Effective: September 30, 2021
Latest Legislation: House Bill 110 - 134th General Assembly
(A) For each fiscal year, the department of developmental disabilities shall determine each ICF/IID's per medicaid day indirect care costs component rate. An ICF/IID's rate shall be the lesser of the individual rate determined under division (B) of this section and the maximum rate determined for the ICF/IID's peer group under division (C) of this section.
(B) An ICF/IID's individual rate is the sum of the following:
(1) The ICF/IID's desk-reviewed, actual, allowable, per diem indirect care costs for the applicable cost report year, adjusted for the inflation rate estimated under division (E) of this section;
(2) Subject to division (D) of this section, an efficiency incentive equal to the difference between the amount of the per diem indirect care costs for the applicable cost report year determined for the ICF/IID under division (B)(1) of this section and the maximum rate established for the ICF/IID's peer group under division (C) of this section for that year.
(C)(1) The maximum rate for an ICF/IID's peer group shall be the following percentage above the peer group's median per diem indirect care costs for the applicable cost report year:
(a) For ICFs/IID in peer group 1, eight per cent;
(b) For ICFs/IID in peer group 2 or peer group 3, ten per cent;
(c) For ICFs/IID in peer group 4 or peer group 5, twelve per cent.
(2) The department shall not redetermine a peer group's maximum rate under division (C)(1) of this section based on additional information that it receives after the maximum rate is set. The department shall redetermine a peer group's maximum rate only if the department made an error in computing the maximum rate based on the information available to the department at the time of the original calculation.
(D) The efficiency incentive for an ICF/IID shall not exceed the following:
(1) If the ICF/IID is in peer group 1, five per cent of the peer group's maximum rate established under division (C)(1)(a) of this section;
(2) If the ICF/IID is in peer group 2, peer group 3, peer group 4, or peer group 5, six per cent of the peer group's maximum rate established under division (C)(1)(b) or (c) of this section.
(E) When adjusting rates for inflation under division (B)(1) of this section, the department shall estimate the rate of inflation for the eighteen-month period beginning on the first day of July of the applicable cost report year and ending on the thirty-first day of December of the fiscal year for which the rate is determined. To estimate the rate of inflation, the department shall use the following:
(1) Subject to division (E)(2) of this section, the consumer price index for all items for all urban consumers for the midwest region, published by the United States bureau of labor statistics;
(2) If the United States bureau of labor statistics ceases to publish the index specified in division (E)(1) of this section, a comparable index that the bureau publishes and the department determines is appropriate.
Last updated August 24, 2021 at 2:55 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.