Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-2 - Hospital Services › Section 5160-2-60 - Hospital cost coverage add-on

Current through all regulations passed and filed through July 1, 2024
Effective for services or discharges on or after the effective
				date of this rule, payments made to Ohio hospitals under the prospective
				payment systems or non-diagnostic related groups (DRG) and non-ambulatory patient grouping (EAPG) prospective
				payment systems will receive a cost coverage
				add-on. The provisions of this rule do not apply to the medicaid maximum
				allowed amount calculation described in rule
				5160-2-25 of the Administrative
				Code.
(A) Definitions.
(1) "Inpatient case mix" means the sum of the
			 relative weight values for all discharges during the calendar year preceding
			 the calendar year that precedes the state fiscal year (SFY) of the cost
			 coverage add-on divided by the total number of discharges during the same
			 calendar year.
(2) "Freestanding
			 psychiatric hospital" means a privately-owned psychiatric hospital with more
			 than sixteen beds that is eligible to provide medicaid services as described in
			 rule 5160-2-01 of the Administrative
			 Code.
(3) "Outpatient case mix"
			 means the sum of the relative weight values for each enhanced ambulatory
			 patient grouping (EAPG) detail line paid with a relative weight during the
			 calendar year preceding the calendar year that precedes the state fiscal year
			 of the cost coverage add-on divided by the total number of EAPG detail lines
			 paid with a relative weight during the same calendar year.
(4) "Total medicaid
			 inpatient discharges" for each hospital means the sum of medicaid fee for
			 service (FFS) discharges reported on "Ohio Medicaid Hospital Cost Report" ODM
			 02930, schedule C-1, section I, columns 2 and 3, line 54 for the applicable SFY
			 and medicaid managed care plan (MCP) discharges reported on ODM 02930, schedule
			 C-1, section I, columns 
									6 and 7, line 54.
(5) "Total medicaid
			 inpatient charges" for each hospital means the sum of FFS medicaid inpatient
			 charges reported on ODM 02930, schedule H, column 1, line 8 and MCP inpatient
			 charges reported on ODM 02930, schedule I, column 2, line 202.
(6)
			 "Total medicaid outpatient charges" for each hospital means the sum of FFS
			 medicaid outpatient charges reported on ODM 02930, schedule H, column 1, line
			 16 and MCP outpatient charges reported on ODM 02930, schedule I, column 4, line
			 202.
(7) "Total medicaid
			 inpatient costs" for each hospital means the sum of FFS medicaid inpatient
			 costs reported on ODM 02930, schedule H, column 1, line 1 and MCP inpatient
			 costs reported on ODM 02930, schedule I, column 3, line 202.
(8)
			 "Total medicaid outpatient costs" for each hospital means the sum of FFS
			 medicaid outpatient costs reported on ODM 02930, schedule H, column 1, line 10
			 and MCP outpatient costs reported on ODM 02930, schedule I, column 5, line
			 202.
(9) "Total medicaid
			 outpatient visits" for each hospital means the sum of medicaid FFS visits
			 reported on ODM 02930, schedule C-1, section I, columns 2 and 3, line 56 and
			 medicaid MCP visits reported on ODM 02930, schedule I, column 4, line
			 205.