later than, except as provided in division (E) of this section, ninety days
after the end of the new ICF/IID's first three full calendar months of
operation. The cost report shall cover the period that begins with the
ICF/IID's first day of operation and ends on the first day of the month
immediately following the first three full months of operation. |
| (D) |
An ICF/IID provider is not required to file a cost
report for an ICF/IID for a calendar year in accordance with division (A) of
this section if the provider files a cost report for the ICF/IID under division
(B)(2) or (C) of this section and that cost report covers a period that begins
after the first day of October of that calendar year. The provider shall file a
cost report for the ICF/IID in accordance with division (A) of this section for
the immediately following calendar year. |
| (E) |
The department may grant to a provider a
fourteen-day extension to file a cost report under this section or section
5124.101 of the Revised Code if
the provider provides the department a written request for the extension and
the department determines that there is good cause for the extension. |
Amended by
131st General Assembly File No. TBD, HB 483, §101.01, eff.
10/12/2016.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
The provider
of an ICF/IID in peer group 1-A, peer group 2-A, peer
group 3-A, peer group 4-A, peer group 1-B,
or peer group 2-B that becomes a downsized
ICF/IID or partially converted ICF/IID on or after July 1, 2013, or becomes a
new ICF/IID on or after that date, may file with the department of
developmental disabilities a cost report covering the period specified in
division (B) of this section if the following applies to the ICF/IID:
| (1) |
In
the case of an ICF/IID that becomes a downsized ICF/IID or partially converted
ICF/IID, the ICF/IID has either of the following on the day it becomes a
downsized ICF/IID or partially converted ICF/IID:
| (a) |
A
medicaid-certified capacity that is at least ten per cent less than its
medicaid-certified capacity on the day immediately preceding the day it becomes
a downsized ICF/IID or partially converted ICF/IID; |
| (b) |
At
least five fewer beds certified as ICF/IID beds than it has on the day
immediately preceding the day it becomes a downsized ICF/IID or partially
converted ICF/IID. |
|
| (2) |
In
the case of a new ICF/IID, the ICF/IID's beds are from a downsized ICF/IID and
the downsized ICF/IID has either of the following on the day it becomes a
downsized ICF/IID:
| (a) |
A
medicaid-certified capacity that is at least ten per cent less than its
medicaid-certified capacity on the day immediately preceding the day it becomes
a downsized ICF/IID; |
| (b) |
At least five
fewer beds certified as ICF/IID beds than it has on the day immediately
preceding the day it becomes a downsized ICF/IID. |
|
|
| (B) |
A cost report
filed under division (A) of this section shall cover the period that begins and
ends as follows:
| (1) |
In the case
of an ICF/IID that becomes a downsized ICF/IID or partially converted ICF/IID:
| (a) |
The
period begins with the day that the ICF/IID becomes a downsized ICF/IID or
partially converted ICF/IID. |
| (b) |
The
period ends on the last day of the last month of the first three full months of
operation as a downsized ICF/IID or partially converted ICF/IID. |
|
| (2) |
In the case
of a new ICF/IID:
| (a) |
The period
begins with the day that the provider agreement for the ICF/IID takes
effect. |
| (b) |
The period
ends on the last day of the last month of the first three full months that the
provider agreement is in effect. |
|
|
| (C) |
| (1) |
If
the department accepts a cost report filed under division (A) of this section
for an ICF/IID that becomes a downsized ICF/IID or partially converted ICF/IID
on or before the first day of October of a calendar year, the provider also
shall do both of the following:
| (a) |
File with the
department a cost report for the ICF/IID in accordance with division (A) of
section
5124.10 of the
Revised Code; |
| (b) |
File with the
department another cost report for the ICF/IID that covers the portion of the
initial calendar year that the ICF/IID operated as a downsized ICF/IID or
partially converted ICF/IID. |
|
| (2) |
If
the department accepts a cost report filed under division (A) of this section
for an ICF/IID that becomes a downsized ICF/IID or partially converted ICF/IID
after the first day of October of a calendar year, the provider is not required
to file a cost report that covers that calendar year in accordance with
division (A) of section
5124.10 of the
Revised Code. Instead, the provider shall file a cost report for the ICF/IID in
accordance with division (A) of section
5124.10 of the
Revised Code covering the immediately following calendar year. |
| (3) |
If
the department accepts a cost report filed under division (A) of this section
for a new ICF/IID that has a provider agreement that takes effect on or before
the first day of October of a calendar year, the provider also shall file a
cost report for the ICF/IID in accordance with division (A) of section
5124.10 of the
Revised Code covering the portion of that calendar year that the provider
agreement was in effect. |
| (4) |
If
the department accepts a cost report filed under division (A) of this section
for a new ICF/IID that has a provider agreement that takes effect after the
first day of October of a calendar year, the provider is not required to file a
cost report that covers that calendar year in accordance with division (A) of
section
5124.10 of the
Revised Code. The provider shall file a cost report for the ICF/IID in
accordance with division (A) of section
5124.10 of the
Revised Code covering the immediately following calendar year. |
|
| (D) |
The
department shall refuse to accept a cost report filed under division (A) or
(C)(1)(b) of this section if either of the following apply:
| (1) |
Except as provided in division (E) of section
5124.10 of the
Revised Code, the provider fails to file the cost report with the department
not later than ninety days after the last day of the period the cost report
covers; |
| (2) |
The cost
report is incomplete or inadequate. |
|
| (E) |
If
the department accepts a cost report filed under division (A) or (C)(1)(b) of
this section, the department shall use that cost report, rather than the cost
report that otherwise would be used pursuant to section
5124.17,
5124.171, 5124.19, 5124.195, 5124.21,
5124.21, 5124.23, or 5124.231 of the Revised Code, to determine
the ICF/IID's medicaid payment rate in accordance with this chapter for ICF/IID
services the ICF/IID provides during the period that begins and ends as
follows:
| (1) |
For a cost
report filed under division (A) of this section, the period begins on the
following:
| (a) |
In the case
of an ICF/IID that becomes a downsized ICF/IID or partially converted ICF/IID:
| (i) |
The
day that the ICF/IID becomes a downsized ICF/IID or partially converted ICF/IID
if that day is the first day of a month; |
| (ii) |
The
first day of the month immediately following the month that the ICF/IID becomes
a downsized ICF/IID or partially converted ICF/IID if division (E)(1)(a)(i) of
this section does not apply. |
|
| (b) |
In
the case of a new ICF/IID, the day that the ICF/IID's provider agreement takes
effect. |
|
| (2) |
For a cost
report filed under division (A) of this section, the period ends on the
following:
| (a) |
In the case
of an ICF/IID that becomes a downsized ICF/IID or partially converted ICF/IID:
| (i) |
The
last day of the fiscal year that immediately precedes the fiscal year for which
the ICF/IID is paid a rate determined using a cost report filed under division
(C)(1)(b) of this section if the ICF/IID became a downsized ICF/IID or
partially converted ICF/IID on or before the first day of October of a calendar
year; |
| (ii) |
The last day
of the fiscal year that immediately precedes the fiscal year for which the
ICF/IID begins to be paid a rate determined using a cost report that division
(C)(2) of this section requires be filed in accordance with division (A) of
section
5124.10 of the
Revised Code if the ICF/IID became a downsized ICF/IID or partially converted
ICF/IID after the first day of October of a calendar year. |
|
| (b) |
In
the case of a new ICF/IID, the last day of the fiscal year that immediately
precedes the fiscal year for which the ICF/IID begins to be paid a rate
determined using a cost report that division (C)(3) or (4) of this section
requires be filed in accordance with division (A) of section
5124.10 of the
Revised Code. |
|
| (3) |
For
a cost report filed under division (C)(1)(b) of this section, the period begins
on the day immediately following the day specified in division (E)(2)(a)(i) of
this section. |
| (4) |
For a cost
report filed under division (C)(1)(b) of this section, the period ends on the
last day of the fiscal year that immediately precedes the fiscal year for which
the ICF/IID begins to be paid a rate determined using the cost report filed
with the department in accordance with division (A) of section
5124.10 of the
Revised Code that covers the calendar year that immediately follows the initial
calendar year that the ICF/IID operated as a downsized ICF/IID or partially
converted ICF/IID. |
|
| (F) |
If
the department accepts a cost report filed under division (A) or (C)(1)(b) of
this section by the provider of a downsized ICF/IID or
partially converted ICF/IID, the following modifications shall be made
for the purpose of determining the medicaid payment rate for ICF/IID services
the ICF/IID provides during the period specified in division (E) of this
section:
| (1) |
In place of the quarterly case mix score otherwise used
in determining the ICF/IID's per medicaid day direct care costs component rate
under division (A) of section
5124.19
of the Revised Code, the ICF/IID's case mix score in effect on the last day of
the calendar quarter that ends during the period the cost report covers (or, if
more than one calendar quarter ends during that period, the last of those
calendar quarters) shall be used to determine the ICF/IID's per medicaid day
direct care costs component rate. |
| (2) |
In
place of the annual average case mix score otherwise used in determining the
ICF/IID's per medicaid day payment rate for direct care costs under division
(A) of section 5124.195 of the Revised Code, the
ICF/IID's case mix score in effect on the last day of the calendar quarter that
ends during the period the cost report covers (or, if more than one calendar
quarter ends during that period, the last of those calendar quarters) shall be
used to determine the ICF/IID's per medicaid day payment rate for direct care
costs.
|
| (3) |
The ICF/IID
shall not be subject to the limit on the costs of ownership per diem payment
rate specified in divisions (B) and (C) of section 5124.171 of the Revised
Code. |
| (4) |
The ICF/IID
shall not be subject to the limit on the payment rate for per diem capitalized
costs of nonextensive renovations specified in division (E)(1) of section
5124.171 of the Revised
Code. |
| (5) |
The ICF/IID
shall be subject to the limit on the total payment rate for costs of ownership,
capitalized costs of nonextensive renovations, and the efficiency incentive
specified in division (H) of section 5124.171 of the Revised Code
regardless of whether the ICF/IID is in peer group 1-B or peer group 2-B. |
|
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Amended by
131st General Assembly File No. TBD, HB 483, §101.01, eff.
10/12/2016.
Amended by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
No ICF/IID provider shall report fines paid under
section 5124.99 of the Revised Code in a cost report filed under section
5124.10, 5124.101, or 5124.522 of the Revised Code.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Cost reports shall be completed using the form
prescribed under section 5124.104 of the Revised Code and in accordance with
the guidelines established under that section.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities shall do
all of the following:
| (A) |
Prescribe the form to be used for completing a cost
report and a uniform chart of accounts for the purpose of reporting costs on
the form; |
| (B) |
Distribute a paper copy
of the form, or computer software for electronic submission of the form, to
each provider at least sixty days before the date the cost report is due; |
| (C) |
Establish guidelines for
completing the form. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities shall
develop an addendum to the cost report form that an ICF/IID provider may use to
set forth costs that the provider believes the department may dispute. The
department may consider such costs in determining an ICF/IID's medicaid payment
rate. If the department does not consider such costs in determining an
ICF/IID's medicaid payment rate, the provider may seek reconsideration of the
determination in accordance with section 5124.38 of the Revised Code. If the
department subsequently includes such costs in an ICF/IID's medicaid payment
rate, the department shall pay the provider interest at a reasonable rate
established in rules adopted under section 5124.03 of the Revised Code for the
period that the rate excluded the costs.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
If an ICF/IID provider required by section 5124.10
of the Revised Code to file a cost report for the ICF/IID fails to file the
cost report by the date it is due or the date, if any, to which the due date is
extended pursuant to division (E) of that section, or files an incomplete or
inadequate report for the ICF/IID under that section, the department of
developmental disabilities shall do both of the following:
| (1) |
Give written notice to the provider that the provider
agreement for the ICF/IID will be terminated in thirty days unless the provider
submits a complete and adequate cost report for the ICF/IID within thirty
days; |
| (2) |
Reduce the per medicaid day payment rate for the provider's
ICF/IID by the amount specified in division (B) of this section for the period
of time specified in division (C) of this section. |
|
| (B) |
For the purpose of
division (A)(2) of this section, an ICF/IID's per medicaid day payment rate
shall be reduced by the following amount:
| (1) |
In the case of a
reduction made during the period beginning on the effective date of this
amendment and ending on the first day of the first fiscal year beginning after
the effective date of this amendment, two dollars; |
| (2) |
In the case of a
reduction made during the first fiscal year beginning after the effective date
of this amendment and each fiscal year thereafter, the amount of the reduction
in effect on the last day of the fiscal year immediately preceding the fiscal
year in which the reduction is made adjusted by the rate of inflation during
that immediately preceding fiscal year, as shown in the consumer price
index for all items for all urban consumers for the midwest region, published
by the United States bureau of labor statistics. |
|
| (C) |
The period of time that
an ICF/IID's per medicaid day payment rate is reduced under this section shall
begin and end as follows:
| (1) |
The period shall begin on
the following date:
| (a) |
The day immediately
following the date the cost report is due or to which the due date is extended,
as applicable, if the reduction is made because the provider fails to file a
cost report by that date; |
| (b) |
The day the department
gives the provider written notice under division (A)(1) of this section of the
proposed provider agreement termination, if the reduction is made because the
provider files an incomplete or inadequate cost report. |
|
| (2) |
The period shall end on
the last day of the thirty-day period specified in the notice given under
division (A)(1) of this section or any additional period allowed for an appeal
of the proposed provider agreement termination. |
|
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Except as provided in division (B) of this section and
not later than three years after an ICF/IID provider files a cost report with
the department of developmental disabilities under section 5124.10 or 5124.101
of the Revised Code, the provider may amend the cost report if the provider
discovers a material error in the cost report or additional information to be
included in the cost report. The department shall review the amended cost
report for accuracy and notify the provider of its determination. |
| (B) |
An ICF/IID provider may
not amend a cost report if the department has notified the provider that an
audit of the cost report or a cost report of the provider for a subsequent cost
reporting period is to be conducted under section 5124.109 of the Revised Code.
The provider may, however, provide the department information that affects the
costs included in the cost report. Such information may not be provided after
the adjudication of the final settlement of the cost report. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities shall
conduct a desk review of all cost reports it receives under sections 5124.10,
5124.101, and 5124.522 of the Revised Code. Based on the desk review, the
department shall make a preliminary determination of whether the reported costs
are allowable costs. The department shall notify each ICF/IID provider of
whether any of the reported costs are preliminarily determined not to be
allowable costs, the medicaid payment rate determined under this chapter as a
result of the determination regarding allowable costs, and the reasons for the
determination and resulting rate. The department shall allow the provider to
verify the calculation and submit additional information.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
The department of developmental disabilities may
conduct an audit, as defined in rules adopted under section 5124.03 of the
Revised Code, of any cost report filed under section 5124.10, 5124.101, or
5124.522 of the Revised Code. The decision whether to conduct an audit and the
scope of the audit, which may be a desk or field audit, may be determined based
on prior performance of the provider, a risk analysis, or other evidence that
gives the department reason to believe that the provider has reported costs
improperly. A desk or field audit may be performed annually, but is required
whenever a provider does not pass the risk analysis tolerance factors. |
| (B) |
Audits shall be conducted
by auditors under contract with the department, auditors working for firms
under contract with the department, or auditors employed by the
department. The department may establish a contract for the
auditing of ICFs/IID by outside firms. Each contract entered into by bidding
shall be effective for one to two years.
|
| (C) |
The department shall notify a provider of the findings
of an audit of a cost report by issuing an audit report. The department shall
issue the audit report not later than three years after the earlier of the
following:
| (1) |
The date the cost report
is filed; |
| (2) |
The date a desk or field
audit of the cost report or a cost report for a subsequent cost reporting
period is completed. |
|
| (D) |
The department shall prepare a written summary of any
audit disallowance that is made after the effective date of the rate that is
based on the cost. Where the provider is pursuing judicial or administrative
remedies in good faith regarding the disallowance, the department shall not
withhold from the provider's current payments any amounts the department claims
to be due from the provider pursuant to section 5124.41 of the Revised
Code. |
| (E) |
| (1) |
The department shall
establish an audit manual and program for field audits conducted under this
section. Each auditor conducting a field audit under this section shall follow
the audit manual and program, regardless of whether the auditor is under
contract with the department, works for a firm under contract with the
department, or is employed by the department. The manual and program shall do
both of the following:
| (a) |
Require each field audit
to be conducted by an auditor to whom all of the following apply:
| (i) |
During the period of the auditor's contract, firm's
contract, or auditor's employment with the department, the auditor or firm does
not have and is not committed to acquire any direct or indirect financial
interest in the ownership, financing, or operation of ICFs/IID in this
state. |
| (ii) |
The auditor does not
audit any provider that has been a client of the auditor or the auditor's
firm. |
| (iii) |
The auditor is
otherwise independent as determined by the standards of independence included
in the government auditing standards produced by the United States government
accountability office. |
|
| (b) |
Require each auditor conducting a field audit to do
all of the following:
| (i) |
Comply with applicable
rules prescribed pursuant to Title XIX; |
| (ii) |
Consider generally
accepted auditing standards prescribed by the American institute of certified
public accountants; |
| (iii) |
Include a written
summary as to whether the costs included in the cost report examined during the
audit are allowable and are presented in accordance with state and federal laws
and regulations, and whether, in all material respects, allowable costs are
documented, reasonable, and related to patient care; |
| (iv) |
Complete the audit
within the time period specified by the department; |
| (v) |
Provide to the provider complete written
interpretations that explain in detail the application of all relevant contract
provisions, regulations, auditing standards, rate formulae, and departmental
policies, with explanations and examples, that are sufficient to permit the
provider to calculate with reasonable certainty those costs that are allowable
and the rate to which the provider's ICF/IID is entitled. |
|
|
| (2) |
For the purpose of
division (E)(1)(a)(i) of this section, employment of a member of an auditor's
family by an ICF/IID that the auditor does not audit does not constitute a
direct or indirect financial interest in the ownership, financing, or operation
of the ICF/IID. |
|
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Except
as otherwise provided by section
5124.101
of the Revised Code, sections
5124.151
to
5124.154
of the Revised Code, and divisions (D) and (E) of this section, the total per
medicaid day payment rate that the department of developmental disabilities
shall pay to an ICF/IID provider for ICF/IID services the provider's ICF/IID
provides during a fiscal year shall equal the following:
| (1) |
Until
July 1, 2021, the greater of the total per medicaid day payment rates
determined under divisions (B) and (C) of this section; |
| (2) |
Beginning July 1, 2021, the total per medicaid day payment rate determined
under division (B) of this section. |
|
| (B) |
The
total per medicaid day payment rate determined under this division is the sum
of all of the following:
| (1) |
The per
medicaid day capital component rate determined for the ICF/IID under section
5124.17
of the Revised Code; |
| (2) |
The per
medicaid day direct care costs component rate determined for the ICF/IID under
section
5124.19
of the Revised Code; |
| (3) |
The per
medicaid day indirect care costs component rate determined for the ICF/IID
under section
5124.21
of the Revised Code; |
| (4) |
The per
medicaid day other protected costs component rate determined for the ICF/IID
under section
5124.23
of the Revised Code; |
| (5) |
Until
July 1, 2021, a direct support personnel payment equal to
three and four-hundredths per cent of the ICF/IID's desk-reviewed, actual,
allowable, per medicaid day direct care costs from the applicable cost report
year; |
| (6) |
Beginning July 1, 2021, the sum of the
following:
| (a) |
The per medicaid day quality incentive payment
determined for the ICF/IID under section
5124.24 of the Revised Code; |
| (b) |
A direct support personnel payment equal to two and
four-hundredths per cent of the ICF/IID's desk-reviewed, actual, allowable, per
medicaid day direct care costs from the applicable cost report
year. |
|
|
| (C) |
The
total per medicaid day payment rate determined under this division is the sum
of all of the following:
| (1) |
The per
medicaid day payment rate for capital costs determined for the ICF/IID under
section 5124.171 of the Revised
Code; |
| (2) |
The per
medicaid day payment rate for direct care costs determined for the ICF/IID
under section 5124.195 of the Revised
Code; |
| (3) |
The per
medicaid day payment rate for indirect care costs determined for the ICF/IID
under section 5124.211 of the Revised
Code; |
| (4) |
The per
medicaid day payment rate for other protected costs determined for the ICF/IID
under section 5124.231 of the Revised
Code; |
| (5) |
A
direct support personnel payment equal to three and four-hundredths per cent of
the ICF/IID's desk-reviewed, actual, allowable, per medicaid day direct care
costs from the applicable cost report year. |
|
| (D) |
The
total per medicaid day payment rate for the following shall not exceed the
average total per medicaid day payment rate in effect on July 1, 2013, for
developmental centers:
| (1) |
An
ICF/IID that is in peer group 5-A for the purpose of the total per medicaid day
payment rate determined under division (B) of this section; |
| (2) |
An
ICF/IID that is in peer group 3-B for the purpose of the total per medicaid day
payment rate determined under division (C) of this section. |
|
| (E) |
The
department shall adjust the total per medicaid day payment rate otherwise
determined for an ICF/IID under divisions (B) and (C) of this section as
directed by the general assembly through the enactment of law governing
medicaid payments to ICF/IID providers. |
| (F) |
| (1) |
In
addition to paying an ICF/IID provider the total per medicaid day payment rate
determined for the provider's ICF/IID under divisions (B), (C), (D), and (E) of
this section for a fiscal year, the department may do either or both of the
following:
| (a) |
In accordance with section
5124.25
of the Revised Code, pay the provider
a rate add-on for ventilator-dependent outlier ICF/IID services if the rate
add-on is to be paid under that section and the department approves the
provider's application for the rate add-on; |
| (b) |
In accordance with section 5124.26 of the Revised
Code, pay the provider for outlier ICF/IID services the ICF/IID provides to
residents identified as needing intensive behavioral health support services if
the rate add-on is to be paid under that section and the department approves
the provider's application for the rate add-on.
|
|
| (2) |
The rate add-ons are not to be part of the
ICF/IID's total per medicaid day payment rate. |
|
Amended by
133rd General Assembly File No. TBD, HB 166, §101.01, eff.
10/17/2019.
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Amended by
132nd General Assembly File No. TBD, HB 49, §101.01, eff.
9/29/2017.
Amended by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Renumbered from § 5111.224 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Added by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
| (A) |
The total per
medicaid day payment rate determined under section
5124.15 of the
Revised Code shall not be the initial rate for ICF/IID services provided by a
new ICF/IID. Instead, the initial total per medicaid day payment rate for
ICF/IID services provided by a new ICF/IID shall be determined in accordance
with this section. |
| (B) |
The initial
total per medicaid day payment rate for ICF/IID
services provided by a new ICF/IID, other than an
ICF/IID in peer group 5-A, shall be determined in the
following manner:
| (1) |
The initial
per
medicaid day capital component rate shall be
the median per medicaid day capital component rate for
the ICF/IID's peer group for the fiscal year. |
| (2) |
The
initial per medicaid day direct care costs
component rate shall be determined as follows:
| (a) |
If
there are no cost or resident assessment data for the new ICF/IID as necessary
to determine a rate under section
5124.19
of the Revised Code, the rate shall be determined as follows:
| (i) |
Determine the median cost per case-mix unit under division (B) of section
5124.19
of the Revised Code for the new ICF/IID's peer group for the
applicable cost report year ; |
| (ii) |
Multiply the
amount determined under division (B)(2)(a)(i) of this section by the median
annual average case-mix score for the new ICF/IID's peer group for that
period; |
| (iii) |
Adjust the
product determined under division (B)(2)(a)(ii) of this section by the rate of
inflation estimated under division (D) of section
5124.19
of the Revised Code. |
|
| (b) |
If
the new ICF/IID is a replacement ICF/IID and the ICF/IID or ICFs/IID that are
being replaced are in operation immediately before the new ICF/IID opens, the
rate shall be the same as the rate for the replaced ICF/IID or ICFs/IID,
proportionate to the number of ICF/IID beds in each replaced ICF/IID. |
| (c) |
If
the new ICF/IID is a replacement ICF/IID and the ICF/IID or ICFs/IID that are
being replaced are not in operation immediately before the new ICF/IID opens,
the rate shall be determined under division (B)(2)(a) of this
section. |
|
| (3) |
The initial
per
medicaid day indirect care costs component
rate shall be the maximum rate for the new ICF/IID's peer group as
determined for the fiscal year in accordance with division (C) of section
5124.21
of the Revised Code. |
| (4) |
The initial
per
medicaid day other protected costs component
rate shall be one hundred fifteen per cent of the median rate for
ICFs/IID determined for the fiscal year under section
5124.23
of the Revised Code. |
|
| (C) |
The
initial total medicaid day payment rate for ICF/IID services provided by a new
ICF/IID in peer group 5-A shall be determined in the following manner:
| (1) |
The
initial per medicaid day capital component
rate shall be $ 29.61. |
| (2) |
The
initial per medicaid day direct care costs
component rate shall be $ 264.89. |
| (3) |
The
initial per medicaid day indirect care costs
component rate shall be $ 59.85. |
| (4) |
The
initial per medicaid day other protected costs
component rate shall be $ 25.99. |
|
| (D) |
| (1) |
Except as provided in division (D)(2) of this section, the department
of developmental disabilities shall adjust a new
ICF/IID's initial total per medicaid day payment rate determined under this
section effective the first day of July, to reflect new rate determinations for
all ICFs/IID under this chapter. |
| (2) |
If
the department accepts, under division (A) of section
5124.101
of the Revised Code, a cost report filed by the provider of a new ICF/IID, the
department shall adjust the ICF/IID's initial total per medicaid day payment
rate in accordance with divisions (E) and (F) of that section rather than
division (D)(1) of this section. |
|
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Amended by
131st General Assembly File No. TBD, HB 483, §101.01, eff.
10/12/2016.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Renumbered from § 5111.255 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
Effective Date:
07-01-2000; 07-01-2005
| (A) |
The total per
medicaid day payment rate determined under section
5124.15 of the
Revised Code shall not be paid for ICF/IID services provided by an ICF/IID, or
discrete unit of an ICF/IID, designated by the department of developmental
disabilities as an outlier ICF/IID or unit. Instead, the provider of a
designated outlier ICF/IID or unit shall be paid each fiscal year a total per
medicaid day payment rate that the department shall prospectively determine in
accordance with a methodology established in rules authorized by this
section. |
| (B) |
The
department may designate an ICF/IID, or discrete unit of an ICF/IID, as an
outlier ICF/IID or unit if the ICF/IID or unit serves residents who have either
of the following:
| (1) |
Diagnoses or
special care needs that require direct care resources that are not measured
adequately by the resident assessment instrument specified in rules authorized
by sections 5124.191 and 5124.196 of the Revised Code; |
| (2) |
Diagnoses or special care needs that are specified in rules authorized by this
section as otherwise qualifying for consideration under this section. |
|
| (C) |
Notwithstanding any other provision of this chapter, the costs incurred by a
designated outlier ICF/IID or unit shall not be considered in establishing
medicaid payment rates for other ICFs/IID or units. |
| (D) |
The
director of developmental disabilities shall adopt rules under section
5124.03 of the Revised Code
as necessary to implement this section.
| (1) |
| (a) |
The
rules shall do both of the following:
| (i) |
Specify the criteria and procedures the department will apply when designating
an ICF/IID, or discrete unit of an ICF/IID, as an outlier ICF/IID or
unit; |
| (ii) |
Establish a
methodology for prospectively determining the total per medicaid day payment
rate that will be paid each fiscal year for ICF/IID services provided by a
designated outlier ICF/IID or unit. |
|
| (b) |
The
rules adopted under division (D)(1)(a)(i) of this section regarding the
criteria for designating outlier ICFs/IID and units shall do both of the
following:
| (i) |
Provide for
consideration of whether all of the allowable costs of an ICF/IID, or discrete
unit of an ICF/IID, would be paid by the rate determined under section
5124.15 of the
Revised Code; |
| (ii) |
Specify the
minimum number of ICF/IID beds that an ICF/IID, or discrete unit of an ICF/IID,
must have to be designated an outlier ICF/IID or unit. |
|
| (c) |
The
rules authorized by division (D)(1)(a)(i) of this section regarding the
criteria for designating outlier ICFs/IID and units shall not limit the
designation to ICFs/IID, or discrete units of ICFs/IID, located in large
cities. |
| (d) |
The rules
authorized by division (D)(1)(a)(ii) of this section regarding the methodology
for prospectively determining the rates of designated outlier ICFs/IID and
units shall provide for the methodology to consider the historical costs of
providing ICF/IID services to the residents of designated outlier ICFs/IID and
units. |
|
| (2) |
| (a) |
The
rules may do both of the following:
| (i) |
Include for designation as an outlier ICF/IID or unit, an ICF/IID, or discrete
unit of an ICF/IID, that serves residents who have complex medical conditions
or severe behavioral problems; |
| (ii) |
Require that a designated outlier ICF/IID or unit receive authorization from
the department before admitting or retaining a resident. |
|
| (b) |
If
the director adopts rules authorized by division (D)(2)(a)(ii) of this section
regarding the authorization of a designated outlier ICF/IID or unit to admit or
retain a resident, the rules shall specify the criteria and procedures the
department will apply when granting the authorization. |
|
|
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
To the extent, if any, provided for in rules
authorized by this section, the total per medicaid day payment rate determined
under section 5124.15 of the Revised Code shall not be paid for ICF/IID
services that an ICF/IID not designated as an outlier ICF/IID or unit provides
to a resident who meets the criteria for admission to a designated outlier
ICF/IID or unit, as specified in rules authorized by section 5124.152 of the
Revised Code. Instead, the provider of an ICF/IID providing ICF/IID services to
such a resident shall be paid each fiscal year a total per medicaid day payment
rate that the department shall prospectively determine in accordance with a
methodology established in rules authorized by this section. |
| (B) |
The director of developmental disabilities may adopt
rules under section 5124.03 of the Revised Code to implement this section. The
rules may require that an ICF/IID receive authorization from the department
before admitting or retaining a resident who meets the criteria for admission
to a designated outlier ICF/IID or unit. If the director adopts such rules, the
rules shall specify the criteria and procedures the department will apply when
granting the authorization. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental
disabilities is not required to pay the total per medicaid day payment rates
determined under section 5124.15 of the Revised Code for ICF/IID services
provided by developmental centers. Instead, the department
may
determine the medicaid payment
rates for developmental
centers according to the
reasonable cost principles of Title XVIII.
Renumbered from § 5111.291 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
Amended by
128th General Assemblych.28, SB 79,
§1, eff.
10/6/2009.
Effective Date:
07-01-2000; 07-01-2005
Repealed by
132nd General Assembly File No. TBD, HB 24, §2,
eff. 7/1/2018.
Added by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
| (A) |
For each fiscal year, the department of developmental
disabilities shall determine each ICF/IID's per medicaid day capital component
rate. An ICF/IID's rate for a fiscal year shall equal the sum of the
following:
| (1) |
The lesser of the following:
| (a) |
The sum of all of the following:
| (i) |
The ICF/IID's per diem fair rental value rate for the
fiscal year as determined under division (B) of this section; |
| (ii) |
The ICF/IID's per diem equipment rate for the fiscal
year as determined under division (D) of this section; |
| (iii) |
The ICF/IID's per diem secondary building rate for the
fiscal year as determined under division (E) of this section. |
|
| (b) |
The sum determined for the fiscal year under division
(G) of this section. |
|
| (2) |
The ICF/IID's per diem nonextensive renovation rate
for the fiscal year as determined under division (H) of this
section. |
|
| (B) |
An ICF/IID's per diem fair rental value rate for a
fiscal year is the quotient of the following:
| (1) |
The ICF/IID's fair rental value as determined under
division (C) of this section; |
| (2) |
The greater of the following:
| (a) |
The number of the ICF/IID's inpatient days for the
applicable cost report year; |
| (b) |
The number of inpatient days the ICF/IID would have
had during the applicable cost report year if its occupancy rate had been
ninety-two per cent that year. |
|
|
| (C) |
| (1) |
An ICF/IID's fair rental value is the product of the
following:
| (a) |
The sum of the following:
| (i) |
The ICF/IID's depreciated current asset value as
determined under division (C)(2) of this section; |
| (ii) |
The ICF/IID's land value as determined under division
(C)(10) of this section. |
|
|
| (2) |
An ICF/IID's depreciated current asset value is its
current asset value, as determined under division (C)(3) of this section,
depreciated by the product of the following:
| (a) |
The ICF/IID's effective age as determined under
division (C)(5) of this section; |
| (b) |
One and six-tenths per cent. |
|
| (3) |
An ICF/IID's current asset value is the product of the
following:
| (a) |
The ICF/IID's value per square foot as determined
under division (C)(4) of this section; |
| (b) |
The lesser of the ICF/IID's square footage and the
following:
| (i) |
If the ICF/IID is in peer group 1-A and is a downsized
ICF/II, its medicaid-certified capacity on the last day of the applicable cost
report year multiplied by one thousand; |
| (ii) |
If the ICF/IID is in peer group 1-A and is not a
downsized ICF/IID, its medicaid-certified capacity on the last day of the
applicable cost report year multiplied by five hundred fifty; |
| (iii) |
If the ICF/IID is in peer group 2-A and is a downsized
ICF/IID, its medicaid-certified capacity on the last day of the applicable cost
report year multiplied by one thousand; |
| (iv) |
If the ICF/IID is in peer group 2-A and is not a
downsized ICF/IID, its medicaid-certified capacity on the last day of the
applicable cost report year multiplied by seven hundred fifty; |
| (v) |
If the ICF/IID is in peer group 3-A, its
medicaid-certified capacity on the last day of the applicable cost report year
multiplied by eight hundred fifty; |
| (vi) |
If the ICF/IID is in peer group 4-A or peer group 5-A,
its medicaid-certified capacity on the last day of the applicable cost report
year multiplied by nine hundred. |
|
|
| (4) |
| (a) |
An ICF/IID's value per square foot shall be determined
by using the version of the following RS means data that was most recently
published at the time the determination is made:
| (i) |
If the ICF/IID is in peer group 1-A or peer group 2-A,
the RS means data for assisted-senior living facility construction
costs; |
| (ii) |
If the ICF/IID is in peer group 3-A, peer group 4-A,
or peer group 5-A, the RS means data for nursing home construction
costs. |
|
| (b) |
Except as provided in division (C)(4)(c) of this
section, in determining an ICF/IID's value per square foot, the following
modifier shall be used:
| (i) |
If the ICF/IID is located in Summit county, the
modifier specified in the applicable RS means data for Akron; |
| (ii) |
If the ICF/IID is located in Athens county, the
modifier specified in the applicable RS means data for Athens; |
| (iii) |
If the ICF/IID is located in Ashtabula, Geauga, Lake,
Medina, Portage, Stark, Trumbull, or Wayne county, the modifier specified in
the applicable RS means data for Canton; |
| (iv) |
If the ICF/IID is located in Ross county, the modifier
specified in the applicable RS means data for Chillicothe; |
| (v) |
If the ICF/IID is located in Hamilton county, the
modifier specified in the applicable RS means data for
Cincinnati; |
| (vi) |
If the ICF/IID is located in Cuyahoga county, the
modifier specified in the applicable RS means data for
Cleveland; |
| (vii) |
If the ICF/IID is located in Franklin county, the
modifier specified in the applicable RS means data for
Columbus; |
| (viii) |
If the ICF/IID is located in Montgomery county, the
modifier specified in the applicable RS means data for Dayton; |
| (ix) |
If the ICF/IID is located in Brown, Butler, Clermont,
Clinton, Champaign, Darke, Greene, Logan, Miami, Preble, Shelby, or Warren
county, the modifier specified in the applicable RS means data for
Hamilton; |
| (x) |
If the ICF/IID is located in Allen, Auglaize,
Defiance, Erie, Fulton, Hancock, Henry, Huron, Mercer, Paulding, Putnam,
Ottawa, Sandusky, Seneca, Van Wert, Williams, or Wood county, the modifier
specified in the applicable RS means data for Lima; |
| (xi) |
If the ICF/IID is located in Lorain county, the
modifier specified in the applicable RS means data for Lorain; |
| (xii) |
If the ICF/IID is located in Ashland, Crawford,
Delaware, Fairfield, Fayette, Hardin, Knox, Licking, Madison, Morrow, Pickaway,
Richland, Union, or Wyandot county, the modifier specified in the applicable RS
means data for Mansfield; |
| (xiii) |
If the ICF/IID is located in Marion county, the
modifier specified in the applicable RS means data for Marion; |
| (xiv) |
If the ICF/IID is located in Clark county, the
modifier specified in the applicable RS means data for
Springfield; |
| (xv) |
If the ICF/IID is located in Jefferson county, the
modifier specified in the applicable RS means data for
Steubenville; |
| (xvi) |
If the ICF/IID is located in Lucas county, the
modifier specified in the applicable RS means data for Toledo; |
| (xvii) |
If the ICF/IID is located in Mahoning county, the
modifier specified in the applicable RS means data for
Youngstown; |
| (xviii) |
If the ICF/IID is located in Adams, Belmont, Carroll,
Columbiana, Coshocton, Gallia, Guernsey, Harrison, Highland, Hocking, Holmes,
Jackson, Lawrence, Meigs, Monroe, Morgan, Muskingum, Noble, Perry, Pike,
Scioto, Tuscarawas, Vinton, or Washington county, the modifier specified in the
applicable RS means data for Zanesville. |
|
| (c) |
If a modifier ceases to be specified in the applicable
RS means data for a city listed in division (C)(4)(b) of this section, the
director of developmental disabilities shall specify in rules adopted under
section
5124.03 of the Revised Code
a different modifier for the counties that are affected by the
change. |
|
| (5) |
An ICF/IID's effective age shall be determined as
follows:
| (a) |
Determine the sum of the numbers of the ICF/IID's new
bed equivalents for renovations for the applicable cost report year and the
immediately preceding thirty-nine calendar years as determined for each of
those years under division (C)(7)(a) of this section; |
| (b) |
Determine the sum of the numbers of the ICF/IID's new
bed equivalents for additions that do not increase the ICF/IID's
medicaid-certified capacity for the applicable cost report year and the
immediately preceding thirty-nine calendar years as determined for each of
those years under division (C)(8)(a) of this section; |
| (c) |
Determine the sum of the numbers of the ICF/IID's new
beds resulting from additions that increase the ICF/IID's medicaid-certified
capacity for the applicable cost report year and the immediately preceding
thirty-nine calendar years as determined for each of those years under division
(C)(9)(a) of this section; |
| (d) |
Determine the sum of the sums determined under
divisions (C)(5)(a), (b), and (c) of this section; |
| (e) |
Determine the difference of the following:
| (i) |
The ICF/IID's medicaid-certified capacity on the last
day of the applicable cost report year; |
| (ii) |
The lesser of the amount specified in division
(C)(5)(e)(i) of this section and the sum determined under division (C)(5)(d) of
this section. |
|
| (f) |
For the purpose of determining the weighted age of the
ICF/IID's original beds, determine the product of the following:
| (i) |
The difference determined under division (C)(5)(e) of
this section; |
| (ii) |
The ICF/IID's age as determined under division (C)(6)
of this section. |
|
| (g) |
Determine the sum of the weighted ages of the
ICF/IID's new bed equivalents for renovations for the applicable cost report
year and the immediately preceding thirty-nine calendar years as determined for
each of those years under division (C)(7)(c) of this section; |
| (h) |
Determine the sum of the weighted ages of the
ICF/IID's new bed equivalents for additions that do not increase its
medicaid-certified capacity for the applicable cost report year and the
immediately preceding thirty-nine calendar years as determined for each of
those years under division (C)(8)(d) of this section; |
| (i) |
Determine the sum of the weighted ages of the
ICF/IID's new beds resulting from additions that increase its
medicaid-certified capacity for the applicable cost report year and the
immediately preceding thirty-nine calendar years as determined for that period
and each of those years under division (C)(9)(b) of this
section; |
| (j) |
Determine the sum of the following:
| (i) |
The product determined under division (C)(5)(f) of
this section; |
| (ii) |
The sum of the sums determined under divisions
(C)(5)(g), (h), and (i) of this section. |
|
| (k) |
Determine the quotient of the following:
| (i) |
The sum determined under division (C)(5)(j) of this
section; |
| (ii) |
The ICF/IID's medicaid-certified capacity on the last
day of the applicable cost report year. |
|
|
| (6) |
An ICF/IID's age is the lesser of the following:
| (a) |
The difference between the following:
| (i) |
The calendar year in which occurs the last day of the
period covered by the cost report being used to determine the ICF/IID's rate
under this section; |
| (ii) |
The calendar year in which the ICF/IID was initially
constructed. |
|
|
| (7) |
| (a) |
The number, for a year, of an ICF/IID's new bed
equivalents for renovations is the quotient of the following:
| (i) |
The ICF/IID's desk-reviewed, actual, allowable
renovation costs for the year; |
| (ii) |
Seventy thousand dollars. |
|
| (b) |
The age of an ICF/IID's new bed equivalents for
renovations is the difference of the following:
| (i) |
The calendar year in which occurs the last day of the
period covered by the cost report being used to determine the ICF/IID's rate
under this section; |
| (ii) |
The calendar year the renovations were
completed. |
|
| (c) |
The weighted age, for a year, of an ICF/IID's new bed
equivalents for renovations is the product of the following:
| (i) |
The number, for that year, of the ICF/IID's new bed
equivalents for renovations as determined under division (C)(7)(a) of this
section; |
| (ii) |
The age of those new bed equivalents as determined
under division (C)(7)(b) of this section. |
|
|
| (8) |
| (a) |
The number, for a year, of an ICF/IID's new bed
equivalents for additions that do not increase its medicaid-certified capacity
is the quotient of the following:
| (i) |
The value of such additions made to the ICF/IID that
year as determined under division (C)(8)(b) of this section: |
| (ii) |
Seventy thousand dollars. |
|
| (b) |
The value of additions that do not increase an
ICF/IID's medicaid-certified capacity is the product of the following:
| (i) |
The total square footage of the
additions; |
| (ii) |
The ICF/IID's value per square foot as determined
under division (C)(4) of this section. |
|
| (c) |
The age of an ICF/IID's new bed equivalents for
additions that do not increase its medicaid-certified capacity is the
difference of the following:
| (i) |
The calendar year in which occurs the last day of the
period covered by the cost report being used to determine the ICF/IID's rate
under this section; |
| (ii) |
The calendar year the additions were
completed. |
|
| (d) |
The weighted age, for a year, of an ICF/IID's new bed
equivalents for additions that do not increase its medicaid-certified capacity
is the product of the following:
| (i) |
The number, for that year, of the ICF/IID's new bed
equivalents for such additions as determined under division (C)(8)(a) of this
section; |
| (ii) |
The age of those new bed equivalents as determined
under division (C)(8)(c) of this section. |
|
|
| (9) |
| (a) |
The number, for a year, of new beds resulting from
additions that increase an ICF/IID's medicaid-certified capacity is the number
by which the new beds increased the ICF/IID's medicaid-certified capacity that
year. |
| (b) |
The weighted age, for a year, of new beds resulting
from additions that increase an ICF/IID's medicaid-certified capacity is the
product of the following:
| (i) |
The number by which those new beds increased the
ICF/IID's medicaid-certified capacity that year; |
| (ii) |
The difference of the calendar year in which occurs
the last day of the period covered by the cost report being used to determine
the ICF/IID's rate under this section and the calendar year the ICF/IID's
medicaid-certified capacity was so increased. |
|
|
| (10) |
An ICF/IID's land value is the product of the
following:
| (a) |
The ICF/IID's current asset value as determined under
division (C)(3) of this section; |
|
|
| (D) |
An ICF/IID's per diem equipment rate for a fiscal year
shall be the lesser of the following:
| (1) |
The quotient of the following:
| (a) |
The ICF/IID's costs for capital equipment for the
applicable cost report year; |
| (b) |
The greater of the following:
| (i) |
The number of the ICF/IID's inpatient days for the
applicable cost report year; |
| (ii) |
The number of inpatient days the ICF/IID would have
had during the applicable cost report year if its occupancy rate had been
ninety-two per cent that year. |
|
|
| (2) |
The following amount:
| (a) |
If the ICF/IID is in peer group 1-A, five
dollars; |
| (b) |
If the ICF/IID is in peer group 2-A, six dollars and
fifty cents; |
| (c) |
If the ICF/IID is in peer group 3-A, eight
dollars; |
| (d) |
If the ICF/IID is in peer group 4-A or peer group 5-A,
nine dollars. |
|
|
| (E) |
An ICF/IID's per diem secondary building rate for a
fiscal year is the quotient of the following:
| (1) |
The ICF/IID's secondary building value as determined
under division (F) of this section; |
| (2) |
The greater of the following:
| (a) |
The number of the ICF/IID's inpatient days for the
applicable cost report year; |
| (b) |
The number of inpatient days the ICF/IID would have
had during the applicable cost report year if its occupancy rate had been
ninety-two per cent that year. |
|
|
| (F) |
| (1) |
An ICF/IID's secondary building value is the product
of the following:
| (a) |
The sum of the following:
| (i) |
The sum of the depreciated current asset values of the
ICF/IID's secondary buildings as determined under division (F)(2) of this
section; |
| (ii) |
The sum of the land values of the ICF/IID's secondary
buildings as determined under division (F)(6) of this section. |
|
| (b) |
A rental rate of eleven per cent. |
|
| (2) |
The depreciated current asset value of an ICF/IID's
secondary building is the current asset value of the secondary building, as
determined under division (F)(3) of this section, depreciated by the product of
the following:
| (a) |
The age of the secondary building as determined under
division (F)(5) of this section; |
| (b) |
One and six-tenths per cent. |
|
| (3) |
The current asset value of an ICF/IID's secondary
building is the product of the following:
| (a) |
The part of the secondary building's square footage
that is allocated to the ICF/IID; |
| (b) |
The secondary building's value per square foot as
determined under division (F)(4) of this section. |
|
| (4) |
The value per square foot of an ICF/IID's secondary
building shall be determined by using the following:
| (a) |
Except as provided in division (F)(4)(b) of this
section, the most recent national average commercial cost estimate for
office/warehouse buildings according to information available atbuildingjournal.comon
the last day of the applicable cost report year; |
| (b) |
If the national average commercial cost estimate for
office/warehouse buildings ceases to be available atbuildingjournal.com. the
most recent comparable cost estimate as specified in rules the director of
developmental disabilities shall adopt under section
5124.03 of the Revised
Code. |
|
| (5) |
The age of an ICF/IID's secondary building is the
lesser of the following:
| (a) |
The difference of the following:
| (i) |
The calendar year in which occurs the last day of the
period covered by the cost report being used to determine the ICF/IID's rate
under this section; |
| (ii) |
The calendar year the secondary building was initially
constructed. |
|
|
| (6) |
The land value of an ICF/IID's secondary building is
the product of the following:
| (a) |
The current asset value of the ICF/IID's secondary
building as determined under division (F)(3) of this section; |
|
|
| (G) |
For the purposes of divisions (A)(1)(b) and
(H)(1)(b)(ii) of this section, the department shall determine the sum of the
following for each ICF/IID for each fiscal year:
| (1) |
The quotient of the following:
| (a) |
The ICF/IID's desk-reviewed, actual, allowable capital
costs for the applicable cost report year; |
| (b) |
The greater of the following:
| (i) |
The number of the ICF/IID's inpatient days for the
applicable cost report year; |
| (ii) |
The number of inpatient days the ICF/HD would have had
during the applicable cost report year if its occupancy rate had been
ninety-two per cent that year. |
|
|
| (2) |
The following amount:
| (a) |
If the ICF/HD is in peer group 1-A, or peer group 2-A,
three dollars; |
| (b) |
If the ICF/IID is in peer group 3-A, peer group 4-A,
or peer group 5-A, five dollars. |
|
| (3) |
The greater of the following:
| (a) |
Ten per cent of the difference of the following:
| (i) |
The sum of the quotient determined for the fiscal year
under division (G)(1) of this section and the applicable amount specified in
division (G)(2) of this section; |
| (ii) |
The sum determined for the fiscal year under division
(A)(1)(a) of this section. |
|
|
|
| (H) |
An ICF/IID's per diem nonextensive renovation rate for
a fiscal year is the following:
| (1) |
If the sum of the ICF/IID's per diem costs of
nonextensive renovations for the applicable cost report year as determined
under division (I) of this section and the ICF/IID's per diem costs of
ownership for the applicable cost report year as determined under division (J)
of this section is greater than the sum determined for the ICF/IID for the
fiscal year under division (G) of this section, the lesser of the
following:
| (a) |
The ICF/IID's per diem costs of nonextensive
renovations for the applicable cost report year as determined under division
(I) of this section; |
| (b) |
The difference of the following:
| (i) |
The sum of the ICF/IID's per diem costs of
nonextensive renovation for the applicable cost report year as determined under
division (I) of this section and the ICF/IID's per diem costs of ownership for
the applicable cost report year as determined under division (J) of this
section; |
| (ii) |
The sum determined for the ICF/IID for the fiscal year
under division (G) of this section. |
|
|
| (2) |
If the sum of the ICF/IID's per diem costs of
nonextensive renovation for the applicable cost report year as determined under
division (I) of this section and the ICF/IID's per diem costs of ownership for
the applicable cost report year as determined under division (J) of this
section is less than or equal to the sum determined for the ICF/IID for the
fiscal year under division (G) of this section, zero. |
|
| (I) |
An ICF/IID's per diem costs of nonextensive
renovations for an applicable cost report year are the quotient of the
following:
| (1) |
The ICF/IID's desk-reviewed, actual, allowable costs
of nonextensive renovations for the applicable cost report
year; |
| (2) |
The greater of the following:
| (a) |
The number of the ICF/IID's inpatient days for the
applicable cost report year; |
| (b) |
The number of inpatient days the ICF/IID would have
had during the applicable cost report year if its occupancy rate had been
ninety-two per cent that year. |
|
|
| (J) |
An ICF/IID's per diem costs of ownership for an
applicable cost report year are the quotient of the following:
| (1) |
The ICF/IID's desk-reviewed, actual, allowable costs
of ownership for the applicable cost report year; |
| (2) |
The greater of the following:
| (a) |
The number of the ICF/IID's inpatient days for the
applicable cost report year; |
| (b) |
The number of inpatient days the ICF/IID would have
had during the applicable cost report year if its occupancy rate had been
ninety-two per cent that year. |
|
|
Added by
132nd General Assembly File No. TBD, HB 24, §1,
eff.
7/1/2018.
| (A) |
For each
fiscal year until fiscal year 2022 and for the purpose
of division (C) of section
5124.15 of the
Revised Code, the department of developmental disabilities shall
determine each ICF/IID's per medicaid day payment rate for reasonable capital
costs. Except as otherwise provided in this chapter, an ICF/IID's rate shall be
determined prospectively and based on the ICF/IID's capital costs for the
calendar year preceding the fiscal year for which the
rate will be determined. Subject to section
5124.28
of the Revised Code, an ICF/IID's rate shall equal the sum of the following:
| (1) |
The
ICF/IID's desk-reviewed, actual, allowable, per diem costs of ownership for the
immediately preceding cost reporting period, limited as provided in divisions
(B), (C), and (D) of this section; |
| (2) |
The
ICF/IID's per medicaid day payment for the ICF/IID's per diem capitalized costs
of nonextensive renovations determined under division (E)(1) of this section if
the ICF/IID qualifies for a payment for such costs as specified in division
(E)(2) of this section; |
| (3) |
The ICF/IID's
per medicaid day efficiency incentive determined under division (F) of this
section. |
|
| (B) |
The costs of
ownership per diem payment rates for ICFs/IID in peer group 1-B shall not exceed the following limits as adjusted
for inflation in accordance with division (G) of this section:
| (1) |
For
ICFs/IID with dates of licensure prior to January 1, 1958, not exceeding two
dollars and fifty cents; |
| (2) |
For
ICFs/IID with dates of licensure after December 31, 1957, but prior to January
1, 1968, not exceeding:
| (a) |
Three dollars
and fifty cents if the cost of construction was three thousand five hundred
dollars or more per bed; |
| (b) |
Two
dollars and fifty cents if the cost of construction was less than three
thousand five hundred dollars per bed. |
|
| (3) |
For
ICFs/IID with dates of licensure after December 31, 1967, but prior to January
1, 1976, not exceeding:
| (a) |
Four dollars
and fifty cents if the cost of construction was five thousand one hundred fifty
dollars or more per bed; |
| (b) |
Three dollars and fifty cents if the cost of construction was less than five
thousand one hundred fifty dollars per bed, but exceeds three thousand five
hundred dollars per bed; |
| (c) |
Two
dollars and fifty cents if the cost of construction was three thousand five
hundred dollars or less per bed. |
|
| (4) |
For
ICFs/IID with dates of licensure after December 31, 1975, but prior to January
1, 1979, not exceeding:
| (a) |
Five dollars
and fifty cents if the cost of construction was six thousand eight hundred
dollars or more per bed; |
| (b) |
Four
dollars and fifty cents if the cost of construction was less than six thousand
eight hundred dollars per bed but exceeds five thousand one hundred fifty
dollars per bed; |
| (c) |
Three dollars
and fifty cents if the cost of construction was five thousand one hundred fifty
dollars or less per bed, but exceeds three thousand five hundred dollars per
bed; |
| (d) |
Two dollars
and fifty cents if the cost of construction was three thousand five hundred
dollars or less per bed. |
|
| (5) |
For
ICFs/IID with dates of licensure after December 31, 1978, but prior to January
1, 1980, not exceeding:
| (a) |
Six dollars
if the cost of construction was seven thousand six hundred twenty-five dollars
or more per bed; |
| (b) |
Five dollars
and fifty cents if the cost of construction was less than seven thousand six
hundred twenty-five dollars per bed but exceeds six thousand eight hundred
dollars per bed; |
| (c) |
Four dollars
and fifty cents if the cost of construction was six thousand eight hundred
dollars or less per bed but exceeds five thousand one hundred fifty dollars per
bed; |
| (d) |
Three dollars
and fifty cents if the cost of construction was five thousand one hundred fifty
dollars or less but exceeds three thousand five hundred dollars per
bed; |
| (e) |
Two dollars
and fifty cents if the cost of construction was three thousand five hundred
dollars or less per bed. |
|
| (6) |
For
ICFs/IID with dates of licensure after December 31, 1979, but prior to January
1, 1981, not exceeding:
| (a) |
Twelve
dollars if the beds were originally licensed as residential facility beds by
the department of developmental disabilities; |
| (b) |
Six
dollars if the beds were originally licensed as nursing home beds by the
department of health. |
|
| (7) |
For
ICFs/IID with dates of licensure after December 31, 1980, but prior to January
1, 1982, not exceeding:
| (a) |
Twelve
dollars if the beds were originally licensed as residential facility beds by
the department of developmental disabilities; |
| (b) |
Six
dollars and forty-five cents if the beds were originally licensed as nursing
home beds by the department of health. |
|
| (8) |
For
ICFs/IID with dates of licensure after December 31, 1981, but prior to January
1, 1983, not exceeding:
| (a) |
Twelve
dollars if the beds were originally licensed as residential facility beds by
the department of developmental disabilities; |
| (b) |
Six
dollars and seventy-nine cents if the beds were originally licensed as nursing
home beds by the department of health. |
|
| (9) |
For
ICFs/IID with dates of licensure after December 31, 1982, but prior to January
1, 1984, not exceeding:
| (a) |
Twelve
dollars if the beds were originally licensed as residential facility beds by
the department of developmental disabilities; |
| (b) |
Seven dollars and nine cents if the beds were originally licensed as nursing
home beds by the department of health. |
|
| (10) |
For
ICFs/IID with dates of licensure after December 31, 1983, but prior to January
1, 1985, not exceeding:
| (a) |
Twelve
dollars and twenty-four cents if the beds were originally licensed as
residential facility beds by the department of developmental
disabilities; |
| (b) |
Seven dollars
and twenty-three cents if the beds were originally licensed as nursing home
beds by the department of health. |
|
| (11) |
For
ICFs/IID with dates of licensure after December 31, 1984, but prior to January
1, 1986, not exceeding:
| (a) |
Twelve
dollars and fifty-three cents if the beds were originally licensed as
residential facility beds by the department of developmental
disabilities; |
| (b) |
Seven dollars
and forty cents if the beds were originally licensed as nursing home beds by
the department of health. |
|
| (12) |
For
ICFs/IID with dates of licensure after December 31, 1985, but prior to January
1, 1987, not exceeding:
| (a) |
Twelve
dollars and seventy cents if the beds were originally licensed as residential
facility beds by the department of developmental disabilities; |
| (b) |
Seven dollars and fifty cents if the beds were originally licensed as nursing
home beds by the department of health. |
|
| (13) |
For
ICFs/IID with dates of licensure after December 31, 1986, but prior to January
1, 1988, not exceeding:
| (a) |
Twelve
dollars and ninety-nine cents if the beds were originally licensed as
residential facility beds by the department of developmental
disabilities; |
| (b) |
Seven dollars
and sixty-seven cents if the beds were originally licensed as nursing home beds
by the department of health. |
|
| (14) |
For
ICFs/IID with dates of licensure after December 31, 1987, but prior to January
1, 1989, not exceeding thirteen dollars and twenty-six cents; |
| (15) |
For
ICFs/IID with dates of licensure after December 31, 1988, but prior to January
1, 1990, not exceeding thirteen dollars and forty-six cents; |
| (16) |
For
ICFs/IID with dates of licensure after December 31, 1989, but prior to January
1, 1991, not exceeding thirteen dollars and sixty cents; |
| (17) |
For
ICFs/IID with dates of licensure after December 31, 1990, but prior to January
1, 1992, not exceeding thirteen dollars and forty-nine cents; |
| (18) |
For
ICFs/IID with dates of licensure after December 31, 1991, but prior to January
1, 1993, not exceeding thirteen dollars and sixty-seven cents; |
| (19) |
For
ICFs/IID with dates of licensure after December 31, 1992, not exceeding
fourteen dollars and twenty-eight cents. |
|
| (C) |
| (1) |
The
costs of ownership per diem payment rate for an ICF/IID in peer group 2-B shall not exceed the following limits:
| (a) |
Eighteen dollars and thirty cents as adjusted for inflation pursuant to
division (C)(2) of this section if any of the following apply to the ICF/IID:
| (i) |
The
ICF/IID has a date of licensure, or was granted project authorization by the
department of developmental disabilities, before July 1, 1993. |
| (ii) |
The
ICF/IID has a date of licensure, or was granted project authorization by the
department, on or after July 1, 1993, and the provider demonstrates that the
provider made substantial commitments of funds for the ICF/IID before that
date. |
| (iii) |
The ICF/IID
has a date of licensure, or was granted project authorization by the
department, on or after July 1, 1993, the provider made no substantial
commitment of funds for the ICF/IID before that date, and the department of job
and family services or department of developmental disabilities gave prior
approval for the ICF/IID's construction. |
|
| (b) |
If
division (C)(1)(a) of this section does not apply to the ICF/IID, the amount
that would apply to the ICF/IID under division (B) of this section if it were
in peer group 1-B. |
|
| (2) |
The
eighteen-dollar and thirty-cent payment rate specified in division (C)(1)(a) of
this section shall be increased as follows:
| (a) |
For
the period beginning June 30, 1990, and ending July 1, 1993, by the change in
the "Dodge building cost indexes, northeastern and north central states,"
published by Marshall and Swift; |
| (b) |
For
each fiscal year thereafter, in accordance with division (G) of this
section. |
|
|
| (D) |
The
costs of ownership per diem payment rate for an ICF/IID in peer group 3-B shall not exceed the amount that is used for the
purpose of division (C)(1)(a) of this section and is in effect on July 1, 2014,
That rate shall be increased each fiscal year that begins after
September 15, 2014, and ends not later than July 1,
2021, in accordance with division (G) of this section. |
| (E) |
| (1) |
Beginning January 1, 1981, regardless of the original date of licensure, the
payment rate for the per diem capitalized costs of nonextensive renovations
made after January 1, 1981, to a qualifying ICF/IID, shall not exceed six
dollars per medicaid day using 1980 as the base year and adjusting the amount
annually until June 30, 1993, for fluctuations in construction costs calculated
by the department using the "Dodge building cost indexes, northeastern and
north central states," published by Marshall and Swift. The payment rate shall
be further adjusted in accordance with division (G) of this section. The
payment provided for in this division is the only payment that shall be made
for an ICF/IID's capitalized costs of nonextensive renovations. Costs of
nonextensive renovations shall not be included in costs of ownership and shall
not affect the date of licensure for purposes of division (B) or (C) of this
section. This division applies to nonextensive renovations regardless of
whether they are made by an owner or a lessee. If the tenancy of a lessee that
has made nonextensive renovations ends before the depreciation expense for the
costs of nonextensive renovations has been fully reported, the former lessee
shall not report the undepreciated balance as an expense. |
| (2) |
An
ICF/IID qualifies for a payment for costs of nonextensive renovations if all of
the following apply:
| (a) |
Either of the
following applies:
| (i) |
The ICF/IID
is in peer group 1-B and either the department
approved the nonextensive renovation before July 1, 2013, or the nonextensive
renovation is part of a project that results in the ICF/IID becoming a
downsized ICF/IID or partially converted ICF/IID. |
| (ii) |
The
ICF/IID is in peer group 2-B or peer group 3-B. |
|
| (b) |
At
least five years have elapsed since the ICF/IID's date of licensure or date of
an extensive renovation of the portion of the ICF/IID that is proposed to be
nonextensively renovated, unless the nonextensive renovation is necessary to
meet the requirements of federal, state, or local statutes, ordinances, rules,
or policies. |
| (c) |
The provider
of the ICF/IID does both of the following:
| (i) |
Submits to the department a plan that describes in detail the changes in
capital assets to be accomplished by means of the nonextensive renovation and
the timetable for completing the project, which shall be not more than eighteen
months after the nonextensive renovation begins; |
| (ii) |
Obtains prior approval from the department for the nonextensive
renovation. |
|
|
| (3) |
The
director of developmental disabilities shall adopt rules under section
5124.03 of the Revised Code
that specify criteria and procedures for prior approval of nonextensive
renovation and extensive renovation projects. No provider shall separate a
project with the intent to evade the characterization of the project as a
nonextensive renovation or as an extensive renovation. No provider shall
increase the scope of a project after it is approved by the department unless
the increase in scope is approved by the department. |
|
| (F) |
| (1) |
Subject to division (F)(2) of this section, an ICF/IID's per medicaid day
efficiency incentive payment rate shall equal the following percentage of the
difference between the ICF/IID's desk-reviewed, actual, allowable per diem
costs of ownership and the applicable limit on costs of ownership payment rates
established by division (B) of this section:
| (a) |
In
the case of an ICF/IID in peer group 1-B, the
following percentage:
| (i) |
Fifty per
cent if the provider of the ICF/IID obtains the department's approval to become
a downsized ICF/IID and the approval is conditioned on the downsizing being
completed not later than July 1,2018; |
| (ii) |
Twenty-five per cent if division (F)(1)(a)(i) of this section does not
apply; |
|
| (b) |
In the case
of an ICF/IID in peer group 2J3 or peer group 3ji, fifty per cent. |
|
| (2) |
The
efficiency incentive payment rate for an ICF/IID in peer group 2J3 or peer
group 3-B shall not exceed three dollars per
medicaid day, adjusted annually in accordance with division (G) of this
section. For the purpose of determining an ICF/IID's efficiency incentive
payment rate, both of the following apply:
| (a) |
Depreciation for costs paid or reimbursed by any government agency shall be
considered as a cost of ownership; |
| (b) |
The
applicable limit under division (B) of this section shall apply to all ICFs/UD
regardless of which peer group they are in. |
|
|
| (G) |
The
amounts specified in divisions (B), (C), (D), (E), and (F) of this section
shall be adjusted beginning on the first day of each fiscal year
until fiscal year 2022 for the estimated
inflation rate for the twelve-month period beginning on the first day of July
of the calendar year immediately preceding the calendar year that immediately
precedes the fiscal year for which rate is determined and ending on the
thirtieth day of the following June, using the consumer price index for shelter
costs for all urban consumers for the midwest region, as published by the
United States bureau of labor statistics. |
| (H) |
Notwithstanding divisions (C) and (E) of this section, the total payment rate
for costs of ownership, capitalized costs of nonextensive renovations, and the
efficiency incentive for an ICF/IID in peer group 2-B shall not exceed the sum of the limitations
specified in divisions (C) and (E) of this section. Notwithstanding divisions
(D) and (E) of this section, the total payment rate for costs of ownership,
capitalized costs of nonextensive renovations, and the efficiency incentive for
an ICF/IID in peer group 3-B shall not exceed the
sum of the limitations specified in divisions (D) and (E) of this
section. |
| (I) |
| (1) |
For
the purpose of determining ICFs/IID's medicaid payment rates for capital costs
under this section:
| (a) |
Buildings shall be depreciated using the straight line method over forty years
or over a different period approved by the department. |
| (b) |
Components and equipment shall be depreciated using the straight line method
over a period designated by the director of developmental disabilities in rules
adopted under section
5124.03 of the Revised
Code, consistent with the guidelines of the American hospital association, or
over a different period approved by the department. |
|
| (2) |
Any
rules authorized by division (I)(1) of this section that specify useful lives
of buildings, components, or equipment apply only to assets acquired on or
after July 1, 1993, Depreciation for costs paid or reimbursed by any government
agency shall not be included in costs of ownership or costs of nonextensive
renovations unless that part of the payment under this chapter is used to
reimburse the government agency. |
|
| (J) |
| (1) |
Except as provided in division (J)(2) of this section, if a provider leases or
transfers an interest in an ICF/IID to another provider who is a related party,
the related party's allowable costs of ownership shall include the lesser of
the following:
| (a) |
The annual
lease expense or actual cost of ownership, whichever is applicable; |
| (b) |
The
reasonable cost to the lessor or provider making the transfer. |
|
| (2) |
If a provider
leases or transfers an interest in an ICF/IID to another provider who is a
related party, regardless of the date of the lease or transfer, the related
party's allowable cost of ownership shall include the annual lease expense or
actual cost of ownership, whichever is applicable, subject to the limitations
specified in divisions (B) to (I) of this section, if all of the following
conditions are met:
| (a) |
The related
party is a relative of owner; |
| (b) |
In
the case of a lease, if the lessor retains any ownership interest, it is,
except as provided in division (J)(2)(d)(ii) of this section, in only the real
property and any improvements on the real property; |
| (c) |
In
the case of a transfer, the provider making the transfer retains, except as
provided in division (J)(2)(d)(iv) of this section, no ownership interest in
the ICF/IID; |
| (d) |
The
department determines that the lease or transfer is an arm's length transaction
pursuant to rules adopted under section
5124.03 of the Revised
Code. The rules shall provide that a lease or transfer is an arm's length
transaction if all of the following, as applicable, apply:
| (i) |
In
the case of a lease, once the lease goes into effect, the lessor has no direct
or indirect interest in the lessee or, except as provided in division (J)(2)(b)
of this section, the ICF/IID itself, including interest as an owner, officer,
director, employee, independent contractor, or consultant, but excluding
interest as a lessor. |
| (ii) |
In the case
of a lease, the lessor does not reacquire an interest in the ICF/IID except
through the exercise of a lessor's rights in the event of a default. If the
lessor reacquires an interest in the ICF/IID in this manner, the department
shall treat the ICF/IID as if the lease never occurred when the department
determines its payment rate for capital costs. |
| (iii) |
In
the case of a transfer, once the transfer goes into effect, the provider that
made the transfer has no direct or indirect interest in the provider that
acquires the ICF/IID or the ICF/IID itself, including interest as an owner,
officer, director, employee, independent contractor, or consultant, but
excluding interest as a creditor. |
| (iv) |
In
the case of a transfer, the provider that made the transfer does not reacquire
an interest in the ICF/IID except through the exercise of a creditor's rights
in the event of a default. If the provider reacquires an interest in the
ICF/IID in this manner, the department shall treat the ICF/IID as if the
transfer never occurred when the department determines its payment rate for
capital costs. |
| (v) |
The lease or
transfer satisfies any other criteria specified in the rules. |
|
| (e) |
Except in the
case of hardship caused by a catastrophic event, as determined by the
department, or in the case of a lessor or provider making the transfer who is
at least sixty-five years of age, not less than twenty years have elapsed
since, for the same ICF/IID, allowable cost of ownership was determined most
recently under this division. |
|
|
| (K) |
This section is obsolete beginning July 1,
2021. |
Renumbered from § 5124.17 by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Renumbered from § 5111.251 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
Amended by
128th General Assemblych.28, SB 79,
§1, eff.
10/6/2009.
Effective Date:
06-06-2001; 07-01-2005
| (A) |
For each fiscal year, the department of developmental
disabilities shall determine each ICF/IID's per medicaid day direct care costs
component rate. An ICF/UD's rate shall be determined as follows:
| (1) |
Determine the product of the following:
| (a) |
The ICF/IID's quarterly case-mix score determined or
assigned under section
5124.193
of the Revised Code for the following calendar quarter:
| (i) |
For the rate determined for fiscal year 2019, the
calendar quarter ending December 31, 2017: |
| (ii) |
For the rate determined for each subsequent fiscal
year, the calendar quarter ending on the last day of March of the calendar year
in which the fiscal year begins. |
|
| (b) |
The lesser of the following:
| (i) |
The ICF/IID's cost per case-mix unit for the
applicable cost report year as determined under division (B) of this
section: |
| (ii) |
The maximum cost per case-mix unit for the ICF/IID's
peer group for the fiscal year for which the rate is determined as determined
under division (C) of this section. |
|
|
| (2) |
Adjust the product determined under division (A)(1) of
this section by the inflation rate estimated under division (D) of this
section. |
|
| (B) |
To determine an ICF/UD's cost per case-mix unit for a
cost report year, the department shall determine the quotient of the
following:
| (1) |
The ICF/IID's desk-reviewed, actual, allowable, per
diem direct care costs for the cost report year: |
| (2) |
The ICF/IID's annual average case-mix score as
determined under section
5124.193
of the Revised Code for the fiscal year for which the rate is
determined. |
|
| (C) |
| (1) |
The maximum cost per case-mix unit for a peer group
for a fiscal year, other than peer group 5-A. is the following percentage above
the peer group's median cost per case-mix unit for that fiscal year:
| (a) |
For peer group 1-A, sixteen per cent; |
| (b) |
For peer group 2-A, fourteen per cent; |
| (c) |
For peer group 3-A, eighteen per cent; |
| (d) |
For peer group 4-A, twenty-two per
cent. |
|
| (2) |
The maximum cost per case-mix unit for peer group 5-A
for a fiscal year is the ninety-fifth percentile of all ICFs/IID in peer group
5-A for the applicable cost report year. |
| (3) |
In determining the maximum cost per case-mix unit for
a peer group under division (C) (1) of this section, the department shall
exclude from its determination the cost per case-mix unit of any ICF/IID in the
peer group that participated in the medicaid program under the same provider
for less than twelve months during the applicable cost report
year. |
| (4) |
In determining the maximum cost per case-mix unit for
a peer group under division (C) (1) or (2) of this section, the department
shall exclude from its determination the cost per case-mix unit of any ICF/IID
in the peer group that has a case-mix score that was assigned by the department
to the ICF/IID under division (B) of section
5124.193
of the Revised Code. |
| (5) |
The department shall not reset a peer group's maximum
cost per case-mix unit for a fiscal year under division (C)(1) or (2) of this
section based on additional information that the department receives after it
sets the maximum for that fiscal year. The department shall reset a peer
group's maximum cost per case-mix unit for a fiscal year only if it made an
error in setting the maximum for that fiscal year based on information
available to the department at the time it originally sets the maximum for that
fiscal year. |
|
| (D) |
The department shall estimate the rate of inflation
for the eighteen-month period beginning on the first day of July of the
applicable cost report year and ending on the last day of December of the
fiscal year for which the rate is determined, using the following:
| (1) |
Subject to division (D)(2) of this section, the
employment cost index for total compensation, health care and social assistance
component, published by the United States bureau of labor
statistics; |
| (2) |
If the United States bureau of labor statistics ceases
to publish the index specified in division (D)(1) of this section, the index
that is subsequently published by the bureau and covers the staff costs of
ICFs/IID. |
|
Added by
132nd General Assembly File No. TBD, HB 24, §1,
eff.
7/1/2018.
| (A) |
As used in sections
5124.191
to
5124.193
of the Revised Code. "ICF/IID resident" includes an individual who is on
hospital or therapeutic leave from an ICF/IID. |
| (B) |
In accordance with rules adopted under section
5124.03 of the Revised
Code, the department of developmental disabilities shall assess each ICF/IID
resident regardless of payment source and compile complete assessment data on
the residents. The department shall perform the initial assessment of an
ICF/IID resident. The department may perform a subsequent assessment of an
ICF/IID resident under any of the following circumstances:
| (1) |
The provider of the ICF/IID in which the resident
resides or from which the resident is on hospital or therapeutic leave has
submitted to the department under division (D) of this section revised
assessment data for the resident or an attestation of no changes in the
resident's assessment data and the department has reason to believe that the
revised assessment data or attestation is inaccurate; |
| (2) |
The department has reason to believe that the
resident's most recent assessment no longer accurately reflects the resident's
condition; |
| (3) |
The department determines that the resident's most
recent assessment should be updated because of the passage of time since that
assessment was performed. |
|
| (C) |
If an ICF/HD provider disagrees with the results of an
assessment performed by the department under this section, the provider may
request that the department reconsider the results in accordance with rules
adopted under section
5124.03 of the Revised
Code. |
| (D) |
After the department assesses an ICF/HD resident under
this section, the provider of the ICF/HD in which the resident resides or from
which the resident is on hospital or therapeutic leave shall submit to the
department, not later than fifteen days after the end of each subsequent
calendar quarter and through the medium or media specified in rules adopted
under section
5124.03 of the Revised
Code, either of the following:
| (1) |
Revised assessment data for the resident if there are
changes in the resident's assessment data; |
| (2) |
An attestation that there are no changes in the
resident's assessment data. |
|
| (E) |
A resident assessment instrument specified in rules
adopted under section
5124.03 of the Revised Code
shall be used to compile or revise assessment data of ICF/IID residents under
this section. The resident assessment instrument used for the purpose of this
section may be different from the resident assessment instrument used for the
purpose of section 5124.196 of the Revised Code. |
Added by
132nd General Assembly File No. TBD, HB 24, §1,
eff.
7/1/2018.
| (A) |
The department of developmental disabilities shall
establish six acuity groups for the purpose of assigning case-mix scores to
ICF/IID residents. An ICF/IID resident's case-mix score shall be the score of
the resident's acuity group as specified in rules authorized by this
section. |
| (B) |
The department shall place each ICF/IID resident into
one of the acuity groups. In determining which acuity group an ICF/IID resident
is to be placed into, the department shall do all of the following:
| (1) |
In accordance with rules authorized by this section
and using the most recent resident assessment data for the ICF/IID resident
available to the department, calculate for the resident an assessment score for
each of the medical, behavioral, and adaptive skills domains on the resident
assessment instrument used to compile or revise assessment data for ICF/IID
residents under section
5124.191
of the Revised Code: |
| (2) |
For each of the ICF/IID resident's domain assessment
scores and using values specified in rules authorized by this section, assign
the following points:
| (a) |
If the resident's assessment score for the domain is
more than one standard deviation above the mean assessment score for the domain
for all ICF/IID residents as of December 31, 2017, one point; |
| (b) |
If the resident's assessment score for the domain is
more than one-half standard deviation above the mean assessment score for the
domain for all ICF/IID residents as of December 31, 2017, and not more than one
standard deviation above that mean, two points; |
| (c) |
If the resident's assessment score for the domain is
more than the mean assessment score for the domain for all ICF/IID residents as
of December 31, 2017, and not more than one-half standard deviation above that
mean, three points; |
| (d) |
If the resident's assessment score for the domain is
not more than the mean assessment score for the domain for all ICF/IID
residents as of December 31, 2017, and not more than one-half standard
deviation below that mean, four points; |
| (e) |
If the resident's assessment score for the domain is
more than one-half standard deviation below the mean assessment score for the
domain for all ICF/IID residents as of December 31, 2017, and not more than one
standard deviation below that mean, five points; |
| (f) |
If the resident's assessment score for the domain is
more than one standard deviation below the mean assessment score for the domain
for all ICF/IID residents as of December 31, 2017, six points. |
|
| (3) |
Using the following weights, determine the weighted
sum of the points assigned under division (B)(2) of this section to each of the
ICF/IID resident's domain assessment scores and round the weighted sum to the
nearest whole number:
| (a) |
Points assigned to the resident's assessment score for
the medical domain shall be weighted at thirty-five per cent. |
| (b) |
Points assigned to the resident's assessment score for
the behavioral domain shall be weighted at thirty per cent. |
| (c) |
Points assigned to the resident's assessment score for
the adaptive skills domain shall be weighted at thirty-five per
cent. |
|
| (4) |
Place the ICF/IID resident into the following acuity
group:
| (a) |
If the resident's weighted sum of points is five or
lower, group one; |
| (b) |
If the resident's weighted sum of points is at least
six and not more than eight, group two; |
| (c) |
If the resident's weighted sum of points is nine or
ten, group three; |
| (d) |
If the resident's weighted sum of points is eleven or
twelve, group four; |
| (e) |
If the resident's weighted sum of points is at least
thirteen and not more than fifteen, group five; |
| (f) |
If the resident's weighted sum of points is sixteen or
higher, group six. |
|
|
| (C) |
| (1) |
The director of developmental disabilities shall adopt
rules under section
5124.03 of the Revised Code
as necessary to implement this section, including rules that do all of the
following:
| (a) |
Subject to division (C)(2) of this section, specify
case-mix scores for each acuity group established under this
section; |
| (b) |
Prescribe a methodology for calculating assessment
scores for the medical, behavioral, and adaptive skills domains on the resident
assessment instrument used to compile or revise assessment data of ICF/IID
residents under section
5124.191
of the Revised Code; |
| (c) |
Specify values to be used in assigning points to
domain assessment scores. |
|
| (2) |
The case-mix score specified for an acuity group shall
be based on relative resource use by ICF/IID residents who are placed in the
group and were included in a time study of ICF/IID residents performed by the
department. |
|
Added by
132nd General Assembly File No. TBD, HB 24, §1,
eff.
7/1/2018.
| (A) |
Except as provided in division (B) of this section,
the department of developmental disabilities shall do both of the
following:
| (1) |
For each calendar quarter, determine a case-mix score
for each ICF/IID using both of the following:
| (a) |
The most recent (as of the date the determination is
made) resident assessment data compiled and revised for the ICF/IID's residents
under section
5124.191
of the Revised Code; |
| (b) |
The case-mix scores of the ICF/IID's residents as
determined under section
5124.192 of the
Revised Code. |
|
| (2) |
After the end of each calendar year, determine an
annual average case-mix score for each ICF/HD using the ICF/IID's quarterly
case-mix scores for that calendar year. |
|
| (B) |
| (1) |
Subject to divisions (B)(2) and (3) of this section,
the department, for one or more months of a calendar quarter, may assign to an
ICF/IID a case-mix score that is five per cent less than the ICF/IID's case-mix
score as of the day immediately preceding the day on which the reduction takes
effect if the provider does not timely comply with division (D) of section
5124.191
of the Revised Code. |
| (2) |
Subject to division (B)(3) of this section, before
assigning a case-mix score to an ICF/IID under division (B)(1) of this section,
the department shall permit the provider to come into compliance with division
(D) of section
5124.191
of the Revised Code. The department may assign the case-mix score if the
provider fails to comply not later than forty-five days after the end of the
calendar quarter to which the noncompliance pertains or a later date specified
in rules authorized by this section. |
| (3) |
The department shall take action under division (B)(1)
or (2) of this section only in accordance with rules authorized by this
section. The department shall not take an action that affects medicaid payment
rates for prior payment periods except in accordance with sections
5124.41
and
5124.42 of
the Revised Code. |
|
| (C) |
The director of developmental disabilities shall adopt
rules under section
5124.03 of the Revised Code
as necessary to implement this section. |
Added by
132nd General Assembly File No. TBD, HB 24, §1,
eff.
7/1/2018.
| (A) |
No change that the department of developmental
disabilities makes to either of the following is valid unless the change is
applied prospectively and the department complies with division (B) of this
section:
| (1) |
The department's instructions or guidelines for the
resident assessment instrument used to compile or revise assessment data of
ICF/IID residents under section
5124.191
of the Revised Code; |
| (2) |
The methodology prescribed in rules authorized by
division (C)(1)(b) of section
5124.192 of the
Revised Code for calculating assessment scores for the medical, behavioral, and
adaptive skills domains on the resident assessment instrument. |
|
| (B) |
Before making a change described in division (A) of
this section, the department shall do all of the following:
| (1) |
Notify all ICF/IID providers of the proposed
change; |
| (2) |
Provide representatives of ICF/IID providers an
opportunity to provide the department their concerns about, and suggestions to
revise, the proposed change; |
| (3) |
In the case of a proposed change described in division
(A)(2) of this section, determine that the proposed change is consistent with
the documentation of ICF/IID staff time that was used to validate the
methodology. |
|
Added by
132nd General Assembly File No. TBD, HB 24, §1,
eff.
7/1/2018.
| (A) |
| (1) |
For
each fiscal year until fiscal year 2022 and for the
purpose of division (C) of section
5124.15 of the
Revised Code, the department of developmental disabilities shall
determine each ICF/IID's per medicaid day payment rate for direct care costs as
follows:
| (a) |
Multiply the
lesser of the following by the ICF/IID's annual average case-mix score
determined or assigned under section 5124.197 of the Revised Code for the
calendar year immediately preceding the fiscal year for which the rate
is
determined:
| (i) |
The ICF/IID's
cost per case-mix unit for the calendar year immediately preceding the fiscal
year for which the rate is determined, as determined under division (B)
of this section; |
| (ii) |
The maximum
cost per case-mix unit for the ICF/IID's peer group for the fiscal year for
which the rate is determined, as set under division (C) of this
section; |
|
| (b) |
Adjust the
product determined under division (A)(1)(a) of this section by the inflation
rate estimated under division (D)(1) of this section and modified under
division (D)(2) of this section. |
|
| (2) |
Except as otherwise directed by law enacted by the general assembly, the
department shall determine each ICF/IID's rate for direct care costs
prospectively. |
|
| (B) |
To
determine an ICF/IID's cost per case-mix unit for the calendar year immediately
preceding the fiscal year for which the rate is
determined, the department shall divide the ICF/IID's desk-reviewed,
actual, allowable, per diem direct care costs for that calendar year by its
annual average case-mix score determined under section
5124.197 of the Revised Code for the
same calendar year. |
| (C) |
| (1) |
For
each fiscal year for which a rate is determined under this section,
the department shall set the maximum cost per case-mix unit for ICFs/IID in
peer group 1-B at a percentage above the cost per
case-mix unit determined under division (B) of this section for the ICF/IID in
peer group 1-B that has the peer group's median
number of medicaid days for the calendar year immediately preceding the fiscal
year for
which the rate is determined. The percentage shall be no less
than twenty-two and forty-six hundredths per cent. |
| (2) |
For
each fiscal year for which a rate is determined under this section,
the department shall set the maximum cost per case-mix unit for ICFs/IID in
peer group 2-B at a percentage above the cost per
case-mix unit determined under division (B) of this section for the ICF/IID in
peer group 2-B that has the peer group's median
number of medicaid days for the calendar year immediately preceding the fiscal
year for
which the rate is determined. The percentage shall be no less
than eighteen and eight-tenths per cent. |
| (3) |
For
each fiscal year for which a rate is determined under this section,
the department shall set the maximum cost per case-mix unit for ICFs/IID in
peer group 3-B at the ninety-fifth percentile of
all ICFs/IID in peer group 3-B for the calendar
year immediately preceding the fiscal year for which the
rate is determined. |
| (4) |
In
determining the maximum cost per case-mix unit under divisions (C)(1) and (2)
of this section for peer group 1-B and peer group
2-B, the department shall exclude from its
determinations the cost per case-mix unit of any ICF/IID in peer group 1-B or peer group 2-B
that participated in the medicaid program under the same provider for less than
twelve months during the calendar year immediately preceding the fiscal year
for
which the rate is determined. |
| (5) |
The
department shall not reset a peer group's maximum cost per case-mix unit for a
fiscal year under division (C)(1), (2), or (3) of this section based on
additional information that it receives after it sets the maximum for that
fiscal year. The department shall reset a peer group's maximum cost per
case-mix unit for a fiscal year only if it made an error in setting the maximum
for that fiscal year based on information available to the department at the
time it originally sets the maximum for that fiscal year. |
|
| (D) |
| (1) |
The
department shall estimate the rate of inflation for the eighteen-month period
beginning on the first day of July of the calendar year preceding the fiscal
year for
which a rate is determined under this section and ending on
the thirty-first day of December of the fiscal year for which the
rate is determined, using the following:
| (a) |
Subject to division (D)(1)(b) of this section, the employment cost index for
total compensation, health care and social assistance component, published by
the United States bureau of labor statistics; |
| (b) |
If
the United States bureau of labor statistics ceases to publish the index
specified in division (D)(1)(a) of this section, the index that is subsequently
published by the bureau and covers the staff costs of ICFs/IID. |
|
| (2) |
If the
estimated inflation rate for the eighteen-month period specified in division
(D)(1) of this section is different from the actual inflation rate for that
period, as measured using the same index, the difference shall be added to or
subtracted from the inflation rate estimated under division (D)(1) of this
section for the following fiscal year. |
|
| (E) |
This section is obsolete beginning July 1,
2021. |
Renumbered from § 5124.19 by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Renumbered from § 5111.23 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.127, HB 487,
§101.01, eff.
9/10/2012.
Amended by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
Effective Date:
07-01-2000; 07-01-2005
Each calendar quarter
until the calendar quarter beginning July 1,
2021, each ICF/IID provider shall compile complete assessment data for
each resident of each of the provider's ICFs/IID, regardless of payment source,
who is in the ICF/IID, or on hospital or therapeutic leave from the ICF/IID, on
the last day of the quarter. A resident assessment instrument specified in
rules adopted under section
5124.03 of the Revised Code
shall be used to compile the resident assessment data. The resident assessment instrument used for the purpose of
this section may be different from the resident assessment instrument used for
the purpose of section
5124.191
of the Revised Code. Each provider shall submit the resident assessment
data to the department of developmental disabilities not later than fifteen
days after the end of the calendar quarter for which the data is compiled. The
resident assessment data shall be submitted to the department through the
medium or media specified in rules adopted under section
5124.03 of the Revised
Code.
This section is obsolete beginning July 1,
2021.
Renumbered from § 5124.191 by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Except as
provided in division (B) of this section, the department of developmental
disabilities shall do both of the following until July
1, 2021:
| (1) |
For each
calendar quarter, determine a case-mix score for each ICF/IID using the
resident assessment data submitted to the department under section
5124.196 of the Revised Code and the
grouper methodology prescribed in rules authorized by this section; |
| (2) |
After the end of each calendar year and in accordance with rules authorized by
this section, determine an annual average case-mix score for each ICF/IID using
the ICF/IID's quarterly case-mix scores for that calendar year. |
|
| (B) |
| (1) |
Subject to division (B)(2) of this section and until
July 1, 2021, the department, for one or more months of a calendar
quarter, may assign to an ICF/IID a case-mix score that is five per cent less
than the ICF/IID's case-mix score for the immediately preceding calendar
quarter if any of the following apply:
| (a) |
The
provider does not timely submit complete and accurate resident assessment data
necessary to determine the ICF/IID's case-mix score for the calendar
quarter; |
| (b) |
The ICF/IID
was subject to an exception review under section 5124.198 of the Revised Code for the
immediately preceding calendar quarter; |
| (c) |
The
ICF/IID was assigned a case-mix score for the immediately preceding calendar
quarter. |
|
| (2) |
Before
assigning a case-mix score to an ICF/IID due to the submission of incorrect
resident assessment data, the department shall permit the provider to correct
the data. The department may assign the case-mix score if the provider fails to
submit the corrected resident assessment data not later than forty-five days
after the end of the calendar quarter to which the data pertains or later due
date specified in rules authorized by this section. |
| (3) |
If,
for more than six months during a calendar year, a provider is paid a rate
determined for an ICF/IID using a case-mix score assigned to the ICF/IID under
division (B)(1) of this section, the department may assign the ICF/IID a cost
per case-mix unit that is five per cent less than the ICF/IID's actual or
assigned cost per case-mix unit for the immediately preceding calendar year.
The department may use the assigned cost per case-mix unit, instead of
determining the ICF/IID's actual cost per case-mix unit in accordance with
section 5124.195 of the Revised Code, to
establish the ICF/IID's rate for direct care costs for the fiscal year
immediately following the calendar year for which the cost per case-mix unit is
assigned. |
| (4) |
The
department shall take action under division (B)(1), (2), or (3) of this section
only in accordance with rules authorized by this section. The department shall
not take an action that affects medicaid payment rates for prior payment
periods except in accordance with sections
5124.41
and
5124.42 of
the Revised Code. |
|
| (C) |
The
director of developmental disabilities shall adopt rules under section
5124.03 of the Revised Code
as necessary to implement this section.
| (1) |
The
rules shall do all of the following:
| (a) |
Prescribe a grouper methodology to be used when determining the case-mix scores
for ICFs/IID; |
| (b) |
Specify the
process for determining the annual average case-mix scores for
ICFs/IID; |
| (c) |
Establish
procedures under which resident assessment data is to be reviewed for accuracy
and providers are to be notified of any data that requires
correction; |
| (d) |
Establish
procedures for providers to correct resident assessment data and, if necessary,
specify a due date for corrections that is later than the due date specified in
division (B)(2) of this section. |
| (e) |
Specify when and how the department will assign a case-mix score or cost per
case-mix unit to an ICF/IID under division (B) of this section if information
necessary to calculate the ICF/IID's case-mix score is not provided or
corrected in accordance with the procedures established by the rules. |
|
| (2) |
Notwithstanding any other provision of this chapter except division (D) of this section, the rules may
provide for excluding case-mix scores assigned to an ICF/IID under division (B)
of this section from the determination of the ICF/IID's annual average case-mix
score and the maximum cost per case-mix unit for the ICF/IID's peer
group. |
|
| (D) |
This section is obsolete beginning July 1,
2021. |
Renumbered from § 5124.192 by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Until July 1,
2021, the department of developmental disabilities may, pursuant to rules
authorized by this section, conduct an exception review of resident assessment
data submitted by an ICF/IID provider under section 5124.196 of the Revised Code. The
department may conduct an exception review based on the findings of a medicaid
certification survey conducted by the department of health, a risk analysis, or
prior performance of the provider. Exception reviews shall be
conducted at the ICF/IID by appropriate health professionals under contract
with or employed by the department. The professionals may review resident
assessment forms and supporting documentation, conduct interviews, and observe
residents to identify any patterns or trends of inaccurate resident assessments
and resulting inaccurate case-mix scores.
|
| (B) |
| (1) |
If
an exception review is conducted before the effective date of an ICF/IID's rate
for direct care costs that is based on the resident assessment data being
reviewed and the review results in findings that exceed tolerance levels
specified in the rules authorized by this section, the department, in
accordance with the rules authorized by this section, may use the findings to
redetermine individual resident case-mix scores, the ICF/IID's case-mix score
for the quarter, and the ICF/IID's annual average case-mix score.
Except as
provided in division (B)(2) of this section, the department may use the
ICF/IID's redetermined quarterly and annual average case-mix scores to
determine the ICF/IID's rate for direct care costs for the appropriate calendar
quarter or quarters. |
| (2) |
If an ICF/IID provider disagrees with a
redetermination of the ICF/IID's quarterly or annual average case-mix score
made under division (B)(1) of this section, the provider may request that the
department reconsider the redetermination in accordance with rules authorized
by this section. If the department reconsiders the redetermination and revises
the ICF/IID's quarterly or annual average case-mix score, the department shall
use the revised case-mix score to determine the ICF/IID's rate for direct care
costs for the appropriate calendar quarter or quarters. |
|
| (C) |
The
department shall prepare a written summary of any exception review finding that
is made after the effective date of an ICF/IID's rate for direct care costs
that is based on the resident assessment data that was reviewed. Where the
provider is pursuing judicial or administrative remedies in good faith
regarding the finding, the department shall not withhold from the provider's
current payments any amounts the department claims to be due from the provider
pursuant to section
5124.41
of the Revised Code. |
| (D) |
| (1) |
The
director of developmental disabilities shall adopt rules under section
5124.03 of the Revised Code
as necessary to implement this section. The rules shall establish an exception
review program that does all of the following:
| (a) |
Requires each exception review to comply with Title XIX; |
| (b) |
Requires a written summary for each exception review that states whether
resident assessment forms have been completed accurately; |
| (c) |
Prohibits each health professional who conducts an exception review from doing
either of the following:
| (i) |
During the
period of the professional's contract or employment with the department, having
or being committed to acquire any direct or indirect financial interest in the
ownership, financing, or operation of ICFs/IID in this state; |
| (ii) |
Reviewing any provider that has been a client of the professional. |
|
|
| (2) |
For the
purposes of division (D)(1)(c)(i) of this section, employment of a member of a
health professional's family by an ICF/IID that the professional does not
review does not constitute a direct or indirect financial interest in the
ownership, financing, or operation of the ICF/IID. |
|
| (E) |
This section is obsolete beginning July 1,
2021. |
Renumbered from § 5124.193 by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
No change
that the department of developmental disabilities makes to either of the
following is valid unless the change is applied prospectively and the
department complies with division (B) of this section:
| (1) |
The
department's instructions or guidelines for the resident assessment forms that
are used for the purpose of section 5124.196 of the Revised
Code; |
| (2) |
The manner in
which the grouper methodology prescribed in rules authorized by section
5124.197 of the Revised Code is
applied in determining case-mix scores under that section. |
|
| (B) |
Before making a change described in division (A) of this section, the
department shall do all of the following:
| (1) |
Notify all ICF/IID providers of the proposed change; |
| (2) |
Provide representatives of ICF/IID providers an opportunity to provide the
department their concerns about, and suggestions to revise, the proposed
change; |
| (3) |
In the case
of a proposed change described in division (A)(2) of this section, determine
that the proposed change is consistent with the documentation of ICF/IID staff
time that was used to create the grouper methodology. |
|
| (C) |
This section is obsolete beginning July 1,
2021. |
Renumbered from § 5124.195 by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Renumbered from § 5124.19 by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
131st General Assembly File No. TBD, HB 483, §101.01, eff.
10/12/2016.
| (A) |
For each fiscal year, the department of developmental
disabilities shall determine each ICF/IID's per medicaid day indirect care
costs component rate. An ICF/IID's rate shall be the lesser of the individual
rate determined under division (B) of this section and the maximum rate
determined for the ICF/IID's peer group under division (C) of this
section. |
| (B) |
An ICF/IID's individual rate is the sum of the
following:
| (1) |
The ICF/IID's desk-reviewed, actual, allowable, per
diem indirect care costs for the applicable cost report year, adjusted for the
inflation rate estimated under division (E) of this section; |
| (2) |
Subject to division (D) of this section, an efficiency
incentive equal to the difference between the amount of the per diem indirect
care costs for the applicable cost report year determined for the ICF/IID under
division (B)(1) of this section and the maximum rate established for the
ICF/IID's peer group under division (C) of this section for that
year. |
|
| (C) |
| (1) |
The maximum rate for an ICF/IID's peer group shall be
the following percentage above the peer group's median per diem indirect care
costs for the applicable cost report year:
| (a) |
For ICFs/IID in peer group 1-A, eight per
cent; |
| (b) |
For ICFs/IID in peer group 2-A or peer group 3-A, ten
per cent; |
| (c) |
For ICFs/IID in peer group 4-A or peer group 5-A,
twelve per cent. |
|
| (2) |
The department shall not redetermine a peer group's
maximum rate under division (C)(1) of this section based on additional
information that it receives after the maximum rate is set. The department
shall redetermine a peer group's maximum rate only if the department made an
error in computing the maximum rate based on the information available to the
department at the time of the original calculation. |
|
| (D) |
The efficiency incentive for an ICF/IID shall not
exceed the following:
| (1) |
If the ICF/IID is in peer group 1-A, five per cent of
the peer group's maximum rate established under division (C)(1)(a) of this
section; |
| (2) |
If the ICF/IID is in peer group 2-A, peer group 3-A,
peer group 4-A, or peer group 5-A, six per cent of the peer group's maximum
rate established under division (C)(1)(b) or (c) of this
section. |
|
| (E) |
When adjusting rates for inflation under division
(B)(1) of this section, the department shall estimate the rate of inflation for
the eighteen-month period beginning on the first day of July of the applicable
cost report year and ending on the thirty-first day of December of the fiscal
year for which the rate is determined. To estimate the rate of inflation, the
department shall use the following:
| (1) |
Subject to division (E)(2) of this section, the
consumer price index for all items for all urban consumers for the midwest
region, published by the United States bureau of labor
statistics; |
| (2) |
If the United States bureau of labor statistics ceases
to publish the index specified in division (E)(1) of this section, a comparable
index that the bureau publishes and the department determines is
appropriate. |
|
Added by
132nd General Assembly File No. TBD, HB 24, §1,
eff.
7/1/2018.
| (A) |
For each
fiscal year until fiscal year 2022 and for the purpose
of division (C) of section
5124.15 of the
Revised Code, the department of developmental disabilities shall
determine each ICF/IID's per medicaid day payment rate for indirect care costs.
Except as otherwise provided in this chapter, an ICF/IID's rate shall be
determined prospectively. Subject to section
5124.28
of the Revised Code, an ICF/IID's rate shall be the lesser of the individual
rate determined under division (B) of this section and the maximum rate
determined for the ICF/IID's peer group under division (C) of this
section. |
| (B) |
An ICF/IID's
individual rate is the sum of the following:
| (1) |
The
ICF/IID's desk-reviewed, actual, allowable, per diem indirect care costs from
the calendar year immediately preceding the fiscal year
for
which the rate is determined, adjusted for the inflation rate
estimated under division (E)(1) of this section; |
| (2) |
Subject to division (D) of this section, an efficiency incentive equal to the
difference between the amount of the per diem indirect care costs determined
for the ICF/IID under division (B) (1) of this section for the fiscal year
for
which the rate is determined and the maximum rate established
for the ICF/IID's peer group under division (C) of this section for that fiscal
year. |
|
| (C) |
| (1) |
The
maximum rate for indirect care costs for each ICF/IID in peer group 1-B shall be determined as follows:
| (a) |
For
each fiscal year ending in an even-numbered calendar year, the maximum rate for
ICFs/IID in peer group 1-B shall be the rate that
is no less than twelve and four-tenths per cent above the median desk-reviewed,
actual, allowable, per diem indirect care cost for all ICFs/IID in peer group
1-B (excluding ICFs/IID in peer group 1-B whose indirect care costs for that period are more
than three standard deviations from the mean desk-reviewed, actual, allowable,
per diem indirect care cost for all ICFs/IID in peer group 1-B) for the calendar year immediately preceding the
fiscal year for which the rate is determined, adjusted by the
inflation rate estimated under division (E)(1) of this section. |
| (b) |
For
each fiscal year ending in an odd-numbered calendar year, the maximum rate for
ICFs/IID in peer group 1-B is the maximum rate
for ICFs/IID in peer group 1-B for the previous
fiscal year, adjusted for the inflation rate estimated under division (E)(2) of
this section. |
|
| (2) |
The
maximum rate for indirect care costs for ICFs/IID in peer group 2-B or peer group 3-B
shall be determined as follows:
| (a) |
For each
fiscal year ending in an even-numbered calendar year, the maximum rate for
ICFs/IID in peer group 2-B or peer group 3-B shall be the rate that is no less than ten and
three-tenths per cent above the median desk-reviewed, actual, allowable, per
diem indirect care cost for all ICFs/IID in peer group 2-B or peer group 3-B
(excluding ICFs/IID in peer group 2-B or peer
group 3-B whose indirect care costs are more than
three standard deviations from the mean desk-reviewed, actual, allowable, per
diem indirect care cost for all ICFs/IID in peer group 2-B or peer group 3-B)
for the calendar year immediately preceding the fiscal year
for
which the rate is determined, adjusted by the inflation rate
estimated under division (E)(1) of this section. |
| (b) |
For
each fiscal year ending in an odd-numbered calendar year, the maximum rate for
ICFs/IID in peer group 2-B or peer group 3-B is the maximum rate for ICFs/IID in peer group
2-B or peer group 3-B for the previous fiscal year, adjusted for the
inflation rate estimated under division (E) (2) of this section. |
|
| (3) |
The
department shall not redetermine a maximum rate for indirect care costs under
division (C)(1) or (2) of this section based on additional information that it
receives after the maximum rate is set. The department shall redetermine the
maximum rate for indirect care costs only if it made an error in computing the
maximum rate based on the information available to the department at the time
of the original calculation. |
|
| (D) |
| (1) |
The
efficiency incentive for an ICF/IID in peer group 1-B shall not exceed the following:
| (a) |
For each fiscal year ending in an even-numbered calendar
year, the following percentages of the maximum rate established for ICFs/IID in
peer group 1-B under division (C) of this
section:
| (i) |
Seven and
one-tenth per cent if the provider of the ICF/IID obtains the department's
approval to become a downsized ICF/IID and the approval is conditioned on the
downsizing being completed not later than July 1, 2018; |
| (ii) |
Three and fifty-five hundredths per cent if division (D)(1)(a)(i) of this
section does not apply to the ICF/IID. |
|
| (b) |
For
each fiscal year
ending in an odd-numbered
calendar year, the amount calculated for the immediately preceding fiscal year
under division (D)(1) (a) of this
section. |
|
| (2) |
The
efficiency incentive for an ICF/IID in peer group 2-B or peer group 3-B
shall not exceed the following:
| (a) |
For each
fiscal year ending in an even-numbered calendar year, seven per cent of the
maximum rate established for ICFs/IID in peer group 2-B or peer group 3-B
under division (C) of this section; |
| (b) |
For
each fiscal year ending in an odd-numbered calendar year, the amount calculated
for the immediately preceding fiscal year under division (D)(2)(a) of this
section. |
|
|
| (E) |
| (1) |
When
adjusting rates for inflation under divisions (B)(1), (C)(1)(a), and (C)(2)(a)
of this section, the department shall estimate the rate of inflation for the
eighteen-month period beginning on the first day of July of the calendar year
immediately preceding the fiscal year for which the rate is
determined and ending on the thirty-first day of December of the fiscal
year for
which the rate is determined. To estimate the rate of inflation,
the department shall use the following:
| (a) |
Subject to division (E)(1)(b) of this section, the consumer price index for all
items for all urban consumers for the midwest region, published by the United
States bureau of labor statistics; |
| (b) |
If
the United States bureau of labor statistics ceases to publish the index
specified in division (E)(1)(a) of this section, a comparable index that the
bureau publishes and the department determines is appropriate. |
|
| (2) |
When
adjusting rates for inflation under divisions (C)(1)(b) and (C)(2)(b) of this
section, the department shall estimate the rate of inflation for the
twelve-month period beginning on the first day of January of the fiscal year
immediately preceding the fiscal year for which the rate is
determined and ending on the thirty-first day of December of the fiscal
year for
which the rate is determined. To estimate the rate of inflation,
the department shall use the following:
| (a) |
Subject to division (E)(2)(b) of this section, the consumer price index for all
items for all urban consumers for the midwest region, published by the United
States bureau of labor statistics; |
| (b) |
If
the United States bureau of labor statistics ceases to publish the index
specified in division (E)(2)(a) of this section, a comparable index that the
bureau publishes and the department determines is appropriate. |
|
| (3) |
If an
inflation rate estimated under division (E)(1) or (2) of this section is
different from the actual inflation rate for the relevant time period, as
measured using the same index, the difference shall be added to or subtracted
from the inflation rate estimated pursuant to this division for the following
fiscal year. |
|
| (F) |
This section is obsolete beginning July 1,
2021. |
Renumbered from § 5124.21 by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Renumbered from § 5111.241 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
Effective Date:
07-01-2000; 07-01-2005
For each fiscal year, the department of developmental
disabilities shall determine each ICF/IID's per medicaid day other protected
costs component rate. An ICF/IID's rate shall be the ICF/IID's desk-reviewed,
actual, allowable, per diem other protected costs from the applicable cost
report year, adjusted for inflation using the following:
| (A) |
Subject to division (B) of this section, the consumer
price index for all urban consumers for nonprescription drugs and medical
supplies, as published by the United States bureau of labor
statistics; |
| (B) |
If the United States bureau of labor statistics ceases
to publish the index specified in division (B)(1) of this section, the index
that is subsequently published by the bureau and covers nonprescription drugs
and medical supplies. |
Added by
132nd General Assembly File No. TBD, HB 24, §1,
eff.
7/1/2018.
| (A) |
For each
fiscal year until fiscal year 2022 and for the purpose
of division (C) of section
5124.15 of the
Revised Code, the department of developmental disabilities shall
determine each ICF/IID's per medicaid day payment rate for other protected
costs. Except as otherwise provided in this chapter, an ICF/IID's rate shall be
determined prospectively. An ICF/IID's rate shall be the ICF/IID's
desk-reviewed, actual, allowable, per diem other protected costs from the
calendar year immediately preceding the fiscal year for which the
rate is determined, all adjusted for the estimated
inflation rate for the eighteen-month period beginning on the first day of July
of the calendar year immediately preceding the fiscal year
for
which the rate is determined and ending on the thirty-first day
of December of that fiscal year. The department shall estimate inflation using
the index specified in division (B) of this section. 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 year. |
| (B) |
The
department shall use the following index for the purpose of division (A) of
this section:
| (1) |
Subject to
division (B)(2) of this section, the consumer price index for all urban
consumers for nonprescription drugs and medical supplies, as published by the
United States bureau of labor statistics; |
| (2) |
If
the United States bureau of labor statistics ceases to publish the index
specified in division (B)(1) of this section, the index that is subsequently
published by the bureau and covers nonprescription drugs and medical supplies.
|
|
| (C) |
This section is obsolete beginning July 1,
2021. |
Renumbered from § 5124.23 by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Renumbered from § 5111.235 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
Effective Date:
07-01-2000; 07-01-2005
| (A) |
For
fiscal year 2022 and each fiscal year thereafter, the department
of developmental disabilities shall determine in accordance with division (C)
of this section a per medicaid day quality incentive payment for each ICF/IID
that earns for the fiscal year at least one point under division (B) of this
section. |
| (B) |
Each
fiscal year beginning with fiscal year 2022, the
department, in accordance with rules authorized by this section, shall award to
an ICF/IID points for
quality indicators the ICF/IID meets for the fiscal year . The quality indicators used
under this division shall be based on the recommendations contained in the
report submitted to the director of developmental disabilities by the ICF/IID
quality indicators workgroup established by Section 261.230 of this
act.
|
| (C) |
An
ICF/IID's per medicaid day quality incentive payment for a fiscal year shall be
the product of the following:
| (1) |
The
relative weight point value for the fiscal year as determined under division
(D) of this section; |
| (2) |
The
number of points the ICF/IID was awarded under division
(B) of
this section for the fiscal year. |
|
| (D) |
The
relative weight point value for a fiscal year shall be determined as follows:
| (1) |
For
each ICF/IID, determine the product of the following:
| (a) |
The
number of inpatient days the ICF/IID had for the applicable cost report
year; |
| (b) |
The
number of points the ICF/IID was awarded under division
(B) of
this section for the fiscal year. |
|
| (2) |
Determine the sum of all of the products determined under division (D)(1) of
this section for the fiscal year; |
| (3) |
Determine the amount equal to one per cent of the total
desk-reviewed, actual, allowable direct care costs of all ICFs/IID for the
applicable cost report year; |
| (4) |
Divide
the amount determined under division (D)(3) of this section by the sum
determined under division (D)(2) of this section. |
|
| (E) |
The
director of developmental disabilities shall adopt rules under section
5124.03 of the Revised Code
as necessary to implement this section, including rules that specify or
establish all of the following:
| (1) |
The
data needed for the department to determine whether an ICF/IID meets the
quality indicators specified in division (B) of this section, the medium
through which a report of the data is to be submitted to the department, and
the date by which the report of the data must be submitted to the
department; |
| (2) |
Satisfactory evidence needed to determine that an ICF/IID has met the quality
indicators; |
| (3) |
The
method by which ICFs/IID are to be awarded points under division (B) of this
section and the number of points that each quality indicator is worth based on
the quality indicator's relative importance compared to the other quality
indicators. |
|
Amended by
133rd General Assembly File No. TBD, HB 166, §101.01, eff.
10/17/2019.
Added by
132nd General Assembly File No. TBD, HB 24, §1,
eff.
7/1/2018.
| (A) |
Subject to division (D) of this section, the department of developmental
disabilities may pay a medicaid rate add-on to an ICF/IID provider for outlier
ICF/IID services the ICF/IID provides to qualifying ventilator-dependent
residents on or after September 29, 2013, if the
provider applies to the department of developmental disabilities to receive the
rate add-on and the department approves the application. The department of
developmental disabilities may approve a provider's application if both of the
following apply:
| (1) |
The
provider submits to the department of developmental disabilities a best
practices protocol for providing outlier ICF/IID services under this section
and the department of developmental disabilities determines that the protocol
is acceptable; |
| (2) |
The
provider and ICF/IID meet all other eligibility requirements for the rate
add-on established in rules authorized by this section. |
|
| (B) |
An ICF/IID that has been approved by the department of developmental
disabilities to provider outlier ICF/IID services under this section shall
provide the services in accordance with both of the following:
| (1) |
The best practices protocol the department of developmental disabilities
determined is acceptable; |
| (2) |
Requirements regarding the services established in rules authorized by this
section. |
|
| (C) |
To qualify to receive outlier ICF/IID services from an ICF/IID under this
section, a resident of the ICF/IID must be a medicaid recipient,
be
dependent on a ventilator, and meet all other eligibility requirements
established in rules authorized by this section. |
| (D) |
The department of developmental disabilities shall negotiate the amount of the
medicaid payment rate add-on, if any, to be paid under this section, or the
method by which that amount is to be determined, with the department of
medicaid. The department of developmental disabilities shall not pay the rate
add-on unless the department of medicaid has approved the amount of the rate
add-on or method by which the amount is to be determined. |
Amended by
132nd General Assembly File No. TBD, HB 49, §101.01, eff.
9/29/2017.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Subject to division (D) of this section, the
department of developmental disabilities may pay a medicaid rate add-on to an
ICF/IID provider for outlier ICF/IID services the ICF/IID provides to residents
identified as needing intensive behavioral support services, if the provider
applies to the department to receive the rate add-on and the department
approves the application. The department may approve a provider's application
if both of the following apply:
| (1) |
The provider submits to the department a best
practices protocol for providing outlier ICF/IID services under this section
and the department determines that the protocol is acceptable; |
| (2) |
The provider meets all other eligibility requirements
for the rate add-on established in rules adopted under section
5124.03 of the Revised
Code. |
|
| (B) |
An ICF/IID that has been approved by the department to
provide outlier ICF/IID services under this section shall provide the services
in accordance with both of the following:
| (1) |
The best practices protocol described in division
(A)(1) of this section; |
| (2) |
Requirements regarding the services established in
rules adopted under section
5124.03 of the Revised
Code. |
|
| (C) |
To qualify to receive outlier ICF/IID services from an
ICF/IID under this section, a resident of the ICF/IID must be a medicaid
recipient, be determined to need intensive behavioral support services, and
meet all other eligibility requirements established in rules adopted under
section
5124.03 of the Revised
Code. |
| (D) |
The department shall negotiate with the department of
medicaid the amount of the medicaid payment rate add-on, if any, to be paid
under this section or the method by which that amount is to be
determined. |
Added by
133rd General Assembly File No. TBD, HB 166, §101.01, eff.
10/17/2019.
Notwithstanding any
provision of section 5124.171 or 5124.211 of the Revised Code, the
director of developmental disabilities may adopt rules under section
5124.03 of the Revised Code
that provide for the determination of a combined maximum payment limit for
indirect care costs and costs of ownership for ICFs/IID in peer group 2-B.
This section is obsolete beginning July 1,
2021.
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Except as otherwise
provided in section
5124.30
of the Revised Code, the department of developmental disabilities, in
determining whether an ICF/IID's direct care costs and indirect care costs are
allowable, shall place no limit on specific categories of reasonable costs
other than compensation of owners, compensation of relatives of owners, and
compensation of administrators.
Compensation cost limits
for owners and relatives of owners shall be based on compensation costs for
individuals who hold comparable positions but who are not owners or relatives
of owners, as reported on ICFs/IID's cost reports. As used in this section,
"comparable position" means the position that is held by the owner or the
owner's relative, if that position is listed separately on the cost report
form, or if the position is not listed separately, the group of positions that
is listed on the cost report form and that includes the position held by the
owner or the owner's relative. In the case of an owner or owner's relative who
serves the ICFs/IID in a capacity such as corporate officer, proprietor, or
partner for which no comparable position or group of positions is listed on the
cost report form, the compensation cost limit shall be based on civil service
equivalents and shall be specified in rules adopted under section
5124.03 of the Revised
Code.
Compensation cost limits
for administrators shall be based on compensation costs for administrators who
are not owners or relatives of owners, as reported on ICFs/IID's cost reports.
For
the purpose of determining an ICF/IID's total per medicaid day payment rate
under division (C) of section
5124.15 of the
Revised Code, compensation cost limits for administrators of four or more
ICFs/IID shall be the same as the limits for administrators of ICFs/IID with
one hundred fifty or more beds.
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Renumbered from § 5111.263 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Renumbered from § 5111.261 by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
Amended by
128th General AssemblyFile No.9, HB 1,
§101.01, eff.
10/16/2009.
Effective Date:
07-01-2000; 07-01-2005
Except as provided in
sections 5124.17 and 5124.171 of the Revised Code, the costs of
goods, services, and facilities, furnished to an ICF/IID provider by a related
party are includable in the allowable costs of the provider at the reasonable
cost to the related party.
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities shall
adjust medicaid payment rates determined under this chapter to account for
reasonable additional costs that must be incurred by ICFs/IID to comply with
requirements of federal or state statutes, rules, or policies enacted or
amended after January 1, 1992, or with orders issued by state or local fire
authorities.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities shall not
reduce an ICF/IID's medicaid payment rate determined under this chapter on the
basis that the provider charges a lower rate to any resident who is not
eligible for medicaid.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
No medicaid payment
shall be made to an ICF/IID provider for the day a medicaid recipient is
discharged from the ICF/IID, unless the recipient is
discharged from the ICF/IID because all of the beds in the ICF/IID are
converted from providing ICF/IID services to providing home and community-based
services pursuant to section
5124.60 or
5124.61 of the Revised
Code.
Amended by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
As used in this section,
"participation in therapeutic programs" includes visits to potential new
residential settings. |
| (B) |
The department of developmental disabilities shall
pay an ICF/IID provider one hundred per cent of the total per medicaid day
payment rate determined for the ICF/IID under this chapter to reserve a bed for
a resident who is a medicaid recipient if all of the following apply:
| (1) |
The
recipient is temporarily absent from the ICF/IID for a reason that makes the
absence qualified for payments under this section as specified in rules
authorized by this section; |
| (2) |
The
resident's plan of care provides for the absence; |
| (3) |
Federal
financial participation is available for the payments. |
|
| (C) |
The maximum
period during which medicaid payments may be made to reserve a bed shall not
exceed the maximum period specified in federal regulations and shall not be
more than thirty days during any calendar year for hospital stays, visits with
relatives and friends, and participation in therapeutic programs. However, a
resident shall not be subject to a maximum period during which payments may be
made to reserve a bed if prior authorization of the department is obtained for
hospital stays, visits with relatives and friends, and participation in
therapeutic programs. |
| (D) |
| (1) |
The director of developmental disabilities shall
adopt rules under section
5124.03 of the Revised Code as
necessary to implement this section, including rules that do the following:
| (a) |
Specify
the reasons for which a temporary absence from an ICF/IID makes the absence
qualify for payments under this section; |
| (b) |
Establish conditions under which prior authorization may be obtained for the
purpose of division (C) of this section. |
|
| (2) |
The rules authorized by division
(D)(1)(a) of this section shall include the following
as reasons for which a temporary absence from an ICF/IID qualifies for payments
under this section:
| (a) |
Hospitalization for acute conditions; |
| (b) |
Visits
with relatives and friends; |
| (c) |
Participation in therapeutic programs outside the ICF/IID. |
|
|
Amended by
131st General Assembly File No. TBD, HB 483, §101.01, eff.
10/12/2016.
Renumbered from § 5111.33 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
Effective Date:
07-01-2000; 07-01-2005
Medicaid payments may be made for ICF/IID services
provided not later than thirty days after the effective date of an involuntary
termination of the ICF/IID that provides the services if the services are
provided to a medicaid recipient who is eligible for the services and resided
in the ICF/IID before the effective date of the involuntary termination.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities shall
make its best efforts each year to determine ICFs/IID's medicaid payment rates
under this chapter in time to pay the rates by August fifteenth of each fiscal
year. If the department is unable to calculate the rates so that they can be
paid by that date, the department shall pay each provider the rate calculated
for the provider's ICFs/IID under those sections at the end of the previous
fiscal year. If the department also is unable to calculate the rates to make
the payments due by the fifteenth day of September and the fifteenth day of
October, the department shall pay the previous fiscal year's rate to make those
payments. The department may increase by five per cent the previous fiscal
year's rate paid for any ICF/IID pursuant to this section at the request of the
provider. The department shall use rates calculated for the current fiscal year
to make the payments due by the fifteenth day of November.
If an ICF/IID's medicaid payment rate paid under this
section is lower than the rate calculated for it for the current fiscal year,
the department shall pay the provider the difference between the two rates for
the number of days for which the provider is paid the lower rate. If an
ICF/IID's medicaid payment rate paid under this section is higher than the rate
calculated for it for the current fiscal year, the provider shall refund to the
department the difference between the two rates for the number of days for
which the provider is paid the higher rate.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
The director
of developmental disabilities shall establish a process under which an ICF/IID
provider, or a group or association of ICF/IID providers, may seek
reconsideration of medicaid payment rates established under this chapter,
including a rate for direct care costs redetermined before the effective date
of the rate as a result of an exception review conducted under section
5124.198 of the Revised Code. Except
as provided in divisions (B) to (E) of this section, the only issue that a
provider, group, or association may raise in the rate reconsideration is
whether the rate was calculated in accordance with this chapter and the rules
adopted under section
5124.03 of the Revised
Code. The provider, group, or association may submit written arguments or other
materials that support its position. The provider, group, or association and
department shall take actions regarding the rate reconsideration within time
frames specified in rules authorized by this section. If the department
determines, as a result of the rate reconsideration, that the rate established
for one or more ICFs/IID is less than the rate to which the ICF/IID is
entitled, the department shall increase the rate. If the department has paid
the incorrect rate for a period of time, the department shall pay the provider
of the ICF/IID the difference between the amount the provider was paid for that
period for the ICF/IID and the amount the provider should have been paid for
the ICF/IID.
|
| (B) |
| (1) |
The
department, through the rate reconsideration process, may increase during a
fiscal year the medicaid payment rate determined for an ICF/IID under this
chapter if the provider demonstrates that the ICF/IID's actual, allowable costs
have increased because of any of the following extreme circumstances:
| (b) |
A
nonextensive renovation approved under division (E) of section
5124.171 of the Revised
Code; |
| (c) |
If the
ICF/IID has an appropriate claims management program, an increase in the
ICF/IID's workers' compensation experience rating of greater than five per
cent; |
| (d) |
If the
ICF/IID is an inner-city ICF/IID, increased security costs; |
| (e) |
A
change of ownership that results from bankruptcy, foreclosure, or findings by
the department of health of violations of medicaid certification
requirements; |
| (f) |
Other extreme
circumstances specified in rules authorized by this section. |
|
| (2) |
An ICF/IID
may qualify for a rate increase under this division only if its per diem,
actual, allowable costs have increased to a level that exceeds its total rate.
An increase under this division is subject to any rate limitations or maximum
rates established by this chapter for specific cost centers. Any rate increase
granted under this division shall take effect on the first day of the first
month after the department receives the request. |
|
| (C) |
The
department, through the rate reconsideration process, may increase an ICF/IID's
rate as determined under this chapter if the department, in the department's
sole discretion, determines that the rate as determined under those sections
works an extreme hardship on the ICF/IID. |
| (D) |
| (1) |
When
beds certified for the medicaid program are added to an existing ICF/IID or
replaced at the same site, the department, through the rate reconsideration
process, may do either of the
following to account for the costs of the beds that are added or
replaced;
| (a) |
Subject to any applicable limitation under section
5124.17
of the Revised Code, proportionately increase the ICF/IID's per medicaid day
capital component rate determined under that section; |
| (b) |
Subject to any applicable limitation under section
5124.171 of the Revised Code, proportionately increase the ICF/IID's per
medicaid day payment rate for reasonable capital costs determined under that
section. |
|
| (2) |
If the department grants
an increase under division (D)(1)(a) or (b) of
this section, the increase shall go into
effect one month after the first day of the month after the department
receives sufficient documentation needed to determine the amount of the
increase. |
| (3) |
Any rate increase of an
ICF/IID's per medicaid day payment rate for reasonable capital costs determined
under section 5124.171 of the Revised Code that is granted under
division (D)
(1)(b) of this section after June 30, 1993, shall remain in effect until
the earlier of the following:
| (a) |
The effective date of a per medicaid day payment rate for
reasonable capital costs determined under section
5124.171 of the Revised Code that
includes costs incurred for a full calendar year for the bed addition or bed
replacement; |
| (b) |
The date the provider of the ICF/IID begins to be paid
a rate determined under division (B) of section
5124.15 of the
Revised Code. |
|
| (4) |
The provider of an ICF/IID
that has its per medicaid day payment rate for
reasonable capital costs increased under division (D)(1)(b) of this
section shall report double accumulated depreciation in an amount equal
to the depreciation included in the rate adjustment on its cost report for the
first year of operation. During the term of any loan used to finance a project
for which the rate increase
is granted ,
the provider, if the ICF/IID is
operated by the same provider, shall subtract from the interest costs it
reports on the ICF/IID's cost report an amount equal to the
difference between the following:
| (a) |
The actual, allowable interest costs for the loan
during the calendar year for which the costs are being reported; |
| (b) |
The actual,
allowable interest costs attributable to the loan that were used to calculate
the rates paid to the provider for the ICF/IID during the same calendar
year. |
|
|
| (E) |
If the provider of an ICF/IID submits to the department
revised assessment data for a resident of the ICF/IID under division (D) of
section
5124.191
of the Revised Code and the revised assessment data results in at least a
fifteen per cent increase in the ICF/IID's case-mix score determined under
section
5124.193
of the Revised Code, the provider may request that the department, through the
rate reconsideration process, increase the ICF/IID's per medicaid day direct
care costs component rate determined under section
5124.19
of the Revised Code to account for the increase in the ICF/IID's case-mix
score. If the department determines that the revised assessment data so
increases the ICF/IID's case-mix score, the department shall grant the rate
increase. The increase shall go into effect one month after the first day of
the month after the department receives sufficient documentation needed to
determine the amount of the increase. |
| (F) |
The
department's decision at the conclusion of a rate
reconsideration process is not subject to any administrative proceedings under
Chapter 119. or any other provision of the Revised Code. |
| (G) |
The director of
developmental disabilities shall adopt rules under section
5124.03 of the Revised Code
as necessary to implement this section. |
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Except as
provided in divisions (B) and (C) of this section, if the provider of an
ICF/IID in peer group 1-B obtained approval from
the department of developmental disabilities to become a downsized ICF/IID not
later than July 1, 2018, and the ICF/IID does not become a downsized ICF/IID by
that date, the department shall recoup from the provider an amount equal to the
sum of the following:
| (1) |
The
difference between the amount of the efficiency incentive payments the ICF/IID
earned under sections 5124.171 and
5124.211 of the Revised Code because
the provider obtained such approval and the amount of the efficiency incentive
payments the ICF/IID would have earned under those sections had the provider
not obtained such approval; |
| (2) |
An
amount of interest on the difference determined under division (A)(1) of this
section. |
|
| (B) |
The
department shall exempt an ICF/IID provider from a recoupment otherwise
required by this section if the provider voluntarily repays the department the
difference determined under division (A)(1) of this section. No interest shall
be charged on the amount voluntarily repaid. |
| (C) |
The
department may exempt an ICF/IID provider from a recoupment otherwise required
by this section if both of the following apply:
| (1) |
The
provider, on or before July 1, 2018, demonstrates to the department's
satisfaction that the provider made a good faith effort to complete the
downsizing by July 1, 2018, but the ICF/IID did not become a downsized ICF/IID
by that date for reasons beyond the provider's control; |
| (2) |
The
ICF/IID becomes a downsized ICF/IID within a period of time after July 1, 2018,
that the department determines is reasonable. |
|
| (D) |
An
ICF/IID provider subject to a recoupment under division (A) of this section or
voluntarily making a repayment under division (B) of this section shall choose
one of the following methods by which the recoupment or voluntary repayment
shall be made:
| (1) |
In a lump sum
payment; |
| (2) |
Subject to
the department's approval, in installment payments; |
| (3) |
In a
single deduction from the next available medicaid payment made to the provider
if that payment at least equals the total amount of the recoupment or voluntary
repayment; |
| (4) |
Subject to
the department's approval, in installment deductions from medicaid payments
made to the provider. |
|
| (E) |
An
ICF/IID provider may request that the director of developmental disabilities
reconsider either or both of the following:
| (1) |
A
decision that the provider is subject to a recoupment under this
section; |
| (2) |
A
determination under this section of the amount to be recouped from the
provider. |
|
| (F) |
The director
shall adopt rules under section
5124.03 of the Revised Code
as necessary to implement this section, including rules specifying how the
amount of interest charged under division (A)(2) of this section is to be
determined. |
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
131st General Assembly File No. TBD, HB 483, §101.01, eff.
10/12/2016.
If an ICF/IID provider
properly amends a cost report for an ICF/IID under section
5124.107 of
the Revised Code and the amended report shows that the provider received a
lower medicaid payment rate under the original cost report than the provider
was entitled to receive, the department of developmental disabilities shall
adjust the provider's rate for the ICF/IID prospectively to reflect the
corrected information. The department shall pay the adjusted rate beginning two
months after the first day of the month after the provider files the amended
cost report.
If the department finds,
from an exception review of resident assessment data conducted pursuant to
section 5124.198 of the Revised Code after the
effective date of an ICF/IID's rate for direct care costs that is based on the
resident assessment data, that inaccurate resident assessment data resulted in
the provider receiving a lower rate for the ICF/IID than the provider was
entitled to receive, the department prospectively shall adjust the provider's
rate for the ICF/IID accordingly. The department shall make payments to the
provider using the adjusted rate for the remainder of the calendar quarter for
which the resident assessment data is used to determine the rate, beginning one
month after the first day of the month after the exception review is
completed.
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
The
department of developmental disabilities shall redetermine a provider's
medicaid payment rate for an ICF/IID using revised information if any of the
following results in a determination that the provider received a higher
medicaid payment rate for the ICF/IID than the provider was entitled to
receive:
| (1) |
The provider
properly amends a cost report for the ICF/IID under section
5124.107 of
the Revised Code; |
| (2) |
The
department makes a finding based on an audit under section
5124.109 of the Revised
Code; |
| (3) |
The
department makes a finding based on an exception review of resident assessment
data conducted under section 5124.198 of the Revised Code after the
effective date of the ICF/IID's rate for direct care costs that is based on the
resident assessment data. |
|
| (B) |
The
department shall apply the redetermined 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. The department may charge
the provider the following amount of interest from the time the overpayment was
made:
| (1) |
If the overpayment resulted from costs reported for calendar year 1993, the
interest shall be not greater than one and one-half times the current average
bank prime rate. |
| (2) |
If the
overpayment resulted from costs reported for a subsequent calendar year:
| (a) |
The
interest shall be not greater than two times the current average bank prime
rate if the overpayment was not more than one per cent of the total medicaid
payments to the provider for the fiscal year for which the incorrect
information was used to determine a rate. |
| (b) |
The
interest shall be not greater than two and one-half times the current average
bank prime rate if the overpayment was more than one per cent of the total
medicaid payments to the provider for the fiscal year for which the incorrect
information was used to determine a rate. |
|
|
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
In addition to the other penalties authorized by this
chapter, the department of developmental disabilities may impose the following
penalties on an ICF/IID provider:
| (A) |
If the provider does not furnish invoices or other
documentation that the department requests during an audit within sixty days
after the request, a fine of not more than the greater of the following:
| (1) |
One thousand dollars per audit; |
| (2) |
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 determine a rate. |
|
| (B) |
If an exiting operator or owner fails to provide
notice of a facility closure or voluntary termination as required by section
5124.50 of the Revised Code, or an exiting operator or owner and entering
operator fail to provide notice of a change of operator as required by section
5124.51 of the Revised Code, a fine of not more than the current average bank
prime rate plus four per cent of the last two monthly payments. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
For the purposes of sections 5124.41 and 5124.42 of
the Revised Code, the department of developmental disabilities shall determine
the current average bank prime rate using statistical release H.15, "selected
interest rates," a weekly publication of the federal reserve board, 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.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Except as provided in division (B) of this section,
the department of developmental disabilities shall deduct the following from
the next available medicaid payment the department makes to an ICF/IID provider
who continues to participate in medicaid:
| (1) |
Any amount the provider is required to refund, and any
interest charged, under section 5124.41 of the Revised Code; |
| (2) |
The amount of any penalty imposed on the provider
under section 5124.42 of the Revised Code. |
|
| (B) |
The department and an ICF/IID provider may enter into
an agreement under which a deduction required by division (A) of this section
is taken in installments from payments the department makes to the
provider. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of
developmental disabilities shall transmit to the treasurer of state for deposit
in the general revenue fund amounts collected from the following:
| (A) |
Recoupments and voluntary
repayments made under section 5124.39 of the Revised Code; |
| (B) |
Refunds required by, and interest charged under,
section 5124.41 of the Revised
Code; |
| (C) |
Penalties imposed
under section 5124.42 of the Revised
Code. |
Amended by
131st General Assembly File No. TBD, HB 483, §101.01, eff.
10/12/2016.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
All of the following are
subject to an adjudication conducted in accordance with Chapter 119. of the
Revised Code:
| (A) |
Any audit
disallowance that the department of developmental disabilities makes as the
result of an audit under section
5124.109 of the Revised
Code; |
| (B) |
Any adverse
finding that results from an exception review of resident assessment data
conducted for an ICF/IID under section 5124.198 of the Revised Code after the
effective date of the ICF/IID's medicaid payment rate for direct care costs
that is based on the resident assessment data; |
| (C) |
Any
medicaid payment deemed an overpayment under section
5124.523
of the Revised Code; |
| (D) |
Any penalty
the department imposes under section
5124.42 of
the Revised Code or section
5124.523
of the Revised Code. |
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
An exiting operator or owner of an ICF/IID
participating in the medicaid program shall provide the department of
developmental disabilities and department of medicaid written notice of a
facility closure or voluntary termination not less than ninety days before the
effective date of the facility closure or voluntary termination. The written
notice shall be provided to the department of developmental disabilities and
department of medicaid in accordance with the method specified in rules
authorized by section 5124.53 of the Revised Code.
The written notice shall include all of the
following:
| (A) |
The name of the exiting
operator and, if any, the exiting operator's authorized agent; |
| (B) |
The name of the ICF/IID that is the subject of the
written notice; |
| (C) |
The exiting operator's medicaid provider agreement
number for the ICF/IID that is the subject of the written notice; |
| (D) |
The effective date of the
facility closure or voluntary termination; |
| (E) |
The signature of the exiting operator's or owner's
representative. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
An exiting operator or owner and entering operator
shall provide the department of developmental disabilities and department of
medicaid written notice of a change of operator if the ICF/IID participates in
the medicaid program and the entering operator seeks to continue the ICF/IID's
participation. The written notice shall be provided to the department of
developmental disabilities and department of medicaid in accordance with the
method specified in rules authorized by section 5124.53 of the Revised Code.
The written notice shall be provided to the department of developmental
disabilities and department of medicaid not later than forty-five days before
the effective date of the change of operator if the change of operator does not
entail the relocation of residents. The written notice shall be provided to the
department of developmental disabilities and department of medicaid not later
than ninety days before the effective date of the change of operator if the
change of operator entails the relocation of residents. The written notice shall include all of the
following:
| (1) |
The name of the exiting
operator and, if any, the exiting operator's authorized agent; |
| (2) |
The name of the ICF/IID that is the subject of the
change of operator; |
| (3) |
The exiting operator's seven-digit medicaid legacy
number and ten-digit national provider identifier number for the ICF/IID that
is the subject of the change of operator; |
| (4) |
The name of the entering operator; |
| (5) |
The effective date of the change of operator; |
| (6) |
The manner in which the
entering operator becomes the ICF/IID's operator, including through sale,
lease, merger, or other action; |
| (7) |
If the manner in which the entering operator becomes
the ICF/IID's operator involves more than one step, a description of each
step; |
| (8) |
Written authorization
from the exiting operator or owner and entering operator for the department of
medicaid to process a provider agreement for the entering operator; |
| (9) |
The names and addresses
of the persons to whom the department of developmental disabilities and
department of medicaid should send initial correspondence regarding the change
of operator; |
| (10) |
The signature of the exiting operator's or owner's
representative. |
|
| (B) |
An exiting operator or owner and entering operator
immediately shall provide the department of developmental disabilities and
department of medicaid notice of any changes to information included in a
written notice of a change of operator that occur after that notice is provided
to the department of developmental disabilities and department of medicaid. The
notice of the changes shall be provided to the department of developmental
disabilities and department of medicaid in accordance with the method specified
in rules authorized by section 5124.53 of the Revised Code. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of medicaid may enter into a provider
agreement with an entering operator that goes into effect at 12:01 a.m. on the
effective date of the change of operator if all of the following requirements
are met:
| (A) |
The department receives a
properly completed written notice required by section 5124.51 of the Revised
Code on or before the date required by that section. |
| (B) |
The department receives both of the following in
accordance with the method specified in rules authorized by section 5124.53 of
the Revised Code and not later than ten days after the effective date of the
change of operator:
| (1) |
From the entering
operator, a completed application for a provider agreement and all other forms
and documents specified in rules authorized by section 5124.53 of the Revised
Code; |
| (2) |
From the exiting operator
or owner, all forms and documents specified in rules authorized by section
5124.53 of the Revised Code. |
|
| (C) |
The entering operator is eligible to enter into a
provider agreement for the ICF/IID as provided in section 5124.06 of the
Revised Code. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
The department of medicaid may enter into a provider
agreement with an entering operator that goes into effect at 12:01 a.m. on the
date determined under division (B) of this section if all of the following are
the case:
| (1) |
The department receives a
properly completed written notice required by section 5124.51 of the Revised
Code. |
| (2) |
The department receives,
from the entering operator and in accordance with the method specified in rules
authorized by section 5124.53 of the Revised Code, a completed application for
a provider agreement and all other forms and documents specified in rules
adopted under that section. |
| (3) |
The department receives, from the exiting operator or
owner and in accordance with the method specified in rules authorized by
section 5124.53 of the Revised Code, all forms and documents specified in rules
adopted under that section. |
| (4) |
One or more of the following apply:
| (a) |
The requirement of division (A)(1) of this section is
met after the time required by section 5124.51 of the Revised Code; |
| (b) |
The requirement of
division (A)(2) of this section is met more than ten days after the effective
date of the change of operator; |
| (c) |
The requirement of division (A)(3) of this section is
met more than ten days after the effective date of the change of
operator. |
|
| (5) |
The entering operator is eligible to enter into a
provider agreement for the ICF/IID as provided in section 5124.06 of the
Revised Code. |
|
| (B) |
The department shall determine the date a provider
agreement entered into under this section is to go into effect as
follows:
| (1) |
The effective date shall
give the department sufficient time to process the change of operator and give
the department sufficient time to assure no duplicate payments are made and
make the withholding required by section 5124.521 of the Revised Code. |
| (2) |
The effective date shall
be not earlier than the latest of the following:
| (a) |
The effective date of the change of operator; |
| (b) |
The date that the
entering operator complies with section 5124.51 of the Revised Code and
division (A)(2) of this section; |
| (c) |
The date that the exiting operator or owner complies
with section 5124.51 of the Revised Code and division (A)(3) of this
section. |
|
| (3) |
The effective date shall be not later than the
following after the later of the dates specified in division (B)(2) of this
section:
| (a) |
Forty-five days if the
change of operator does not entail the relocation of residents; |
| (b) |
Ninety days if the change
of operator entails the relocation of residents. |
|
|
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
A provider that enters into a provider agreement with
the department of medicaid under section 5124.511 or 5124.512 of the Revised
Code shall do all of the following:
| (A) |
Comply with all applicable federal statutes and
regulations; |
| (B) |
Comply with section 5124.07 of the Revised Code and
all other applicable state statutes and rules; |
| (C) |
Comply with all the terms and conditions of the
exiting operator's provider agreement, including all of the following:
| (1) |
Any plan of correction; |
| (2) |
Compliance with health and safety standards; |
| (3) |
Compliance with the
ownership and financial interest disclosure requirements of 42 C.F.R. 455.104,
455.105, and 1002.3; |
| (4) |
Compliance with the civil rights requirements of 45
C.F.R. parts 80, 84, and 90; |
| (5) |
Compliance with additional requirements imposed by the
department; |
| (6) |
Any sanctions relating to
remedies for violation of the provider agreement, including deficiencies,
compliance periods, accountability periods, monetary penalties, notification
for correction of contract violations, and history of deficiencies. |
|
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
In the case of a change of operator, the exiting
operator shall be considered to be the operator of the ICF/IID for purposes of
the medicaid program, including medicaid payments, until the effective date of
the entering operator's provider agreement if the provider agreement is entered
into under section 5124.511 or 5124.512 of the Revised Code.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of medicaid may enter into a provider
agreement as provided in section 5124.07 of the Revised Code, rather than
section 5124.511 or 5124.512 of the Revised Code, with an entering operator if
the entering operator does not agree to a provider agreement that satisfies the
requirements of division (C) of section 5124.513 of the Revised Code. The
department may not enter into the provider agreement unless the department of
health certifies the ICF/IID under Title XIX. The effective date of the
provider agreement shall not precede any of the following:
| (A) |
The date that the department of health certifies the
ICF/IID; |
| (B) |
The effective date of the
change of operator; |
| (C) |
The date the requirement of section 5124.51 of the
Revised Code is satisfied. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The director of developmental disabilities may adopt
rules under section 5124.03 of the Revised Code governing adjustments to the
medicaid reimbursement rate for an ICF/IID that undergoes a change of operator.
No rate adjustment resulting from a change of operator shall be effective
before the effective date of the entering operator's provider agreement. This
is the case regardless of whether the provider agreement is entered into under
section 5124.511, section 5124.512, or, pursuant to section 5124.515, section
5124.07 of the Revised Code.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities'
determination that a change of operator has or has not occurred for purposes of
licensure under section 5123.19 of the Revised Code shall not affect either of
the following:
| (A) |
A determination by the
department of developmental disabilities or department of medicaid of whether
or when a change of operator occurs; |
| (B) |
The department of medicaid's determination of the
effective date of an entering operator's provider agreement under section
5124.511, section 5124.512, or, pursuant to section 5124.515, section 5124.07
of the Revised Code. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
On receipt of a written notice under section 5124.50
of the Revised Code of a facility closure or voluntary termination, on receipt
of a written notice under section 5124.51 of the Revised Code of a change of
operator, or on the effective date of an involuntary termination, the
department of developmental disabilities shall estimate the amount of any
overpayments made under the medicaid program to the exiting operator, including
overpayments the exiting operator disputes, and other actual and potential
debts the exiting operator owes or may owe to the department and United States
centers for medicare and medicaid services under the medicaid program,
including a franchise permit fee. |
| (B) |
In estimating the exiting operator's other actual and
potential debts to the department and the United States centers for medicare
and medicaid services under the medicaid program, the department shall use a
debt estimation methodology the director of developmental disabilities shall
establish in rules authorized by section 5124.53 of the Revised Code. The
methodology shall provide for estimating all of the following that the
department determines are applicable:
| (1) |
Refunds due the department under section 5124.41 of
the Revised Code; |
| (2) |
Interest owed to the department and United States
centers for medicare and medicaid services; |
| (3) |
Final civil monetary and other penalties for which all
right of appeal has been exhausted; |
| (4) |
Money owed the department and United States centers
for medicare and medicaid services from any outstanding final fiscal audit,
including a final fiscal audit for the last fiscal year or portion thereof in
which the exiting operator participated in the medicaid program; |
| (5) |
Other amounts the
department determines are applicable. |
|
| (C) |
The department shall provide the exiting operator
written notice of the department's estimate under division (A) of this section
not later than thirty days after the department receives the notice under
section 5124.50 of the Revised Code of the facility closure or voluntary
termination; the department receives the notice under section 5124.51 of the
Revised Code of the change of operator; or the effective date of the
involuntary termination. The department's written notice shall include the
basis for the estimate. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Except as provided in divisions (B), (C), and (D) of
this section, the department of developmental disabilities may withhold from
payment due an exiting operator under the medicaid program the total amount
specified in the notice provided under division (C) of section 5124.52 of the
Revised Code that the exiting operator owes or may owe to the department and
United States centers for medicare and medicaid services under the medicaid
program. |
| (B) |
In the case of a change
of operator and subject to division (E) of this section, the following shall
apply regarding a withholding under division (A) of this section if the exiting
operator or entering operator or an affiliated operator executes a successor
liability agreement meeting the requirements of division (F) of this
section:
| (1) |
If the exiting operator,
entering operator, or affiliated operator assumes liability for the total,
actual amount of debt the exiting operator owes the department and the United
States centers for medicare and medicaid services under the medicaid program as
determined under section 5124.525 of the Revised Code, the department shall not
make the withholding. |
| (2) |
If the exiting operator, entering operator, or
affiliated operator assumes liability for only the portion of the amount
specified in division (B)(1) of this section that represents the franchise
permit fee the exiting operator owes, the department shall withhold not more
than the difference between the total amount specified in the notice provided
under division (C) of section 5124.52 of the Revised Code and the amount for
which the exiting operator, entering operator, or affiliated operator assumes
liability. |
|
| (C) |
In the case of a voluntary termination or facility
closure and subject to division (E) of this section, the following shall apply
regarding a withholding under division (A) of this section if the exiting
operator or an affiliated operator executes a successor liability agreement
meeting the requirements of division (F) of this section:
| (1) |
If the exiting operator or affiliated operator assumes
liability for the total, actual amount of debt the exiting operator owes the
department and the United States centers for medicare and medicaid services
under the medicaid program as determined under section 5124.525 of the Revised
Code, the department shall not make the withholding. |
| (2) |
If the exiting operator or affiliated operator assumes
liability for only the portion of the amount specified in division (C)(1) of
this section that represents the franchise permit fee the exiting operator
owes, the department shall withhold not more than the difference between the
total amount specified in the notice provided under division (C) of section
5124.52 of the Revised Code and the amount for which the exiting operator or
affiliated operator assumes liability. |
|
| (D) |
In the case of an involuntary termination and subject
to division (E) of this section, the following shall apply regarding a
withholding under division (A) of this section if the exiting operator, the
entering operator, or an affiliated operator executes a successor liability
agreement meeting the requirements of division (F) of this section and the
department approves the successor liability agreement:
| (1) |
If the exiting operator, entering operator, or
affiliated operator assumes liability for the total, actual amount of debt the
exiting operator owes the department and the United States centers for medicare
and medicaid services under the medicaid program as determined under section
5124.525 of the Revised Code, the department shall not make the
withholding. |
| (2) |
If the exiting operator, entering operator, or
affiliated operator assumes liability for only the portion of the amount
specified in division (D)(1) of this section that represents the franchise
permit fee the exiting operator owes, the department shall withhold not more
than the difference between the total amount specified in the notice provided
under division (C) of section 5124.52 of the Revised Code and the amount for
which the exiting operator, entering operator, or affiliated operator assumes
liability. |
|
| (E) |
For an exiting operator or affiliated operator to be
eligible to enter into a successor liability agreement under division (B), (C),
or (D) of this section, both of the following must apply:
| (1) |
The exiting operator or affiliated operator must have
one or more valid provider agreements, other than the provider agreement for
the ICF/IID that is the subject of the involuntary termination, voluntary
termination, facility closure, or change of operator; |
| (2) |
During the twelve-month period preceding either the
effective date of the involuntary termination or the month in which the
department receives the notice of the voluntary termination or facility closure
under section 5124.50 of the Revised Code or the notice of the change of
operator under section 5124.51 of the Revised Code, the average monthly
medicaid payment made to the exiting operator or affiliated operator pursuant
to the exiting operator's or affiliated operator's one or more provider
agreements, other than the provider agreement for the ICF/IID that is the
subject of the involuntary termination, voluntary termination, facility
closure, or change of operator, must equal at least ninety per cent of the sum
of the following:
| (a) |
The average monthly
medicaid payment made to the exiting operator pursuant to the exiting
operator's provider agreement for the ICF/IID that is the subject of the
involuntary termination, voluntary termination, facility closure, or change of
operator; |
| (b) |
Whichever of the
following apply:
| (i) |
If the exiting operator
or affiliated operator has assumed liability under one or more other successor
liability agreements, the total amount for which the exiting operator or
affiliated operator has assumed liability under the other successor liability
agreements; |
| (ii) |
If the exiting operator
or affiliated operator has not assumed liability under any other successor
liability agreements, zero. |
|
|
|
| (F) |
A successor liability agreement executed under this
section must comply with all of the following:
| (1) |
It must provide for the operator who executes the
successor liability agreement to assume liability for either of the following
as specified in the agreement:
| (a) |
The total, actual amount of debt the exiting operator
owes the department and the United States centers for medicare and medicaid
services under the medicaid program as determined under section 5124.525 of the
Revised Code; |
| (b) |
The portion of the amount specified in division
(F)(1)(a) of this section that represents the franchise permit fee the exiting
operator owes. |
|
| (2) |
It may not require the operator who executes the
successor liability agreement to furnish a surety bond. |
| (3) |
It must provide that the department, after determining
under section 5124.525 of the Revised Code the actual amount of debt the
exiting operator owes the department and United States centers for medicare and
medicaid services under the medicaid program, may deduct the lesser of the
following from medicaid payments made to the operator who executes the
successor liability agreement:
| (a) |
The total, actual amount of debt the exiting operator
owes the department and the United States centers for medicare and medicaid
services under the medicaid program as determined under section 5124.525 of the
Revised Code; |
| (b) |
The amount for which the operator who executes the
successor liability agreement assumes liability under the agreement. |
|
| (4) |
It must provide that the
deductions authorized by division (F)(3) of this section are to be made for a
number of months, not to exceed six, agreed to by the operator who executes the
successor liability agreement and the department or, if the operator who
executes the successor liability agreement and department cannot agree on a
number of months that is less than six, a greater number of months determined
by the attorney general pursuant to a claims collection process authorized by
statute of this state. |
| (5) |
It must provide that, if the attorney general
determines the number of months for which the deductions authorized by division
(F)(3) of this section are to be made, the operator who executes the successor
liability agreement shall pay, in addition to the amount collected pursuant to
the attorney general's claims collection process, the part of the amount so
collected that, if not for division (H) of this section, would be required by
section 109.081 of the Revised Code to be paid into the attorney general claims
fund. |
|
| (G) |
Execution of a successor liability agreement does not
waive an exiting operator's right to contest the amount specified in the notice
the department provides the exiting operator under division (C) of section
5124.52 of the Revised Code. |
| (H) |
Notwithstanding section 109.081 of the Revised Code,
the entire amount that the attorney general, whether by employees or agents of
the attorney general or by special counsel appointed pursuant to section 109.08
of the Revised Code, collects under a successor liability agreement, other than
the additional amount the operator who executes the agreement is required by
division (F)(5) of this section to pay, shall be paid to the department of
developmental disabilities for deposit into the appropriate fund. The
additional amount that the operator is required to pay shall be paid into the
state treasury to the credit of the attorney general claims fund created under
section 109.081 of the Revised Code. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
Except as provided in division (B) of this section, an
exiting operator shall file with the department of developmental disabilities a
cost report not later than ninety days after the last day the exiting
operator's provider agreement is in effect. The cost report shall cover the
period that begins with the day after the last day covered by the operator's
most recent previous cost report filed under section 5124.10 or 5124.101 of the
Revised Code and ends on the last day the exiting operator's provider agreement
is in effect. The cost report shall include, as applicable, all of the
following:
| (1) |
The sale price of the
ICF/IID; |
| (2) |
A final depreciation
schedule that shows which assets are transferred to the buyer and which assets
are not transferred to the buyer; |
| (3) |
Any other information the department requires. |
|
| (B) |
The department, at its
sole discretion, may waive the requirement that an exiting operator file a cost
report in accordance with division (A) of this section. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
If an exiting operator required by section 5124.522 of
the Revised Code to file a cost report with the department of developmental
disabilities fails to file the cost report in accordance with that section, all
payments under the medicaid program for the period the cost report is required
to cover are deemed overpayments until the date the department receives the
properly completed cost report. The department may impose on the exiting
operator a penalty of one hundred dollars for each calendar day the properly
completed cost report is late.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities may not
provide an exiting operator final payment under the medicaid program until the
department receives all properly completed cost reports the exiting operator is
required to file under sections 5124.10 and 5124.522 of the Revised Code.
Amended by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities shall
determine the actual amount of debt an exiting operator owes the department and
the United States centers for medicare and medicaid services under the medicaid
program by completing all final fiscal audits not already completed and
performing all other appropriate actions the department determines to be
necessary. The department shall issue an initial debt summary report on this
matter not later than sixty days after the date the exiting operator files the
properly completed cost report required by section 5124.522 of the Revised Code
with the department or, if the department waives the cost report requirement
for the exiting operator, sixty days after the date the department waives the
cost report requirement. The initial debt summary report becomes the final debt
summary report thirty-one days after the department issues the initial debt
summary report unless the exiting operator, or an affiliated operator who
executes a successor liability agreement under section 5124.521 of the Revised
Code, requests a review before that date.
The exiting operator, and an affiliated operator who
executes a successor liability agreement under section 5124.521 of the Revised
Code, may request a review to contest any of the department's findings included
in the initial debt summary report. The request for the review must be
submitted to the department not later than thirty days after the date the
department issues the initial debt summary report. The department shall conduct
the review on receipt of a timely request and issue a revised debt summary
report. If the department has withheld money from payment due the exiting
operator under division (A) of section 5124.521 of the Revised Code, the
department shall issue the revised debt summary report not later than ninety
days after the date the department receives the timely request for the review
unless the department and exiting operator or affiliated operator agree to a
later date. The exiting operator or affiliated operator may submit information
to the department explaining what the operator contests before and during the
review, including documentation of the amount of any debt the department owes
the operator. The exiting operator or affiliated operator may submit additional
information to the department not later than thirty days after the department
issues the revised debt summary report. The revised debt summary report becomes
the final debt summary report thirty-one days after the department issues the
revised debt summary report unless the exiting operator or affiliated operator
timely submits additional information to the department. If the exiting
operator or affiliated operator timely submits additional information to the
department, the department shall consider the additional information and issue
a final debt summary report not later than sixty days after the department
issues the revised debt summary report unless the department and exiting
operator or affiliated operator agree to a later date.
Each debt summary report the department issues under
this section shall include the department's findings and the amount of debt the
department determines the exiting operator owes the department and United
States centers for medicare and medicaid services under the medicaid program.
The department shall explain its findings and determination in each debt
summary report.
The exiting operator, and an affiliated operator who
executes a successor liability agreement under section 5124.521 of the Revised
Code, may request, in accordance with Chapter 119. of the Revised Code, an
adjudication regarding a finding in a 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.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities shall
release the actual amount withheld under division (A) of section 5124.521 of
the Revised Code, less any amount the exiting operator owes the department and
United States centers for medicare and medicaid services under the medicaid
program, as follows:
| (A) |
Unless the department issues the initial debt summary
report required by section 5124.525 of the Revised Code not later than sixty
days after the date the exiting operator files the properly completed cost
report required by section 5124.522 of the Revised Code, sixty-one days after
the date the exiting operator files the properly completed cost report; |
| (B) |
If the department issues
the initial debt summary report required by section 5124.525 of the Revised
Code not later than sixty days after the date the exiting operator files a
properly completed cost report required by section 5124.522 of the Revised
Code, not later than the following:
| (1) |
Thirty days after the deadline for requesting an
adjudication under section 5124.525 of the Revised Code regarding the final
debt summary report if the exiting operator, and an affiliated operator who
executes a successor liability agreement under section 5124.521 of the Revised
Code, fail to request the adjudication on or before the deadline; |
| (2) |
Thirty days after the
completion of an adjudication of the final debt summary report if the exiting
operator, or an affiliated operator who executes a successor liability
agreement under section 5124.521 of the Revised Code, requests the adjudication
on or before the deadline for requesting the adjudication. |
|
| (C) |
Unless the department
issues the initial debt summary report required by section 5124.525 of the
Revised Code not later than sixty days after the date the department waives the
cost report requirement of section 5124.522 of the Revised Code, sixty-one days
after the date the department waives the cost report requirement; |
| (D) |
If the department issues
the initial debt summary report required by section 5124.525 of the Revised
Code not later than sixty days after the date the department waives the cost
report requirement of section 5124.522 of the Revised Code, not later than the
following:
| (1) |
Thirty days after the
deadline for requesting an adjudication under section 5124.525 of the Revised
Code regarding the final debt summary report if the exiting operator, and an
affiliated operator who executes a successor liability agreement under section
5124.521 of the Revised Code, fail to request the adjudication on or before the
deadline; |
| (2) |
Thirty days after the
completion of an adjudication of the final debt summary report if the exiting
operator, or an affiliated operator who executes a successor liability
agreement under section 5124.521 of the Revised Code, requests the adjudication
on or before the deadline for requesting the adjudication. |
|
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The department of developmental disabilities, at its
sole discretion, may release the amount withheld under division (A) of section
5124.521 of the Revised Code if the exiting operator submits to the department
written notice of a postponement of a change of operator, facility closure, or
voluntary termination and the transactions leading to the change of operator,
facility closure, or voluntary termination are postponed for at least thirty
days but less than ninety days after the date originally proposed for the
change of operator, facility closure, or voluntary termination as reported in
the written notice required by section 5124.50 or 5124.51 of the Revised Code.
The department shall release the amount withheld if the exiting operator
submits to the department written notice of a cancellation or postponement of a
change of operator, facility closure, or voluntary termination and the
transactions leading to the change of operator, facility closure, or voluntary
termination are canceled or postponed for more than ninety days after the date
originally proposed for the change of operator, facility closure, or voluntary
termination as reported in the written notice required by section 5124.50 or
5124.51 of the Revised Code. A written notice shall be provided to the
department in accordance with the method specified in rules authorized by
section 5124.53 of the Revised Code.
After the department receives a written notice
regarding a cancellation or postponement of a facility closure or voluntary
termination, the exiting operator or owner shall provide new written notice to
the department under section 5124.50 of the Revised Code regarding any
transactions leading to a facility closure or voluntary termination at a future
time. After the department receives a written notice regarding a cancellation
or postponement of a change of operator, the exiting operator or owner and
entering operator shall provide new written notice to the department under
section 5124.51 of the Revised Code regarding any transactions leading to a
change of operator at a future time.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
All amounts withheld under section 5124.521 of the
Revised Code from payment due an exiting operator under the medicaid program
shall be deposited into the medicaid payment withholding fund created by the
controlling board pursuant to section 131.35 of the Revised Code. Money in the
fund shall be used as follows:
| (1) |
To pay an exiting operator when a withholding is
released to the exiting operator under section 5124.526 or 5124.527 of the
Revised Code; |
| (2) |
To pay the department of medicaid or department of
developmental disabilities, and United States centers for medicare and medicaid
services, the amount an exiting operator owes the department of medicaid or
department of developmental disabilities and United States centers under the
medicaid program. |
|
| (B) |
Amounts paid from the medicaid payment withholding
fund pursuant to division (A)(2) of this section shall be deposited into the
appropriate fund. |
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
The director of developmental disabilities shall adopt
rules under section 5124.03 of the Revised Code to implement sections 5124.50
to 5124.53 of the Revised Code. The rules shall specify all of the
following:
| (A) |
The method by which
written notices to the department required by sections 5124.50 to 5124.53 of
the Revised Code are to be provided; |
| (B) |
The forms and documents that are to be provided to the
department under sections 5124.511 and 5124.512 of the Revised Code, which
shall include, in the case of such forms and documents provided by entering
operators, all the fully executed leases, management agreements, merger
agreements and supporting documents, and fully executed sales contracts and any
other supporting documents culminating in the change of operator; |
| (C) |
The method by which the
forms and documents identified in division (B) of this section are to be
provided to the department. |
Amended by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
For the purpose of increasing the number of slots
available for home and community-based services, the operator of an ICF/IID may
convert some or all of the beds in the ICF/IID from providing ICF/IID services
to providing home and community-based services if all of the following
requirements are met:
| (1) |
The
operator provides the directors of health and developmental disabilities at
least ninety days' notice of the operator's intent to make the
conversion. |
| (2) |
The
operator complies with the requirements of sections
5124.50 to
5124.53 of the Revised Code
regarding a voluntary termination if those requirements are
applicable. |
| (3) |
If the
operator intends to convert all of the ICF/IID's beds, the operator notifies
each of the ICF/IID's residents that the ICF/IID is to cease providing ICF/IID
services and inform each resident that the resident may do either of the
following:
| (a) |
Continue
to receive ICF/IID services by transferring to another ICF/IID that is willing
and able to accept the resident if the resident continues to qualify for
ICF/IID services; |
| (b) |
Begin to
receive home and community-based services instead of ICF/IID services from any
provider of home and community-based services that is willing and able to
provide the services to the resident if the resident is eligible for the
services and a slot for the services is available to the
resident. |
|
| (4) |
If the
operator intends to convert some but not all of the ICF/IID's beds, the
operator notifies each of the ICF/IID's residents that the ICF/IID is to
convert some of its beds from providing ICF/IID services to providing home and
community-based services and inform each resident that the resident may do
either of the following:
| (a) |
Continue
to receive ICF/IID services from any ICF/IID that is willing and able to
provide the services to the resident if the resident continues to qualify for
ICF/IID services; |
| (b) |
Begin to
receive home and community-based services instead of ICF/IID services from any
provider of home and community-based services that is willing and able to
provide the services to the resident if the resident is eligible for the
services and a slot for the services is available to the
resident. |
|
| (5) |
The
operator meets the requirements for providing home and community-based
services, including the following:
| (a) |
Such requirements applicable to a residential facility if the operator
maintains the facility's license as a residential facility; |
| (b) |
Such requirements applicable to a facility that is not licensed as a
residential facility if the operator surrenders the facility's license as a
residential facility under section
5123.19 of the Revised
Code. |
|
| (6) |
The
director of developmental disabilities approves the
conversion. |
|
| (B) |
A decision by the director of developmental
disabilities to approve or refuse to approve a proposed conversion of beds is
final. In making a decision, the director shall consider all of the following:
| (1) |
The fiscal impact on the ICF/IID if some but not all of the beds are
converted; |
| (2) |
The
fiscal impact on the medicaid program; |
| (3) |
The availability of home and community-based services. |
|
| (C) |
The notice provided to the directors under
division (A)(1) of this section shall specify whether some or all of the
ICF/IID's beds are to be converted. If some but not all of the beds are to be
converted, the notice shall specify how many of the ICF/IID's beds are to be
converted and how many of the beds are to continue to provide ICF/IID services.
The notice to the director of developmental disabilities shall specify whether
the operator wishes to surrender the ICF/IID's license as a residential
facility under section
5123.19 of the Revised
Code. |
| (D) |
| (1) |
If the
director of developmental disabilities approves a conversion under division (B)
of this section, the director of health shall do the following:
| (a) |
Terminate the ICF/IID's medicaid certification if the notice specifies that all
of the ICF/IID's beds are to be converted; |
| (b) |
Reduce the ICF/IID's medicaid-certified capacity by the number of beds being
converted if the notice specifies that some but not all of the beds are to be
converted. |
|
| (2) |
The director of health shall notify the medicaid
director of the termination or reduction. On receipt of the notice, the
medicaid director shall do the following:
| (a) |
Terminate the operator's medicaid provider agreement that authorizes the
operator to provide ICF/IID services at the ICF/IID if the ICF/IID's
certification was terminated; |
| (b) |
Amend the operator's medicaid provider agreement to reflect the ICF/IID's
reduced medicaid-certified capacity if the ICF/IID's medicaid-certified
capacity is reduced. |
|
| (3) |
The medicaid director is not
required to conduct an adjudication in accordance with
Chapter 119. of the Revised Code when taking action under division (D)(2) of this
section. |
|
Amended by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Renumbered from § 5111.874 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.127, HB 487,
§101.01, eff.
9/10/2012.
Amended by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
Amended by
128th General AssemblyFile No.33, HB 398,
§1, eff.
8/31/2010.
Amended by
128th General AssemblyFile No.9, HB 1,
§101.01, eff.
7/17/2009.
Amended by
128th General Assemblych.9, SB 79,
§1, eff.
10/6/2009.
Effective Date: 2008 HB562
06-24-2008
| (A) |
For the purpose of increasing the number of slots
available for home and community-based services, a person who acquires, through
a request for proposals issued by the director of developmental disabilities,
an ICF/IID for which a residential facility license was previously surrendered
or revoked may convert some or all of the ICF/IID's beds from providing ICF/IID
services to providing home and community-based services if all of the following
requirements are met:
| (1) |
The
person provides the directors of health and developmental disabilities and
medicaid director at least ninety days' notice of the person's intent to make
the conversion. |
| (2) |
The
person complies with the requirements of sections
5124.50 to
5124.53 of the Revised Code
regarding a voluntary termination if those requirements are
applicable. |
| (3) |
If the
person intends to convert all of the ICF/IID's beds, the person notifies each
of the ICF/IID's residents that the ICF/IID is to cease providing ICF/IID
services and informs each resident that the resident may do either of the
following:
| (a) |
Continue
to receive ICF/IID services by transferring to another ICF/IID willing and able
to accept the resident if the resident continues to qualify for ICF/IID
services; |
| (b) |
Begin to
receive home and community-based services instead of ICF/IID services from any
provider of home and community-based services that is willing and able to
provide the services to the resident if the resident is eligible for the
services and a slot for the services is available to the
resident. |
|
| (4) |
If the
person intends to convert some but not all of the ICF/IID's beds, the person
notifies each of the ICF/IID's residents that the ICF/IID is to convert some of
its beds from providing ICF/IID services to providing home and community-based
services and inform each resident that the resident may do either of the
following:
| (a) |
Continue
to receive ICF/IID services from any that is willing and able to provide the
services to the resident if the resident continues to qualify for ICF/IID
services; |
| (b) |
Begin to
receive home and community-based services instead of ICF/IID services from any
provider of home and community-based services that is willing and able to
provide the services to the resident if the resident is eligible for the
services and a slot for the services is available to the
resident. |
|
| (5) |
The
person meets the requirements for providing home and community-based services
at a residential facility. |
|
| (B) |
The notice provided to the directors under
division (A)(1) of this section shall specify whether some or all of the
ICF/IID's beds are to be converted. If some but not all of the beds are to be
converted, the notice shall specify how many of the ICF/IID's beds are to be
converted and how many of the beds are to continue to provide ICF/IID
services. |
| (C) |
On receipt of a notice under division (A)(1) of
this section, the director of health shall do the following:
| (1) |
Terminate the ICF/IID's medicaid certification if the notice specifies that all
of the facility's beds are to be converted; |
| (2) |
Reduce the ICF/IID's medicaid-certified capacity by the number of beds being
converted if the notice specifies that some but not all of the beds are to be
converted. |
|
| (D) |
The director of health shall notify the medicaid
director of the termination or reduction under division (C) of this section. On
receipt of the director of health's notice, the medicaid director shall do the
following:
| (1) |
Terminate the person's medicaid provider agreement that authorizes the person
to provide ICF/IID services at the ICF/IID if the ICF/IID's medicaid
certification was terminated; |
| (2) |
Amend the person's medicaid provider agreement to reflect the ICF/IID's reduced
medicaid-certified capacity if the ICF/IID's medicaid-certified capacity is
reduced. The
medicaid
director is not required to conduct an adjudication in
accordance with Chapter 119. of the Revised Code
when taking
action under division (D)(1) or (2) of this
section.
|
|
Amended by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Renumbered from § 5111.875 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
128th General AssemblyFile No.33, HB 398,
§1, eff.
8/31/2010.
Amended by
128th General AssemblyFile No.9, HB 1,
§101.01, eff.
7/17/2009.
Amended by
128th General Assemblych.9, SB 79,
§1, eff.
10/6/2009.
Effective Date: 2008 HB562
06-24-2008
The director of developmental
disabilities may request that the medicaid director seek the approval of the
United States secretary of health and human services to increase the number of
slots available for home and community-based services by a number not exceeding
the number of beds that were part of the licensed capacity of a residential
facility that had its license revoked or surrendered under section 5123.19 of
the Revised Code if the residential facility was an ICF/IID at the time of the
license revocation or surrender. The request may include beds the director of developmental
disabilities removed from such a residential facility's licensed capacity
before transferring ownership or operation of the residential facility pursuant
to a request for proposals.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Renumbered from § 5111.876 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
128th General Assemblych.9, SB 79,
§1, eff.
10/6/2009.
Effective Date: 2008 HB562
06-24-2008
Repealed by
130th General Assembly File No. TBD, HB 483, §105.01, eff.
9/15/2014.
Renumbered from § 5111.877 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.127, HB 487,
§101.01, eff.
9/10/2012.
Amended by
129th General AssemblyFile No.28, HB 153,
§101.01, eff.
9/29/2011.
Effective Date: 2008 HB562
06-24-2008
Repealed by
130th General Assembly File No. TBD, HB 483, §105.01, eff.
9/15/2014.
Renumbered from § 5111.878 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Amended by
129th General AssemblyFile No.127, HB 487,
§101.01, eff.
9/10/2012.
Effective Date: 2008 HB562
06-24-2008
No person or
government entity may reconvert a bed to be used for ICF/IID
services if the bed was converted to use for home and community-based services
under section 5124.60 or 5124.61 of
the Revised Code. This prohibition applies regardless of either of the
following:
| (A) |
The bed is part of the licensed capacity of a
residential facility. |
| (B) |
The bed has been sold, leased, or otherwise transferred to another person or
government entity. |
Renumbered from § 5111.879 by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
Effective Date: 2008 HB562
06-24-2008
Amended by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
Amended by
130th General Assembly File No. TBD, HB 483, §101.01, eff.
9/15/2014.
Repealed by
130th General Assembly File No. 25, HB 59, §125.11.03, eff.
7/1/2018.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.
| (A) |
| (1) |
Except as provided in division (D) of this section, an ICF/IID
with a medicaid-certified capacity exceeding eight
shall not admit an individual as a resident unless all of the following apply:
| (a) |
The
provider of the ICF/IID provides written notice about the individual's
potential admission, and all information about the individual in the provider's
possession, to the county board of developmental disabilities serving the
county in which the individual resides at the time the notice is
provided. |
| (b) |
The county
board has provided to the individual and department of developmental
disabilities a copy of the findings the county board makes pursuant to division
(B) of this section; |
| (c) |
Not later
than seven business days after the provider provides the county board the
notice required by division (A)(1)(a) of this section, the department
determines that the individual chooses to receive ICF/IID services from the
ICF/IID after being fully informed of all available alternatives. |
|
| (2) |
For the
purpose of division (A)(1)(a) of this section, the provider of an ICF/IID
with a medicaid-certified capacity exceeding eight may
provide a county board written notices about multiple individuals' potential
admissions to the ICF/IID at the same time. |
|
| (B) |
Not
later than five business days after a county board receives notice from the
provider of an ICF/IID with a medicaid-certified capacity exceeding
eight about an individual seeking admission to the ICF/IID, the county
board shall do both of the following:
| (1) |
Using the information included in the notification and the additional
information, if any, the department specifies pursuant to division (C) of this
section, evaluate the individual and counsel the individual about both of the
following:
| (a) |
The nature,
extent, and timing of the services that the individual needs; |
| (b) |
The
least restrictive environment in which the individual could receive the needed
services. |
|
| (2) |
Using the
form prescribed under division (C) of this section, make findings about the
individual based on the evaluation and counseling and provide a copy of the
findings to the individual and the department. |
|
| (C) |
The
department shall prescribe the form to be used for the purpose of making
findings pursuant to division (B)(2) of this section. The department may
specify additional information that a county board is to use when evaluating
and counseling individuals under division (B)(1) of this section. |
| (D) |
Division (A) of this section does not apply to an individual seeking admission
to an ICF/IID with a medicaid-certified capacity exceeding
eight if any of the following is the case:
| (1) |
The
individual is a medicaid recipient receiving ICF/IID services on the date
immediately preceding the date the individual is admitted to the
ICF/IID. |
| (2) |
The
individual is a medicaid recipient returning to the ICF/IID following a
temporary absence for which the ICF/IID is paid to reserve a bed for the
individual pursuant to section
5124.34
of the Revised Code or during which the individual received rehabilitation
services in another health care setting. |
| (3) |
The
requirements of divisions (A)(1)(a) and (b) of this section are satisfied but
the department fails to make the determination required by division (A)(1)(c)
of this section before the deadline specified in that division. |
|
Amended by
132nd General Assembly File No. TBD, HB 24, §1,
eff. 7/1/2018.
Added by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
| (A) |
The department of
developmental disabilities shall develop and make available to all ICFs/IID a
written pamphlet that describes all of the items and services covered by
medicaid as ICF/IID services and as home and community-based services. The
department shall develop the pamphlet in consultation with persons and
organizations interested in matters pertaining to individuals eligible for
ICF/IID services and home and community-based services. |
| (B) |
Each ICF/IID provider
shall provide the pamphlet to the residents of the ICF/IID who receive ICF/IID
services, and the guardians of such residents, and shall discuss the items and
services described in the pamphlet with those residents and their guardians, as
follows:
| (2) |
Any time such a resident,
or resident's guardian, requests to receive the pamphlet and to discuss the
items and services described in the pamphlet; |
| (3) |
Any time such a resident,
or resident's guardian, expresses to the provider an interest in home and
community-based services. |
|
| (C) |
If a resident of an
ICF/IID who receives ICF/IID services, or the resident's guardian, indicates to
the ICF/IID provider an interest in enrolling the resident in a medicaid waiver
component providing home and community-based services, the provider shall refer
the resident or guardian to the county board of developmental disabilities
serving the county in which the resident would reside while enrolled in a
medicaid waiver component. |
| (D) |
Not later than thirty
days after a county board is contacted by an ICF/IID resident or resident's
guardian who was referred to the county board pursuant to division (C) of this
section, the county board, notwithstanding a waiting list for the component
established pursuant to section
5126.042 of the Revised Code,
shall enroll the resident in the component if all of the following apply:
| (1) |
The resident is eligible
and chooses to enroll in the component. |
| (2) |
The component has an
available slot. |
| (3) |
The director of
developmental disabilities determines that the department has the funds
necessary to pay the nonfederal share of the medicaid expenditures for the home
and community-based services provided to the resident under the
component. |
|
Added by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
| (A) |
This section does not
apply to either of the following:
| (1) |
An ICF/IID to which both
of the following apply:
| (a) |
On or before January 1,
2015, the ICF/IID became a downsized ICF/IID or partially converted
ICF/IID. |
| (b) |
On January 1, 2015, the
ICF/IID's medicaid-certified capacity was at least twenty per cent less than
the greatest medicaid-certified capacity it had before it became a downsized
ICF/IID or partially converted ICF/IID. |
|
| (2) |
An ICF/IID's sleeping
room in which more than two residents reside if both of the following
apply:
| (a) |
All of the residents of
the sleeping room are under twenty-one years of age. |
| (b) |
The parents or guardians
of all of the residents of the sleeping room consent to the residents residing
in a sleeping room with more than two residents. |
|
|
| (B) |
Except as provided in
divisions (G) and (H) of this section, an ICF/IID provider shall not permit
more than two residents to reside in the same sleeping room. |
| (C) |
| (1) |
If, on the effective date of this section, more than
two residents of an ICF/IID reside in the same sleeping room, the ICF/IID
provider shall submit to the department of developmental disabilities for its
review a plan to come into compliance with division (B) of this section. The
provider shall submit the plan not later than December 31, 2015. |
| (2) |
The plan shall include
all of the following:
| (a) |
The date by which not
more than two residents will reside in the same sleeping room, which shall be
not later than June 30, 2025; |
| (b) |
Detailed descriptions of
the actions the ICF/IID provider will take to come into compliance with
division (B) of this section, which shall include becoming either a downsized
ICF/IID or a partially converted ICF/IID; |
| (c) |
The ICF/IID's projected
medicaid-certified capacity for each year covered by the plan, which must
demonstrate that the provider will make regular progress toward coming into
compliance with division (B) of this section; |
| (d) |
A discharge planning
process that includes providing information to residents regarding home and
community-based services; |
| (e) |
Additional interim steps
the provider will take to demonstrate that the provider is making regular
progress toward coming into compliance with division (B) of this section. |
|
| (3) |
The plan shall not
include the creation of a new ICF/IID that has a medicaid-certified capacity
that is greater than six unless the department determines that a new ICF/IID
would need a larger medicaid-certified capacity to be financially viable. If
the department determines that a new ICF/IID would need a larger
medicaid-certified capacity to be financially viable, the plan may include the
creation of a new ICF/IID that has a medicaid-certified capacity that is
greater than six but not greater than eight. |
|
| (D) |
The department shall
review each plan submitted under division (C) of this section and decide
whether to approve the plan. In making this decision, the department shall
consider both of the following:
| (1) |
Whether the plan conforms
to the requirements of division (C) of this section; |
| (2) |
The feasibility of
completing the implementation as described in the plan. |
|
| (E) |
If the department
approves an ICF/IID provider's plan under division (D) of this section, the
provider shall submit to the department annual reports regarding the plan's
implementation. |
| (F) |
The department may issue
a written order to an ICF/IID provider that suspends new admissions to the
ICF/IID if both of the following apply:
| (1) |
The department has
approved the provider's plan under division (D) of this section. |
| (2) |
The provider fails to do
either of the following:
| (a) |
Submit to the department
an annual report required by division (E) of this section; |
| (b) |
Meet, to the department's
satisfaction, the projected medicaid-certified capacity for the ICF/IID for a
year as specified in the plan and the failure is due to factors within the
provider's control. |
|
|
| (G) |
| (1) |
Before January 1, 2016, an ICF/IID provider may permit
more than two residents to reside in the same sleeping room if more than two
residents resided in the same sleeping room on the effective date of this
section. |
| (2) |
On and after January 1,
2016, an ICF/IID provider may permit more than two residents to reside in the
same sleeping room only if all of the following apply:
| (a) |
More than two residents
resided in the same sleeping room on the effective date of this section. |
| (b) |
The provider has
submitted a plan in accordance with division (C) of this section. |
| (c) |
Either of the following
applies:
| (i) |
The department has
approved and the provider complies with the plan. |
| (ii) |
The department has not
decided whether to approve the plan. |
|
|
|
| (H) |
The department shall
waive application of division (B) of this section for an ICF/IID's sleeping
room in which more than two residents reside on June 30, 2025, if both of the
following apply:
| (1) |
The same residents have
continuously resided in the sleeping room since the effective date of this
section; |
| (2) |
The department determines
that at least three of these residents want to continue to reside together in
the sleeping room. |
|
Added by
131st General Assembly File No. TBD, HB 64, §101.01, eff.
9/29/2015.
Whoever violates section 5124.102 or division (E) of
section 5124.08 of the Revised Code shall be fined not less than five hundred
dollars nor more than one thousand dollars for the first offense and not less
than one thousand dollars nor more than five thousand dollars for each
subsequent offense.
Fines paid under this section shall be deposited in the
state treasury to the credit of the general revenue fund.
Added by
130th General Assembly File No. 25, HB 59, §101.01, eff.
9/29/2013.