Current through all regulations passed and filed through September 16, 2024
(A) For cost-reporting purposes,
each eligible
provider, as defined in rule
5160-2-01 of the Administrative
Code, is to submit periodic reports that
generally cover a consecutive twelve-month period of the provider's operations.
Failure to submit all necessary items and schedules will delay processing and
may result in a reduction of payment or termination as a provider as described
in paragraph (A)(7) of this rule.
Any hospital that fails to submit cost reports on or
before the dates specified by the department of medicaid (ODM)
will be
fined one thousand dollars for each day after the due date that the information
is not reported.
The hospital is to complete and submit the ODM 02930 "Ohio Medicaid
Hospital Cost Report" that is applicable to the state fiscal year in which the
hospital's cost reporting period ends. The hospital's cost report
is
to:
(1) Be prepared in
accordance with medicare principles governing reasonable cost reimbursement set
forth in the providers' reimbursement manual "CMS Publications, 15-1 and 15-2",
as applicable to the hospital's reporting period.
(2) Include all information necessary for the
proper determination of costs payable under medicaid, including financial
records and statistical data.
(3)
Be submitted in accordance with the cost report instructions and include an
electronic copy of the medicare cost report, which is to be
identical in all respects to the cost report submitted to the medicare fiscal
intermediary.
(4) Include the cost
report certification executed by an officer of the hospital attesting to the
accuracy of the cost report and to the accuracy of the
Omnibus Budget
Reconciliation Act (OBRA) survey. In addition, all subsequent revisions
to the cost report are to include an executed certification.
(5)
The executed certification is to
include an
acknowledgement by the officer of the hospital that an independent, certified
public accountant has successfully
verified the data reported on "Schedule F" of the cost report in accordance
with the procedures included in the cost report instructions. In addition, all
subsequent revisions to "Schedule F" are also
to be successfully verified by an independent,
certified public accountant in accordance with the recertification procedures
included in the cost report instructions.
(6) For hospital reporting periods ending
between January first and June thirtieth the cost report
is to be
postmarked on or before December thirty-first of the same calendar year. For
hospital reporting periods ending between July first and December thirty-first,
the cost report is to be postmarked on or before June thirtieth of the
following calendar year.
(a) Extensions may be
granted as specified in the cost report instructions.
(b) The department may grant a blanket
extension that affects one or both of the due dates described in paragraph
(A)(6) of this rule. When the department grants a blanket extension, hospitals
may still request an extension as specified in paragraph (A)(6)(a) of this
rule.
(7) Hospitals that
fail to submit cost reports timely as described in paragraph (A) of this rule
will receive a delinquency letter from ODM and are subject to notification that
thirty days following the date on which the cost report was due, payments for
hospital services will be suspended. Suspension of payments will be terminated
on the fifth working day following receipt of the delinquent cost report. At
the beginning of the third month following the month in which the hospital cost
report became overdue, if the cost report has not yet been submitted,
termination of the provider from the program will be proposed in accordance
with Chapter 5160-1 of the Administrative Code.
(8) Hospitals are to
separately report all supplemental payments received for services provided
during the cost report period, including;
(a)
"Medicaid Managed
Care Incentive Payments," as established by Section 309.30.33 of Amended
Substitute House Bill 153 of the 129th General Assembly, and continued as a
baseline program, and
(b)
"Hospital Additional Payments," as established by
Section 16 of Amended Substitute Senate Bill 310 of the 133rd General Assembly
and continued in Section 333.45 of Amended Substitute House Bill 110 of the
134th General Assembly.
(B) Hospitals having a distinct part
psychiatric or rehabilitation unit recognized by medicare in accordance with
the provisions of 42 C.F.R.
412.25 effective as of October 1,2022,
42 C.F.R.
412.27 effective as of October 1,
2022, and
42 C.F.R.
412.29 effective as of October 1,
2022,
are to
identify distinct part unit costs separately within the cost report as
described in paragraph (A) of this rule.
(C) Ohio hospitals performing ambulatory
surgery within the hospital outpatient setting are to identify
ambulatory surgery costs and charges separately within the cost report as
described in paragraph (A) of this rule.
(D) Ohio hospitals providing services to
medicaid managed care entities (MCE) enrollees are to identify
MCE costs,
charges and payments separately within the cost report as described in
paragraph (A) of this rule.
(E) It
is not necessary for the hospital to wait for the medicare (Title XVIII) audit
in order to file the initial cost report for the stated time period. The
interim cost report filing can be audited by ODM prior to any applicable final
adjustment and settlement. If an amount is due ODM as a result of the filing,
payment is
to be forwarded, in accordance with the cost report instructions, at the
time the cost report is submitted for it to be considered a complete filing.
Any revised interim cost report is to be received within thirty days of the mailing of
the interim cost settlement. A desk audit will be performed by the hospital
cost report review and audit section on all as
filed and interim cost reports. An interim cost settlement by ODM does not
preclude the finding of additional cost exceptions in a final settlement for
the same cost-reporting period.
(1) If an
amended medicare cost report is filed with the medicare fiscal intermediary, a
copy of the amended medicare cost report is to be filed
with the hospital audit section. Information contained in the amended medicare
cost report will be incorporated into the interim cost report, as originally
filed, if received prior to interim settlement; otherwise, it is subject to the
provisions of paragraph (E) of this rule.
(2) Adjustments may be made to the interim
cost report as described in rule
5160-2-24 of the Administrative
Code.
(F) Out-of-state
hospitals that are paid on a non-diagnostic related
groups (DRG) prospective payment basis as described in rule
5160-2-22 of the Administrative
Code and provide either inpatient
or
outpatient services, or both, to eligible Ohio
medicaid recipients will be assigned a cost-to-charge ratio as
described in rule
5160-2-22 of the Administrative
Code.
