Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-2 - Hospital Services › Section 5160-2-10 - Payment policies for disproportionate share and indigent care adjustments for psychiatric hospitals

Current through all regulations passed and filed through July 1, 2024
This rule is applicable for each program year for all
				medicaid-participating psychiatric hospitals as described in paragraphs (B) to
				(D) of rule
				5160-2-01 of the Administrative
				Code.
(A) Definitions for each
			 psychiatric hospital.
(1) "Cash subsidies for
			 inpatient services received directly from state and local governments" is the
			 amount of cash subsidies each psychiatric hospital has received from state and
			 local governments for inpatient services for the applicable state fiscal year.
			 In accordance with paragraph (C) of this rule, each psychiatric hospital
			 reports cash subsidies received from state and local government on "Ohio
			 Medicaid Hospital Cost Report" ODM 02930, for the applicable state fiscal year,
			 schedule F, section II, column 4.
(2) "Charges for charity care" is the total
			 charges for inpatient services provided to indigent patients, which includes
			 charges for services provided to individuals who do not possess health
			 insurance for the service provided. Charity care does not include bad debts,
			 contractual allowances, or uncompensated care costs rendered to patients with
			 insurance as described in paragraph (A)(13) of this rule. Each psychiatric
			 hospital reports charges for charity care on ODM 02930, schedule F, section II,
			 column 3.
(3) "Inpatient days" is
			 the sum of the number of inpatient fee for service (FFS) hospital days as
			 reported on ODM 02930, schedule C, section I, column 4 and the number of
			 inpatient managed care plan (MCP) hospital days as reported on ODM 02930,
			 schedule C, section III, column 2.
(4) "Insurance revenues" are the revenues
			 received in the same twelve months of the hospital's cost-reporting period for
			 inpatient services provided to, billed to, and received from all sources other
			 than medicaid or self-pay revenues as described in paragraph (A)(6) of this
			 rule. Each psychiatric hospital reports insurance revenues on ODM 02930,
			 schedule F, section II, column 1.
(5) "Medicaid inpatient utilization rate" is
			 the ratio of the psychiatric hospital's number of inpatient days attributable
			 to patients who were medicaid eligible as described in paragraph (A)(10) of
			 this rule divided by the psychiatric hospital's total number of inpatient days
			 as described in paragraph (A)(3) of this rule.
(6) "Self-pay revenues" are the revenues
			 received in the same twelve months of the hospital's cost-reporting period for
			 inpatient services provided to, billed to, and received from either the person
			 that received inpatient services or the family of the person that received
			 inpatient services. Each psychiatric hospital reports self-pay revenues on ODM
			 02930, schedule F, section II, column 2.
(7) "Total charges for inpatient services"
			 for each psychiatric hospital, except for free-standing, state-owned
			 psychiatric hospitals, is the sum of the amounts reported for inpatient
			 hospital services on ODM 02930, schedule B, column 6. For free-standing,
			 state-owned psychiatric hospitals, "total charges for inpatient services"
			 equals "total inpatient allowable costs" as defined in paragraph (A)(9) of this
			 rule.
(8) "Total facility inpatient
			 revenues" is the sum of the hospital's insurance revenues as described in
			 paragraph (A)(4) of this rule, self-pay revenues as described in paragraph
			 (A)(6) of this rule, and total medicaid revenues as described in paragraph
			 (A)(11) of this rule.
(9) "Total
			 inpatient allowable costs" is the sum of the general service and capital
			 related costs for inpatient hospital services. Each psychiatric hospital
			 reports total inpatient allowable costs on ODM 02930 schedule B, column
			 7.
(10) "Total medicaid days" is
			 the sum of the amounts that each psychiatric hospital reports on ODM 02930,
			 schedule F, section II, columns 6 to 8.
(11) "Total medicaid revenues" are the
			 revenues received in the same twelve months of the hospital's cost-reporting
			 period for inpatient services provided to, billed to, and received from all
			 sources other than insurance revenues as described in paragraph (A)(4) of this
			 rule or self-pay revenues as described in paragraph (A)(6) of this rule. Each
			 psychiatric hospital reports total FFS medicaid revenues on ODM 02930, schedule
			 H, section I, column 1 and total MCP medicaid revenues on ODM 02930, schedule
			 I, column 2.
(12) "Uncompensated
			 care costs" is the amount calculated by subtracting the sum of the total
			 facility inpatient revenue as described in paragraph (A)(8) of this rule and
			 the uncompensated care costs rendered to patients with insurance as described
			 in paragraph (A)(13) of this rule from the total inpatient allowable costs as
			 described in paragraph (A)(9) of this rule. For hospitals with negative
			 uncompensated care costs, the result is equal to zero.
(13) "Uncompensated care costs rendered to
			 patients with insurance" is the costs for an individual that has insurance
			 coverage for the service provided, but the full cost of the service was not
			 reimbursed because of per diem caps or coverage limitations. Each psychiatric
			 hospital reports uncompensated care costs rendered to patients with insurance
			 on ODM 02930, schedule F, section II, column 5.