(A)
Purpose
This rule sets forth procedures for estimating the debt an
exiting operator of an intermediate care facility for individuals with
intellectual disabilities (ICFIID) owes the department and the federal centers
for medicare and medicaid services at the time of a change of operator,
facility closure, involuntary termination, or voluntary
termination.
(B) Definitions
For the purposes of this rule, the following definitions
shall apply:
(1) "Change of operator" has the same meaning
as in section 5124.01 of the Revised
Code.
(2) "Exiting operator" has
the same meaning as in section
5124.01 of the Revised
Code.
(3) "Facility closure" has
the same meaning as in section
5124.01 of the Revised
Code.
(4) "Involuntary termination"
has the same meaning as in section
5124.01 of the Revised
Code.
(5) "Voluntary termination"
has the same meaning as in section
5124.01 of the Revised
Code.
(C) Debt estimation
(1) The Ohio department of medicaid
shall
will use
the debt estimation methodology set forth in this rule to estimate an exiting
operator's actual and potential debts to the department and the centers for
medicare and medicaid services under the medicaid program.
(2) The Ohio department of medicaid
shall
will
total the value of all of the following that are determined applicable in
calculating the debt estimate:
(a)
Overpayments due to the department pursuant to section
5124.41 of the Revised Code,
including:
(i) Overpayments owed for
adjudicated final fiscal audit periods.
(ii) Overpayments identified in proposed
adjudication orders that have been issued but not adjudicated.
(iii) Overpayment amounts for any outstanding
periods where a final fiscal audit has not yet been issued. Such amounts are
estimated by generating preliminary reports of amounts owed by the exiting
operator for the applicable periods.
(b) Monies owed to the department and the
centers for medicare and medicaid services resulting from penalties authorized
by federal and state law, including but not limited to:
(i) Penalties assessed pursuant to section
5124.42 of the Revised Code for:
(a) Lack of proper notice of a change of
operator, facility closure, or voluntary termination from the medicaid program;
or
(b) Failure to furnish invoices
or other documentation that the department requests during an audit.
(ii) Late cost report filing
penalties assessed pursuant to rule
5123-7-12 of the Administrative
Code.
(c) Penalties
assessed pursuant to section
5124.99 of the Revised Code for
violation of cost reporting provisions or provider agreement
obligations.
(d) Interest monies
owed to the department pursuant to section
5124.41 of the Revised Code and
to the centers for medicare and medicaid services pursuant to 42 C.F.R.
488.442, as in effect on the effective date of this
rule.
(e) Monies owed to
the department and the centers for medicare and medicaid services pursuant to
sections 5124.52 and
5124.525 of the Revised Code,
including a final fiscal audit for the last fiscal year or portion thereof that
the exiting operator participated in the medicaid program.
(f) Franchise permit fee owed to the
department pursuant to section
5168.63 of the Revised Code
which
shall
will include unpaid franchise permit fee for:
(i) Amounts due for periods assessed or to be
assessed but for which payment is not yet required pursuant to section
5168.63 of the Revised
Code.
(ii) Amounts due that are
certified to the Ohio attorney general's office for collection, including
penalties assessed pursuant to section
5168.63 of the Revised Code for
failure to pay the full amount when due.
(g) Monies owed for recapture of excess
depreciation.
(h) Monies owed due
to a credit balance.
(i) Monies
owed pursuant to successor liability or assumption of liability agreements the
exiting operator entered into.
(j)
Other amounts the department determines are applicable.
(3) The sum of the amounts determined owed,
or estimated to be owed, to the department and the centers for medicare and
medicaid services pursuant to paragraphs (C)(2)(a) to (C)(2)(j) of this rule
shall
will be
the total estimated debt.
(4) The
Ohio department of medicaid may release a portion of funds withheld pursuant to
division (A) of section
5124.521 of the Revised Code if
the funds withheld are materially greater than the debt calculated by the
department in the initial debt summary report issued pursuant to section
5124.525 of the Revised
Code.
(D) Provision of
debt estimate For the purposes of division (C) of section
5124.52 of the Revised Code, the
debt estimate is considered provided by the Ohio department of medicaid on the
date of mailing or date of personal service.
(E) Initial debt summary report
(1) Whenever the Ohio department of medicaid
issues an initial debt summary report pursuant to section
5124.525 of the Revised Code,
the Ohio department of medicaid
shall
will give notice to the affected party informing the
affected party of the affected party's right to request a review. Notice
shall be given by registered mail, return receipt
requested, and shall
will be served in the same
manner as notices issued under rule
5160-70-03 of the Administrative
Code and include:
(a) A statement
informing the affected party that the affected party is entitled to request a
review of the initial debt summary report.
(b) A statement informing the affected party
that if a request for review of the initial debt summary report is not
submitted on or before thirty calendar days after
the mailing
issuance
of the initial debt summary report, the initial debt summary report becomes the
final debt summary report thirty-one calendar days after the mailing of the
initial debt summary report, and that the affected party may request, in
accordance with Chapter 119. of the Revised Code, an adjudication hearing
regarding a finding in the final debt summary report that pertains to an audit
or alleged overpayment made under the medicaid program to the exiting operator.
The adjudication
shall
will be consolidated with any other uncompleted
adjudication that concerns a matter addressed in the final debt summary report.
(2) The Ohio department of medicaid
shall also mail a copy of the notice to the affected party's attorney or other
representative of record. To qualify as an attorney or representative of
record, the affected party or the attorney or representative must notify the
Ohio department of medicaid, in writing, that the attorney or representative is
to be designated the attorney or representative of record for purposes of
receiving notice of an initial debt summary report. The notification must
include the address where the Ohio department of medicaid should mail the
notice to the attorney or representative of record. The mailing of notice to
the affected party's attorney or representative is not deemed to perfect
service of the notice. Failure to mail a copy of the notice to the attorney or
representative of record will not result in failure of otherwise perfected
service upon the affected party. In those instances where an affected party is
a corporation doing business in Ohio or is incorporated in Ohio, the mailing of
notice to the corporation's statutory agent pursuant to sections 1701.07 and
1703.19 of the Revised Code will perfect service.
(3) When any notice of an initial
debt summary report sent by registered mail pursuant to this rule is returned
because the affected party fails to claim the notice, the Ohio department of
medicaid shall send the notice by ordinary mail to the affected party at the
affected party's last known address and shall obtain a certificate of mailing.
Service by ordinary mail is complete when the certificate of mailing is
obtained unless the notice is returned showing failure of
delivery.
(4) When any notice of an initial
debt summary report sent by registered mail or ordinary mail is returned for
failure of delivery, the Ohio department of medicaid shall make personal
delivery of the notice by an employee or agent of the Ohio department of
medicaid. An employee or agent of the Ohio department of medicaid may make
personal delivery of the notice upon a party at any time.
(5) Refusal of delivery of an
initial debt summary report by personal service or by mail is not failure of
delivery and service is deemed to be complete at the time of personal refusal
or at the time of receipt by the Ohio department of medicaid of the refused
mail as evidenced by the Ohio department of medicaid date and time stamp.
Failure of delivery occurs only when a mailed notice is returned by the postal
authorities marked undeliverable, address or addressee unknown, or forwarding
address unknown or expired.
(6)(2)
Any request for a review made as the result of notice of an initial debt
summary report issued pursuant to this rule must be made in writing and mailed
or delivered to the Ohio department of medicaid office and address identified
in the initial debt summary report within thirty calendar days of
the following, as applicable:
notice given.
(a) The time of mailing the notice
if notice is given pursuant to paragraph (E)(1) of this rule.
(b) The date that service is
complete if notice is given pursuant to paragraph (E)(3) or (E)(5) of this
rule.
(c) The date of personal
service.
(7)(3) If a request for
review is mailed to the Ohio department of medicaid office and address
identified in the initial debt summary report, the request is deemed to have
been made:
(a) If the request for review is
mailed by certified mail, as of the date stamped by the United States postal
service on its receipt form.
(b) If
the request for review is mailed by regular United States mail, as of the date
of the postmark appearing upon the envelope containing the request.
(c) If the request for review is mailed by
regular United States mail and the postmark is illegible or fails to appear on
the envelope, as of the date of its receipt by the Ohio department of medicaid
office identified in the initial debt summary report as evidenced by that
office's date and time stamp.
(8)(4) If a request for
review is made by electronic mail to the office identified in the initial debt
summary report, the request is deemed to have been made as of the date of its
receipt as evidenced by the date of receipt shown in the source code of the
electronic mail received by the office identified in the initial debt summary
report.
(9)(5) If a request for
review is mailed, personally delivered, or made by electronic mail to a party
or address other than the proper office identified in the initial debt summary
report, the request is deemed to have been made as of the date of its receipt
by the office identified in the initial debt summary report as evidenced by
that office's date and time stamp.
(10)(6) If a request for
review is personally delivered to the office identified in the initial debt
summary report, the request is deemed to have been made as of the date of its
receipt as evidenced by that office's date and time stamp.
(11)(7)
All requests for review must clearly identify both the affected party involved
and the initial debt summary report that is being contested.
(F) Revised debt summary report
(1) Whenever the Ohio department of medicaid
issues a revised debt summary report pursuant to section
5124.525 of the Revised Code,
the Ohio department of medicaid
shall
will give notice to the affected party informing the
affected party of the affected party's right to submit additional information.
Notice
shall be given by registered mail, return
receipt requested, and shall
will be served in
the same manner as notices issued under rule
5160-70-03 of the Administrative
Code and include:
(a) A statement
informing the affected party that the affected party is entitled to submit
additional information.
(b) A
statement informing the affected party that if additional information is not
submitted on or before thirty calendar days after the
mailing
issuance of the revised debt summary report, the
revised debt summary report becomes the final debt summary report thirty-one
calendar days after the mailing of the revised debt summary report, and that
the affected party may request, in accordance with Chapter 119. of the Revised
Code, an adjudication hearing regarding a finding in the final debt summary
report that pertains to an audit or alleged overpayment made under the medicaid
program to the exiting operator. The adjudication
shall
will be
consolidated with any other uncompleted adjudication that concerns a matter
addressed in the final debt summary report.
(2) The Ohio department of medicaid
shall also mail a copy of the notice to the affected party's attorney or other
representative of record. To qualify as an attorney or representative of
record, the affected party or the attorney or representative must notify the
Ohio department of medicaid, in writing, that the attorney or representative is
to be designated the attorney or representative of record for purposes of
receiving notice of a revised debt summary report. The notification must
include the address where the Ohio department of medicaid should mail the
notice to the attorney or representative of record. The mailing of notice to
the affected party's attorney or representative is not deemed to perfect
service of the notice. Failure to mail a copy of the notice to the attorney or
representative of record will not result in failure of otherwise perfected
service upon the affected party. In those instances where an affected party is
a corporation doing business in Ohio or is incorporated in Ohio, the mailing of
notice to the corporation's statutory agent pursuant to sections 1701.07 and
1703.19 of the Revised Code will perfect service.
(3) When any notice of a revised
debt summary report sent by registered mail pursuant to this rule is returned
because the affected party fails to claim the notice, the Ohio department of
medicaid shall send the notice by ordinary mail to the affected party at the
affected party's last known address and shall obtain a certificate of mailing.
Service by ordinary mail is complete when the certificate of mailing is
obtained unless the notice is returned showing failure of
delivery.
(4) When any notice of a revised
debt summary report sent by registered mail or ordinary mail is returned for
failure of delivery, the Ohio department of medicaid shall make personal
delivery of the notice by an employee or agent of the Ohio department of
medicaid. An employee or agent of the Ohio department of medicaid may make
personal delivery of the notice upon a party at any time.
(5) Refusal of delivery of a revised
debt summary report by personal service or by mail is not failure of delivery
and service is deemed to be complete at the time of personal refusal or at the
time of receipt by the Ohio department of medicaid of the refused mail as
evidenced by the Ohio department of medicaid date and time stamp. Failure of
delivery occurs only when a mailed notice is returned by the postal authorities
marked undeliverable, address or addressee unknown, or forwarding address
unknown or expired.
(6)(2) Any submission of
additional information made as the result of notice of a revised debt summary
report issued pursuant to this rule must be made in writing and mailed or
delivered to the Ohio department of medicaid office and address identified in
the revised debt summary report within thirty calendar days of
the following, as applicable:
notice given.
(a) The time of mailing the notice
if notice is given pursuant to paragraph (F)(1) of this rule.
(b) The date that service is
complete if notice is given pursuant to paragraph (F)(3) or (F)(5) of this
rule.
(c) The date of personal
service.
(7)(3) If a submission of
additional information is mailed to the Ohio department of medicaid office and
address identified in the revised debt summary report, the request is deemed to
have been made:
(a) If the submission of
additional information is mailed by certified mail, as of the date stamped by
the United States postal service on its receipt form.
(b) If the submission of additional
information is mailed by regular United States mail, as of the date of the
postmark appearing upon the envelope containing the request.
(c) If the submission of additional
information is mailed by regular United States mail and the postmark is
illegible or fails to appear on the envelope, as of the date of its receipt by
the Ohio department of medicaid office identified in the revised debt summary
report as evidenced by that office's date and time stamp.
(8)(4) If
a submission of additional information is made by electronic mail to the office
identified in the revised debt summary report, the submission is deemed to have
been made as of the date of its receipt as evidenced by the date of receipt
shown in the source code of the electronic mail received by the office
identified in the revised debt summary report.
(9)(5) If a submission of
additional information is mailed, personally delivered, or made by electronic
mail to a party or address other than the proper office identified in the
revised debt summary report, the submission is deemed to have been made as of
the date of its receipt by the office identified in the revised debt summary
report as evidenced by that office's date and time stamp.
(10)(6)
If a submission of additional information is personally delivered to the office
identified in the revised debt summary report, the submission is deemed to have
been made as of the date of its receipt as evidenced by that office's date and
time stamp.
(11)(7) All submissions of
additional information must clearly identify both the affected party involved
and the revised debt summary report that is being contested.
(G) Final debt summary report Rule
5101:6-50-03 of the
Administrative Code
shall apply
applies if an affected party timely submits a request
for review and additional information in response to a revised debt summary
report, and the Ohio department of medicaid issues a final debt summary report
pursuant to section
5124.525 of the Revised Code. An
adjudication on a final debt summary report
shall
will be
conducted only with respect to findings in the final debt summary report that
pertain to an audit or alleged overpayment made under the medicaid program to
the exiting operator. The adjudication
shall
will be
consolidated with any other uncompleted adjudication that concerns a matter
addressed in the final debt summary report.
(H) Computation of time deadlines Section
1.14 of the Revised Code
controls the computing of time deadlines imposed by this rule
section
5124.525 of the Revised
Code. The time within which an act is required
by law to be completed is computed by excluding the first day and including the
last day. When the last day falls on a Saturday, Sunday, or legal holiday, the
act may be completed on the next succeeding day that is not a Saturday, Sunday,
or legal holiday. When the last day to perform an act that is required by law
is to be performed in a public office and that public office is closed to the
public for the entire day, the act may be performed on the next succeeding day
that is not a Saturday, Sunday, or legal holiday.
(I) Successor liability agreements
(1) Successor liability agreements entered
into pursuant to section
5124.521 of the Revised Code are
subject to approval by the Ohio department of medicaid.
(2) Successor liability agreements must be
signed by the exiting operator, the Ohio department of medicaid, and the entity
assuming liability pursuant to section
5124.521 of the Revised
Code.
Notes
Ohio Admin. Code
5123-7-14
Effective:
6/30/2025
Five Year Review (FYR) Dates:
4/14/2025 and
06/30/2030
Promulgated
Under: 119.03
Statutory
Authority: 5123.04,
5124.03
Rule
Amplifies: 5123.04,
5124.03,
5124.41,
5124.42,
5124.52,
5124.521,
5124.525,
5124.99,
5168.63
Prior
Effective Dates: 01/10/2013,
12/16/2019
