Ohio Revised Code Chapter 5124 - Intermediate Care Facility For Individuals With Intellectual Disabilities Services

• Section 5124.01 - Definitions.
  As used in this chapter: (A) "Affiliated operator" means an operator affiliated with either of the following: (1) The exiting operator for whom the...
• Section 5124.02 - [Renumbered From 5111.226] Assumption Of Powers And Duties Regarding Medicaid Program's Coverage Of Icf/iid Services.
  The department of medicaid shall enter into a contract with the department of developmental disabilities under section 5162.35 of the Revised Code that provides...
• Section 5124.03 - Rules.
  To the extent authorized by rules authorized by section 5162.021 of the Revised Code, the director of developmental disabilities shall adopt rules in accordance...
• Section 5124.05 - Scope Of Coverage.
  The medicaid program shall cover ICF/IID services when all of the following apply: (A) The ICF/IID services are provided to a medicaid recipient eligible...
• Section 5124.06 - Eligibility To Enter Into Provider Agreements.
  (A) Subject to section 5124.072 of the Revised Code, an ICF/IID operator is eligible to enter into a provider agreement for an ICF/IID if...
• Section 5124.07 - Department Provider Agreements; Contents.
  (A) Except as provided in section 5124.072 of the Revised Code, the department of medicaid shall enter into a provider agreement with an ICF/IID...
• Section 5124.071 - Agreements With More Than One Icf/iid.
  An ICF/IID operator may enter into provider agreements for more than one ICF/IID. Added by 130th General Assembly File No. 25, HB 59, §101.01,...
• Section 5124.072 - Revalidation Of Agreements.
  The department of medicaid shall not revalidate an ICF/IID provider agreement if the provider fails to maintain eligibility for the provider agreement as provided...
• Section 5124.08 - Provider Agreements With Icf/iid Providers.
  (A) Every provider agreement with an ICF/IID provider shall do both of the following: (1) Except as provided by division (B) of this section,...
• Section 5124.081 - Resident's Cause Of Action For Breach.
  An ICF/IID resident has a cause of action against the provider of the ICF/IID for breach of the provider agreement obligations or other duties...
• Section 5124.10 - Cost Reports.
  (A) Except as provided in division (D) of this section and division (E)(2) of section 5124.101 of the Revised Code, each ICF/IID provider shall...
• Section 5124.101 - Cost Reports For Downsized Or Partially Converted Provider.
  (A) The provider of an ICF/IID in peer group 1 or peer group 2 that becomes a downsized ICF/IID or partially converted ICF/IID on...
• Section 5124.102 - Fines Paid Excluded From Reports.
  No ICF/IID provider shall report fines paid under section 5124.99 of the Revised Code in a cost report filed under section 5124.10, 5124.101, or...
• Section 5124.103 - Form Of Cost Reports.
  Cost reports shall be completed using the form prescribed under section 5124.104 of the Revised Code and in accordance with the guidelines established under...
• Section 5124.104 - Duties Of Department.
  The department of developmental disabilities shall do all of the following: (A) Prescribe the form to be used for completing a cost report and...
• Section 5124.105 - Addendum For Disputed Costs.
  The department of developmental disabilities shall develop an addendum to the cost report form that an ICF/IID provider may use to set forth costs...
• Section 5124.106 - Failure To Timely File Report; Consequences.
  (A) If an ICF/IID provider required by section 5124.10 of the Revised Code to file a cost report for the ICF/IID fails to file...
• Section 5124.107 - Amendments To Reports.
  (A) Except as provided in division (B) of this section and not later than three years after an ICF/IID provider files a cost report...
• Section 5124.108 - Desk Review.
  The department of developmental disabilities shall conduct a desk review of all cost reports it receives under sections 5124.10, 5124.101, and 5124.522 of the...
• Section 5124.109 - Audits.
  (A) The department of developmental disabilities may conduct an audit, as defined in rules adopted under section 5124.03 of the Revised Code, of any...
• Section 5124.15 - Amount Of Payments.
  (A) Except as otherwise provided by section 5124.101 of the Revised Code, sections 5124.151 to 5124.155 of the Revised Code, and divisions (B) and...
• Section 5124.151 - Initial Rates For Services Provided By A New Icf/iid.
  (A) The total per medicaid day payment rate determined under section 5124.15 of the Revised Code shall not be the initial rate for ICF/IID...
• Section 5124.152 - Payment Rate For Service Provided By Outlier Icf/iid Or Unit.
  (A) The total per medicaid day payment rate determined under section 5124.15 of the Revised Code shall not be paid for ICF/IID services provided...
• Section 5124.153 - Payment Rate For Services Provided To Resident Who Meets Criteria For Admission To Outlier Icf/iid Or Unit.
  (A) To the extent, if any, provided for in rules authorized by this section, the total per medicaid day payment rate determined under section...
• Section 5124.154 - [Renumbered From 5111.291] Computing Rate For Services Provided By Developmental Centers.
  The department of developmental disabilities is not required to pay the total per medicaid day payment rates determined under section 5124.15 of the Revised...
• Section 5124.155 - Payment Rate For Icf/iid Services For Recipient Placed In Chronic Behaviors And Typical Adaptive Needs Classification Or The Typical Adaptive Needs And Non-significant Behaviors Classification.
  The total per medicaid day payment rate for ICF/IID services an ICF/IID in peer group 1 provides to a medicaid recipient who is admitted...
• Section 5124.17 - Icf/iid's Per Medicaid Day Payment Rate For Reasonable Capital Costs.
  (A) For each fiscal year, the department of developmental disabilities shall determine each ICF/IID's per medicaid day payment rate for reasonable capital costs. Except...
• Section 5124.19 - Icf/iid's Per Medicaid Day Payment Rate For Direct Care Costs.
  (A) (1) For each fiscal year, the department of developmental disabilities shall determine each ICF/IID's per medicaid day payment rate for direct care costs...
• Section 5124.191 - Compilation Of Assessment Data For Residents.
  Each calendar quarter, each ICF/IID provider shall compile complete assessment data for each resident of each of the provider's ICFs/IID, regardless of payment source,...
• Section 5124.192 - Case-mix Scores.
  (A) Except as provided in division (B) of this section, the department of developmental disabilities shall do both of the following: (1) For each...
• Section 5124.193 - Exception Reviews Of Resident Assessment Data.
  (A) The department of developmental disabilities may, pursuant to rules authorized by this section, conduct an exception review of resident assessment data submitted by...
• Section 5124.194 - [Renumbered From 5111.233] Day Programming.
  The costs of day programming shall be part of the direct care costs of an ICF/IID as off-site day programming if the area in...
• Section 5124.21 - Per Medicaid Day Payment Rate For Indirect Care Costs.
  (A) For each fiscal year, the department of developmental disabilities shall determine each ICF/IID's per medicaid day payment rate for indirect care costs. Except...
• Section 5124.23 - [Renumbered From 5111.235] Per Medicaid Day Payment Rate For Other Protected Costs.
  (A) For each fiscal year, the department of developmental disabilities shall determine each ICF/IID's per medicaid day payment rate for other protected costs ....
• Section 5124.25 - Payment Of Medicaid Rate Add-on For Outlier Services Provided For Ventilator-dependent Residents.
  (A) Subject to division (D) of this section, the department of developmental disabilities may pay a medicaid rate add-on to an ICF/IID provider for...
• Section 5124.28 - Rules For Payment Limits.
  Notwithstanding any provision of section 5124.17 or 5124.21 of the Revised Code, the director of developmental disabilities may adopt rules under section 5124.03 of...
• Section 5124.29 - [Renumbered From 5111.263] Limiting Compensation Of Owners, Their Relatives, Administrators, And Resident Meals Outside Facility.
  Except as otherwise provided in section 5124.30 of the Revised Code, the department of developmental disabilities, in determining whether an ICF/IID's direct care costs...
• Section 5124.30 - Costs Of Goods Furnished By Related Party.
  Except as provided in section 5124.17 of the Revised Code, the costs of goods, services, and facilities, furnished to an ICF/IID provider by a...
• Section 5124.31 - Adjustment Of Payment Rates.
  The department of developmental disabilities shall adjust medicaid payment rates determined under this chapter to account for reasonable additional costs that must be incurred...
• Section 5124.32 - Reduction In Rate Not Permitted.
  The department of developmental disabilities shall not reduce an ICF/IID's medicaid payment rate determined under this chapter on the basis that the provider charges...
• Section 5124.33 - No Payment For Day Of Discharge.
  No medicaid payment shall be made to an ICF/IID provider for the day a medicaid recipient is discharged from the ICF/IID, unless the recipient...
• Section 5124.34 - [Renumbered From 5111.33] Payment For Reserving Beds.
  (A) The department of developmental disabilities shall pay an ICF/IID provider one hundred per cent of the total per medicaid day payment rate determined...
• Section 5124.35 - Timing Of Payments After Involuntary Termination.
  Medicaid payments may be made for ICF/IID services provided not later than thirty days after the effective date of an involuntary termination of the...
• Section 5124.37 - Timing Of Payments; Calculations.
  The department of developmental disabilities shall make its best efforts each year to determine ICFs/IID's medicaid payment rates under this chapter in time to...
• Section 5124.38 - Process For Reconsideration Of Rates.
  (A) The director of developmental disabilities shall establish a process under which an ICF/IID provider, or a group or association of ICF/IID providers, may...
• Section 5124.40 - Adjustment Of Rates.
  If an ICF/IID provider properly amends a cost report for an ICF/IID under section 5124.107 of the Revised Code and the amended report shows...
• Section 5124.41 - Redetermination Of Rates.
  (A) The department of developmental disabilities shall redetermine a provider's medicaid payment rate for an ICF/IID using revised information if any of the following...
• Section 5124.42 - Additional Penalties.
  In addition to the other penalties authorized by this chapter, the department of developmental disabilities may impose the following penalties on an ICF/IID provider:...
• Section 5124.43 - Determination Of Interest Rate.
  For the purposes of sections 5124.41 and 5124.42 of the Revised Code, the department of developmental disabilities shall determine the current average bank prime...
• Section 5124.44 - Deductions.
  (A) Except as provided in division (B) of this section, the department of developmental disabilities shall deduct the following from the next available medicaid...
• Section 5124.45 - Deposits To General Revenue Fund.
  The department of developmental disabilities shall transmit to the treasurer of state for deposit in the general revenue fund amounts collected from the following:...
• Section 5124.46 - Adjudications Under The Administrative Procedure Act.
  All of the following are subject to an adjudication conducted in accordance with Chapter 119. of the Revised Code: (A) Any audit disallowance that...
• Section 5124.50 - Notice Of Facility Closure Or Voluntary Termination.
  An exiting operator or owner of an ICF/IID participating in the medicaid program shall provide the department of developmental disabilities and department of medicaid...
• Section 5124.51 - Notice Of Change Of Operator.
  (A) An exiting operator or owner and entering operator shall provide the department of developmental disabilities and department of medicaid written notice of a...
• Section 5124.511 - Agreements With Entering Operators Effective On Date Of Change Of Operator.
  The department of medicaid may enter into a provider agreement with an entering operator that goes into effect at 12:01 a.m. on the effective...
• Section 5124.512 - Agreements With Entering Operators Effective At A Later Date.
  (A) The department of medicaid may enter into a provider agreement with an entering operator that goes into effect at 12:01 a.m. on the...
• Section 5124.513 - Entering Operator Duties Under Provider Agreement.
  A provider that enters into a provider agreement with the department of medicaid under section 5124.511 or 5124.512 of the Revised Code shall do...
• Section 5124.514 - Exiting Operator Deemed Operator Pending Change.
  In the case of a change of operator, the exiting operator shall be considered to be the operator of the ICF/IID for purposes of...
• Section 5124.515 - Provider Agreement With Operator Not Complying With Prior Agreement.
  The department of medicaid may enter into a provider agreement as provided in section 5124.07 of the Revised Code, rather than section 5124.511 or...
• Section 5124.516 - Medicaid Reimbursement Adjustments; Change Of Operator.
  The director of developmental disabilities may adopt rules under section 5124.03 of the Revised Code governing adjustments to the medicaid reimbursement rate for an...
• Section 5124.517 - Determination That A Change Of Operator Has Or Has Not Occurred; Effect.
  The department of developmental disabilities' determination that a change of operator has or has not occurred for purposes of licensure under section 5123.19 of...
• Section 5124.52 - Overpayment Amounts Determined Following Notice Of Closure, Etc.
  (A) On receipt of a written notice under section 5124.50 of the Revised Code of a facility closure or voluntary termination, on receipt of...
• Section 5124.521 - Withholding From Medicaid Payment Due Exiting Operator.
  (A) Except as provided in divisions (B), (C), and (D) of this section, the department of developmental disabilities may withhold from payment due an...
• Section 5124.522 - Cost Report By Exiting Operator; Waiver.
  (A) Except as provided in division (B) of this section, an exiting operator shall file with the department of developmental disabilities a cost report...
• Section 5124.523 - Failure To File Cost Report; Payments Deemed Overpayments.
  If an exiting operator required by section 5124.522 of the Revised Code to file a cost report with the department of developmental disabilities fails...
• Section 5124.524 - Final Payment Withheld Pending Receipt Of Cost Reports.
  The department of developmental disabilities may not provide an exiting operator final payment under the medicaid program until the department receives all properly completed...
• Section 5124.525 - Determination Of Debt Of Exiting Operator; Summary Report.
  The department of developmental disabilities shall determine the actual amount of debt an exiting operator owes the department and the United States centers for...
• Section 5124.526 - Release Of Amount Withheld Less Amounts Owed.
  The department of developmental disabilities shall release the actual amount withheld under division (A) of section 5124.521 of the Revised Code, less any amount...
• Section 5124.527 - Release Of Amount Withheld On Postponement Of Change Of Operator.
  The department of developmental disabilities, at its sole discretion, may release the amount withheld under division (A) of section 5124.521 of the Revised Code...
• Section 5124.528 - Disposition Of Amounts Withheld From Payment Due An Exiting Operator.
  (A) All amounts withheld under section 5124.521 of the Revised Code from payment due an exiting operator under the medicaid program shall be deposited...
• Section 5124.53 - Adoption Of Rules For Implementation Of Sections 5124.50 To .
  The director of developmental disabilities shall adopt rules under section 5124.03 of the Revised Code to implement sections 5124.50 to 5124.53 of the Revised...
• Section 5124.60 - Conversion Of Beds To Home And Community-based Services.
  (A) For the purpose of increasing the number of slots available for home and community-based services, the operator of an ICF/IID may convert some...
• Section 5124.61 - Conversion Of Beds In Acquired Icf/iid.
  (A) For the purpose of increasing the number of slots available for home and community-based services, a person who acquires, through a request for...
• Section 5124.62 - Request For Federal Approval Of Conversion Of Beds.
  The director of developmental disabilities may request that the medicaid director seek the approval of the United States secretary of health and human services...
• Section 5124.63 - [Repealed].
  Repealed by 130th General Assembly File No. TBD, HB 483, §105.01, eff. 9/15/2014. Renumbered from § 5111.877 by 130th General Assembly File No. 25,...
• Section 5124.64 - [Repealed].
  Repealed by 130th General Assembly File No. TBD, HB 483, §105.01, eff. 9/15/2014. Renumbered from § 5111.878 by 130th General Assembly File No. 25,...
• Section 5124.65 - [Renumbered From 5111.879] Reconversion Of Beds To Icf/iid Use.
  No person or government entity may reconvert a bed to be used for ICF/IID services if the bed was converted to use for home...
• Section 5124.67 - [Repealed Effective 7/1/2018] Reduction In Number Of Icf/iid Beds.
  (A) (1) The department of developmental disabilities shall strive to achieve, not later than July 1, 2018, the following statewide reductions in ICF/IID beds:...
• Section 5124.68 - Admission As Resident In An Icf/iid In Peer Group 1.
  (A) (1) Except as provided in division (D) of this section, an ICF/IID in peer group 1 shall not admit an individual as a...
• Section 5124.69 - Informational Pamphlet.
  (A) The department of developmental disabilities shall develop and make available to all ICFs/IID a written pamphlet that describes all of the items and...
• Section 5124.70 - Maximum Number Of Residents Per Sleeping Room.
  (A) This section does not apply to either of the following: (1) An ICF/IID to which both of the following apply: (a) On or...
• Section 5124.99 - Penalty For Violation Of Cost Reporting Provisions.
  Whoever violates section 5124.102 or division (E) of section 5124.08 of the Revised Code shall be fined not less than five hundred dollars nor...

Last modified: October 10, 2016