Ohio Code 5124.151 – Initial rates for services provided by a new ICF/IID
(A) The total per medicaid day payment rate determined under section 5124.15 of the Revised Code shall not be the initial rate for ICF/IID services provided by a new ICF/IID. Instead, the initial total per medicaid day payment rate for ICF/IID services provided by a new ICF/IID shall be determined in accordance with this section.
Terms Used In Ohio Code 5124.151
- Case-mix score: means the measure determined under section 5124. See Ohio Code 5124.01
- cost report year: means the calendar year immediately preceding the calendar year in which a fiscal year for which a medicaid payment rate determination is made begins. See Ohio Code 5124.01
- Direct care costs: means all of the following costs incurred by an ICF/IID:
(1) Costs for registered nurses, licensed practical nurses, and nurse aides employed by the ICF/IID;
(2) Costs for direct care staff, administrative nursing staff, medical directors, respiratory therapists, physical therapists, physical therapy assistants, occupational therapists, occupational therapy assistants, speech therapists, audiologists, habilitation staff (including habilitation supervisors), qualified intellectual disability professionals, program directors, social services staff, activities staff, psychologists, psychology assistants, social workers, counselors, and other persons holding degrees qualifying them to provide therapy;
(3) Costs of purchased nursing services;
(4) Costs of training and staff development, employee benefits, payroll taxes, and workers' compensation premiums or costs for self-insurance claims and related costs as specified in rules adopted under section 5124. See Ohio Code 5124.01
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- Fiscal year: means the fiscal year of this state, as specified in section 9. See Ohio Code 5124.01
- Indirect care costs: includes costs of habilitation supplies, pharmacy consultants, medical and habilitation records, program supplies, incontinence supplies, food, enterals, dietary supplies and personnel, laundry, housekeeping, security, administration, liability insurance, bookkeeping, purchasing department, human resources, communications, travel, dues, license fees, subscriptions, home office costs not otherwise allocated, legal services, accounting services, minor equipment, maintenance and repair expenses, help-wanted advertising, informational advertising, start-up costs, organizational expenses, other interest, property insurance, employee training and staff development, employee benefits, payroll taxes, and workers' compensation premiums or costs for self-insurance claims and related costs, as specified in rules adopted under section 5124. See Ohio Code 5124.01
- Other protected costs: means costs incurred by an ICF/IID for medical supplies; real estate, franchise, and property taxes; natural gas, fuel oil, water, electricity, sewage, and refuse and hazardous medical waste collection; allocated other protected home office costs; and any additional costs defined as other protected costs in rules adopted under section 5124. See Ohio Code 5124.01
- Provider: means an operator with a valid provider agreement. See Ohio Code 5124.01
(B) The initial total per medicaid day payment rate for ICF/IID services provided by a new ICF/IID, other than an ICF/IID in peer group 5, shall be determined in the following manner:
(1) The initial per medicaid day capital component rate shall be the median per medicaid day capital component rate for the ICF/IID’s peer group for the fiscal year.
(2) The initial per medicaid day direct care costs component rate shall be determined as follows:
(a) If there are no cost or resident assessment data for the new ICF/IID as necessary to determine a rate under section 5124.19 of the Revised Code, the rate shall be determined as follows:
(i) Determine the median cost per case-mix unit under division (B) of section 5124.19 of the Revised Code for the new ICF/IID’s peer group for the applicable cost report year;
(ii) Multiply the amount determined under division (B)(2)(a)(i) of this section by the median annual average case-mix score for the new ICF/IID’s peer group for that period;
(iii) Adjust the product determined under division (B)(2)(a)(ii) of this section by the rate of inflation estimated under division (D) of section 5124.19 of the Revised Code.
(b) If the new ICF/IID is a replacement ICF/IID and the ICF/IID or ICFs/IID that are being replaced are in operation immediately before the new ICF/IID opens, the rate shall be the same as the rate for the replaced ICF/IID or ICFs/IID, proportionate to the number of ICF/IID beds in each replaced ICF/IID.
(c) If the new ICF/IID is a replacement ICF/IID and the ICF/IID or ICFs/IID that are being replaced are not in operation immediately before the new ICF/IID opens, the rate shall be determined under division (B)(2)(a) of this section.
(3) The initial per medicaid day indirect care costs component rate shall be the maximum rate for the new ICF/IID’s peer group as determined for the fiscal year in accordance with division (C) of section 5124.21 of the Revised Code.
(4) The initial per medicaid day other protected costs component rate shall be one hundred fifteen per cent of the median rate for ICFs/IID determined for the fiscal year under section 5124.23 of the Revised Code.
(C) The initial total medicaid day payment rate for ICF/IID services provided by a new ICF/IID in peer group 5 shall be determined in the following manner:
(1) The initial per medicaid day capital component rate shall be $29.61.
(2) The initial per medicaid day direct care costs component rate shall be $264.89.
(3) The initial per medicaid day indirect care costs component rate shall be $59.85.
(4) The initial per medicaid day other protected costs component rate shall be $25.99.
(D)(1) Except as provided in division (D)(2) of this section, the department of developmental disabilities shall adjust a new ICF/IID’s initial total per medicaid day payment rate determined under this section effective the first day of July, to reflect new rate determinations for all ICFs/IID under this chapter.
(2) If the department accepts, under division (A) of section 5124.101 of the Revised Code, a cost report filed by the provider of a new ICF/IID, the department shall adjust the ICF/IID’s initial total per medicaid day payment rate in accordance with divisions (E) and (F) of that section rather than division (D)(1) of this section.
Last updated August 24, 2021 at 2:52 PM