Current through all regulations passed and filed through September 16, 2024
(A) Pursuant to section
5162.363
of the Revised Code, the purpose of this rule is to establish a process by
which qualified medicaid school providers participating in the medicaid school
component of the medicaid program pay to the department of education the
nonfederal share of the department's expenses incurred administering the
component.
(B) As used in this
rule, the following definitions apply:
(1)
"Medicaid school component of the Medicaid program" means the program
established pursuant to sections
5162.36
to
5162.364
of the Revised Code;
(2) "Provider"
means a qualified medicaid school provider as defined in section
5162.36
of the Revised Code;
(3)
"Department" means the Ohio department of education;
(4) "Administering office" means the office
within the department assigned the duty of administering the department's
responsibilities related to the medicaid program;
(5) "Administering costs" means the costs
incurred by the department in carrying out its administrative responsibilities
related to the medicaid school component of the medicaid program. Such costs
include, but shall not be limited to, personnel, contracted services, costs
expected to be paid to the Ohio department of medicaid pursuant to
the interagency agreement entered into pursuant to section
5162.363
of the Revised Code, and other appropriate indirect costs; and
(6) "State education aid" has the same
meaning as defined in section
5751.20
of the Revised Code.
(C)
The administering office shall compute the following for each fiscal year
during which the medicaid school component is in operation:
(1) An estimate of the total administrative
costs for the fiscal year, developed pursuant to this paragraph, which may be
revised from time to time as determined by the administering office. Amounts to
ensure sufficient cash flow may be included in this estimate;
(2) An estimate of the federal share of
funding to be reimbursed to the department from the department of medicaid for
administrative costs for the fiscal year;
(3) In consultation with the department of
medicaid, a numeric value for each provider, reflective of the proportion that
each provider's estimated paid claims represents, of the estimated total of all
paid claims to all providers for the fiscal year;
(4) An estimate of the amount to be collected
from each provider for administrative costs by subtracting the amount computed
pursuant to paragraph (C)(2) of this rule from the amount computed pursuant to
paragraph (C)(1) of this rule and multiplying the resulting value by the
numeric value developed for each provider pursuant to paragraph (C)(3) of this
rule. The results of these computations shall be published on the department's
website, and should specify for each provider the estimate of the annual amount
computed to be collected and the schedule, frequency, and proportion by which
such amounts shall be calculated; and
(5) After the close of each fiscal year, the
following shall be computed by the administering office:
(a) The department's actual administrative
costs;
(b) The actual federal share
of funding reimbursed to the department;
(c) The actual federal share of funding
reimbursed to each provider, and for the program as a whole, and a numerical
value for each provider reflective of the actual proportion of each provider's
actual paid claims to the actual total of all paid claims for the fiscal
year;
(d) The amount each provider
would have actually contributed toward the administrative costs by subtracting
the amount computed in paragraph (C)(5)(b) of this rule from the amount
computed in paragraph (C)(5)(a) of this rule and multiplying the resulting
value by the numeric value developed for each provider in paragraph (C)(5)(c)
of this rule.
(e) The difference
between the actual amount each provider should have contributed as computed in
paragraph (C)(5)(d) of this rule and the amount estimated and actually
collected pursuant to paragraph (C)(4) and paragraph (D) of this rule. The
results of this computation shall be published on the department's website and
disseminated to providers.
(D) Pursuant to a schedule published on the
department's website and proportions determined by the administering office,
the estimated amount to be collected from each provider as determined pursuant
to paragraph (C)(4) of this rule shall be collected in the following manner:
(1) In the case of a city, exempted village,
or local school district, the amount shall be deducted from the state education
aid calculated for the district, and, if necessary, from the payment made to
the district under sections
321.24
and
323.156
of the Revised Code;
(2) In the
case of a community school, the amount shall be deducted from the payment made
to the school pursuant to division (D) of section
3314.08
of the Revised Code; and
(3) In the
case of the state school for the blind or the state school for the deaf, the
amount shall be collected by the submission of an intrastate transfer voucher
for the amount owed to the respective entity.
(E) Upon the computation of amounts pursuant
to paragraph (C)(5)(e) of this rule, if the computation is a positive value,
additional collections shall be made in the manner specified in paragraphs
(D)(1) to (D)(3) of this rule. If the amount is a negative value, amounts shall
be repaid to the provider in a manner determined by the administering office
and communicated to the effected providers.
