5160-28-04.1 Cost-based clinics: submission of an FQHC cost report.

 

 

 

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

 

 

5160-28-04.1

Rule Number

NEW

TYPE of rule filing

Rule Title/Tag Line              Cost-based clinics: submission of an FQHC 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 These rules are being rescinded and their provisions consolidated into a new chapter, numbered 5160-28, that addresses all three types of cost-based clinics.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 the circumstances under which an FQHC must submit a cost report.

One new provision permits (but does not require) the imposition of a penalty for cost reports submitted after the deadline.

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).

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:

Revisions are being made to this rule as a result of testimony given at the public hearing. The Ohio Association of Community Health Centers asked that language defining "timely" be added to the rule. They stated, "Language defining timely (90

days to submit the cost report following the reporting year) is absent in the proposed rule and we respectively ask for its re-insertion." Paragraph (C) now reads, "No extension will be granted for submission of cost reports. If an FQHC fails to submit a complete and accurate cost report within ninety days after the end of a reporting period, the department may choose to take either or both of two courses of action."

In paragraph (B), reference is now made simply to "cost reports" rather than to "an annual cost report."

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:

This rule requires the submittal of a cost report for payment setting purposes for

newly enrolled FQHCs, for FQHCs that are modifying the scope of their service offering, and for government-operated FQHCs that elect to receive payment through the Alternate Payment Methodology. The cost to complete a cost report varies depending on the size of the organization. The Department estimates the average cost to complete a cost report is approximately $2,500.

A new provision in this rule makes a sanction possible in the event an FQHC fails to submit a cost report as required. The requirement for submitting a cost report is not new, but the possibility of a sanction being imposed is new. The maximum amount of the sanction, should the Department elect to apply one, is $500 for each business day on which the cost report is late.

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? Yes

A new provision in this rule enables (but does not require) the imposition of a penalty of not more than $500 per business day if an FQHC fails to submit a cost report in a complete, accurate, and timely manner.

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

This rule requires the submission of a cost report by newly enrolled FQHCs, by

FQHCs reporting a change in scope of services, and by government-operated FQHCs that request the alternete payment method (APM).

                                                                                                                                             

Page B-1                                                                                Rule Number: 5160-28-04.1

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.

This rule requires newly enrolled FQHCs, FQHCs that are modifying the scope of their service offering, and government operated FQHCs that elect to receive payment under the Alternate Payment Methodology to submit a cost report for payment amount setting purposes. Some of these FQHCs may be owned or operated by a county or municipal corporation. The cost to complete a cost report varies based on the size of the organization. The Department estimates the average cost to complete a cost report is approximately $2,500.

A new provision in this rule makes a sanction possible in the event an FQHC fails to submit a cost report as required. The requirement to submit a cost report is not new, but the possibility of a sanction being imposed is new. The maximum amount of the sanction, should the Department elect to apply one, is $500 for each business day on which the cost report is late. The Department is proposing the sanction as an impetus for new-start FQHCs to submit a final cost-report for payment amount setting purposes. A number of the new starts elect to continue operating at their initial rate which is based on the payment amount of other FQHCs in the immediate area that are similar in size, caseload, and scope of service or, if no such FQHC exists, the payment amount for each service is set at the applicable statewide sixtieth percentile for either urban or rural FQHCs. The possiblity of a financial sanction for non-compliance will assure that all FQHCs adhere to this rule and each FQHC's per visit payment amount is based on its own cost experience.

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 to complete a cost report resides mainly in the category of personnel costs (e.g., time) and varies based on the size of the organization. The Department estimates the average cost to complete a cost report is approximately $2,500.

(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 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.

The cost to complete a cost report for an FQHC owned or operated by a county or local government is minimal.

Any cost arising from the new policy permitting (but not requiring) ODM to impose a penalty for the late submission of cost reports would be the direct result of action (or inaction) on the part of the government-owned or -operated FQHC. ODM does not anticipate a need to impose penalties, however, because ODM expects that clinics will submit timely cost reports.

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.