As Passed by the Senate 1
123rd General Assembly 4
Regular Session Sub. H. B. No. 403 5
1999-2000 6
REPRESENTATIVES TIBERI-VAN VYVEN-NETZLEY-GOODMAN-MOTTLEY- 8
OGG-DePIERO-OLMAN-TAYLOR-JONES-BUEHRER-EVANS-KRUPINSKI- 9
FLANNERY-BRITTON-ROBERTS-R. MILLER-D. MILLER-BOYD- 10
CORBIN-EVANS-STAPLETON-BARRETT-GARDNER-SCHURING-METTLER- 11
WINKLER-BUCHY-HARTNETT-SALERNO-ALLEN-O'BRIEN-PATTON-DISTEL- 13
J. BEATTY-VERICH-BARNES-CLANCY-CALVERT-HOLLISTER-REDFERN-
GOODING-VESPER-A. CORE-WIDENER-HOOPS-PETERSON-JOLIVETTE- 14
HARRIS-TERWILLEGER-AUSTRIA-STEVENS-SENATORS HOTTINGER- 15
WHITE-JOHNSON-GARDNER-KEARNS-RAY-CUPP-OELSLAGER-FINAN 16
_________________________________________________________________ 18
A B I L L
To amend sections 173.19, 3702.525, 3721.21, 20
5111.20, 5111.25, 5111.251, and 5111.62 and to 21
enact sections 173.45 to 173.59, 3721.026, and 22
3721.027 of the Revised Code to require the
publication of the Ohio Long-Term Care Consumer 24
Guide, to create a nursing facility technical 25
assistance program, to change the method of 27
calculating nursing facilities' and intermediate
care facilities for the mentally retarded's 28
Medicaid reimbursement rates for indirect care 29
and capital costs, to specify in the law 30
governing nursing homes that neglect does not 31
include allowing a resident to receive only 32
treatment by spiritual means through prayer in
accordance with the tenets of a recognized 33
religious denomination, to require the Department 35
of Health to investigate valid, unresolved
complaints that the State Long-Term Care 36
Ombudsperson refers to the Department, to make an 37
exception to the certificate of need 38
2
implementation deadline, and to make an 39
appropriation. 40
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO: 42
Section 1. That sections 173.19, 3702.525, 3721.21, 44
5111.20, 5111.25, 5111.251, and 5111.62 be amended and sections 46
173.45, 173.46, 173.47, 173.48, 173.49, 173.50, 173.51, 173.52, 47
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: 49
Sec. 173.19. (A) The office of the state long-term care 58
ombudsperson program, through the state long-term care 59
ombudsperson and the regional long-term care ombudsperson 61
programs, shall receive, investigate, and attempt to resolve 63
complaints made by residents, recipients, sponsors, providers of 64
long-term care, or any person acting on behalf of a resident or 65
recipient, relating to either of the following: 66
(1) The health, safety, welfare, or civil rights of a 68
resident or recipient or any violation of a resident's rights 69
described in sections 3721.10 to 3721.17 of the Revised Code; 70
(2) Any action or inaction or decision by a provider of 72
long-term care or representative of a provider, a governmental 73
entity, or a private social service agency that may adversely 74
affect the health, safety, welfare, or rights of a resident or 75
recipient. 76
(B) The department of aging shall adopt rules in 78
accordance with Chapter 119. of the Revised Code regarding the 79
handling of complaints received under this section, including 80
procedures for conducting investigations of complaints. The 81
rules shall include procedures to ensure that no representative 82
of the office investigates any complaint involving a provider of 83
long-term care with which the representative was once employed or 84
associated. 85
The state ombudsperson and regional programs shall 87
3
establish procedures for handling complaints consistent with the 89
department's rules. Complaints shall be dealt with in accordance 90
with the procedures established under this division. 91
(C) The office of the state long-term care ombudsperson 94
program may decline to investigate any complaint if it determines 95
any of the following: 96
(1) That the complaint is frivolous, vexatious, or not 98
made in good faith; 99
(2) That the complaint was made so long after the 101
occurrence of the incident on which it is based that it is no 102
longer reasonable to conduct an investigation; 103
(3) That an adequate investigation cannot be conducted 105
because of insufficient funds, insufficient staff, lack of staff 106
expertise, or any other reasonable factor that would result in an 107
inadequate investigation despite a good faith effort; 108
(4) That an investigation by the office would create a 110
real or apparent conflict of interest. 111
(D) If a regional long-term care ombudsperson program 113
declines to investigate a complaint, it shall refer the complaint 114
to the state long-term care ombudsperson. 115
(E) Each complaint to be investigated by a regional 117
program shall be assigned to a representative of the office of 118
the state long-term care ombudsperson program. If the 119
representative determines that the complaint is valid, the 120
representative shall assist the parties in attempting to resolve 122
it. If the representative is unable to resolve it, the 124
representative may SHALL refer the complaint to the state 126
ombudsperson.
In order to carry out the duties of sections 173.14 to 128
173.26 of the Revised Code, a representative has the right to 130
private communication with residents and their sponsors and 131
access to long-term care facilities, including the right to tour 132
resident areas unescorted and the right to tour facilities 133
unescorted as reasonably necessary to the investigation of a 134
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complaint. Access to facilities shall be during reasonable hours 135
or, during investigation of a complaint, at other times 136
appropriate to the complaint. 137
When community-based long-term care services are provided 139
at a location other than the recipient's home, a representative 140
has the right to private communication with the recipient and the 142
recipient's sponsors and access to the community-based long-term 143
care site, including the right to tour the site unescorted. 144
Access to the site shall be during reasonable hours or, during 145
the investigation of a complaint, at other times appropriate to 146
the complaint. 147
(F) The state ombudsperson shall determine whether 149
complaints referred to the ombudsperson under division (D) or (E) 151
of this section warrant investigation. The ombudsperson's 153
determination in this matter is final. 154
Sec. 173.45. AS USED IN SECTIONS 173.45 TO 173.59 OF THE 157
REVISED CODE:
(A) "CLINICAL QUALITY INDICATOR" MEANS A MEASURE OF AN 159
ASPECT OF THE PHYSICAL OR MENTAL CONDITIONS OF THE RESIDENTS OF A 160
NURSING FACILITY THAT IS DERIVED FROM DATA TAKEN FROM RESIDENT 162
ASSESSMENT INSTRUMENTS SUBMITTED BY NURSING FACILITIES FOR 163
PURPOSES OF THE MEDICARE AND MEDICAID PROGRAMS. 164
(B) "MEDICAID" HAS THE SAME MEANING AS IN SECTION 5111.01 166
OF THE REVISED CODE. 167
(C) "MEDICARE" MEANS THE PROGRAM OPERATED PURSUANT TO 170
TITLE XVIII OF THE "SOCIAL SECURITY ACT," 49 STAT. 620 (1935), 42 172
U.S.C.A. 301, AS AMENDED. 173
(D) "NURSING FACILITY" MEANS EITHER OF THE FOLLOWING: 175
(1) A FACILITY, OR A DISTINCT PART OF A FACILITY, THAT IS 178
CERTIFIED AS A NURSING FACILITY OR A SKILLED NURSING FACILITY FOR 179
PURPOSES OF THE MEDICARE OR MEDICAID PROGRAM; 180
(2) A NURSING HOME LICENSED UNDER SECTION 3721.02 OF THE 183
REVISED CODE THAT IS NOT CERTIFIED AS A NURSING FACILITY OR 184
SKILLED NURSING FACILITY.
5
(E) "DEFICIENCY," "IMMEDIATE JEOPARDY," "STANDARD SURVEY," 186
AND "SUBSTANDARD CARE" HAVE THE SAME MEANINGS AS IN SECTION 188
5111.35 OF THE REVISED CODE. 189
(F) "SURVEY DATA TAG" MEANS ANY OF THE DATA TAGS USED IN 191
THE MEDICARE AND MEDICAID PROGRAMS FOR IDENTIFICATION OF SPECIFIC 192
REGULATORY REQUIREMENTS. 193
Sec. 173.46. THE DEPARTMENT OF AGING SHALL DEVELOP AND 195
PUBLISH A GUIDE TO NURSING FACILITIES IN THIS STATE FOR USE BY 196
INDIVIDUALS CONSIDERING NURSING FACILITY PLACEMENT AND THEIR 197
FAMILIES, FRIENDS, AND ADVISORS. THE GUIDE SHALL BE TITLED THE 198
OHIO LONG-TERM CARE CONSUMER GUIDE. 199
THE CONSUMER GUIDE SHALL BE PUBLISHED IN COMPUTERIZED FORM 201
FOR DISTRIBUTION OVER THE INTERNET. THE GUIDE SHALL BE MADE 203
AVAILABLE NOT LATER THAN FOURTEEN MONTHS AFTER THE EFFECTIVE DATE 204
OF THIS SECTION AND SHALL BE UPDATED IN ACCORDANCE WITH SECTION 205
173.52 OF THE REVISED CODE. 206
EVERY TWO YEARS, THE DEPARTMENT SHALL PUBLISH AN EXECUTIVE 208
SUMMARY OF THE CONSUMER GUIDE, AND SHALL MAKE THE EXECUTIVE 209
SUMMARY AVAILABLE IN BOTH COMPUTERIZED AND PRINTED FORMS. 210
Sec. 173.47. THE DEPARTMENT OF AGING MAY CONTRACT WITH ANY 212
PERSON OR GOVERNMENT ENTITY TO PERFORM ANY FUNCTION RELATED TO 213
THE PUBLICATION OF THE OHIO LONG-TERM CARE CONSUMER GUIDE OR THE 215
COLLECTION AND PREPARATION OF DATA AND OTHER MATERIAL FOR THE 217
GUIDE, EXCEPT THAT THE DEPARTMENT SHALL CONTRACT TO HAVE THE 219
CUSTOMER SATISFACTION SURVEYS CONDUCTED UNDER SECTION 173.54 OF
THE REVISED CODE. IN AWARDING THE CONTRACT TO HAVE THE SURVEYS 221
CONDUCTED, THE DEPARTMENT SHALL CONTRACT WITH A PERSON OR
GOVERNMENT ENTITY THAT HAS EXPERIENCE IN SURVEYING THE CUSTOMER 222
SATISFACTION OF NURSING FACILITY RESIDENTS AND THEIR FAMILIES. 223
THE DEPARTMENT'S CONTRACT SHALL PERMIT THE PERSON OR GOVERNMENT 224
ENTITY TO SUBCONTRACT WITH OTHER PERSONS OR GOVERNMENT ENTITIES 225
FOR PURPOSES OF CONDUCTING ALL OR PART OF THE SURVEYS.
Sec. 173.48. IN DEVELOPING AND PUBLISHING THE OHIO 227
LONG-TERM CARE CONSUMER GUIDE, THE DEPARTMENT OF AGING SHALL 228
6
ADHERE TO THE FOLLOWING PRINCIPLES: 229
(A) THE GUIDE SHOULD BE DESIGNED TO PROVIDE USERS WITH A 231
VARIETY OF MEASURES OF NURSING FACILITY QUALITY AND WITH OTHER 232
INFORMATION USEFUL IN COMPARING AND SELECTING NURSING FACILITIES. 234
(B) THE GUIDE SHOULD PRESENT THE INFORMATION SPECIFIED IN 236
DIVISION (A) OF THIS SECTION IN A MANNER THAT IS EASY TO USE AND 237
UNDERSTAND. 238
(C) THE GUIDE SHOULD ALLOW USERS TO DETERMINE WHICH OF THE 240
AVAILABLE MEASURES ARE MOST IMPORTANT TO THEM. 242
(D) THE INFORMATION IN THE GUIDE SHOULD BE KEPT AS CURRENT 244
AS PRACTICABLE. 245
(E) THE GUIDE SHOULD BE DESIGNED TO PROMOTE EXCELLENCE IN 247
NURSING FACILITY QUALITY. 248
(F) THE GUIDE SHOULD PROMOTE AWARENESS OF THE RANGE OF 250
LONG-TERM CARE SERVICES AVAILABLE TO OHIOANS. 251
Sec. 173.49. WITH REGARD TO THE ACCESSIBILITY OF THE OHIO 253
LONG-TERM CARE CONSUMER GUIDE AND THE EXECUTIVE SUMMARY OF THE 254
GUIDE, THE FOLLOWING SHALL APPLY: 255
(A) THE DEPARTMENT OF AGING SHALL MAKE THE GUIDE AND 257
SUMMARY AVAILABLE TO ANY PERSON OR GOVERNMENT ENTITY AND SHALL 259
NOT RESTRICT ACCESS BY REQUIRING PAYMENT OF A FEE, USE OF A 260
PASSWORD, OR FULFILLMENT OF ANY OTHER CONDITION.
(B) THE DEPARTMENT OF AGING SHALL DEVELOP AND IMPLEMENT 263
PROGRAMS AND OTHER STRATEGIES TO ENCOURAGE USE OF THE GUIDE BY 264
INDIVIDUALS CONSIDERING NURSING FACILITY PLACEMENT AND THEIR 265
FAMILIES, FRIENDS, AND ADVISORS. 266
Sec. 173.50. THE OHIO LONG-TERM CARE CONSUMER GUIDE SHALL 268
INCLUDE INFORMATION ON EACH NURSING FACILITY IN THIS STATE. FOR 269
EACH FACILITY, THE GUIDE SHALL INCLUDE, TO THE EXTENT IT IS 271
AVAILABLE TO THE DEPARTMENT OF AGING, ALL OF THE FOLLOWING 272
INFORMATION:
(A) CUSTOMER SATISFACTION DATA OBTAINED UNDER SECTION 274
173.54 OF THE REVISED CODE; 275
(B) CLINICAL QUALITY INDICATOR DATA OBTAINED UNDER SECTION 277
7
173.56 OF THE REVISED CODE; 278
(C) DATA DERIVED FROM STANDARD SURVEYS AS SPECIFIED IN 281
DIVISION (C)(3) OF SECTION 173.51 OF THE REVISED CODE; 282
(D) ANY OTHER INFORMATION SPECIFIED IN SECTIONS 173.45 TO 284
173.59 OF THE REVISED CODE OR THE RULES ADOPTED UNDER SECTION 286
173.57 OF THE REVISED CODE.
Sec. 173.51. THE OHIO LONG-TERM CARE CONSUMER GUIDE SHALL 289
BE STRUCTURED IN ACCORDANCE WITH THIS SECTION AND ANY APPLICABLE 291
RULES ADOPTED UNDER SECTION 173.57 OF THE REVISED CODE. 292
(A) THE OPENING ELECTRONIC PAGE OF THE CONSUMER GUIDE 294
SHALL INCLUDE ALL OF THE FOLLOWING GENERAL INFORMATION: 295
(1) A DESCRIPTION OF THE GUIDE; 297
(2) DISCLAIMERS STATING THE LIMITATIONS OF THE DATA 299
INCLUDED IN THE GUIDE. THE DISCLAIMERS SHALL INCLUDE A STATEMENT 300
THAT STANDARD SURVEYS OF NURSING FACILITIES ARE CONDUCTED AT 301
PERIODIC INTERVALS AND A STATEMENT THAT CONDITIONS AT A FACILITY 302
CAN CHANGE SIGNIFICANTLY BETWEEN STANDARD SURVEYS. 303
(3) A RECOMMENDATION THAT INDIVIDUALS CONSIDERING NURSING 305
FACILITY PLACEMENT VISIT ANY FACILITIES THEY ARE CONSIDERING; 306
(4) ELECTRONIC LINKS TO OTHER INFORMATION ON THE INTERNET 308
ABOUT SELECTING NURSING FACILITIES AND ABOUT OTHER LONG-TERM CARE 309
OPTIONS, INCLUDING INFORMATION MAINTAINED BY PERTINENT GOVERNMENT 311
AGENCIES AND PRIVATE ORGANIZATIONS AND TELEPHONE NUMBERS FOR 312
THOSE AGENCIES AND ORGANIZATIONS;
(5) ANY OTHER INFORMATION THE DEPARTMENT OF AGING 314
SPECIFIES IN RULES ADOPTED UNDER SECTION 173.57 OF THE REVISED 316
CODE.
(B) THE CONSUMER GUIDE SHALL BE STRUCTURED IN A MANNER 318
THAT ALLOWS THE USER TO SEARCH FOR INFORMATION IN THE GUIDE IN 319
MULTIPLE WAYS, INCLUDING SEARCHES BY FACILITY NAME, COUNTY, 321
MUNICIPALITY, POSTAL ZIP CODE, SOURCE OF NURSING FACILITY 322
PAYMENT, AND SPECIAL CARE SERVICE. 323
(C) THE FIRST INFORMATION TO APPEAR ON THE COMPUTER SCREEN 325
FOLLOWING A SEARCH SHALL BE A LIST OF ALL FACILITIES IDENTIFIED 326
8
BY THE SEARCH. FOR ALL OF THE FACILITIES LISTED, THE CONSUMER 327
GUIDE SHALL PRESENT THE USER WITH SUMMARIZED COMPARATIVE MEASURES 329
AND ELECTRONIC LINKS TO DEFINITIONS AND DESCRIPTIONS OF THE 330
MEASURES. THE GUIDE SHALL INCLUDE A FEATURE THAT ALLOWS THE USER
TO CHOOSE THE PARTICULAR COMPARATIVE MEASURES THAT WILL BE 331
DISPLAYED ON THE SCREEN. THE GUIDE ALSO MAY INCLUDE A CONSUMER 332
NEEDS ASSESSMENT FUNCTION TO ASSIST THE USER IN CHOOSING 333
MEASURES. THE COMPARATIVE MEASURES SHALL BE DERIVED FROM THE 334
FOLLOWING SOURCES:
(1) THE AGGREGATE RESPONSES MADE BY A FACILITY'S RESIDENTS 336
OR THEIR FAMILIES TO MEASURES OF CUSTOMER SATISFACTION INCLUDED 339
IN THE SURVEYS CONDUCTED UNDER SECTION 173.54 OF THE REVISED 340
CODE. THE MEASURES SHALL BE SPECIFIED IN RULES ADOPTED UNDER 342
SECTION 173.57 OF THE REVISED CODE. FOR EACH MEASURE, THE GUIDE 343
SHALL COMPARE THE RESPONSES FOR THE FACILITY TO THE STATEWIDE 344
AVERAGE OR TO A PEER-GROUP AVERAGE SPECIFIED IN RULE UNDER 345
SECTION 173.57 OF THE REVISED CODE. 346
(2) THE SCORES ON CLINICAL QUALITY INDICATORS CALCULATED 349
UNDER SECTION 173.56 OF THE REVISED CODE. THE INDICATORS SHALL 350
BE SPECIFIED IN RULES ADOPTED UNDER SECTION 173.57 OF THE REVISED 351
CODE. FOR EACH INDICATOR, THE GUIDE SHALL COMPARE THE FACILITY'S 352
SCORE TO THE STATEWIDE AVERAGE OR TO A PEER-GROUP AVERAGE 353
SPECIFIED IN RULE UNDER SECTION 173.57 OF THE REVISED CODE. THE 354
SCORES SHALL BE EXPRESSED AS PERCENTAGES. 355
(3) ALL OF THE FOLLOWING: 357
(a) THE DATE OF THE FACILITY'S MOST RECENT STANDARD 359
SURVEY; 360
(b) THE PERCENTAGE OF SPECIFIED SURVEY DATA TAGS FOR WHICH 362
THE FACILITY WAS FOUND TO BE IN COMPLIANCE DURING THE FACILITY'S 363
MOST RECENT STANDARD SURVEY. THE DEPARTMENT OF AGING SHALL 365
SPECIFY IN RULE THE SURVEY DATA TAGS USED FOR THIS PURPOSE AND 366
MAY EXCLUDE TAGS THAT ARE NEVER OR VERY RARELY CITED DURING 367
SURVEYS.
(c) THE STATEWIDE AVERAGE PERCENTAGE OF THE SPECIFIED 369
9
SURVEY DATA TAGS FOR WHICH FACILITIES WERE FOUND TO BE IN 371
COMPLIANCE DURING THE MOST RECENT STANDARD SURVEYS. 372
ALTERNATIVELY, THE DEPARTMENT OF AGING MAY PRESCRIBE BY RULE THAT 373
A PEER-GROUP AVERAGE BE USED. 374
(d) THE NUMBER OF SPECIFIED SURVEY DATA TAGS CITED BY THE 376
DEPARTMENT OF HEALTH IN THE FACILITY'S MOST RECENT STANDARD 377
SURVEY; 378
(e) THE STATEWIDE AVERAGE NUMBER OF SPECIFIED SURVEY DATA 380
TAGS CITED BY THE DEPARTMENT OF HEALTH DURING THE MOST RECENT 381
STANDARD SURVEYS. ALTERNATIVELY, THE DEPARTMENT OF AGING MAY 383
PRESCRIBE BY RULE THAT A PEER-GROUP AVERAGE BE USED.
(f) THE DATE THE FACILITY ACHIEVED SUBSTANTIAL COMPLIANCE 385
WITH MEDICARE AND MEDICAID CERTIFICATION REQUIREMENTS; 386
(g) WHETHER THE DEPARTMENT OF HEALTH DETERMINED THAT THE 388
FACILITY PROVIDED SUBSTANDARD CARE TO RESIDENTS DURING TWO OF ITS 390
LAST THREE STANDARD SURVEYS; 391
(h) WHETHER THE DEPARTMENT OF HEALTH FOUND THAT THE CARE 393
PROVIDED BY THE FACILITY PLACED RESIDENTS IN IMMEDIATE JEOPARDY 395
DURING TWO OF ITS LAST THREE STANDARD SURVEYS. 396
(4) AN ELECTRONIC LINK FOR EACH FACILITY ON THE LIST 398
ALLOWING THE USER TO GAIN ACCESS TO INFORMATION ON THE FACILITY 400
MAINTAINED UNDER DIVISION (D) OF THIS SECTION. 402
(D) IN ADDITION TO THE SUMMARIZED INFORMATION PROVIDED BY 404
THE GUIDE PURSUANT TO DIVISION (C) OF THIS SECTION, THE GUIDE 405
SHALL PROVIDE SPECIFIC COMPARATIVE INFORMATION ON EACH NURSING 406
FACILITY. WHEN THE GUIDE'S USER OPENS AN ELECTRONIC LINK TO THE 408
SPECIFIC INFORMATION, THE FIRST INFORMATION TO APPEAR ON THE 409
COMPUTER SCREEN SHALL INCLUDE ALL OF THE FOLLOWING:
(1) THE NAME OF THE FACILITY AND ITS OWNER, THE FACILITY'S 411
TELEPHONE NUMBER AND ADDRESS, INCLUDING THE COUNTY IN WHICH THE 413
FACILITY IS LOCATED. THE GUIDE SHALL INCLUDE A FUNCTION THAT 414
PINPOINTS ON A MAP THE FACILITY'S LOCATION.
(2) THE FACILITY'S STATUS WITH REGARD TO MEDICARE AND 416
MEDICAID CERTIFICATION AND PRIVATE ACCREDITATION; 417
10
(3) THE NUMBER OF BEDS IN THE FACILITY; 419
(4) AN ELECTRONIC LINK ALLOWING THE USER OF THE GUIDE TO 421
GAIN ACCESS TO A LISTING OF SERVICES PROVIDED BY THE FACILITY. 422
THE LISTING SHALL BE PRESENTED IN THE FORMAT SPECIFIED IN RULES 423
ADOPTED UNDER SECTION 173.57 OF THE REVISED CODE. 424
(5) AT THE FACILITY'S OPTION, A PICTURE OF THE FACILITY, A 426
BRIEF STATEMENT PROVIDED BY THE FACILITY, AND AN ELECTRONIC LINK 427
TO ANY INFORMATION THE FACILITY MAINTAINS ABOUT ITSELF ON THE 428
INTERNET;
(6) THE SUMMARIZED INFORMATION SPECIFIED IN DIVISION (C) 430
OF THIS SECTION FOR THE FACILITY, WITH ELECTRONIC LINKS ALLOWING 432
THE USER TO GAIN ACCESS TO ADDITIONAL INFORMATION PRESENTED AS 434
FOLLOWS:
(a) FOR EACH STATISTICALLY VALID AND RELIABLE QUESTION 436
ASKED ON THE QUESTIONNAIRES USED IN THE RESIDENT AND FAMILY 438
SURVEYS CONDUCTED UNDER SECTION 173.54 OF THE REVISED CODE, THE 439
GUIDE SHALL PRESENT THE CUSTOMER SATISFACTION RESPONSES. THE 441
RESPONSES FOR THE FACILITY SHALL BE COMPARED TO THE STATEWIDE 442
AVERAGE OR TO A PEER-GROUP AVERAGE SPECIFIED IN RULE UNDER 443
SECTION 173.57 OF THE REVISED CODE AND SHALL BE EXPRESSED IN 445
PERCENTAGES.
(b) FOR EACH CLINICAL QUALITY INDICATOR CALCULATED UNDER 448
SECTION 173.56 OF THE REVISED CODE, THE GUIDE SHALL PRESENT THE 449
FACILITY'S SCORE COMPARED TO THE STATEWIDE AVERAGE SCORE. THE 450
SCORES SHALL BE EXPRESSED AS PERCENTAGES. 451
(c) THE GUIDE SHALL PRESENT A LIST OF ALL SURVEY DATA TAGS 454
THAT WERE CITED DURING THE FACILITY'S MOST RECENT STANDARD 455
SURVEY, A BRIEF DESCRIPTION PERTAINING TO EACH DATA TAG, 456
DIRECTIONS OR ELECTRONIC LINKS FOR OBTAINING MORE INFORMATION 457
ABOUT THE FACILITY'S SURVEY HISTORY, AND LINKS TO THE TEXT OF 460
EACH CITATION AND TO THE FACILITY'S PLAN OF CORRECTION FILED WITH 461
THE STATE FOR EACH CITATION.
(7) ANY OTHER INFORMATION, WHICH MAY INCLUDE INFORMATION 463
ABOUT STAFFING, THE DEPARTMENT OF AGING PRESCRIBES BY RULE. 464
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Sec. 173.52. (A) THE DEPARTMENT OF AGING SHALL UPDATE 468
INFORMATION IN THE OHIO LONG-TERM CARE CONSUMER GUIDE AS FOLLOWS: 469
(1) THE CUSTOMER SATISFACTION DATA OBTAINED UNDER SECTION 471
173.54 OF THE REVISED CODE SHALL BE UPDATED ANNUALLY FOLLOWING 474
THE SURVEYS CONDUCTED UNDER THAT SECTION.
(2) THE CLINICAL QUALITY INDICATOR DATA OBTAINED UNDER 476
SECTION 173.56 OF THE REVISED CODE SHALL BE UPDATED IN JANUARY, 478
APRIL, JULY, AND OCTOBER OF EACH YEAR, USING THE MOST RECENT 480
RESIDENT ASSESSMENT DATA AVAILABLE TO THE DEPARTMENT.
(3) THE DATA DERIVED FROM STANDARD SURVEYS OF EACH NURSING 482
FACILITY, AS SPECIFIED IN DIVISION (C)(3) OF SECTION 173.51 OF 484
THE REVISED CODE, SHALL BE UPDATED WEEKLY, USING THE MOST RECENT 485
STANDARD SURVEY DATA AVAILABLE TO THE DEPARTMENT. THE DEPARTMENT 487
SHALL MODIFY THE DATA INCLUDED IN THE CONSUMER GUIDE TO REFLECT 489
EITHER OF THE FOLLOWING:
(a) ANY CHANGE IN THE SURVEY DATA RESULTING FROM INFORMAL 491
DISPUTE RESOLUTION, APPEAL, OR ANY OTHER PROCESS; 492
(b) THE DATE OF CORRECTION OF ANY CITATION. 494
(4) ANY OTHER INFORMATION SPECIFIED IN SECTIONS 173.45 TO 496
173.59 OF THE REVISED CODE OR THE RULES ADOPTED UNDER SECTION 498
173.57 OF THE REVISED CODE SHALL BE UPDATED AT THE TIME SPECIFIED 499
IN THOSE SECTIONS OR THE RULES.
(B) THE DEPARTMENT OF AGING SHALL SPECIFY BY RULE 501
INFORMATION IN THE GUIDE THAT NURSING FACILITIES CAN 502
ELECTRONICALLY UPDATE WITHOUT THE NEED FOR ANY ACTION BY THE 504
DEPARTMENT, WHICH SHALL INCLUDE ANY INFORMATION THAT THE FACILITY 505
ORIGINALLY SUBMITTED TO THE DEPARTMENT. THE GUIDE SHALL INCLUDE 506
A MECHANISM FOR SUCH UPDATES. THIS DIVISION DOES NOT APPLY TO
INFORMATION DESCRIBED IN DIVISIONS (A)(1), (2), AND (3) OF THIS 508
SECTION.
(C) THE DEPARTMENT OF HEALTH SHALL COOPERATE WITH THE 510
DEPARTMENT OF AGING TO ENSURE THAT STANDARD SURVEY INFORMATION 511
AND QUALITY INDICATOR DATA ARE UPDATED IN ACCORDANCE WITH THIS 513
SECTION, SUBJECT TO THE REGULATORY REQUIREMENTS, PROCEDURES, AND 514
12
GUIDELINES OF THE UNITED STATES HEALTH CARE FINANCING 515
ADMINISTRATION.
Sec. 173.53. IN ADDITION TO THE COMPUTERIZED OHIO 517
LONG-TERM CARE CONSUMER GUIDE, THE DEPARTMENT OF AGING SHALL 519
PREPARE AND MAKE AVAILABLE TO THE PUBLIC PRINTED INFORMATION TO 520
ASSIST CONSUMERS IN MAKING LONG-TERM CARE AND NURSING FACILITY 521
PLACEMENT DECISIONS, PARTICULARLY CONSUMERS WHO DO NOT HAVE 522
ACCESS TO THE INTERNET. THE PRINTED INFORMATION SHALL SPECIFY 523
ORGANIZATIONS THAT WILL PROVIDE CONSUMERS FREE ON-SITE ACCESS TO 524
THE CONSUMER GUIDE AND WILL MAIL TO CONSUMERS FREE PAPER COPIES 525
OF ELECTRONIC PAGES OF THE GUIDE.
Sec. 173.54. (A) THROUGH THE CONTRACT REQUIRED UNDER 527
SECTION 173.47 OF THE REVISED CODE, THE DEPARTMENT OF AGING SHALL 528
PROVIDE FOR CUSTOMER SATISFACTION SURVEYS FOR USE IN PUBLISHING 529
THE OHIO LONG-TERM CARE CONSUMER GUIDE. THE DEPARTMENT SHALL 530
ENSURE THAT THE CUSTOMER SATISFACTION SURVEYS ARE CONDUCTED AS 531
FOLLOWS: 532
(1) THE SURVEYS SHALL BE CONDUCTED ANNUALLY. 534
(2) THE SURVEYS SHALL CONSIST OF STANDARDIZED, 536
STATISTICALLY VALID AND RELIABLE QUESTIONNAIRES FOR NURSING 538
FACILITY RESIDENTS AND FOR FAMILIES OF NURSING FACILITY 539
RESIDENTS. EACH QUESTIONNAIRE SHALL BE STRUCTURED IN A MANNER 540
THAT PRODUCES STATISTICALLY TESTED VALID AND RELIABLE RESPONSES, 541
AS SPECIFIED IN RULES ADOPTED BY THE DEPARTMENT. EACH 542
QUESTIONNAIRE SHALL ASK THE RESIDENT'S AGE AND GENDER. THE 543
RESIDENT QUESTIONNAIRE SHALL ASK WHO, IF ANYONE, ASSISTED THE 544
RESIDENT IN COMPLETING THE QUESTIONNAIRE. THE FAMILY 545
QUESTIONNAIRE SHALL ASK THE RELATIONSHIP OF THE PERSON COMPLETING 546
THE QUESTIONNAIRE TO THE RESIDENT. 547
(3) THE RESIDENT SURVEY SHALL BE CONDUCTED IN PERSON, 549
USING A STANDARDIZED SURVEY PROTOCOL DEVELOPED BY THE DEPARTMENT 550
IN CONSULTATION WITH THE LONG-TERM CARE CONSUMER GUIDE ADVISORY 551
COUNCIL. THE SURVEY SHALL BE CONDUCTED IN A MANNER DESIGNED TO 553
PRESERVE THE RESIDENT'S CONFIDENTIALITY AS MUCH AS POSSIBLE. 554
13
(4) THE FAMILY SURVEY SHALL BE CONDUCTED USING ANONYMOUS 556
QUESTIONNAIRES DISTRIBUTED TO FAMILIES AND RETURNED TO A PERSON 557
OTHER THAN THE NURSING FACILITY, IN ACCORDANCE WITH A 558
STANDARDIZED SURVEY PROTOCOL DEVELOPED BY THE DEPARTMENT IN 560
CONSULTATION WITH THE LONG-TERM CARE CONSUMER GUIDE ADVISORY 561
COUNCIL.
(B) IN ADDITION TO BEING USED FOR THE CONSUMER GUIDE, THE 563
RESULTS OF THE SURVEYS CONDUCTED UNDER THIS SECTION SHALL BE 564
PROVIDED TO THE NURSING FACILITIES TO WHICH THEY PERTAIN. EACH 566
NURSING FACILITY IN THIS STATE SHALL PARTICIPATE AS NECESSARY FOR 567
SUCCESSFUL COMPLETION OF THE SURVEYS. 568
Sec. 173.55. THE DEPARTMENT OF AGING MAY CHARGE A FEE, NOT 570
TO EXCEED FOUR HUNDRED DOLLARS, FOR EACH OF THE ANNUAL CUSTOMER 571
SATISFACTION SURVEYS CONDUCTED UNDER SECTION 173.54 OF THE 573
REVISED CODE. THE FEE SHALL BE PAID BY THE NURSING FACILITY AND 574
IS SUBJECT TO REIMBURSEMENT THROUGH THE MEDICAID PROGRAM PURSUANT 575
TO SECTIONS 5111.20 TO 5111.32 OF THE REVISED CODE. 576
ALL FEES COLLECTED UNDER THIS SECTION SHALL BE DEPOSITED TO 579
THE CREDIT OF THE LONG-TERM CARE CONSUMER GUIDE FUND, WHICH IS
HEREBY CREATED IN THE STATE TREASURY. THE FUND SHALL BE USED FOR 582
COSTS ASSOCIATED WITH PUBLISHING THE OHIO LONG-TERM CARE CONSUMER 583
GUIDE, INCLUDING THE COST OF CONTRACTING WITH PERSONS AND 584
GOVERNMENT ENTITIES UNDER SECTION 173.47 OF THE REVISED CODE. 585
THE DEPARTMENT MAY CONTRACT WITH A PERSON OR GOVERNMENT ENTITY TO 587
COLLECT THE FEES ON BEHALF OF THE DEPARTMENT. 588
Sec. 173.56. FOR PURPOSES OF THE LONG-TERM CARE CONSUMER 590
GUIDE, THE DEPARTMENT OF AGING SHALL USE, SUBJECT TO FEDERAL 592
REGULATORY REQUIREMENTS, PROCEDURES, AND GUIDELINES, THE CLINICAL 593
QUALITY INDICATORS CALCULATED FOR EACH NURSING FACILITY BY THE 595
UNITED STATES HEALTH CARE FINANCING ADMINISTRATION FOR THE 596
PURPOSES OF THE MEDICARE AND MEDICAID PROGRAMS. 597
Sec. 173.57. (A) THE DEPARTMENT OF AGING SHALL ADOPT 599
RULES TO IMPLEMENT AND ADMINISTER SECTIONS 173.45 TO 173.59 OF 602
THE REVISED CODE. THE RULES SHALL SPECIFY ALL OF THE FOLLOWING: 604
14
(1) THE CONTENT OF THE OHIO LONG-TERM CARE CONSUMER GUIDE, 607
INCLUDING ANY INFORMATION IN ADDITION TO THE INFORMATION 609
SPECIFIED IN SECTION 173.51 OF THE REVISED CODE; 610
(2) THE CONTENT OF THE COMPUTERIZED AND PRINTED FORMS OF 613
THE EXECUTIVE SUMMARY OF THE CONSUMER GUIDE;
(3) THE CUSTOMER SATISFACTION MEASURES TO BE PUBLISHED IN 615
THE CONSUMER GUIDE PURSUANT TO DIVISION (C)(1) OF SECTION 173.51 616
OF THE REVISED CODE; 618
(4) THE CLINICAL QUALITY INDICATORS TO BE PUBLISHED IN THE 620
CONSUMER GUIDE PURSUANT TO DIVISION (C)(2) OF SECTION 173.51 OF 622
THE REVISED CODE; 623
(5) FOR PURPOSES OF CLINICAL QUALITY, CUSTOMER 625
SATISFACTION, AND SURVEY DATA TAG COMPARISONS UNDER SECTION 627
173.51 OF THE REVISED CODE, CRITERIA TO BE USED IN CLASSIFYING
NURSING FACILITIES INTO PEER GROUPS, WHICH MAY BE BASED ON 629
CASE-MIX SCORES CALCULATED UNDER SECTION 5111.231 OF THE REVISED 630
CODE, THE SIZE OF NURSING FACILITIES, THE LOCATION OF FACILITIES, 631
OR OTHER PERTINENT FACTORS;
(6) THE FORMAT FOR LISTING NURSING FACILITY SERVICES IN 633
THE CONSUMER GUIDE AND THE MANNER IN WHICH THAT INFORMATION IS TO 634
BE COLLECTED FROM NURSING FACILITIES; 635
(7) A METHOD OF INCLUDING ADDITIONAL LONG-TERM CARE 637
FACILITIES AND SERVICE PROVIDERS IN THE CONSUMER GUIDE PURSUANT 639
TO CONSIDERATIONS MADE UNDER DIVISION (B)(4) OF SECTION 173.58 OF 640
THE REVISED CODE;
(8) ANY OTHER REQUIREMENTS NECESSARY TO IMPLEMENT AND 642
ADMINISTER SECTIONS 173.45 TO 173.59 OF THE REVISED CODE. 643
(B) THE DEPARTMENT SHALL DEVELOP RULES UNDER THIS SECTION 645
IN CONSULTATION WITH THE LONG-TERM CARE CONSUMER GUIDE ADVISORY 647
COUNCIL CREATED UNDER SECTION 173.58 OF THE REVISED CODE. BEFORE 649
FILING A RULE UNDER SECTION 119.03 OF THE REVISED CODE, THE 650
DEPARTMENT SHALL PRESENT IT TO THE ADVISORY COUNCIL AND PROVIDE 651
THE COUNCIL A REASONABLE TIME TO COMMENT ON IT. THE DEPARTMENT 652
SHALL GIVE APPROPRIATE CONSIDERATION TO RECOMMENDATIONS OF THE 653
15
ADVISORY COUNCIL REGARDING PROPOSED RULES. 654
(C) ALL RULES ADOPTED UNDER THIS SECTION SHALL BE ADOPTED 656
IN ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE. INITIAL 658
RULES SHALL BE ADOPTED NOT LATER THAN SIX MONTHS AFTER THE 659
EFFECTIVE DATE OF THIS SECTION. 660
Sec. 173.58. (A) THERE IS HEREBY CREATED THE LONG-TERM 662
CARE CONSUMER GUIDE ADVISORY COUNCIL. THE COUNCIL SHALL BE 663
CONVENED BY THE DIRECTOR OF AGING AND SHALL CONSIST OF THE 665
FOLLOWING MEMBERS:
(1) A REPRESENTATIVE OF THE DEPARTMENT OF AGING, APPOINTED 667
BY THE DIRECTOR OF AGING; 668
(2) A REPRESENTATIVE OF THE DEPARTMENT OF HEALTH, 670
APPOINTED BY THE DIRECTOR OF HEALTH; 671
(3) A REPRESENTATIVE OF THE DEPARTMENT OF JOB AND FAMILY 673
SERVICES, APPOINTED BY THE DIRECTOR OF JOB AND FAMILY SERVICES; 674
(4) THE STATE LONG-TERM CARE OMBUDSPERSON; 676
(5) A FAMILY MEMBER OF A NURSING FACILITY RESIDENT, 678
APPOINTED BY THE GOVERNOR; 679
(6) A REPRESENTATIVE OF THE OHIO ASSOCIATION OF AREA 681
AGENCIES ON AGING, APPOINTED BY THE PRESIDENT OF THE ASSOCIATION; 682
(7) TWO REPRESENTATIVES OF THE OHIO HEALTH CARE 684
ASSOCIATION, APPOINTED BY THE CHIEF ADMINISTRATOR OF THE 685
ASSOCIATION;
(8) TWO REPRESENTATIVES OF THE ASSOCIATION OF OHIO 687
PHILANTHROPIC HOMES, HOUSING, AND SERVICES FOR THE AGING, 688
APPOINTED BY THE CHIEF ADMINISTRATOR OF THE ASSOCIATION; 690
(9) TWO REPRESENTATIVES OF THE OHIO ACADEMY OF NURSING 692
HOMES, APPOINTED BY THE CHIEF ADMINISTRATOR OF THE ACADEMY; 693
(10) A REPRESENTATIVE OF THE OHIO ASSOCIATION OF REGIONAL 695
LONG-TERM CARE OMBUDSMEN, APPOINTED BY THE CHIEF ADMINISTRATOR OF 696
THE ASSOCIATION; 697
(11) A REPRESENTATIVE OF THE OHIO CHAPTER OF THE AMERICAN 700
ASSOCIATION OF RETIRED PERSONS, APPOINTED BY THE CHIEF 701
ADMINISTRATOR OF THE CHAPTER; 702
16
(12) A REPRESENTATIVE OF A CONSUMER GROUP OR OTHER 705
NOT-FOR-PROFIT ENTITY THAT IS ORGANIZED FOR THE PURPOSE OF 706
PROMOTING IMPROVED CARE FOR NURSING HOME RESIDENTS, APPOINTED BY 707
THE GOVERNOR;
(13) A REPRESENTATIVE OF A RESEARCH ORGANIZATION, 709
APPOINTED BY THE CHIEF ADMINISTRATOR OF THE ORGANIZATION. THE 710
RESEARCH ORGANIZATION REPRESENTED SHALL BE SELECTED BY THE 711
DIRECTOR OF AGING FROM AMONG RESEARCH ORGANIZATIONS IN THIS STATE 712
THAT HAVE EXPERIENCE IN LONG-TERM CARE POLICY MATTERS. 713
EACH COUNCIL MEMBER SHALL SERVE AT THE DISCRETION OF THE 715
AUTHORITY THAT APPOINTED THE MEMBER. EACH MEMBER SHALL SERVE 716
WITHOUT COMPENSATION OR REIMBURSEMENT FOR EXPENSES, EXCEPT TO THE 717
EXTENT THAT SERVING AS A MEMBER OF THE COUNCIL IS PART OF THE 718
MEMBER'S REGULAR DUTIES OF EMPLOYMENT. 719
THE MEMBER SERVING AS THE REPRESENTATIVE OF THE DEPARTMENT 721
OF AGING SHALL SERVE AS THE COUNCIL'S CHAIRPERSON. THE 722
DEPARTMENT SHALL SUPPLY MEETING SPACE AND STAFF SUPPORT FOR THE 723
COUNCIL.
(B) THE COUNCIL'S DUTIES INCLUDE ALL OF THE FOLLOWING: 725
(1) TO HELP DEVELOP AND REVIEW RULES TO BE ADOPTED BY THE 727
DEPARTMENT OF AGING UNDER SECTION 173.57 OF THE REVISED CODE; 729
(2) TO RECOMMEND ADMINISTRATIVE PRACTICES TO THE 731
DEPARTMENT FOR IMPROVING THE OPERATION AND CONTENT OF THE OHIO 732
LONG-TERM CARE CONSUMER GUIDE; 733
(3) TO RECOMMEND LEGISLATIVE CHANGES TO THE DEPARTMENT 735
NEEDED TO IMPROVE THE CONSUMER GUIDE; 737
(4) TO CONSIDER WHETHER IT IS FEASIBLE TO INCLUDE IN THE 739
CONSUMER GUIDE OTHER LONG-TERM CARE FACILITIES, SUCH AS 740
RESIDENTIAL CARE FACILITIES AND INTERMEDIATE CARE FACILITIES FOR 741
THE MENTALLY RETARDED, AND LONG-TERM CARE SERVICE PROVIDERS, SUCH 742
AS HOME HEALTH AGENCIES AND ADULT DAY SERVICE PROVIDERS; 743
(5) TO CONSIDER WHETHER IT IS FEASIBLE TO INCLUDE IN THE 745
CONSUMER GUIDE MEASUREMENTS OF QUALITY OF LIFE STANDARDS. 746
(C) THE LONG-TERM CARE CONSUMER GUIDE ADVISORY COUNCIL IS 748
17
NOT SUBJECT TO SECTION 101.84 OF THE REVISED CODE. 749
Sec. 173.59. (A) THE DEPARTMENT OF AGING SHALL INCLUDE NO 751
ADVERTISING IN THE OHIO LONG-TERM CARE CONSUMER GUIDE THAT SHALL 752
CAUSE A CONFLICT OF INTEREST. 753
(B) THIS SECTION DOES NOT AFFECT INFORMATION INCLUDED IN 755
THE OHIO LONG-TERM CARE CONSUMER GUIDE UNDER DIVISION (D)(5) OF 757
SECTION 173.51 OF THE REVISED CODE. 758
Sec. 3702.525. (A) Not later than twenty-four months 768
after the date the director of health mails the notice that the 769
certificate of need has been granted or, if the grant or denial 770
of the certificate of need is appealed under section 3702.60 of 771
the Revised Code, not later than twenty-four months after 772
issuance of an order granting the certificate that is not subject 773
to further appeal, each person holding a certificate of need 774
granted on or after the effective date of this section APRIL 20, 775
1995, shall:
(1) If the project for which the certificate of need was 778
granted primarily involves construction and is to be financed
primarily through external borrowing of funds, secure financial 779
commitment for the stated purpose of developing the project and 780
commence construction that continues uninterrupted except for 781
interruptions or delays that are unavoidable due to reasons 782
beyond the person's control, including labor strikes, natural 783
disasters, material shortages, or comparable events; 784
(2) If the project for which the certificate of need was 787
granted primarily involves construction and is to be financed
primarily internally, receive formal approval from the holder's 788
board of directors or trustees or other governing authority to 789
commit specified funds for implementation of the project and 790
commence construction that continues uninterrupted except for 791
interruptions or delays that are unavoidable due to reasons 792
beyond the person's control, including labor strikes, natural 793
disasters, material shortages, or comparable events; 794
(3) If the project for which the certificate of need was 797
18
granted primarily involves acquisition of medical equipment,
enter into a contract to purchase or lease the equipment and to 798
accept the equipment at the site for which the certificate was 799
granted; 800
(4) If the project for which the certificate of need was 803
granted involves no capital expenditure or only minor renovations 804
to existing structures, provide the health service or activity by 805
the means specified in the approved application for the 806
certificate;
(5) If the project for which the certificate of need was 809
granted primarily involves leasing a building or space that
requires only minor renovations to the existing space, execute a 810
lease and provide the health service or activity by the means 811
specified in the approved application for the certificate; 812
(6) If the project for which the certificate of need was 815
granted primarily involves leasing a building or space that has 816
not been constructed or requires substantial renovations to
existing space, commence construction for the purpose of 817
implementing the reviewable activity that continues uninterrupted 818
except for interruptions or delays that are unavoidable due to 819
reasons beyond the person's control, including labor strikes, 820
natural disasters, material shortages, or comparable events. 821
(B) The twenty-four-month period specified in division (A) 824
of this section shall not be extended by any means, including the 825
transfer of a certificate of need under division (C) of section 826
3702.524 of the Revised Code or granting of a subsequent or
replacement certificate of need. Each person holding a 828
certificate of need granted on or after the effective date of 829
this section APRIL 20, 1995, shall provide the director of health 831
documentation of compliance with that division not later than the 832
earlier of thirty days after complying with that division or five 833
days after the twenty-four-month period expires. Not later than 834
the earlier of fifteen days after he receives RECEIVING the 835
documentation or fifteen days after the twenty-four-month period 836
19
expires, the director shall send by certified mail a notice to 837
the holder of the certificate of need specifying whether the 838
holder has complied with division (A) of this section. 839
(C) NOTWITHSTANDING DIVISION (B) OF THIS SECTION, THE 841
TWENTY-FOUR-MONTH PERIOD SPECIFIED IN DIVISION (A) OF THIS 842
SECTION SHALL BE EXTENDED FOR AN ADDITIONAL TWENTY-FOUR MONTHS 843
FOR ANY CERTIFICATE OF NEED GRANTED FOR THE PURCHASE AND 844
RELOCATION OF LICENSED NURSING HOME BEDS ON FEBRUARY 26, 1999. 845
(D) A certificate of need granted on or after the 848
effective date of this section APRIL 20, 1995, expires, 849
regardless of whether the director sends a notice under division 850
(B) of this section, if the holder fails to comply with division 851
(A) OR (C) of this section or to provide information under 853
division (B) of this section as necessary for the director to 854
determine compliance. 855
Sec. 3721.026. (A) AS USED IN THIS SECTION AND SECTION 857
3721.027 OF THE REVISED CODE, "NURSING FACILITY" AND "SURVEY" 859
HAVE THE SAME MEANINGS AS IN SECTION 5111.35 OF THE REVISED CODE. 860
(B) THE DIRECTOR OF HEALTH SHALL ESTABLISH A UNIT WITHIN 862
THE DEPARTMENT OF HEALTH TO PROVIDE ADVICE AND TECHNICAL 863
ASSISTANCE AND TO CONDUCT ON-SITE VISITS TO NURSING FACILITIES 865
FOR THE PURPOSE OF IMPROVING RESIDENT OUTCOMES. THE DIRECTOR 866
SHALL ASSIGN TO THE UNIT EMPLOYEES WHO HAVE TRAINING OR 867
EXPERIENCE IN CONDUCTING OR SUPERVISING SURVEYS, BUT EMPLOYEES 868
ASSIGNED TO THE UNIT SHALL NOT CONDUCT SURVEYS. THE DIRECTOR 869
SHALL ADOPT RULES IN ACCORDANCE WITH CHAPTER 119. OF THE REVISED 870
CODE TO IMPLEMENT THIS SECTION AND SHALL CONSULT WITH INTERESTED 871
PARTIES IN DEVELOPING THE RULES. TECHNICAL ASSISTANCE REPORTS 872
ARE NOT PUBLIC RECORDS UNDER SECTION 149.43 OF THE REVISED CODE 873
AND SHALL NOT BE DISTRIBUTED TO ANY PERSON OUTSIDE THE UNIT
EXCEPT: 874
(1) THE NURSING FACILITY THAT IS PROVIDED WITH THE 876
TECHNICAL ASSISTANCE;
(2) PERSONS CHARGED WITH INSPECTING NURSING FACILITIES 878
20
UNDER SECTION 3721.02 OF THE REVISED CODE OR WITH CONDUCTING 879
SURVEYS OR REVIEWS OF NURSING FACILITIES UNDER SECTION 3721.022 880
OF THE REVISED CODE WHENEVER ANY SUCH PERSON FINDS THAT THERE IS
SERIOUS HARM TO RESIDENT HEALTH OR SAFETY THAT IS MORE THAN 881
ISOLATED AT THE NURSING FACILITY. 882
THE PROVISIONS OF THIS SECTION AND RULES ADOPTED UNDER THIS 884
SECTION DO NOT AFFECT THE DEPARTMENT'S AUTHORITY TO ADMINISTER 885
AND ENFORCE OTHER SECTIONS OF THIS CHAPTER. 886
(C) ON OR BEFORE THE LAST DAY OF DECEMBER EACH YEAR, THE 888
DIRECTOR SHALL SUBMIT A REPORT TO THE GOVERNOR AND THE GENERAL 891
ASSEMBLY DESCRIBING THE UNIT'S ACTIVITIES THAT YEAR AND ITS
EFFECTIVENESS IN IMPROVING RESIDENT OUTCOMES. 892
Sec. 3721.027. THE DEPARTMENT OF HEALTH SHALL INVESTIGATE 894
WITHIN TEN WORKING DAYS AFTER REFERRAL, IN ACCORDANCE WITH 895
PROCEDURES AND CRITERIA TO BE ESTABLISHED BY THE DEPARTMENT OF 896
HEALTH AND THE DEPARTMENT OF AGING, ANY UNRESOLVED COMPLAINT THAT 897
THE OFFICE OF THE STATE LONG-TERM CARE OMBUDSPERSON HAS 898
INVESTIGATED AND FOUND TO BE VALID AND REFERS TO THE DEPARTMENT 899
OF HEALTH. THIS REQUIREMENT DOES NOT SUPERSEDE FEDERAL 901
REQUIREMENTS FOR SURVEY AGENCY COMPLAINT INVESTIGATIONS. 902
Sec. 3721.21. As used in sections 3721.21 to 3721.34 of 911
the Revised Code: 912
(A) "Long-term care facility" means either of the 914
following: 915
(1) A nursing home as defined in section 3721.01 of the 917
Revised Code, other than a nursing home or part of a nursing home 918
certified as an intermediate care facility for the mentally 919
retarded under Title XIX of the "Social Security Act," 49 Stat. 920
620 (1935), 42 U.S.C.A. 301, as amended; 921
(2) A facility or part of a facility that is certified as 923
a skilled nursing facility or a nursing facility under Title 924
XVIII or XIX of the "Social Security Act." 925
(B) "Residential care facility" has the same meaning as in 927
section 3721.01 of the Revised Code. 928
21
(C) "Abuse" means knowingly causing physical harm or 930
recklessly causing serious physical harm to a resident by 931
physical contact with the resident or by use of physical or 932
chemical restraint, medication, or isolation as punishment, for 933
staff convenience, excessively, as a substitute for treatment, or 934
in amounts that preclude habilitation and treatment. 935
(D) "Neglect" means recklessly failing to provide a 937
resident with any treatment, care, goods, or service necessary to 938
maintain the health or safety of the resident when the failure 939
results in serious physical harm to the resident. "NEGLECT" DOES 940
NOT INCLUDE ALLOWING A RESIDENT, AT THE RESIDENT'S OPTION, TO 941
RECEIVE ONLY TREATMENT BY SPIRITUAL MEANS THROUGH PRAYER IN 943
ACCORDANCE WITH THE TENETS OF A RECOGNIZED RELIGIOUS
DENOMINATION. 944
(E) "Misappropriation" means depriving, defrauding, or 946
otherwise obtaining the real or personal property of a resident 947
by any means prohibited by the Revised Code, including violations 948
of Chapter 2911. or 2913. of the Revised Code. 949
(F) "Resident" includes a resident, patient, former 952
resident or patient, or deceased resident or patient of a
long-term care facility or a residential care facility. 953
(G) "Physical restraint" has the same meaning as in 955
section 3721.10 of the Revised Code. 956
(H) "Chemical restraint" has the same meaning as in 958
section 3721.10 of the Revised Code. 959
(I) "Nursing and nursing-related services" means the 962
personal care services and other services not constituting
skilled nursing care that are specified in rules the public 963
health council shall adopt in accordance with Chapter 119. of the 965
Revised Code.
(J) "Personal care services" has the same meaning as in 967
section 3721.01 of the Revised Code. 968
(K) "Nurse aide" means an individual, other than a 970
licensed health professional practicing within the scope of the 971
22
professional's license, who provides nursing and nursing-related 973
services to residents in a long-term care facility, either as a 974
member of the staff of the facility for monetary compensation or 975
as a volunteer without monetary compensation. 976
(L) "Licensed health professional" means all of the 978
following: 979
(1) An occupational therapist or occupational therapy 981
assistant licensed under Chapter 4755. of the Revised Code; 982
(2) A physical therapist or physical therapy assistant 984
licensed under Chapter 4755. of the Revised Code; 985
(3) A physician authorized under Chapter 4731. of the 987
Revised Code to practice medicine and surgery, osteopathic 988
medicine and surgery, or podiatry; 989
(4) A physician assistant authorized under Chapter 4730. 992
of the Revised Code to practice as a physician assistant;
(5) A registered nurse or licensed practical nurse 994
licensed under Chapter 4723. of the Revised Code; 995
(6) A social worker or independent social worker licensed 998
under Chapter 4757. of the Revised Code or a social work
assistant registered under that chapter; 999
(7) A speech-language pathologist or audiologist licensed 1,001
under Chapter 4753. of the Revised Code; 1,002
(8) A dentist or dental hygienist licensed under Chapter 1,004
4715. of the Revised Code; 1,005
(9) An optometrist licensed under Chapter 4725. of the 1,007
Revised Code; 1,008
(10) A pharmacist licensed under Chapter 4729. of the 1,010
Revised Code; 1,011
(11) A psychologist licensed under Chapter 4732. of the 1,013
Revised Code; 1,014
(12) A chiropractor licensed under Chapter 4734. of the 1,016
Revised Code; 1,017
(13) A nursing home administrator licensed or temporarily 1,019
licensed under Chapter 4751. of the Revised Code; 1,020
23
(14) A professional counselor or professional clinical 1,022
counselor licensed under Chapter 4757. of the Revised Code. 1,023
(M) "Competency evaluation program" means a program 1,025
through which the competency of a nurse aide to provide nursing 1,026
and nursing-related services is evaluated. 1,027
(N) "Training and competency evaluation program" means a 1,029
program of nurse aide training and evaluation of competency to 1,030
provide nursing and nursing-related services. 1,031
Sec. 5111.20. As used in sections 5111.20 to 5111.32 of 1,040
the Revised Code: 1,041
(A) "Allowable costs" are those costs determined by the 1,043
department of job and family services to be reasonable and do not 1,044
include fines paid under sections 5111.35 to 5111.61 and section 1,046
5111.99 of the Revised Code. 1,047
(B) "Capital costs" means costs of ownership and 1,049
nonextensive renovation. 1,050
(1) "Cost of ownership" means the actual expense incurred 1,052
for all of the following: 1,053
(a) Depreciation and interest on any capital assets that 1,055
cost five hundred dollars or more per item, including the 1,056
following: 1,057
(i) Buildings; 1,059
(ii) Building improvements that are not approved as 1,061
nonextensive renovations under section 5111.25 or 5111.251 of the 1,062
Revised Code; 1,063
(iii) Equipment; 1,065
(iv) Extensive renovations; 1,067
(v) Transportation equipment. 1,069
(b) Amortization and interest on land improvements and 1,071
leasehold improvements; 1,072
(c) Amortization of financing costs; 1,074
(d) Except as provided in division (I) of this section, 1,076
lease and rent of land, building, and equipment. 1,077
The costs of capital assets of less than five hundred 1,079
24
dollars per item may be considered costs of ownership in 1,080
accordance with a provider's practice.
(2) "Costs of nonextensive renovation" means the actual 1,082
expense incurred for depreciation or amortization and interest on 1,083
renovations that are not extensive renovations. 1,084
(C) "Capital lease" and "operating lease" shall be 1,086
construed in accordance with generally accepted accounting 1,087
principles.
(D) "Case-mix score" means the measure determined under 1,089
section 5111.231 of the Revised Code of the relative direct-care 1,090
resources needed to provide care and habilitation to a resident 1,091
of a nursing facility or intermediate care facility for the 1,092
mentally retarded. 1,093
(E) "Date of licensure," for a facility originally 1,095
licensed as a nursing home under Chapter 3721. of the Revised 1,096
Code, means the date specific beds were originally licensed as 1,097
nursing home beds under that chapter, regardless of whether they 1,098
were subsequently licensed as residential facility beds under 1,099
section 5123.19 of the Revised Code. For a facility originally 1,100
licensed as a residential facility under section 5123.19 of the 1,101
Revised Code, "date of licensure" means the date specific beds 1,102
were originally licensed as residential facility beds under that 1,103
section.
(1) If nursing home beds licensed under Chapter 3721. of 1,105
the Revised Code or residential facility beds licensed under 1,106
section 5123.19 of the Revised Code were not required by law to 1,107
be licensed when they were originally used to provide nursing 1,108
home or residential facility services, "date of licensure" means 1,109
the date the beds first were used to provide nursing home or
residential facility services, regardless of the date the present 1,110
provider obtained licensure. 1,111
(2) If a facility adds nursing home beds or residential 1,113
facility beds or extensively renovates all or part of the 1,114
facility after its original date of licensure, it will have a 1,115
25
different date of licensure for the additional beds or 1,116
extensively renovated portion of the facility, unless the beds 1,117
are added in a space that was constructed at the same time as the 1,118
previously licensed beds but was not licensed under Chapter 3721. 1,119
or section 5123.19 of the Revised Code at that time. 1,120
(F) "Desk-reviewed" means that costs as reported on a cost 1,122
report submitted under section 5111.26 of the Revised Code have 1,123
been subjected to a desk review under division (A) of section 1,124
5111.27 of the Revised Code and preliminarily determined to be 1,125
allowable costs. 1,126
(G) "Direct care costs" means all of the following: 1,128
(1)(a) Costs for registered nurses, licensed practical 1,130
nurses, and nurse aides employed by the facility; 1,131
(b) Costs for direct care staff, administrative nursing 1,133
staff, medical directors, social services staff, activities 1,134
staff, psychologists and psychology assistants, social workers 1,135
and counselors, habilitation staff, qualified mental retardation 1,136
professionals, program directors, respiratory therapists, 1,137
habilitation supervisors, and except as provided in division 1,138
(G)(2) of this section, other persons holding degrees qualifying 1,139
them to provide therapy; 1,140
(c) Costs of purchased nursing services; 1,142
(d) Costs of quality assurance; 1,144
(e) Costs of training and staff development, employee 1,146
benefits, payroll taxes, and workers' compensation premiums or 1,147
costs for self-insurance claims and related costs as specified in 1,148
rules adopted by the director of job and family services in 1,150
accordance with Chapter 119. of the Revised Code, for personnel 1,152
listed in divisions (G)(1)(a), (b), and (d) of this section; 1,153
(f) Costs of consulting and management fees related to 1,155
direct care;
(g) Allocated direct care home office costs. 1,157
(2) In addition to the costs specified in division (G)(1) 1,159
of this section, for intermediate care facilities for the 1,160
26
mentally retarded only, direct care costs include both of the 1,161
following: 1,162
(a) Costs for physical therapists and physical therapy 1,164
assistants, occupational therapists and occupational therapy 1,165
assistants, speech therapists, and audiologists; 1,166
(b) Costs of training and staff development, employee 1,168
benefits, payroll taxes, and workers' compensation premiums or 1,169
costs for self-insurance claims and related costs as specified in 1,170
rules adopted by the director of job and family services in 1,172
accordance with Chapter 119. of the Revised Code, for personnel 1,173
listed in division (G)(2)(a) of this section. 1,174
(3) Costs of other direct-care resources that are 1,176
specified as direct care costs in rules adopted by the director 1,178
of job and family services in accordance with Chapter 119. of the 1,179
Revised Code. 1,180
(H) "Fiscal year" means the fiscal year of this state, as 1,182
specified in section 9.34 of the Revised Code. 1,183
(I) "Indirect care costs" means all reasonable costs other 1,185
than direct care costs, other protected costs, or capital costs. 1,186
"Indirect care costs" includes but is not limited to costs of 1,187
habilitation supplies, pharmacy consultants, medical and 1,188
habilitation records, program supplies, incontinence supplies, 1,189
food, enterals, dietary supplies and personnel, laundry, 1,190
housekeeping, security, administration, liability insurance, 1,191
bookkeeping, purchasing department, human resources, 1,192
communications, travel, dues, license fees, subscriptions, home 1,193
office costs not otherwise allocated, legal services, accounting 1,194
services, minor equipment, maintenance and repairs, help-wanted 1,196
advertising, informational advertising, CONSUMER SATISFACTION 1,197
SURVEY FEES PAID UNDER SECTION 173.55 OF THE REVISED CODE, 1,198
start-up costs, organizational expenses, other interest, property 1,199
insurance, employee training and staff development, employee 1,200
benefits, payroll taxes, and workers' compensation premiums or 1,201
costs for self-insurance claims and related costs as specified in 1,202
27
rules adopted by the director of job and family services in 1,203
accordance with Chapter 119. of the Revised Code, for personnel 1,204
listed in this division. Notwithstanding division (B)(1) of this 1,205
section, "indirect care costs" also means the cost of equipment, 1,206
including vehicles, acquired by operating lease executed before 1,207
December 1, 1992, if the costs are reported as administrative and 1,208
general costs on the facility's cost report for the cost 1,209
reporting period ending December 31, 1992. 1,210
(J) "Inpatient days" means all days during which a 1,212
resident, regardless of payment source, occupies a bed in a 1,213
nursing facility or intermediate care facility for the mentally 1,214
retarded that is included in the facility's certified capacity 1,215
under Title XIX of the "Social Security Act," 49 Stat. 610 1,216
(1935), 42 U.S.C.A. 301, as amended. Therapeutic or hospital 1,217
leave days for which payment is made under section 5111.33 of the 1,218
Revised Code are considered inpatient days proportionate to the 1,219
percentage of the facility's per resident per day rate paid for 1,220
those days. 1,221
(K) "Intermediate care facility for the mentally retarded" 1,223
means an intermediate care facility for the mentally retarded 1,224
certified as in compliance with applicable standards for the 1,225
medical assistance program by the director of health in 1,226
accordance with Title XIX of the "Social Security Act." 1,227
(L) "Maintenance and repair expenses" means, except as 1,229
provided in division (X)(2) of this section, expenditures that 1,230
are necessary and proper to maintain an asset in a normally 1,231
efficient working condition and that do not extend the useful 1,232
life of the asset two years or more. "Maintenance and repair 1,233
expenses" includes but is not limited to the cost of ordinary 1,234
repairs such as painting and wallpapering. 1,235
(M) "Nursing facility" means a facility, or a distinct 1,237
part of a facility, that is certified as a nursing facility by 1,238
the director of health in accordance with Title XIX of the 1,239
"Social Security Act," and is not an intermediate care facility 1,240
28
for the mentally retarded. "Nursing facility" includes a 1,241
facility, or a distinct part of a facility, that is certified as 1,242
a nursing facility by the director of health in accordance with 1,243
Title XIX of the "Social Security Act," and is certified as a 1,244
skilled nursing facility by the director in accordance with Title 1,245
XVIII of the "Social Security Act." 1,246
(N) "Other protected costs" means costs for medical 1,248
supplies; real estate, franchise, and property taxes; natural 1,249
gas, fuel oil, water, electricity, sewage, and refuse and 1,250
hazardous medical waste collection; allocated other protected 1,251
home office costs; and any additional costs defined as other 1,254
protected costs in rules adopted by the director of job and 1,255
family services in accordance with Chapter 119. of the Revised 1,257
Code.
(O) "Owner" means any person or government entity that has 1,259
at least five per cent ownership or interest, either directly, 1,260
indirectly, or in any combination, in a nursing facility or 1,261
intermediate care facility for the mentally retarded. 1,262
(P) "Patient" includes "resident." 1,264
(Q) Except as provided in divisions (Q)(1) and (2) of this 1,266
section, "per diem" means a nursing facility's or intermediate 1,267
care facility for the mentally retarded's actual, allowable costs 1,268
in a given cost center in a cost reporting period, divided by the 1,269
facility's inpatient days for that cost reporting period. 1,270
(1) When calculating indirect care costs for the purpose 1,272
of establishing rates under section 5111.24 or 5111.241 of the 1,273
Revised Code, "per diem" means a facility's actual, allowable 1,274
indirect care costs in a cost reporting period divided by the 1,275
greater of the facility's inpatient days for that period or the 1,276
number of inpatient days the facility would have had during that 1,277
period if its occupancy rate had been eighty-five per cent. 1,278
(2) When calculating capital costs for the purpose of 1,280
establishing rates under section 5111.25 or 5111.251 of the 1,281
Revised Code, "per diem" means a facility's actual, allowable 1,282
29
capital costs in a cost reporting period divided by the greater 1,283
of the facility's inpatient days for that period or the number of 1,284
inpatient days the facility would have had during that period if 1,285
its occupancy rate had been ninety-five per cent. 1,286
(R) "Provider" means a person or government entity that 1,288
operates a nursing facility or intermediate care facility for the 1,289
mentally retarded under a provider agreement. 1,290
(S) "Provider agreement" means a contract between the 1,292
department of job and family services and a nursing facility or 1,293
intermediate care facility for the mentally retarded for the 1,294
provision of nursing facility services or intermediate care 1,295
facility services for the mentally retarded under the medical 1,296
assistance program. 1,297
(T) "Purchased nursing services" means services that are 1,299
provided in a nursing facility by registered nurses, licensed 1,300
practical nurses, or nurse aides who are not employees of the 1,301
facility. 1,302
(U) "Reasonable" means that a cost is an actual cost that 1,304
is appropriate and helpful to develop and maintain the operation 1,305
of patient care facilities and activities, including normal 1,306
standby costs, and that does not exceed what a prudent buyer pays 1,307
for a given item or services. Reasonable costs may vary from 1,308
provider to provider and from time to time for the same provider. 1,309
(V) "Related party" means an individual or organization 1,311
that, to a significant extent, has common ownership with, is 1,312
associated or affiliated with, has control of, or is controlled 1,313
by, the provider. 1,314
(1) An individual who is a relative of an owner is a 1,316
related party. 1,317
(2) Common ownership exists when an individual or 1,319
individuals possess significant ownership or equity in both the 1,320
provider and the other organization. Significant ownership or 1,321
equity exists when an individual or individuals possess five per 1,322
cent ownership or equity in both the provider and a supplier. 1,323
30
Significant ownership or equity is presumed to exist when an 1,324
individual or individuals possess ten per cent ownership or 1,325
equity in both the provider and another organization from which 1,326
the provider purchases or leases real property. 1,327
(3) Control exists when an individual or organization has 1,329
the power, directly or indirectly, to significantly influence or 1,330
direct the actions or policies of an organization. 1,331
(4) An individual or organization that supplies goods or 1,333
services to a provider shall not be considered a related party if 1,334
all of the following conditions are met: 1,335
(a) The supplier is a separate bona fide organization. 1,337
(b) A substantial part of the supplier's business activity 1,339
of the type carried on with the provider is transacted with 1,340
others than the provider and there is an open, competitive market 1,341
for the types of goods or services the supplier furnishes. 1,342
(c) The types of goods or services are commonly obtained 1,344
by other nursing facilities or intermediate care facilities for 1,345
the mentally retarded from outside organizations and are not a 1,346
basic element of patient care ordinarily furnished directly to 1,347
patients by the facilities. 1,348
(d) The charge to the provider is in line with the charge 1,350
for the goods or services in the open market and no more than the 1,351
charge made under comparable circumstances to others by the 1,352
supplier. 1,353
(W) "Relative of owner" means an individual who is related 1,355
to an owner of a nursing facility or intermediate care facility 1,356
for the mentally retarded by one of the following relationships: 1,357
(1) Spouse; 1,359
(2) Natural parent, child, or sibling; 1,361
(3) Adopted parent, child, or sibling; 1,363
(4) Step-parent, step-child, step-brother, or step-sister; 1,365
(5) Father-in-law, mother-in-law, son-in-law, 1,367
daughter-in-law, brother-in-law, or sister-in-law; 1,368
(6) Grandparent or grandchild; 1,370
31
(7) Foster parent, foster child, foster brother, or foster 1,372
sister. 1,373
(X) "Renovation" and "extensive renovation" mean: 1,375
(1) Any betterment, improvement, or restoration of a 1,377
nursing facility or intermediate care facility for the mentally 1,378
retarded started before July 1, 1993, that meets the definition 1,379
of a renovation or extensive renovation established in rules 1,380
adopted by the director of job and family services in effect on 1,382
December 22, 1992.
(2) In the case of betterments, improvements, and 1,384
restorations of nursing facilities and intermediate care 1,385
facilities for the mentally retarded started on or after July 1, 1,386
1993: 1,387
(a) "Renovation" means the betterment, improvement, or 1,389
restoration of a nursing facility or intermediate care facility 1,390
for the mentally retarded beyond its current functional capacity 1,391
through a structural change that costs at least five hundred 1,392
dollars per bed. A renovation may include betterment, 1,393
improvement, restoration, or replacement of assets that are 1,394
affixed to the building and have a useful life of at least five 1,395
years. A renovation may include costs that otherwise would be 1,396
considered maintenance and repair expenses if they are an 1,397
integral part of the structural change that makes up the 1,398
renovation project. "Renovation" does not mean construction of 1,399
additional space for beds that will be added to a facility's 1,400
licensed or certified capacity. 1,401
(b) "Extensive renovation" means a renovation that costs 1,403
more than sixty-five per cent and no more than eighty-five per 1,404
cent of the cost of constructing a new bed and that extends the 1,405
useful life of the assets for at least ten years. 1,406
For the purposes of division (X)(2) of this section, the 1,408
cost of constructing a new bed shall be considered to be forty 1,409
thousand dollars, adjusted for the estimated rate of inflation 1,410
from January 1, 1993, to the end of the calendar year during 1,411
32
which the renovation is completed, using the consumer price index 1,412
for shelter costs for all urban consumers for the north central 1,413
region, as published by the United States bureau of labor 1,414
statistics. 1,415
The department of job and family services may treat a 1,417
renovation that costs more than eighty-five per cent of the cost 1,418
of constructing new beds as an extensive renovation if the 1,419
department determines that the renovation is more prudent than 1,420
construction of new beds. 1,421
Sec. 5111.25. (A) The department of job and family 1,431
services shall pay each eligible nursing facility a per resident 1,432
per day rate for its reasonable capital costs established 1,433
prospectively each fiscal year for each facility. Except as 1,434
otherwise provided in sections 5111.20 to 5111.32 of the Revised 1,435
Code, the rate shall be based on the facility's capital costs for 1,436
the calendar year preceding the fiscal year in which the rate
will be paid. The rate shall equal the sum of divisions (A)(1) 1,437
to (3) of this section: 1,438
(1) The lesser of the following: 1,440
(a) Eighty-eight and sixty-five one-hundredths per cent of 1,442
the facility's desk-reviewed, actual, allowable, per diem cost of 1,443
ownership and eighty-five per cent of the facility's actual, 1,444
allowable, per diem cost of nonextensive renovation determined 1,445
under division (F) of this section; 1,446
(b) Eighty-eight and sixty-five one-hundredths per cent of 1,448
the following limitation: 1,449
(i) For the fiscal year beginning July 1, 1993, sixteen 1,451
dollars per resident day; 1,452
(ii) For the fiscal year beginning July 1, 1994, sixteen 1,454
dollars per resident day, adjusted to reflect the rate of 1,455
inflation for the twelve-month period beginning July 1, 1992, and 1,456
ending June 30, 1993, using the consumer price index for shelter 1,457
costs for all urban consumers for the north central region, 1,458
published by the United States bureau of labor statistics; 1,459
33
(iii) For subsequent fiscal years, the limitation in 1,461
effect during the previous fiscal year, adjusted to reflect the 1,462
rate of inflation for the twelve-month period beginning on the 1,463
first day of July for the calendar year preceding the calendar 1,464
year that precedes the fiscal year and ending on the following 1,465
thirtieth day of June, using the consumer price index for shelter 1,466
costs for all urban consumers for the north central region, 1,467
published by the United States bureau of labor statistics. 1,468
(2) Any efficiency incentive determined under division (D) 1,470
of this section; 1,471
(3) Any amounts for return on equity determined under 1,473
division (H) of this section. 1,474
Buildings shall be depreciated using the straight line 1,476
method over forty years or over a different period approved by 1,477
the department. Components and equipment shall be depreciated 1,478
using the straight-line method over a period designated in rules 1,479
adopted by the director of job and family services in accordance 1,481
with Chapter 119. of the Revised Code, consistent with the 1,482
guidelines of the American hospital association, or over a 1,483
different period approved by the department. Any rules adopted 1,484
under this division that specify useful lives of buildings, 1,485
components, or equipment apply only to assets acquired on or 1,486
after July 1, 1993. Depreciation for costs paid or reimbursed by 1,487
any government agency shall not be included in cost of ownership 1,488
or renovation unless that part of the payment under sections 1,489
5111.20 to 5111.32 of the Revised Code is used to reimburse the 1,490
government agency.
(B) The capital cost basis of nursing facility assets 1,492
shall be determined in the following manner: 1,493
(1) For purposes of calculating the rate to be paid for 1,495
the fiscal year beginning July 1, 1993, for facilities with dates 1,497
of licensure on or before June 30, 1993, the capital cost basis 1,498
shall be equal to the following: 1,499
(a) For facilities that have not had a change of ownership 1,501
34
during the period beginning January 1, 1993, and ending June 30, 1,502
1993, the desk-reviewed, actual, allowable capital cost basis 1,503
that is listed on the facility's cost report for the cost 1,504
reporting period ending December 31, 1992, plus the actual, 1,505
allowable capital cost basis of any assets constructed or 1,506
acquired after December 31, 1992, but before July 1, 1993, if the 1,507
aggregate capital costs of those assets would increase the 1,508
facility's rate for capital costs by twenty or more cents per 1,509
resident per day. 1,510
(b) For facilities that have a date of licensure or had a 1,512
change of ownership during the period beginning January 1, 1993, 1,513
and ending June 30, 1993, the actual, allowable capital cost 1,514
basis of the person or government entity that owns the facility 1,515
on June 30, 1993. 1,516
Capital cost basis shall be calculated as provided in 1,518
division (B)(1) of this section subject to approval by the United 1,519
States health care financing administration of any necessary 1,520
amendment to the state plan for providing medical assistance. 1,521
The department shall include the actual, allowable capital 1,523
cost basis of assets constructed or acquired during the period 1,524
beginning January 1, 1993, and ending June 30, 1993, in the 1,525
calculation for the facility's rate effective July 1, 1993, if 1,526
the aggregate capital costs of the assets would increase the 1,527
facility's rate by twenty or more cents per resident per day and 1,528
the facility provides the department with sufficient 1,529
documentation of the costs before June 1, 1993. If the facility 1,530
provides the documentation after that date, the department shall 1,531
adjust the facility's rate to reflect the costs of the assets one 1,532
month after the first day of the month after the department 1,533
receives the documentation. 1,534
(2) Except as provided in division (B)(4) of this section, 1,537
for purposes of calculating the rates to be paid for fiscal years 1,538
beginning after June 30, 1994, for facilities with dates of 1,539
licensure on or before June 30, 1993, the capital cost basis of 1,540
35
each asset shall be equal to the desk-reviewed, actual, 1,541
allowable, capital cost basis that is listed on the facility's 1,542
cost report for the calendar year preceding the fiscal year 1,543
during which the rate will be paid.
(3) For facilities with dates of licensure after June 30, 1,546
1993, the capital cost basis shall be determined in accordance 1,547
with the principles of the medicare program established under 1,548
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42 1,549
U.S.C.A. 301, as amended, except as otherwise provided in 1,550
sections 5111.20 to 5111.32 of the Revised Code. 1,551
(4) Except as provided in division (B)(5) of this section, 1,554
if a provider transfers an interest in a facility to another 1,555
provider after June 30, 1993, there shall be no increase in the 1,556
capital cost basis of the asset if the providers are related 1,557
parties. If the providers are not related parties or if they are 1,558
related parties and division (B)(5) of this section requires the 1,559
adjustment of the capital cost basis under this division, the 1,560
basis of the asset shall be adjusted by the lesser of the 1,561
following:
(a) One-half of the change in construction costs during 1,563
the time that the transferor held the asset, as calculated by the 1,564
department of job and family services using the "Dodge building 1,566
cost indexes, northeastern and north central states," published
by Marshall and Swift; 1,567
(b) One-half of the change in the consumer price index for 1,569
all items for all urban consumers, as published by the United 1,570
States bureau of labor statistics, during the time that the 1,571
transferor held the asset. 1,572
(5) If a provider transfers an interest in a facility to 1,575
another provider who is a related party, the capital cost basis
of the asset shall be adjusted as specified in division (B)(4) of 1,578
this section for a transfer to a provider that is not a related 1,579
party if all of the following conditions are met:
(a) The related party is a relative of owner; 1,582
36
(b) The EXCEPT AS PROVIDED IN DIVISION (B)(5)(c)(ii) OF 1,585
THIS SECTION, THE provider making the transfer retains no 1,587
ownership interest in the facility;
(c) The United States internal revenue service has issued 1,590
a ruling DEPARTMENT OF JOB AND FAMILY SERVICES DETERMINES that 1,591
the transfer is an arm's length transaction for purposes of 1,592
federal income taxation; PURSUANT TO RULES THE DEPARTMENT SHALL 1,594
ADOPT IN ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE NO 1,595
LATER THAN DECEMBER 31, 2000. THE RULES SHALL PROVIDE THAT A 1,597
TRANSFER IS AN ARM'S LENGTH TRANSACTION IF ALL OF THE FOLLOWING 1,598
APPLY:
(i) ONCE THE TRANSFER GOES INTO EFFECT, THE PROVIDER THAT 1,600
MADE THE TRANSFER HAS NO DIRECT OR INDIRECT INTEREST IN THE 1,601
PROVIDER THAT ACQUIRES THE FACILITY OR THE FACILITY ITSELF, 1,602
INCLUDING INTEREST AS AN OWNER, OFFICER, DIRECTOR, EMPLOYEE,
INDEPENDENT CONTRACTOR, OR CONSULTANT, BUT EXCLUDING INTEREST AS 1,603
A CREDITOR.
(ii) THE PROVIDER THAT MADE THE TRANSFER DOES NOT 1,605
REACQUIRE AN INTEREST IN THE FACILITY EXCEPT THROUGH THE EXERCISE 1,606
OF A CREDITOR'S RIGHTS IN THE EVENT OF A DEFAULT. IF THE 1,607
PROVIDER REACQUIRES AN INTEREST IN THE FACILITY IN THIS MANNER, 1,608
THE DEPARTMENT SHALL TREAT THE FACILITY AS IF THE TRANSFER NEVER 1,609
OCCURRED WHEN THE DEPARTMENT CALCULATES ITS REIMBURSEMENT RATES 1,610
FOR CAPITAL COSTS.
(iii) THE TRANSFER SATISFIES ANY OTHER CRITERIA SPECIFIED 1,612
IN THE RULES. 1,613
(d) Except in the case of hardship caused by a 1,616
catastrophic event, as determined by the department, or in the 1,617
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 1,619
the same facility, the capital cost basis was adjusted most 1,620
recently under division (B)(5) of this section or actual, 1,622
allowable cost of ownership was determined most recently under
division (C)(9) of this section. 1,624
37
(C) As used in this division, "lease expense" means lease 1,626
payments in the case of an operating lease and depreciation 1,627
expense and interest expense in the case of a capital lease. As 1,628
used in this division, "new lease" means a lease, to a different 1,629
lessee, of a nursing facility that previously was operated under 1,630
a lease. 1,631
(1) Subject to the limitation specified in division (A)(1) 1,633
of this section, for a lease of a facility that was effective on 1,634
May 27, 1992, the entire lease expense is an actual, allowable 1,635
cost of ownership during the term of the existing lease. The 1,636
entire lease expense also is an actual, allowable cost of 1,637
ownership if a lease in existence on May 27, 1992, is renewed 1,638
under either of the following circumstances: 1,639
(a) The renewal is pursuant to a renewal option that was 1,641
in existence on May 27, 1992; 1,642
(b) The renewal is for the same lease payment amount and 1,644
between the same parties as the lease in existence on May 27, 1,645
1992. 1,646
(2) Subject to the limitation specified in division (A)(1) 1,648
of this section, for a lease of a facility that was in existence 1,649
but not operated under a lease on May 27, 1992, actual, allowable 1,650
cost of ownership shall include the lesser of the annual lease 1,651
expense or the annual depreciation expense and imputed interest 1,652
expense that would be calculated at the inception of the lease 1,653
using the lessor's entire historical capital asset cost basis, 1,654
adjusted by the lesser of the following amounts: 1,655
(a) One-half of the change in construction costs during 1,657
the time the lessor held each asset until the beginning of the 1,658
lease, as calculated by the department using the "Dodge building 1,659
cost indexes, northeastern and north central states," published 1,660
by Marshall and Swift; 1,661
(b) One-half of the change in the consumer price index for 1,663
all items for all urban consumers, as published by the United 1,664
States bureau of labor statistics, during the time the lessor 1,665
38
held each asset until the beginning of the lease. 1,666
(3) Subject to the limitation specified in division (A)(1) 1,668
of this section, for a lease of a facility with a date of 1,669
licensure on or after May 27, 1992, that is initially operated 1,670
under a lease, actual, allowable cost of ownership shall include 1,671
the annual lease expense if there was a substantial commitment of 1,672
money for construction of the facility after December 22, 1992, 1,673
and before July 1, 1993. If there was not a substantial 1,674
commitment of money after December 22, 1992, and before July 1, 1,675
1993, actual, allowable cost of ownership shall include the 1,676
lesser of the annual lease expense or the sum of the following: 1,677
(a) The annual depreciation expense that would be 1,679
calculated at the inception of the lease using the lessor's 1,680
entire historical capital asset cost basis; 1,681
(b) The greater of the lessor's actual annual amortization 1,683
of financing costs and interest expense at the inception of the 1,684
lease or the imputed interest expense calculated at the inception 1,685
of the lease using seventy per cent of the lessor's historical 1,686
capital asset cost basis. 1,687
(4) Subject to the limitation specified in division (A)(1) 1,689
of this section, for a lease of a facility with a date of 1,690
licensure on or after May 27, 1992, that was not initially 1,691
operated under a lease and has been in existence for ten years, 1,692
actual, allowable cost of ownership shall include the lesser of 1,693
the annual lease expense or the annual depreciation expense and 1,694
imputed interest expense that would be calculated at the 1,695
inception of the lease using the entire historical capital asset 1,696
cost basis of the lessor, adjusted by the lesser of the 1,697
following: 1,698
(a) One-half of the change in construction costs during 1,700
the time the lessor held each asset until the beginning of the 1,701
lease, as calculated by the department using the "Dodge building 1,702
cost indexes, northeastern and north central states," published 1,703
by Marshall and Swift; 1,704
39
(b) One-half of the change in the consumer price index for 1,706
all items for all urban consumers, as published by the United 1,707
States bureau of labor statistics, during the time the lessor 1,708
held each asset until the beginning of the lease. 1,709
(5) Subject to the limitation specified in division (A)(1) 1,711
of this section, for a new lease of a facility that was operated 1,712
under a lease on May 27, 1992, actual, allowable cost of 1,713
ownership shall include the lesser of the annual new lease 1,714
expense or the annual old lease payment. If the old lease was in 1,715
effect for ten years or longer, the old lease payment from the 1,716
beginning of the old lease shall be adjusted by the lesser of the 1,717
following: 1,718
(a) One-half of the change in construction costs from the 1,720
beginning of the old lease to the beginning of the new lease, as 1,721
calculated by the department using the "Dodge building cost 1,722
indexes, northeastern and north central states," published by 1,723
Marshall and Swift; 1,724
(b) One-half of the change in the consumer price index for 1,726
all items for all urban consumers, as published by the United 1,727
States bureau of labor statistics, from the beginning of the old 1,728
lease to the beginning of the new lease. 1,729
(6) Subject to the limitation specified in division (A)(1) 1,731
of this section, for a new lease of a facility that was not in 1,732
existence or that was in existence but not operated under a lease 1,733
on May 27, 1992, actual, allowable cost of ownership shall 1,734
include the lesser of annual new lease expense or the annual 1,735
amount calculated for the old lease under division (C)(2), (3), 1,736
(4), or (6) of this section, as applicable. If the old lease was 1,737
in effect for ten years or longer, the lessor's historical 1,738
capital asset cost basis shall be adjusted by the lesser of the 1,739
following for purposes of calculating the annual amount under 1,740
division (C)(2), (3), (4), or (6) of this section: 1,741
(a) One-half of the change in construction costs from the 1,743
beginning of the old lease to the beginning of the new lease, as 1,744
40
calculated by the department using the "Dodge building cost 1,745
indexes, northeastern and north central states," published by 1,746
Marshall and Swift; 1,747
(b) One-half of the change in the consumer price index for 1,749
all items for all urban consumers, as published by the United 1,750
States bureau of labor statistics, from the beginning of the old 1,751
lease to the beginning of the new lease. 1,752
In the case of a lease under division (C)(3) of this 1,754
section of a facility for which a substantial commitment of money 1,755
was made after December 22, 1992, and before July 1, 1993, the 1,756
old lease payment shall be adjusted for the purpose of 1,757
determining the annual amount. 1,758
(7) For any revision of a lease described in division 1,760
(C)(1), (2), (3), (4), (5), or (6) of this section, or for any 1,761
subsequent lease of a facility operated under such a lease, other 1,762
than execution of a new lease, the portion of actual, allowable 1,763
cost of ownership attributable to the lease shall be the same as 1,764
before the revision or subsequent lease. 1,765
(8) Except as provided in division (C)(9) of this section, 1,768
if a provider leases an interest in a facility to another 1,769
provider who is a related party, the related party's actual, 1,771
allowable cost of ownership shall include the lesser of the 1,772
annual lease expense or the reasonable cost to the lessor. 1,773
(9) If a provider leases an interest in a facility to 1,775
another provider who is a related party, regardless of the date 1,777
of the lease, the related party's actual, allowable cost of 1,778
ownership shall include the annual lease expense, subject to the 1,779
limitations specified in divisions (C)(1) to (7) of this section, 1,780
if all of the following conditions are met: 1,781
(a) The related party is a relative of owner; 1,783
(b) If the lessor retains an ownership interest, it is, 1,786
EXCEPT AS PROVIDED IN DIVISION (C)(9)(c)(ii) OF THIS SECTION, in 1,787
only the real property and any improvements on the real property; 1,789
(c) The United States internal revenue service has issued 1,792
41
a ruling DEPARTMENT OF JOB AND FAMILY SERVICES DETERMINES that 1,793
the lease is an arm's length transaction for purposes of federal 1,794
income taxation; PURSUANT TO RULES THE DEPARTMENT SHALL ADOPT IN 1,796
ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE NO LATER THAN 1,797
DECEMBER 31, 2000. THE RULES SHALL PROVIDE THAT A LEASE IS AN 1,799
ARM'S LENGTH TRANSACTION IF ALL OF THE FOLLOWING APPLY: 1,800
(i) ONCE THE LEASE GOES INTO EFFECT, THE LESSOR HAS NO 1,802
DIRECT OR INDIRECT INTEREST IN THE LESSEE OR, EXCEPT AS PROVIDED 1,803
IN DIVISION (C)(9)(b) OF THIS SECTION, THE FACILITY ITSELF, 1,804
INCLUDING INTEREST AS AN OWNER, OFFICER, DIRECTOR, EMPLOYEE, 1,806
INDEPENDENT CONTRACTOR, OR CONSULTANT, BUT EXCLUDING INTEREST AS 1,808
A LESSOR.
(ii) THE LESSOR DOES NOT REACQUIRE AN INTEREST IN THE 1,810
FACILITY EXCEPT THROUGH THE EXERCISE OF A LESSOR'S RIGHTS IN THE 1,811
EVENT OF A DEFAULT. IF THE LESSOR REACQUIRES AN INTEREST IN THE 1,812
FACILITY IN THIS MANNER, THE DEPARTMENT SHALL TREAT THE FACILITY 1,813
AS IF THE LEASE NEVER OCCURRED WHEN THE DEPARTMENT CALCULATES ITS 1,814
REIMBURSEMENT RATES FOR CAPITAL COSTS.
(iii) THE LEASE SATISFIES ANY OTHER CRITERIA SPECIFIED IN 1,816
THE RULES. 1,817
(d) Except in the case of hardship caused by a 1,820
catastrophic event, as determined by the department, or in the 1,821
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, 1,823
the capital cost basis was adjusted most recently under division 1,824
(B)(5) of this section or actual, allowable cost of ownership was 1,826
determined most recently under division (C)(9) of this section. 1,828
(10) This division does not apply to leases of specific 1,830
items of equipment. 1,831
(D)(1) Subject to division (D)(2) of this section, the 1,833
department shall pay each nursing facility an efficiency 1,834
incentive that is equal to fifty per cent of the difference 1,835
between the following:
(a) Eighty-eight and sixty-five one-hundredths per cent of 1,837
42
the facility's desk-reviewed, actual, allowable, per diem cost of 1,838
ownership;
(b) The applicable amount specified in division (E) of 1,840
this section. 1,841
(2) The efficiency incentive paid to a nursing facility 1,844
shall not exceed the greater of the following:
(a) The efficiency incentive the facility was paid during 1,847
the fiscal year ending June 30, 1994;
(b) Three dollars per resident per day, adjusted annually 1,850
for rates paid beginning July 1, 1994, for the inflation rate for 1,851
the twelve-month period beginning on the first day of July of the 1,852
calendar year preceding the calendar year that precedes the 1,853
fiscal year for which the efficiency incentive is determined and 1,854
ending on the thirtieth day of the following June, using the 1,855
consumer price index for shelter costs for all urban consumers 1,856
for the north central region, as published by the United States 1,857
bureau of labor statistics. 1,858
(3) For purposes of calculating the efficiency incentive, 1,861
depreciation for costs that are paid or reimbursed by any 1,862
government agency shall be considered as costs of ownership, and 1,863
renovation costs that are paid under division (F) of this section 1,864
shall not be considered costs of ownership. 1,865
(E) The following amounts shall be used to calculate 1,867
efficiency incentives for nursing facilities under this section: 1,868
(1) For facilities with dates of licensure prior to 1,870
January 1, 1958, four dollars and twenty-four cents per patient 1,871
day; 1,872
(2) For facilities with dates of licensure after December 1,874
31, 1957, but prior to January 1, 1968: 1,875
(a) Five dollars and twenty-four cents per patient day if 1,877
the cost of construction was three thousand five hundred dollars 1,878
or more per bed; 1,879
(b) Four dollars and twenty-four cents per patient day if 1,881
the cost of construction was less than three thousand five 1,882
43
hundred dollars per bed. 1,883
(3) For facilities with dates of licensure after December 1,885
31, 1967, but prior to January 1, 1976: 1,886
(a) Six dollars and twenty-four cents per patient day if 1,888
the cost of construction was five thousand one hundred fifty 1,889
dollars or more per bed; 1,890
(b) Five dollars and twenty-four cents per patient day if 1,892
the cost of construction was less than five thousand one hundred 1,893
fifty dollars per bed, but exceeded three thousand five hundred 1,894
dollars per bed; 1,895
(c) Four dollars and twenty-four cents per patient day if 1,897
the cost of construction was three thousand five hundred dollars 1,898
or less per bed. 1,899
(4) For facilities with dates of licensure after December 1,901
31, 1975, but prior to January 1, 1979: 1,902
(a) Seven dollars and twenty-four cents per patient day if 1,904
the cost of construction was six thousand eight hundred dollars 1,905
or more per bed; 1,906
(b) Six dollars and twenty-four cents per patient day if 1,908
the cost of construction was less than six thousand eight hundred 1,909
dollars per bed but exceeded five thousand one hundred fifty 1,910
dollars per bed; 1,911
(c) Five dollars and twenty-four cents per patient day if 1,913
the cost of construction was five thousand one hundred fifty 1,914
dollars or less per bed, but exceeded three thousand five hundred 1,915
dollars per bed; 1,916
(d) Four dollars and twenty-four cents per patient day if 1,918
the cost of construction was three thousand five hundred dollars 1,919
or less per bed. 1,920
(5) For facilities with dates of licensure after December 1,922
31, 1978, but prior to January 1, 1981: 1,923
(a) Seven dollars and seventy-four cents per patient day 1,925
if the cost of construction was seven thousand six hundred 1,926
twenty-five dollars or more per bed; 1,927
44
(b) Seven dollars and twenty-four cents per patient day if 1,929
the cost of construction was less than seven thousand six hundred 1,930
twenty-five dollars per bed but exceeded six thousand eight 1,931
hundred dollars per bed; 1,932
(c) Six dollars and twenty-four cents per patient day if 1,934
the cost of construction was six thousand eight hundred dollars 1,935
or less per bed but exceeded five thousand one hundred fifty 1,936
dollars per bed; 1,937
(d) Five dollars and twenty-four cents per patient day if 1,939
the cost of construction was five thousand one hundred fifty 1,940
dollars or less but exceeded three thousand five hundred dollars 1,941
per bed; 1,942
(e) Four dollars and twenty-four cents per patient day if 1,944
the cost of construction was three thousand five hundred dollars 1,945
or less per bed. 1,946
(6) For facilities with dates of licensure in 1981 or any 1,948
year thereafter prior to December 22, 1992, the following amount: 1,949
(a) For facilities with construction costs less than seven 1,951
thousand six hundred twenty-five dollars per bed, the applicable 1,952
amounts for the construction costs specified in divisions 1,953
(E)(5)(b) to (e) of this section; 1,954
(b) For facilities with construction costs of seven 1,956
thousand six hundred twenty-five dollars or more per bed, six 1,957
dollars per patient day, provided that for 1981 and annually 1,958
thereafter prior to December 22, 1992, department shall do both 1,959
of the following to the six-dollar amount: 1,960
(i) Adjust the amount for fluctuations in construction 1,962
costs calculated by the department using the "Dodge building cost 1,963
indexes, northeastern and north central states," published by 1,964
Marshall and Swift, using 1980 as the base year; 1,965
(ii) Increase the amount, as adjusted for inflation under 1,967
division (E)(6)(b)(i) of this section, by one dollar and 1,968
seventy-four cents. 1,969
(7) For facilities with dates of licensure on or after 1,971
45
January 1, 1992, seven dollars and ninety-seven cents, adjusted 1,972
for fluctuations in construction costs between 1991 and 1993 as 1,973
calculated by the department using the "Dodge building cost 1,974
indexes, northeastern and north central states," published by 1,975
Marshall and Swift, and then increased by one dollar and 1,976
seventy-four cents. 1,977
For the fiscal year that begins July 1, 1994, each of the 1,979
amounts listed in divisions (E)(1) to (7) of this section shall 1,980
be increased by twenty-five cents. For the fiscal year that 1,981
begins July 1, 1995, each of those amounts shall be increased by 1,982
an additional twenty-five cents. For subsequent fiscal years, 1,983
each of those amounts, as increased for the prior fiscal year, 1,984
shall be adjusted to reflect the rate of inflation for the 1,985
twelve-month period beginning on the first day of July of the 1,986
calendar year preceding the calendar year that precedes the 1,987
fiscal year and ending on the following thirtieth day of June, 1,988
using the consumer price index for shelter costs for all urban 1,989
consumers for the north central region, as published by the 1,990
United States bureau of labor statistics. 1,991
If the amount established for a nursing facility under this 1,993
division is less than the amount that applied to the facility 1,994
under division (B) of former section 5111.25 of the Revised Code, 1,995
as the former section existed immediately prior to December 22, 1,996
1992, the amount used to calculate the efficiency incentive for 1,997
the facility under division (D)(2) of this section shall be the 1,998
amount that was calculated under division (B) of the former 1,999
section. 2,000
(F) Beginning July 1, 1993, regardless of the facility's 2,002
date of licensure or the date of the nonextensive renovations, 2,003
the rate for the costs of nonextensive renovations for nursing 2,004
facilities shall be eighty-five per cent of the desk-reviewed, 2,005
actual, allowable, per diem, nonextensive renovation costs. This 2,006
division applies to nonextensive renovations regardless of 2,007
whether they are made by an owner or a lessee. If the tenancy of 2,008
46
a lessee that has made nonextensive renovations ends before the 2,009
depreciation expense for the renovation costs has been fully 2,010
reported, the former lessee shall not report the undepreciated 2,011
balance as an expense. 2,012
(1) For a nonextensive renovation made after July 1, 1993, 2,014
to qualify for payment under this division, both of the following 2,015
conditions must be met: 2,016
(a) At least five years have elapsed since the date of 2,018
licensure of the portion of the facility that is proposed to be 2,019
renovated, except that this condition does not apply if the 2,020
renovation is necessary to meet the requirements of federal, 2,021
state, or local statutes, ordinances, rules, or policies. 2,022
(b) The provider has obtained prior approval from the 2,024
department of job and family services, and if required the 2,026
director of health has granted a certificate of need for the
renovation under section 3702.52 of the Revised Code. The 2,027
provider shall submit a plan that describes in detail the changes 2,028
in capital assets to be accomplished by means of the renovation 2,029
and the timetable for completing the project. The time for 2,030
completion of the project shall be no more than eighteen months 2,031
after the renovation begins. The DEPARTMENT of job and family 2,032
services shall adopt rules in accordance with Chapter 119. of the 2,033
Revised Code that specify criteria and procedures for prior 2,034
approval of renovation projects. No provider shall separate a 2,035
project with the intent to evade the characterization of the 2,036
project as a renovation or as an extensive renovation. No 2,037
provider shall increase the scope of a project after it is 2,038
approved by the department of job and family services unless the 2,039
increase in scope is approved by the department. 2,040
(2) The payment provided for in this division is the only 2,042
payment that shall be made for the costs of a nonextensive 2,043
renovation. Nonextensive renovation costs shall not be included 2,044
in costs of ownership, and a nonextensive renovation shall not 2,045
affect the date of licensure for purposes of calculating the 2,046
47
efficiency incentive under divisions (D) and (E) of this section. 2,047
(G) The owner of a nursing facility operating under a 2,049
provider agreement shall provide written notice to the department 2,050
of job and family services at least forty-five days prior to 2,052
entering into any contract of sale for the facility or
voluntarily terminating participation in the medical assistance 2,053
program. After the date on which a transaction of sale is 2,054
closed, the owner shall refund to the department the amount of 2,055
excess depreciation paid to the facility by the department for 2,056
each year the owner has operated the facility under a provider
agreement and prorated according to the number of medicaid 2,057
patient days for which the facility has received payment. If a 2,058
nursing facility is sold after five or fewer years of operation 2,059
under a provider agreement, the refund to the department shall be 2,061
equal to the excess depreciation paid to the facility. If a 2,062
nursing facility is sold after more than five years but less than
ten years of operation under a provider agreement, the refund to 2,063
the department shall equal the excess depreciation paid to the 2,064
facility multiplied by twenty per cent, multiplied by the 2,065
difference between ten and the number of years that the facility 2,066
was operated under a provider agreement. If a nursing facility 2,067
is sold after ten or more years of operation under a provider 2,068
agreement, the owner shall not refund any excess depreciation to 2,069
the department. The owner of a facility that is sold or that 2,070
voluntarily terminates participation in the medical assistance 2,071
program also shall refund any other amount that the department 2,072
properly finds to be due after the audit conducted under this 2,073
division. For the purposes of this division, "depreciation paid 2,074
to the facility" means the amount paid to the nursing facility 2,075
for cost of ownership pursuant to this section less any amount 2,076
paid for interest costs, amortization of financing costs, and 2,078
lease expenses. For the purposes of this division, "excess 2,079
depreciation" is the nursing facility's depreciated basis, which 2,080
is the owner's cost less accumulated depreciation, subtracted 2,081
48
from the purchase price net of selling costs but not exceeding 2,082
the amount of depreciation paid to the facility. 2,083
A cost report shall be filed with the department within 2,085
ninety days after the date on which the transaction of sale is 2,086
closed or participation is voluntarily terminated. The report 2,087
shall show the accumulated depreciation, the sales price, and 2,088
other information required by the department. The amount of the 2,089
last two monthly payments to a nursing facility made pursuant to 2,090
division (A)(1) of section 5111.22 of the Revised Code before a 2,091
sale or termination of participation shall be held in escrow by a 2,092
bank, trust company, or savings and loan association, except that 2,093
if the amount the owner will be required to refund under this 2,094
section is likely to be less than the amount of the last two 2,095
monthly payments, the department shall take one of the following 2,096
actions instead of withholding the amount of the last two monthly 2,097
payments: 2,098
(1) In the case of an owner that owns other facilities 2,100
that participate in the medical assistance program, obtain a 2,101
promissory note in an amount sufficient to cover the amount 2,102
likely to be refunded; 2,103
(2) In the case of all other owners, withhold the amount 2,105
of the last monthly payment to the nursing facility. 2,106
The department shall, within ninety days following the 2,108
filing of the cost report, audit the cost report and issue an 2,109
audit report to the owner. The department also may audit any 2,110
other cost report that the facility has filed during the previous 2,111
three years. In the audit report, the department shall state its 2,112
findings and the amount of any money owed to the department by 2,113
the nursing facility. The findings shall be subject to 2,114
adjudication conducted in accordance with Chapter 119. of the 2,115
Revised Code. No later than fifteen days after the owner agrees 2,116
to a settlement, any funds held in escrow less any amounts due to 2,117
the department shall be released to the owner and amounts due to 2,118
the department shall be paid to the department. If the amounts 2,119
49
in escrow are less than the amounts due to the department, the 2,120
balance shall be paid to the department within fifteen days after 2,121
the owner agrees to a settlement. If the department does not 2,122
issue its audit report within the ninety-day period, the 2,123
department shall release any money held in escrow to the owner. 2,124
For the purposes of this section, a transfer of corporate stock, 2,125
the merger of one corporation into another, or a consolidation 2,126
does not constitute a sale. 2,127
If a nursing facility is not sold or its participation is 2,129
not terminated after notice is provided to the department under 2,130
this division, the department shall order any payments held in 2,131
escrow released to the facility upon receiving written notice 2,132
from the owner that there will be no sale or termination. After 2,133
written notice is received from a nursing facility that a sale or 2,134
termination will not take place, the facility shall provide 2,135
notice to the department at least forty-five days prior to 2,136
entering into any contract of sale or terminating participation 2,137
at any future time. 2,138
(H) The department shall pay each eligible proprietary 2,140
nursing facility a return on the facility's net equity computed 2,141
at the rate of one and one-half times the average interest rate 2,142
on special issues of public debt obligations issued to the 2,143
federal hospital insurance trust fund for the cost reporting 2,144
period, except that no facility's return on net equity shall 2,145
exceed one dollar per patient day. 2,146
When calculating the rate for return on net equity, the 2,148
department shall use the greater of the facility's inpatient days 2,149
during the applicable cost reporting period or the number of 2,150
inpatient days the facility would have had during that period if 2,151
its occupancy rate had been ninety-five per cent. 2,152
(I) If a nursing facility would receive a lower rate for 2,154
capital costs for assets in the facility's possession on July 1, 2,155
1993, under this section than it would receive under former 2,156
section 5111.25 of the Revised Code, as the former section 2,157
50
existed immediately prior to December 22, 1992, the facility 2,158
shall receive for those assets the rate it would have received 2,159
under the former section for each fiscal year beginning on or 2,160
after July 1, 1993, until the rate it would receive under this 2,161
section exceeds the rate it would have received under the former 2,162
section. Any facility that receives a rate calculated under the 2,163
former section 5111.25 of the Revised Code for assets in the 2,164
facility's possession on July 1, 1993, also shall receive a rate 2,165
calculated under this section for costs of any assets it 2,166
constructs or acquires after July 1, 1993. 2,167
Sec. 5111.251. (A) The department of job and family 2,176
services shall pay each eligible intermediate care facility for 2,177
the mentally retarded for its reasonable capital costs, a per 2,178
resident per day rate established prospectively each fiscal year 2,179
for each intermediate care facility for the mentally retarded. 2,180
Except as otherwise provided in sections 5111.20 to 5111.32 of 2,181
the Revised Code, the rate shall be based on the facility's 2,182
capital costs for the calendar year preceding the fiscal year in 2,183
which the rate will be paid. The rate shall equal the sum of the 2,184
following:
(1) The facility's desk-reviewed, actual, allowable, per 2,186
diem cost of ownership for the preceding cost reporting period, 2,187
limited as provided in divisions (C) and (F) of this section; 2,188
(2) Any efficiency incentive determined under division (B) 2,190
of this section; 2,191
(3) Any amounts for renovations determined under division 2,193
(D) of this section; 2,194
(4) Any amounts for return on equity determined under 2,196
division (I) of this section. 2,197
Buildings shall be depreciated using the straight line 2,199
method over forty years or over a different period approved by 2,200
the department. Components and equipment shall be depreciated 2,201
using the straight line method over a period designated by the 2,202
director of job and family services in rules adopted in 2,204
51
accordance with Chapter 119. of the Revised Code, consistent with 2,205
the guidelines of the American hospital association, or over a 2,206
different period approved by the department of job and family 2,207
services. Any rules adopted under this division that specify 2,208
useful lives of buildings, components, or equipment apply only to 2,209
assets acquired on or after July 1, 1993. Depreciation for costs 2,210
paid or reimbursed by any government agency shall not be included 2,211
in costs of ownership or renovation unless that part of the 2,212
payment under sections 5111.20 to 5111.32 of the Revised Code is 2,213
used to reimburse the government agency. 2,214
(B) The department of job and family services shall pay to 2,217
each intermediate care facility for the mentally retarded an
efficiency incentive equal to fifty per cent of the difference 2,219
between any desk-reviewed, actual, allowable cost of ownership 2,220
and the applicable limit on cost of ownership payments under 2,221
division (C) of this section. For purposes of computing the 2,222
efficiency incentive, depreciation for costs paid or reimbursed 2,223
by any government agency shall be considered as a cost of
ownership, and the applicable limit under division (C) of this 2,224
section shall apply both to facilities with more than eight beds 2,225
and facilities with eight or fewer beds. The efficiency 2,226
incentive paid to a facility with eight or fewer beds shall not 2,227
exceed three dollars per patient day, adjusted annually for the 2,228
inflation rate for the twelve-month period beginning on the first 2,229
day of July of the calendar year preceding the calendar year that 2,230
precedes the fiscal year for which the efficiency incentive is 2,231
determined and ending on the thirtieth day of the following June, 2,232
using the consumer price index for shelter costs for all urban 2,233
consumers for the north central region, as published by the 2,234
United States bureau of labor statistics. 2,235
(C) Cost of ownership payments to intermediate care 2,237
facilities for the mentally retarded with more than eight beds 2,238
shall not exceed the following limits: 2,239
(1) For facilities with dates of licensure prior to 2,241
52
January 1, l958, not exceeding two dollars and fifty cents per 2,242
patient day; 2,243
(2) For facilities with dates of licensure after December 2,245
31, l957, but prior to January 1, l968, not exceeding: 2,246
(a) Three dollars and fifty cents per patient day if the 2,248
cost of construction was three thousand five hundred dollars or 2,249
more per bed; 2,250
(b) Two dollars and fifty cents per patient day if the 2,252
cost of construction was less than three thousand five hundred 2,253
dollars per bed. 2,254
(3) For facilities with dates of licensure after December 2,256
31, l967, but prior to January 1, l976, not exceeding: 2,257
(a) Four dollars and fifty cents per patient day if the 2,259
cost of construction was five thousand one hundred fifty dollars 2,260
or more per bed; 2,261
(b) Three dollars and fifty cents per patient day if the 2,263
cost of construction was less than five thousand one hundred 2,264
fifty dollars per bed, but exceeds three thousand five hundred 2,265
dollars per bed; 2,266
(c) Two dollars and fifty cents per patient day if the 2,268
cost of construction was three thousand five hundred dollars or 2,269
less per bed. 2,270
(4) For facilities with dates of licensure after December 2,272
31, l975, but prior to January 1, l979, not exceeding: 2,273
(a) Five dollars and fifty cents per patient day if the 2,275
cost of construction was six thousand eight hundred dollars or 2,276
more per bed; 2,277
(b) Four dollars and fifty cents per patient day if the 2,279
cost of construction was less than six thousand eight hundred 2,280
dollars per bed but exceeds five thousand one hundred fifty 2,281
dollars per bed; 2,282
(c) Three dollars and fifty cents per patient day if the 2,284
cost of construction was five thousand one hundred fifty dollars 2,285
or less per bed, but exceeds three thousand five hundred dollars 2,286
53
per bed; 2,287
(d) Two dollars and fifty cents per patient day if the 2,289
cost of construction was three thousand five hundred dollars or 2,290
less per bed. 2,291
(5) For facilities with dates of licensure after December 2,293
31, l978, but prior to January 1, l980, not exceeding: 2,294
(a) Six dollars per patient day if the cost of 2,296
construction was seven thousand six hundred twenty-five dollars 2,297
or more per bed; 2,298
(b) Five dollars and fifty cents per patient day if the 2,300
cost of construction was less than seven thousand six hundred 2,301
twenty-five dollars per bed but exceeds six thousand eight 2,302
hundred dollars per bed; 2,303
(c) Four dollars and fifty cents per patient day if the 2,305
cost of construction was six thousand eight hundred dollars or 2,306
less per bed but exceeds five thousand one hundred fifty dollars 2,307
per bed; 2,308
(d) Three dollars and fifty cents per patient day if the 2,310
cost of construction was five thousand one hundred fifty dollars 2,311
or less but exceeds three thousand five hundred dollars per bed; 2,312
(e) Two dollars and fifty cents per patient day if the 2,314
cost of construction was three thousand five hundred dollars or 2,315
less per bed. 2,316
(6) For facilities with dates of licensure after December 2,319
31, 1979, but prior to January 1, 1981, not exceeding: 2,320
(a) Twelve dollars per patient day if the beds were 2,322
originally licensed as residential facility beds by the 2,323
department of mental retardation and developmental disabilities; 2,324
(b) Six dollars per patient day if the beds were 2,326
originally licensed as nursing home beds by the department of 2,327
health.
(7) For facilities with dates of licensure after December 2,329
31, 1980, but prior to January 1, 1982, not exceeding: 2,330
(a) Twelve dollars per patient day if the beds were 2,332
54
originally licensed as residential facility beds by the 2,333
department of mental retardation and developmental disabilities; 2,334
(b) Six dollars and forty-five cents per patient day if 2,336
the beds were originally licensed as nursing home beds by the 2,337
department of health.
(8) For facilities with dates of licensure after December 2,339
31, 1981, but prior to January 1, 1983, not exceeding: 2,340
(a) Twelve dollars per patient day if the beds were 2,342
originally licensed as residential facility beds by the 2,343
department of mental retardation and developmental disabilities; 2,344
(b) Six dollars and seventy-nine cents per patient day if 2,346
the beds were originally licensed as nursing home beds by the 2,347
department of health.
(9) For facilities with dates of licensure after December 2,349
31, 1982, but prior to January 1, 1984, not exceeding: 2,350
(a) Twelve dollars per patient day if the beds were 2,352
originally licensed as residential facility beds by the 2,353
department of mental retardation and developmental disabilities; 2,354
(b) Seven dollars and nine cents per patient day if the 2,356
beds were originally licensed as nursing home beds by the 2,357
department of health.
(10) For facilities with dates of licensure after December 2,359
31, 1983, but prior to January 1, 1985, not exceeding: 2,360
(a) Twelve dollars and twenty-four cents per patient day 2,362
if the beds were originally licensed as residential facility beds 2,364
by the department of mental retardation and developmental 2,365
disabilities;
(b) Seven dollars and twenty-three cents per patient day 2,367
if the beds were originally licensed as nursing home beds by the 2,369
department of health.
(11) For facilities with dates of licensure after December 2,371
31, 1984, but prior to January 1, 1986, not exceeding: 2,372
(a) Twelve dollars and fifty-three cents per patient day 2,374
if the beds were originally licensed as residential facility beds 2,376
55
by the department of mental retardation and developmental 2,377
disabilities;
(b) Seven dollars and forty cents per patient day if the 2,379
beds were originally licensed as nursing home beds by the 2,381
department of health.
(12) For facilities with dates of licensure after December 2,383
31, 1985, but prior to January 1, 1987, not exceeding: 2,384
(a) Twelve dollars and seventy cents per patient day if 2,386
the beds were originally licensed as residential facility beds by 2,388
the department of mental retardation and developmental 2,389
disabilities;
(b) Seven dollars and fifty cents per patient day if the 2,391
beds were originally licensed as nursing home beds by the 2,393
department of health.
(13) For facilities with dates of licensure after December 2,395
31, 1986, but prior to January 1, 1988, not exceeding: 2,396
(a) Twelve dollars and ninety-nine cents per patient day 2,398
if the beds were originally licensed as residential facility beds 2,400
by the department of mental retardation and developmental 2,401
disabilities;
(b) Seven dollars and sixty-seven cents per patient day if 2,403
the beds were originally licensed as nursing home beds by the 2,405
department of health.
(14) For facilities with dates of licensure after December 2,407
31, 1987, but prior to January 1, 1989, not exceeding thirteen 2,408
dollars and twenty-six cents per patient day; 2,409
(15) For facilities with dates of licensure after December 2,411
31, 1988, but prior to January 1, 1990, not exceeding thirteen 2,412
dollars and forty-six cents per patient day; 2,413
(16) For facilities with dates of licensure after December 2,415
31, 1989, but prior to January 1, 1991, not exceeding thirteen 2,416
dollars and sixty cents per patient day; 2,417
(17) For facilities with dates of licensure after December 2,419
31, 1990, but prior to January 1, 1992, not exceeding thirteen 2,420
56
dollars and forty-nine cents per patient day; 2,421
(18) For facilities with dates of licensure after December 2,423
31, 1991, but prior to January 1, 1993, not exceeding thirteen 2,424
dollars and sixty-seven cents per patient day; 2,425
(19) For facilities with dates of licensure after December 2,427
31, 1992, not exceeding fourteen dollars and twenty-eight cents 2,428
per patient day.
(D) Beginning January 1, 1981, regardless of the original 2,430
date of licensure, the department of job and family services 2,432
shall pay a rate for the per diem capitalized costs of 2,433
renovations to intermediate care facilities for the mentally 2,434
retarded made after January 1, l981, not exceeding six dollars 2,435
per patient day using 1980 as the base year and adjusting the 2,436
amount annually until June 30, 1993, for fluctuations in 2,437
construction costs calculated by the department using the "Dodge 2,438
building cost indexes, northeastern and north central states," 2,439
published by Marshall and Swift. The payment provided for in 2,440
this division is the only payment that shall be made for the 2,441
capitalized costs of a nonextensive renovation of an intermediate 2,442
care facility for the mentally retarded. Nonextensive renovation 2,443
costs shall not be included in cost of ownership, and a 2,444
nonextensive renovation shall not affect the date of licensure 2,445
for purposes of division (C) of this section. This division 2,446
applies to nonextensive renovations regardless of whether they 2,447
are made by an owner or a lessee. If the tenancy of a lessee 2,448
that has made renovations ends before the depreciation expense 2,449
for the renovation costs has been fully reported, the former 2,450
lessee shall not report the undepreciated balance as an expense. 2,451
For a nonextensive renovation to qualify for payment under 2,453
this division, both of the following conditions must be met: 2,454
(1) At least five years have elapsed since the date of 2,456
licensure or date of an extensive renovation of the portion of 2,457
the facility that is proposed to be renovated, except that this 2,458
condition does not apply if the renovation is necessary to meet 2,459
57
the requirements of federal, state, or local statutes, 2,460
ordinances, rules, or policies. 2,461
(2) The provider has obtained prior approval from the 2,463
department of job and family services. The provider shall submit 2,465
a plan that describes in detail the changes in capital assets to 2,466
be accomplished by means of the renovation and the timetable for 2,467
completing the project. The time for completion of the project 2,468
shall be no more than eighteen months after the renovation 2,469
begins. The director of job and family services shall adopt 2,471
rules in accordance with Chapter 119. of the Revised Code that 2,473
specify criteria and procedures for prior approval of renovation 2,474
projects. No provider shall separate a project with the intent 2,475
to evade the characterization of the project as a renovation or 2,476
as an extensive renovation. No provider shall increase the scope 2,477
of a project after it is approved by the department of job and 2,478
family services unless the increase in scope is approved by the 2,479
department.
(E) The amounts specified in divisions (C) and (D) of this 2,481
section shall be adjusted beginning July 1, 1993, for the 2,482
estimated inflation for the twelve-month period beginning on the 2,483
first day of July of the calendar year preceding the calendar 2,484
year that precedes the fiscal year for which rate will be paid 2,485
and ending on the thirtieth day of the following June, using the 2,486
consumer price index for shelter costs for all urban consumers 2,487
for the north central region, as published by the United States 2,488
bureau of labor statistics. 2,489
(F)(1) For facilities of eight or fewer beds that have 2,491
dates of licensure or have been granted project authorization by 2,492
the department of mental retardation and developmental 2,493
disabilities before July 1, 1993, and for facilities of eight or 2,494
fewer beds that have dates of licensure or have been granted 2,495
project authorization after that date if the facilities 2,496
demonstrate that they made substantial commitments of funds on or 2,497
before that date, cost of ownership shall not exceed eighteen 2,498
58
dollars and thirty cents per resident per day. The 2,499
eighteen-dollar and thirty-cent amount shall be increased by the 2,500
change in the "Dodge building cost indexes, northeastern and 2,501
north central states," published by Marshall and Swift, during 2,502
the period beginning June 30, 1990, and ending July 1, 1993, and 2,503
by the change in the consumer price index for shelter costs for 2,504
all urban consumers for the north central region, as published by 2,505
the United States bureau of labor statistics, annually 2,506
thereafter. 2,507
(2) For facilities with eight or fewer beds that have 2,509
dates of licensure or have been granted project authorization by 2,510
the department of mental retardation and developmental 2,511
disabilities on or after July 1, 1993, for which substantial 2,512
commitments of funds were not made before that date, cost of 2,513
ownership payments shall not exceed the applicable amount 2,514
calculated under division (F)(1) of this section, if the 2,515
department of job and family services gives prior approval for 2,517
construction of the facility. If the department does not give
prior approval, cost of ownership payments shall not exceed the 2,518
amount specified in division (C) of this section. 2,519
(3) Notwithstanding divisions (D) and (F)(1) and (2) of 2,521
this section, the total payment for cost of ownership, cost of 2,522
ownership efficiency incentive, and capitalized costs of 2,523
renovations for an intermediate care facility for the mentally 2,524
retarded with eight or fewer beds shall not exceed the sum of the 2,525
limitations specified in divisions (C) and (D) of this section. 2,527
(G) Notwithstanding any provision of this section or 2,529
section 5111.24 of the Revised Code, the director of job and 2,531
family services may adopt rules in accordance with Chapter 119. 2,532
of the Revised Code that provide for a calculation of a combined 2,533
maximum payment limit for indirect care costs and cost of 2,534
ownership for intermediate care facilities for the mentally 2,535
retarded with eight or fewer beds.
(H) After June 30, 1980, the owner of an intermediate care 2,537
59
facility for the mentally retarded operating under a provider 2,538
agreement shall provide written notice to the department of job 2,540
and family services at least forty-five days prior to entering
into any contract of sale for the facility or voluntarily 2,542
terminating participation in the medical assistance program. 2,543
After the date on which a transaction of sale is closed, the 2,544
owner shall refund to the department the amount of excess 2,545
depreciation paid to the facility by the department for each year 2,546
the owner has operated the facility under a provider agreement 2,547
and prorated according to the number of medicaid patient days for 2,548
which the facility has received payment. If an intermediate care 2,549
facility for the mentally retarded is sold after five or fewer 2,550
years of operation under a provider agreement, the refund to the 2,551
department shall be equal to the excess depreciation paid to the 2,552
facility. If an intermediate care facility for the mentally 2,553
retarded is sold after more than five years but less than ten 2,554
years of operation under a provider agreement, the refund to the 2,555
department shall equal the excess depreciation paid to the 2,556
facility multiplied by twenty per cent, multiplied by the number 2,557
of years less than ten that a facility was operated under a 2,558
provider agreement. If an intermediate care facility for the 2,559
mentally retarded is sold after ten or more years of operation 2,560
under a provider agreement, the owner shall not refund any excess 2,561
depreciation to the department. For the purposes of this 2,562
division, "depreciation paid to the facility" means the amount 2,563
paid to the intermediate care facility for the mentally retarded 2,564
for cost of ownership pursuant to this section less any amount 2,565
paid for interest costs. For the purposes of this division, 2,566
"excess depreciation" is the intermediate care facility for the 2,567
mentally retarded's depreciated basis, which is the owner's cost 2,568
less accumulated depreciation, subtracted from the purchase price 2,569
but not exceeding the amount of depreciation paid to the 2,570
facility.
A cost report shall be filed with the department within 2,572
60
ninety days after the date on which the transaction of sale is 2,573
closed or participation is voluntarily terminated for an 2,574
intermediate care facility for the mentally retarded subject to 2,575
this division. The report shall show the accumulated 2,576
depreciation, the sales price, and other information required by 2,577
the department. The amount of the last two monthly payments to 2,578
an intermediate care facility for the mentally retarded made 2,579
pursuant to division (A)(1) of section 5111.22 of the Revised 2,580
Code before a sale or voluntary termination of participation 2,581
shall be held in escrow by a bank, trust company, or savings and 2,582
loan association, except that if the amount the owner will be 2,583
required to refund under this section is likely to be less than 2,584
the amount of the last two monthly payments, the department shall 2,585
take one of the following actions instead of withholding the 2,586
amount of the last two monthly payments: 2,587
(1) In the case of an owner that owns other facilities 2,589
that participate in the medical assistance program, obtain a 2,590
promissory note in an amount sufficient to cover the amount 2,591
likely to be refunded; 2,592
(2) In the case of all other owners, withhold the amount 2,594
of the last monthly payment to the intermediate care facility for 2,595
the mentally retarded. 2,596
The department shall, within ninety days following the 2,598
filing of the cost report, audit the report and issue an audit 2,599
report to the owner. The department also may audit any other 2,600
cost reports for the facility that have been filed during the 2,601
previous three years. In the audit report, the department shall 2,602
state its findings and the amount of any money owed to the 2,603
department by the intermediate care facility for the mentally 2,604
retarded. The findings shall be subject to an adjudication 2,605
conducted in accordance with Chapter 119. of the Revised Code. 2,606
No later than fifteen days after the owner agrees to a 2,607
settlement, any funds held in escrow less any amounts due to the 2,608
department shall be released to the owner and amounts due to the 2,609
61
department shall be paid to the department. If the amounts in 2,610
escrow are less than the amounts due to the department, the 2,611
balance shall be paid to the department within fifteen days after 2,612
the owner agrees to a settlement. If the department does not 2,613
issue its audit report within the ninety-day period, the 2,614
department shall release any money held in escrow to the owner. 2,615
For the purposes of this section, a transfer of corporate stock, 2,616
the merger of one corporation into another, or a consolidation 2,617
does not constitute a sale. 2,618
If an intermediate care facility for the mentally retarded 2,620
is not sold or its participation is not terminated after notice 2,621
is provided to the department under this division, the department 2,622
shall order any payments held in escrow released to the facility 2,623
upon receiving written notice from the owner that there will be 2,624
no sale or termination of participation. After written notice is 2,625
received from an intermediate care facility for the mentally 2,626
retarded that a sale or termination of participation will not 2,627
take place, the facility shall provide notice to the department 2,628
at least forty-five days prior to entering into any contract of 2,629
sale or terminating participation at any future time. 2,630
(I) The department of job and family services shall pay 2,632
each eligible proprietary intermediate care facility for the 2,633
mentally retarded a return on the facility's net equity computed 2,634
at the rate of one and one-half times the average of interest 2,635
rates on special issues of public debt obligations issued to the 2,636
federal hospital insurance trust fund for the cost reporting 2,637
period. No facility's return on net equity paid under this 2,638
division shall exceed one dollar per patient day. 2,639
In calculating the rate for return on net equity, the 2,641
department shall use the greater of the facility's inpatient days 2,642
during the applicable cost reporting period or the number of 2,643
inpatient days the facility would have had during that period if 2,644
its occupancy rate had been ninety-five per cent. 2,645
(J)(1) Except as provided in division (J)(2) of this 2,648
62
section, if a provider leases or transfers an interest in a 2,649
facility to another provider who is a related party, the related 2,651
party's allowable cost of ownership shall include the lesser of 2,652
the following:
(a) The annual lease expense or actual cost of ownership, 2,655
whichever is applicable;
(b) The reasonable cost to the lessor or provider making 2,658
the transfer.
(2) If a provider leases or transfers an interest in a 2,660
facility to another provider who is a related party, regardless 2,661
of the date of the lease or transfer, the related party's 2,663
allowable cost of ownership shall include the annual lease 2,664
expense or actual cost of ownership, whichever is applicable, 2,665
subject to the limitations specified in divisions (B) to (I) of 2,667
this section, if all of the following conditions are met: 2,668
(a) The related party is a relative of owner; 2,671
(b) In the case of a lease, if the lessor retains any 2,673
ownership interest, it is, EXCEPT AS PROVIDED IN DIVISION 2,675
(J)(2)(d)(ii) OF THIS SECTION, in only the real property and any 2,676
improvements on the real property; 2,677
(c) In the case of a transfer, the provider making the 2,680
transfer retains, EXCEPT AS PROVIDED IN DIVISION (J)(2)(d)(iv) OF 2,681
THIS SECTION, no ownership interest in the facility; 2,683
(d) The United States internal revenue service has issued 2,686
a ruling DEPARTMENT OF JOB AND FAMILY SERVICES DETERMINES that 2,687
the lease or transfer is an arm's length transaction for purposes 2,688
of federal income taxation; PURSUANT TO RULES THE DEPARTMENT 2,689
SHALL ADOPT IN ACCORDANCE WITH CHAPTER 119. OF THE REVISED CODE 2,690
NO LATER THAN DECEMBER 31, 2000. THE RULES SHALL PROVIDE THAT A 2,693
LEASE OR TRANSFER IS AN ARM'S LENGTH TRANSACTION IF ALL OF THE 2,694
FOLLOWING, AS APPLICABLE, APPLY:
(i) IN THE CASE OF A LEASE, ONCE THE LEASE GOES INTO 2,696
EFFECT, THE LESSOR HAS NO DIRECT OR INDIRECT INTEREST IN THE 2,697
LESSEE OR, EXCEPT AS PROVIDED IN DIVISION (J)(2)(b) OF THIS 2,698
63
SECTION, THE FACILITY ITSELF, INCLUDING INTEREST AS AN OWNER, 2,699
OFFICER, DIRECTOR, EMPLOYEE, INDEPENDENT CONTRACTOR, OR 2,700
CONSULTANT, BUT EXCLUDING INTEREST AS A LESSOR. 2,701
(ii) IN THE CASE OF A LEASE, THE LESSOR DOES NOT REACQUIRE 2,703
AN INTEREST IN THE FACILITY EXCEPT THROUGH THE EXERCISE OF A 2,704
LESSOR'S RIGHTS IN THE EVENT OF A DEFAULT. IF THE LESSOR
REACQUIRES AN INTEREST IN THE FACILITY IN THIS MANNER, THE 2,705
DEPARTMENT SHALL TREAT THE FACILITY AS IF THE LEASE NEVER 2,706
OCCURRED WHEN THE DEPARTMENT CALCULATES ITS REIMBURSEMENT RATES 2,707
FOR CAPITAL COSTS. 2,708
(iii) IN THE CASE OF A TRANSFER, ONCE THE TRANSFER GOES 2,710
INTO EFFECT, THE PROVIDER THAT MADE THE TRANSFER HAS NO DIRECT OR 2,711
INDIRECT INTEREST IN THE PROVIDER THAT ACQUIRES THE FACILITY OR 2,712
THE FACILITY ITSELF, INCLUDING INTEREST AS AN OWNER, OFFICER,
DIRECTOR, EMPLOYEE, INDEPENDENT CONTRACTOR, OR CONSULTANT, BUT 2,713
EXCLUDING INTEREST AS A CREDITOR. 2,714
(iv) IN THE CASE OF A TRANSFER, THE PROVIDER THAT MADE THE 2,716
TRANSFER DOES NOT REACQUIRE AN INTEREST IN THE FACILITY EXCEPT 2,717
THROUGH THE EXERCISE OF A CREDITOR'S RIGHTS IN THE EVENT OF A 2,718
DEFAULT. IF THE PROVIDER REACQUIRES AN INTEREST IN THE FACILITY 2,719
IN THIS MANNER, THE DEPARTMENT SHALL TREAT THE FACILITY AS IF THE 2,720
TRANSFER NEVER OCCURRED WHEN THE DEPARTMENT CALCULATES ITS 2,721
REIMBURSEMENT RATES FOR CAPITAL COSTS.
(v) THE LEASE OR TRANSFER SATISFIES ANY OTHER CRITERIA 2,723
SPECIFIED IN THE RULES. 2,724
(e) Except in the case of hardship caused by a 2,727
catastrophic event, as determined by the department, or in the 2,728
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 2,729
since, for the same facility, allowable cost of ownership was 2,730
determined most recently under this division. 2,731
Sec. 5111.62. The proceeds of all fines, including 2,740
interest, collected under sections 5111.35 to 5111.62 of the 2,741
Revised Code shall be deposited in the state treasury to the 2,742
64
credit of the residents protection fund, which is hereby created. 2,743
Moneys in the fund shall be used solely for the protection of the 2,744
health or property of residents of nursing facilities in which 2,745
the department of health finds deficiencies, including payment 2,746
for the costs of relocation of residents to other facilities, 2,747
maintenance of operation of a facility pending correction of 2,748
deficiencies or closure, and reimbursement of residents for the 2,749
loss of money managed by the facility under section 3721.15 of 2,750
the Revised Code. The fund shall be maintained and administered 2,752
by the department of job and family services under rules 2,753
developed in consultation with the departments of health and 2,754
aging and adopted by the director of job and family services 2,756
under Chapter 119. of the Revised Code. 2,757
Section 2. That existing sections 173.19, 3702.525, 2,759
3721.21, 5111.20, 5111.25, 5111.251, and 5111.62 of the Revised 2,761
Code are hereby repealed.
Section 3. Notwithstanding the fourteen-month publishing 2,763
deadline established in section 173.46 of the Revised Code, the 2,764
Department of Aging shall not publish the Ohio Long-term Care 2,765
Consumer Guide unless it includes in the guide the results of 2,766
customer satisfaction surveys conducted under section 173.54 of 2,767
the Revised Code. For the purposes of this condition, the 2,768
department may publish the guide if it includes in the guide the 2,769
results of surveys of families of nursing facility residents 2,770
covering at least twenty-five per cent of the nursing facilities 2,771
in this state and it has established a process for conducting 2,772
both family and resident satisfaction surveys under section 2,773
173.54 of the Revised Code.
Section 4. All items in this section are hereby 2,775
appropriated as designated out of any moneys in the state 2,776
treasury to the credit of the designated fund group. For all 2,777
appropriations made in this act, those in the first column are 2,778
for fiscal year 2000 and those in the second column are for 2,779
fiscal year 2001. The appropriations made in this act are in 2,780
65
addition to any other appropriations made for the 1999-2001 2,781
biennium.
JFS DEPARTMENT OF JOB AND FAMILY SERVICES 2,783
General Revenue Fund 2,786
GRF 600-525 Health Care/Medicaid 2,789
State $ 0 $ 8,150,410 2,793
Federal $ 0 $ 11,699,590 2,796
Health Care Total $ 0 $ 19,850,000 2,799
Total GRF General Revenue Fund 2,800
Group
State $ 0 $ 8,150,410 2,804
Federal $ 0 $ 11,699,590 2,807
GRF Total $ 0 $ 19,850,000 2,810
TOTAL ALL BUDGET FUND GROUPS $ 0 $ 19,850,000 2,813
Health Care/Medicaid 2,816
Of the foregoing appropriation item 600-525, Health 2,818
Care/Medicaid, $3,650,000 shall be used in fiscal year 2001 to 2,819
support additional slots for the Department of Job and Family 2,820
Services' Ohio Home Care Waiver Program.
DMR DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL 2,822
DISABILITIES
General Revenue Fund 2,824
GRF 322-413 Residential and 2,826
Support Services $ 0 $ 4,500,000 2,828
TOTAL GRF General Revenue Fund $ 0 $ 4,500,000 2,830
Federal Special Revenue Fund Group 2,833
3G6 322-639 Medicaid Waiver $ 0 $ 6,460,000 2,837
TOTAL FSR Federal Special Revenue $ 0 $ 6,460,000 2,840
Fund Group
TOTAL ALL BUDGET FUND GROUPS $ 0 $ 10,960,000 2,842
Residential and Support Services 2,845
Of the foregoing appropriation item 322-413, Residential 2,847
and Support Services, $4,500,000 shall be used in fiscal year 2,848
2001 as state matching funds to support additional slots for the 2,849
66
Individual Options Home and Community-based waiver program 2,850
operated pursuant to Title XVIII of the "Social Security Act," 49 2,851
Stat. 620 (1935), 42 U.S.C. 301, as amended.
Medicaid Waiver 2,853
Of the foregoing appropriation item 322-639, Medicaid 2,855
Waiver (Fund 3G6), $6,460,000 shall be used in fiscal year 2001 2,856
to support additional slots for the Individual Options Home and 2,857
Community-based waiver program operated pursuant to Title XVIII 2,858
of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301, 2,859
as amended.
AGE DEPARTMENT OF AGING 2,860
State Special Revenue Fund Group 2,861
5K9 490-613 Long-Term Care 2,864
Consumer Guide $ 0 $ 807,000 2,866
TOTAL SSR State Special Revenue 2,867
Fund Group $ 0 $ 807,000 2,870
TOTAL ALL BUDGET FUND GROUPS $ 0 $ 807,000 2,872
Long-Term Care Consumer Guide 2,875
Notwithstanding section 5111.62 of the Revised Code, not 2,877
later than July 15, 2000, the Director of Budget and Management 2,879
shall transfer $407,000 cash from Fund 4E3, Resident Protection 2,880
Fund, to Fund 5K9, Long-Term Care Consumer Guide Fund.
The foregoing appropriation item 490-613, Long-Term Care 2,882
Consumer Guide, shall be used by the Department of Aging for 2,883
costs associated with publishing the Ohio Long-Term Care Consumer 2,884
Guide.
DOH DEPARTMENT OF HEALTH 2,886
State Special Revenue Fund Group 2,888
5L1 440-623 Nursing Facility 2,890
Technical Assistance
Program $ 0 $ 1,400,000 2,892
TOTAL SSR State Special Revenue 2,893
Fund Group $ 0 $ 1,400,000 2,896
TOTAL ALL BUDGET FUND GROUPS $ 0 $ 1,400,000 2,899
67
Nursing Facility Technical Assistance Program 2,902
Notwithstanding section 5111.62 of the Revised Code, not 2,904
later than July 15, 2000, the Director of Budget and Management 2,906
shall transfer $1,400,000 cash from Fund 4E3, Resident Protection 2,907
Fund, to Fund 5L1, Nursing Facility Technical Assistance Fund, to 2,908
be used in accordance with section 3721.026 of the Revised Code. 2,909
Within the limits set forth in this act, the Director of 2,911
Budget and Management shall establish accounts indicating source 2,912
and amount of funds for each appropriation made in this act, and 2,913
shall determine the form and manner in which appropriation 2,914
accounts shall be maintained. Expenditures from appropriations 2,915
contained in this act shall be accounted for as though made in 2,916
Am. Sub. H.B. 283 of the 123rd General Assembly. 2,917
The appropriations made in this act are subject to all 2,919
provisions of Am. Sub. H.B. 283 of the 123rd General Assembly. 2,920
Section 5. (A) Notwithstanding division (Q)(1) of section 2,923
5111.20 of the Revised Code, when calculating indirect care costs 2,924
for the purpose of establishing rates under section 5111.24 or 2,925
5111.241 of the Revised Code for fiscal year 2001, "per diem," as 2,926
used in sections 5111.20 to 5111.32 of the Revised Code, means a 2,927
nursing facility's or intermediate care facility for the mentally 2,928
retarded's actual, allowable indirect care costs in the cost 2,929
reporting period divided by the greater of the facility's 2,930
inpatient days for that period or the number of inpatient days 2,931
the facility would have had during that period if its occupancy 2,932
rate had been seventy-five per cent.
(B) Notwithstanding division (Q)(2) of section 5111.20 of 2,934
the Revised Code, when calculating capital costs for the purpose 2,935
of establishing rates under section 5111.25 or 5111.251 of the 2,936
Revised Code for fiscal year 2001, "per diem," as used in 2,937
sections 5111.20 to 5111.32 of the Revised Code, means a nursing 2,938
facility's or intermediate care facility for the mentally 2,939
retarded's actual, allowable capital costs in the cost reporting 2,940
period divided by the greater of the facility's inpatient days 2,941
68
for that period or the number of inpatient days the facility 2,942
would have had during that period if its occupancy rate had been 2,943
eighty-five per cent.
(C) Notwithstanding section 5111.261 and division (C) of 2,945
section 5111.262 of the Revised Code, for costs incurred during 2,946
calendar year 1999, costs reported in a nursing facility's cost 2,947
report for purchased nursing services shall be allowable direct 2,948
care costs up to seventeen per cent of the nursing facility's 2,949
cost specified in the cost report for services provided that year 2,950
by registered nurses, licensed practical nurses, and nurse aides 2,951
who are employees of the facility, plus one-half of the amount by 2,952
which the reported costs for purchased nursing services exceed 2,953
that percentage. 2,954
(D) As soon as practicable, the Department of Job and 2,956
Family Services shall follow this section for the purpose of 2,957
calculating nursing facilities' and intermediate care facilities 2,958
for the mentally retarded's Medicaid reimbursement rates for 2,959
indirect care and capital costs for fiscal year 2001. If the 2,960
Department is unable to calculate the rates before it makes 2,961
payments for services provided during fiscal year 2001, the 2,962
Department shall pay a nursing facility or intermediate care 2,963
facility for the mentally retarded the difference between the 2,964
amount it pays the facility and the amount that would have been 2,965
paid had the Department made the calculation in time. 2,966
Section 6. Except for sections 3702.525, 3721.21, 5111.25, 2,969
and 5111.251 of the Revised Code as amended by this act, the
codified and uncodified sections of law contained in this act are 2,971
not subject to the referendum and take effect on the later of 2,972
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 2,973
Code made by this act constitute items of law that are subject to 2,975
the referendum. Therefore, under Article II, Section 1c of the 2,976
Ohio Constitution and section 1.471 of the Revised Code, these 2,977
items of law take effect on the 91st day after this act is filed 2,978
69
with the Secretary of State. If, however, a referendum petition 2,979
is filed against these items of law, these items of law, unless 2,980
rejected at the referendum, take effect at the earliest time 2,981
permitted by law.