Ohio Revised Code Search

...n 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 act...

...(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 whi...

...(A) The provider of an ICF/IID in peer group 1, peer group 2, peer group 3, or peer group 4 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 c...

...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.

...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.

...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 ...

...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 re...

...al 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 ...

...(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 ...

...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 deter...

... 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...

...vised 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 of the following: (a) The per medicaid day quality incentive payment determined for the ICF/IID under section 5124.24 of t...

...on. (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 ...

...(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 th...

...(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...

...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.

...(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) ...

...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.

...ed 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 ...

...(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 re...

...(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...

...(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 me...

...termine 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...

...(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 (A) of this section, the index that is subsequently published by the bureau and covers nonprescription drugs and medical supplies.

... 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 this act . (C) An ICF/IID's per medicaid day quality incentive payment for a fiscal yea...