Rule 5160-3-24 | Nursing facilities (NFs): prospective rate reconsideration for possible calculation errors.
(A) A nursing facility provider, or a group or association of nursing facility providers, may request a reconsideration of a prospective NF rate on the basis of a possible error in the calculation of the rate as follows:
(1) A request for reconsideration shall be filed with the Ohio department of medicaid (ODM) no more than thirty days after the later of the date on the rate setting package notification or the effective date of the rate.
(2) The request for a reconsideration shall be filed in accordance with the following procedures:
(a) The request for rate reconsideration shall be in writing; and
(b) The request shall be addressed to "Ohio Department of Medicaid, Fiscal Operations - LTC Rate Methodology Unit, P.O. Box 182709, Columbus, Ohio 43215-3414"; and
(c) The request shall indicate that it is a request for rate reconsideration due to a possible error in the calculation of the rate; and
(d) The request shall include a detailed explanation of the possible error and the proposed corrected calculation; and
(e) The request shall include references to the relevant sections of the Revised Code or paragraphs of the Administrative Code as appropriate.
(3) ODM shall respond in writing within sixty days of receiving each written request for reconsideration. If ODM requests additional information to determine whether a rate adjustment is warranted, the NF shall respond in writing and shall provide additional supporting documentation no more than thirty days after the receipt of the request for additional information. ODM shall respond in writing within sixty days of receiving the additional information to the request for reconsideration.
(4) If a rate adjustment is warranted as the result of a reconsideration of a prospective rate, the adjustment shall be implemented retroactively to the initial service date for which the rate is effective.
(B) ODM's decision at the conclusion of the rate reconsideration process is final and shall not be subject to any administrative proceedings under Chapter 119. or any other provision of the Revised Code or Administrative Code.
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