Ohio Code 5124.52 – Overpayment amounts determined following notice of closure, etc
(A) On receipt of a written notice under section 5124.50 of the Revised Code of a facility closure or voluntary termination, on receipt of a written notice under section 5124.51 of the Revised Code of a change of operator, or on the effective date of an involuntary termination, the department of developmental disabilities shall estimate the amount of any overpayments made under the medicaid program to the exiting operator, including overpayments the exiting operator disputes, and other actual and potential debts the exiting operator owes or may owe to the department and United States centers for medicare and medicaid services under the medicaid program, including a franchise permit fee.
Terms Used In Ohio Code 5124.52
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Change of operator: means an entering operator becoming the operator of an ICF/IID in the place of the exiting operator. See Ohio Code 5124.01
- Effective date of an involuntary termination: means the date the department of medicaid terminates the operator's provider agreement for the ICF/IID or the last day that such a provider agreement is in effect when the department cancels or refuses to revalidate it. See Ohio Code 5124.01
- Exiting operator: means any of the following:
(1) An operator that will cease to be the operator of an ICF/IID on the effective date of a change of operator;
(2) An operator that will cease to be the operator of an ICF/IID on the effective date of a facility closure;
(3) An operator of an ICF/IID that is undergoing or has undergone a voluntary termination;
(4) An operator of an ICF/IID that is undergoing or has undergone an involuntary termination. See Ohio Code 5124.01
- facility closure: means either of the following:
(a) Discontinuance of the use of the building, or part of the building, that houses the facility as an ICF/IID that results in the relocation of all of the facility's residents;
(b) Conversion of the building, or part of the building, that houses an ICF/IID to a different use with any necessary license or other approval needed for that use being obtained and one or more of the facility's residents remaining in the facility to receive services under the new use. See Ohio Code 5124.01
- Franchise permit fee: means the fee imposed by sections 5168. See Ohio Code 5124.01
- Involuntary termination: means the department of medicaid's termination of, cancellation of, or refusal to revalidate the operator's provider agreement for the ICF/IID when such action is not taken at the operator's request. See Ohio Code 5124.01
- Operator: means the person or government entity responsible for the daily operating and management decisions for an ICF/IID. See Ohio Code 5124.01
- United States: includes all the states. See Ohio Code 1.59
- Voluntary termination: means an operator's voluntary election to terminate the participation of an ICF/IID in the medicaid program but to continue to provide service of the type provided by a residential facility as defined in section 5123. See Ohio Code 5124.01
(B) In estimating the exiting operator’s other actual and potential debts to the department and the United States centers for medicare and medicaid services under the medicaid program, the department shall use a debt estimation methodology the director of developmental disabilities shall establish in rules authorized by section 5124.53 of the Revised Code. The methodology shall provide for estimating all of the following that the department determines are applicable:
(1) Refunds due the department under section 5124.41 of the Revised Code;
(2) Interest owed to the department and United States centers for medicare and medicaid services;
(3) Final civil monetary and other penalties for which all right of appeal has been exhausted;
(4) Money owed the department and United States centers for medicare and medicaid services from any outstanding final fiscal audit, including a final fiscal audit for the last fiscal year or portion thereof in which the exiting operator participated in the medicaid program;
(5) Other amounts the department determines are applicable.
(C) The department shall provide the exiting operator written notice of the department’s estimate under division (A) of this section not later than thirty days after the department receives the notice under section 5124.50 of the Revised Code of the facility closure or voluntary termination; the department receives the notice under section 5124.51 of the Revised Code of the change of operator; or the effective date of the involuntary termination. The department’s written notice shall include the basis for the estimate.