Ohio Admin. Code 5160-3-42.4 - Nursing facilities (NFs): non-reimbursable costs
The following costs are not reimbursable to NFs through the NF
per diem, except as specified under Chapter 5101:3-3
5160-3 of the
Administrative Code. Nonreimbursable
Non-reimbursable costs include but are not limited
to:
(A) Fines or penalties paid under
sections 5111.271
5165.1010
,
5111.28, 5111.35
5165.72
to
5111.62
5165.77
,
and 5111.99
5165.83, and
5165.99
of the Revised
Code.
(B) Disallowances made during
the audit of the NF's
NF cost report
which
reports that are sanctioned through
adjudication in accordance with Chapter 119. of the Revised Code.
(C) Costs which
that exceed
prudent buyer tests of reasonableness which
that may be applied pursuant to the provisions of
the centers for medicare and medicaid services (CMS)
publication 15-1 "Provider Reimbursement Manual" (rev. 9/28/15)provider reimbursement manual (centers for medicare and
medicaid services (CMS) Publication 15-1, www.cms.hhs.gov/manuals), during the audit of the NF's
NF cost
report
reports.
(D)
The
costs
Costs of ancillary services
rendered to NF residents by providers who bill medicaid directly. Ancillary
services include but are not limited to:
physicians, legend drugs, radiology, and laboratory.
(E)
Cost
Costs per case-mix units in excess of the
applicable peer group ceiling for direct care cost
costs.
(F) Expenses in excess of the capital costs
limitations.
(G) Expenses
associated with lawsuits filed against the Ohio department of
job and family services (ODJFS)
medicaid (ODM)
which
that are not
upheld by the courts.
(H)
Cost
Costs of
meals sold to visitors or the public (i.e.
e.g., meals on
wheels).
(I)
Cost
Costs of
supplies or services sold to nonfacility residents or the public. (J) Cost
Costs of
operating a gift shop.
Notes
Promulgated Under: 119.03
Statutory Authority: 5165.02
Rule Amplifies: 5165.02
Prior Effective Dates: 12/30/77, 8/3/79, 7/1/80, 1/1/84, 7/1/88 (Emer.), 9/25/88, 12/30/88 (Emer.), 3/31/89 (Emer.), 6/18/89, 10/1/89, 12/20/91, 9/30/93 (Emer.), 1/1/94, 12/17/98, 9/12/03, 2/9/06, 2/15/10, 3/19/12
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