(A) Definitions.
"Effective FPF termination date" (EFTD) means the date on which
the centers for medicare and medicaid services (CMS) determines that the FPF
does not qualify for federal financial participation.
(B) Determination of the FPF as an
impermissible health care related tax.
If CMS determines that the FPF is an impermissible health care
related tax, the Ohio department of job and family
services (ODJFS)
medicaid (ODM) shall
take all necessary actions to cease implementation of the FPF program, pursuant
to section 3721.51
5168.42
of the Revised
Code.
(C) Notification.
ODJFS
ODM shall notify each facility previously
assessed the FPF of the effective date of the termination of the FPF program,
and what impact this change will have on the facility.
(D) Reconciliation procedure.
ODJFS
ODM shall conduct an accounting of the funds paid
to or collected from each facility as a result of the FPF program and shall do
all of the following:
(1) Reconcile
FPFs paid by NFs, NHs, and hospitals.
(a) The
annual assessment of the FPF shall be prorated on a daily basis.
(b) FPF assessments for the days preceding
the EFTD shall remain due and payable.
(c) Collection shall be pursued in accordance
with sections 3721.54
5168.51
and
3721.57
5168.55
of the Revised
Code.
(d) FPF assessments issued
for days on and after the EFTD shall be rescinded.
(i)
ODJFS
ODM shall issue refunds to NHs and hospitals for
any FPF remittances representing payment for daily fees on or beyond the EFTD,
unless a NF or skilled nursing facility/nursing facility (SNF/NF) has already
received medicaid payment for service dates described in paragraph (D)(3) of
this rule.
(ii) The source of the
refunds shall be the funds established by the FPF assessments as set forth in
section 3721.56
5168.54
and 3721.561of the Revised Code, if
necessary, to each NH and hospital assessed the FPF.
(2) Adjust NF rates set by
ODJFS
ODM that
include reimbursement for FPF assessment payments by medicaid certified NFs and
SNF/NFs. ODJFS
ODM
shall adjust the per diem rate of a NF to remove any FPF
reimbursement-related amount retroactively and/or prospectively from the rate
for dates of service on and after EFTD.
(3) Reconcile paid claims for service dates
on and following the EFTD with rates adjusted according to paragraph (D)(2) of
this rule.
(a) Active providers.
(i) If claims have already been submitted to
ODJFS
ODM and
processed for dates of service on or after the EFTD, ODJFS
ODM shall
offset the amount of overpayment received with the amount of refund due from
paragraph (D)(1) of this rule.
(ii)
If the offset results in amounts owed to the facility, refunds shall be
issued.
(iii) If the offset results
in amounts owed to ODJFS
ODM, the amount payable may be collected via offsets
of future payments.
(b)
Inactive providers.
(i) If claims have
already been submitted to ODJFS
ODM and processed for dates of service on or after the
EFTD by a NF or SNF/NF provider that no longer participates in the medicaid
program, ODJFS
ODM shall offset the amount of overpayment received
with the amount of refund due from paragraph (D)(1) of this rule.
(ii) If the offset results in amounts owed to
the facility, refunds shall be issued if the provider has furnished an adequate
forwarding address.
(iii) If the
offset results in amounts owed to ODJFS
ODM, the amount payable may be collected via direct
payment from the provider.
(iv)
Failure to provide payment may result in certification to the attorney general
for collection as set forth in section 3721.57
5168.55
of the Revised
Code.
Notes
Ohio Admin. Code
5160-3-30.4
Effective:
6/24/2016
Five Year Review (FYR) Dates:
03/04/2016 and
06/24/2021
Promulgated
Under: 119.03
Statutory
Authority: 5165.02,
5168.56
Rule
Amplifies: 5168.40,
5168.41,
5168.42,
5168.43,
5168.44,
5168.45,
5168.46,
5168.47,
5168.48,
5168.49,
5168.50,
5168.51,
5168.52,
5168.53,
5168.54,
5168.55,
5168.56
Prior
Effective Dates: 9/30/93 (Emer.), 1/1/94, 9/30/01, 2/14/02, 4/12/04, 12/30/05,
10/15/10, 1/10/13
