Current through all regulations passed and filed through March 18, 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