5123:2-7-08 Intermediate care facilities - coverage of bed-hold days for medical necessity and other liimited absences.

 

 

 

 

 

 

 

NOTICE OF PUBLIC HEARING

 

Pursuant to Chapter 119. of the Revised Code, the Ohio Department of Developmental Disabilities hereby gives notice of its intent to adopt the following rules on a permanent basis on or about January 3, 2013, and to conduct a public hearing thereon. In accordance with section 5111.226 of the Revised Code, the Department is proposing 28 new rules necessary for the Department to assume the powers and duties of the Ohio Department of Job and Family Services (now Office of Medical Assistance) with regard to the services provided by intermediate care facilities:

 

Rule 5123:2-7-01 entitled "Intermediate Care Facilities - Definitions"

defines terms used in Chapter 5123:2-7 of the Administrative Code.

 

Rule 5123:2-7-02 entitled "Intermediate Care Facilities - Provider Agreements" sets forth the requirement for operators of intermediate care facilities to have a Medicaid provider agreement with the Ohio Office of Medical Assistance.

 

Rule 5123:2-7-03 entitled "Intermediate Care Facilities - Institutions Eligible to Participate in Medicaid" sets forth requirements for operators of intermediate care facilities to participate in the Medicaid program and receive payment for intermediate care facility services.

 

Rule 5123:2-7-04 entitled "Intermediate Care Facilities - Payment During the Ohio Office of Medical Assistance Administrative Appeals Process for Termination of a Provider Agreement" sets forth the process to be followed when the Ohio Office of Medical Assistance is required to provide an adjudicatory hearing pursuant to Chapter 119. of the Revised Code during the appeal of and proposed termination of the Medicaid provider agreement.

 

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Rule 5123:2-7-05 entitled "Intermediate Care Facilities - Payment During the State Survey Agency's Administrative Appeals Process for Termination or Non-Renewal of Medicaid Certification" sets forth the process to be followed when Medicaid certification is terminated or not renewed by the state survey agency (i.e., the Ohio Department of Health).

Rule 5123:2-7-06 entitled "Intermediate Care Facilities - Level of Care Review Process" sets forth the requirements and process for conduct of level of care review of individuals seeking admission or readmission to an intermediate care facility or seeking admission to a different intermediate care facility.

Rule 5123:2-7-07 entitled "Intermediate Care Facilities - Resource Assessment Notice" sets forth the requirement for intermediate care facilities to furnish notice to individuals of an individual's right to have a resource assessment performed by the county department of job and family services.

Rule 5123:2-7-08 entitled "Intermediate Care Facilities - Coverage of Bed- Hold Days for Medical Necessity and Other Limited Absences" sets forth terms and requirements regarding bed-hold days.

Rule 5123:2-7-09 entitled "Intermediate Care Facilities - Personal Needs Allowance Accounts and Other Resident Funds" sets forth requirements regarding management, deposit, accounting, release, use, and conveyance of personal needs allowance accounts and other resident funds.

Rule 5123:2-7-10 entitled "Intermediate Care Facilities - Outlier Services for Behavioral Redirection and Medical Monitoring" identifies a subpopulation of individuals determined to require an intermediate care facility level of care whose care needs are not adequately measured by the individual assessment form or by the resident assessment classification and case mix payment system described in rule 5123:2-7-20 of the Administrative Code.

Rule 5123:2-7-11 entitled "Intermediate Care Facilities - Relationship of Other Covered Medicaid Services" identifies covered services generally available to Medicaid recipients and describes the relationship of such services to those provided in an intermediate care facility.

Rule 5123:2-7-12 entitled "Intermediate Care Facilities - Medicaid Cost Report, Record Retention, and Disclosure Requirements" sets forth the requirement and procedures for intermediate care facilities to file a Medicaid cost report with the Department.

Rule 5123:2-7-13 entitled "Intermediate Care Facilities - Rate Calculations, Interest on Overpayments, Penalties, Repayment of Overpayments, and Deposit of Repayment of Overpayments" sets forth procedures to be followed when it is determined that an intermediate care facility received a higher rate than it was entitled to receive.

Rule 5123:2-7-14 entitled "Intermediate Care Facilities - Debt Estimation, Debt Summary Report, and Successor Liability Agreements for Change of Operator, Facility Closure, Voluntary Termination, Involuntary Termination, or Voluntary Withdrawal" sets forth the method used to estimate an exiting operator's actual and potential debts to the Department and the federal Centers for Medicare and Medicaid Services and sets forth requirements for successor liability agreements.

Rule 5123:2-7-15 entitled "Intermediate Care Facilities - Payment and Adjustment Process" sets forth the process for intermediate care facilities to be reimbursed for services.

Rule 5123:2-7-16 entitled "Intermediate Care Facilities - Chart of Accounts" provides a recommended chart of accounts for providers to use for Medicaid cost reporting purposes.

Rule 5123:2-7-17 entitled "Intermediate Care Facilities - Leased Staff Services" sets forth requirements for staff leasing arrangements to be reimbursable through the Medicaid cost reporting mechanism.

Rule 5123:2-7-18 entitled "Intermediate Care Facilities - Capital Asset and Depreciation Guidelines" provides guidelines to determine if an expenditure should be capitalized, instructions to determine the useful life of a capital asset, and conventions to calculate depreciation expense.

Rule 5123:2-7-19 entitled "Intermediate Care Facilities - Nonreimbursable Costs" provides a list of costs which are not reimbursable through the Medicaid cost reporting mechanism.

Rule 5123:2-7-20 entitled "Intermediate Care Facilities - Resident Classification and Case Mix Payment System" describes the system and process used to classify residents of intermediate care facilities into case mix classifications used to gather data for the direct care payment system.

Rule 5123:2-7-21 entitled "Intermediate Care Facilities - Cost Limits, Reasonable Costs for Compensation, and Compensation Disallowances if any for Owners and Relatives of Owners" provides guidelines and instructions for calculating compensation cost limits for owners and relatives of owners of intermediate care facilities.

Rule 5123:2-7-22 entitled "Intermediate Care Facilities - Cost Limits, Reasonable Costs for Compensation, and Compensation Disallowances if any for Administrators" provides guidelines and instructions for calculating compensation cost limits for administrators of intermediate care facilities who are not owners and relatives of owners.

Rule 5123:2-7-23 entitled "Intermediate Care Facilities - Method for Establishing the Other Protected Costs Component of the Prospective Rate" describes how the per diem rate for each resident for other protected costs is established.

Rule 5123:2-7-24 entitled "Intermediate Care Facilities - Cost of Ownership, Efficiency Incentive, and Reporting of Accumulated Depreciation" describes how the per diem cost of ownership is determined and sets forth that an efficiency incentive is paid in accordance with section

5111.25 of the Revised Code.

Rule 5123:2-7-25 entitled "Intermediate Care Facilities - Nonextensive Renovation" describes how the per diem cost of nonextensive renovation is determined.

Rule 5123:2-7-26 entitled "Intermediate Care Facilities - Active Treatment Day Programming" sets forth requirements for an active treatment program and establishes that the costs of active treatment day programming are part of the direct care costs of an intermediate care facility as off-site active treatment day programming.

Rule 5123:2-7-27 entitled "Intermediate Care Facilities - Prospective Rate Reconsideration on the Basis of Possible Calculation Errors" sets forth the requirements and process for an intermediate care facility to request reconsideration of a prospective rate on the basis of a possible error in the calculation of the rate.

Rule 5123:2-7-28 entitled "Intermediate Care Facilities - Prospective Rate Reconsideration on the Basis of Extreme Hardship Upon Admission of a Resident from a State-Operated Developmental Center" sets forth the requirements and process for an intermediate care facility to request reconsideration of a prospective rate upon direct admission of a resident from a state-operated developmental center.

A public hearing on the proposed rule actions will be held on November 21, 2012, beginning at 10:00 a.m., and continuing until all persons in attendance have had an opportunity to testify. The hearing will be held in the Lobby Hearing Room of the Rhodes State Office Tower located at 30 East Broad Street, Columbus, Ohio 43215. At this hearing, the Department will accept verbal and/or written testimony on the proposed rule actions under consideration.

Persons unable to attend the public hearing may submit written comments on the proposed rules. Any written comments received on or before the public hearing date will be treated as testimony and made available for public review. Submittal of written comments may be made to Becky Phillips, Administrative Rules Coordinator, by email to [e-mail], by fax to 614/644- 5013, or by U.S. mail to 30 East Broad Street, 12th Floor, Columbus, Ohio 43215- 3414.

The rules are available at the Register of Ohio website:  http://registerofohio.state.oh.us and at the Department's website:  https://doddportal.dodd.ohio.gov/rules/underdevelopment/Pages/default.aspx. The rules are also available for review at each county board of developmental disabilities.