Current through all regulations passed and filed through September 16, 2024
In addition to the provisions contained
in sections 5165.10 to
5165.109 of the Revised Code,
the following provisions apply.
(A)
For reporting
purposes NFs shall use the chart of accounts for NFs as set forth in rule
5160-3-42 of the Administrative
Code, or relate its chart of accounts directly to the cost
report.
(B)
Unless an extension is granted by the Ohio department
of medicaid (ODM), NF cost reports should be filed electronically within ninety
days after the end of the reporting period via the medicaid information
technology system (MITS) web portal or other electronic means designated by
ODM.
(1)
For
good cause shown, cost reports may be submitted within fourteen days after the
original due date if written approval is received from ODM prior to the
original due date of the cost report. Requests for extensions should be in
writing and explain the circumstances resulting in the need for an
extension.
(2)
In the case of a NF that has a change of operator
during a calendar year, the cost report by the new provider should cover the
portion of the calendar year following the change of operator encompassed by
the first day of participation up to and including December
thirty-first.
(3)
In the case of a NF that begins participation after
January first and ceases participation before December thirty-first of the same
calendar year, the reporting period should be the first day of participation to
the last day of participation.
(4)
Unless waived by
ODM, the reporting period ends as follows:
(a)
On the last day
of the calendar year for a facility's year end cost report; or
(b)
On the last day
of medicaid participation or when the facility closes in accordance with
paragraph (A)(1) of rule
5160-3-02 of the Administrative
Code; or
(c)
On the last day before a change of operator for an
exiting provider.
(5)
If a cost report
is not received by the original due date, or by an approved extension due date
if applicable, the provider may be assessed a late file penalty for each day a
complete and adequate cost report is not received. The late file penalty may be
assessed even if ODM has provided written notice of termination to a
facility.
(a)
The late file penalty is determined using the prorated
medicaid days paid in the late file period multiplied by the penalty. The
penalty is two dollars per patient day.
(b)
The late file
penalty period begins on the day after the original due date or on the day
after the extension due date, whichever is applicable, and continues until the
complete and adequate cost report is received by ODM or the facility is
terminated from the medicaid program.
(c)
The late file
penalty is a reduction to the medicaid payment. No penalty is imposed during a
fourteen-day extension granted by ODM.
(C)
The desk review
is a process of reviewing information pertaining to the cost report without
detailed verification and is designed to identify problems warranting
additional review.
(1)
A facility may revise the cost report within sixty days
after the original due date without the revised information being considered an
amended cost report.
(2)
The cost report is considered accepted after the cost
report has passed the desk review process.
(3)
After final rates
have been issued, a provider that disagrees with a desk review decision may
request a rate reconsideration.
(D)
ODM shall not
charge interest under division (B) of section
5165.41 of the Revised Code
based on any error or additional information that is not required to be
reported.
(E)
Cost reports shall be completed using accrual basis
accounting and generally accepted accounting principles unless otherwise
specified in Chapter 5160-3 of the Administrative Code.
(F)
Providers should
identify all known related parties as set forth under paragraph (F) of rule
5160-3-01 of the Administrative
Code.
(G)
Providers should identify all of the following:
(1)
Each known
individual, group of individuals, or organization not otherwise publicly
disclosed who owns or has common ownership as set forth under paragraph (F) of
rule 5160-3-01 of the Administrative
Code, in whole or in part, any mortgage, deed of trust, property or asset of
the facility; and
(2)
Each corporate officer or director, if the provider is
a corporation; and
(3)
Each partner, if the provider is a partnership;
and
(4)
Each provider, whether participating in the medicare or
medicaid program or not, which is part of an organization which is owned, or
through any other device controlled, by the organization of which the provider
is a part; and
(5)
Any director, officer, manager, employee, individual,
or organization having five per cent or more direct or indirect ownership or
control of the provider, or who has been convicted of or pleaded guilty to a
civil or criminal offense related to his involvement in programs established by
Title XVIII (December 9, 2019), Title XIX (December 9, 2019), or Title XX
(December 9, 2019) of the Social Security Act; and
(6)
Any individual
currently employed by or under contract with the provider, or related party
organization, as defined under paragraph (F) of rule
5160-3-01 of the Administrative
Code, in a managerial, accounting, auditing, legal, or similar capacity who was
employed by ODM, the Ohio department of health, the office of attorney general,
the office of the auditor of state, the Ohio department of aging, the Ohio
department of developmental disabilities, the Ohio department of commerce, or
the industrial commission of Ohio within the previous twelve
months.
(H)
Providers are required to provide upon request all
contracts in effect during the cost report period for which the cost of the
service from any individual or organization is ten thousand dollars or more in
a twelve-month period; or for the services of a sole proprietor or partnership
where there is no cost incurred and the imputed value of the service is ten
thousand dollars or more in a twelve-month period.
(1)
For purposes of
this rule, "contract for service" is defined as the component of a contract
that details services provided exclusive of supplies and equipment. It includes
any contract that details services, supplies, and equipment to the extent the
value of the service component is ten thousand dollars or more within a
twelve-month period.
(2)
For purposes of this rule, "subcontractor" is defined
as any entity, including an individual or individuals, that contracts with a
provider to supply a service, either to the provider or directly to the
beneficiary, where medicaid reimburses the provider the cost of the service.
This includes organizations related to the subcontractor that have a contract
with the subcontractor for which the cost or value is ten thousand dollars or
more in a twelve-month period.
(I)
Financial,
statistical and medical records (which shall be available to ODM or its
authorized agent and to the U.S. department of health and human services and
other federal agencies) supporting the cost reports or claims for services
rendered to residents shall be retained for the greater of seven years after
the cost report is filed if ODM issues an audit report, or six years after all
appeal rights relating to the audit report are exhausted.
(1)
Failure to retain
the required financial, statistical, or medical records, renders the provider
liable for monetary damages that are the greater of the following:
(a)
One thousand
dollars per audit; or
(b)
Twenty-five per cent of the amount by which the
undocumented cost increased the medicaid payments to the provider during the
fiscal year.
(2)
Failure to retain the required financial, statistical,
or medical records to the extent that filed cost reports are unauditable will
result in the penalty as specified in paragraph (I)(1) of this rule. Providers
whose records have been found to be unauditable will be allowed sixty days to
provide the necessary documentation. If, at the end of the sixty days, the
required records have been provided and are determined auditable, the proposed
penalty will be withdrawn. If ODM, after review of the documentation submitted
during the sixty-day period, determines that the records are still unauditable,
ODM will impose the penalty as specified in paragraph (I)(1) of this
rule.
(3)
Refusing legal access to financial, statistical, or
medical records will result in a penalty as specified in paragraph (I)(1) of
this rule for outstanding medical services until such time as the requested
information is made available to ODM.
(4)
All requested
financial, statistical, and medical records supporting the cost reports or
claims for services rendered to residents shall be available at a location in
the state of Ohio for facilities certified for participation in the medicaid
program by this state within at least sixty days after request by the state or
its subcontractors. The preferred Ohio location is the facility itself, but may
be a corporate office, an accountant's office, or an attorney's office
elsewhere in Ohio. The state or its subcontractors may conduct the audit or a
review at the site of such records if outside of Ohio.
(J)
When
completing cost reports, the following guidelines shall be used to properly
classify costs:
(1)
All depreciable equipment valued at five thousand
dollars or more per item and a useful life of at least two years or more is to
be reported in the capital cost component set forth under the Administrative
Code. The costs of any equipment leases executed before December 1, 1992 and
reported as capital costs, shall continue to be reported under the capital cost
component. The costs of any new leases for equipment executed on or after
December 1, 1992, shall be reported under the capital costs component.
Operating lease costs for equipment that result from extended leases under the
provision of a lease option negotiated on or after December 1, 1992 shall be
reported under the capital cost component.
(2)
Except for
employers' share of payroll taxes, workers compensation, employee fringe
benefits, and home office costs, allocation of commonly shared expenses across
cost centers is not allowed. Wages and benefits for staff, including related
parties, who perform duties directly related to functions performed in more
than one cost center that would be expended under separate cost centers if
performed by separate staff may be expended to separate cost centers based upon
documented hours worked, provided the facility maintains adequate documentation
of hours worked in each cost center. For example, the salary of an aide who is
assigned to bathing and dressing chores in the early hours but works in the
kitchen as a dietary aide for the remainder of the shift may be expended to
separate cost centers provided the facility maintains adequate documentation of
hours worked in each cost center.
(3)
The costs of
resident transport vehicles are reported under the capital cost component.
Maintenance and repairs of these vehicles is reported under the
ancillary/support cost component.
Replaces: 5160-3-20
