Ohio Code 5165.52 – Overpayment amounts determined following notice of closure, etc
(A) On receipt of a written notice under section 5165.50 of the Revised Code of a facility closure or voluntary withdrawal of participation, on receipt of a written notice under section 5165.51 of the Revised Code of a change of operator, or on the effective date of an involuntary termination, the department of medicaid 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 under the medicaid program, including a franchise permit fee.
Terms Used In Ohio Code 5165.52
- Change of operator: includes circumstances in which an entering operator becomes the operator of a nursing facility in the place of the exiting operator or there is a change in owner of a nursing facility. See Ohio Code 5165.01
- Effective date of an involuntary termination: means the date the department of medicaid terminates the operator's provider agreement for the nursing facility. See Ohio Code 5165.01
- Exiting operator: means any of the following:
(1) An operator that will cease to be the operator of a nursing facility on the effective date of a change of operator;
(2) An operator that will cease to be the operator of a nursing facility on the effective date of a facility closure;
(3) An operator of a nursing facility that is undergoing or has undergone a voluntary withdrawal of participation;
(4) An operator of a nursing facility that is undergoing or has undergone an involuntary termination. See Ohio Code 5165.01
- 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 a nursing facility that results in the relocation of all of the nursing facility's residents;
(b) Conversion of the building, or part of the building, that houses a nursing facility to a different use with any necessary license or other approval needed for that use being obtained and one or more of the nursing facility's residents remaining in the building, or part of the building, to receive services under the new use. See Ohio Code 5165.01
- 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.
- Franchise permit fee: means the fee imposed by sections 5168. See Ohio Code 5165.01
- Involuntary termination: means the department of medicaid's termination of the operator's provider agreement for the nursing facility when the termination is not taken at the operator's request. See Ohio Code 5165.01
- Operator: means the person or government entity responsible for the daily operating and management decisions for a nursing facility. See Ohio Code 5165.01
- state: means the state of Ohio. See Ohio Code 1.59
- Voluntary withdrawal of participation: means an operator's voluntary election to terminate the participation of a nursing facility in the medicaid program but to continue to provide service of the type provided by a nursing facility. See Ohio Code 5165.01
(B) In estimating the exiting operator’s other actual and potential debts to the department under the medicaid program, the department shall use a debt estimation methodology the medicaid director shall establish in rules authorized by section 5165.53 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 5165.41 of the Revised Code;
(2) Interest owed to the department;
(3) Money owed the department from any outstanding final fiscal audit, including a final fiscal audit for the last state fiscal year or portion thereof in which the exiting operator participated in the medicaid program;
(4) 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 whichever of the following applies: the department receives the notice under section 5165.50 of the Revised Code of the facility closure or voluntary withdrawal of participation, the department receives the notice under section 5165.51 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.
Last updated October 6, 2023 at 10:43 AM