Source: http://codes.ohio.gov/orc/5168
Timestamp: 2019-04-21 20:12:19+00:00

Document:
5168.01 [Repealed Effective 10/16/2019] Hospital care assurance program definitions.
(A) "Bad debt," "charity care," "courtesy care," and "contractual allowances" have the same meanings given these terms in regulations adopted under Title XVIII of the "Social Security Act," 42 U.S.C. 1395 et seq.
(B) "Cost reporting period" means the twelve-month period used by a hospital in reporting costs for purposes of Title XVIII of the "Social Security Act," 42 U.S.C. 1395 et seq.
(C) "Disproportionate share hospital" means a hospital that meets the definition of a disproportionate share hospital in rules adopted under section 5168.02 of the Revised Code.
(D) "Federal poverty line" means the official poverty line defined by the United States office of management and budget based on the most recent data available from the United States bureau of the census and revised by the United States secretary of health and human services pursuant to the "Omnibus Budget Reconciliation Act of 1981," section 673(2), 42 U.S.C. 9902(2).
(E) "Governmental hospital" means a county hospital with more than five hundred registered beds or a state-owned and -operated hospital with more than five hundred registered beds.
(b) The hospital is recognized under the medicare program as a cancer hospital and is exempt from the medicare prospective payment system.
(2) "Hospital" does not include a hospital operated by a health insuring corporation that has been issued a certificate of authority under section 1751.05 of the Revised Code or a hospital that does not charge patients for services.
(3) The total amount of federal matching funds that will be made available in the same program year as a result of funds distributed by the department of medicaid to hospitals under section 5168.09 of the Revised Code.
(H) "Intergovernmental transfer" means any transfer of money by a governmental hospital under section 5168.07 of the Revised Code.
(I) "Medicaid services" has the same meaning as in section 5164.01 of the Revised Code.
(J) "Program year" means a period beginning the first day of October, or a later date designated in rules adopted under section 5168.02 of the Revised Code, and ending the thirtieth day of September, or an earlier date designated in rules adopted under that section.
(K) "Registered beds" means the total number of hospital beds registered with the department of health, as reported in the most recent "directory of registered hospitals" published by the department of health.
(L) "Third-party payer" means any person or government entity that may be liable by law or contract to make payment to or on behalf of an individual for health care services. "Third-party payer" does not include a hospital.
(M) "Total facility costs" means the total costs for all services rendered to all patients, including the direct, indirect, and overhead cost to the hospital of all services, supplies, equipment, and capital related to the care of patients, regardless of whether patients are enrolled in a health insuring corporation, excluding costs associated with providing skilled nursing services in distinct-part nursing facility units, as shown on the hospital's cost report filed under section 5168.05 of the Revised Code. Effective October 1, 1993, if rules adopted under section 5168.02 of the Revised Code so provide, "total facility costs" may exclude costs associated with providing care to recipients of any of the governmental programs listed in division (B) of that section.
(N) "Uncompensated care" means bad debt and charity care.
Amended by 132nd General Assembly File No. TBD, HB 49, §610.40, eff. 9/29/2017, op. 10/16/2019.
Amended by 131st General Assembly File No. TBD, HB 64, §610.10, eff. 7/1/2015.
Repealed by 130th General Assembly File No. 25, HB 59, §125.10, eff. 10/16/2019.
Renumbered from § 5112.01 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
Amended by 130th General Assembly File No. 25, HB 59, §125.12, eff. 9/29/2013.
5168.02 [Repealed Effective 10/16/2019] Adoption of rules.
(7) Establish, in accordance with section 5168.09 of the Revised Code, the methodology for paying hospitals under that section.
The director shall consult with hospitals when adopting the rules required by divisions (A)(4) and (5) of this section in order to minimize hospitals' cash flow difficulties.
(5) Any other category of costs deemed appropriate by the director in accordance with Title XIX of the "Social Security Act," 42 U.S.C. 1396 et seq., and the rules adopted under that title.
Renumbered from § 5112.03 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.03 [Repealed Effective 10/16/2019] Provisions dependent on assessment as permissible health care-related tax.
The requirements of sections 5168.06 to 5168.09 of the Revised Code apply only as long as the United States health care financing administration determines that the assessment imposed under section 5168.06 of the Revised Code is a permissible health care-related tax pursuant to the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w). Whenever the department of medicaid is informed that the assessment is an impermissible health care-related tax, the department shall promptly refund to each hospital the amount of money currently in the hospital care assurance program fund created by section 5168.11 of the Revised Code that has been paid by the hospital under section 5168.06 or 5168.07 of the Revised Code, plus any investment earnings on that amount.
Renumbered from § 5112.05 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.04 [Repealed Effective 10/16/2019] Program year basis of operation.
The department of medicaid shall operate the hospital care assurance program established by sections 5168.01 to 5168.14 of the Revised Code on a program year basis. The department shall complete all program requirements on or before the thirtieth day of September each year.
Renumbered from § 5112.10 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.05 [Repealed Effective 10/16/2019] Submitting financial statement and cost report.
(A) Except as provided in division (C) of this section, each hospital, on or before the first day of July of each year or at a later date approved by the medicaid director , shall submit to the department of medicaid a financial statement for the preceding calendar year that accurately reflects the income, expenses, assets, liabilities, and net worth of the hospital, and accompanying notes. A hospital that has a fiscal year different from the calendar year shall file its financial statement within one hundred eighty days of the end of its fiscal year or at a later date approved by the director . The financial statement shall be prepared by an independent certified public accountant and reflect an official audit report prepared in a manner consistent with generally accepted accounting principles. The financial statement shall, to the extent that the hospital has sufficient financial records, show bad debt and charity care separately from courtesy care and contractual allowances.
(B) Except as provided in division (C) of this section, each hospital, within one hundred eighty days after the end of the hospital's cost reporting period, shall submit to the department a cost report in a format prescribed in rules adopted under section 5168.02 of the Revised Code. The department shall grant a hospital an extension of the one hundred eighty day period if the health care financing administration of the United States department of health and human services extends the date by which the hospital must submit its cost report for the hospital's cost reporting period.
(C) The director may adopt rules under section 5168.02 of the Revised Code specifying financial information that must be submitted by hospitals for which no financial statement or cost report is available. The rules shall specify deadlines for submitting the information. Each such hospital shall submit the information specified in the rules not later than the deadline specified in the rules.
Renumbered from § 5112.04 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.06 [Repealed Effective 10/16/2019] Annual assessment.
(A) For the purpose of distributing funds to hospitals under the medicaid program pursuant to sections 5168.01 to 5168.14 of the Revised Code and depositing funds into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code, there is hereby imposed an assessment on all hospitals. Each hospital's assessment shall be based on total facility costs. All hospitals shall be assessed according to the rate or rates established each program year in rules adopted under section 5168.02 of the Revised Code. The department shall assess all hospitals uniformly and in a manner consistent with federal statutes and regulations. During any program year, the department shall not assess any hospital more than two per cent of the hospital's total facility costs.
(2) Yield funds that, when combined with intergovernmental transfers and federal matching funds, will produce amounts for distribution to disproportionate share hospitals that do not exceed, in the aggregate, the limits prescribed by the United States health care financing administration under the "Social Security Act," section 1923(f), 42 U.S.C. 1396r-4(f).
(1) Except as provided in division (B)(3) of this section, each hospital shall pay its assessment in periodic installments in accordance with a schedule established in rules adopted under section 5168.02 of the Revised Code.
(b) The medicaid director determines that adjustments in the amounts of installments are necessary for the administration of sections 5168.01 to 5168.14 of the Revised Code and that unequal installments will not create cash flow difficulties for hospitals.
(3) The director may adopt rules under section 5168.02 of the Revised Code establishing alternate schedules for hospitals to pay assessments under this section in order to reduce hospitals' cash flow difficulties.
Renumbered from § 5112.06 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.07 [Repealed Effective 10/16/2019] Requiring governmental hospitals to make intergovernmental transfers.
(A) The department of medicaid may require governmental hospitals to make intergovernmental transfers each program year for the purpose of distributing funds to hospitals under the medicaid program pursuant to sections 5168.01 to 5168.14 of the Revised Code and depositing funds into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code. The department shall not require transfers in an amount that, when combined with hospital assessments paid under section 5168.06 of the Revised Code and federal matching funds, produce amounts for distribution to disproportionate share hospitals that, in the aggregate, exceed limits prescribed by the United States health care financing administration under the "Social Security Act," section 1923(f), 42 U.S.C. 1396r-4(f).
(B) Before or during each program year, the department shall notify each governmental hospital of the amount of the intergovernmental transfer it is required to make during the program year. Each governmental hospital shall make intergovernmental transfers as required by the department under this section in periodic installments, executed by electronic fund transfer, in accordance with a schedule established in rules adopted under section 5168.02 of the Revised Code.
Renumbered from § 5112.07 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.08 [Repealed Effective 10/16/2019] Preliminary determination of assessment.
(A) Before or during each program year, the department of medicaid shall mail to each hospital by certified mail, return receipt requested, the preliminary determination of the amount that the hospital is assessed under section 5168.06 of the Revised Code during the program year. The preliminary determination of a hospital's assessment shall be calculated for a cost-reporting period that is specified in rules adopted under section 5168.02 of the Revised Code.
The department shall consult with hospitals each year when determining the date on which it will mail the preliminary determinations in order to minimize hospitals' cash flow difficulties.
If no hospital submits a request for reconsideration under division (B) of this section, the preliminary determination constitutes the final reconciliation of each hospital's assessment under section 5168.06 of the Revised Code. The final reconciliation is subject to adjustments under division (D) of this section.
(B) Not later than fourteen days after the preliminary determinations are mailed, any hospital may submit to the department a written request to reconsider the preliminary determinations. The request shall be accompanied by written materials setting forth the basis for the reconsideration. If one or more hospitals submit a request, the department shall hold a public hearing not later than thirty days after the preliminary determinations are mailed to reconsider the preliminary determinations. The department shall mail to each hospital a written notice of the date, time, and place of the hearing at least ten days prior to the hearing. On the basis of the evidence submitted to the department or presented at the public hearing, the department shall reconsider and may adjust the preliminary determinations. The result of the reconsideration is the final reconciliation of the hospital's assessment under section 5168.06 of the Revised Code. The final reconciliation is subject to adjustments under division (D) of this section.
(C) The department shall mail to each hospital a written notice of its assessment for the program year under the final reconciliation. A hospital may appeal the final reconciliation of its assessment to the court of common pleas of Franklin county. While a judicial appeal is pending, the hospital shall pay, in accordance with the schedules required by division (B) of section 5168.06 of the Revised Code, any amount of its assessment that is not in dispute into the hospital care assurance program fund created in section 5168.11 of the Revised Code.
(D) In the course of any program year, the department may adjust the assessment rate or rates established in rules pursuant to section 5168.06 of the Revised Code or adjust the amounts of intergovernmental transfers required under section 5168.07 of the Revised Code and, as a result of the adjustment, adjust each hospital's assessment and intergovernmental transfer, to reflect refinements made by the United States health care financing administration during that program year to the limits it prescribed under the "Social Security Act," section 1923(f), 42 U.S.C. 1396r-4(f). When adjusted, the assessment rate or rates must comply with division (A) of section 5168.06 of the Revised Code. An adjusted intergovernmental transfer must comply with division (A) of section 5168.07 of the Revised Code. The department shall notify hospitals of adjustments made under this division and adjust for the remainder of the program year the installments paid by hospitals under sections 5168.06 and 5168.07 of the Revised Code in accordance with rules adopted under section 5168.02 of the Revised Code.
Renumbered from § 5112.09 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.09 [Repealed Effective 10/16/2019] Methodology to pay hospitals sufficient to expend all money in indigent care pool.
(A) The department of medicaid may classify similar hospitals into groups and allocate funds for distribution within each group.
(4) Other factors that the director considers to be appropriate indicators of indigent care.
(C) The department shall distribute funds to each hospital or group of hospitals in a manner that first may provide for an additional distribution to individual hospitals that provide a high proportion of indigent care in relation to the total care provided by the hospital or in relation to other hospitals. The department shall establish a formula to distribute the remainder of the funds. The formula shall be consistent with the "Social Security Act," section 1923, 42 U.S.C. 1396r-4, and shall be based on any combination of the indicators of indigent care listed in division (B) of this section that the director considers appropriate.
(D) The department shall distribute funds to each hospital in installments not later than ten working days after the deadline established in rules for each hospital to pay an installment on its assessment under section 5168.06 of the Revised Code. In the case of a governmental hospital that makes intergovernmental transfers, the department shall pay an installment under this section not later than ten working days after the earlier of that deadline or the deadline established in rules for the governmental hospital to pay an installment on its intergovernmental transfer. If the amount in the hospital care assurance program fund created under section 5168.11 of the Revised Code and the portion of the health care-federal fund created under section 5162.50 of the Revised Code that is credited to that fund pursuant to division (B) of section 5168.11 of the Revised Code are insufficient to make the total distributions for which hospitals are eligible to receive in any period, the department shall reduce the amount of each distribution by the percentage by which the amount and portion are insufficient. The department shall distribute to hospitals any amounts not distributed in the period in which they are due as soon as moneys are available in the funds.
Renumbered from § 5112.08 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.10 [Repealed Effective 10/16/2019] Prohibiting replacing funds appropriated for medicaid program.
Except for moneys deposited into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code, the department of medicaid shall not use money paid to the department under sections 5168.06 and 5168.07 of the Revised Code or money that the department pays to hospitals under section 5168.09 of the Revised Code to replace any funds appropriated by the general assembly for the medicaid program.
Renumbered from § 5112.11 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.11 [Repealed Effective 10/16/2019] Hospital care assurance program fund.
(A) Except as provided in section 5162.52 of the Revised Code, all payments of assessments by hospitals under section 5168.06 of the Revised Code and all intergovernmental transfers under section 5168.07 of the Revised Code shall be deposited in the state treasury to the credit of the hospital care assurance program fund, hereby created. All investment earnings of the hospital care assurance program fund shall be credited to the fund. The department of medicaid shall maintain records that show the amount of money in the hospital care assurance program fund at any time that has been paid by each hospital and the amount of any investment earnings on that amount. All moneys credited to the hospital care assurance program fund shall be used solely to make payments to hospitals under division (D) of this section and section 5168.09 of the Revised Code.
(B) All federal matching funds received as a result of the department distributing funds from the hospital care assurance program fund to hospitals under section 5168.09 of the Revised Code shall be credited to the health care-federal fund created under section 5162.50 of the Revised Code.
(b) The available portion of the money in the health care-federal fund that is credited to that fund pursuant to division (B) of this section.
(3) The hospital's compliance with section 5168.14 of the Revised Code.
(2) Take action to recover from a hospital any amounts that the audit reveals it should have been required to pay but did not pay or that it should not have received but did receive.
Payments made under division (D)(1) of this section shall be made from the hospital care assurance program fund. Amounts recovered under division (D)(2) of this section shall be deposited to the credit of that fund. Any hospital may appeal the amount the hospital is to be paid under division (D)(1) or the amount that is to be recovered from the hospital under division (D)(2) of this section to the court of common pleas of Franklin county.
Renumbered from § 5112.18 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
Repealed by 130th General Assembly File No. 25, HB 59, §125.10, eff. 10/16/2017.
Renumbered from § 5112.19 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.13 [Repealed Effective 10/16/2019] Confidentiality.
Except as specifically required by sections 5168.01 to 5168.14 of the Revised Code, information filed under those sections shall not include any patient-identifying material. Information that includes patient-identifying material is not a public record under section 149.43 of the Revised Code, and no patient-identifying material shall be released publicly by the department of medicaid or by any person under contract with the department who has access to such information.
Renumbered from § 5112.21 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.14 Providing basic, medically necessary hospital-level services to individuals who are residents.
(A) Each hospital that receives funds distributed under sections 5168.01 to 5168.14 of the Revised Code shall provide, without charge to the individual, basic, medically necessary hospital-level services to individuals who are residents of this state, are not medicaid recipients, and whose income is at or below the federal poverty line. The medicaid director shall adopt rules under section 5168.02 of the Revised Code specifying the hospital services to be provided under this section.
(1) The hospital has an established post-billing procedure for determining the individual's income and canceling the charges if the individual is found to qualify for services under this section.
(c) Describes the procedure required by division (C)(1) of this section.
(3) The hospital complies with any additional rules adopted under section 5168.02 of the Revised Code.
Notwithstanding division (B) of this section, a hospital providing care to an individual under this section is subrogated to the rights of any individual to receive compensation or benefits from any person or governmental entity for the hospital goods and services rendered.
(C) Each hospital shall collect and report to the department of medicaid, in the form and manner prescribed by the department, information on the number and identity of patients served pursuant to this section.
(D) This section applies beginning May 22, 1992, regardless of whether rules specifying the services to be provided have been adopted. Nothing in this section alters the scope or limits the obligation of any governmental entity or program, including the program awarding reparations to victims of crime under sections 2743.51 to 2743.72 of the Revised Code and the program for medically handicapped children established under section 3701.023 of the Revised Code, to pay for hospital services in accordance with state or local law.
Renumbered from § 5112.17 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.20 [Repealed Effective 10/1/2019] Definitions for sections 5168.20 to 5168.28.
(A) "Applicable assessment percentage" means the percentage specified in rules adopted under section 5168.26 of the Revised Code that is used in calculating a hospital's assessment under section 5168.21 of the Revised Code.
(B) "Assessment program year" means the twelve-month period beginning the first day of October of a calendar year and ending the last day of September of the following calendar year.
(C) "Cost reporting period" means the period of time used by a hospital in reporting costs for purposes of the medicare program.
(D) "Federal fiscal year" means the twelve-month period beginning the first day of October of a calendar year and ending the last day of September of the following calendar year.
(a) The hospital is registered under section 3701.07 of the Revised Code as a general medical and surgical hospital or a pediatric general hospital and provides inpatient hospital services, as defined in 42 C.F.R. 440.10.
(c) The hospital is a psychiatric hospital licensed under section 5119.33 of the Revised Code.
(b) A hospital that does not charge any of its patients for its services.
(F) "Hospital care assurance program" means the program established under sections 5168.01 to 5168.14 of the Revised Code.
"State fiscal year" means the twelve-month period beginning the first day of July of a calendar year and ending the last day of June of the following calendar year.
(1) Except as provided in divisions (H)(2) and (3) of this section, "total facility costs" means the total costs to a hospital for all care provided to all patients, including the direct, indirect, and overhead costs to the hospital of all services, supplies, equipment, and capital related to the care of patients, regardless of whether patients are enrolled in a health insuring corporation.
Amended by 132nd General Assembly File No. TBD, HB 49, §610.40, eff. 9/29/2017, op. 10/1/2019.
Repealed by 130th General Assembly File No. 25, HB 59, §125.11, eff. 10/1/2019.
Renumbered from § 5112.40 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
Amended by 130th General Assembly File No. 25, HB 59, §125.13, eff. 9/29/2013.
5168.21 [Repealed Effective 10/1/2019] Additional annual assessment.
(A) For the purposes specified in section 5168.25 of the Revised Code and subject to section 5168.28 of the Revised Code, there is hereby imposed an assessment on all hospitals each assessment program year. The amount of a hospital's assessment for an assessment program year shall equal the applicable assessment percentage of the hospital's total facility costs for the period of time specified in division (B) of this section. The amount of a hospital's total facility costs shall be derived from cost-reporting data for the hospital submitted to the department of medicaid for purposes of the hospital care assurance program. If a hospital has not submitted that cost-reporting data to the department, the amount of a hospital's total facility costs shall be derived from other financial statements that the hospital shall provide to the department as directed by the department. The cost-reporting data or financial statements used to determine a hospital's assessment is subject to the same type of adjustments made to the cost-reporting data under the hospital care assurance program.
(B) The period of time specified in this division is the hospital's cost reporting period that ends in the state fiscal year that ends in the federal fiscal year that precedes the federal fiscal year that precedes the assessment program year for which the assessment is imposed.
(C) The assessment imposed by this section on a hospital is in addition to the assessment imposed by section 5168.06 of the Revised Code.
Renumbered from § 5112.41 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.22 [Repealed Effective 10/1/2019] Preliminary determination of assessment amount.
(A) Before or during each assessment program year, the department of medicaid shall mail to each hospital by certified mail, return receipt requested, the preliminary determination of the amount that the hospital is assessed under section 5168.21 of the Revised Code for the assessment program year. Except as provided in division (B) of this section, the preliminary determination becomes the final determination for the assessment program year fifteen days after the preliminary determination is mailed to the hospital.
(B) A hospital may request that the department reconsider the preliminary determination mailed to the hospital under division (A) of this section by submitting to the department a written request for a reconsideration not later than fourteen days after the hospital's preliminary determination is mailed to the hospital. The request must be accompanied by written materials setting forth the basis for the reconsideration. On receipt of the timely request, the department shall reconsider the preliminary determination and may adjust the preliminary determination on the basis of the written materials accompanying the request. The result of the reconsideration is the final determination of the hospital's assessment under section 5168.21 of the Revised Code for the assessment program year.
(C) The department shall mail to each hospital a written notice of the final determination of its assessment for the assessment program year. A hospital may appeal the final determination to the court of common pleas of Franklin county. While a judicial appeal is pending, the hospital shall pay, in accordance with section 5168.23 of the Revised Code, any amount of its assessment that is not in dispute.
Renumbered from § 5112.42 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.23 [Repealed Effective 10/1/2019] Assessment payment schedule.
the department of medicaid shall establish for each assessment program year. The department shall consult with the Ohio hospital association before establishing the payment schedule for any assessment program year. The department shall include the payment schedule in each preliminary determination notice the department mails to hospitals under division (A) of section 5168.22 of the Revised Code.
Renumbered from § 5112.43 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.24 [Repealed Effective 10/1/2019] Audit.
The department of medicaid may audit a hospital to ensure that the hospital properly pays the amount it is assessed under section 5168.21 of the Revised Code. The department shall take action to recover from a hospital any amount the audit reveals that the hospital should have paid but did not pay.
Renumbered from § 5112.44 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.25 [Repealed Effective 10/1/2019] Hospital assessment fund.
There is hereby created in the state treasury the hospital assessment fund. All installment payments made by hospitals under section 5168.23 of the Revised Code and all recoveries the department of medicaid makes under section 5168.24 of the Revised Code shall be deposited into the fund. All investment earnings of the fund shall be credited to the fund. The department shall use money in the fund to pay for the costs of the medicaid program, including the program's administrative costs.
Renumbered from § 5112.45 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.26 [Repealed Effective 10/1/2019] Excluded costs.
(A) The medicaid director shall adopt rules in accordance with Chapter 119. of the Revised Code as necessary to implement sections 5168.20 to 5168.28 of the Revised Code, including rules that specify the percentage of hospitals' total facility costs to be used in calculating hospitals' assessments under section 5168.21 of the Revised Code.
(iv) Services provided under the maternal and child health services block grant established under Title V of the "Social Security Act," 42 U.S.C. 701 et seq.
(b) Any other category of hospital costs the director deems appropriate under federal law and regulations governing the medicaid program.
(2) Subject to division (C) of this section, provide for the percentage of hospitals' total facility costs used in calculating hospitals' assessments to vary for different hospitals.
(C) Before adopting rules authorized by division (B)(2) of this section that establish varied percentages to be used in calculating hospitals' assessments, the director shall obtain a waiver from the United States secretary of health and human services under the "Social Security Act," section 1903(w)(3)(E), 42 U.S.C. 1396b(w)(3)(E), if the varied percentages would cause the assessments to not be imposed uniformly.
Renumbered from § 5112.46 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.27 [Repealed Effective 10/1/2019] Implementation shall not cause reduction in federal participation for medicaid program.
The medicaid director shall implement the assessment imposed by section 5168.21 of the Revised Code in a manner that does not cause a reduction in federal financial participation for the medicaid program under the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w).
Renumbered from § 5112.47 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.28 Determination of assessment as impermissible health care-related tax.
If the United States secretary of health and human services determines that the assessment imposed by section 5168.21 of the Revised Code is an impermissible health care-related tax under the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w), the medicaid director shall take all necessary actions to cease implementation of sections 5168.20 to 5168.27 of the Revised Code and shall promptly refund to each hospital the amount of money in the hospital assessment fund at the time the refund is to be made that the hospital paid under section 5168.23 of the Revised Code, plus any corresponding investment earnings on that amount.
Renumbered from § 5112.48 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.40 Franchise permit fee definitions.
(2) In the case of a hospital, the removal of a hospital bed from registration under section 3701.07 of the Revised Code as a skilled nursing facility bed or long-term care bed in a manner that reduces the total number of hospital beds registered under that section as skilled nursing facility beds or long-term care beds and makes it impossible for the bed to ever be registered as a skilled nursing facility bed or long-term care bed.
(B) "Change of operator" means an entering operator becoming the operator of a nursing home or hospital in the place of the exiting operator.
(C) "Effective date of a change of operator" means the day an entering operator becomes the operator of a nursing home or hospital.
(D) "Entering operator" means the person or government entity that will become the operator of a nursing home or hospital on the effective date of a change of operator.
(E) "Exiting operator" means an operator that will cease to be the operator of a nursing home or hospital on the effective date of a change of operator.
(F) "Franchise permit fee rate" means the rate determined in accordance with section 5168.41 of the Revised Code.
(2) For the part of the fiscal year beginning with the date the indirect guarantee percentage changes, the new percentage.
(J) "Medicaid days" and "nursing facility" have the same meanings as in section 5165.01 of the Revised Code.
(b) A nursing home maintained and operated by the department of veterans services under section 5907.01 of the Revised Code.
(L) "Operator" means the person or government entity responsible for the daily operating and management decisions for a nursing home or hospital.
(M) "Title XIX" means Title XIX of the "Social Security Act," 42 U.S.C. 1396 et seq.
(N) "Title XVIII" means Title XVIII of the "Social Security Act," 42 U.S.C. 1395 et seq.
Renumbered from § 3721.50 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 6/30/2013 and 9/29/2013.
5168.41 Determination of nursing home and hospital long-term care franchise permit fee rate.
(b) The total number of nursing home beds that are exempt from the franchise permit fee for the fiscal year because of the waiver obtained pursuant to section 5168.43 of the Revised Code.
(5) Divide the quotient determined under division (A)(3) of this section by the sum determined under division (A)(4) of this section.
(3) The projected total number of medicaid days for the fiscal year.
Added by 130th General Assembly File No. 25, HB 59, §101.01, eff. 7/1/2013.
5168.42 Annual franchise permit fee.
(2) The number of days in the fiscal year beginning on the first day of July of the calendar year in which the fee is determined pursuant to division (A) of section 5168.47 of the Revised Code.
(2) Refund the difference between the amount of the franchise permit fee assessed for that fiscal year under divisions (A) and (B) of this section and the amount recalculated under division (C)(1) of this section as a credit against the assessments imposed under divisions (A) and (B) of this section for the subsequent fiscal year.
(D) If the United States centers for medicare and medicaid services determines that the franchise permit fee established by sections 5168.40 to 5168.56 of the Revised Code is an impermissible health care-related tax under the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w), take all necessary actions to cease implementation of sections 5168.40 to 5168.56 of the Revised Code in accordance with rules adopted under section 5168.56 of the Revised Code.
Renumbered from § 3721.51 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
Effective Date: 06-05-2002; 07-01-2005; 2007 HB119 06-30-2007.
5168.43 Waiver of franchise permit fee.
(iv) Provides services for the life of each resident without regard to the resident's ability to secure payment for the services.
(iii) Does not participate in medicaid or medicare.
(2) For each nursing facility with more than two hundred beds certified as nursing facility beds under Title XIX, reduce the franchise permit fee rate for a number of the nursing facility's beds specified by the department to the amount necessary to obtain approval of the waiver sought under this section.
(B) The effective date of the waiver sought under this section shall be the first day of the quarter beginning after the United States secretary approves the waiver.
Renumbered from § 3721.511 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
Added by 128th General AssemblyFile No.9, HB 1, §101.01, eff. 7/1/2009, op. 7/17/2009.
5168.44 Approval of waiver; Reduction in franchise permit fee rate.
If the United States secretary of health and human services approves the waiver sought under section 5168.43 of the Revised Code, the department of medicaid shall, for each nursing home and hospital that qualifies for a reduction of its franchise permit fee rate under the waiver, reduce the franchise permit fee rate in accordance with the terms of the waiver. For purposes of the first fiscal year during which the waiver takes effect, the department shall determine the amount of the reduction not later than the effective date of the waiver and shall mail to each nursing home and hospital qualifying for the reduction notice of the reduction not later than the last day of the first month of the quarter that begins after the United States secretary approves the waiver. For purposes of subsequent fiscal years, the department shall make such determinations and notify the nursing homes and hospitals in accordance with section 5168.47 of the Revised Code.
Renumbered from § 3721.512 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.45 Increase in franchise permit fee rate.
(2) For each nursing home and hospital subject to the franchise permit fee, other than a nursing home or hospital that has its franchise permit fee rate reduced under section 5168.44 of the Revised Code, uniformly increase the amount of the franchise permit fee rate for a fiscal year to an amount that will have the franchise permit fee raise an amount of money that does not exceed the amount determined under division (A)(1) of this section for that fiscal year.
(B) If the department increases the franchise permit fee rate in accordance with division (A) of this section for the first fiscal year during which the waiver takes effect, the department shall determine the amount of the increase not later than the effective date of the waiver and shall mail to each nursing home and hospital subject to the increase notice of the increase not later than the last day of the first month of the quarter that begins after the United States secretary approves the waiver. If the department increases the franchise permit fee rate in accordance with division (A) of this section for a subsequent fiscal year, the department shall make such determinations and notify the nursing homes and hospitals in accordance with section 5168.47 of the Revised Code.
Renumbered from § 3721.513 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
(2) For each hospital, the number of beds in the hospital registered on the preceding first day of May pursuant to section 3701.07 of the Revised Code as skilled nursing facility or long-term care beds or licensed on that date under section 3721.02 or 3721.09 of the Revised Code as nursing home beds.
(B) For the purpose of the redetermination under section 5168.48 of the Revised Code and not later than the fifteenth day of each January, report to the department of medicaid, for each nursing home and hospital, the number of beds for which a bed surrender occurred during the period beginning on the first day of May of the preceding calendar year and ending on the first day of January of the calendar year in which the redetermination is made.
Renumbered from § 3721.52 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.47 Determination, notice, and payment of annual fee.
(A) Not later than the fifteenth day of September of each year, the department of medicaid shall determine the annual franchise permit fee for each nursing home and hospital in accordance with section 5168.42 of the Revised Code and any adjustments made in accordance with sections 5168.44 and 5168.45 of the Revised Code.
(B) Not later than the first day of October of each year, the department shall notify, electronically or by United States postal service, each nursing home and hospital of the amount of the franchise permit fee that has been determined for the nursing home or hospital.
(C) Subject to section 5168.48 of the Revised Code, each nursing home and hospital shall pay its fee under section 5168.42 of the Revised Code, as adjusted in accordance with sections 5168.44 and 5168.45 of the Revised Code, to the department in four installment payments not later than forty-five days after the last day of each October, December, March, and June.
Renumbered from § 3721.53 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.48 Redetermination of franchise permit fees.
(A) Not later than the last day of February of each year, the department of medicaid shall redetermine each nursing home's and hospital's franchise permit fee if one or more bed surrenders occur during the period beginning on the first day of May of the preceding calendar year and ending on the first day of January of the calendar year in which the redetermination is made.
(a) In the case of a nursing home or hospital for which one or more bed surrenders occurred during the period beginning on the first day of May of the preceding calendar year and ending on the first day of January of the calendar year in which the redetermination is made, the number of beds included in the calculation for the purpose of division (A)(1) or (B)(1) of section 5168.42 of the Revised Code shall exclude the beds for which bed surrenders occurred during that period.
(b) The number of days used in the calculation under division (A)(2) or (B)(2) of section 5168.42 of the Revised Code shall be the number of days in the first half of the calendar year in which the redetermination is made.
(c) The franchise permit fee rate shall reflect adjustments made under sections 5168.44 and 5168.45 of the Revised Code.
(C) Not later than the first day of March of each year, the department shall notify, electronically or by United States postal service, each nursing home and hospital of the amount of its redetermined franchise permit fee.
(D) Each nursing home and hospital shall pay its redetermined fee to the department in two installment payments not later than forty-five days after the last day of March and June of the calendar year in which the redetermination is made.
Renumbered from § 3721.531 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
Added by 129th General AssemblyFile No.28, HB 153, §101.01, eff. 7/1/2011.
5168.49 Change of operator; division of franchise permit fees.
If a nursing home or hospital undergoes a change of operator during a fiscal year, the responsibility for paying the franchise permit fee that was determined for the nursing home or hospital under section 5168.47 of the Revised Code, or redetermined for the nursing home or hospital under section 5168.48 of the Revised Code, for that fiscal year shall be divided proportionally. The exiting operator shall be responsible for paying the amount of the fee that is for the part of the fiscal year that ends on the day before the effective date of the change of operator. The entering operator shall be responsible for paying the amount of the fee that is for the part of the fiscal year that begins on the effective date of the change of operator. The department of medicaid is not required to notify the entering operator regarding the amount of that fiscal year's fee for which the entering operator is responsible.
Renumbered from § 3721.532 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.50 Direct billing for franchise permit fee prohibited.
No nursing home or hospital shall directly bill its residents for the franchise permit fee paid under section 5168.47 or 5168.48 of the Revised Code or otherwise directly pass the fee through to its residents.
Renumbered from § 3721.533 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.51 Assessment for past due fee installment.
If a nursing home or hospital fails to pay the full amount of a franchise permit fee installment when due, the department of medicaid may assess a five per cent penalty on the amount due for each month or fraction thereof the installment is overdue.
Renumbered from § 3721.54 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.52 Additional sanctions for past due fee installment.
(3) Terminate the nursing facility or hospital's medicaid provider agreement.
(B) The department may offset a medicaid payment under division (A) of this section without providing notice to the nursing facility or hospital and without conducting an adjudication under Chapter 119. of the Revised Code.
Renumbered from § 3721.541 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
(A) A nursing home or hospital may appeal the fee assessed under section 5168.42 of the Revised Code, as adjusted under section 5168.44 or 5168.45 of the Revised Code, and redetermined under section 5168.48 of the Revised Code solely on the grounds that the department of medicaid committed a material error in determining or redetermining the amount of the fee. A request for an appeal must be received by the department not later than fifteen days after the date the department notifies the nursing home or hospital of the fee and must include written materials setting forth the basis for the appeal.
(B) If a nursing home or hospital submits a request for an appeal within the time required under division (A) of this section, the department shall hold a public hearing in Columbus not later than thirty days after the date the department receives the request for an appeal. The department shall, not later than ten days before the date of the hearing, notify, electronically or by United States postal service, the nursing home or hospital of the date, time, and place of the hearing . The department may hear all the requested appeals in one public hearing.
(C) On the basis of the evidence presented at the hearing or any other evidence submitted by the nursing home or hospital, the department may adjust a fee. The department's decision is final.
Renumbered from § 3721.55 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.54 Nursing home franchise permit fee fund.
(A) There is hereby created in the state treasury the nursing home franchise permit fee fund. All payments and penalties paid by nursing homes and hospitals under sections 5168.47, 5168.48, and 5168.51 of the Revised Code shall be deposited into the fund. The fund shall also consist of money deposited into it pursuant to sections 3769.08 and 3769.26 of the Revised Code. Subject to division (B) of section 3769.08 of the Revised Code, the department of medicaid shall use the money in the fund to make medicaid payments to providers of nursing facility services and providers of home and community-based services. Money in the fund may also be used for the residential state supplement program established under section 5119.41 of the Revised Code.
(B) Any money remaining in the nursing home franchise permit fee fund after payments specified in division (A) of this section are made shall be retained in the fund. Any interest or other investment proceeds earned on money in the fund shall be credited to the fund and used to make medicaid payments in accordance with division (A) of this section.
Renumbered from § 3721.56 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
The department of medicaid may make any investigation it considers appropriate to obtain information necessary to fulfill its duties under sections 5168.40 to 5168.56 of the Revised Code. At the request of the department, the attorney general shall aid in any such investigations. The attorney general shall institute and prosecute all necessary actions for the enforcement of sections 5168.40 to 5168.56 of the Revised Code, except that at the request of the attorney general, the county prosecutor of the county in which a nursing home or hospital that has failed to comply with sections 5168.40 to 5168.56 of the Revised Code is located shall institute and prosecute any necessary action against the nursing home or hospital.
Renumbered from § 3721.57 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
(B) Establish any requirements or procedures the director considers necessary to implement sections 5168.40 to 5168.56 of the Revised Code.
Renumbered from § 3721.58 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.60 Definitions for sections 5112.30 to 5112.39.
(2) For fiscal year 2017 and each fiscal year thereafter, eighteen dollars and two cents.
(C) "ICF/IID" has the same meaning as in section 5124.01 of the Revised Code.
(D) "Medicaid-certified capacity" has the same meaning as in section 5124.01 of the Revised Code.
(E) "Provider agreement" has the same meaning as in section 5124.01 of the Revised Code.
Renumbered from § 5112.30 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 7/1/2013 and 9/29/2013.
5168.61 ICF/IID annual franchise permit fees.
(2) The number of days in the fiscal year.
(2) Refund the difference between the amount of the franchise permit fee assessed for that fiscal year under division (A) of this section and the amount recalculated under division (B)(1) of this section as a credit against the assessments imposed under division (A) of this section for the subsequent fiscal year.
(C) If the United States secretary of health and human services determines that the franchise permit fee established by sections 5168.60 to 5168.71 of the Revised Code would be an impermissible health care-related tax under the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w), take all necessary actions to cease implementation of those sections in accordance with rules adopted under section 5168.71 of the Revised Code.
Renumbered from § 5112.31 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
Effective Date: 07-01-2003; 07-01-2005; 06-30-2006; 2008 HB562 07-01-2008.
5168.62 Reporting number of beds in each facility.
For the purpose of the franchise permit fee imposed under section 5168.61 of the Revised Code and not later than the first day of each June, the department of developmental disabilities shall report to the department of medicaid the number of beds in each ICF/IID on the preceding first day of May .
Renumbered from § 5112.32 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.63 Determination, notice and payment of annual franchise permit fee.
(A) Not later than the fifteenth day of August of each year, the department of developmental disabilities shall determine the annual franchise permit fee for each ICF/IID in accordance with section 5168.61 of the Revised Code.
(B) Not later than the first day of September of each year, the department shall notify, electronically or by United States postal service, each ICF/IID of the amount of the franchise permit fee the ICF/IID has been assessed under section 5168.61 of the Revised Code.
(C) Subject to section 5168.64 of the Revised Code, each ICF/IID shall pay its fee under section 5168.61 of the Revised Code to the department in quarterly installment payments not later than forty-five days after the last day of each September, December, March, and June.
Renumbered from § 5112.33 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.64 Consequences of converting beds to providing home and community-based services.
(A) If the operator of an ICF/IID converts, pursuant to section 5124.60 or 5124.61 of the Revised Code, all of the ICF/IID's beds to providing home and community-based services and the operator's provider agreement for the ICF/IID is terminated as a consequence, the department of developmental disabilities shall terminate the ICF/IID's franchise permit fee effective on the first day of the quarter immediately following the quarter in which the conversion takes place.
(b) The number of days in the second half of the fiscal year for which the redetermination is made.
(2) The ICF/IID shall pay its franchise permit fee as redetermined under division (B)(1) of this section in installment payments not later than forty-five days after the last day of March and June of the fiscal year for which the redetermination is made.
Renumbered from § 5112.331 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.65 Assessing penalty for overdue installment.
If an ICF/IID fails to pay the full amount of an installment when due, the department of developmental disabilities may assess a five per cent penalty on the amount due for each month or fraction thereof the installment is overdue.
Renumbered from § 5112.34 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.66 Additional sanctions for overdue installment.
(3) Provide for the department of medicaid to terminate the ICF/IID's provider agreement.
(B) The department may offset a medicaid payment under division (A) of this section without providing notice to the ICF/IID and without conducting an adjudication under Chapter 119. of the Revised Code.
Renumbered from § 5112.341 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
(A) An ICF/IID may appeal the franchise permit fee imposed under section 5168.61 of the Revised Code solely on the grounds that the department of developmental disabilities committed a material error in determining the amount of the fee. A request for an appeal must be received by the department not later than fifteen days after the date the department notifies the ICF/IID of the fee and must include written materials setting forth the basis for the appeal.
(B) If an ICF/IID submits a request for an appeal within the time required under division (A) of this section, the department shall hold a public hearing in Columbus not later than thirty days after the date the department receives the request for an appeal. The department shall, not later than ten days before the date of the hearing, notify, electronically or by United States postal service, the ICF/IID of the date, time, and place of the hearing . The department may hear all requested appeals in one public hearing.
(C) On the basis of the evidence presented at the hearing or any other evidence submitted by the ICF/IID, the department may adjust a fee. The department's decision is final.
Renumbered from § 5112.35 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.68 Home and community-based services for persons with developmental disabilities fund.
There is hereby created in the state treasury the home and community-based services for persons with developmental disabilities fund. All installment payments and penalties paid by an ICF/IID under sections 5168.63 and 5168.65 of the Revised Code shall be deposited into the fund. As soon as possible after the end of each quarter, the medicaid director shall certify to the director of budget and management the amount of money that is in the fund as of the last day of that quarter. On receipt of a certification, the director of budget and management shall transfer the amount so certified from the home and community-based services for persons with developmental disabilities fund to the department of developmental disabilities operating and services fund created under section 5168.69 of the Revised Code.
Renumbered from § 5112.37 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.69 Department of developmental disabilities operating and services fund.
There is hereby created in the state treasury the department of developmental disabilities operating and services fund. The fund shall consist of the money transferred to it under section 5168.68 of the Revised Code. The money in the fund shall be used for the expenses of the programs that the department of developmental disabilities administers and the department's administrative expenses.
Renumbered from § 5112.371 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
Amended by 128th General AssemblyFile No.9, HB 1, §105.01, eff. 7/17/2009.
The department of developmental disabilities may make any investigation it considers appropriate to obtain information necessary to fulfill its duties under sections 5168.60 to 5168.71 of the Revised Code. At the request of the department, the attorney general shall aid in any such investigations. The attorney general shall institute and prosecute all necessary actions for the enforcement of sections 5168.60 to 5168.71 of the Revised Code, except that at the request of the attorney general, the county prosecutor of the county in which an ICF/IID that has failed to comply with those sections is located shall institute and prosecute any necessary action against the ICF/IID.
Renumbered from § 5112.38 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
(B) Establish any other requirements or procedures the director considers necessary to implement sections 5168.60 to 5168.71 of the Revised Code.
Renumbered from § 5112.39 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.75 Definitions for section 5168.75 to 5168.86.
(A) "Basic health care services" means all of the services listed in division (A)(1) of section 1751.01 of the Revised Code.
(B) "Care management system" means the system established under section 5167.03 of the Revised Code.
(C) "Dual eligible individual" has the same meaning as in section 5160.01 of the Revised Code.
(D) "Franchise fee" means the fee imposed on health insuring corporation plans under section 5168.76 of the Revised Code.
(E) "Health insuring corporation" has the same meaning as in section 1751.01 of the Revised Code, except it does not mean a corporation that, pursuant to a policy, contract, certificate, or agreement, pays for, reimburses, or provides, delivers, arranges for, or otherwise makes available, only supplemental health care services or only specialty health care services.
(3) A medicare advantage plan authorized by Part C of Title XVIII of the "Social Security Act," 42 U.S.C. 1395w-21 et seq.
(H) "Medicaid managed care organization" has the same meaning as in section 5167.01 of the Revised Code.
(I) "Medicaid provider" has the same meaning as in section 5164.01 of the Revised Code.
(J) "Ohio medicaid member month" means a month in which a medicaid recipient residing in this state is enrolled in a health insuring corporation plan.
(K) "Other Ohio member month" means a month in which a resident of this state who is not a medicaid recipient is enrolled in a health insuring corporation plan.
(N) "Rate year" means the fiscal year for which a franchise fee is imposed.
Added by 132nd General Assembly File No. TBD, HB 49, §101.01, eff. 6/29/2017 (Vetoed Provisions).
5168.76 Franchise fee on health insuring corporation plans.
(A) For the purposes specified in section 5168.85 of the Revised Code and subject to sections 5168.82, 5168.83, and 5168.84 of the Revised Code, a franchise fee is hereby imposed each month beginning with July 2017 on each health insuring corporation plan. The franchise fee shall have a component based on Ohio medicaid member months and another component based on other Ohio member months.
(C) The amount of the monthly franchise fee to be imposed on a health insuring corporation plan under the component based on other Ohio member months shall be determined by multiplying the number of other Ohio member months that the health insuring corporation plan had for the month by the applicable rate or rates. The applicable rate or rates to be used in the calculation for a health insuring corporation plan for a month shall depend on the cumulative total number of other Ohio member months the health insuring corporation plan had for all of a rate year's months that ended before the beginning of the month in which the franchise fee is due.
The component of the monthly franchise fee based on Ohio medicaid member months is due not later than the fifth business day of the month immediately following the month for which it is imposed. The component of the monthly franchise fee based on other Ohio member months is due not later than the last day of September of the calendar year in which the rate year ends, and the total amount due under that component for all of the months of the rate year shall be paid in one payment.
If a health insuring corporation administers multiple health insuring corporation plans, the corporation shall pay the total amount due for all of the plans under the component of the franchise fee based on Ohio medicaid member months in one payment and pay the total amount due for all of the plans under the component of the franchise fee based on other Ohio member months in one payment.
Added by 132nd General Assembly File No. TBD, HB 49, §101.01, eff. 6/29/2017.
The department of medicaid may request that a health insuring corporation provide the department documentation the department needs to verify the amount of the franchise fees imposed on the health insuring corporation plans administered by the corporation and to ensure the corporation's compliance with sections 5168.75 to 5168.86 of the Revised Code. On receipt of the request, the health insuring corporation shall provide the department the requested documentation. The department also may review relevant documentation possessed by other entities for the purpose of making such verifications.
5168.79 Determination of higher fee.
If the department of medicaid determines that the amount of a franchise fee that a health insuring corporation paid is less than the amount it should have paid, the department shall notify the health insuring corporation. Except as otherwise provided by the results of a reconsideration conducted under section 5168.80 of the Revised Code, the health insuring corporation shall pay the amount due.
A health insuring corporation may request a reconsideration of a determination made by the department of medicaid under section 5168.79 of the Revised Code. A reconsideration may be requested solely on the grounds that the department made a material error in making the determination. A request for a reconsideration must be received by the department not later than fifteen days after the date the department notifies the health insuring corporation of the department's determination and must include written materials setting forth the basis for the reconsideration. If a health insuring corporation requests a reconsideration within the time required, the department shall reconsider the determination and issue a final decision not later than thirty days after the date the department receives the request.
5168.81 Penalty for overdue payments.
If a health insuring corporation fails to pay the full amount of a component of a franchise fee when due, the department of medicaid may assess a ten per cent penalty on the amount due for each month or fraction thereof that the component of the franchise fee is overdue.
The franchise fee shall not be imposed on any health insuring corporation plan unless there is in effect a waiver authorizing the franchise fee issued by the United States secretary of health and human services pursuant to section 1903(w)(3)(E) of the "Social Security Act," 42 U.S.C. 1396b(w)(3)(E).
If the total amount of franchise fees imposed on all health insuring corporation plans under section 5168.76 of the Revised Code during a fiscal year exceeds the indirect guarantee percentage of the net patient revenue for all health insuring corporations for that fiscal year and seventy-five per cent or more of all health insuring corporations receive enhanced medicaid payments or other state payments equal to seventy-five per cent or more of the total franchise fees imposed on their health insuring corporation plans, the department of medicaid shall refund the excess amount of the franchise fees to the health insuring corporations.
(B) Take all necessary actions to cease the imposition of the franchise fee until the determination is reversed.
5168.85 Health insuring corporation franchise fee fund.
(A) There is hereby created in the state treasury the health insuring corporation franchise fee fund. All payments and penalties paid by health insuring corporations under sections 5168.77, 5168.79, and 5168.81 of the Revised Code shall be deposited into the fund. Money in the fund shall be used to make medicaid payments to medicaid providers and medicaid managed care organizations.
(B) Any interest or other investment proceeds earned on money in the fund shall be credited to the fund and used to make medicaid payments in accordance with division (A) of this section.
The medicaid director may adopt rules in accordance with Chapter 119. as necessary to implement sections 5168.75 to 5168.86 of the Revised Code.
5168.99 [Repealed Effective 10/16/2019] Penalties.
(A) The medicaid director shall impose a penalty for each day that a hospital fails to report the information required under section 5168.05 of the Revised Code on or before the dates specified in that section. The amount of the penalty shall be established by the director in rules adopted under section 5168.02 of the Revised Code.
(B) In addition to any other remedy available to the department of medicaid under law to collect unpaid assessments and transfers under sections 5168.01 to 5168.14 of the Revised Code, the director shall impose a penalty of ten per cent of the amount due on any hospital that fails to pay assessments or make intergovernmental transfers by the dates required by rules adopted under section 5168.02 of the Revised Code.
(C) In addition to any other remedy available to the department of medicaid under law to collect unpaid assessments imposed under section 5168.21 of the Revised Code, the director shall impose a penalty of ten per cent of the amount due on any hospital that fails to pay the assessment by the date it is due.
(D) The director shall waive the penalties provided for in this section for good cause shown by the hospital.
(E) All penalties imposed under this section shall be deposited into the health care/medicaid support and recoveries fund created by section 5162.52 of the Revised Code.
Renumbered from § 5112.99 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
5168.991 [Repealed Effective 10/16/2019] Offsetting unpaid penalty.
The department of medicaid may offset the amount of a hospital's unpaid penalty imposed under section 5168.99 of the Revised Code from one or more payments due the hospital under the medicaid program. The total amount that may be offset from one or more payments shall not exceed the amount of the unpaid penalty.
Renumbered from § 5112.991 by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.

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 § 5112
 §101
 § 5112
 §101
 § 5112
 §101
 § 5112
 §101
 § 5112
 §101
 § 5112
 §101
 § 5112
 §101
 §105
 § 5112
 §101
 § 5112
 §101
 §101
 §101
 § 5112
 §101
 § 5112
 §101