Current through all regulations passed and filed through December 16, 2024
For cost reporting purposes, each
eligible psychiatric residential treatment facility (PRTF), as defined in
Chapter 5160-59 of the Administrative Code, is to submit cost reports that
cover a consecutive twelve-month period of the provider's operations as
designated by the department.
(A)
Effective for
medicaid cost reports filed for cost-reporting periods ending in state fiscal
year (SFY) 2024, the PRTF will annually complete and submit the ODM 10278 "Ohio
Medicaid Psychiatric Residential Treatment Facility (PRTF) Cost Report" that is
applicable to the state fiscal year and each state fiscal year thereafter. The
PRTF's cost report will:
(1)
Be prepared in accordance with medicare principles
governing reasonable cost reimbursement set forth in the providers'
reimbursement manual "CMS Publications, 15-1 and 15-2," as applicable to the
PRTF's reporting period.
(2)
Be submitted in accordance with the cost report
instructions.
(3)
Include the cost report certification executed by an
officer of the PRTF attesting to the accuracy of the cost report. In addition,
all subsequent revisions to the cost report will include an executed
certification.
(4)
Unless waived by ODM, the reporting period begins July
first of each year and ends as follows:
(a)
On June thirtieth
the following year; 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
existing provider.
(5)
The cost report
is to be submitted on or before December thirty-first of the same calendar year
the reporting period ends or ninety days after reporting periods that end as
described in paragraphs (A)(4)(b) and (A)(4)(c) of this rule.
(B)
Unless
an extension is granted by the Ohio department of medicaid (ODM), PRTF cost
reports should be filed via the 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 PRTF that has a change of operator
during a reporting year, the cost report by the new provider should cover the
portion of the reporting year following the change of operator encompassed by
the first day of participation up to and including June
thirtieth.
(3)
In the case of a PRTF that begins participation after
July first and ceases participation before June thirtieth of the same reporting
year, the reporting period should be the first day of participation to the last
day of participation.
(4)
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. For the purposes of this
paragraph, a PRTF will be treated the same as a nursing facility as defined in
Chapter 5160 of the Administrative Code and the penalty assessed will be
determined with the same methodology described in paragraph (B) of rule
5160-3-20 of the Administrative
Code.
(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. Desk review procedures will
take into consideration the relationship between the prior year's costs and the
current year's reported costs.
(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)
Adjustments made
by ODM do not preclude findings of additional cost exceptions issued as the
result of an audit as described in paragraph (E) of this rule.
(D)
Cost
reports shall be completed using accrual basis accounting and generally
accepted accounting principles.
(E)
Audits.
ODM or its designee will perform field
audits of the most current cost report for each PRTF at least once every three
years or more often as determined by ODM. Cost reports for other periods may
also be audited within three years from the fiscal year end, unless justified
from previous audit findings. ODM will use a full or limited scope
audit.
(1)
The audits will be performed in accordance with
auditing standards adopted by ODM.
(2)
ODM will develop
a risk-based methodology to determine which PRTFs are subject to
audit.
(3)
The audit scope will be determined by ODM and will be
sufficient to determine if costs reflected in the cost report are accurate,
made in compliance with pertinent regulations, and based on actual
cost.
