Ohio Administrative Code › Title 5123 - Department of Developmental Disabilities › Chapter 5123-7 - Intermediate Care Facilities for Individuals with Intellectual Disabilities › Section 5123-7-33 - Intermediate care facilities for individuals with intellectual disabilities - resident assessment classification system based on administration of the Ohio developmental disabilities profile

Current through all regulations passed and filed through July 1, 2024
(A) Purpose
This rule sets forth a method and process for determining the
				per resident/per day rate paid to an intermediate care facility for individuals
				with intellectual disabilities (ICFIID) for direct care costs using the Ohio
				developmental disabilities profile pursuant to sections
				5124.19 to
				5124.193 of the Revised
				Code.
(B) Definitions
For the purposes of this rule, the following definitions
				 apply:
(1) "Annual facility average case mix score"
			 means the ICFIID's average case mix score of all qualifying quarters in a
			 calendar year.
(2) "Case mix score"
			 means the measure of the relative direct care resources needed to provide care
			 and rehabilitation to a resident of an ICFIID using the Ohio developmental
			 disabilities profile.
(3)
			 "Correction submission due date" means the deadline for an ICFIID to submit
			 corrected Ohio developmental disabilities profile data to the department. The
			 correction submission due date applies to corrections submitted in electronic
			 format for facility level errors and resident record changes.
(4) "Cost per case mix unit" is calculated by
			 dividing an ICFIID's desk-reviewed, actual, allowable, per diem direct care
			 costs for the calendar year preceding the fiscal year in which the rate will be
			 paid by the annual facility average case mix score for the calendar year
			 preceding the fiscal year in which the rate will be paid.
(5) "Facility level errors" means errors
			 which must be corrected before a facility average case mix score can be
			 calculated and include:
(a) Failure to
			 electronically submit the certification of Ohio developmental disabilities
			 profile data by the filing date; and
(b) Incomplete or inaccurate changes to a
			 resident's assessment data are submitted to the department.
(6) "Filing date" means the
			 deadline for initial quarterly electronic submission and certification of an
			 ICFIID's Ohio developmental disabilities profile data, which is the fifteenth
			 calendar day following the reporting period end date.
(7) "Ohio developmental
			 disabilities profile" means the instrument used to assess the needs and
			 circumstances of an individual with developmental disabilities for the purpose
			 of calculating an ICFIID's direct care component rate pursuant to sections
			 5124.19 to
			 5124.193 of the Revised
			 Code.
(8) "Peer group" means
			 one of the following groups of ICFIID:
(a)
			 "Peer group 
										1" includes each ICFIID with a medicaid-certified
			 capacity exceeding sixteen.
(b)
			 "Peer group 
										2" includes each ICFIID with a medicaid-certified
			 capacity exceeding eight but not exceeding sixteen.
(c) "Peer group 
										3" includes each
			 ICFIID with a medicaid-certified capacity of seven or eight.
(d) "Peer group 
										4" includes each
			 ICFIID with a medicaid-certified capacity not exceeding six, other than an
			 ICFIID that is in peer group 
										5.
(e) "Peer group 
										5" includes each
			 ICFIID to which all of the following apply:
(i) The ICFIID is first certified as an
			 ICFIID after July 1, 2014;
(ii) The
			 ICFIID has a medicaid-certified capacity not exceeding six;
(iii) The ICFIID has a contract with the
			 department that is for fifteen years and includes a provision for the
			 department to approve all admissions to, and discharges from, the ICFIID;
			 and
(iv) The ICFIID's residents are
			 admitted to the ICFIID directly from a department-operated ICFIID or have been
			 determined by the department to be at risk of admission to a
			 department-operated ICFIID.
(f)
										"Peer group 6"
			 includes each ICFIID to which all of the following apply:
(i)
											The ICFIID has
			 submitted a best practices protocol for providing services to youth up to
			 twenty-one years of age in need of intensive behavioral support services that
			 has been approved by the department;
(ii)
											The ICFIID, or a
			 distinct unit of the ICFIID, has a medicaid-certified capacity not exceeding
			 six;
(iii)
											The ICFIID has a contract with the department that
			 includes a provision for the department to approve all admissions to the
			 ICFIID; and
(iv)
											The ICFIID has agreed to be reimbursed in accordance
			 with the reimbursement methodology established under the rules authorized by
			 section 5124.03 of the Revised
			 Code.
(9) "Processing
			 quarter" means the quarter that follows the reporting quarter and is the
			 quarter in which the department receives the Ohio developmental disabilities
			 profile data for the reporting quarter.
(10) "Quarterly
			 facility average case mix score" means the facility average case mix score
			 based on Ohio developmental disabilities profile data submitted for one
			 reporting quarter.
(11) "Record" means a
			 resident's Ohio developmental disabilities profile data processed by the
			 department.
(12) "Relative
			 resource weight" means the measure of the relative costliness of caring for
			 residents in one case mix classification versus another, indicating the
			 relative amount and cost of staff time required on average for defined job
			 types to care for residents in a single case mix classification.
(13)
			 "Reporting period end date" means the last day of each calendar
			 quarter.
(14) "Reporting
			 quarter" means the quarter which precedes the processing quarter.
(15)
			 "Resident assessment classification system" means the system for classifying
			 residents of an ICFIID into case mix classifications that reflect clusters of
			 residents, defined by resident characteristics, determined using data from the
			 Ohio developmental disabilities profile, that explain resource use.
(16)
			 "Resident case mix score" means the relative resource weight for the
			 classification to which a resident is assigned based on data elements from the
			 resident's Ohio developmental disabilities profile.