5160-3-30.4 Procedure for terminating the franchise permit fee (FPF) for nursing facilities (NFs), nursing homes (NHs), and long term care hospital beds.
5160-3-30.4
Procedure for terminating the franchise permit fee (FPF) fornursingNursing facilities (NFs), nursing homes (NHs), and long term care hospital beds: procedure for terminating the franchise permit fee (FPF).(A) Definitions.
"Effective FPF termination date" (EFTD) means the date on which the centers for medicare and medicaid services (CMS) determines that the FPF does not qualify for federal financial participation.
(B) Determination of the FPF as an impermissible health care related tax.
If CMS determines that the FPF is an impermissible health care related tax, the Ohio department of
job and family services (ODJFS)medicaid (ODM) shall take all necessary actions to cease implementation of the FPF program, pursuant to section3721.515168.42 of the Revised Code.(C) Notification.
ODJFSODM shall notify each facility previously assessed the FPF of the effective date of the termination of the FPF program, and what impact this change will have on the facility.(D) Reconciliation procedure.
ODJFSODM shall conduct an accounting of the funds paid to or collected from each facility as a result of the FPF program and shall do all of the following:(1) Reconcile FPFs paid by NFs, NHs, and hospitals.
(a) The annual assessment of the FPF shall be prorated on a daily basis.
(b) FPF assessments for the days preceding the EFTD shall remain due and payable.
(c) Collection shall be pursued in accordance with sections
3721.545168.51 and3721.575168.55 of the Revised Code.(d) FPF assessments issued for days on and after the EFTD shall be rescinded.
(i)
ODJFSODM shall issue refunds to NHs and hospitals for any FPFremittances representing payment for daily fees on or beyond the EFTD, unless a NF or skilled nursing facility/nursing facility (SNF/NF) has already received medicaid payment for service dates described in paragraph (D)(3) of this rule.
(ii) The source of the refunds shall be the funds established by the FPF assessments as set forth in sections
3721.565168.54and 3721.561of the Revised Code, if necessary, to each NH and hospital assessed the FPF.(2) Adjust NF rates set by
ODJFSODM that include reimbursement for FPF assessment payments by medicaid certified NFs and SNF/NFs.ODJFSODM shall adjust the per diem rate of a NF to remove any FPF reimbursement-related amount retroactively and/or prospectively from the rate for dates of service on and after EFTD.(3) Reconcile paid claims for service dates on and following the EFTD with rates adjusted according to paragraph (D)(2) of this rule.
(a) Active providers.
(i) If claims have already been submitted to
ODJFSODM and processed for dates of service on or after the EFTD,ODJFSODM shall offset the amount of overpayment received with the amount of refund due from paragraph (D)(1) of this rule.(ii) If the offset results in amounts owed to the facility, refunds shall be issued.
(iii) If the offset results in amounts owed to
ODJFSODM, the amount payable may be collected via offsets of future payments.(b) Inactive providers.
(i) If claims have already been submitted to
ODJFSODM and processed for dates of service on or after the EFTD by a NF or SNF/NF provider that no longer participates in the medicaid program,ODJFSODM shall offset the amount of overpayment received with the amount of refund due from paragraph (D)(1) of this rule.(ii) If the offset results in amounts owed to the facility, refunds shall be issued if the provider has furnished an adequate forwarding
address.
(iii) If the offset results in amounts owed to
ODJFSODM, the amount payable may be collected via direct payment from the provider.(iv) Failure to provide payment may result in certification to the attorney general for collection as set forth in section
3721.575168.55 of the Revised Code.Effective: 06/24/2016
Five Year Review (FYR) Dates: 03/04/2016 and 06/24/2021
CERTIFIED ELECTRONICALLY
Certification
06/14/2016
Date
Promulgated Under: 119.03
Statutory Authority: 5165.02, 5168.56
Rule Amplifies: 5168.40, 5168.41, 5168.42, 5168.43, 5168.44,
5168.45, 5168.46, 5168.47, 5168.48, 5168.49,
5168.50, 5168.51, 5168.52, 5168.53, 5168.54,
5168.55, 5168.56
Prior Effective Dates: 9/30/93 (Emer.), 1/1/94, 9/30/01, 2/14/02, 4/12/04,
12/30/05, 10/15/10, 1/10/13
Document Information
- Effective Date:
- 6/24/2016
- File Date:
- 2016-06-14
- Last Day in Effect:
- 2016-06-24
- Five Year Review:
- Yes
- Rule File:
- 5160-3-30$4_PH_FF_A_RU_20160614_1224.pdf
- Related Chapter/Rule NO.: (1)
- Ill. Adm. Code 5160-3-30.4. Procedure for terminating the franchise permit fee (FPF) for nursing facilities (NFs), nursing homes (NHs), and long term care hospital beds