Ohio Code 5124.21 – Per medicaid day indirect care costs component rate
(A) For each fiscal year, the department of developmental disabilities shall determine each ICF/IID’s per medicaid day indirect care costs component rate. An ICF/IID’s rate shall be the lesser of the individual rate determined under division (B) of this section and the maximum rate determined for the ICF/IID’s peer group under division (C) of this section.
Terms Used In Ohio Code 5124.21
- 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
- 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
- per diem: means an ICF/IID's desk-reviewed, actual, allowable costs in a given cost center in a cost reporting period, divided by the facility's inpatient days for that cost reporting period. See Ohio Code 5124.01
- United States: includes all the states. See Ohio Code 1.59
(B) An ICF/IID’s individual rate is the sum of the following:
(1) The ICF/IID’s desk-reviewed, actual, allowable, per diem indirect care costs for the applicable cost report year, adjusted for the inflation rate estimated under division (E) of this section;
(2) Subject to division (D) of this section, an efficiency incentive equal to the difference between the amount of the per diem indirect care costs for the applicable cost report year determined for the ICF/IID under division (B)(1) of this section and the maximum rate established for the ICF/IID’s peer group under division (C) of this section for that year.
(C)(1) The maximum rate for an ICF/IID’s peer group shall be the following percentage above the peer group’s median per diem indirect care costs for the applicable cost report year:
(a) For ICFs/IID in peer group 1, eight per cent;
(b) For ICFs/IID in peer group 2 or peer group 3, ten per cent;
(c) For ICFs/IID in peer group 4 or peer group 5, twelve per cent.
(2) The department shall not redetermine a peer group’s maximum rate under division (C)(1) of this section based on additional information that it receives after the maximum rate is set. The department shall redetermine a peer group’s maximum rate only if the department made an error in computing the maximum rate based on the information available to the department at the time of the original calculation.
(D) The efficiency incentive for an ICF/IID shall not exceed the following:
(1) If the ICF/IID is in peer group 1, five per cent of the peer group’s maximum rate established under division (C)(1)(a) of this section;
(2) If the ICF/IID is in peer group 2, peer group 3, peer group 4, or peer group 5, six per cent of the peer group’s maximum rate established under division (C)(1)(b) or (c) of this section.
(E) When adjusting rates for inflation under division (B)(1) of this section, the department shall estimate the rate of inflation for the eighteen-month period beginning on the first day of July of the applicable cost report year and ending on the thirty-first day of December of the fiscal year for which the rate is determined. To estimate the rate of inflation, the department shall use the following:
(1) Subject to division (E)(2) of this section, the consumer price index for all items for all urban consumers for the midwest region, published by the United States bureau of labor statistics;
(2) If the United States bureau of labor statistics ceases to publish the index specified in division (E)(1) of this section, a comparable index that the bureau publishes and the department determines is appropriate.
Last updated August 24, 2021 at 2:55 PM