Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-2 - Hospital Services
Section 5160-2-67 - Medical education
Universal Citation: OH Admin Code 5160-2-67
Current through all regulations passed and filed through September 16, 2024
Effective for dates of discharge on or after the effective date of this rule, to qualify for a medical education payment as described in this rule, Ohio hospitals must have an approved medical education program as defined in 42 C.F.R. 415.152 (October 1, 2016) and the costs of the approved medical education program were reflected in their state fiscal year (SFY) 2014 Ohio medicaid hospital cost report (ODM 02930 rev. 6/2014). This rule describes the methodology used for computing the direct graduate medical education and indirect medical education components of each hospital's medical education add-on rate.
(A) Computation of direct graduate medical education (DGME) costs, which are the costs that are directly related to the training of interns and residents and allied professionals in an approved medical education program.
(1) Tabulate the
costs captured on the ODM 02930 for interns and residents
and allied professionals.
(2)
Tabulate the total facility charges and total medicaid fee-for-service and
managed care charges reported on the ODM 02930. Calculate the medicaid factor
by dividing the sum of total medicaid fee-for-service and managed care charges
by total charges.
(3) Tabulate the
total medicaid fee-for-service and managed care discharges from the ODM
02930.
(4) The medicaid portion of
DGME costs equal the total DGME costs as described in paragraph (A)(1) of this
rule multiplied by the medicaid factor as described in paragraph (A)(2) of this
rule.
(5) A cost per discharge is
computed using the medicaid portion of DGME costs as described in paragraph
(A)(4) of this rule divided by the total number of medicaid discharges as
described in paragraph (A)(3) of this rule.
(B) Computation of indirect medical education (IME) costs, which are the costs that recognize the increased costs of patient care that results from operating an approved medical education program.
(1) Identify the number of interns and
residents and number of beds reported on the ODM 02930.
(2) Compute the IME factor by using the
logarithmic formula 1.35 * ((1+((interns and residents)/beds)^ 0.405
)-1).
(3) Tabulate the total
medicaid fee-for-service and managed care net operating costs reported on the
ODM 02930.
(4) The medicaid portion
of IME is the medicaid net operating costs as described in paragraph (B)(3) of
this rule multiplied by the IME factor as described in paragraph (B)(2) of this
rule.
(5) A cost per discharge is
computed using the medicaid portion of IME costs as described in paragraph
(B)(4) of this rule divided by the total number of medicaid discharges as
described in paragraph (A)(3) of this rule.
(a) The IME cost per discharge is capped. The
capped value is the statewide mean IME cost per discharge plus one standard
deviation.
(b) If the hospital's
IME cost per discharge is greater than the capped IME cost per discharge as
described in paragraph (B)(5)(a) of this rule, then the hospital's IME cost per
discharge is equal to the capped IME cost per discharge as described in
paragraph (B)(5)(a) of this rule.
(C) Case-mix adjustment of medical education add-on rate.
(1) The case-mix score for each
hospital equals the sum of the relative weight values for all SFY 2014
discharges divided by the total number of medicaid discharges as described in
paragraph (A)(3) of this rule.
(2)
Sum the DGME cost per discharge as described in paragraph (A)(5) of this rule
and the IME cost per discharge as described in paragraph (B)(5) of this
rule.
(3) Divide the sum of the
DGME cost per discharge and IME cost per discharge as described in paragraph
(C)(2) of this rule by the case-mix score as described in paragraph (C)(1) of
this rule. The resulting value is the hospital's total medical education add-on
rate.
(4) The hospital's total
medical education add-on rate as described in paragraph (C)(3) of this rule
shall be subject to a payment neutrality adjustment of fifty-nine and
seven-tenths per cent .
(D) Medical education and stop-loss/stop-gain.
(1) For each hospital, determine the total
value of current medical education payments as reimbursed by the all patient
refined diagnosis related groups prospective payment system prior to July 1,
2017 by multiplying the hospital's medical education add-on rate effective
January 1, 2017 by the hospital's case-mix score in effect prior to July 1,
2017 by the total number of medicaid discharges for the twelve month period
used to estimate the fiscal impact.
(2) Determine the hospital's projected
medical education payments by multiplying the case-mix adjusted medical
education add-on rate as described in paragraph (C) of this rule by the total
number of medicaid discharges for the twelve month period used to estimate the
fiscal impact.
(3) If the
hospital's current medical education payments as described in paragraph (D)(1)
of this rule are greater than the projected medical education payments as
described in paragraph (D)(2) of this rule, then the hospital's medical
education add-on rate shall be the medical education add-on rate used to
calculate current medical education payments as described in paragraph (D)(1)
of this rule.
(4) If the hospital's
projected medical education payments as described in paragraph (D)(2) of this
rule are more than one-hundred and ten per cent of current medical education
payments as described in paragraph (D)(1) of this rule, then the hospital's
medical education payments shall be the current medical education add-on rate
multiplied by one-hundred and ten per cent.
(5) If the hospital's projected medical
education payments as described in paragraph (D)(2) of this rule are greater
than its current medical education payments as described in paragraph (D)(1) of
this rule but less than one-hundred and ten per cent of its current medical
education payments as described in paragraph (D) (1) of this rule, then the
hospital's medical education add-on rate is the addon rate used to calculate
projected medical education payments as described in paragraph (D)(2) of this
rule.
(E) Recognition of approved medical education programs outside of rebasing.
(1) For rate years when a rebasing is not
being conducted, hospitals that have added an approved graduate medical
education program and demonstrate such costs on the interim-settled cost report
that ends in the SFY ending in the calendar year preceding the immediate past
calendar year prior to January first of the rate year, the interim medical
education add-on rate shall be the sum of eighty per cent of the statewide
average DGME add-on rate plus fifty per cent of the statewide average IME
add-on rate.
(2) For a hospital
that only demonstrates costs for medical education of allied professionals on
the interim-settled cost report that ends in the SFY ending in the calendar
year preceding the immediate past calendar year prior to January first of the
rate year, the medical education add-on rate will be fifty per cent of the
statewide average DGME add-on rate.
(3) For a hospital that has a newly approved
graduate medical education program but whose costs are not yet reflected on a
cost report, the medical education addon rate will be fifty per cent of the
statewide average DGME add-on rate.
(a) A
hospital with a newly approved graduate medical education program must notify
the department no later than October first of the calendar year immediately
preceding January first of the rate year.
(b) Notification to the department must
include documentation from the "Accreditation Council of Graduate Medical
Education" that the hospital has an approved medical education program or
documentation of medicare's recognition of the hospital's approved full-time
equivalent interns and residents count, or both.
(4) For a hospital whose interim-settled cost
report that ends in the SFY ending in the calendar year preceding the immediate
past calendar year prior to January first of the rate year no longer reflects
costs for interns and residents, the medical education add-on rate will be
reduced by the portion of the add-on rate that represented their IME
costs.
(5) For a hospital whose
interim-settled cost report that ends in the SFY ending in the calendar year
preceding the immediate past calendar year prior to January first of the rate
no longer reflects costs for interns and residents and allied professionals,
the medical education add-on rate will be reduced to zero.
(F) The medical education payment is the product of a hospital's medical education addon rate as described in either paragraph (C), (D), or (E) of this rule and the relative weight of the claim's assigned all patient refined diagnosis related group and severity of illness as described in rule 5160-2-65 of the Administrative Code.
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