Ohio Admin. Code 5160-28-06.1 - FQHC and RHC services: limits on a per-visit payment amount (PVPA) determined on the basis of a cost report for an FQHC PPS service
(A)
Allowable costs are calculated in accordance with the
instructions for the federally qualified health center (FQHC) cost report.
Certain restrictions apply:
(1)
Costs related to direct inpatient care are not
allowable.
(2)
Procedures or items that are not PPS services are not
allowable.
(3)
The straight-line method of computing depreciation is
used for all depreciable assets.
(4)
The cost claimed
for services, facilities, and supplies furnished by a related organization
cannot exceed the lesser of two figures:
(a)
The cost to the
related organization; or
(b)
The price of comparable services, facilities, or
supplies that are generally available in the competitive
marketplace.
(5)
Total allowable administrative and general overhead
costs cannot exceed thirty-five per cent of the costs of the services to which
they are applied. Of these costs, not more than thirty thousand dollars are
allowable annually as recruitment cost incurred by a provider of FQHC medical
service.
(B)
Limits are established by applying tests of
reasonableness to the allowable costs.
(1)
For each PPS
service except transportation, a limit is established by dividing the allowable
cost by the greater of two figures:
(a)
The total number of visits; or
(b)
The product of
the actual number of direct hours worked by the professional and the applicable
number of visits per hour from the following list:
(i)
Physician
services, per physician - 2.4;
(ii)
Physician
assistant or advanced practice registered nurse services, per practitioner -
1.2;
(iii)
Dental services - 1.8;
(iv)
Physical therapy
services - 2.0;
(v)
Behavioral health services or substance use disorder
services - 0.7;
(vi)
Speech pathology and audiology services -
1.8;
(vii)
Podiatry services - 2.4;
(viii)
Vision
services - 1.9;
(ix)
Chiropractor services - 2.4. and
(x)
Occupational
therapy services - 2.0;
(2)
For
transportation, a limit is established of twenty-five dollars per unit of
service.
(C)
A ceiling is established for each PPS service at one
hundred twenty per cent of the statewide sixtieth percentile
PVPA.
(D)
The final PVPA for an FQHC PPS service is the least of
the allowable cost, the limit, or the ceiling.
Replaces: 5160-28- 06.1
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 10/25/2001, 07/01/2006, 10/01/2016
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