Ohio Revised Code Search

...epartment 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 t...

...ider 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 sectio...

...uracy 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...

... 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 r...

...ed, 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 c...

...ode; (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) The sum o...

...(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'...

...e 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 section 5124.191 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 provi...

... 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 IC...

...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.

...t 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 f...

... each ICF/IID's per medicaid day direct care costs component rate. An ICF/IID'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 ...

...ent'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/IID 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 5124.0...

...ent 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 ski...

...ing: (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...

...d 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.

...ach 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 fo...

...t 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 nonprescriptio...

...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 e...

...artment 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 th...

...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...

...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 n...

...Except as provided in section 5124.17 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.

... 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.

...ce 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.