Ohio Revised Code Search

... 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/IID 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 a...

...es. 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 fed...

...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.

...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.

...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.

...eement 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 pro...

...An ICF/IID operator may enter into provider agreements for more than one ICF/IID.

...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.

...ID) 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 a...

... 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 affirmativ...

...st 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 ...

...ized 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 ful...

... of the Revised Code in a cost report filed under section 5124.10, 5124.101, or 5124.522 of the Revised Code.

...be completed using the form prescribed under section 5124.104 of the Revised Code and in accordance with the guidelines established under that section.

...sed 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.

...able rate established in rules adopted under section 5124.03 of the Revised Code for the period that the rate excluded the costs.

...e 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 prov...

...partment 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 ...

...f 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 veri...

... 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 bel...

...rt year; (c) For state fiscal year 2026, a professional workforce development payment equal to ten and four hundred five thousandths per cent of the ICF/IID's desk-reviewed, actual, allowable, per medicaid day direct care costs from the applicable cost report year. (B) The department shall adjust the total per medicaid day payment rate otherwise determined for an ICF/IID under this section as directed by the ge...

...ew 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. (...

...nce 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 au...

...r 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 ser...

...mental centers according to the reasonable cost principles of Title XVIII.