Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-3 - Long-Term Care Facilities; Nursing Facilities; Intermediate Care Facilities for the Individuals with Intellectual Disabilities › Section 5160-3-99 - Payment methodology for state-operated intermediate care facilities for individuals with intellectual disabilities (ICFs/IID)

Current through all regulations passed and filed through July 1, 2024
This rule describes the methodology for
				calculating payment rates for state-operated intermediate care facilities for
				individuals with intellectual disabilities (ICFs/IID) operated by the Ohio
				department of developmental disabilities (DODD) and is effective for periods on
				or after July 1, 2019.
(A)
								Definitions.
(1)
									"Ancillary care
			 costs" are costs for services other than direct care, incurred by the ICF/IID
			 that are reasonable and provided to ICF/IID residents through an ICF/IID
			 employee or through a contractual arrangement with the ICF/IID. For the purpose
			 of the ICF/IID cost reporting and rate calculation, ancillary care costs
			 include pharmacy, radiology, and laboratory, clinic care, and physician service
			 costs.
(2)
									"Base rate year" means the period used to establish the
			 interim payment rate for each ICF/IID.
(3)
									"Base year cost
			 report" means the cost report used to establish the interim payment
			 rate.
(4)
									"Capital costs" are reasonable costs for the
			 depreciation, amortization and interest on any capital assets that cost one
			 thousand dollars or more per item, including buildings and improvements,
			 equipment, transportation equipment, land improvements, leasehold improvements,
			 and financing costs.
(5)
									"Clinic care costs" for the purpose of the ICF/IID cost
			 reporting and rate calculation, are a component of ancillary care costs and
			 include audiology, dental and vision services and exclude direct care
			 costs.
(6)
									"Cost report" means an ODM approved, electronically
			 filed, cost report format, including its supplements and attachments, used to
			 report cost and statistical data for the operation of an
			 ICF/IID.
(7)
									"Covered services" are medicaid reimbursable services
			 provided to a resident of an ICF/IID by an ICF/IID employee or through a
			 contractual arrangement with an ICF/IID. Covered services include ancillary
			 care and direct care services.
(8)
									"Direct care
			 costs" are costs which can be directly assigned to one program or cost center
			 for services delivered to a resident of an ICF/IID through an ICF/ IID employee
			 or contractual arrangement with an ICF/IID. Direct care costs include wages,
			 taxes, staff development, contracting and consulting services. Direct care
			 costs exclude ancillary care costs.
(9)
									"Federal
			 financial participation (FFP)" means the federal government's share of a
			 state's expenditures under the medicaid program.
(10)
									"Final payment
			 rate" means the rate of payment calculated using the audited rate year cost
			 report data.
(11)
									"Final settlement" is the process where allowable and
			 reasonable costs included in the audited rate year cost report are used to
			 establish a final payment rate that is reconciled to the interim payment
			 rate.
(12)
									"Indirect cost" are costs which cannot be directly
			 assigned to one program or cost center, and benefit multiple programs or cost
			 centers.
(13)
									"Interim payment rate" means the rate of payment
			 calculated using the desk reviewed base year cost report data until the final
			 payment rate is determined.
(14)
									"Medicaid days"
			 are days an individual is eligible to receive medicaid covered
			 services.
(15)
									"Medicaid paid days" are days that an ICF/IID is paid
			 by the Ohio department of medicaid (ODM) for a medicaid eligible resident
			 residing in an ICF/IID.
(16)
									"Non-medicaid days" are days an individual is not
			 covered by medicaid and are, therefore, not billable.
(17)
									"Per diem" means
			 the payment made to an ICF/IID covering all costs (direct care, ancillary care,
			 and capital) related to the services furnished to medicaid
			 recipients.
(18)
									"Rate year" means the period where calculated interim
			 rates are paid to the ICF/IID using the base year cost report
			 data.
(19)
									"Rate year cost report" means the cost report used to
			 establish the final payment rate.
(20)
									"Reasonable and
			 allowable costs" means costs established in accordance with the centers for
			 medicare and medicaid services (CMS) publications 15-1 ("The Provider
			 Reimbursement Manual - Part 1") and 15-2 ("The Provider Reimbursement Manual -
			 Part 2") as in effect October 16, 2018, available at
https://www.cms.gov/
and 45 C.F.R. part 92 in effect as of October 16,
			 2018.
(21)
									"State-operated intermediate care facility for
			 individuals with intellectual disabilities" means an institution as defined in
			 section 1905(d) of the Social Security Act
			 42
			 U.S.C. 1396d(d) (October 16,
			 2018) and operated by DODD under a medicaid provider agreement with
			 ODM.
(22)
									"Total inpatient days" means the sum of all days during
			 which a resident, regardless of payment source, occupies a bed in an ICF/IID
			 that is included in the ICF/IID certified capacity under Title XIX of the
			 Social Security Act, 49 stat. 620,
			 42 U.S.C.A.
			 301 in effect as of October 16, 2018.
			 Therapeutic and hospital leave days for which payment is made under section
			 5124.34 of the Revised Code are
			 considered inpatient days.