Current through all regulations passed and filed through September 16, 2024
(A) Applicability.
The requirements of this rule apply as long as the United
States centers for medicare and medicaid services (CMS) determines that the
assessment imposed under section
5168.06 of the Revised Code is a
permissible health care related tax. Whenever the department of medicaid is
informed that the assessment is an impermissible health care-related tax, the
department shall promptly refund to each hospital the amount of money currently
in the hospital care assurance match fund that has been paid by the hospital,
plus any investment earnings on that amount.
(B)
Definitions
(1)
"Program year" -
The period beginning the first day of October of a calendar year and ending on
the thirtieth day of September of the following calendar year.
(2)
"Current program
year" - The program year beginning the first day of October of the most recent
calendar year and ending on the thirtieth day of September the following
calendar year.
(3)
"Past program year" - Any program year beginning the
first day of October in a calendar year preceding the current program year and
ending the thirtieth day of September the following calendar year.
(C) The program years
to which this rule applies are identified in paragraphs
(C)(1) to
(C)(3) of
this rule. When the department is notified by the CMS that an additional disproportionate share allotment
is available for a
past program year, the department may amend the
assessment rates for the
past program year.
(1) The assessment rates applicable to the
current program year are specified in
paragraph (D) of this rule.
(2) The assessment rates applicable to the
past program year when
federal allotment is increased
are specified in paragraph (E)(1) of this rule.
(3) The revised assessment rates applicable
to the past program year
when federal allotment is decreased are specified
in paragraph (E)(2) of this
rule.
(D) Calculation of
assessment amounts.
The calculations described in this rule will be based on
the cost-reporting data described in rule
5160-2-23 of the Administrative
Code that reflect the most recently completed interim settled medicaid cost
report for all hospitals. For non-medicaid participating hospitals, the
calculations shall be based on the most recent as-filed medicare cost
report.
The assessment is calculated as follows:
(1) Determine each hospital's adjusted total
facility costs as the amount calculated in paragraph (A)(17) of rule
5160-2-08 of the Administrative
Code.
(2) For hospitals with
adjusted total facility costs, as described in paragraph
(D)(1) of
this rule, that are less than or equal to $216,372,500, multiply the hospital's
adjusted total facility costs as described in paragraph
(D)(1) of
this rule by one and one half per cent. The product will be each
hospital's assessment amount. For hospitals with adjusted total facility costs,
as described in paragraph (D)(1) of this rule, that are greater than
$216,372,500, multiply a factor of
one and one
half per cent times the hospital's adjusted total facility costs as
described in paragraph (D)(1) of this rule, up to $216,372,500. Multiply a
factor of
one per cent times the hospital's adjusted total
facility costs as described in paragraph (D)(1) of this
rule, that are in excess of $216,372,500. The sum of the two products will be
each hospital's assessment amount.
(3) The assessment amounts calculated in
paragraph (D)(2) of this rule are subject to adjustment under
the provisions of paragraph (G) of this rule.
(4)
The department
may establish a rate lower than the rates described in paragraph (D)(2) of this
rule based on the assessment necessary to maximize the disproportionate share
allotment for the current program year.
(E)
Federal allotment adjustment.
(1)
For past program years in
which the federal disproportionate share allotment has increased, the
department shall recalculate the assessment rate for that program year and
notify each hospital via rate letter of the additional amount to be paid by the
hospital to collect the state share necessary to expend the additional
allotment. The adjusted assessment rate described in this paragraph will be
calculated in accordance with paragraph (D) of this rule. The assessment
collected will then be matched with federal funds and distributed to hospitals
based upon the distribution model for the applicable past program year.
Notwithstanding paragraph (D)(3) of this rule, the provisions outlined in
paragraph (G)(2) of this rule are not applicable to any past program
year.
(2)
When the
department is notified by the CMS of a decrease in the federal disproportionate
share allotment for a past program year, the department shall recalculate the
distribution for that program year and notify each hospital via recoupment
letter of the amount to be recouped. Of the total amount recouped, the portion
that was funded with federal funding shall be returned to the CMS. The portion
of the recoupment that is state funds shall be applied toward the required
assessment for a future program year. Notwithstanding paragraph (D)(3) of this
rule, the provisions outlined in paragraph (G)(2) of this rule are not
applicable to any past program year.
(F) Determination of intergovernmental
transfer amounts.
The department may require governmental hospitals, as described
in paragraph (A)(2) of rule
5160-2-08 of the Administrative
Code, to make intergovernmental transfers each program year.
The department shall notify each governmental hospital of the
amount of the intergovernmental transfer it is required to make during the
program year.
Each governmental hospital shall make intergovernmental
transfers in periodic installments, executed by electronic funds
transfer.
(G) Notification
and reconsideration procedures.
(1) The
department shall mail by certified mail, return receipt requested, the results
of the determinations made under paragraphs (D) and
(E) of
this rule to each hospital. If no hospital submits a request for
reconsideration as described in paragraph (G)(2) of this rule, the preliminary
determinations constitute the final reconciliation of the amounts that each
hospital must pay under this rule.
(2) Not later than fourteen days after the
department mails the preliminary determinations as described in paragraphs
(D) and
(E) of
this rule, any hospital may submit to the department a written request for
reconsideration of the preliminary determination made under paragraphs
(D) and
(E) of
this rule. The request must be accompanied by written materials setting forth
the basis for the reconsideration.
If one or more hospitals submit such a request, the department
shall hold a public hearing in Columbus, Ohio not later than thirty days after
the preliminary determinations have been mailed by the department for the
purpose of reconsidering its preliminary determinations. The department shall
mail written notice of the date, time, and place of the hearing to every
hospital at least ten days before the date of the hearing.
On the basis of the evidence submitted to the department or
presented at the public hearing, the department shall reconsider and may adjust
the preliminary determinations. The result of the reconsideration is the final
reconciliation of the amounts that each hospital must pay under the provisions
of this rule.
(3) The
department shall mail each hospital written notice of the amount it must pay
under the final reconciliation as soon as practical. Any hospital may appeal
the amount it must pay to the court of common pleas of Franklin
county.
(4) In the course of any
program year, the department may adjust the assessment rate defined in
paragraphs (D) and (E) of this rule or adjust the amount of the
intergovernmental transfers required under paragraph (F) of this rule, and, as
a result of the adjustment, adjust each hospital's assessment and
intergovernmental transfer, to reflect refinements made by the CMS during that
program year.
