Current through all regulations passed and filed through September 16, 2024
(A)
Definitions.
For purposes of this rule:
(1)
"Ancillary and
support costs," "cost center," "direct care costs," "rebasing" and "tax costs"
have the same meaning as in section
5165.01 of the Revised
Code.
(2)
"Cost center report" means a report submitted to the
Ohio department of medicaid (ODM) by a nursing facility provider that
identifies the amount spent on each cost center included in
rebasing.
(B)
Direct care spending.
(1)
In accordance
with section 5165.36 of the Revised Code,
nursing facilities should increase direct care spending by at least seventy
percent of any additional dollars received as a result of
rebasing.
(2)
For purposes of determining compliance with section
5165.36 of the Revised Code, the
increased spending in direct care will be evaluated using calendar year 2019
medicaid nursing facility cost report data for direct care.
(C)
Submission of cost center reports.
(1)
In accordance
with Section 333.240 of Amended Substitute House Bill 110 of the 134th General
Assembly, for state fiscal years 2022 and 2023, cost center reports are to be
submitted as follows:
(a)
The first cost center report is to be submitted not
later than ninety days after the end of calendar year 2021 and should cover the
period of July 1, 2021 through December 31, 2021.
(b)
Subsequent cost
center reports should cover one calendar year each and should be submitted not
later than ninety days after the end of the applicable calendar
year.
(2)
Reports should include only direct care, ancillary and
support, and tax costs as well as inpatient days.
(3)
Reports should be
submitted on an electronic form prescribed by ODM.
(D)
Extensions.
For good cause shown, cost center
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
report. Requests for extensions should be sent via email to
LTCAudits@medicaid.ohio.gov and explain the circumstances resulting in the need
for an extension.
(E)
Late reporting penalties.
(1)
If a 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 reporting penalty for each day
a complete and adequate report is not received
(2)
The late
reporting 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 report is received by ODM.
(3)
The late
reporting penalty will be one hundred dollars per calendar day for each day
after the original due date or the extension due date, whichever is applicable,
that a nursing facility does not submit a cost center report.
(4)
The late
reporting penalty is assessed annually and will be a reduction in payments to
providers that submit claims directly to ODM or by payment submitted to ODM
outside the claims process for providers that do not submit claims directly to
ODM. No penalty is imposed during a fourteen-day extension granted by
ODM.
(F)
Change of operator (CHOP).
In cases of a change of operator, the
exiting operator's 2019 cost reports and the additional dollars received as a
result of rebasing will be used for the purposes of determining the entering
operator's compliance with section
5165.36 of the Revised Code and
Section 333.240 of Amended Substitute House Bill 110 of the 134th General
Assembly.
(G)
New providers.
For state fiscal years 2022 and 2023,
nursing facilities with an initial medicaid certification date on or after
January 1, 2020 are excluded from the requirements set forth in paragraphs (B)
and (C) of this rule.
(H)
Reviews.
For purposes of determining compliance
with this rule, Section 333.240 of Amended Substitute House Bill 110 of the
134th General Assembly, and section
5165.36 of the Revised Code, ODM
may conduct reviews of cost center report data beginning with calendar year
2022 data.
(I)
Reimbursement of funds to ODM.
(1)
Any amounts spent
on cost centers other than as permitted by this rule, Section 333.240 of
Amended Substitute House Bill 110 of the 134th General Assembly, and section
5165.36 of the Revised Code will
be reimbursed to ODM with interest.
(a)
The interest will be no greater than two times the
current average bank prime rate determined at the mid-point of the reporting
quarter.
(b)
Interest will accrue from the mid-point of the
reporting quarter until the date funds are recouped from medicaid payments or
until payment is submitted to ODM outside the claims process for providers who
do not submit claims directly to ODM.
(2)
Reimbursement of
funds pursuant to a review as set forth in paragraphs (H) and (I) of this rule
is not subject to appeal under Chapter 119. of the Revised
Code.
