As Re-reported by the Senate Finance and 2
Financial Institutions Committee 2
123rd General Assembly 5
Regular Session Sub. H. B. No. 403 6
1999-2000 7
REPRESENTATIVES TIBERI-VAN VYVEN-NETZLEY-GOODMAN-MOTTLEY- 9
OGG-DePIERO-OLMAN-TAYLOR-JONES-BUEHRER-EVANS-KRUPINSKI- 10
FLANNERY-BRITTON-ROBERTS-R. MILLER-D. MILLER-BOYD- 11
CORBIN-EVANS-STAPLETON-BARRETT-GARDNER-SCHURING-METTLER- 12
WINKLER-BUCHY-HARTNETT-SALERNO-ALLEN-O'BRIEN-PATTON-DISTEL- 14
J. BEATTY-VERICH-BARNES-CLANCY-CALVERT-HOLLISTER-REDFERN-
GOODING-VESPER-A. CORE-WIDENER-HOOPS-PETERSON-JOLIVETTE- 15
HARRIS-TERWILLEGER-AUSTRIA-STEVENS-SENATORS HOTTINGER- 16
WHITE-JOHNSON-GARDNER-KEARNS 17
_________________________________________________________________ 19
A B I L L
To amend sections 173.19, 3702.525, 3721.21, 21
5111.20, 5111.25, 5111.251, and 5111.62 and to 22
enact sections 173.45 to 173.59, 3721.026, and 23
3721.027 of the Revised Code to require the
publication of the Ohio Long-Term Care Consumer 25
Guide, to create a nursing facility technical 26
assistance program, to change the method of 28
calculating nursing facilities' and intermediate
care facilities for the mentally retarded's 29
Medicaid reimbursement rates for indirect care 30
and capital costs, to specify in the law 31
governing nursing homes that neglect does not 32
include allowing a resident to receive only 33
treatment by spiritual means through prayer in
accordance with the tenets of a recognized 34
religious denomination, to require the Department 36
of Health to investigate valid, unresolved
complaints that the State Long-Term Care 37
Ombudsperson refers to the Department, to make an 38
2
exception to the certificate of need 39
implementation deadline, and to make an 40
appropriation. 41
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 43
Section 1. That sections 173.19, 3702.525, 3721.21, 45
5111.20, 5111.25, 5111.251, and 5111.62 be amended and sections 47
173.45, 173.46, 173.47, 173.48, 173.49, 173.50, 173.51, 173.52, 48
173.53, 173.54, 173.55, 173.56, 173.57, 173.58, 173.59, 3721.026,
and 3721.027 of the Revised Code be enacted to read as follows: 50
Sec. 173.19. (A) The office of the state long-term care 59
ombudsperson program, through the state long-term care 60
ombudsperson and the regional long-term care ombudsperson 62
programs, shall receive, investigate, and attempt to resolve 64
complaints made by residents, recipients, sponsors, providers of 65
long-term care, or any person acting on behalf of a resident or 66
recipient, relating to either of the following: 67
(1) The health, safety, welfare, or civil rights of a 69
resident or recipient or any violation of a resident's rights 70
described in sections 3721.10 to 3721.17 of the Revised Code; 71
(2) Any action or inaction or decision by a provider of 73
long-term care or representative of a provider, a governmental 74
entity, or a private social service agency that may adversely 75
affect the health, safety, welfare, or rights of a resident or 76
recipient. 77
(B) The department of aging shall adopt rules in 79
accordance with Chapter 119. of the Revised Code regarding the 80
handling of complaints received under this section, including 81
procedures for conducting investigations of complaints. The 82
rules shall include procedures to ensure that no representative 83
of the office investigates any complaint involving a provider of 84
long-term care with which the representative was once employed or 85
associated. 86
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The state ombudsperson and regional programs shall 88
establish procedures for handling complaints consistent with the 90
department's rules. Complaints shall be dealt with in accordance 91
with the procedures established under this division. 92
(C) The office of the state long-term care ombudsperson 95
program may decline to investigate any complaint if it determines 96
any of the following: 97
(1) That the complaint is frivolous, vexatious, or not 99
made in good faith; 100
(2) That the complaint was made so long after the 102
occurrence of the incident on which it is based that it is no 103
longer reasonable to conduct an investigation; 104
(3) That an adequate investigation cannot be conducted 106
because of insufficient funds, insufficient staff, lack of staff 107
expertise, or any other reasonable factor that would result in an 108
inadequate investigation despite a good faith effort; 109
(4) That an investigation by the office would create a 111
real or apparent conflict of interest. 112
(D) If a regional long-term care ombudsperson program 114
declines to investigate a complaint, it shall refer the complaint 115
to the state long-term care ombudsperson. 116
(E) Each complaint to be investigated by a regional 118
program shall be assigned to a representative of the office of 119
the state long-term care ombudsperson program. If the 120
representative determines that the complaint is valid, the 121
representative shall assist the parties in attempting to resolve 123
it. If the representative is unable to resolve it, the 125
representative may SHALL refer the complaint to the state 127
ombudsperson.
In order to carry out the duties of sections 173.14 to 129
173.26 of the Revised Code, a representative has the right to 131
private communication with residents and their sponsors and 132
access to long-term care facilities, including the right to tour 133
resident areas unescorted and the right to tour facilities 134
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unescorted as reasonably necessary to the investigation of a 135
complaint. Access to facilities shall be during reasonable hours 136
or, during investigation of a complaint, at other times 137
appropriate to the complaint. 138
When community-based long-term care services are provided 140
at a location other than the recipient's home, a representative 141
has the right to private communication with the recipient and the 143
recipient's sponsors and access to the community-based long-term 144
care site, including the right to tour the site unescorted. 145
Access to the site shall be during reasonable hours or, during 146
the investigation of a complaint, at other times appropriate to 147
the complaint. 148
(F) The state ombudsperson shall determine whether 150
complaints referred to the ombudsperson under division (D) or (E) 152
of this section warrant investigation. The ombudsperson's 154
determination in this matter is final. 155
Sec. 173.45. AS USED IN SECTIONS 173.45 TO 173.59 OF THE 158
REVISED CODE:
(A) "CLINICAL QUALITY INDICATOR" MEANS A MEASURE OF AN 160
ASPECT OF THE PHYSICAL OR MENTAL CONDITIONS OF THE RESIDENTS OF A 161
NURSING FACILITY THAT IS DERIVED FROM DATA TAKEN FROM RESIDENT 163
ASSESSMENT INSTRUMENTS SUBMITTED BY NURSING FACILITIES FOR 164
PURPOSES OF THE MEDICARE AND MEDICAID PROGRAMS. 165
(B) "MEDICAID" HAS THE SAME MEANING AS IN SECTION 5111.01 167
OF THE REVISED CODE. 168
(C) "MEDICARE" MEANS THE PROGRAM OPERATED PURSUANT TO 171
TITLE XVIII OF THE "SOCIAL SECURITY ACT," 49 STAT. 620 (1935), 42 173
U.S.C.A. 301, AS AMENDED. 174
(D) "NURSING FACILITY" MEANS EITHER OF THE FOLLOWING: 176
(1) A FACILITY, OR A DISTINCT PART OF A FACILITY, THAT IS 179
CERTIFIED AS A NURSING FACILITY OR A SKILLED NURSING FACILITY FOR 180
PURPOSES OF THE MEDICARE OR MEDICAID PROGRAM; 181
(2) A NURSING HOME LICENSED UNDER SECTION 3721.02 OF THE 184
REVISED CODE THAT IS NOT CERTIFIED AS A NURSING FACILITY OR 185
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SKILLED NURSING FACILITY.
(E) "DEFICIENCY," "IMMEDIATE JEOPARDY," "STANDARD SURVEY," 187
AND "SUBSTANDARD CARE" HAVE THE SAME MEANINGS AS IN SECTION 189
5111.35 OF THE REVISED CODE. 190
(F) "SURVEY DATA TAG" MEANS ANY OF THE DATA TAGS USED IN 192
THE MEDICARE AND MEDICAID PROGRAMS FOR IDENTIFICATION OF SPECIFIC 193
REGULATORY REQUIREMENTS. 194
Sec. 173.46. THE DEPARTMENT OF AGING SHALL DEVELOP AND 196
PUBLISH A GUIDE TO NURSING FACILITIES IN THIS STATE FOR USE BY 197
INDIVIDUALS CONSIDERING NURSING FACILITY PLACEMENT AND THEIR 198
FAMILIES, FRIENDS, AND ADVISORS. THE GUIDE SHALL BE TITLED THE 199
OHIO LONG-TERM CARE CONSUMER GUIDE. 200
THE CONSUMER GUIDE SHALL BE PUBLISHED IN COMPUTERIZED FORM 202
FOR DISTRIBUTION OVER THE INTERNET. THE GUIDE SHALL BE MADE 204
AVAILABLE NOT LATER THAN FOURTEEN MONTHS AFTER THE EFFECTIVE DATE 205
OF THIS SECTION AND SHALL BE UPDATED IN ACCORDANCE WITH SECTION 206
173.52 OF THE REVISED CODE. 207
EVERY TWO YEARS, THE DEPARTMENT SHALL PUBLISH AN EXECUTIVE 209
SUMMARY OF THE CONSUMER GUIDE, AND SHALL MAKE THE EXECUTIVE 210
SUMMARY AVAILABLE IN BOTH COMPUTERIZED AND PRINTED FORMS. 211
Sec. 173.47. THE DEPARTMENT OF AGING MAY CONTRACT WITH ANY 213
PERSON OR GOVERNMENT ENTITY TO PERFORM ANY FUNCTION RELATED TO 214
THE PUBLICATION OF THE OHIO LONG-TERM CARE CONSUMER GUIDE OR THE 216
COLLECTION AND PREPARATION OF DATA AND OTHER MATERIAL FOR THE 218
GUIDE, EXCEPT THAT THE DEPARTMENT SHALL CONTRACT TO HAVE THE 220
CUSTOMER SATISFACTION SURVEYS CONDUCTED UNDER SECTION 173.54 OF
THE REVISED CODE. IN AWARDING THE CONTRACT TO HAVE THE SURVEYS 222
CONDUCTED, THE DEPARTMENT SHALL CONTRACT WITH A PERSON OR
GOVERNMENT ENTITY THAT HAS EXPERIENCE IN SURVEYING THE CUSTOMER 223
SATISFACTION OF NURSING FACILITY RESIDENTS AND THEIR FAMILIES. 224
THE DEPARTMENT'S CONTRACT SHALL PERMIT THE PERSON OR GOVERNMENT 225
ENTITY TO SUBCONTRACT WITH OTHER PERSONS OR GOVERNMENT ENTITIES 226
FOR PURPOSES OF CONDUCTING ALL OR PART OF THE SURVEYS.
Sec. 173.48. IN DEVELOPING AND PUBLISHING THE OHIO 228
6
LONG-TERM CARE CONSUMER GUIDE, THE DEPARTMENT OF AGING SHALL 229
ADHERE TO THE FOLLOWING PRINCIPLES: 230
(A) THE GUIDE SHOULD BE DESIGNED TO PROVIDE USERS WITH A 232
VARIETY OF MEASURES OF NURSING FACILITY QUALITY AND WITH OTHER 233
INFORMATION USEFUL IN COMPARING AND SELECTING NURSING FACILITIES. 235
(B) THE GUIDE SHOULD PRESENT THE INFORMATION SPECIFIED IN 237
DIVISION (A) OF THIS SECTION IN A MANNER THAT IS EASY TO USE AND 238
UNDERSTAND. 239
(C) THE GUIDE SHOULD ALLOW USERS TO DETERMINE WHICH OF THE 241
AVAILABLE MEASURES ARE MOST IMPORTANT TO THEM. 243
(D) THE INFORMATION IN THE GUIDE SHOULD BE KEPT AS CURRENT 245
AS PRACTICABLE. 246
(E) THE GUIDE SHOULD BE DESIGNED TO PROMOTE EXCELLENCE IN 248
NURSING FACILITY QUALITY. 249
(F) THE GUIDE SHOULD PROMOTE AWARENESS OF THE RANGE OF 251
LONG-TERM CARE SERVICES AVAILABLE TO OHIOANS. 252
Sec. 173.49. WITH REGARD TO THE ACCESSIBILITY OF THE OHIO 254
LONG-TERM CARE CONSUMER GUIDE AND THE EXECUTIVE SUMMARY OF THE 255
GUIDE, THE FOLLOWING SHALL APPLY: 256
(A) THE DEPARTMENT OF AGING SHALL MAKE THE GUIDE AND 258
SUMMARY AVAILABLE TO ANY PERSON OR GOVERNMENT ENTITY AND SHALL 260
NOT RESTRICT ACCESS BY REQUIRING PAYMENT OF A FEE, USE OF A 261
PASSWORD, OR FULFILLMENT OF ANY OTHER CONDITION.
(B) THE DEPARTMENT OF AGING SHALL DEVELOP AND IMPLEMENT 264
PROGRAMS AND OTHER STRATEGIES TO ENCOURAGE USE OF THE GUIDE BY 265
INDIVIDUALS CONSIDERING NURSING FACILITY PLACEMENT AND THEIR 266
FAMILIES, FRIENDS, AND ADVISORS. 267
Sec. 173.50. THE OHIO LONG-TERM CARE CONSUMER GUIDE SHALL 269
INCLUDE INFORMATION ON EACH NURSING FACILITY IN THIS STATE. FOR 270
EACH FACILITY, THE GUIDE SHALL INCLUDE, TO THE EXTENT IT IS 272
AVAILABLE TO THE DEPARTMENT OF AGING, ALL OF THE FOLLOWING 273
INFORMATION:
(A) CUSTOMER SATISFACTION DATA OBTAINED UNDER SECTION 275
173.54 OF THE REVISED CODE; 276
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(B) CLINICAL QUALITY INDICATOR DATA OBTAINED UNDER SECTION 278
173.56 OF THE REVISED CODE; 279
(C) DATA DERIVED FROM STANDARD SURVEYS AS SPECIFIED IN 282
DIVISION (C)(3) OF SECTION 173.51 OF THE REVISED CODE; 283
(D) ANY OTHER INFORMATION SPECIFIED IN SECTIONS 173.45 TO 285
173.59 OF THE REVISED CODE OR THE RULES ADOPTED UNDER SECTION 287
173.57 OF THE REVISED CODE.
Sec. 173.51. THE OHIO LONG-TERM CARE CONSUMER GUIDE SHALL 290
BE STRUCTURED IN ACCORDANCE WITH THIS SECTION AND ANY APPLICABLE 292
RULES ADOPTED UNDER SECTION 173.57 OF THE REVISED CODE. 293
(A) THE OPENING ELECTRONIC PAGE OF THE CONSUMER GUIDE 295
SHALL INCLUDE ALL OF THE FOLLOWING GENERAL INFORMATION: 296
(1) A DESCRIPTION OF THE GUIDE; 298
(2) DISCLAIMERS STATING THE LIMITATIONS OF THE DATA 300
INCLUDED IN THE GUIDE. THE DISCLAIMERS SHALL INCLUDE A STATEMENT 301
THAT STANDARD SURVEYS OF NURSING FACILITIES ARE CONDUCTED AT 302
PERIODIC INTERVALS AND A STATEMENT THAT CONDITIONS AT A FACILITY 303
CAN CHANGE SIGNIFICANTLY BETWEEN STANDARD SURVEYS. 304
(3) A RECOMMENDATION THAT INDIVIDUALS CONSIDERING NURSING 306
FACILITY PLACEMENT VISIT ANY FACILITIES THEY ARE CONSIDERING; 307
(4) ELECTRONIC LINKS TO OTHER INFORMATION ON THE INTERNET 309
ABOUT SELECTING NURSING FACILITIES AND ABOUT OTHER LONG-TERM CARE 310
OPTIONS, INCLUDING INFORMATION MAINTAINED BY PERTINENT GOVERNMENT 312
AGENCIES AND PRIVATE ORGANIZATIONS AND TELEPHONE NUMBERS FOR 313
THOSE AGENCIES AND ORGANIZATIONS;
(5) ANY OTHER INFORMATION THE DEPARTMENT OF AGING 315
SPECIFIES IN RULES ADOPTED UNDER SECTION 173.57 OF THE REVISED 317
CODE.
(B) THE CONSUMER GUIDE SHALL BE STRUCTURED IN A MANNER 319
THAT ALLOWS THE USER TO SEARCH FOR INFORMATION IN THE GUIDE IN 320
MULTIPLE WAYS, INCLUDING SEARCHES BY FACILITY NAME, COUNTY, 322
MUNICIPALITY, POSTAL ZIP CODE, SOURCE OF NURSING FACILITY 323
PAYMENT, AND SPECIAL CARE SERVICE. 324
(C) THE FIRST INFORMATION TO APPEAR ON THE COMPUTER SCREEN 326
8
FOLLOWING A SEARCH SHALL BE A LIST OF ALL FACILITIES IDENTIFIED 327
BY THE SEARCH. FOR ALL OF THE FACILITIES LISTED, THE CONSUMER 328
GUIDE SHALL PRESENT THE USER WITH SUMMARIZED COMPARATIVE MEASURES 330
AND ELECTRONIC LINKS TO DEFINITIONS AND DESCRIPTIONS OF THE 331
MEASURES. THE GUIDE SHALL INCLUDE A FEATURE THAT ALLOWS THE USER
TO CHOOSE THE PARTICULAR COMPARATIVE MEASURES THAT WILL BE 332
DISPLAYED ON THE SCREEN. THE GUIDE ALSO MAY INCLUDE A CONSUMER 333
NEEDS ASSESSMENT FUNCTION TO ASSIST THE USER IN CHOOSING 334
MEASURES. THE COMPARATIVE MEASURES SHALL BE DERIVED FROM THE 335
FOLLOWING SOURCES:
(1) THE AGGREGATE RESPONSES MADE BY A FACILITY'S RESIDENTS 337
OR THEIR FAMILIES TO MEASURES OF CUSTOMER SATISFACTION INCLUDED 340
IN THE SURVEYS CONDUCTED UNDER SECTION 173.54 OF THE REVISED 341
CODE. THE MEASURES SHALL BE SPECIFIED IN RULES ADOPTED UNDER 343
SECTION 173.57 OF THE REVISED CODE. FOR EACH MEASURE, THE GUIDE 344
SHALL COMPARE THE RESPONSES FOR THE FACILITY TO THE STATEWIDE 345
AVERAGE OR TO A PEER-GROUP AVERAGE SPECIFIED IN RULE UNDER 346
SECTION 173.57 OF THE REVISED CODE. 347
(2) THE SCORES ON CLINICAL QUALITY INDICATORS CALCULATED 350
UNDER SECTION 173.56 OF THE REVISED CODE. THE INDICATORS SHALL 351
BE SPECIFIED IN RULES ADOPTED UNDER SECTION 173.57 OF THE REVISED 352
CODE. FOR EACH INDICATOR, THE GUIDE SHALL COMPARE THE FACILITY'S 353
SCORE TO THE STATEWIDE AVERAGE OR TO A PEER-GROUP AVERAGE 354
SPECIFIED IN RULE UNDER SECTION 173.57 OF THE REVISED CODE. THE 355
SCORES SHALL BE EXPRESSED AS PERCENTAGES. 356
(3) ALL OF THE FOLLOWING: 358
(a) THE DATE OF THE FACILITY'S MOST RECENT STANDARD 360
SURVEY; 361
(b) THE PERCENTAGE OF SPECIFIED SURVEY DATA TAGS FOR WHICH 363
THE FACILITY WAS FOUND TO BE IN COMPLIANCE DURING THE FACILITY'S 364
MOST RECENT STANDARD SURVEY. THE DEPARTMENT OF AGING SHALL 366
SPECIFY IN RULE THE SURVEY DATA TAGS USED FOR THIS PURPOSE AND 367
MAY EXCLUDE TAGS THAT ARE NEVER OR VERY RARELY CITED DURING 368
SURVEYS.
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(c) THE STATEWIDE AVERAGE PERCENTAGE OF THE SPECIFIED 370
SURVEY DATA TAGS FOR WHICH FACILITIES WERE FOUND TO BE IN 372
COMPLIANCE DURING THE MOST RECENT STANDARD SURVEYS. 373
ALTERNATIVELY, THE DEPARTMENT OF AGING MAY PRESCRIBE BY RULE THAT 374
A PEER-GROUP AVERAGE BE USED. 375
(d) THE NUMBER OF SPECIFIED SURVEY DATA TAGS CITED BY THE 377
DEPARTMENT OF HEALTH IN THE FACILITY'S MOST RECENT STANDARD 378
SURVEY; 379
(e) THE STATEWIDE AVERAGE NUMBER OF SPECIFIED SURVEY DATA 381
TAGS CITED BY THE DEPARTMENT OF HEALTH DURING THE MOST RECENT 382
STANDARD SURVEYS. ALTERNATIVELY, THE DEPARTMENT OF AGING MAY 384
PRESCRIBE BY RULE THAT A PEER-GROUP AVERAGE BE USED.
(f) THE DATE THE FACILITY ACHIEVED SUBSTANTIAL COMPLIANCE 386
WITH MEDICARE AND MEDICAID CERTIFICATION REQUIREMENTS; 387
(g) WHETHER THE DEPARTMENT OF HEALTH DETERMINED THAT THE 389
FACILITY PROVIDED SUBSTANDARD CARE TO RESIDENTS DURING TWO OF ITS 391
LAST THREE STANDARD SURVEYS; 392
(h) WHETHER THE DEPARTMENT OF HEALTH FOUND THAT THE CARE 394
PROVIDED BY THE FACILITY PLACED RESIDENTS IN IMMEDIATE JEOPARDY 396
DURING TWO OF ITS LAST THREE STANDARD SURVEYS. 397
(4) AN ELECTRONIC LINK FOR EACH FACILITY ON THE LIST 399
ALLOWING THE USER TO GAIN ACCESS TO INFORMATION ON THE FACILITY 401
MAINTAINED UNDER DIVISION (D) OF THIS SECTION. 403
(D) IN ADDITION TO THE SUMMARIZED INFORMATION PROVIDED BY 405
THE GUIDE PURSUANT TO DIVISION (C) OF THIS SECTION, THE GUIDE 406
SHALL PROVIDE SPECIFIC COMPARATIVE INFORMATION ON EACH NURSING 407
FACILITY. WHEN THE GUIDE'S USER OPENS AN ELECTRONIC LINK TO THE 409
SPECIFIC INFORMATION, THE FIRST INFORMATION TO APPEAR ON THE 410
COMPUTER SCREEN SHALL INCLUDE ALL OF THE FOLLOWING:
(1) THE NAME OF THE FACILITY AND ITS OWNER, THE FACILITY'S 412
TELEPHONE NUMBER AND ADDRESS, INCLUDING THE COUNTY IN WHICH THE 414
FACILITY IS LOCATED. THE GUIDE SHALL INCLUDE A FUNCTION THAT 415
PINPOINTS ON A MAP THE FACILITY'S LOCATION.
(2) THE FACILITY'S STATUS WITH REGARD TO MEDICARE AND 417
10
MEDICAID CERTIFICATION AND PRIVATE ACCREDITATION; 418
(3) THE NUMBER OF BEDS IN THE FACILITY; 420
(4) AN ELECTRONIC LINK ALLOWING THE USER OF THE GUIDE TO 422
GAIN ACCESS TO A LISTING OF SERVICES PROVIDED BY THE FACILITY. 423
THE LISTING SHALL BE PRESENTED IN THE FORMAT SPECIFIED IN RULES 424
ADOPTED UNDER SECTION 173.57 OF THE REVISED CODE. 425
(5) AT THE FACILITY'S OPTION, A PICTURE OF THE FACILITY, A 427
BRIEF STATEMENT PROVIDED BY THE FACILITY, AND AN ELECTRONIC LINK 428
TO ANY INFORMATION THE FACILITY MAINTAINS ABOUT ITSELF ON THE 429
INTERNET;
(6) THE SUMMARIZED INFORMATION SPECIFIED IN DIVISION (C) 431
OF THIS SECTION FOR THE FACILITY, WITH ELECTRONIC LINKS ALLOWING 433
THE USER TO GAIN ACCESS TO ADDITIONAL INFORMATION PRESENTED AS 435
FOLLOWS:
(a) FOR EACH STATISTICALLY VALID AND RELIABLE QUESTION 437
ASKED ON THE QUESTIONNAIRES USED IN THE RESIDENT AND FAMILY 439
SURVEYS CONDUCTED UNDER SECTION 173.54 OF THE REVISED CODE, THE 440
GUIDE SHALL PRESENT THE CUSTOMER SATISFACTION RESPONSES. THE 442
RESPONSES FOR THE FACILITY SHALL BE COMPARED TO THE STATEWIDE 443
AVERAGE OR TO A PEER-GROUP AVERAGE SPECIFIED IN RULE UNDER 444
SECTION 173.57 OF THE REVISED CODE AND SHALL BE EXPRESSED IN 446
PERCENTAGES.
(b) FOR EACH CLINICAL QUALITY INDICATOR CALCULATED UNDER 449
SECTION 173.56 OF THE REVISED CODE, THE GUIDE SHALL PRESENT THE 450
FACILITY'S SCORE COMPARED TO THE STATEWIDE AVERAGE SCORE. THE 451
SCORES SHALL BE EXPRESSED AS PERCENTAGES. 452
(c) THE GUIDE SHALL PRESENT A LIST OF ALL SURVEY DATA TAGS 455
THAT WERE CITED DURING THE FACILITY'S MOST RECENT STANDARD 456
SURVEY, A BRIEF DESCRIPTION PERTAINING TO EACH DATA TAG, 457
DIRECTIONS OR ELECTRONIC LINKS FOR OBTAINING MORE INFORMATION 458
ABOUT THE FACILITY'S SURVEY HISTORY, AND LINKS TO THE TEXT OF 461
EACH CITATION AND TO THE FACILITY'S PLAN OF CORRECTION FILED WITH 462
THE STATE FOR EACH CITATION.
(7) ANY OTHER INFORMATION, WHICH MAY INCLUDE INFORMATION 464
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ABOUT STAFFING, THE DEPARTMENT OF AGING PRESCRIBES BY RULE. 465
Sec. 173.52. (A) THE DEPARTMENT OF AGING SHALL UPDATE 469
INFORMATION IN THE OHIO LONG-TERM CARE CONSUMER GUIDE AS FOLLOWS: 470
(1) THE CUSTOMER SATISFACTION DATA OBTAINED UNDER SECTION 472
173.54 OF THE REVISED CODE SHALL BE UPDATED ANNUALLY FOLLOWING 475
THE SURVEYS CONDUCTED UNDER THAT SECTION.
(2) THE CLINICAL QUALITY INDICATOR DATA OBTAINED UNDER 477
SECTION 173.56 OF THE REVISED CODE SHALL BE UPDATED IN JANUARY, 479
APRIL, JULY, AND OCTOBER OF EACH YEAR, USING THE MOST RECENT 481
RESIDENT ASSESSMENT DATA AVAILABLE TO THE DEPARTMENT.
(3) THE DATA DERIVED FROM STANDARD SURVEYS OF EACH NURSING 483
FACILITY, AS SPECIFIED IN DIVISION (C)(3) OF SECTION 173.51 OF 485
THE REVISED CODE, SHALL BE UPDATED WEEKLY, USING THE MOST RECENT 486
STANDARD SURVEY DATA AVAILABLE TO THE DEPARTMENT. THE DEPARTMENT 488
SHALL MODIFY THE DATA INCLUDED IN THE CONSUMER GUIDE TO REFLECT 490
EITHER OF THE FOLLOWING:
(a) ANY CHANGE IN THE SURVEY DATA RESULTING FROM INFORMAL 492
DISPUTE RESOLUTION, APPEAL, OR ANY OTHER PROCESS; 493
(b) THE DATE OF CORRECTION OF ANY CITATION. 495
(4) ANY OTHER INFORMATION SPECIFIED IN SECTIONS 173.45 TO 497
173.59 OF THE REVISED CODE OR THE RULES ADOPTED UNDER SECTION 499
173.57 OF THE REVISED CODE SHALL BE UPDATED AT THE TIME SPECIFIED 500
IN THOSE SECTIONS OR THE RULES.
(B) THE DEPARTMENT OF AGING SHALL SPECIFY BY RULE 502
INFORMATION IN THE GUIDE THAT NURSING FACILITIES CAN 503
ELECTRONICALLY UPDATE WITHOUT THE NEED FOR ANY ACTION BY THE 505
DEPARTMENT, WHICH SHALL INCLUDE ANY INFORMATION THAT THE FACILITY 506
ORIGINALLY SUBMITTED TO THE DEPARTMENT. THE GUIDE SHALL INCLUDE 507
A MECHANISM FOR SUCH UPDATES. THIS DIVISION DOES NOT APPLY TO
INFORMATION DESCRIBED IN DIVISIONS (A)(1), (2), AND (3) OF THIS 509
SECTION.
(C) THE DEPARTMENT OF HEALTH SHALL COOPERATE WITH THE 511
DEPARTMENT OF AGING TO ENSURE THAT STANDARD SURVEY INFORMATION 512
AND QUALITY INDICATOR DATA ARE UPDATED IN ACCORDANCE WITH THIS 514
12
SECTION, SUBJECT TO THE REGULATORY REQUIREMENTS, PROCEDURES, AND 515
GUIDELINES OF THE UNITED STATES HEALTH CARE FINANCING 516
ADMINISTRATION.
Sec. 173.53. IN ADDITION TO THE COMPUTERIZED OHIO 518
LONG-TERM CARE CONSUMER GUIDE, THE DEPARTMENT OF AGING SHALL 520
PREPARE AND MAKE AVAILABLE TO THE PUBLIC PRINTED INFORMATION TO 521
ASSIST CONSUMERS IN MAKING LONG-TERM CARE AND NURSING FACILITY 522
PLACEMENT DECISIONS, PARTICULARLY CONSUMERS WHO DO NOT HAVE 523
ACCESS TO THE INTERNET. THE PRINTED INFORMATION SHALL SPECIFY 524
ORGANIZATIONS THAT WILL PROVIDE CONSUMERS FREE ON-SITE ACCESS TO 525
THE CONSUMER GUIDE AND WILL MAIL TO CONSUMERS FREE PAPER COPIES 526
OF ELECTRONIC PAGES OF THE GUIDE.
Sec. 173.54. (A) THROUGH THE CONTRACT REQUIRED UNDER 528
SECTION 173.47 OF THE REVISED CODE, THE DEPARTMENT OF AGING SHALL 529
PROVIDE FOR CUSTOMER SATISFACTION SURVEYS FOR USE IN PUBLISHING 530
THE OHIO LONG-TERM CARE CONSUMER GUIDE. THE DEPARTMENT SHALL 531
ENSURE THAT THE CUSTOMER SATISFACTION SURVEYS ARE CONDUCTED AS 532
FOLLOWS: 533
(1) THE SURVEYS SHALL BE CONDUCTED ANNUALLY. 535
(2) THE SURVEYS SHALL CONSIST OF STANDARDIZED, 537
STATISTICALLY VALID AND RELIABLE QUESTIONNAIRES FOR NURSING 539
FACILITY RESIDENTS AND FOR FAMILIES OF NURSING FACILITY 540
RESIDENTS. EACH QUESTIONNAIRE SHALL BE STRUCTURED IN A MANNER 541
THAT PRODUCES STATISTICALLY TESTED VALID AND RELIABLE RESPONSES, 542
AS SPECIFIED IN RULES ADOPTED BY THE DEPARTMENT. EACH 543
QUESTIONNAIRE SHALL ASK THE RESIDENT'S AGE AND GENDER. THE 544
RESIDENT QUESTIONNAIRE SHALL ASK WHO, IF ANYONE, ASSISTED THE 545
RESIDENT IN COMPLETING THE QUESTIONNAIRE. THE FAMILY 546
QUESTIONNAIRE SHALL ASK THE RELATIONSHIP OF THE PERSON COMPLETING 547
THE QUESTIONNAIRE TO THE RESIDENT. 548
(3) THE RESIDENT SURVEY SHALL BE CONDUCTED IN PERSON, 550
USING A STANDARDIZED SURVEY PROTOCOL DEVELOPED BY THE DEPARTMENT 551
IN CONSULTATION WITH THE LONG-TERM CARE CONSUMER GUIDE ADVISORY 552
COUNCIL. THE SURVEY SHALL BE CONDUCTED IN A MANNER DESIGNED TO 554
13
PRESERVE THE RESIDENT'S CONFIDENTIALITY AS MUCH AS POSSIBLE. 555
(4) THE FAMILY SURVEY SHALL BE CONDUCTED USING ANONYMOUS 557
QUESTIONNAIRES DISTRIBUTED TO FAMILIES AND RETURNED TO A PERSON 558
OTHER THAN THE NURSING FACILITY, IN ACCORDANCE WITH A 559
STANDARDIZED SURVEY PROTOCOL DEVELOPED BY THE DEPARTMENT IN 561
CONSULTATION WITH THE LONG-TERM CARE CONSUMER GUIDE ADVISORY 562
COUNCIL.
(B) IN ADDITION TO BEING USED FOR THE CONSUMER GUIDE, THE 564
RESULTS OF THE SURVEYS CONDUCTED UNDER THIS SECTION SHALL BE 565
PROVIDED TO THE NURSING FACILITIES TO WHICH THEY PERTAIN. EACH 567
NURSING FACILITY IN THIS STATE SHALL PARTICIPATE AS NECESSARY FOR 568
SUCCESSFUL COMPLETION OF THE SURVEYS. 569
Sec. 173.55. THE DEPARTMENT OF AGING MAY CHARGE A FEE, NOT 571
TO EXCEED FOUR HUNDRED DOLLARS, FOR EACH OF THE ANNUAL CUSTOMER 572
SATISFACTION SURVEYS CONDUCTED UNDER SECTION 173.54 OF THE 574
REVISED CODE. THE FEE SHALL BE PAID BY THE NURSING FACILITY AND 575
IS SUBJECT TO REIMBURSEMENT THROUGH THE MEDICAID PROGRAM PURSUANT 576
TO SECTIONS 5111.20 TO 5111.32 OF THE REVISED CODE. 577
ALL FEES COLLECTED UNDER THIS SECTION SHALL BE DEPOSITED TO 580
THE CREDIT OF THE LONG-TERM CARE CONSUMER GUIDE FUND, WHICH IS
HEREBY CREATED IN THE STATE TREASURY. THE FUND SHALL BE USED FOR 583
COSTS ASSOCIATED WITH PUBLISHING THE OHIO LONG-TERM CARE CONSUMER 584
GUIDE, INCLUDING THE COST OF CONTRACTING WITH PERSONS AND 585
GOVERNMENT ENTITIES UNDER SECTION 173.47 OF THE REVISED CODE. 586
THE DEPARTMENT MAY CONTRACT WITH A PERSON OR GOVERNMENT ENTITY TO 588
COLLECT THE FEES ON BEHALF OF THE DEPARTMENT. 589
Sec. 173.56. FOR PURPOSES OF THE LONG-TERM CARE CONSUMER 591
GUIDE, THE DEPARTMENT OF AGING SHALL USE, SUBJECT TO FEDERAL 593
REGULATORY REQUIREMENTS, PROCEDURES, AND GUIDELINES, THE CLINICAL 594
QUALITY INDICATORS CALCULATED FOR EACH NURSING FACILITY BY THE 596
UNITED STATES HEALTH CARE FINANCING ADMINISTRATION FOR THE 597
PURPOSES OF THE MEDICARE AND MEDICAID PROGRAMS. 598
Sec. 173.57. (A) THE DEPARTMENT OF AGING SHALL ADOPT 600
RULES TO IMPLEMENT AND ADMINISTER SECTIONS 173.45 TO 173.59 OF 603
14
THE REVISED CODE. THE RULES SHALL SPECIFY ALL OF THE FOLLOWING: 605
(1) THE CONTENT OF THE OHIO LONG-TERM CARE CONSUMER GUIDE, 608
INCLUDING ANY INFORMATION IN ADDITION TO THE INFORMATION 610
SPECIFIED IN SECTION 173.51 OF THE REVISED CODE; 611
(2) THE CONTENT OF THE COMPUTERIZED AND PRINTED FORMS OF 614
THE EXECUTIVE SUMMARY OF THE CONSUMER GUIDE;
(3) THE CUSTOMER SATISFACTION MEASURES TO BE PUBLISHED IN 616
THE CONSUMER GUIDE PURSUANT TO DIVISION (C)(1) OF SECTION 173.51 617
OF THE REVISED CODE; 619
(4) THE CLINICAL QUALITY INDICATORS TO BE PUBLISHED IN THE 621
CONSUMER GUIDE PURSUANT TO DIVISION (C)(2) OF SECTION 173.51 OF 623
THE REVISED CODE; 624
(5) FOR PURPOSES OF CLINICAL QUALITY, CUSTOMER 626
SATISFACTION, AND SURVEY DATA TAG COMPARISONS UNDER SECTION 628
173.51 OF THE REVISED CODE, CRITERIA TO BE USED IN CLASSIFYING
NURSING FACILITIES INTO PEER GROUPS, WHICH MAY BE BASED ON 630
CASE-MIX SCORES CALCULATED UNDER SECTION 5111.231 OF THE REVISED 631
CODE, THE SIZE OF NURSING FACILITIES, THE LOCATION OF FACILITIES, 632
OR OTHER PERTINENT FACTORS;
(6) THE FORMAT FOR LISTING NURSING FACILITY SERVICES IN 634
THE CONSUMER GUIDE AND THE MANNER IN WHICH THAT INFORMATION IS TO 635
BE COLLECTED FROM NURSING FACILITIES; 636
(7) A METHOD OF INCLUDING ADDITIONAL LONG-TERM CARE 638
FACILITIES AND SERVICE PROVIDERS IN THE CONSUMER GUIDE PURSUANT 640
TO CONSIDERATIONS MADE UNDER DIVISION (B)(4) OF SECTION 173.58 OF 641
THE REVISED CODE;
(8) ANY OTHER REQUIREMENTS NECESSARY TO IMPLEMENT AND 643
ADMINISTER SECTIONS 173.45 TO 173.59 OF THE REVISED CODE. 644
(B) THE DEPARTMENT SHALL DEVELOP RULES UNDER THIS SECTION 646
IN CONSULTATION WITH THE LONG-TERM CARE CONSUMER GUIDE ADVISORY 648
COUNCIL CREATED UNDER SECTION 173.58 OF THE REVISED CODE. BEFORE 650
FILING A RULE UNDER SECTION 119.03 OF THE REVISED CODE, THE 651
DEPARTMENT SHALL PRESENT IT TO THE ADVISORY COUNCIL AND PROVIDE 652
THE COUNCIL A REASONABLE TIME TO COMMENT ON IT. THE DEPARTMENT 653
15
SHALL GIVE APPROPRIATE CONSIDERATION TO RECOMMENDATIONS OF THE 654
ADVISORY COUNCIL REGARDING PROPOSED RULES. 655
(C) ALL RULES ADOPTED UNDER THIS SECTION SHALL BE ADOPTED 657
IN ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE. INITIAL 659
RULES SHALL BE ADOPTED NOT LATER THAN SIX MONTHS AFTER THE 660
EFFECTIVE DATE OF THIS SECTION. 661
Sec. 173.58. (A) THERE IS HEREBY CREATED THE LONG-TERM 663
CARE CONSUMER GUIDE ADVISORY COUNCIL. THE COUNCIL SHALL BE 664
CONVENED BY THE DIRECTOR OF AGING AND SHALL CONSIST OF THE 666
FOLLOWING MEMBERS:
(1) A REPRESENTATIVE OF THE DEPARTMENT OF AGING, APPOINTED 668
BY THE DIRECTOR OF AGING; 669
(2) A REPRESENTATIVE OF THE DEPARTMENT OF HEALTH, 671
APPOINTED BY THE DIRECTOR OF HEALTH; 672
(3) A REPRESENTATIVE OF THE DEPARTMENT OF JOB AND FAMILY 674
SERVICES, APPOINTED BY THE DIRECTOR OF JOB AND FAMILY SERVICES; 675
(4) THE STATE LONG-TERM CARE OMBUDSPERSON; 677
(5) A FAMILY MEMBER OF A NURSING FACILITY RESIDENT, 679
APPOINTED BY THE GOVERNOR; 680
(6) A REPRESENTATIVE OF THE OHIO ASSOCIATION OF AREA 682
AGENCIES ON AGING, APPOINTED BY THE PRESIDENT OF THE ASSOCIATION; 683
(7) TWO REPRESENTATIVES OF THE OHIO HEALTH CARE 685
ASSOCIATION, APPOINTED BY THE CHIEF ADMINISTRATOR OF THE 686
ASSOCIATION;
(8) TWO REPRESENTATIVES OF THE ASSOCIATION OF OHIO 688
PHILANTHROPIC HOMES, HOUSING, AND SERVICES FOR THE AGING, 689
APPOINTED BY THE CHIEF ADMINISTRATOR OF THE ASSOCIATION; 691
(9) TWO REPRESENTATIVES OF THE OHIO ACADEMY OF NURSING 693
HOMES, APPOINTED BY THE CHIEF ADMINISTRATOR OF THE ACADEMY; 694
(10) A REPRESENTATIVE OF THE OHIO ASSOCIATION OF REGIONAL 696
LONG-TERM CARE OMBUDSMEN, APPOINTED BY THE CHIEF ADMINISTRATOR OF 697
THE ASSOCIATION; 698
(11) A REPRESENTATIVE OF THE OHIO CHAPTER OF THE AMERICAN 701
ASSOCIATION OF RETIRED PERSONS, APPOINTED BY THE CHIEF 702
16
ADMINISTRATOR OF THE CHAPTER; 703
(12) A REPRESENTATIVE OF A CONSUMER GROUP OR OTHER 706
NOT-FOR-PROFIT ENTITY THAT IS ORGANIZED FOR THE PURPOSE OF 707
PROMOTING IMPROVED CARE FOR NURSING HOME RESIDENTS, APPOINTED BY 708
THE GOVERNOR;
(13) A REPRESENTATIVE OF A RESEARCH ORGANIZATION, 710
APPOINTED BY THE CHIEF ADMINISTRATOR OF THE ORGANIZATION. THE 711
RESEARCH ORGANIZATION REPRESENTED SHALL BE SELECTED BY THE 712
DIRECTOR OF AGING FROM AMONG RESEARCH ORGANIZATIONS IN THIS STATE 713
THAT HAVE EXPERIENCE IN LONG-TERM CARE POLICY MATTERS. 714
EACH COUNCIL MEMBER SHALL SERVE AT THE DISCRETION OF THE 716
AUTHORITY THAT APPOINTED THE MEMBER. EACH MEMBER SHALL SERVE 717
WITHOUT COMPENSATION OR REIMBURSEMENT FOR EXPENSES, EXCEPT TO THE 718
EXTENT THAT SERVING AS A MEMBER OF THE COUNCIL IS PART OF THE 719
MEMBER'S REGULAR DUTIES OF EMPLOYMENT. 720
THE MEMBER SERVING AS THE REPRESENTATIVE OF THE DEPARTMENT 722
OF AGING SHALL SERVE AS THE COUNCIL'S CHAIRPERSON. THE 723
DEPARTMENT SHALL SUPPLY MEETING SPACE AND STAFF SUPPORT FOR THE 724
COUNCIL.
(B) THE COUNCIL'S DUTIES INCLUDE ALL OF THE FOLLOWING: 726
(1) TO HELP DEVELOP AND REVIEW RULES TO BE ADOPTED BY THE 728
DEPARTMENT OF AGING UNDER SECTION 173.57 OF THE REVISED CODE; 730
(2) TO RECOMMEND ADMINISTRATIVE PRACTICES TO THE 732
DEPARTMENT FOR IMPROVING THE OPERATION AND CONTENT OF THE OHIO 733
LONG-TERM CARE CONSUMER GUIDE; 734
(3) TO RECOMMEND LEGISLATIVE CHANGES TO THE DEPARTMENT 736
NEEDED TO IMPROVE THE CONSUMER GUIDE; 738
(4) TO CONSIDER WHETHER IT IS FEASIBLE TO INCLUDE IN THE 740
CONSUMER GUIDE OTHER LONG-TERM CARE FACILITIES, SUCH AS 741
RESIDENTIAL CARE FACILITIES AND INTERMEDIATE CARE FACILITIES FOR 742
THE MENTALLY RETARDED, AND LONG-TERM CARE SERVICE PROVIDERS, SUCH 743
AS HOME HEALTH AGENCIES AND ADULT DAY SERVICE PROVIDERS; 744
(5) TO CONSIDER WHETHER IT IS FEASIBLE TO INCLUDE IN THE 746
CONSUMER GUIDE MEASUREMENTS OF QUALITY OF LIFE STANDARDS. 747
17
(C) THE LONG-TERM CARE CONSUMER GUIDE ADVISORY COUNCIL IS 749
NOT SUBJECT TO SECTION 101.84 OF THE REVISED CODE. 750
Sec. 173.59. (A) THE DEPARTMENT OF AGING SHALL INCLUDE NO 752
ADVERTISING IN THE OHIO LONG-TERM CARE CONSUMER GUIDE THAT SHALL 753
CAUSE A CONFLICT OF INTEREST. 754
(B) THIS SECTION DOES NOT AFFECT INFORMATION INCLUDED IN 756
THE OHIO LONG-TERM CARE CONSUMER GUIDE UNDER DIVISION (D)(5) OF 758
SECTION 173.51 OF THE REVISED CODE. 759
Sec. 3702.525. (A) Not later than twenty-four months 769
after the date the director of health mails the notice that the 770
certificate of need has been granted or, if the grant or denial 771
of the certificate of need is appealed under section 3702.60 of 772
the Revised Code, not later than twenty-four months after 773
issuance of an order granting the certificate that is not subject 774
to further appeal, each person holding a certificate of need 775
granted on or after the effective date of this section APRIL 20, 776
1995, shall:
(1) If the project for which the certificate of need was 779
granted primarily involves construction and is to be financed
primarily through external borrowing of funds, secure financial 780
commitment for the stated purpose of developing the project and 781
commence construction that continues uninterrupted except for 782
interruptions or delays that are unavoidable due to reasons 783
beyond the person's control, including labor strikes, natural 784
disasters, material shortages, or comparable events; 785
(2) If the project for which the certificate of need was 788
granted primarily involves construction and is to be financed
primarily internally, receive formal approval from the holder's 789
board of directors or trustees or other governing authority to 790
commit specified funds for implementation of the project and 791
commence construction that continues uninterrupted except for 792
interruptions or delays that are unavoidable due to reasons 793
beyond the person's control, including labor strikes, natural 794
disasters, material shortages, or comparable events; 795
18
(3) If the project for which the certificate of need was 798
granted primarily involves acquisition of medical equipment,
enter into a contract to purchase or lease the equipment and to 799
accept the equipment at the site for which the certificate was 800
granted; 801
(4) If the project for which the certificate of need was 804
granted involves no capital expenditure or only minor renovations 805
to existing structures, provide the health service or activity by 806
the means specified in the approved application for the 807
certificate;
(5) If the project for which the certificate of need was 810
granted primarily involves leasing a building or space that
requires only minor renovations to the existing space, execute a 811
lease and provide the health service or activity by the means 812
specified in the approved application for the certificate; 813
(6) If the project for which the certificate of need was 816
granted primarily involves leasing a building or space that has 817
not been constructed or requires substantial renovations to
existing space, commence construction for the purpose of 818
implementing the reviewable activity that continues uninterrupted 819
except for interruptions or delays that are unavoidable due to 820
reasons beyond the person's control, including labor strikes, 821
natural disasters, material shortages, or comparable events. 822
(B) The twenty-four-month period specified in division (A) 825
of this section shall not be extended by any means, including the 826
transfer of a certificate of need under division (C) of section 827
3702.524 of the Revised Code or granting of a subsequent or
replacement certificate of need. Each person holding a 829
certificate of need granted on or after the effective date of 830
this section APRIL 20, 1995, shall provide the director of health 832
documentation of compliance with that division not later than the 833
earlier of thirty days after complying with that division or five 834
days after the twenty-four-month period expires. Not later than 835
the earlier of fifteen days after he receives RECEIVING the 836
19
documentation or fifteen days after the twenty-four-month period 837
expires, the director shall send by certified mail a notice to 838
the holder of the certificate of need specifying whether the 839
holder has complied with division (A) of this section. 840
(C) NOTWITHSTANDING DIVISION (B) OF THIS SECTION, THE 842
TWENTY-FOUR-MONTH PERIOD SPECIFIED IN DIVISION (A) OF THIS 843
SECTION SHALL BE EXTENDED FOR AN ADDITIONAL TWENTY-FOUR MONTHS 844
FOR ANY CERTIFICATE OF NEED GRANTED FOR THE PURCHASE AND 845
RELOCATION OF LICENSED NURSING HOME BEDS ON FEBRUARY 26, 1999. 846
(D) A certificate of need granted on or after the 849
effective date of this section APRIL 20, 1995, expires, 850
regardless of whether the director sends a notice under division 851
(B) of this section, if the holder fails to comply with division 852
(A) OR (C) of this section or to provide information under 854
division (B) of this section as necessary for the director to 855
determine compliance. 856
Sec. 3721.026. (A) AS USED IN THIS SECTION AND SECTION 858
3721.027 OF THE REVISED CODE, "NURSING FACILITY" AND "SURVEY" 860
HAVE THE SAME MEANINGS AS IN SECTION 5111.35 OF THE REVISED CODE. 861
(B) THE DIRECTOR OF HEALTH SHALL ESTABLISH A UNIT WITHIN 863
THE DEPARTMENT OF HEALTH TO PROVIDE ADVICE AND TECHNICAL 864
ASSISTANCE AND TO CONDUCT ON-SITE VISITS TO NURSING FACILITIES 866
FOR THE PURPOSE OF IMPROVING RESIDENT OUTCOMES. THE DIRECTOR 867
SHALL ASSIGN TO THE UNIT EMPLOYEES WHO HAVE TRAINING OR 868
EXPERIENCE IN CONDUCTING OR SUPERVISING SURVEYS, BUT EMPLOYEES 869
ASSIGNED TO THE UNIT SHALL NOT CONDUCT SURVEYS. THE DIRECTOR 870
SHALL ADOPT RULES IN ACCORDANCE WITH CHAPTER 119. OF THE REVISED 871
CODE TO IMPLEMENT THIS SECTION AND SHALL CONSULT WITH INTERESTED 872
PARTIES IN DEVELOPING THE RULES. TECHNICAL ASSISTANCE REPORTS 873
ARE NOT PUBLIC RECORDS UNDER SECTION 149.43 OF THE REVISED CODE 874
AND SHALL NOT BE DISTRIBUTED TO ANY PERSON OUTSIDE THE UNIT
EXCEPT: 875
(1) THE NURSING FACILITY THAT IS PROVIDED WITH THE 877
TECHNICAL ASSISTANCE;
20
(2) PERSONS CHARGED WITH INSPECTING NURSING FACILITIES 879
UNDER SECTION 3721.02 OF THE REVISED CODE OR WITH CONDUCTING 880
SURVEYS OR REVIEWS OF NURSING FACILITIES UNDER SECTION 3721.022 881
OF THE REVISED CODE WHENEVER ANY SUCH PERSON FINDS THAT THERE IS
SERIOUS HARM TO RESIDENT HEALTH OR SAFETY THAT IS MORE THAN 882
ISOLATED AT THE NURSING FACILITY. 883
THE PROVISIONS OF THIS SECTION AND RULES ADOPTED UNDER THIS 885
SECTION DO NOT AFFECT THE DEPARTMENT'S AUTHORITY TO ADMINISTER 886
AND ENFORCE OTHER SECTIONS OF THIS CHAPTER. 887
(C) ON OR BEFORE THE LAST DAY OF DECEMBER EACH YEAR, THE 889
DIRECTOR SHALL SUBMIT A REPORT TO THE GOVERNOR AND THE GENERAL 892
ASSEMBLY DESCRIBING THE UNIT'S ACTIVITIES THAT YEAR AND ITS
EFFECTIVENESS IN IMPROVING RESIDENT OUTCOMES. 893
Sec. 3721.027. THE DEPARTMENT OF HEALTH SHALL INVESTIGATE 895
WITHIN TEN WORKING DAYS AFTER REFERRAL, IN ACCORDANCE WITH 896
PROCEDURES AND CRITERIA TO BE ESTABLISHED BY THE DEPARTMENT OF 897
HEALTH AND THE DEPARTMENT OF AGING, ANY UNRESOLVED COMPLAINT THAT 898
THE OFFICE OF THE STATE LONG-TERM CARE OMBUDSPERSON HAS 899
INVESTIGATED AND FOUND TO BE VALID AND REFERS TO THE DEPARTMENT 900
OF HEALTH. THIS REQUIREMENT DOES NOT SUPERSEDE FEDERAL 902
REQUIREMENTS FOR SURVEY AGENCY COMPLAINT INVESTIGATIONS. 903
Sec. 3721.21. As used in sections 3721.21 to 3721.34 of 912
the Revised Code: 913
(A) "Long-term care facility" means either of the 915
following: 916
(1) A nursing home as defined in section 3721.01 of the 918
Revised Code, other than a nursing home or part of a nursing home 919
certified as an intermediate care facility for the mentally 920
retarded under Title XIX of the "Social Security Act," 49 Stat. 921
620 (1935), 42 U.S.C.A. 301, as amended; 922
(2) A facility or part of a facility that is certified as 924
a skilled nursing facility or a nursing facility under Title 925
XVIII or XIX of the "Social Security Act." 926
(B) "Residential care facility" has the same meaning as in 928
21
section 3721.01 of the Revised Code. 929
(C) "Abuse" means knowingly causing physical harm or 931
recklessly causing serious physical harm to a resident by 932
physical contact with the resident or by use of physical or 933
chemical restraint, medication, or isolation as punishment, for 934
staff convenience, excessively, as a substitute for treatment, or 935
in amounts that preclude habilitation and treatment. 936
(D) "Neglect" means recklessly failing to provide a 938
resident with any treatment, care, goods, or service necessary to 939
maintain the health or safety of the resident when the failure 940
results in serious physical harm to the resident. "NEGLECT" DOES 941
NOT INCLUDE ALLOWING A RESIDENT, AT THE RESIDENT'S OPTION, TO 942
RECEIVE ONLY TREATMENT BY SPIRITUAL MEANS THROUGH PRAYER IN 944
ACCORDANCE WITH THE TENETS OF A RECOGNIZED RELIGIOUS
DENOMINATION. 945
(E) "Misappropriation" means depriving, defrauding, or 947
otherwise obtaining the real or personal property of a resident 948
by any means prohibited by the Revised Code, including violations 949
of Chapter 2911. or 2913. of the Revised Code. 950
(F) "Resident" includes a resident, patient, former 953
resident or patient, or deceased resident or patient of a
long-term care facility or a residential care facility. 954
(G) "Physical restraint" has the same meaning as in 956
section 3721.10 of the Revised Code. 957
(H) "Chemical restraint" has the same meaning as in 959
section 3721.10 of the Revised Code. 960
(I) "Nursing and nursing-related services" means the 963
personal care services and other services not constituting
skilled nursing care that are specified in rules the public 964
health council shall adopt in accordance with Chapter 119. of the 966
Revised Code.
(J) "Personal care services" has the same meaning as in 968
section 3721.01 of the Revised Code. 969
(K) "Nurse aide" means an individual, other than a 971
22
licensed health professional practicing within the scope of the 972
professional's license, who provides nursing and nursing-related 974
services to residents in a long-term care facility, either as a 975
member of the staff of the facility for monetary compensation or 976
as a volunteer without monetary compensation. 977
(L) "Licensed health professional" means all of the 979
following: 980
(1) An occupational therapist or occupational therapy 982
assistant licensed under Chapter 4755. of the Revised Code; 983
(2) A physical therapist or physical therapy assistant 985
licensed under Chapter 4755. of the Revised Code; 986
(3) A physician authorized under Chapter 4731. of the 988
Revised Code to practice medicine and surgery, osteopathic 989
medicine and surgery, or podiatry; 990
(4) A physician assistant authorized under Chapter 4730. 993
of the Revised Code to practice as a physician assistant;
(5) A registered nurse or licensed practical nurse 995
licensed under Chapter 4723. of the Revised Code; 996
(6) A social worker or independent social worker licensed 999
under Chapter 4757. of the Revised Code or a social work
assistant registered under that chapter; 1,000
(7) A speech-language pathologist or audiologist licensed 1,002
under Chapter 4753. of the Revised Code; 1,003
(8) A dentist or dental hygienist licensed under Chapter 1,005
4715. of the Revised Code; 1,006
(9) An optometrist licensed under Chapter 4725. of the 1,008
Revised Code; 1,009
(10) A pharmacist licensed under Chapter 4729. of the 1,011
Revised Code; 1,012
(11) A psychologist licensed under Chapter 4732. of the 1,014
Revised Code; 1,015
(12) A chiropractor licensed under Chapter 4734. of the 1,017
Revised Code; 1,018
(13) A nursing home administrator licensed or temporarily 1,020
23
licensed under Chapter 4751. of the Revised Code; 1,021
(14) A professional counselor or professional clinical 1,023
counselor licensed under Chapter 4757. of the Revised Code. 1,024
(M) "Competency evaluation program" means a program 1,026
through which the competency of a nurse aide to provide nursing 1,027
and nursing-related services is evaluated. 1,028
(N) "Training and competency evaluation program" means a 1,030
program of nurse aide training and evaluation of competency to 1,031
provide nursing and nursing-related services. 1,032
Sec. 5111.20. As used in sections 5111.20 to 5111.32 of 1,041
the Revised Code: 1,042
(A) "Allowable costs" are those costs determined by the 1,044
department of job and family services to be reasonable and do not 1,045
include fines paid under sections 5111.35 to 5111.61 and section 1,047
5111.99 of the Revised Code. 1,048
(B) "Capital costs" means costs of ownership and 1,050
nonextensive renovation. 1,051
(1) "Cost of ownership" means the actual expense incurred 1,053
for all of the following: 1,054
(a) Depreciation and interest on any capital assets that 1,056
cost five hundred dollars or more per item, including the 1,057
following: 1,058
(i) Buildings; 1,060
(ii) Building improvements that are not approved as 1,062
nonextensive renovations under section 5111.25 or 5111.251 of the 1,063
Revised Code; 1,064
(iii) Equipment; 1,066
(iv) Extensive renovations; 1,068
(v) Transportation equipment. 1,070
(b) Amortization and interest on land improvements and 1,072
leasehold improvements; 1,073
(c) Amortization of financing costs; 1,075
(d) Except as provided in division (I) of this section, 1,077
lease and rent of land, building, and equipment. 1,078
24
The costs of capital assets of less than five hundred 1,080
dollars per item may be considered costs of ownership in 1,081
accordance with a provider's practice.
(2) "Costs of nonextensive renovation" means the actual 1,083
expense incurred for depreciation or amortization and interest on 1,084
renovations that are not extensive renovations. 1,085
(C) "Capital lease" and "operating lease" shall be 1,087
construed in accordance with generally accepted accounting 1,088
principles.
(D) "Case-mix score" means the measure determined under 1,090
section 5111.231 of the Revised Code of the relative direct-care 1,091
resources needed to provide care and habilitation to a resident 1,092
of a nursing facility or intermediate care facility for the 1,093
mentally retarded. 1,094
(E) "Date of licensure," for a facility originally 1,096
licensed as a nursing home under Chapter 3721. of the Revised 1,097
Code, means the date specific beds were originally licensed as 1,098
nursing home beds under that chapter, regardless of whether they 1,099
were subsequently licensed as residential facility beds under 1,100
section 5123.19 of the Revised Code. For a facility originally 1,101
licensed as a residential facility under section 5123.19 of the 1,102
Revised Code, "date of licensure" means the date specific beds 1,103
were originally licensed as residential facility beds under that 1,104
section.
(1) If nursing home beds licensed under Chapter 3721. of 1,106
the Revised Code or residential facility beds licensed under 1,107
section 5123.19 of the Revised Code were not required by law to 1,108
be licensed when they were originally used to provide nursing 1,109
home or residential facility services, "date of licensure" means 1,110
the date the beds first were used to provide nursing home or
residential facility services, regardless of the date the present 1,111
provider obtained licensure. 1,112
(2) If a facility adds nursing home beds or residential 1,114
facility beds or extensively renovates all or part of the 1,115
25
facility after its original date of licensure, it will have a 1,116
different date of licensure for the additional beds or 1,117
extensively renovated portion of the facility, unless the beds 1,118
are added in a space that was constructed at the same time as the 1,119
previously licensed beds but was not licensed under Chapter 3721. 1,120
or section 5123.19 of the Revised Code at that time. 1,121
(F) "Desk-reviewed" means that costs as reported on a cost 1,123
report submitted under section 5111.26 of the Revised Code have 1,124
been subjected to a desk review under division (A) of section 1,125
5111.27 of the Revised Code and preliminarily determined to be 1,126
allowable costs. 1,127
(G) "Direct care costs" means all of the following: 1,129
(1)(a) Costs for registered nurses, licensed practical 1,131
nurses, and nurse aides employed by the facility; 1,132
(b) Costs for direct care staff, administrative nursing 1,134
staff, medical directors, social services staff, activities 1,135
staff, psychologists and psychology assistants, social workers 1,136
and counselors, habilitation staff, qualified mental retardation 1,137
professionals, program directors, respiratory therapists, 1,138
habilitation supervisors, and except as provided in division 1,139
(G)(2) of this section, other persons holding degrees qualifying 1,140
them to provide therapy; 1,141
(c) Costs of purchased nursing services; 1,143
(d) Costs of quality assurance; 1,145
(e) Costs of training and staff development, employee 1,147
benefits, payroll taxes, and workers' compensation premiums or 1,148
costs for self-insurance claims and related costs as specified in 1,149
rules adopted by the director of job and family services in 1,151
accordance with Chapter 119. of the Revised Code, for personnel 1,153
listed in divisions (G)(1)(a), (b), and (d) of this section; 1,154
(f) Costs of consulting and management fees related to 1,156
direct care;
(g) Allocated direct care home office costs. 1,158
(2) In addition to the costs specified in division (G)(1) 1,160
26
of this section, for intermediate care facilities for the 1,161
mentally retarded only, direct care costs include both of the 1,162
following: 1,163
(a) Costs for physical therapists and physical therapy 1,165
assistants, occupational therapists and occupational therapy 1,166
assistants, speech therapists, and audiologists; 1,167
(b) Costs of training and staff development, employee 1,169
benefits, payroll taxes, and workers' compensation premiums or 1,170
costs for self-insurance claims and related costs as specified in 1,171
rules adopted by the director of job and family services in 1,173
accordance with Chapter 119. of the Revised Code, for personnel 1,174
listed in division (G)(2)(a) of this section. 1,175
(3) Costs of other direct-care resources that are 1,177
specified as direct care costs in rules adopted by the director 1,179
of job and family services in accordance with Chapter 119. of the 1,180
Revised Code. 1,181
(H) "Fiscal year" means the fiscal year of this state, as 1,183
specified in section 9.34 of the Revised Code. 1,184
(I) "Indirect care costs" means all reasonable costs other 1,186
than direct care costs, other protected costs, or capital costs. 1,187
"Indirect care costs" includes but is not limited to costs of 1,188
habilitation supplies, pharmacy consultants, medical and 1,189
habilitation records, program supplies, incontinence supplies, 1,190
food, enterals, dietary supplies and personnel, laundry, 1,191
housekeeping, security, administration, liability insurance, 1,192
bookkeeping, purchasing department, human resources, 1,193
communications, travel, dues, license fees, subscriptions, home 1,194
office costs not otherwise allocated, legal services, accounting 1,195
services, minor equipment, maintenance and repairs, help-wanted 1,197
advertising, informational advertising, CONSUMER SATISFACTION 1,198
SURVEY FEES PAID UNDER SECTION 173.55 OF THE REVISED CODE, 1,199
start-up costs, organizational expenses, other interest, property 1,200
insurance, employee training and staff development, employee 1,201
benefits, payroll taxes, and workers' compensation premiums or 1,202
27
costs for self-insurance claims and related costs as specified in 1,203
rules adopted by the director of job and family services in 1,204
accordance with Chapter 119. of the Revised Code, for personnel 1,205
listed in this division. Notwithstanding division (B)(1) of this 1,206
section, "indirect care costs" also means the cost of equipment, 1,207
including vehicles, acquired by operating lease executed before 1,208
December 1, 1992, if the costs are reported as administrative and 1,209
general costs on the facility's cost report for the cost 1,210
reporting period ending December 31, 1992. 1,211
(J) "Inpatient days" means all days during which a 1,213
resident, regardless of payment source, occupies a bed in a 1,214
nursing facility or intermediate care facility for the mentally 1,215
retarded that is included in the facility's certified capacity 1,216
under Title XIX of the "Social Security Act," 49 Stat. 610 1,217
(1935), 42 U.S.C.A. 301, as amended. Therapeutic or hospital 1,218
leave days for which payment is made under section 5111.33 of the 1,219
Revised Code are considered inpatient days proportionate to the 1,220
percentage of the facility's per resident per day rate paid for 1,221
those days. 1,222
(K) "Intermediate care facility for the mentally retarded" 1,224
means an intermediate care facility for the mentally retarded 1,225
certified as in compliance with applicable standards for the 1,226
medical assistance program by the director of health in 1,227
accordance with Title XIX of the "Social Security Act." 1,228
(L) "Maintenance and repair expenses" means, except as 1,230
provided in division (X)(2) of this section, expenditures that 1,231
are necessary and proper to maintain an asset in a normally 1,232
efficient working condition and that do not extend the useful 1,233
life of the asset two years or more. "Maintenance and repair 1,234
expenses" includes but is not limited to the cost of ordinary 1,235
repairs such as painting and wallpapering. 1,236
(M) "Nursing facility" means a facility, or a distinct 1,238
part of a facility, that is certified as a nursing facility by 1,239
the director of health in accordance with Title XIX of the 1,240
28
"Social Security Act," and is not an intermediate care facility 1,241
for the mentally retarded. "Nursing facility" includes a 1,242
facility, or a distinct part of a facility, that is certified as 1,243
a nursing facility by the director of health in accordance with 1,244
Title XIX of the "Social Security Act," and is certified as a 1,245
skilled nursing facility by the director in accordance with Title 1,246
XVIII of the "Social Security Act." 1,247
(N) "Other protected costs" means costs for medical 1,249
supplies; real estate, franchise, and property taxes; natural 1,250
gas, fuel oil, water, electricity, sewage, and refuse and 1,251
hazardous medical waste collection; allocated other protected 1,252
home office costs; and any additional costs defined as other 1,255
protected costs in rules adopted by the director of job and 1,256
family services in accordance with Chapter 119. of the Revised 1,258
Code.
(O) "Owner" means any person or government entity that has 1,260
at least five per cent ownership or interest, either directly, 1,261
indirectly, or in any combination, in a nursing facility or 1,262
intermediate care facility for the mentally retarded. 1,263
(P) "Patient" includes "resident." 1,265
(Q) Except as provided in divisions (Q)(1) and (2) of this 1,267
section, "per diem" means a nursing facility's or intermediate 1,268
care facility for the mentally retarded's actual, allowable costs 1,269
in a given cost center in a cost reporting period, divided by the 1,270
facility's inpatient days for that cost reporting period. 1,271
(1) When calculating indirect care costs for the purpose 1,273
of establishing rates under section 5111.24 or 5111.241 of the 1,274
Revised Code, "per diem" means a facility's actual, allowable 1,275
indirect care costs in a cost reporting period divided by the 1,276
greater of the facility's inpatient days for that period or the 1,277
number of inpatient days the facility would have had during that 1,278
period if its occupancy rate had been eighty-five per cent. 1,279
(2) When calculating capital costs for the purpose of 1,281
establishing rates under section 5111.25 or 5111.251 of the 1,282
29
Revised Code, "per diem" means a facility's actual, allowable 1,283
capital costs in a cost reporting period divided by the greater 1,284
of the facility's inpatient days for that period or the number of 1,285
inpatient days the facility would have had during that period if 1,286
its occupancy rate had been ninety-five per cent. 1,287
(R) "Provider" means a person or government entity that 1,289
operates a nursing facility or intermediate care facility for the 1,290
mentally retarded under a provider agreement. 1,291
(S) "Provider agreement" means a contract between the 1,293
department of job and family services and a nursing facility or 1,294
intermediate care facility for the mentally retarded for the 1,295
provision of nursing facility services or intermediate care 1,296
facility services for the mentally retarded under the medical 1,297
assistance program. 1,298
(T) "Purchased nursing services" means services that are 1,300
provided in a nursing facility by registered nurses, licensed 1,301
practical nurses, or nurse aides who are not employees of the 1,302
facility. 1,303
(U) "Reasonable" means that a cost is an actual cost that 1,305
is appropriate and helpful to develop and maintain the operation 1,306
of patient care facilities and activities, including normal 1,307
standby costs, and that does not exceed what a prudent buyer pays 1,308
for a given item or services. Reasonable costs may vary from 1,309
provider to provider and from time to time for the same provider. 1,310
(V) "Related party" means an individual or organization 1,312
that, to a significant extent, has common ownership with, is 1,313
associated or affiliated with, has control of, or is controlled 1,314
by, the provider. 1,315
(1) An individual who is a relative of an owner is a 1,317
related party. 1,318
(2) Common ownership exists when an individual or 1,320
individuals possess significant ownership or equity in both the 1,321
provider and the other organization. Significant ownership or 1,322
equity exists when an individual or individuals possess five per 1,323
30
cent ownership or equity in both the provider and a supplier. 1,324
Significant ownership or equity is presumed to exist when an 1,325
individual or individuals possess ten per cent ownership or 1,326
equity in both the provider and another organization from which 1,327
the provider purchases or leases real property. 1,328
(3) Control exists when an individual or organization has 1,330
the power, directly or indirectly, to significantly influence or 1,331
direct the actions or policies of an organization. 1,332
(4) An individual or organization that supplies goods or 1,334
services to a provider shall not be considered a related party if 1,335
all of the following conditions are met: 1,336
(a) The supplier is a separate bona fide organization. 1,338
(b) A substantial part of the supplier's business activity 1,340
of the type carried on with the provider is transacted with 1,341
others than the provider and there is an open, competitive market 1,342
for the types of goods or services the supplier furnishes. 1,343
(c) The types of goods or services are commonly obtained 1,345
by other nursing facilities or intermediate care facilities for 1,346
the mentally retarded from outside organizations and are not a 1,347
basic element of patient care ordinarily furnished directly to 1,348
patients by the facilities. 1,349
(d) The charge to the provider is in line with the charge 1,351
for the goods or services in the open market and no more than the 1,352
charge made under comparable circumstances to others by the 1,353
supplier. 1,354
(W) "Relative of owner" means an individual who is related 1,356
to an owner of a nursing facility or intermediate care facility 1,357
for the mentally retarded by one of the following relationships: 1,358
(1) Spouse; 1,360
(2) Natural parent, child, or sibling; 1,362
(3) Adopted parent, child, or sibling; 1,364
(4) Step-parent, step-child, step-brother, or step-sister; 1,366
(5) Father-in-law, mother-in-law, son-in-law, 1,368
daughter-in-law, brother-in-law, or sister-in-law; 1,369
31
(6) Grandparent or grandchild; 1,371
(7) Foster parent, foster child, foster brother, or foster 1,373
sister. 1,374
(X) "Renovation" and "extensive renovation" mean: 1,376
(1) Any betterment, improvement, or restoration of a 1,378
nursing facility or intermediate care facility for the mentally 1,379
retarded started before July 1, 1993, that meets the definition 1,380
of a renovation or extensive renovation established in rules 1,381
adopted by the director of job and family services in effect on 1,383
December 22, 1992.
(2) In the case of betterments, improvements, and 1,385
restorations of nursing facilities and intermediate care 1,386
facilities for the mentally retarded started on or after July 1, 1,387
1993: 1,388
(a) "Renovation" means the betterment, improvement, or 1,390
restoration of a nursing facility or intermediate care facility 1,391
for the mentally retarded beyond its current functional capacity 1,392
through a structural change that costs at least five hundred 1,393
dollars per bed. A renovation may include betterment, 1,394
improvement, restoration, or replacement of assets that are 1,395
affixed to the building and have a useful life of at least five 1,396
years. A renovation may include costs that otherwise would be 1,397
considered maintenance and repair expenses if they are an 1,398
integral part of the structural change that makes up the 1,399
renovation project. "Renovation" does not mean construction of 1,400
additional space for beds that will be added to a facility's 1,401
licensed or certified capacity. 1,402
(b) "Extensive renovation" means a renovation that costs 1,404
more than sixty-five per cent and no more than eighty-five per 1,405
cent of the cost of constructing a new bed and that extends the 1,406
useful life of the assets for at least ten years. 1,407
For the purposes of division (X)(2) of this section, the 1,409
cost of constructing a new bed shall be considered to be forty 1,410
thousand dollars, adjusted for the estimated rate of inflation 1,411
32
from January 1, 1993, to the end of the calendar year during 1,412
which the renovation is completed, using the consumer price index 1,413
for shelter costs for all urban consumers for the north central 1,414
region, as published by the United States bureau of labor 1,415
statistics. 1,416
The department of job and family services may treat a 1,418
renovation that costs more than eighty-five per cent of the cost 1,419
of constructing new beds as an extensive renovation if the 1,420
department determines that the renovation is more prudent than 1,421
construction of new beds. 1,422
Sec. 5111.25. (A) The department of job and family 1,432
services shall pay each eligible nursing facility a per resident 1,433
per day rate for its reasonable capital costs established 1,434
prospectively each fiscal year for each facility. Except as 1,435
otherwise provided in sections 5111.20 to 5111.32 of the Revised 1,436
Code, the rate shall be based on the facility's capital costs for 1,437
the calendar year preceding the fiscal year in which the rate
will be paid. The rate shall equal the sum of divisions (A)(1) 1,438
to (3) of this section: 1,439
(1) The lesser of the following: 1,441
(a) Eighty-eight and sixty-five one-hundredths per cent of 1,443
the facility's desk-reviewed, actual, allowable, per diem cost of 1,444
ownership and eighty-five per cent of the facility's actual, 1,445
allowable, per diem cost of nonextensive renovation determined 1,446
under division (F) of this section; 1,447
(b) Eighty-eight and sixty-five one-hundredths per cent of 1,449
the following limitation: 1,450
(i) For the fiscal year beginning July 1, 1993, sixteen 1,452
dollars per resident day; 1,453
(ii) For the fiscal year beginning July 1, 1994, sixteen 1,455
dollars per resident day, adjusted to reflect the rate of 1,456
inflation for the twelve-month period beginning July 1, 1992, and 1,457
ending June 30, 1993, using the consumer price index for shelter 1,458
costs for all urban consumers for the north central region, 1,459
33
published by the United States bureau of labor statistics; 1,460
(iii) For subsequent fiscal years, the limitation in 1,462
effect during the previous fiscal year, adjusted to reflect the 1,463
rate of inflation for the twelve-month period beginning on the 1,464
first day of July for the calendar year preceding the calendar 1,465
year that precedes the fiscal year and ending on the following 1,466
thirtieth day of June, using the consumer price index for shelter 1,467
costs for all urban consumers for the north central region, 1,468
published by the United States bureau of labor statistics. 1,469
(2) Any efficiency incentive determined under division (D) 1,471
of this section; 1,472
(3) Any amounts for return on equity determined under 1,474
division (H) of this section. 1,475
Buildings shall be depreciated using the straight line 1,477
method over forty years or over a different period approved by 1,478
the department. Components and equipment shall be depreciated 1,479
using the straight-line method over a period designated in rules 1,480
adopted by the director of job and family services in accordance 1,482
with Chapter 119. of the Revised Code, consistent with the 1,483
guidelines of the American hospital association, or over a 1,484
different period approved by the department. Any rules adopted 1,485
under this division that specify useful lives of buildings, 1,486
components, or equipment apply only to assets acquired on or 1,487
after July 1, 1993. Depreciation for costs paid or reimbursed by 1,488
any government agency shall not be included in cost of ownership 1,489
or renovation unless that part of the payment under sections 1,490
5111.20 to 5111.32 of the Revised Code is used to reimburse the 1,491
government agency.
(B) The capital cost basis of nursing facility assets 1,493
shall be determined in the following manner: 1,494
(1) For purposes of calculating the rate to be paid for 1,496
the fiscal year beginning July 1, 1993, for facilities with dates 1,498
of licensure on or before June 30, 1993, the capital cost basis 1,499
shall be equal to the following: 1,500
34
(a) For facilities that have not had a change of ownership 1,502
during the period beginning January 1, 1993, and ending June 30, 1,503
1993, the desk-reviewed, actual, allowable capital cost basis 1,504
that is listed on the facility's cost report for the cost 1,505
reporting period ending December 31, 1992, plus the actual, 1,506
allowable capital cost basis of any assets constructed or 1,507
acquired after December 31, 1992, but before July 1, 1993, if the 1,508
aggregate capital costs of those assets would increase the 1,509
facility's rate for capital costs by twenty or more cents per 1,510
resident per day. 1,511
(b) For facilities that have a date of licensure or had a 1,513
change of ownership during the period beginning January 1, 1993, 1,514
and ending June 30, 1993, the actual, allowable capital cost 1,515
basis of the person or government entity that owns the facility 1,516
on June 30, 1993. 1,517
Capital cost basis shall be calculated as provided in 1,519
division (B)(1) of this section subject to approval by the United 1,520
States health care financing administration of any necessary 1,521
amendment to the state plan for providing medical assistance. 1,522
The department shall include the actual, allowable capital 1,524
cost basis of assets constructed or acquired during the period 1,525
beginning January 1, 1993, and ending June 30, 1993, in the 1,526
calculation for the facility's rate effective July 1, 1993, if 1,527
the aggregate capital costs of the assets would increase the 1,528
facility's rate by twenty or more cents per resident per day and 1,529
the facility provides the department with sufficient 1,530
documentation of the costs before June 1, 1993. If the facility 1,531
provides the documentation after that date, the department shall 1,532
adjust the facility's rate to reflect the costs of the assets one 1,533
month after the first day of the month after the department 1,534
receives the documentation. 1,535
(2) Except as provided in division (B)(4) of this section, 1,538
for purposes of calculating the rates to be paid for fiscal years 1,539
beginning after June 30, 1994, for facilities with dates of 1,540
35
licensure on or before June 30, 1993, the capital cost basis of 1,541
each asset shall be equal to the desk-reviewed, actual, 1,542
allowable, capital cost basis that is listed on the facility's 1,543
cost report for the calendar year preceding the fiscal year 1,544
during which the rate will be paid.
(3) For facilities with dates of licensure after June 30, 1,547
1993, the capital cost basis shall be determined in accordance 1,548
with the principles of the medicare program established under 1,549
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42 1,550
U.S.C.A. 301, as amended, except as otherwise provided in 1,551
sections 5111.20 to 5111.32 of the Revised Code. 1,552
(4) Except as provided in division (B)(5) of this section, 1,555
if a provider transfers an interest in a facility to another 1,556
provider after June 30, 1993, there shall be no increase in the 1,557
capital cost basis of the asset if the providers are related 1,558
parties. If the providers are not related parties or if they are 1,559
related parties and division (B)(5) of this section requires the 1,560
adjustment of the capital cost basis under this division, the 1,561
basis of the asset shall be adjusted by the lesser of the 1,562
following:
(a) One-half of the change in construction costs during 1,564
the time that the transferor held the asset, as calculated by the 1,565
department of job and family services using the "Dodge building 1,567
cost indexes, northeastern and north central states," published
by Marshall and Swift; 1,568
(b) One-half of the change in the consumer price index for 1,570
all items for all urban consumers, as published by the United 1,571
States bureau of labor statistics, during the time that the 1,572
transferor held the asset. 1,573
(5) If a provider transfers an interest in a facility to 1,576
another provider who is a related party, the capital cost basis
of the asset shall be adjusted as specified in division (B)(4) of 1,579
this section for a transfer to a provider that is not a related 1,580
party if all of the following conditions are met:
36
(a) The related party is a relative of owner; 1,583
(b) The EXCEPT AS PROVIDED IN DIVISION (B)(5)(c)(ii) OF 1,586
THIS SECTION, THE provider making the transfer retains no 1,588
ownership interest in the facility;
(c) The United States internal revenue service has issued 1,591
a ruling DEPARTMENT OF JOB AND FAMILY SERVICES DETERMINES that 1,592
the transfer is an arm's length transaction for purposes of 1,593
federal income taxation; PURSUANT TO RULES THE DEPARTMENT SHALL 1,595
ADOPT IN ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE NO 1,596
LATER THAN DECEMBER 31, 2000. THE RULES SHALL PROVIDE THAT A 1,598
TRANSFER IS AN ARM'S LENGTH TRANSACTION IF ALL OF THE FOLLOWING 1,599
APPLY:
(i) ONCE THE TRANSFER GOES INTO EFFECT, THE PROVIDER THAT 1,601
MADE THE TRANSFER HAS NO DIRECT OR INDIRECT INTEREST IN THE 1,602
PROVIDER THAT ACQUIRES THE FACILITY OR THE FACILITY ITSELF, 1,603
INCLUDING INTEREST AS AN OWNER, OFFICER, DIRECTOR, EMPLOYEE,
INDEPENDENT CONTRACTOR, OR CONSULTANT, BUT EXCLUDING INTEREST AS 1,604
A CREDITOR.
(ii) THE PROVIDER THAT MADE THE TRANSFER DOES NOT 1,606
REACQUIRE AN INTEREST IN THE FACILITY EXCEPT THROUGH THE EXERCISE 1,607
OF A CREDITOR'S RIGHTS IN THE EVENT OF A DEFAULT. IF THE 1,608
PROVIDER REACQUIRES AN INTEREST IN THE FACILITY IN THIS MANNER, 1,609
THE DEPARTMENT SHALL TREAT THE FACILITY AS IF THE TRANSFER NEVER 1,610
OCCURRED WHEN THE DEPARTMENT CALCULATES ITS REIMBURSEMENT RATES 1,611
FOR CAPITAL COSTS.
(iii) THE TRANSFER SATISFIES ANY OTHER CRITERIA SPECIFIED 1,613
IN THE RULES. 1,614
(d) Except in the case of hardship caused by a 1,617
catastrophic event, as determined by the department, or in the 1,618
case of a provider making the transfer who is at least sixty-five
years of age, not less than twenty years have elapsed since, for 1,620
the same facility, the capital cost basis was adjusted most 1,621
recently under division (B)(5) of this section or actual, 1,623
allowable cost of ownership was determined most recently under
37
division (C)(9) of this section. 1,625
(C) As used in this division, "lease expense" means lease 1,627
payments in the case of an operating lease and depreciation 1,628
expense and interest expense in the case of a capital lease. As 1,629
used in this division, "new lease" means a lease, to a different 1,630
lessee, of a nursing facility that previously was operated under 1,631
a lease. 1,632
(1) Subject to the limitation specified in division (A)(1) 1,634
of this section, for a lease of a facility that was effective on 1,635
May 27, 1992, the entire lease expense is an actual, allowable 1,636
cost of ownership during the term of the existing lease. The 1,637
entire lease expense also is an actual, allowable cost of 1,638
ownership if a lease in existence on May 27, 1992, is renewed 1,639
under either of the following circumstances: 1,640
(a) The renewal is pursuant to a renewal option that was 1,642
in existence on May 27, 1992; 1,643
(b) The renewal is for the same lease payment amount and 1,645
between the same parties as the lease in existence on May 27, 1,646
1992. 1,647
(2) Subject to the limitation specified in division (A)(1) 1,649
of this section, for a lease of a facility that was in existence 1,650
but not operated under a lease on May 27, 1992, actual, allowable 1,651
cost of ownership shall include the lesser of the annual lease 1,652
expense or the annual depreciation expense and imputed interest 1,653
expense that would be calculated at the inception of the lease 1,654
using the lessor's entire historical capital asset cost basis, 1,655
adjusted by the lesser of the following amounts: 1,656
(a) One-half of the change in construction costs during 1,658
the time the lessor held each asset until the beginning of the 1,659
lease, as calculated by the department using the "Dodge building 1,660
cost indexes, northeastern and north central states," published 1,661
by Marshall and Swift; 1,662
(b) One-half of the change in the consumer price index for 1,664
all items for all urban consumers, as published by the United 1,665
38
States bureau of labor statistics, during the time the lessor 1,666
held each asset until the beginning of the lease. 1,667
(3) Subject to the limitation specified in division (A)(1) 1,669
of this section, for a lease of a facility with a date of 1,670
licensure on or after May 27, 1992, that is initially operated 1,671
under a lease, actual, allowable cost of ownership shall include 1,672
the annual lease expense if there was a substantial commitment of 1,673
money for construction of the facility after December 22, 1992, 1,674
and before July 1, 1993. If there was not a substantial 1,675
commitment of money after December 22, 1992, and before July 1, 1,676
1993, actual, allowable cost of ownership shall include the 1,677
lesser of the annual lease expense or the sum of the following: 1,678
(a) The annual depreciation expense that would be 1,680
calculated at the inception of the lease using the lessor's 1,681
entire historical capital asset cost basis; 1,682
(b) The greater of the lessor's actual annual amortization 1,684
of financing costs and interest expense at the inception of the 1,685
lease or the imputed interest expense calculated at the inception 1,686
of the lease using seventy per cent of the lessor's historical 1,687
capital asset cost basis. 1,688
(4) Subject to the limitation specified in division (A)(1) 1,690
of this section, for a lease of a facility with a date of 1,691
licensure on or after May 27, 1992, that was not initially 1,692
operated under a lease and has been in existence for ten years, 1,693
actual, allowable cost of ownership shall include the lesser of 1,694
the annual lease expense or the annual depreciation expense and 1,695
imputed interest expense that would be calculated at the 1,696
inception of the lease using the entire historical capital asset 1,697
cost basis of the lessor, adjusted by the lesser of the 1,698
following: 1,699
(a) One-half of the change in construction costs during 1,701
the time the lessor held each asset until the beginning of the 1,702
lease, as calculated by the department using the "Dodge building 1,703
cost indexes, northeastern and north central states," published 1,704
39
by Marshall and Swift; 1,705
(b) One-half of the change in the consumer price index for 1,707
all items for all urban consumers, as published by the United 1,708
States bureau of labor statistics, during the time the lessor 1,709
held each asset until the beginning of the lease. 1,710
(5) Subject to the limitation specified in division (A)(1) 1,712
of this section, for a new lease of a facility that was operated 1,713
under a lease on May 27, 1992, actual, allowable cost of 1,714
ownership shall include the lesser of the annual new lease 1,715
expense or the annual old lease payment. If the old lease was in 1,716
effect for ten years or longer, the old lease payment from the 1,717
beginning of the old lease shall be adjusted by the lesser of the 1,718
following: 1,719
(a) One-half of the change in construction costs from the 1,721
beginning of the old lease to the beginning of the new lease, as 1,722
calculated by the department using the "Dodge building cost 1,723
indexes, northeastern and north central states," published by 1,724
Marshall and Swift; 1,725
(b) One-half of the change in the consumer price index for 1,727
all items for all urban consumers, as published by the United 1,728
States bureau of labor statistics, from the beginning of the old 1,729
lease to the beginning of the new lease. 1,730
(6) Subject to the limitation specified in division (A)(1) 1,732
of this section, for a new lease of a facility that was not in 1,733
existence or that was in existence but not operated under a lease 1,734
on May 27, 1992, actual, allowable cost of ownership shall 1,735
include the lesser of annual new lease expense or the annual 1,736
amount calculated for the old lease under division (C)(2), (3), 1,737
(4), or (6) of this section, as applicable. If the old lease was 1,738
in effect for ten years or longer, the lessor's historical 1,739
capital asset cost basis shall be adjusted by the lesser of the 1,740
following for purposes of calculating the annual amount under 1,741
division (C)(2), (3), (4), or (6) of this section: 1,742
(a) One-half of the change in construction costs from the 1,744
40
beginning of the old lease to the beginning of the new lease, as 1,745
calculated by the department using the "Dodge building cost 1,746
indexes, northeastern and north central states," published by 1,747
Marshall and Swift; 1,748
(b) One-half of the change in the consumer price index for 1,750
all items for all urban consumers, as published by the United 1,751
States bureau of labor statistics, from the beginning of the old 1,752
lease to the beginning of the new lease. 1,753
In the case of a lease under division (C)(3) of this 1,755
section of a facility for which a substantial commitment of money 1,756
was made after December 22, 1992, and before July 1, 1993, the 1,757
old lease payment shall be adjusted for the purpose of 1,758
determining the annual amount. 1,759
(7) For any revision of a lease described in division 1,761
(C)(1), (2), (3), (4), (5), or (6) of this section, or for any 1,762
subsequent lease of a facility operated under such a lease, other 1,763
than execution of a new lease, the portion of actual, allowable 1,764
cost of ownership attributable to the lease shall be the same as 1,765
before the revision or subsequent lease. 1,766
(8) Except as provided in division (C)(9) of this section, 1,769
if a provider leases an interest in a facility to another 1,770
provider who is a related party, the related party's actual, 1,772
allowable cost of ownership shall include the lesser of the 1,773
annual lease expense or the reasonable cost to the lessor. 1,774
(9) If a provider leases an interest in a facility to 1,776
another provider who is a related party, regardless of the date 1,778
of the lease, the related party's actual, allowable cost of 1,779
ownership shall include the annual lease expense, subject to the 1,780
limitations specified in divisions (C)(1) to (7) of this section, 1,781
if all of the following conditions are met: 1,782
(a) The related party is a relative of owner; 1,784
(b) If the lessor retains an ownership interest, it is, 1,787
EXCEPT AS PROVIDED IN DIVISION (C)(9)(c)(ii) OF THIS SECTION, in 1,788
only the real property and any improvements on the real property; 1,790
41
(c) The United States internal revenue service has issued 1,793
a ruling DEPARTMENT OF JOB AND FAMILY SERVICES DETERMINES that 1,794
the lease is an arm's length transaction for purposes of federal 1,795
income taxation; PURSUANT TO RULES THE DEPARTMENT SHALL ADOPT IN 1,797
ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE NO LATER THAN 1,798
DECEMBER 31, 2000. THE RULES SHALL PROVIDE THAT A LEASE IS AN 1,800
ARM'S LENGTH TRANSACTION IF ALL OF THE FOLLOWING APPLY: 1,801
(i) ONCE THE LEASE GOES INTO EFFECT, THE LESSOR HAS NO 1,803
DIRECT OR INDIRECT INTEREST IN THE LESSEE OR, EXCEPT AS PROVIDED 1,804
IN DIVISION (C)(9)(b) OF THIS SECTION, THE FACILITY ITSELF, 1,805
INCLUDING INTEREST AS AN OWNER, OFFICER, DIRECTOR, EMPLOYEE, 1,807
INDEPENDENT CONTRACTOR, OR CONSULTANT, BUT EXCLUDING INTEREST AS 1,809
A LESSOR.
(ii) THE LESSOR DOES NOT REACQUIRE AN INTEREST IN THE 1,811
FACILITY EXCEPT THROUGH THE EXERCISE OF A LESSOR'S RIGHTS IN THE 1,812
EVENT OF A DEFAULT. IF THE LESSOR REACQUIRES AN INTEREST IN THE 1,813
FACILITY IN THIS MANNER, THE DEPARTMENT SHALL TREAT THE FACILITY 1,814
AS IF THE LEASE NEVER OCCURRED WHEN THE DEPARTMENT CALCULATES ITS 1,815
REIMBURSEMENT RATES FOR CAPITAL COSTS.
(iii) THE LEASE SATISFIES ANY OTHER CRITERIA SPECIFIED IN 1,817
THE RULES. 1,818
(d) Except in the case of hardship caused by a 1,821
catastrophic event, as determined by the department, or in the 1,822
case of a lessor who is at least sixty-five years of age, not
less than twenty years have elapsed since, for the same facility, 1,824
the capital cost basis was adjusted most recently under division 1,825
(B)(5) of this section or actual, allowable cost of ownership was 1,827
determined most recently under division (C)(9) of this section. 1,829
(10) This division does not apply to leases of specific 1,831
items of equipment. 1,832
(D)(1) Subject to division (D)(2) of this section, the 1,834
department shall pay each nursing facility an efficiency 1,835
incentive that is equal to fifty per cent of the difference 1,836
between the following:
42
(a) Eighty-eight and sixty-five one-hundredths per cent of 1,838
the facility's desk-reviewed, actual, allowable, per diem cost of 1,839
ownership;
(b) The applicable amount specified in division (E) of 1,841
this section. 1,842
(2) The efficiency incentive paid to a nursing facility 1,845
shall not exceed the greater of the following:
(a) The efficiency incentive the facility was paid during 1,848
the fiscal year ending June 30, 1994;
(b) Three dollars per resident per day, adjusted annually 1,851
for rates paid beginning July 1, 1994, for the inflation rate for 1,852
the twelve-month period beginning on the first day of July of the 1,853
calendar year preceding the calendar year that precedes the 1,854
fiscal year for which the efficiency incentive is determined and 1,855
ending on the thirtieth day of the following June, using the 1,856
consumer price index for shelter costs for all urban consumers 1,857
for the north central region, as published by the United States 1,858
bureau of labor statistics. 1,859
(3) For purposes of calculating the efficiency incentive, 1,862
depreciation for costs that are paid or reimbursed by any 1,863
government agency shall be considered as costs of ownership, and 1,864
renovation costs that are paid under division (F) of this section 1,865
shall not be considered costs of ownership. 1,866
(E) The following amounts shall be used to calculate 1,868
efficiency incentives for nursing facilities under this section: 1,869
(1) For facilities with dates of licensure prior to 1,871
January 1, 1958, four dollars and twenty-four cents per patient 1,872
day; 1,873
(2) For facilities with dates of licensure after December 1,875
31, 1957, but prior to January 1, 1968: 1,876
(a) Five dollars and twenty-four cents per patient day if 1,878
the cost of construction was three thousand five hundred dollars 1,879
or more per bed; 1,880
(b) Four dollars and twenty-four cents per patient day if 1,882
43
the cost of construction was less than three thousand five 1,883
hundred dollars per bed. 1,884
(3) For facilities with dates of licensure after December 1,886
31, 1967, but prior to January 1, 1976: 1,887
(a) Six dollars and twenty-four cents per patient day if 1,889
the cost of construction was five thousand one hundred fifty 1,890
dollars or more per bed; 1,891
(b) Five dollars and twenty-four cents per patient day if 1,893
the cost of construction was less than five thousand one hundred 1,894
fifty dollars per bed, but exceeded three thousand five hundred 1,895
dollars per bed; 1,896
(c) Four dollars and twenty-four cents per patient day if 1,898
the cost of construction was three thousand five hundred dollars 1,899
or less per bed. 1,900
(4) For facilities with dates of licensure after December 1,902
31, 1975, but prior to January 1, 1979: 1,903
(a) Seven dollars and twenty-four cents per patient day if 1,905
the cost of construction was six thousand eight hundred dollars 1,906
or more per bed; 1,907
(b) Six dollars and twenty-four cents per patient day if 1,909
the cost of construction was less than six thousand eight hundred 1,910
dollars per bed but exceeded five thousand one hundred fifty 1,911
dollars per bed; 1,912
(c) Five dollars and twenty-four cents per patient day if 1,914
the cost of construction was five thousand one hundred fifty 1,915
dollars or less per bed, but exceeded three thousand five hundred 1,916
dollars per bed; 1,917
(d) Four dollars and twenty-four cents per patient day if 1,919
the cost of construction was three thousand five hundred dollars 1,920
or less per bed. 1,921
(5) For facilities with dates of licensure after December 1,923
31, 1978, but prior to January 1, 1981: 1,924
(a) Seven dollars and seventy-four cents per patient day 1,926
if the cost of construction was seven thousand six hundred 1,927
44
twenty-five dollars or more per bed; 1,928
(b) Seven dollars and twenty-four cents per patient day if 1,930
the cost of construction was less than seven thousand six hundred 1,931
twenty-five dollars per bed but exceeded six thousand eight 1,932
hundred dollars per bed; 1,933
(c) Six dollars and twenty-four cents per patient day if 1,935
the cost of construction was six thousand eight hundred dollars 1,936
or less per bed but exceeded five thousand one hundred fifty 1,937
dollars per bed; 1,938
(d) Five dollars and twenty-four cents per patient day if 1,940
the cost of construction was five thousand one hundred fifty 1,941
dollars or less but exceeded three thousand five hundred dollars 1,942
per bed; 1,943
(e) Four dollars and twenty-four cents per patient day if 1,945
the cost of construction was three thousand five hundred dollars 1,946
or less per bed. 1,947
(6) For facilities with dates of licensure in 1981 or any 1,949
year thereafter prior to December 22, 1992, the following amount: 1,950
(a) For facilities with construction costs less than seven 1,952
thousand six hundred twenty-five dollars per bed, the applicable 1,953
amounts for the construction costs specified in divisions 1,954
(E)(5)(b) to (e) of this section; 1,955
(b) For facilities with construction costs of seven 1,957
thousand six hundred twenty-five dollars or more per bed, six 1,958
dollars per patient day, provided that for 1981 and annually 1,959
thereafter prior to December 22, 1992, department shall do both 1,960
of the following to the six-dollar amount: 1,961
(i) Adjust the amount for fluctuations in construction 1,963
costs calculated by the department using the "Dodge building cost 1,964
indexes, northeastern and north central states," published by 1,965
Marshall and Swift, using 1980 as the base year; 1,966
(ii) Increase the amount, as adjusted for inflation under 1,968
division (E)(6)(b)(i) of this section, by one dollar and 1,969
seventy-four cents. 1,970
45
(7) For facilities with dates of licensure on or after 1,972
January 1, 1992, seven dollars and ninety-seven cents, adjusted 1,973
for fluctuations in construction costs between 1991 and 1993 as 1,974
calculated by the department using the "Dodge building cost 1,975
indexes, northeastern and north central states," published by 1,976
Marshall and Swift, and then increased by one dollar and 1,977
seventy-four cents. 1,978
For the fiscal year that begins July 1, 1994, each of the 1,980
amounts listed in divisions (E)(1) to (7) of this section shall 1,981
be increased by twenty-five cents. For the fiscal year that 1,982
begins July 1, 1995, each of those amounts shall be increased by 1,983
an additional twenty-five cents. For subsequent fiscal years, 1,984
each of those amounts, as increased for the prior fiscal year, 1,985
shall be adjusted to reflect the rate of inflation for the 1,986
twelve-month period beginning on the first day of July of the 1,987
calendar year preceding the calendar year that precedes the 1,988
fiscal year and ending on the following thirtieth day of June, 1,989
using the consumer price index for shelter costs for all urban 1,990
consumers for the north central region, as published by the 1,991
United States bureau of labor statistics. 1,992
If the amount established for a nursing facility under this 1,994
division is less than the amount that applied to the facility 1,995
under division (B) of former section 5111.25 of the Revised Code, 1,996
as the former section existed immediately prior to December 22, 1,997
1992, the amount used to calculate the efficiency incentive for 1,998
the facility under division (D)(2) of this section shall be the 1,999
amount that was calculated under division (B) of the former 2,000
section. 2,001
(F) Beginning July 1, 1993, regardless of the facility's 2,003
date of licensure or the date of the nonextensive renovations, 2,004
the rate for the costs of nonextensive renovations for nursing 2,005
facilities shall be eighty-five per cent of the desk-reviewed, 2,006
actual, allowable, per diem, nonextensive renovation costs. This 2,007
division applies to nonextensive renovations regardless of 2,008
46
whether they are made by an owner or a lessee. If the tenancy of 2,009
a lessee that has made nonextensive renovations ends before the 2,010
depreciation expense for the renovation costs has been fully 2,011
reported, the former lessee shall not report the undepreciated 2,012
balance as an expense. 2,013
(1) For a nonextensive renovation made after July 1, 1993, 2,015
to qualify for payment under this division, both of the following 2,016
conditions must be met: 2,017
(a) At least five years have elapsed since the date of 2,019
licensure of the portion of the facility that is proposed to be 2,020
renovated, except that this condition does not apply if the 2,021
renovation is necessary to meet the requirements of federal, 2,022
state, or local statutes, ordinances, rules, or policies. 2,023
(b) The provider has obtained prior approval from the 2,025
department of job and family services, and if required the 2,027
director of health has granted a certificate of need for the
renovation under section 3702.52 of the Revised Code. The 2,028
provider shall submit a plan that describes in detail the changes 2,029
in capital assets to be accomplished by means of the renovation 2,030
and the timetable for completing the project. The time for 2,031
completion of the project shall be no more than eighteen months 2,032
after the renovation begins. The DEPARTMENT of job and family 2,033
services shall adopt rules in accordance with Chapter 119. of the 2,034
Revised Code that specify criteria and procedures for prior 2,035
approval of renovation projects. No provider shall separate a 2,036
project with the intent to evade the characterization of the 2,037
project as a renovation or as an extensive renovation. No 2,038
provider shall increase the scope of a project after it is 2,039
approved by the department of job and family services unless the 2,040
increase in scope is approved by the department. 2,041
(2) The payment provided for in this division is the only 2,043
payment that shall be made for the costs of a nonextensive 2,044
renovation. Nonextensive renovation costs shall not be included 2,045
in costs of ownership, and a nonextensive renovation shall not 2,046
47
affect the date of licensure for purposes of calculating the 2,047
efficiency incentive under divisions (D) and (E) of this section. 2,048
(G) The owner of a nursing facility operating under a 2,050
provider agreement shall provide written notice to the department 2,051
of job and family services at least forty-five days prior to 2,053
entering into any contract of sale for the facility or
voluntarily terminating participation in the medical assistance 2,054
program. After the date on which a transaction of sale is 2,055
closed, the owner shall refund to the department the amount of 2,056
excess depreciation paid to the facility by the department for 2,057
each year the owner has operated the facility under a provider
agreement and prorated according to the number of medicaid 2,058
patient days for which the facility has received payment. If a 2,059
nursing facility is sold after five or fewer years of operation 2,060
under a provider agreement, the refund to the department shall be 2,062
equal to the excess depreciation paid to the facility. If a 2,063
nursing facility is sold after more than five years but less than
ten years of operation under a provider agreement, the refund to 2,064
the department shall equal the excess depreciation paid to the 2,065
facility multiplied by twenty per cent, multiplied by the 2,066
difference between ten and the number of years that the facility 2,067
was operated under a provider agreement. If a nursing facility 2,068
is sold after ten or more years of operation under a provider 2,069
agreement, the owner shall not refund any excess depreciation to 2,070
the department. The owner of a facility that is sold or that 2,071
voluntarily terminates participation in the medical assistance 2,072
program also shall refund any other amount that the department 2,073
properly finds to be due after the audit conducted under this 2,074
division. For the purposes of this division, "depreciation paid 2,075
to the facility" means the amount paid to the nursing facility 2,076
for cost of ownership pursuant to this section less any amount 2,077
paid for interest costs, amortization of financing costs, and 2,079
lease expenses. For the purposes of this division, "excess 2,080
depreciation" is the nursing facility's depreciated basis, which 2,081
48
is the owner's cost less accumulated depreciation, subtracted 2,082
from the purchase price net of selling costs but not exceeding 2,083
the amount of depreciation paid to the facility. 2,084
A cost report shall be filed with the department within 2,086
ninety days after the date on which the transaction of sale is 2,087
closed or participation is voluntarily terminated. The report 2,088
shall show the accumulated depreciation, the sales price, and 2,089
other information required by the department. The amount of the 2,090
last two monthly payments to a nursing facility made pursuant to 2,091
division (A)(1) of section 5111.22 of the Revised Code before a 2,092
sale or termination of participation shall be held in escrow by a 2,093
bank, trust company, or savings and loan association, except that 2,094
if the amount the owner will be required to refund under this 2,095
section is likely to be less than the amount of the last two 2,096
monthly payments, the department shall take one of the following 2,097
actions instead of withholding the amount of the last two monthly 2,098
payments: 2,099
(1) In the case of an owner that owns other facilities 2,101
that participate in the medical assistance program, obtain a 2,102
promissory note in an amount sufficient to cover the amount 2,103
likely to be refunded; 2,104
(2) In the case of all other owners, withhold the amount 2,106
of the last monthly payment to the nursing facility. 2,107
The department shall, within ninety days following the 2,109
filing of the cost report, audit the cost report and issue an 2,110
audit report to the owner. The department also may audit any 2,111
other cost report that the facility has filed during the previous 2,112
three years. In the audit report, the department shall state its 2,113
findings and the amount of any money owed to the department by 2,114
the nursing facility. The findings shall be subject to 2,115
adjudication conducted in accordance with Chapter 119. of the 2,116
Revised Code. No later than fifteen days after the owner agrees 2,117
to a settlement, any funds held in escrow less any amounts due to 2,118
the department shall be released to the owner and amounts due to 2,119
49
the department shall be paid to the department. If the amounts 2,120
in escrow are less than the amounts due to the department, the 2,121
balance shall be paid to the department within fifteen days after 2,122
the owner agrees to a settlement. If the department does not 2,123
issue its audit report within the ninety-day period, the 2,124
department shall release any money held in escrow to the owner. 2,125
For the purposes of this section, a transfer of corporate stock, 2,126
the merger of one corporation into another, or a consolidation 2,127
does not constitute a sale. 2,128
If a nursing facility is not sold or its participation is 2,130
not terminated after notice is provided to the department under 2,131
this division, the department shall order any payments held in 2,132
escrow released to the facility upon receiving written notice 2,133
from the owner that there will be no sale or termination. After 2,134
written notice is received from a nursing facility that a sale or 2,135
termination will not take place, the facility shall provide 2,136
notice to the department at least forty-five days prior to 2,137
entering into any contract of sale or terminating participation 2,138
at any future time. 2,139
(H) The department shall pay each eligible proprietary 2,141
nursing facility a return on the facility's net equity computed 2,142
at the rate of one and one-half times the average interest rate 2,143
on special issues of public debt obligations issued to the 2,144
federal hospital insurance trust fund for the cost reporting 2,145
period, except that no facility's return on net equity shall 2,146
exceed one dollar per patient day. 2,147
When calculating the rate for return on net equity, the 2,149
department shall use the greater of the facility's inpatient days 2,150
during the applicable cost reporting period or the number of 2,151
inpatient days the facility would have had during that period if 2,152
its occupancy rate had been ninety-five per cent. 2,153
(I) If a nursing facility would receive a lower rate for 2,155
capital costs for assets in the facility's possession on July 1, 2,156
1993, under this section than it would receive under former 2,157
50
section 5111.25 of the Revised Code, as the former section 2,158
existed immediately prior to December 22, 1992, the facility 2,159
shall receive for those assets the rate it would have received 2,160
under the former section for each fiscal year beginning on or 2,161
after July 1, 1993, until the rate it would receive under this 2,162
section exceeds the rate it would have received under the former 2,163
section. Any facility that receives a rate calculated under the 2,164
former section 5111.25 of the Revised Code for assets in the 2,165
facility's possession on July 1, 1993, also shall receive a rate 2,166
calculated under this section for costs of any assets it 2,167
constructs or acquires after July 1, 1993. 2,168
Sec. 5111.251. (A) The department of job and family 2,177
services shall pay each eligible intermediate care facility for 2,178
the mentally retarded for its reasonable capital costs, a per 2,179
resident per day rate established prospectively each fiscal year 2,180
for each intermediate care facility for the mentally retarded. 2,181
Except as otherwise provided in sections 5111.20 to 5111.32 of 2,182
the Revised Code, the rate shall be based on the facility's 2,183
capital costs for the calendar year preceding the fiscal year in 2,184
which the rate will be paid. The rate shall equal the sum of the 2,185
following:
(1) The facility's desk-reviewed, actual, allowable, per 2,187
diem cost of ownership for the preceding cost reporting period, 2,188
limited as provided in divisions (C) and (F) of this section; 2,189
(2) Any efficiency incentive determined under division (B) 2,191
of this section; 2,192
(3) Any amounts for renovations determined under division 2,194
(D) of this section; 2,195
(4) Any amounts for return on equity determined under 2,197
division (I) of this section. 2,198
Buildings shall be depreciated using the straight line 2,200
method over forty years or over a different period approved by 2,201
the department. Components and equipment shall be depreciated 2,202
using the straight line method over a period designated by the 2,203
51
director of job and family services in rules adopted in 2,205
accordance with Chapter 119. of the Revised Code, consistent with 2,206
the guidelines of the American hospital association, or over a 2,207
different period approved by the department of job and family 2,208
services. Any rules adopted under this division that specify 2,209
useful lives of buildings, components, or equipment apply only to 2,210
assets acquired on or after July 1, 1993. Depreciation for costs 2,211
paid or reimbursed by any government agency shall not be included 2,212
in costs of ownership or renovation unless that part of the 2,213
payment under sections 5111.20 to 5111.32 of the Revised Code is 2,214
used to reimburse the government agency. 2,215
(B) The department of job and family services shall pay to 2,218
each intermediate care facility for the mentally retarded an
efficiency incentive equal to fifty per cent of the difference 2,220
between any desk-reviewed, actual, allowable cost of ownership 2,221
and the applicable limit on cost of ownership payments under 2,222
division (C) of this section. For purposes of computing the 2,223
efficiency incentive, depreciation for costs paid or reimbursed 2,224
by any government agency shall be considered as a cost of
ownership, and the applicable limit under division (C) of this 2,225
section shall apply both to facilities with more than eight beds 2,226
and facilities with eight or fewer beds. The efficiency 2,227
incentive paid to a facility with eight or fewer beds shall not 2,228
exceed three dollars per patient day, adjusted annually for the 2,229
inflation rate for the twelve-month period beginning on the first 2,230
day of July of the calendar year preceding the calendar year that 2,231
precedes the fiscal year for which the efficiency incentive is 2,232
determined and ending on the thirtieth day of the following June, 2,233
using the consumer price index for shelter costs for all urban 2,234
consumers for the north central region, as published by the 2,235
United States bureau of labor statistics. 2,236
(C) Cost of ownership payments to intermediate care 2,238
facilities for the mentally retarded with more than eight beds 2,239
shall not exceed the following limits: 2,240
52
(1) For facilities with dates of licensure prior to 2,242
January 1, l958, not exceeding two dollars and fifty cents per 2,243
patient day; 2,244
(2) For facilities with dates of licensure after December 2,246
31, l957, but prior to January 1, l968, not exceeding: 2,247
(a) Three dollars and fifty cents per patient day if the 2,249
cost of construction was three thousand five hundred dollars or 2,250
more per bed; 2,251
(b) Two dollars and fifty cents per patient day if the 2,253
cost of construction was less than three thousand five hundred 2,254
dollars per bed. 2,255
(3) For facilities with dates of licensure after December 2,257
31, l967, but prior to January 1, l976, not exceeding: 2,258
(a) Four dollars and fifty cents per patient day if the 2,260
cost of construction was five thousand one hundred fifty dollars 2,261
or more per bed; 2,262
(b) Three dollars and fifty cents per patient day if the 2,264
cost of construction was less than five thousand one hundred 2,265
fifty dollars per bed, but exceeds three thousand five hundred 2,266
dollars per bed; 2,267
(c) Two dollars and fifty cents per patient day if the 2,269
cost of construction was three thousand five hundred dollars or 2,270
less per bed. 2,271
(4) For facilities with dates of licensure after December 2,273
31, l975, but prior to January 1, l979, not exceeding: 2,274
(a) Five dollars and fifty cents per patient day if the 2,276
cost of construction was six thousand eight hundred dollars or 2,277
more per bed; 2,278
(b) Four dollars and fifty cents per patient day if the 2,280
cost of construction was less than six thousand eight hundred 2,281
dollars per bed but exceeds five thousand one hundred fifty 2,282
dollars per bed; 2,283
(c) Three dollars and fifty cents per patient day if the 2,285
cost of construction was five thousand one hundred fifty dollars 2,286
53
or less per bed, but exceeds three thousand five hundred dollars 2,287
per bed; 2,288
(d) Two dollars and fifty cents per patient day if the 2,290
cost of construction was three thousand five hundred dollars or 2,291
less per bed. 2,292
(5) For facilities with dates of licensure after December 2,294
31, l978, but prior to January 1, l980, not exceeding: 2,295
(a) Six dollars per patient day if the cost of 2,297
construction was seven thousand six hundred twenty-five dollars 2,298
or more per bed; 2,299
(b) Five dollars and fifty cents per patient day if the 2,301
cost of construction was less than seven thousand six hundred 2,302
twenty-five dollars per bed but exceeds six thousand eight 2,303
hundred dollars per bed; 2,304
(c) Four dollars and fifty cents per patient day if the 2,306
cost of construction was six thousand eight hundred dollars or 2,307
less per bed but exceeds five thousand one hundred fifty dollars 2,308
per bed; 2,309
(d) Three dollars and fifty cents per patient day if the 2,311
cost of construction was five thousand one hundred fifty dollars 2,312
or less but exceeds three thousand five hundred dollars per bed; 2,313
(e) Two dollars and fifty cents per patient day if the 2,315
cost of construction was three thousand five hundred dollars or 2,316
less per bed. 2,317
(6) For facilities with dates of licensure after December 2,320
31, 1979, but prior to January 1, 1981, not exceeding: 2,321
(a) Twelve dollars per patient day if the beds were 2,323
originally licensed as residential facility beds by the 2,324
department of mental retardation and developmental disabilities; 2,325
(b) Six dollars per patient day if the beds were 2,327
originally licensed as nursing home beds by the department of 2,328
health.
(7) For facilities with dates of licensure after December 2,330
31, 1980, but prior to January 1, 1982, not exceeding: 2,331
54
(a) Twelve dollars per patient day if the beds were 2,333
originally licensed as residential facility beds by the 2,334
department of mental retardation and developmental disabilities; 2,335
(b) Six dollars and forty-five cents per patient day if 2,337
the beds were originally licensed as nursing home beds by the 2,338
department of health.
(8) For facilities with dates of licensure after December 2,340
31, 1981, but prior to January 1, 1983, not exceeding: 2,341
(a) Twelve dollars per patient day if the beds were 2,343
originally licensed as residential facility beds by the 2,344
department of mental retardation and developmental disabilities; 2,345
(b) Six dollars and seventy-nine cents per patient day if 2,347
the beds were originally licensed as nursing home beds by the 2,348
department of health.
(9) For facilities with dates of licensure after December 2,350
31, 1982, but prior to January 1, 1984, not exceeding: 2,351
(a) Twelve dollars per patient day if the beds were 2,353
originally licensed as residential facility beds by the 2,354
department of mental retardation and developmental disabilities; 2,355
(b) Seven dollars and nine cents per patient day if the 2,357
beds were originally licensed as nursing home beds by the 2,358
department of health.
(10) For facilities with dates of licensure after December 2,360
31, 1983, but prior to January 1, 1985, not exceeding: 2,361
(a) Twelve dollars and twenty-four cents per patient day 2,363
if the beds were originally licensed as residential facility beds 2,365
by the department of mental retardation and developmental 2,366
disabilities;
(b) Seven dollars and twenty-three cents per patient day 2,368
if the beds were originally licensed as nursing home beds by the 2,370
department of health.
(11) For facilities with dates of licensure after December 2,372
31, 1984, but prior to January 1, 1986, not exceeding: 2,373
(a) Twelve dollars and fifty-three cents per patient day 2,375
55
if the beds were originally licensed as residential facility beds 2,377
by the department of mental retardation and developmental 2,378
disabilities;
(b) Seven dollars and forty cents per patient day if the 2,380
beds were originally licensed as nursing home beds by the 2,382
department of health.
(12) For facilities with dates of licensure after December 2,384
31, 1985, but prior to January 1, 1987, not exceeding: 2,385
(a) Twelve dollars and seventy cents per patient day if 2,387
the beds were originally licensed as residential facility beds by 2,389
the department of mental retardation and developmental 2,390
disabilities;
(b) Seven dollars and fifty cents per patient day if the 2,392
beds were originally licensed as nursing home beds by the 2,394
department of health.
(13) For facilities with dates of licensure after December 2,396
31, 1986, but prior to January 1, 1988, not exceeding: 2,397
(a) Twelve dollars and ninety-nine cents per patient day 2,399
if the beds were originally licensed as residential facility beds 2,401
by the department of mental retardation and developmental 2,402
disabilities;
(b) Seven dollars and sixty-seven cents per patient day if 2,404
the beds were originally licensed as nursing home beds by the 2,406
department of health.
(14) For facilities with dates of licensure after December 2,408
31, 1987, but prior to January 1, 1989, not exceeding thirteen 2,409
dollars and twenty-six cents per patient day; 2,410
(15) For facilities with dates of licensure after December 2,412
31, 1988, but prior to January 1, 1990, not exceeding thirteen 2,413
dollars and forty-six cents per patient day; 2,414
(16) For facilities with dates of licensure after December 2,416
31, 1989, but prior to January 1, 1991, not exceeding thirteen 2,417
dollars and sixty cents per patient day; 2,418
(17) For facilities with dates of licensure after December 2,420
56
31, 1990, but prior to January 1, 1992, not exceeding thirteen 2,421
dollars and forty-nine cents per patient day; 2,422
(18) For facilities with dates of licensure after December 2,424
31, 1991, but prior to January 1, 1993, not exceeding thirteen 2,425
dollars and sixty-seven cents per patient day; 2,426
(19) For facilities with dates of licensure after December 2,428
31, 1992, not exceeding fourteen dollars and twenty-eight cents 2,429
per patient day.
(D) Beginning January 1, 1981, regardless of the original 2,431
date of licensure, the department of job and family services 2,433
shall pay a rate for the per diem capitalized costs of 2,434
renovations to intermediate care facilities for the mentally 2,435
retarded made after January 1, l981, not exceeding six dollars 2,436
per patient day using 1980 as the base year and adjusting the 2,437
amount annually until June 30, 1993, for fluctuations in 2,438
construction costs calculated by the department using the "Dodge 2,439
building cost indexes, northeastern and north central states," 2,440
published by Marshall and Swift. The payment provided for in 2,441
this division is the only payment that shall be made for the 2,442
capitalized costs of a nonextensive renovation of an intermediate 2,443
care facility for the mentally retarded. Nonextensive renovation 2,444
costs shall not be included in cost of ownership, and a 2,445
nonextensive renovation shall not affect the date of licensure 2,446
for purposes of division (C) of this section. This division 2,447
applies to nonextensive renovations regardless of whether they 2,448
are made by an owner or a lessee. If the tenancy of a lessee 2,449
that has made renovations ends before the depreciation expense 2,450
for the renovation costs has been fully reported, the former 2,451
lessee shall not report the undepreciated balance as an expense. 2,452
For a nonextensive renovation to qualify for payment under 2,454
this division, both of the following conditions must be met: 2,455
(1) At least five years have elapsed since the date of 2,457
licensure or date of an extensive renovation of the portion of 2,458
the facility that is proposed to be renovated, except that this 2,459
57
condition does not apply if the renovation is necessary to meet 2,460
the requirements of federal, state, or local statutes, 2,461
ordinances, rules, or policies. 2,462
(2) The provider has obtained prior approval from the 2,464
department of job and family services. The provider shall submit 2,466
a plan that describes in detail the changes in capital assets to 2,467
be accomplished by means of the renovation and the timetable for 2,468
completing the project. The time for completion of the project 2,469
shall be no more than eighteen months after the renovation 2,470
begins. The director of job and family services shall adopt 2,472
rules in accordance with Chapter 119. of the Revised Code that 2,474
specify criteria and procedures for prior approval of renovation 2,475
projects. No provider shall separate a project with the intent 2,476
to evade the characterization of the project as a renovation or 2,477
as an extensive renovation. No provider shall increase the scope 2,478
of a project after it is approved by the department of job and 2,479
family services unless the increase in scope is approved by the 2,480
department.
(E) The amounts specified in divisions (C) and (D) of this 2,482
section shall be adjusted beginning July 1, 1993, for the 2,483
estimated inflation for the twelve-month period beginning on the 2,484
first day of July of the calendar year preceding the calendar 2,485
year that precedes the fiscal year for which rate will be paid 2,486
and ending on the thirtieth day of the following June, using the 2,487
consumer price index for shelter costs for all urban consumers 2,488
for the north central region, as published by the United States 2,489
bureau of labor statistics. 2,490
(F)(1) For facilities of eight or fewer beds that have 2,492
dates of licensure or have been granted project authorization by 2,493
the department of mental retardation and developmental 2,494
disabilities before July 1, 1993, and for facilities of eight or 2,495
fewer beds that have dates of licensure or have been granted 2,496
project authorization after that date if the facilities 2,497
demonstrate that they made substantial commitments of funds on or 2,498
58
before that date, cost of ownership shall not exceed eighteen 2,499
dollars and thirty cents per resident per day. The 2,500
eighteen-dollar and thirty-cent amount shall be increased by the 2,501
change in the "Dodge building cost indexes, northeastern and 2,502
north central states," published by Marshall and Swift, during 2,503
the period beginning June 30, 1990, and ending July 1, 1993, and 2,504
by the change in the consumer price index for shelter costs for 2,505
all urban consumers for the north central region, as published by 2,506
the United States bureau of labor statistics, annually 2,507
thereafter. 2,508
(2) For facilities with eight or fewer beds that have 2,510
dates of licensure or have been granted project authorization by 2,511
the department of mental retardation and developmental 2,512
disabilities on or after July 1, 1993, for which substantial 2,513
commitments of funds were not made before that date, cost of 2,514
ownership payments shall not exceed the applicable amount 2,515
calculated under division (F)(1) of this section, if the 2,516
department of job and family services gives prior approval for 2,518
construction of the facility. If the department does not give
prior approval, cost of ownership payments shall not exceed the 2,519
amount specified in division (C) of this section. 2,520
(3) Notwithstanding divisions (D) and (F)(1) and (2) of 2,522
this section, the total payment for cost of ownership, cost of 2,523
ownership efficiency incentive, and capitalized costs of 2,524
renovations for an intermediate care facility for the mentally 2,525
retarded with eight or fewer beds shall not exceed the sum of the 2,526
limitations specified in divisions (C) and (D) of this section. 2,528
(G) Notwithstanding any provision of this section or 2,530
section 5111.24 of the Revised Code, the director of job and 2,532
family services may adopt rules in accordance with Chapter 119. 2,533
of the Revised Code that provide for a calculation of a combined 2,534
maximum payment limit for indirect care costs and cost of 2,535
ownership for intermediate care facilities for the mentally 2,536
retarded with eight or fewer beds.
59
(H) After June 30, 1980, the owner of an intermediate care 2,538
facility for the mentally retarded operating under a provider 2,539
agreement shall provide written notice to the department of job 2,541
and family services at least forty-five days prior to entering
into any contract of sale for the facility or voluntarily 2,543
terminating participation in the medical assistance program. 2,544
After the date on which a transaction of sale is closed, the 2,545
owner shall refund to the department the amount of excess 2,546
depreciation paid to the facility by the department for each year 2,547
the owner has operated the facility under a provider agreement 2,548
and prorated according to the number of medicaid patient days for 2,549
which the facility has received payment. If an intermediate care 2,550
facility for the mentally retarded is sold after five or fewer 2,551
years of operation under a provider agreement, the refund to the 2,552
department shall be equal to the excess depreciation paid to the 2,553
facility. If an intermediate care facility for the mentally 2,554
retarded is sold after more than five years but less than ten 2,555
years of operation under a provider agreement, the refund to the 2,556
department shall equal the excess depreciation paid to the 2,557
facility multiplied by twenty per cent, multiplied by the number 2,558
of years less than ten that a facility was operated under a 2,559
provider agreement. If an intermediate care facility for the 2,560
mentally retarded is sold after ten or more years of operation 2,561
under a provider agreement, the owner shall not refund any excess 2,562
depreciation to the department. For the purposes of this 2,563
division, "depreciation paid to the facility" means the amount 2,564
paid to the intermediate care facility for the mentally retarded 2,565
for cost of ownership pursuant to this section less any amount 2,566
paid for interest costs. For the purposes of this division, 2,567
"excess depreciation" is the intermediate care facility for the 2,568
mentally retarded's depreciated basis, which is the owner's cost 2,569
less accumulated depreciation, subtracted from the purchase price 2,570
but not exceeding the amount of depreciation paid to the 2,571
facility.
60
A cost report shall be filed with the department within 2,573
ninety days after the date on which the transaction of sale is 2,574
closed or participation is voluntarily terminated for an 2,575
intermediate care facility for the mentally retarded subject to 2,576
this division. The report shall show the accumulated 2,577
depreciation, the sales price, and other information required by 2,578
the department. The amount of the last two monthly payments to 2,579
an intermediate care facility for the mentally retarded made 2,580
pursuant to division (A)(1) of section 5111.22 of the Revised 2,581
Code before a sale or voluntary termination of participation 2,582
shall be held in escrow by a bank, trust company, or savings and 2,583
loan association, except that if the amount the owner will be 2,584
required to refund under this section is likely to be less than 2,585
the amount of the last two monthly payments, the department shall 2,586
take one of the following actions instead of withholding the 2,587
amount of the last two monthly payments: 2,588
(1) In the case of an owner that owns other facilities 2,590
that participate in the medical assistance program, obtain a 2,591
promissory note in an amount sufficient to cover the amount 2,592
likely to be refunded; 2,593
(2) In the case of all other owners, withhold the amount 2,595
of the last monthly payment to the intermediate care facility for 2,596
the mentally retarded. 2,597
The department shall, within ninety days following the 2,599
filing of the cost report, audit the report and issue an audit 2,600
report to the owner. The department also may audit any other 2,601
cost reports for the facility that have been filed during the 2,602
previous three years. In the audit report, the department shall 2,603
state its findings and the amount of any money owed to the 2,604
department by the intermediate care facility for the mentally 2,605
retarded. The findings shall be subject to an adjudication 2,606
conducted in accordance with Chapter 119. of the Revised Code. 2,607
No later than fifteen days after the owner agrees to a 2,608
settlement, any funds held in escrow less any amounts due to the 2,609
61
department shall be released to the owner and amounts due to the 2,610
department shall be paid to the department. If the amounts in 2,611
escrow are less than the amounts due to the department, the 2,612
balance shall be paid to the department within fifteen days after 2,613
the owner agrees to a settlement. If the department does not 2,614
issue its audit report within the ninety-day period, the 2,615
department shall release any money held in escrow to the owner. 2,616
For the purposes of this section, a transfer of corporate stock, 2,617
the merger of one corporation into another, or a consolidation 2,618
does not constitute a sale. 2,619
If an intermediate care facility for the mentally retarded 2,621
is not sold or its participation is not terminated after notice 2,622
is provided to the department under this division, the department 2,623
shall order any payments held in escrow released to the facility 2,624
upon receiving written notice from the owner that there will be 2,625
no sale or termination of participation. After written notice is 2,626
received from an intermediate care facility for the mentally 2,627
retarded that a sale or termination of participation will not 2,628
take place, the facility shall provide notice to the department 2,629
at least forty-five days prior to entering into any contract of 2,630
sale or terminating participation at any future time. 2,631
(I) The department of job and family services shall pay 2,633
each eligible proprietary intermediate care facility for the 2,634
mentally retarded a return on the facility's net equity computed 2,635
at the rate of one and one-half times the average of interest 2,636
rates on special issues of public debt obligations issued to the 2,637
federal hospital insurance trust fund for the cost reporting 2,638
period. No facility's return on net equity paid under this 2,639
division shall exceed one dollar per patient day. 2,640
In calculating the rate for return on net equity, the 2,642
department shall use the greater of the facility's inpatient days 2,643
during the applicable cost reporting period or the number of 2,644
inpatient days the facility would have had during that period if 2,645
its occupancy rate had been ninety-five per cent. 2,646
62
(J)(1) Except as provided in division (J)(2) of this 2,649
section, if a provider leases or transfers an interest in a 2,650
facility to another provider who is a related party, the related 2,652
party's allowable cost of ownership shall include the lesser of 2,653
the following:
(a) The annual lease expense or actual cost of ownership, 2,656
whichever is applicable;
(b) The reasonable cost to the lessor or provider making 2,659
the transfer.
(2) If a provider leases or transfers an interest in a 2,661
facility to another provider who is a related party, regardless 2,662
of the date of the lease or transfer, the related party's 2,664
allowable cost of ownership shall include the annual lease 2,665
expense or actual cost of ownership, whichever is applicable, 2,666
subject to the limitations specified in divisions (B) to (I) of 2,668
this section, if all of the following conditions are met: 2,669
(a) The related party is a relative of owner; 2,672
(b) In the case of a lease, if the lessor retains any 2,674
ownership interest, it is, EXCEPT AS PROVIDED IN DIVISION 2,676
(J)(2)(d)(ii) OF THIS SECTION, in only the real property and any 2,677
improvements on the real property; 2,678
(c) In the case of a transfer, the provider making the 2,681
transfer retains, EXCEPT AS PROVIDED IN DIVISION (J)(2)(d)(iv) OF 2,682
THIS SECTION, no ownership interest in the facility; 2,684
(d) The United States internal revenue service has issued 2,687
a ruling DEPARTMENT OF JOB AND FAMILY SERVICES DETERMINES that 2,688
the lease or transfer is an arm's length transaction for purposes 2,689
of federal income taxation; PURSUANT TO RULES THE DEPARTMENT 2,690
SHALL ADOPT IN ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE 2,691
NO LATER THAN DECEMBER 31, 2000. THE RULES SHALL PROVIDE THAT A 2,694
LEASE OR TRANSFER IS AN ARM'S LENGTH TRANSACTION IF ALL OF THE 2,695
FOLLOWING, AS APPLICABLE, APPLY:
(i) IN THE CASE OF A LEASE, ONCE THE LEASE GOES INTO 2,697
EFFECT, THE LESSOR HAS NO DIRECT OR INDIRECT INTEREST IN THE 2,698
63
LESSEE OR, EXCEPT AS PROVIDED IN DIVISION (J)(2)(b) OF THIS 2,699
SECTION, THE FACILITY ITSELF, INCLUDING INTEREST AS AN OWNER, 2,700
OFFICER, DIRECTOR, EMPLOYEE, INDEPENDENT CONTRACTOR, OR 2,701
CONSULTANT, BUT EXCLUDING INTEREST AS A LESSOR. 2,702
(ii) IN THE CASE OF A LEASE, THE LESSOR DOES NOT REACQUIRE 2,704
AN INTEREST IN THE FACILITY EXCEPT THROUGH THE EXERCISE OF A 2,705
LESSOR'S RIGHTS IN THE EVENT OF A DEFAULT. IF THE LESSOR
REACQUIRES AN INTEREST IN THE FACILITY IN THIS MANNER, THE 2,706
DEPARTMENT SHALL TREAT THE FACILITY AS IF THE LEASE NEVER 2,707
OCCURRED WHEN THE DEPARTMENT CALCULATES ITS REIMBURSEMENT RATES 2,708
FOR CAPITAL COSTS. 2,709
(iii) IN THE CASE OF A TRANSFER, ONCE THE TRANSFER GOES 2,711
INTO EFFECT, THE PROVIDER THAT MADE THE TRANSFER HAS NO DIRECT OR 2,712
INDIRECT INTEREST IN THE PROVIDER THAT ACQUIRES THE FACILITY OR 2,713
THE FACILITY ITSELF, INCLUDING INTEREST AS AN OWNER, OFFICER,
DIRECTOR, EMPLOYEE, INDEPENDENT CONTRACTOR, OR CONSULTANT, BUT 2,714
EXCLUDING INTEREST AS A CREDITOR. 2,715
(iv) IN THE CASE OF A TRANSFER, THE PROVIDER THAT MADE THE 2,717
TRANSFER DOES NOT REACQUIRE AN INTEREST IN THE FACILITY EXCEPT 2,718
THROUGH THE EXERCISE OF A CREDITOR'S RIGHTS IN THE EVENT OF A 2,719
DEFAULT. IF THE PROVIDER REACQUIRES AN INTEREST IN THE FACILITY 2,720
IN THIS MANNER, THE DEPARTMENT SHALL TREAT THE FACILITY AS IF THE 2,721
TRANSFER NEVER OCCURRED WHEN THE DEPARTMENT CALCULATES ITS 2,722
REIMBURSEMENT RATES FOR CAPITAL COSTS.
(v) THE LEASE OR TRANSFER SATISFIES ANY OTHER CRITERIA 2,724
SPECIFIED IN THE RULES. 2,725
(e) Except in the case of hardship caused by a 2,728
catastrophic event, as determined by the department, or in the 2,729
case of a lessor or provider making the transfer who is at least
sixty-five years of age, not less than twenty years have elapsed 2,730
since, for the same facility, allowable cost of ownership was 2,731
determined most recently under this division. 2,732
Sec. 5111.62. The proceeds of all fines, including 2,741
interest, collected under sections 5111.35 to 5111.62 of the 2,742
64
Revised Code shall be deposited in the state treasury to the 2,743
credit of the residents protection fund, which is hereby created. 2,744
Moneys in the fund shall be used solely for the protection of the 2,745
health or property of residents of nursing facilities in which 2,746
the department of health finds deficiencies, including payment 2,747
for the costs of relocation of residents to other facilities, 2,748
maintenance of operation of a facility pending correction of 2,749
deficiencies or closure, and reimbursement of residents for the 2,750
loss of money managed by the facility under section 3721.15 of 2,751
the Revised Code. The fund shall be maintained and administered 2,753
by the department of job and family services under rules 2,754
developed in consultation with the departments of health and 2,755
aging and adopted by the director of job and family services 2,757
under Chapter 119. of the Revised Code. 2,758
Section 2. That existing sections 173.19, 3702.525, 2,760
3721.21, 5111.20, 5111.25, 5111.251, and 5111.62 of the Revised 2,762
Code are hereby repealed.
Section 3. Notwithstanding the fourteen-month publishing 2,764
deadline established in section 173.46 of the Revised Code, the 2,765
Department of Aging shall not publish the Ohio Long-term Care 2,766
Consumer Guide unless it includes in the guide the results of 2,767
customer satisfaction surveys conducted under section 173.54 of 2,768
the Revised Code. For the purposes of this condition, the 2,769
department may publish the guide if it includes in the guide the 2,770
results of surveys of families of nursing facility residents 2,771
covering at least twenty-five per cent of the nursing facilities 2,772
in this state and it has established a process for conducting 2,773
both family and resident satisfaction surveys under section 2,774
173.54 of the Revised Code.
Section 4. All items in this section are hereby 2,776
appropriated as designated out of any moneys in the state 2,777
treasury to the credit of the designated fund group. For all 2,778
appropriations made in this act, those in the first column are 2,779
for fiscal year 2000 and those in the second column are for 2,780
65
fiscal year 2001. The appropriations made in this act are in 2,781
addition to any other appropriations made for the 1999-2001 2,782
biennium.
JFS DEPARTMENT OF JOB AND FAMILY SERVICES 2,784
General Revenue Fund 2,787
GRF 600-525 Health Care/Medicaid 2,790
State $ 0 $ 8,150,410 2,794
Federal $ 0 $ 11,699,590 2,797
Health Care Total $ 0 $ 19,850,000 2,800
Total GRF General Revenue Fund 2,801
Group
State $ 0 $ 8,150,410 2,805
Federal $ 0 $ 11,699,590 2,808
GRF Total $ 0 $ 19,850,000 2,811
TOTAL ALL BUDGET FUND GROUPS $ 0 $ 19,850,000 2,814
Health Care/Medicaid 2,817
Of the foregoing appropriation item 600-525, Health 2,819
Care/Medicaid, $3,650,000 shall be used in fiscal year 2001 to 2,820
support additional slots for the Department of Job and Family 2,821
Services' Ohio Home Care Waiver Program.
DMR DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL 2,823
DISABILITIES
General Revenue Fund 2,825
GRF 322-413 Residential and 2,827
Support Services $ 0 $ 4,500,000 2,829
TOTAL GRF General Revenue Fund $ 0 $ 4,500,000 2,831
Federal Special Revenue Fund Group 2,834
3G6 322-639 Medicaid Waiver $ 0 $ 6,460,000 2,838
TOTAL FSR Federal Special Revenue $ 0 $ 6,460,000 2,841
Fund Group
TOTAL ALL BUDGET FUND GROUPS $ 0 $ 10,960,000 2,843
Residential and Support Services 2,846
Of the foregoing appropriation item 322-413, Residential 2,848
and Support Services, $4,500,000 shall be used in fiscal year 2,849
66
2001 as state matching funds to support additional slots for the 2,850
Individual Options Home and Community-based waiver program 2,851
operated pursuant to Title XVIII of the "Social Security Act," 49 2,852
Stat. 620 (1935), 42 U.S.C. 301, as amended.
Medicaid Waiver 2,854
Of the foregoing appropriation item 322-639, Medicaid 2,856
Waiver (Fund 3G6), $6,460,000 shall be used in fiscal year 2001 2,857
to support additional slots for the Individual Options Home and 2,858
Community-based waiver program operated pursuant to Title XVIII 2,859
of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301, 2,860
as amended.
AGE DEPARTMENT OF AGING 2,861
State Special Revenue Fund Group 2,862
5K9 490-613 Long-Term Care 2,865
Consumer Guide $ 0 $ 807,000 2,867
TOTAL SSR State Special Revenue 2,868
Fund Group $ 0 $ 807,000 2,871
TOTAL ALL BUDGET FUND GROUPS $ 0 $ 807,000 2,873
Long-Term Care Consumer Guide 2,876
Notwithstanding section 5111.62 of the Revised Code, not 2,878
later than July 15, 2000, the Director of Budget and Management 2,880
shall transfer $407,000 cash from Fund 4E3, Resident Protection 2,881
Fund, to Fund 5K9, Long-Term Care Consumer Guide Fund.
The foregoing appropriation item 490-613, Long-Term Care 2,883
Consumer Guide, shall be used by the Department of Aging for 2,884
costs associated with publishing the Ohio Long-Term Care Consumer 2,885
Guide.
DOH DEPARTMENT OF HEALTH 2,887
State Special Revenue Fund Group 2,889
5L1 440-623 Nursing Facility 2,891
Technical Assistance
Program $ 0 $ 1,400,000 2,893
TOTAL SSR State Special Revenue 2,894
Fund Group $ 0 $ 1,400,000 2,897
67
TOTAL ALL BUDGET FUND GROUPS $ 0 $ 1,400,000 2,900
Nursing Facility Technical Assistance Program 2,903
Notwithstanding section 5111.62 of the Revised Code, not 2,905
later than July 15, 2000, the Director of Budget and Management 2,907
shall transfer $1,400,000 cash from Fund 4E3, Resident Protection 2,908
Fund, to Fund 5L1, Nursing Facility Technical Assistance Fund, to 2,909
be used in accordance with section 3721.026 of the Revised Code. 2,910
Within the limits set forth in this act, the Director of 2,912
Budget and Management shall establish accounts indicating source 2,913
and amount of funds for each appropriation made in this act, and 2,914
shall determine the form and manner in which appropriation 2,915
accounts shall be maintained. Expenditures from appropriations 2,916
contained in this act shall be accounted for as though made in 2,917
Am. Sub. H.B. 283 of the 123rd General Assembly. 2,918
The appropriations made in this act are subject to all 2,920
provisions of Am. Sub. H.B. 283 of the 123rd General Assembly. 2,921
Section 5. (A) Notwithstanding division (Q)(1) of section 2,924
5111.20 of the Revised Code, when calculating indirect care costs 2,925
for the purpose of establishing rates under section 5111.24 or 2,926
5111.241 of the Revised Code for fiscal year 2001, "per diem," as 2,927
used in sections 5111.20 to 5111.32 of the Revised Code, means a 2,928
nursing facility's or intermediate care facility for the mentally 2,929
retarded's actual, allowable indirect care costs in the cost 2,930
reporting period divided by the greater of the facility's 2,931
inpatient days for that period or the number of inpatient days 2,932
the facility would have had during that period if its occupancy 2,933
rate had been seventy-five per cent.
(B) Notwithstanding division (Q)(2) of section 5111.20 of 2,935
the Revised Code, when calculating capital costs for the purpose 2,936
of establishing rates under section 5111.25 or 5111.251 of the 2,937
Revised Code for fiscal year 2001, "per diem," as used in 2,938
sections 5111.20 to 5111.32 of the Revised Code, means a nursing 2,939
facility's or intermediate care facility for the mentally 2,940
retarded's actual, allowable capital costs in the cost reporting 2,941
68
period divided by the greater of the facility's inpatient days 2,942
for that period or the number of inpatient days the facility 2,943
would have had during that period if its occupancy rate had been 2,944
eighty-five per cent.
(C) Notwithstanding section 5111.261 and division (C) of 2,946
section 5111.262 of the Revised Code, for costs incurred during 2,947
calendar year 1999, costs reported in a nursing facility's cost 2,948
report for purchased nursing services shall be allowable direct 2,949
care costs up to seventeen per cent of the nursing facility's 2,950
cost specified in the cost report for services provided that year 2,951
by registered nurses, licensed practical nurses, and nurse aides 2,952
who are employees of the facility, plus one-half of the amount by 2,953
which the reported costs for purchased nursing services exceed 2,954
that percentage. 2,955
(D) As soon as practicable, the Department of Job and 2,957
Family Services shall follow this section for the purpose of 2,958
calculating nursing facilities' and intermediate care facilities 2,959
for the mentally retarded's Medicaid reimbursement rates for 2,960
indirect care and capital costs for fiscal year 2001. If the 2,961
Department is unable to calculate the rates before it makes 2,962
payments for services provided during fiscal year 2001, the 2,963
Department shall pay a nursing facility or intermediate care 2,964
facility for the mentally retarded the difference between the 2,965
amount it pays the facility and the amount that would have been 2,966
paid had the Department made the calculation in time. 2,967
Section 6. Except for sections 3702.525, 3721.21, 5111.25, 2,970
and 5111.251 of the Revised Code as amended by this act, the
codified and uncodified sections of law contained in this act are 2,972
not subject to the referendum and take effect on the later of 2,973
July 1, 2000, or the day this act becomes law. The amendments to
sections 3702.525, 3721.21, 5111.25, and 5111.251 of the Revised 2,974
Code made by this act constitute items of law that are subject to 2,976
the referendum. Therefore, under Article II, Section 1c of the 2,977
Ohio Constitution and section 1.471 of the Revised Code, these 2,978
69
items of law take effect on the 91st day after this act is filed 2,979
with the Secretary of State. If, however, a referendum petition 2,980
is filed against these items of law, these items of law, unless 2,981
rejected at the referendum, take effect at the earliest time 2,982
permitted by law.