Current through all regulations passed and filed through September 16, 2024
(A) The Ohio department of medicaid (ODM)
uses
the debt estimation methodology set forth in this rule to estimate the exiting
operator's actual and potential debts to ODM and the United States centers for
medicare and medicaid services (CMS) under the medicaid program in cases of a
change of operator, facility closure, voluntary termination, involuntary
termination, or voluntary withdrawal.
(B) ODM
totals the value of all of the
following that are determined applicable in calculating the debt estimate:
(1) Overpayments determined due to ODM
pursuant to section 5165.108 of the Revised Code,
including the following:
(a) Overpayments owed
to ODM for adjudicated final fiscal audit periods.
(b) Overpayments identified in proposed
adjudication orders that have been issued but not adjudicated.
(c) Overpayment amounts for any outstanding
periods where a final fiscal audit has not yet been issued. Such amounts are
estimated by generating preliminary reports of amounts owed by the exiting
operator for the applicable periods.
(2) Overpayments determined by ODM pursuant
to section 5165.49 of the Revised Code,
including the following:
(a) Overpayments
identified in the post-payment review summary that have been issued but not
collected.
(b) Overpayment amounts
for any outstanding periods where a post-payment review summary has not yet
been issued. Such amounts are estimated by generating preliminary reports of
amounts owed by the exiting operator for the applicable periods.
(3) Monies owed to ODM and CMS
resulting from penalties authorized by federal and state law, including but not
limited to the following:
(a) Civil monetary
penalties (CMPs) imposed by CMS that CMS has requested ODM to collect.
(b)
Penalties assessed pursuant to section
5165.42 of the Revised Code for
lack of proper notice of a change of operator, facility closure, or voluntary
withdrawal from the medicaid program, or when a
provider fails to furnish invoices or other documentation that ODM requests
during an audit.
(c) Late
cost report filing penalties assessed pursuant to rule
5160-3-20 of the Administrative
Code.
(4) Interest monies owed to ODM pursuant to
section 5165.41 of the Revised Code, and
to CMS pursuant to 42 C.F.R.
488.442 (October 1,
2020)
that CMS has requested ODM to collect.
(5) Monies owed to ODM and CMS pursuant to sections
5165.52 and
5165.525 of the Revised Code,
including a final fiscal audit for the last fiscal year or portion thereof that
the exiting operator participated in the medicaid program.
(6) Franchise permit fee (FPF) owed to ODM
pursuant to section 5168.47 of the Revised Code. FPF
owed to ODM includes unpaid FPF for the following:
(a) Amounts due for periods assessed or to be
assessed but for which payment is not yet required pursuant to section
5168.47 of the Revised
Code.
(b) Amounts due that are
certified to the Ohio attorney general's office for collection, including
penalties assessed pursuant to section
5168.51 of the Revised Code for
failure to pay the full amount when due.
(7) Monies owed due to a credit
balance.
(8) Monies owed pursuant
to successor liability or assumption of liability agreements the exiting
operator entered into.
(9) Other
amounts ODM determines are applicable.
(C) The sum of the amounts determined owed,
or estimated to be owed, to ODM and CMS pursuant to paragraphs (B)(1) to (B)(9)
of this rule
is the total estimated debt.
(D) ODM may release a portion of funds
withheld pursuant to division (A) of section
5165.521 of the Revised Code if
the funds withheld are materially greater than the debt calculated by the
department in the initial debt summary report issued pursuant to section
5165.525 of the Revised
Code.
