Ohio Revised Code Search

...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.

... form, to each provider at least sixty days before the date the cost report is due; (C) Establish guidelines for completing the form.

...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...

...he 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 ...

...(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...

...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...

...f 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 b...

...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...

...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 I...

... 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.

...ollowing: (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 and is a down...

...rt 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, is the following percentage above the peer group's median cost per case-mix unit for that fiscal year: (a) For peer group 1, sixteen per cent; ...

... 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 resid...

...(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...

... 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 divi...

...(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...

...eer 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, eight per cent; (b) For ICFs/IID in peer group 2 or peer group 3, ten per cent; (c) For ICFs/IID in peer group 4 or peer group 5, twelve per cent. (2) The department shall not redetermine a peer group's maximum rate under division (C)(1) ...

...l 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 pub...

...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...

...(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 d...

...(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'...

...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.