5160-28-06.1 Cost-based clinics: determination of a PVPA for an FQHC service on the basis of a medicaid cost report.  

  • Text Box: ACTION: To Be Refiled Text Box: DATE: 03/30/2016 3:29 PM

     

     

     

    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

    tommi.potter@medicaid.ohio.gov

    Email

     

     

     

     

    5160-28-06.1

    Rule Number

    NEW

    TYPE of rule filing

    Rule Title/Tag Line              Cost-based clinics: determination of a PVPA for an FQHC

    service on the basis of a medicaid cost report.

    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

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

    This rule is being proposed to comply with the requirement 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 These rules are being rescinded and their provisions consolidated into a new chapter, numbered 5160-28, that addresses all three types of cost-based clinics.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 sets forth the method for determining a per-visit payment amount (PVPA) for an FQHC service on the basis of a cost report.

    An FQHC includes data in cost reports to document its productivity level. Tests of reasonableness, in the form of numerical standards, are applied to some of this information. For vision services, the benchmark figure is changed from 2.3 to 1.9 encounters per hour.

    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 response left blank because filer specified online that the rule does not incorporate a text or other material by reference.

    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:

    This response left blank because filer specified online that the rule does not incorporate a text or other material by reference.

    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

    There is no fiscal 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? No

    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? No

    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? No