Effective: September 30, 2021
Latest Legislation: House Bill 110 - 134th General Assembly
(A) Except as otherwise provided by section 5124.101 of the Revised Code, sections 5124.151 to 5124.154 of the Revised Code, and divisions (B) and (C) of this section, the total per medicaid day payment rate that the department of developmental disabilities shall pay to an ICF/IID provider for ICF/IID services the provider's ICF/IID provides during a fiscal year shall equal the sum of all of the following:
(1) The per medicaid day capital component rate determined for the ICF/IID under section 5124.17 of the Revised Code;
(2) The per medicaid day direct care costs component rate determined for the ICF/IID under section 5124.19 of the Revised Code;
(3) The per medicaid day indirect care costs component rate determined for the ICF/IID under section 5124.21 of the Revised Code;
(4) The per medicaid day other protected costs component rate determined for the ICF/IID under section 5124.23 of the Revised Code;
(5) The sum of the following:
(a) The per medicaid day quality incentive payment determined for the ICF/IID under section 5124.24 of the Revised Code;
(b) A direct support personnel payment equal to two and four-hundredths per cent of the ICF/IID's desk-reviewed, actual, allowable, per medicaid day direct care costs from the applicable cost report year.
(B) The total per medicaid day payment rate for an ICF/IID that is in peer group 5 shall not exceed the average total per medicaid day payment rate in effect on July 1, 2013, for developmental centers.
(C) The department shall adjust the total per medicaid day payment rate otherwise determined for an ICF/IID under this section as directed by the general assembly through the enactment of law governing medicaid payments to ICF/IID providers.
(D)(1) In addition to paying an ICF/IID provider the total per medicaid day payment rate determined for the provider's ICF/IID under divisions (A), (B), and (C) of this section for a fiscal year, the department may do either or both of the following:
(a) In accordance with section 5124.25 of the Revised Code, pay the provider a rate add-on for ventilator-dependent outlier ICF/IID services if the rate add-on is to be paid under that section and the department approves the provider's application for the rate add-on;
(b) In accordance with section 5124.26 of the Revised Code, pay the provider for outlier ICF/IID services the ICF/IID provides to residents identified as needing intensive behavioral health support services if the rate add-on is to be paid under that section and the department approves the provider's application for the rate add-on.
(2) The rate add-ons are not to be part of the ICF/IID's total per medicaid day payment rate.
Last updated August 24, 2021 at 2:51 PM
Structure Ohio Revised Code
Chapter 5124 | Intermediate Care Facility for Individuals With Intellectual Disabilities Services
Section 5124.01 | Definitions.
Section 5124.05 | Scope of Coverage.
Section 5124.06 | Eligibility to Enter Into Provider Agreements.
Section 5124.07 | Department Provider Agreements; Contents.
Section 5124.071 | Agreements With More Than One Icf/iid.
Section 5124.072 | Revalidation of Agreements.
Section 5124.08 | Provider Agreements With Icf/iid Providers.
Section 5124.081 | Resident's Cause of Action for Breach.
Section 5124.10 | Cost Reports.
Section 5124.101 | Cost Reports for Downsized or Partially Converted Provider.
Section 5124.102 | Fines Paid Excluded From Reports.
Section 5124.103 | Form of Cost Reports.
Section 5124.104 | Duties of Department.
Section 5124.105 | Addendum for Disputed Costs.
Section 5124.106 | Failure to Timely File Report; Consequences.
Section 5124.107 | Amendments to Reports.
Section 5124.108 | Desk Review.
Section 5124.15 | Amount of Payments.
Section 5124.151 | Initial Rates for Services Provided by a New Icf/iid.
Section 5124.152 | Payment Rate for Service Provided by Outlier Icf/iid or Unit.
Section 5124.154 | Computing Rate for Services Provided by Developmental Centers.
Section 5124.17 | Icf/iid's per Medicaid Day Capital Component Rate.
Section 5124.19 | Icf/iid's per Medicaid Day Direct Care Costs Component Rate.
Section 5124.191 | Definition of Icf/iid Resident; Assessment of Residents.
Section 5124.192 | Acuity Groups for Purpose of Assigning Case-Mix Scores.
Section 5124.193 | Quarterly Determination of Case-Mix Scores.
Section 5124.194 | Changes to Instructions, Guidelines, or Methodology.
Section 5124.21 | Per Medicaid Day Indirect Care Costs Component Rate.
Section 5124.23 | Per Medicaid Day Other Protected Costs Component Rate.
Section 5124.24 | Determination of per Medicaid Day Quality Incentive Payment.
Section 5124.26 | Payment of Medicaid Rate Add-on for Outlier Icf/iid Services.
Section 5124.30 | Costs of Goods Furnished by Related Party.
Section 5124.31 | Adjustment of Payment Rates.
Section 5124.32 | Reduction in Rate Not Permitted.
Section 5124.33 | No Payment for Day of Discharge.
Section 5124.34 | Payment for Reserving Beds.
Section 5124.35 | Timing of Payments After Involuntary Termination.
Section 5124.37 | Timing of Payments; Calculations.
Section 5124.38 | Process for Reconsideration of Rates.
Section 5124.39 | Recoupment in Case of Delay in Downsizing.
Section 5124.40 | Adjustment of Rates.
Section 5124.41 | Redetermination of Rates.
Section 5124.42 | Additional Penalties.
Section 5124.43 | Determination of Interest Rate.
Section 5124.45 | Deposits to General Revenue Fund.
Section 5124.46 | Adjudications Under the Administrative Procedure Act.
Section 5124.50 | Notice of Facility Closure or Voluntary Termination.
Section 5124.51 | Notice of Change of Operator.
Section 5124.511 | Agreements With Entering Operators Effective on Date of Change of Operator.
Section 5124.512 | Agreements With Entering Operators Effective at a Later Date.
Section 5124.513 | Entering Operator Duties Under Provider Agreement.
Section 5124.514 | Exiting Operator Deemed Operator Pending Change.
Section 5124.515 | Provider Agreement With Operator Not Complying With Prior Agreement.
Section 5124.516 | Medicaid Reimbursement Adjustments; Change of Operator.
Section 5124.517 | Determination That a Change of Operator Has or Has Not Occurred; Effect.
Section 5124.52 | Overpayment Amounts Determined Following Notice of Closure, Etc.
Section 5124.521 | Withholding From Medicaid Payment Due Exiting Operator.
Section 5124.522 | Cost Report by Exiting Operator; Waiver.
Section 5124.523 | Failure to File Cost Report; Payments Deemed Overpayments.
Section 5124.524 | Final Payment Withheld Pending Receipt of Cost Reports.
Section 5124.525 | Determination of Debt of Exiting Operator; Summary Report.
Section 5124.526 | Release of Amount Withheld Less Amounts Owed.
Section 5124.527 | Release of Amount Withheld on Postponement of Change of Operator.
Section 5124.528 | Disposition of Amounts Withheld From Payment Due an Exiting Operator.
Section 5124.53 | Adoption of Rules for Implementation of Sections 5124.50 to 5124.53.
Section 5124.60 | Conversion of Beds to Home and Community-Based Services.
Section 5124.61 | Conversion of Beds in Acquired Icf/iid.
Section 5124.62 | Request for Federal Approval of Conversion of Beds.
Section 5124.65 | Reconversion of Beds to Icf/iid Use.
Section 5124.69 | Informational Pamphlet.
Section 5124.70 | Maximum Number of Residents per Sleeping Room.
Section 5124.99 | Penalty for Violation of Cost Reporting Provisions.