5160-16-06 Rural health clinics (RHCs): prospective payment system (PPS).

 

 

 

TO BE RESCINDED

 

5160-16-06                  Rural  health  clinics  (RHCs):  prospective  payment  system (PPS).

 

 

 

(A)     Section 702 of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000 requires states to establish a medicaid prospective payment system (PPS) for RHCs. This rule addresses how the department complies with BIPA requirements.

 

(B)  Definitions:

 

(1)  "Base rate" is the initial PPS rate assigned to an RHC.

 

(2)   For the purposes of Chapter 5101:3-16 of the Administrative Code, "change in scope of service" is defined in accordance with paragraph (A)(1)(b) of rule 5101:3-28-09 of the Administrative Code. For the purposes of Chapter 5101:3-16 of the Administrative Code, references to federally qualified health centers in paragraph (B) of rule 5101:3-28-09 of the Administrative Code also apply to RHCs.

 

(C)  Establishment of PPS rates for RHCs:

 

(1)   For RHCs in operation during their fiscal year 1999, the base rate is the average of that RHC's medicare reimbursement rate per visit for its fiscal years 1999 and 2000.

 

(2)   For RHCs beginning operation after their fiscal year 2000, the base rate is the same as the rate(s) established for other RHCs in the nearest adjacent area that are similar in size, caseload, and scope of services. If there is not an RHC in an adjacent area that is similar in size, caseload, and scope of services, the state-wide sixtieth percentile rate will be assigned to the new RHC as the start-up PPS rate.

 

(3)   On October first of each subsequent year of operation, all PPS rates in effect for RHCs on September thirtieth will be increased by the percentage increase in the latest available medicare economic index (MEI).

 

(D)  An RHC may request a PPS rate review upon incurring a change in scope of services. Provisions regarding review of change of scope of service for federally qualified health centers (FQHCs) in paragraph (C) of rule 5101:3-28-09 of the Administrative Code also apply to RHCs, with the exception that RHCs shall utilize the independent rural health clinic and freestanding federally qualified health center cost report form (CMS-222-92), dated 1/2005, for the purpose of filing cost

 

 

reports, rather that the JFS 03421, as described in paragraph (C)(7)(e) of rule 5101:3-28-09 of the Administrative Code.

Effective:	10/01/2016
Five Year Review (FYR) Dates:	02/10/2016
CERTIFIED ELECTRONICALLY
Certification
09/19/2016
Date
Promulgated Under:	119.03
Statutory Authority:	5164.02
Rule Amplifies:	5162.03, 5164.02, 5164.70
Prior Effective Dates:	10/15/2001, 07/01/2006