Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-2 - Hospital Services › Section 5160-2-05 - Classification of hospitals

Current through all regulations passed and filed through July 1, 2024
This rule describes how hospitals
				
								are
				classified into mutually exclusive peer groups for purposes of setting rates
				and making payments under the "All Patient Refined-Diagnosis Related Group"
				(APR-DRG) inpatient prospective payment system, the "Enhanced Ambulatory
				Patient Grouping" (EAPG) outpatient prospective payment system or to those
				hospitals excluded from the prospective payment systems.
(A) Definitions.
(1)
									
									"Cancer hospitals"
			 are those hospitals recognized by medicare that primarily treat neoplastic
			 disease in accordance with 42 C.F.R.
			 412.23(f) effective October
			 1, 2022.
(2) "Children's
			 hospitals" are those hospitals that primarily serve patients eighteen years of
			 age and younger and that are excluded from medicare prospective payment in
			 accordance with 42 C.F.R.
			 412.23(d) effective October
			 1, 
									2022,
			 or are registered with the Ohio department of health in accordance with section
			 3701.07 of the Revised Code. A
			 children's hospital that has less than seventy-five beds and enrolled as a
			 medicaid provider on or after January 1, 2011,
									
									will:
(a) For the purposes of setting base rates,
			 for inpatient services as described in rule
			 5160-2-65 of the Administrative
			 Code and outpatient services as described in rule
			 5160-2-75 of the Administrative
			 Code, be grouped into its natural 
										rural or 
										urban hospital
			 peer group as described in paragraph 
										(A)(7) or 
										(A)(9) of this
			 rule; and
(b) Receive any pricing
			 considerations or differentials as if they were in the children's hospital peer
			 group.
(3)
									
									"Critical access hospitals" (CAH)
			 are those hospitals that are certified as a critical access hospital by the
			 centers for medicare and medicaid services (CMS) and excluded from medicare
			 prospective payment in accordance with
			 42 C.F.R.
			 400.202 effective October 1,
			 2022.
(4)
									
									"Freestanding long-term acute care
			 hospitals" are those hospitals in which the department of health and human
			 services has determined to be excluded from medicare prospective payment in
			 accordance with 42 C.F.R.
			 412.23(e) effective October
			 1, 2022.
(5)
									. "Freestanding psychiatric hospitals" are those hospitals
			 that are eligible to provide medicaid services as described in rule
			 5160-2-01 of the Administrative
			 Code and are grouped into their natural peer group as defined in paragraphs
			 (A)(2), (A)(3), (A)(7), (A)(8), and (A)(9) of this rule.
(6)
			 "Freestanding rehabilitation hospitals" are those hospitals in which the
			 department of health and human services has determined to be excluded from
			 medicare prospective payment in accordance with
			 42 C.F.R.
			 412.23(b) effective October
			 1, 
									2022.
(7)
									
									"Rural hospitals" are those hospitals located in Ohio
			 counties that are not classified into core based statistical areas (CBSA) as
			 designated in the inpatient prospective payment system (IPPS) case-mix and wage
			 index table as published by CMS for the federal fiscal year beginning in the
			 calendar year immediately preceding the effective date of the hospital rates. A
			 copy of the medicare IPPS case-mix and wage index table by CMS certification
			 number (CCN) is available on the department's website at
			 medicaid.ohio.gov.
(8)
									
									"Teaching
			 hospitals" are those hospitals with a major teaching emphasis that have at
			 least two hundred beds and have an intern-and resident-to-bed ratio of at least
			 .35. For non-Ohio hospitals, only those hospitals classified by the Ohio
			 department of medicaid (ODM) as teaching hospitals as of June 30, 2016, will be
			 considered non-Ohio teaching hospitals.
(9)
									"Urban hospitals"
			 are those hospitals located in Ohio counties that are classified into CBSAs as
			 designated in the IPPS case-mix and wage index table as published by CMS for
			 the federal fiscal year beginning in the calendar year immediately preceding
			 the effective date of the hospital rates, and not otherwise defined in
			 paragraphs (A)(2), (A)(3), (A)(7), and (A)(8) of this rule.
(10) For the purposes of this rule, the
			 "number of beds" is the total number of beds reported on the hospital's state
			 fiscal year (SFY) 2014 Ohio medicaid hospital cost report (ODM 02930, rev.
			 06/14).
(11) For the purposes of
			 this rule, "interns and residents" is the net number of interns and residents
			 reported on the hospital's SFY 2014 Ohio medicaid hospital cost
			 report.