5160-2-65 Inpatient hospital reimbursement.

 

 

 

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	614-995-1301 Fax
[e-mail] Email

 

 

5160-2-65

Rule Number

AMENDMENT

TYPE of rule filing

Rule Title/Tag Line              Inpatient hospital reimbursement.

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: 5162.03

5.  Statute(s) the rule, as filed, amplifies or implements: 5162.03, 5164.02, 5164.70

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 regarding the stop loss/stop gain provision and the classification of rural hospitals.

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:

Rule 5160-2-65 sets forth the inpatient hospital reimbursement methodology for

hospitals subject to prospective payment. The proposed changes to the rule are to: extend the end date of the stop loss/stop gain provision in paragraph (H)(5) from June 30, 2016 to December 31, 2016; and to include in paragraph (B) a provision such that if a hospital is in a county recognized as rural as of October 1, 2015 by the United States Office of Management and Budget, the hospital shall be treated as a rural hospital for rate setting and payment purposes.

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 (OAC). This question is not applicable to any incorporation by reference to the OAC 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 dated references to the Code of Federal Regulations (CFR). This question is not applicable to any dated incorporation by reference to the CFR because such reference is exempt from compliance with RC

121.71 to 121.74 in accordance with RC 121.75(D).

This rule incorporates one or more dated references to ODJFS forms. Each cited ODJFS form is dated and is generally available to persons affected by this rule via the "Info Center" link on the ODJFS web site (http://jfs.ohio.gov//) in accordance with RC 121.75(E).

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:

In paragraph (B)(9), the previously filed version made mention of hospitals located in a rural county recognized as rural by the federal office of management and budget shall be considered a rural hospital for rate setting and payment purposes.

The revised version has been updated to reference hospital located in rural counties as designated by the Medicare 2016 inpatient Prospective Payment System (IPPS) and not otherwise re-classed or re-designated as an urban hospital shall be considered a rural hospital for rate setting and payment purposes. Also, the previously filed version of paragraph (B)(9) mentioned a list of rural counties would be posted on ODM's website. The revised version of paragraph (B)(9) makes available on ODM's website a copy of the Medicare 2016 IPPS case mix and wage index table by CMS certification number (CCN).

12.  Five Year Review (FYR) Date: 9/1/2018

(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 increase expenditures. 812,044.23

This rule increases the Department's expenditures in the amount of $812,044.23 during the current biennium.

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:

Not applicable.

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? 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

                                                                                                                                             

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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                              Yes                              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.

There is no cost of compliance for counties, townships or municipal corporations since hospitals in these counties, townships or municipal corporations will receive more in hospital claims reimbursements because of this rule change. These hospitals do not have to do anything as a result of this rule change.

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.

There is no cost of compliance with the proposed changes to this rule.

(a)  Personnel Costs

There is no cost of compliance.

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(b)  New Equipment or Other Capital Costs

There is no cost of compliance.

(c)  Operating Costs

There is no cost of compliance.

(d)  Any Indirect Central Service Costs

There is no cost of compliance.

(e)  Other Costs

There is no cost of compliance.

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.

The Department has anticipated and planned for this in the budget. There is no effect on the local government's ability to pay.

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

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