Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-3 - Long-Term Care Facilities; Nursing Facilities; Intermediate Care Facilities for the Individuals with Intellectual Disabilities
Section 5160-3-24 - Nursing facilities (NFs): prospective rate reconsideration for possible calculation errors
Universal Citation: OH Admin Code 5160-3-24
Current through all regulations passed and filed through September 16, 2024
(A) A nursing facility provider, or a group or association of nursing facility providers, may request a reconsideration of a prospective NF rate on the basis of a possible error in the calculation of the rate as follows:
(1) A request for reconsideration
shall be filed with the Ohio
department of medicaid (ODM) no more than thirty days after the later of the
date on the rate setting
package notification or the effective date of the
rate.
(2) The request for a
reconsideration shall be filed in
accordance with the following procedures:
(a)
The request for rate reconsideration shall be in writing; and
(b) The request shall be addressed to "Ohio
Department of Medicaid, Fiscal Operations - LTC Rate Methodology Unit, P.O. Box
182709, Columbus, Ohio 43215-3414"; and
(c) The request shall indicate that it is a
request for rate reconsideration due to a possible error in the calculation of
the rate; and
(d) The request shall
include a detailed explanation of the possible error and the proposed corrected
calculation; and
(e) The request
shall include references to the relevant sections of the Revised Code
or paragraphs of the Administrative
Code as appropriate.
(3) ODM shall respond in writing within sixty
days of receiving each written request for reconsideration
. If ODM requests additional information to
determine whether a rate adjustment is warranted, the NF shall respond in
writing and shall provide additional supporting documentation no more than
thirty days after the receipt of the request for additional information. ODM
shall respond in writing within sixty days of receiving the additional
information to the request for reconsideration .
(4) If a rate
adjustment is warranted as the result of a reconsideration of a prospective
rate , the adjustment shall be implemented retroactively to the
initial service date for which the rate is effective.
(B) ODM's decision at the conclusion of the rate reconsideration process is final and shall not be subject to any administrative proceedings under Chapter 119. or any other provision of the Revised Code or Administrative Code.
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