Ohio Admin. Code 5160-3-24 - Nursing facilities (NFs): prospective rate reconsideration for possible calculation errors
(A) A nursing
facility provider, group, or a group or
association of nursing facility providers, may
request a reconsideration of a prospective NF rate on the basis of a possible
error in the calculation of the rate as follows:
(1) A request for reconsideration
of a prospective rate on the basis of a possible
error in the calculation of the rate shall be filed with the Ohio
department of medicaid (ODM) no more than thirty days after the later of the
initial payment of the rate for which
reconsideration is being requested or the date on the rate setting
package notification or the effective date of the
rate.
(2) The request for a
reconsideration of a prospective rate on the basis
of a possible error in the calculation of the rate shall be filed in
accordance with the following procedures:
(a)
The request for rate reconsideration shall be in writing; and
(b) The request shall be addressed to "Ohio
Department of Medicaid, Fiscal Operations - LTC Rate Methodology Unit, P.O. Box
182709, Columbus, Ohio 43215-3414"; and
(c) The request shall indicate that it is a
request for rate reconsideration due to a possible error in the calculation of
the rate; and
(d) The request shall
include a detailed explanation of the possible error and the proposed corrected
calculation; and
(e) The request
shall include references to the relevant sections of the Revised Code
and/or paragraphs of the Administrative
Code as appropriate.
(3) ODM shall respond in writing within sixty
days of receiving each written request for reconsideration
of a prospective rate due to a possible error in the
calculation of the rate. If ODM requests additional information to
determine whether a rate adjustment is warranted, the NF shall respond in
writing and shall provide additional supporting documentation no more than
thirty days after the receipt of the request for additional information. ODM
shall respond in writing within sixty days of receiving the additional
information to the request for reconsideration of a
prospective rate due to a possible error in the calculation of the
rate.
(4) If a rate
adjustment is warranted as the result of a reconsideration of a prospective
rate due to a possible error in
calculation, the adjustment shall be implemented retroactively to the
initial service date for which the rate is effective.
(B) ODM's decision at the conclusion of the
rate reconsideration process is final and shall
not be subject to any administrative proceedings under Chapter 119. or any
other provision of the Revised Code or Administrative
Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 5165.02, 5165.38
Rule Amplifies: 5165.38
Prior Effective Dates: 07/01/2006, 03/22/2015
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