Effective: September 30, 2021
Latest Legislation: House Bill 110 - 134th General Assembly
(A) The total per medicaid day payment rate determined under section 5124.15 of the Revised Code shall not be paid for ICF/IID services provided by an ICF/IID, or discrete unit of an ICF/IID, designated by the department of developmental disabilities as an outlier ICF/IID or unit. Instead, the provider of a designated outlier ICF/IID or unit shall be paid each fiscal year a total per medicaid day payment rate that the department shall prospectively determine in accordance with a methodology established in rules authorized by this section.
(B) The department may designate an ICF/IID, or discrete unit of an ICF/IID, as an outlier ICF/IID or unit if the ICF/IID or unit serves residents who have either of the following:
(1) Diagnoses or special care needs that require direct care resources that are not measured adequately by the resident assessment instrument specified in rules authorized by section 5124.191 of the Revised Code;
(2) Diagnoses or special care needs that are specified in rules authorized by this section as otherwise qualifying for consideration under this section.
(C) Notwithstanding any other provision of this chapter, the costs incurred by a designated outlier ICF/IID or unit shall not be considered in establishing medicaid payment rates for other ICFs/IID or units.
(D) The director of developmental disabilities shall adopt rules under section 5124.03 of the Revised Code as necessary to implement this section.
(1)(a) The rules shall do both of the following:
(i) Specify the criteria and procedures the department will apply when designating an ICF/IID, or discrete unit of an ICF/IID, as an outlier ICF/IID or unit;
(ii) Establish a methodology for prospectively determining the total per medicaid day payment rate that will be paid each fiscal year for ICF/IID services provided by a designated outlier ICF/IID or unit.
(b) The rules adopted under division (D)(1)(a)(i) of this section regarding the criteria for designating outlier ICFs/IID and units shall do both of the following:
(i) Provide for consideration of whether all of the allowable costs of an ICF/IID, or discrete unit of an ICF/IID, would be paid by the rate determined under section 5124.15 of the Revised Code;
(ii) Specify the minimum number of ICF/IID beds that an ICF/IID, or discrete unit of an ICF/IID, must have to be designated an outlier ICF/IID or unit.
(c) The rules authorized by division (D)(1)(a)(i) of this section regarding the criteria for designating outlier ICFs/IID and units shall not limit the designation to ICFs/IID, or discrete units of ICFs/IID, located in large cities.
(d) The rules authorized by division (D)(1)(a)(ii) of this section regarding the methodology for prospectively determining the rates of designated outlier ICFs/IID and units shall provide for the methodology to consider the historical costs of providing ICF/IID services to the residents of designated outlier ICFs/IID and units.
(2)(a) The rules may do both of the following:
(i) Include for designation as an outlier ICF/IID or unit, an ICF/IID, or discrete unit of an ICF/IID, that serves residents who have complex medical conditions or severe behavioral problems;
(ii) Require that a designated outlier ICF/IID or unit receive authorization from the department before admitting or retaining a resident.
(b) If the director adopts rules authorized by division (D)(2)(a)(ii) of this section regarding the authorization of a designated outlier ICF/IID or unit to admit or retain a resident, the rules shall specify the criteria and procedures the department will apply when granting the authorization.
Last updated August 24, 2021 at 2:52 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.