Ohio Code 5124.24 – Determination of per medicaid day quality incentive payment
(A) For fiscal year 2022 and each fiscal year thereafter, the department of developmental disabilities shall determine in accordance with division (C) of this section a per medicaid day quality incentive payment for each ICF/IID that earns for the fiscal year at least one point under division (B) of this section.
Terms Used In Ohio Code 5124.24
- 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
- Desk-reviewed: means that an ICF/IID's costs as reported on a cost report filed under section 5124. 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
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- 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
- Inpatient days: means both of the following:
(1) All days during which a resident, regardless of payment source, occupies a bed in an ICF/IID that is included in the ICF/IID's medicaid-certified capacity;
(2) All days for which payment is made under section 5124. See Ohio Code 5124.01
(B) Each fiscal year beginning with fiscal year 2022, the department, in accordance with rules authorized by this section, shall award to an ICF/IID points for quality indicators the ICF/IID meets for the fiscal year. The quality indicators used under this division shall be based on the recommendations contained in the report submitted to the director of developmental disabilities by the ICF/IID quality indicators workgroup established by Section 261.230 this act .
(C) An ICF/IID’s per medicaid day quality incentive payment for a fiscal year shall be the product of the following:
(1) The relative weight point value for the fiscal year as determined under division (D) of this section;
(2) The number of points the ICF/IID was awarded under division (B) of this section for the fiscal year.
(D) The relative weight point value for a fiscal year shall be determined as follows:
(1) For each ICF/IID, determine the product of the following:
(a) The number of inpatient days the ICF/IID had for the applicable cost report year;
(b) The number of points the ICF/IID was awarded under division (B) of this section for the fiscal year.
(2) Determine the sum of all of the products determined under division (D)(1) of this section for the fiscal year;
(3) Determine the amount equal to one per cent of the total desk-reviewed, actual, allowable direct care costs of all ICFs/IID for the applicable cost report year;
(4) Divide the amount determined under division (D)(3) of this section by the sum determined under division (D)(2) of this section.
(E) The director of developmental disabilities shall adopt rules under section 5124.03 of the Revised Code as necessary to implement this section, including rules that specify or establish all of the following:
(1) The data needed for the department to determine whether an ICF/IID meets the quality indicators specified in division (B) of this section, the medium through which a report of the data is to be submitted to the department, and the date by which the report of the data must be submitted to the department;
(2) Satisfactory evidence needed to determine that an ICF/IID has met the quality indicators;
(3) The method by which ICFs/IID are to be awarded points under division (B) of this section and the number of points that each quality indicator is worth based on the quality indicator’s relative importance compared to the other quality indicators.