5160-58-05.3 MyCare Ohio waiver: incident management system.  

  • Text Box: ACTION: Revised Text Box: DATE: 04/20/2016 10:51 AM

     

     

     

    Rule Summary and Fiscal Analysis (Part A)

     

    Ohio Department of Medicaid

    Agency Name

     

    Tommi Potter

    Division                                                                  Contact

     

    50 West Town Street Suite 400 Columbus OH 43218-2709

    614-752-3877        614-995-1301

    Agency Mailing Address (Plus Zip)                                       Phone                     Fax

    Tommi.Potter@medicaid.ohio.gov

    Email

    5160-58-05.3

    Rule Number

    AMENDMENT

    TYPE of rule filing

    Rule Title/Tag Line              MyCare Ohio waiver: incident management system.

    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, 5164.91

    5.  Statute(s) the rule, as filed, amplifies or implements: 5164.02, 5164.91, 5166.02, 5167.02

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

    This rule is being proposed for amendment to update policy relating to the administration of the Medicaid program.

    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:

    The rule sets forth the MyCare Ohio incident requirements. The changes to this rule accommodate the inclusion of requirements specific to the Specialized Recovery Service Program (SRSP) enacted pursuant to Section 1915(i) of the Social Security Act, including the population enrolled in SRSP and specific types of incidents that require investigation.

    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 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).

    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 R.C. 121.71 to

    121.74 pursuant to R.C. 121.76(A)(1).

    This rule incorporates one or more dated references to the U.S. Code. This question is not applicable to any dated incorporation by reference to the U.S. Code because such reference is exempt from compliance with RC 121.71 to 121.74 in accordance with RC 121.75(A).

    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:

    Corrected file type.

    12.  Five Year Review (FYR) Date: 3/1/2019

    (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

    No impact to current 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:

    This rule adds recipients eligible for Medicaid through the Specialized Recovery Services Program to the incident management system requirements. When designing the capitation payments for the

    MyCare Ohio demonstration, the State's actuary accounted for the administrative expenses associated with waiver service coordination, copying and distributing documents and other informational materials, and incident reporting and

    management to members and their families. Additionally, ODM entered into a competitively bid contract with an entity for provider oversight and reimburses the contractor accordingly.

    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? 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? Yes

    Pursuant to paragraph (N) of this rule, MyCare Ohio providers who do not comply with this rule may be subject to monetary and other sanctions that could result in their inability to participate in the Medicaid waiver program.

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

    This rule requires reports of information.