5160-28-02 Federally qualified health centers (FQHCs): covered services.

 

 

 

Rule Summary and Fiscal Analysis (Part A)

 

Ohio Department of Medicaid

Agency Name

 

Tommi Potter

Division                                                                  Contact

 

50 Town St 4th floor Columbus OH 43218-2709 Agency Mailing Address (Plus Zip)	614-752-3877 Phone	Fax
[e-mail] Email

 

 

5160-28-02

Rule Number

NEW

TYPE of rule filing

Rule Title/Tag Line              Cost-based   clinics:   medicaid   provider   requirements   and

limitations.

RULE SUMMARY

1.  Is the rule being filed for five year review (FYR)? No

2.  Are you proposing this rule as a result of recent legislation? No

3.  Statute prescribing the procedure in accordance with the agency is required to adopt the rule: 119.03

4.  Statute(s) authorizing agency to adopt the rule: 5164.02

5.  Statute(s) the rule, as filed, amplifies or implements: 5164.02, 5164.05

6.  State the reason(s) for proposing (i.e., why are you filing,) this rule:

This rule is being proposed to comply with the requirment for five-year rule review.

7.  If the rule is an AMENDMENT, then summarize the changes and the content of the proposed rule; If the rule type is RESCISSION, NEW or NO CHANGE, then summarize the content of the rule:

Rules concerning the delivery of services in federally qualified health centers (FQHCs), outpatient health facilities (OHFs), and rural health clinics (RHCs) are

currently set forth respectively in Chapters 5160-28, 5160-29, and 5160-16 of the Ohio Administrative Code. These rules are being rescinded and their provisions consolidated into a new chapter, numbered 5160-28, that addresses all three types of cost-based clinics.

This rule identifies the requirements for and limitations on a provider enrolled as a cost-based clinic.

Under this new rule, an FQHC (either a "participating" FQHC or an FQHC

look-alike) seeking to enroll as a Medicaid provider must submit to the Department a copy of the letter from the United States Secretary of Health and Human Services (HHS) confirming that its service sites meet the requirements for receiving grant funding under section 330 of the Public Health Service Act (PHSA). The existing requirement that an FQHC submit documentation from the Health Resources and Services Administration (HRSA) is dropped.

An outdated provision concerning Medicare crossover claims is removed.

8.  If the rule incorporates a text or other material by reference and the agency claims the incorporation by reference is exempt from compliance with sections

121.71 to 121.74 of the Revised Code because the text or other material is generally available to persons who reasonably can be expected to be affected by the rule, provide an explanation of how the text or other material is generally available to those persons:

This rule incorporates one or more references to the Ohio Revised Code. This question is not applicable to any incorporation by reference to the Ohio Revised Code because such reference is exempt from compliance with RC 121.71 to 121.74 pursuant to RC 121.76(A)(1).

This rule incorporates one or more references to another rule or rules of the Ohio Administrative Code. This question is not applicable to any incorporation by reference to another OAC rule because such reference is exempt from compliance with RC 121.71 to 121.74 pursuant to RC 121.76(A)(3).

9.  If the rule incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material electronically, provide an explanation of why filing the text or other material electronically was infeasible:

Not Applicable.

10.  If the rule is being rescinded and incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material,

provide an explanation of why filing the text or other material was infeasible:

Not Applicable.

11.  If revising or refiling this rule, identify changes made from the previously filed version of this rule; if none, please state so. If applicable, indicate each specific paragraph of the rule that has been modified:

Not Applicable.

12.  Five Year Review (FYR) Date:

(If the rule is not exempt and you answered NO to question No. 1, provide the scheduled review date. If you answered YES to No. 1, the review date for this rule is the filing date.)

NOTE: If the rule is not exempt at the time of final filing, two dates are required: the current review date plus a date not to exceed 5 years from the effective date for Amended rules or a date not to exceed 5 years from the review date for No Change rules.

FISCAL ANALYSIS

13.  Estimate the total amount by which this proposed rule would increase / decrease either revenues / expenditures for the agency during the current biennium (in dollars): Explain the net impact of the proposed changes to the budget of your agency/department.

This will have no impact on revenues or expenditures.

$0.00

This rule sets forth the requirements for and limitations on a provider enrolled as a cost-based clinic. It has no impact on the Medicaid budget.

14.  Identify the appropriation (by line item etc.) that authorizes each expenditure necessitated by the proposed rule:

Not applicable.

15.  Provide a summary of the estimated cost of compliance with the rule to all directly affected persons. When appropriate, please include the source for your information/estimated costs, e.g. industry, CFR, internal/agency:

There is no cost of compliance associated with this rule.

16.  Does this rule have a fiscal effect on school districts, counties, townships, or municipal corporations? Yes

You must complete Part B of the Rule Summary and Fiscal Analysis in order to comply with Am. Sub. S.B. 33 of the 120th General Assembly.

17.  Does this rule deal with environmental protection or contain a component dealing with environmental protection as defined in R. C. 121.39? No

S.B. 2 (129th General Assembly) Questions

18.  Has this rule been filed with the Common Sense Initiative Office pursuant to

R.C. 121.82? Yes

19.  Specific to this rule, answer the following:

A.) Does this rule require a license, permit, or any other prior authorization to engage in or operate a line of business? No

B.) Does this rule impose a criminal penalty, a civil penalty, or another sanction, or create a cause of action, for failure to comply with its terms? No

C.) Does this rule require specific expenditures or the report of information as a condition of compliance? Yes

A Federally Qualified Health Center must submit a copy of the letter from the United States Secretary of Health and Human Services confirming that its service site meets the requirement for receiving grant funding under the Public Health Service Act.

An Outpatient Health Facility (OHF) that operates more than one service site and that chooses to enroll them under a single provider number must provide written assurance that each service site independently meets all the requirements for an OHF.

                                                                                                                                             

Page B-1                                                                                   Rule Number: 5160-28-02

Rule Summary and Fiscal Analysis (Part B)

1.  Does the Proposed rule have a fiscal effect on any of the following?

(a)  School Districts

(b)    Counties                                 (c) Townships           (d) Municipal

Corporations

No                                Yes                              No                                Yes

2.  Please provide an estimate in dollars of the cost of compliance with the proposed rule for school districts, counties, townships, or municipal corporations. If you are unable to provide an estimate in dollars, please provide a written explanation of why it is not possible to provide such an estimate.

Rural Health Clinincs and Outpatient Health Facilities are not affiliated with counties or municipal corporations and are not addressed here.

This rule requires FQHCs, some of which may be operated by a county or municipal corporation, to submit a copy of a letter from the United States Secretary of Health and Human Services (HHS) confirming that its service site meets the requirements for receiving grant funding under the Public Health Service Act. This requirement applies primarily in instances of new start FQHCs. The cost of compliance is estimated by the Department at less than $50.00.

3.  If the proposed rule is the result of a federal requirement, does the proposed rule exceed the scope and intent of the federal requirement? No

4.  If the proposed rule exceeds the minimum necessary federal requirement, please provide an estimate of, and justification for, the excess costs that exceed the cost of the federal requirement. In particular, please provide an estimate of the excess costs that exceed the cost of the federal requirement for (a) school districts, (b) counties, (c) townships, and (d) municipal corporations.

Not Applicable.

5.  Please provide a comprehensive cost estimate for the proposed rule that includes the procedure and method used for calculating the cost of compliance. This comprehensive cost estimate should identify all of the major cost categories including, but not limited to, (a) personnel costs, (b) new equipment or other capital costs, (c) operating costs, and (d) any indirect central service costs.

The comprehensive cost estimates are provided in the following sections.

(a)  Personnel Costs

The cost of compliance--estimated by the Department at less than

$50.00--will be incurred in the personnel costs category. Personnel costs are likely to include receiving, photocopying, and submitting to the Department a letter from the Health Resources and Services Administration confirming that its service site meets the requirements for receiving grant funding under the Public Health Service Act. This requirement applies primarily in instances of new start FQHCs.

(b)  New Equipment or Other Capital Costs

ODM does not expect that the proposed rule will result in any increase in new equipment or other capital costs to Medicaid providers.

(c)  Operating Costs

ODM does not expect that the proposed rule will result in any increase in operating costs to Medicaid providers.

(d)  Any Indirect Central Service Costs

ODM does not expect that the proposed rule will result in any increase in indirect central service costs to Medicaid providers.

(e)  Other Costs

ODM does not expect that the proposed rule will result in any increase in other costs to Medicaid providers.

6.  Please provide a written explanation of the agency's and the local government's ability to pay for the new requirements imposed by the proposed rule.

There are no new implementation costs associated with this rule.

7.  Please provide a statement on the proposed rule's impact on economic development.

There is no discernable impact on economic development as a result of this proposed rule.