(A) Except as otherwise provided by section 5124.101 of the Revised Code, sections 5124.151 to 5124.154 of the Revised Code, and divisions (B) and (C) of this section, the total per medicaid day payment rate that the department of developmental disabilities shall pay to an ICF/IID provider for ICF/IID services the provider’s ICF/IID provides during a fiscal year shall equal the sum of all of the following:

Terms Used In Ohio Code 5124.15

  • Addition: means an increase in an ICF/IID's square footage. See Ohio Code 5124.01
  • cost report year: means the calendar year immediately preceding the calendar year in which a fiscal year for which a medicaid payment rate determination is made begins. See Ohio Code 5124.01
  • Desk-reviewed: means that an ICF/IID's costs as reported on a cost report filed under section 5124. See Ohio Code 5124.01
  • Direct care costs: means all of the following costs incurred by an ICF/IID:

    (1) Costs for registered nurses, licensed practical nurses, and nurse aides employed by the ICF/IID;

    (2) Costs for direct care staff, administrative nursing staff, medical directors, respiratory therapists, physical therapists, physical therapy assistants, occupational therapists, occupational therapy assistants, speech therapists, audiologists, habilitation staff (including habilitation supervisors), qualified intellectual disability professionals, program directors, social services staff, activities staff, psychologists, psychology assistants, social workers, counselors, and other persons holding degrees qualifying them to provide therapy;

    (3) Costs of purchased nursing services;

    (4) Costs of training and staff development, employee benefits, payroll taxes, and workers' compensation premiums or costs for self-insurance claims and related costs as specified in rules adopted under section 5124. See Ohio Code 5124.01

  • Fiscal year: means the fiscal year of this state, as specified in section 9. See Ohio Code 5124.01
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Indirect care costs: includes costs of habilitation supplies, pharmacy consultants, medical and habilitation records, program supplies, incontinence supplies, food, enterals, dietary supplies and personnel, laundry, housekeeping, security, administration, liability insurance, bookkeeping, purchasing department, human resources, communications, travel, dues, license fees, subscriptions, home office costs not otherwise allocated, legal services, accounting services, minor equipment, maintenance and repair expenses, help-wanted advertising, informational advertising, start-up costs, organizational expenses, other interest, property insurance, employee training and staff development, employee benefits, payroll taxes, and workers' compensation premiums or costs for self-insurance claims and related costs, as specified in rules adopted under section 5124. See Ohio Code 5124.01
  • Other protected costs: means costs incurred by an ICF/IID for medical supplies; real estate, franchise, and property taxes; natural gas, fuel oil, water, electricity, sewage, and refuse and hazardous medical waste collection; allocated other protected home office costs; and any additional costs defined as other protected costs in rules adopted under section 5124. See Ohio Code 5124.01
  • Provider: means an operator with a valid provider agreement. See Ohio Code 5124.01
  • state: means the state of Ohio. See Ohio Code 1.59

(1) The per medicaid day capital component rate determined for the ICF/IID under section 5124.17 of the Revised Code;

(2) The per medicaid day direct care costs component rate determined for the ICF/IID under section 5124.19 of the Revised Code;

(3) The per medicaid day indirect care costs component rate determined for the ICF/IID under section 5124.21 of the Revised Code;

(4) The per medicaid day other protected costs component rate determined for the ICF/IID under section 5124.23 of the Revised Code;

(5) The sum of the following:

(a) The per medicaid day quality incentive payment determined for the ICF/IID under section 5124.24 of the Revised Code;

(b) A direct support personnel payment equal to two and four-hundredths per cent of the ICF/IID’s desk-reviewed, actual, allowable, per medicaid day direct care costs from the applicable cost report year;

(c) A professional workforce development payment equal to thirteen and fifty-five hundredths for state fiscal year 2024 and twenty and eighty-one hundredths during fiscal year 2025 per cent of the ICF/IID’s desk-reviewed, actual, allowable, per medicaid day direct care costs from the applicable cost report year.

(B) The total per medicaid day payment rate for an ICF/IID that is in peer group 5 shall not exceed the average total per medicaid day payment rate in effect on July 1, 2013, for developmental centers.

(C) The department shall adjust the total per medicaid day payment rate otherwise determined for an ICF/IID under this section as directed by the general assembly through the enactment of law governing medicaid payments to ICF/IID providers.

(D)(1) In addition to paying an ICF/IID provider the total per medicaid day payment rate determined for the provider’s ICF/IID under divisions (A), (B), and (C) of this section for a fiscal year, the department may do either or both of the following:

(a) In accordance with section 5124.25 of the Revised Code, pay the provider a rate add-on for ventilator-dependent outlier ICF/IID services if the rate add-on is to be paid under that section and the department approves the provider’s application for the rate add-on;

(b) In accordance with section 5124.26 of the Revised Code, pay the provider for outlier ICF/IID services the ICF/IID provides to residents identified as needing intensive behavioral health support services if the rate add-on is to be paid under that section and the department approves the provider’s application for the rate add-on.

(2) The rate add-ons are not to be part of the ICF/IID’s total per medicaid day payment rate.

Last updated October 4, 2023 at 3:06 PM