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(123rd General Assembly)(Substitute House Bill Number 403)
AN ACT
To amend sections 173.19, 3702.525, 3721.21, 5111.20, 5111.25, 5111.251, and
5111.62 and to enact sections
173.45 to 173.59, 3721.026, and 3721.027 of the Revised Code to require the
publication
of the Ohio Long-Term Care Consumer Guide, to create a
nursing facility technical assistance program,
to change the
method of calculating nursing facilities' and intermediate care
facilities for the mentally retarded's Medicaid reimbursement
rates for indirect care and capital costs,
to specify in the law
governing nursing homes that neglect does not include allowing a resident to
receive only treatment by spiritual means through prayer in accordance with
the tenets of a recognized religious denomination,
to require the
Department of Health to investigate valid, unresolved complaints that the
State Long-Term Care Ombudsperson refers to the Department,
to make an
exception to the certificate of need implementation deadline,
and to make an
appropriation.
Be it enacted by the General Assembly of the State of Ohio:
SECTION 1 . That sections 173.19, 3702.525, 3721.21, 5111.20, 5111.25,
5111.251, and 5111.62 be amended and
sections 173.45, 173.46, 173.47, 173.48, 173.49, 173.50, 173.51,
173.52, 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:
Sec. 173.19. (A) The office of the state long-term care
ombudsperson program, through the state long-term care
ombudsperson and
the regional long-term care ombudsperson programs,
shall receive,
investigate, and attempt to resolve complaints made by residents,
recipients, sponsors, providers of long-term care, or any person
acting on behalf of a resident or recipient, relating to either
of the following: (1) The health, safety, welfare, or civil rights of a
resident or recipient or any violation of a resident's rights
described in sections 3721.10 to 3721.17 of the Revised Code; (2) Any action or inaction or decision by a provider of
long-term care or representative of a provider, a governmental
entity, or a private social service agency that may adversely
affect the health, safety, welfare, or rights of a resident or
recipient. (B) The department of aging shall adopt rules in
accordance with Chapter 119. of the Revised Code regarding the
handling of complaints received under this section, including
procedures for conducting investigations of complaints. The
rules shall include procedures to ensure that no representative
of the office investigates any complaint involving a provider of
long-term care with which the representative was once employed or
associated. The state ombudsperson and regional programs shall
establish
procedures for handling complaints consistent with the
department's rules. Complaints shall be dealt with in accordance
with the procedures established under this division. (C) The office of the state long-term care
ombudsperson
program may decline to investigate any complaint if it determines
any of the following: (1) That the complaint is frivolous, vexatious, or not
made in good faith; (2) That the complaint was made so long after the
occurrence of the incident on which it is based that it is no
longer reasonable to conduct an investigation; (3) That an adequate investigation cannot be conducted
because of insufficient funds, insufficient staff, lack of staff
expertise, or any other reasonable factor that would result in an
inadequate investigation despite a good faith effort; (4) That an investigation by the office would create a
real or apparent conflict of interest. (D) If a regional long-term care ombudsperson program
declines to investigate a complaint, it shall refer the complaint
to the state long-term care ombudsperson. (E) Each complaint to be investigated by a regional
program shall be assigned to a representative of the office of
the state long-term care ombudsperson program. If the
representative determines that the complaint is valid, the
representative shall
assist the parties in attempting to resolve it. If the
representative is unable
to resolve it, the representative may shall refer the complaint
to
the state ombudsperson. In order to carry out the duties of sections 173.14 to
173.26 of the Revised Code, a representative has the
right to
private communication with residents and their sponsors and
access to long-term care facilities, including the right to tour
resident areas unescorted and the right to tour facilities
unescorted as reasonably necessary to the investigation of a
complaint. Access to facilities shall be during reasonable hours
or, during investigation of a complaint, at other times
appropriate to the complaint. When community-based long-term care services are provided
at a location other than the recipient's home, a representative
has the right to private communication with the recipient and
the recipient's
sponsors and access to the community-based long-term care site,
including the right to tour the site unescorted. Access to the
site shall be during reasonable hours or, during the
investigation of a complaint, at other times appropriate to the
complaint. (F) The state ombudsperson shall determine whether
complaints
referred to the ombudsperson under division (D) or (E) of
this section warrant
investigation. The ombudsperson's determination in this
matter is final. Sec. 173.45. As used in sections 173.45 to
173.59 of the Revised Code: (A) "Clinical quality indicator" means a measure of an aspect of
the physical or mental conditions of the residents of a nursing facility that
is derived
from data taken from resident assessment instruments submitted by
nursing facilities for purposes of the medicare and medicaid
programs. (B) "Medicaid" has the same meaning as in section 5111.01 of the
Revised Code. (C) "Medicare" means the program operated pursuant to
Title
XVIII of the "Social Security Act," 49
Stat. 620 (1935), 42
U.S.C.A. 301, as amended. (D) "Nursing facility" means either of the following: (1) A facility, or a distinct part of a
facility, that is certified as a
nursing facility or a skilled nursing facility for purposes of the medicare or
medicaid program; (2) A nursing home licensed under section 3721.02 of
the Revised Code that is not certified as a nursing facility
or skilled nursing facility. (E) "Deficiency," "immediate jeopardy," "standard survey," and
"substandard care" have the same meanings as
in section 5111.35 of the
Revised Code. (F) "Survey data tag" means any of the data tags used in the
medicare and medicaid programs for identification of specific regulatory
requirements. Sec. 173.46. The department of aging shall develop and publish
a guide to nursing facilities in this state for use by individuals
considering nursing facility placement and their families, friends,
and advisors. The guide shall be titled the Ohio long-term care
consumer guide. The consumer guide shall be published in computerized form
for distribution over the internet. The guide
shall be made available not later than fourteen months after the effective
date
of this section and shall be updated in accordance with section 173.52
of the Revised Code. Every two years, the department shall publish an executive
summary of the consumer guide, and shall make the executive summary
available in both computerized and printed forms. Sec. 173.47. The department of aging may contract with any
person or government entity to perform any function related to the
publication of the Ohio long-term care consumer guide
or the collection and
preparation of
data and other material for the guide, except that the department shall
contract to have
the customer satisfaction surveys conducted under section 173.54 of
the Revised Code. In awarding the contract to have the
surveys conducted, the department shall contract with a person or government
entity that has experience in surveying the customer satisfaction of nursing
facility residents and their families. The department's contract
shall permit the person or government entity to subcontract with other persons
or government entities for purposes of conducting all or part of the surveys. Sec. 173.48. In developing and publishing the Ohio long-term care
consumer guide, the department of aging shall adhere to the
following principles: (A) The guide should be designed to provide users with a variety
of measures of nursing facility quality and with other information useful in
comparing and
selecting nursing facilities. (B) The guide should present the information specified in
division (A) of this section in a manner that is easy to use and
understand. (C) The guide should allow users to determine which of the
available measures are
most important to them. (D) The information in the guide should be kept as current as
practicable. (E) The guide should be designed to promote excellence in nursing
facility quality. (F) The guide should promote awareness of the range of long-term
care services available to Ohioans. Sec. 173.49. With regard to the accessibility of the Ohio
long-term care consumer guide and the executive summary of the guide, the
following shall apply: (A) The department of aging shall make the guide and summary
available to
any person or government entity and shall not restrict access by requiring
payment of a fee, use of a password, or fulfillment of any other condition. (B) The department of aging shall
develop and implement programs and other strategies to encourage use of the
guide by individuals
considering nursing facility placement and their families, friends, and
advisors. Sec. 173.50. The Ohio long-term care consumer guide shall
include information on each nursing facility in this state. For each
facility, the guide shall
include, to the extent it is available to the
department of aging, all of the following information: (A) Customer satisfaction data obtained under section 173.54 of
the Revised Code; (B) Clinical quality indicator data obtained under section
173.56 of the Revised Code; (C) Data derived from standard surveys as
specified in division (C)(3) of section 173.51
of the Revised Code; (D) Any other information specified in sections 173.45 to
173.59 of the Revised Code or the rules adopted under
section 173.57 of the Revised Code. Sec. 173.51. The Ohio long-term care consumer guide
shall be structured in accordance with this
section and any
applicable rules adopted under section 173.57 of the Revised
Code. (A) The opening electronic page of the consumer guide shall
include all of the following general information: (1) A description of the guide; (2) Disclaimers stating the limitations of the data included in
the guide. The disclaimers shall include a statement that standard
surveys of nursing facilities are conducted at periodic intervals
and a statement that conditions at a facility can change
significantly between standard surveys. (3) A recommendation that individuals considering nursing
facility placement visit any facilities they are considering; (4) Electronic links to other information on the internet about
selecting nursing facilities and about other long-term care options, including
information maintained by
pertinent government agencies and private organizations and telephone numbers
for those agencies and organizations; (5) Any other information the department of aging specifies in rules
adopted under
section 173.57 of the Revised Code. (B) The consumer guide shall be structured in a manner that
allows the user to search for information in the guide in multiple ways,
including searches by
facility name, county, municipality, postal zip code, source of nursing
facility payment, and special
care service. (C) The first information to appear on the computer screen
following a search shall be a list of all facilities identified by
the search. For all of the facilities listed, the consumer guide
shall present the user with summarized comparative
measures and electronic links to definitions and descriptions of
the measures. The guide shall include a feature that allows the user to
choose the particular comparative measures that will be displayed on the
screen. The guide also may include a consumer needs assessment
function to assist the user in choosing measures. The comparative
measures shall be derived from the following sources: (1) The aggregate responses made by a facility's residents or their
families
to measures
of customer satisfaction included in the surveys conducted under
section 173.54 of the Revised Code. The measures shall
be
specified in rules adopted under section 173.57 of the Revised
Code. For each measure, the guide shall compare the responses for
the facility to the statewide average
or to a peer-group average specified in rule under section 173.57
of the Revised Code. (2) The scores on clinical quality indicators
calculated under section 173.56 of the Revised Code. The
indicators shall be specified in rules adopted under section 173.57
of the Revised Code. For each indicator, the guide shall
compare the facility's score to the statewide average
or to a peer-group average specified in rule under section 173.57
of the Revised Code. The scores shall be
expressed as percentages. (3) All of the following: (a) The date of the facility's most recent standard
survey; (b) The percentage of specified survey data tags for which the
facility was found to be in compliance during the facility's most recent
standard survey. The
department of aging shall specify in rule the survey data tags
used for this purpose and may exclude tags that are never or very
rarely cited during surveys. (c) The statewide average percentage of the specified
survey data
tags for which facilities were found to be in compliance during the most
recent standard surveys. Alternatively,
the department of aging may prescribe by rule that a peer-group
average be used. (d) The number of specified survey data tags cited by the
department of health in the facility's most recent standard
survey; (e) The statewide average number of specified survey data tags
cited by the department of health during the most recent standard surveys.
Alternatively, the department of aging
may prescribe by rule that a peer-group average be used. (f) The date the facility achieved substantial compliance with
medicare and medicaid certification requirements; (g) Whether the department of health determined that the
facility
provided substandard care to residents during two of its last three
standard surveys; (h) Whether the department of health found that the care
provided
by the facility placed residents in immediate jeopardy during two of its
last three standard surveys. (4) An electronic link for each facility on the list allowing the user to
gain
access to information on the facility maintained under division (D)
of
this section. (D) In addition to the summarized information provided by the
guide pursuant to division (C) of this section, the guide shall
provide specific comparative information on each nursing facility. When
the guide's user opens an electronic link to
the specific information, the first information to appear on
the computer screen shall include all of the following: (1) The name of the facility and its owner, the facility's
telephone number and address, including the county
in which the facility is located. The guide shall include a
function that pinpoints on a map the facility's location. (2) The facility's status with regard to medicare and medicaid
certification and private accreditation; (3) The number of beds in the facility; (4) An electronic link allowing the user of the guide to gain
access to a listing of services provided by the facility. The
listing shall be presented in the format specified in rules adopted
under section 173.57 of the Revised Code. (5) At the facility's option, a picture of the facility, a brief
statement provided by the facility, and an electronic link to any
information the facility maintains about itself on the internet; (6) The summarized information specified in division (C) of this
section
for the facility, with electronic links allowing the user to gain access to
additional information
presented as follows: (a) For each statistically valid and reliable question asked on
the questionnaires used in the
resident and family surveys conducted under section 173.54 of the
Revised Code, the guide shall present the customer
satisfaction
responses. The responses
for the facility shall be compared to the statewide average or to a peer-group
average specified in rule under section 173.57 of the Revised
Code and shall be
expressed in percentages. (b) For each clinical quality indicator calculated
under section
173.56 of the Revised Code, the guide shall present the
facility's score compared to the statewide average score. The scores shall be
expressed as percentages. (c) The guide shall present a list of
all survey data tags
that were cited during the facility's most recent standard
survey, a brief description pertaining to each data tag, directions or
electronic links for obtaining more information about the
facility's survey
history, and
links to the text of each citation and to the facility's plan of
correction filed with the state for each citation. (7) Any other information, which may include information about staffing,
the department of aging prescribes by rule. Sec. 173.52. (A) The department of
aging shall update information in the
Ohio long-term care consumer guide as follows: (1) The customer satisfaction data obtained under section 173.54
of
the Revised Code shall be updated
annually following the surveys conducted under that section. (2) The clinical quality indicator data obtained under section
173.56 of the Revised Code shall be updated
in January, April, July, and October of
each year, using the most
recent resident assessment data available to the department. (3) The data derived from standard surveys of each nursing facility, as
specified in division (C)(3) of section 173.51
of the Revised Code, shall be updated weekly, using
the most recent standard survey data available to the
department.
The department shall modify the data included in the consumer
guide
to reflect either of the following: (a) Any change in the survey data resulting from informal
dispute resolution, appeal, or any other process; (b) The date of correction of any citation. (4) Any other information specified in sections 173.45 to
173.59 of the Revised Code or the rules adopted under
section 173.57 of the Revised Code shall be updated at the
time specified in those sections or the rules. (B) The department of aging shall specify by rule information in
the guide that nursing facilities can electronically update without the need
for
any action by the department, which shall include any information that the
facility originally submitted to the department. The guide shall
include a mechanism for such updates. This division does not apply to
information described in divisions (A)(1), (2), and (3) of
this section. (C) The department of health shall cooperate with the department
of aging to ensure that standard survey information and quality indicator data
are updated in
accordance with this section, subject to the regulatory requirements,
procedures, and guidelines of the United States health care
financing administration. Sec. 173.53. In addition to the computerized Ohio long-term care
consumer
guide, the department of aging shall prepare and make available to the public
printed information to assist consumers in making
long-term care and nursing facility placement decisions, particularly
consumers who do not have access to the internet. The printed
information shall specify organizations that will provide
consumers free on-site access to the consumer guide and will mail
to consumers free paper copies of electronic pages of the guide. Sec. 173.54. (A) Through the contract required under section
173.47 of the Revised Code, the department of aging shall provide for
customer satisfaction surveys for use in publishing the
Ohio long-term care consumer guide. The department shall
ensure that the customer satisfaction surveys are conducted as
follows: (1) The surveys shall be conducted annually. (2) The surveys shall consist of standardized, statistically valid and
reliable questionnaires
for nursing facility residents and for families of nursing
facility residents. Each questionnaire shall be structured in a
manner that
produces statistically tested valid and reliable responses, as
specified in rules adopted by the department. Each
questionnaire shall ask the resident's age and gender. The
resident questionnaire shall ask who, if anyone, assisted the
resident in completing the questionnaire. The family
questionnaire shall ask the relationship of the person completing
the questionnaire to the resident. (3) The resident survey shall be conducted in person, using a
standardized survey protocol developed by the department in consultation with
the long-term care consumer guide advisory council. The survey shall be
conducted in a
manner designed to preserve the resident's confidentiality as much
as possible. (4) The family survey shall be conducted using anonymous
questionnaires distributed to families and returned to a person
other than the nursing facility, in accordance with a standardized survey
protocol
developed by the department in consultation with the long-term care consumer
guide advisory council. (B) In addition to being used for the consumer guide, the
results of the surveys conducted under this section shall be provided to the
nursing facilities to
which they pertain. Each nursing facility in this state shall participate as
necessary for
successful completion of the surveys. Sec. 173.55. The department of aging may charge a fee, not to
exceed four hundred dollars, for each of the annual customer
satisfaction surveys conducted under section 173.54 of the
Revised Code. The fee shall be paid
by the nursing facility and is subject to reimbursement through the
medicaid program pursuant to sections 5111.20 to 5111.32 of the
Revised Code. All fees collected under this section shall be
deposited to the credit of the long-term care consumer guide fund, which is
hereby
created in the state treasury. The fund shall be used
for costs associated with publishing
the Ohio long-term care consumer guide, including the cost of
contracting with persons and government entities under section
173.47 of the Revised Code. The department may contract
with
a person or government entity to
collect the fees on behalf of the department. Sec. 173.56. For purposes of the long-term care consumer guide, the
department
of aging shall use, subject to federal regulatory requirements, procedures,
and guidelines, the clinical quality indicators calculated for each nursing
facility by
the United States health care financing administration for
the
purposes of the medicare and medicaid programs. Sec. 173.57. (A) The department of aging shall adopt rules to
implement and
administer sections 173.45 to
173.59 of the Revised Code. The rules shall specify all of
the
following: (1) The content of the Ohio long-term care
consumer guide, including any information
in addition to the
information specified in section 173.51 of the Revised
Code; (2) The content of the computerized
and printed forms of the executive summary of the consumer guide; (3) The customer satisfaction measures to be published in
the consumer guide pursuant to division (C)(1) of section 173.51
of the
Revised Code; (4) The clinical quality indicators to be published in the
consumer guide pursuant to division (C)(2) of section 173.51
of the
Revised Code; (5) For purposes of clinical quality, customer satisfaction, and survey
data tag comparisons under
section 173.51 of the Revised Code, criteria to be used in classifying
nursing facilities into peer
groups, which may be based on case-mix scores calculated
under section 5111.231 of the Revised Code, the size of nursing facilities, the
location of facilities, or other pertinent factors; (6) The format for listing nursing facility services in the
consumer guide and the manner in which that information is to be collected
from nursing facilities; (7) A method of including additional long-term care facilities
and service providers
in the consumer guide pursuant to considerations made under division
(B)(4) of section 173.58 of the Revised Code; (8) Any other requirements necessary to implement and administer
sections 173.45 to 173.59 of the Revised Code. (B) The department shall develop rules under this section
in consultation with the long-term care consumer
guide advisory
council created under section 173.58 of the Revised Code.
Before filing a rule under section 119.03 of the Revised
Code, the
department shall present it to the advisory council and provide
the council a reasonable time to comment on it. The department shall give
appropriate consideration to recommendations of the advisory council regarding
proposed rules. (C) All rules adopted under this section shall be adopted in
accordance with Chapter 119. of the Revised Code.
Initial rules
shall be adopted not later than six months after the effective date of this
section. Sec. 173.58. (A) There is hereby created the long-term care
consumer guide advisory council. The council shall be convened by the
director of aging and
shall consist of the following members: (1) A representative of the department of aging, appointed by
the director of aging; (2) A representative of the department of health, appointed by
the director of health; (3) A representative of the department of job and family
services, appointed by the director of job and family services; (4) The state long-term care ombudsperson; (5) A family member of a nursing facility resident, appointed by the
governor; (6) A representative of the Ohio association of area agencies on
aging, appointed by the president of the association; (7) Two representatives of the Ohio health care association,
appointed by the chief administrator of the association; (8) Two representatives of the association of Ohio philanthropic
homes, housing, and services for the aging, appointed by the chief
administrator of the
association; (9) Two representatives of the Ohio academy of nursing homes,
appointed by the chief administrator of the academy; (10) A representative of the Ohio association of regional
long-term care ombudsmen, appointed by the chief administrator of the
association; (11) A representative of the Ohio chapter of the
American
association of retired persons, appointed by the chief administrator of the
chapter; (12) A representative of a consumer
group or other not-for-profit entity that is organized for the purpose
of promoting improved care for nursing home residents, appointed
by the governor; (13) A representative of a research organization, appointed by
the chief administrator of the organization. The research
organization represented shall be selected by the director of aging
from among research organizations in this state that have
experience in long-term care policy matters. Each council member shall serve at the discretion of the authority that
appointed the member. Each member shall serve without
compensation or reimbursement for expenses, except to the extent
that serving as a member of the council is part of the member's
regular duties of employment. The member serving as the representative of the department of
aging shall serve as the council's chairperson. The department
shall supply meeting space and staff support for the council. (B) The council's duties include all of the following: (1) To help develop and review rules to be adopted by the department of
aging
under section 173.57 of the Revised Code; (2) To recommend administrative practices to the department for
improving the operation and content of the Ohio long-term
care consumer guide; (3) To recommend legislative changes to the department needed to improve
the
consumer guide; (4) To consider whether it is feasible to include in the
consumer guide other long-term care facilities, such as residential
care facilities and intermediate care facilities for the mentally retarded,
and long-term care service providers, such as home health agencies and
adult day service providers; (5) To consider whether it is feasible to include in the consumer
guide measurements of quality of life standards. (C) The long-term care consumer guide advisory council is not
subject to section 101.84 of the Revised Code. Sec. 173.59. (A) The department of aging shall include no
advertising in the Ohio long-term care consumer guide that shall
cause a conflict of interest. (B) This section does not affect information included in the
Ohio
long-term care consumer guide under division (D)(5) of section
173.51 of the Revised Code. Sec. 3702.525. (A) Not later than twenty-four
months after the date the director of health mails the notice
that the certificate of need has been granted or, if the grant or
denial of the certificate of need is appealed under section
3702.60 of the Revised Code, not later than
twenty-four months after issuance of an order granting the
certificate that is not subject to further appeal, each person
holding a certificate of need granted on or after the effective
date of this section APRIL 20, 1995, shall: (1) If the project for which the certificate of need
was granted primarily involves construction and is to be financed
primarily through external borrowing of funds, secure financial
commitment for the stated purpose of developing the project and
commence construction that continues uninterrupted except for
interruptions or delays that are unavoidable due to reasons
beyond the person's control, including labor strikes, natural
disasters, material shortages, or comparable events; (2) If the project for which the certificate of need
was granted primarily involves construction and is to be financed
primarily internally, receive formal approval from the holder's
board of directors or trustees or other governing authority to
commit specified funds for implementation of the project and
commence construction that continues uninterrupted except for
interruptions or delays that are unavoidable due to reasons
beyond the person's control, including labor strikes, natural
disasters, material shortages, or comparable events; (3) If the project for which the certificate of need
was granted primarily involves acquisition of medical equipment,
enter into a contract to purchase or lease the equipment and to
accept the equipment at the site for which the certificate was
granted; (4) If the project for which the certificate of need
was granted involves no capital expenditure or only minor
renovations to existing structures, provide the health service or
activity by the means specified in the approved application for
the certificate; (5) If the project for which the certificate of need
was granted primarily involves leasing a building or space that
requires only minor renovations to the existing space, execute a
lease and provide the health service or activity by the means
specified in the approved application for the certificate; (6) If the project for which the certificate of need
was granted primarily involves leasing a building or space that
has not been constructed or requires substantial renovations to
existing space, commence construction for the purpose of
implementing the reviewable activity that continues uninterrupted
except for interruptions or delays that are unavoidable due to
reasons beyond the person's control, including labor strikes,
natural disasters, material shortages, or comparable events. (B) The twenty-four-month period specified in
division (A) of this section shall not be extended by any
means, including the transfer of a certificate of need under division
(C) of section 3702.524 of the Revised Code or granting of a subsequent or
replacement certificate of
need. Each person holding a certificate of need granted on or
after the effective date of this section APRIL 20,
1995, shall provide the
director of health documentation of compliance with that division
not later than the earlier of thirty days after complying with
that division or five days after the twenty-four-month period
expires. Not later than the earlier of fifteen days after he
receives receiving the documentation or fifteen days after the
twenty-four-month period expires, the director shall send by
certified mail a notice to the holder of the certificate of need
specifying whether the holder has complied with division
(A) of this section. (C) Notwithstanding division (B) of this section, the
twenty-four-month period specified in division (A) of this section
shall be extended for an additional twenty-four months for any
certificate of need granted for the purchase and relocation of
licensed nursing home beds on February 26, 1999. (D) A certificate of need granted on or after
the effective date of this section APRIL 20,
1995, expires, regardless of whether
the director sends a notice under division (B) of this
section, if the holder fails to comply with division (A) or
(C)
of this section or to provide information under division
(B) of this section as necessary for the director to
determine compliance. Sec. 3721.026. (A) As used in this section and section 3721.027
of the Revised Code,
"nursing facility" and "survey" have the
same meanings as in section 5111.35 of the Revised Code. (B) The director of health shall establish a unit within the
department of health to provide advice and technical assistance and to conduct
on-site visits to nursing
facilities for the purpose of improving resident
outcomes. The director shall assign to the
unit employees who have training or experience in conducting or
supervising surveys, but employees assigned to the unit shall not
conduct surveys. The director shall adopt rules in accordance
with Chapter 119. of the Revised Code to implement
this section and shall consult with interested parties in developing the
rules. Technical assistance reports are not public records under section
149.43 of the Revised Code and shall not be distributed to any person outside the unit
except: (1) The nursing facility that is provided with the technical assistance; (2) Persons charged with inspecting nursing facilities under section
3721.02 of the Revised Code or with conducting surveys or reviews of nursing facilities under
section 3721.022 of the Revised Code whenever any such person finds that there is serious
harm to resident health or safety that is more than isolated at the nursing
facility. The provisions of this section and rules adopted under this section do not
affect the department's authority to administer and enforce other sections of
this chapter. (C) On or before the last day of December each year, the
director
shall submit a report to the governor and
the general assembly describing the unit's activities that year and its
effectiveness in improving resident outcomes. Sec. 3721.027. The department of health shall investigate within
ten working days after referral, in accordance with procedures and
criteria to be established by the department of health and the
department of aging, any unresolved complaint that the office of the
state long-term care ombudsperson has investigated and found to be
valid and refers to the department of health.
This requirement does not supersede
federal
requirements for survey agency complaint investigations. Sec. 3721.21. As used in sections 3721.21 to 3721.34 of
the Revised Code: (A) "Long-term care facility" means either of the
following: (1) A nursing home as defined in section 3721.01 of the
Revised Code, other than a nursing home or part of a nursing home
certified as an intermediate care facility for the mentally
retarded under Title XIX of the "Social Security Act," 49 Stat.
620 (1935), 42 U.S.C.A. 301, as amended; (2) A facility or part of a facility that is certified as
a skilled nursing facility or a nursing facility under Title
XVIII or XIX of the "Social Security Act." (B) "Residential care facility" has the same meaning as in section
3721.01 of the Revised Code. (C) "Abuse" means knowingly causing physical harm or
recklessly causing serious physical harm to a resident by
physical contact with the resident or by use of physical or
chemical restraint, medication, or isolation as punishment, for
staff convenience, excessively, as a substitute for treatment, or
in amounts that preclude habilitation and treatment. (D) "Neglect" means recklessly failing to provide a
resident with any treatment, care, goods, or service necessary to
maintain the health or safety of the resident when the failure
results in serious physical harm to the resident. "Neglect" does
not include allowing a resident, at the resident's option, to receive only
treatment by spiritual means
through prayer in accordance with the tenets of a recognized religious
denomination. (E) "Misappropriation" means depriving, defrauding, or
otherwise obtaining the real or personal property of a resident
by any means prohibited by the Revised Code, including violations
of Chapter 2911. or 2913. of the Revised Code. (F) "Resident" includes a resident, patient,
former resident or patient, or deceased resident or patient of a
long-term care facility or a residential care facility. (G) "Physical restraint" has the same meaning as in
section 3721.10 of the Revised Code. (H) "Chemical restraint" has the same meaning as in
section 3721.10 of the Revised Code. (I) "Nursing and nursing-related services" means
the personal care services and other services not constituting
skilled nursing care that are specified in rules the public
health council shall adopt in accordance with Chapter 119.
of the Revised Code. (J) "Personal care services" has the same meaning as in
section 3721.01 of the Revised Code. (K) "Nurse aide" means an individual, other than a
licensed health professional practicing within the scope of the professional's
license, who provides nursing
and nursing-related services to residents in a
long-term care facility, either as a
member of the staff of the facility for monetary compensation or as a
volunteer without monetary compensation. (L) "Licensed health professional" means all of the
following: (1) An occupational therapist or occupational therapy
assistant licensed under Chapter 4755. of the Revised Code; (2) A physical therapist or physical therapy assistant
licensed under Chapter 4755. of the Revised Code; (3) A physician authorized under Chapter 4731. of the
Revised Code to practice medicine and surgery, osteopathic medicine and
surgery, or podiatry; (4) A physician assistant authorized under
Chapter 4730. of the Revised Code to practice as a physician assistant; (5) A registered nurse or licensed practical nurse
licensed under Chapter 4723. of the Revised Code; (6) A social worker or independent social worker
licensed under Chapter 4757. of the Revised Code or a social work assistant
registered under that chapter; (7) A speech-language pathologist or audiologist licensed under
Chapter 4753. of the Revised Code; (8) A dentist or dental hygienist licensed under Chapter
4715. of the Revised Code; (9) An optometrist licensed under Chapter 4725. of the
Revised Code; (10) A pharmacist licensed under Chapter 4729. of the
Revised Code; (11) A psychologist licensed under Chapter 4732. of the
Revised Code; (12) A chiropractor licensed under Chapter 4734. of the
Revised Code; (13) A nursing home administrator licensed or temporarily
licensed under Chapter 4751. of the Revised Code; (14) A professional counselor or professional clinical counselor licensed
under Chapter 4757. of the Revised Code. (M) "Competency evaluation program" means a program
through which the competency of a nurse aide to provide nursing and
nursing-related services is evaluated. (N) "Training and competency evaluation program" means a
program of nurse aide training and evaluation of competency to
provide nursing and nursing-related services. Sec. 5111.20. As used in sections 5111.20 to 5111.32 of
the Revised Code: (A) "Allowable costs" are those costs determined by the
department of job and family services to be reasonable and do not
include
fines paid under sections 5111.35 to 5111.61 and section 5111.99
of the Revised Code. (B) "Capital costs" means costs of ownership and
nonextensive renovation. (1) "Cost of ownership" means the actual expense incurred
for all of the following: (a) Depreciation and interest on any capital assets that
cost five hundred dollars or more per item, including the
following: (i) Buildings; (ii) Building improvements that are not approved as
nonextensive renovations under section 5111.25 or 5111.251 of the
Revised Code; (iii) Equipment; (iv) Extensive renovations; (v) Transportation equipment. (b) Amortization and interest on land improvements and
leasehold improvements; (c) Amortization of financing costs; (d) Except as provided in division (I) of this section, lease and rent of
land, building, and equipment. The costs of capital assets of less than five hundred dollars per item may be
considered costs of ownership in accordance with a provider's practice. (2) "Costs of nonextensive renovation" means the actual expense incurred for
depreciation or amortization and interest on renovations that are not
extensive renovations. (C) "Capital lease" and "operating lease" shall be construed in accordance
with generally accepted accounting principles. (D) "Case-mix score" means the measure determined under
section 5111.231 of the Revised Code of the relative direct-care
resources needed to provide care and habilitation to a resident
of a nursing facility or intermediate care facility for the
mentally retarded. (E) "Date of licensure," for a facility originally licensed as a
nursing home under Chapter 3721. of the Revised Code, means the
date specific beds were originally licensed as
nursing home beds under that chapter, regardless of whether they were
subsequently licensed as residential facility beds under section 5123.19
of the Revised Code. For a facility originally licensed as a
residential facility under section 5123.19 of the Revised Code,
"date of licensure" means the date specific beds were
originally licensed as residential facility beds under that section. (1) If nursing home beds licensed under Chapter 3721. of the Revised Code or
residential facility beds licensed under section 5123.19 of the Revised Code
were not required by law to be licensed when they were originally used to
provide nursing home or residential facility services, "date of licensure"
means the date the beds first were used to provide nursing home or residential
facility services, regardless of the date the present provider obtained
licensure. (2) If a facility adds nursing home beds or residential
facility beds or extensively renovates all or part of the
facility after its original date of licensure, it will have a
different date of licensure for the additional beds or
extensively renovated portion of the facility, unless the beds
are added in a space that was constructed at the same time as the
previously licensed beds but was not licensed under Chapter 3721.
or section 5123.19 of the Revised Code at that time. (F) "Desk-reviewed" means that costs as reported on a cost
report submitted under section 5111.26 of the Revised Code have
been subjected to a desk review under division (A) of section
5111.27 of the Revised Code and preliminarily determined to be
allowable costs. (G) "Direct care costs" means all of the following: (1)(a) Costs for registered nurses, licensed practical
nurses, and nurse aides employed by the facility; (b) Costs for direct care staff, administrative nursing
staff, medical directors, social services staff, activities
staff, psychologists and psychology assistants, social workers
and counselors, habilitation staff, qualified mental retardation
professionals, program directors, respiratory therapists,
habilitation supervisors, and except as provided in division
(G)(2) of this section, other persons holding degrees qualifying
them to provide therapy; (c) Costs of purchased nursing services; (d) Costs of quality assurance; (e) Costs of training and staff development, employee
benefits, payroll taxes, and workers' compensation premiums or
costs for self-insurance claims and related costs as specified in
rules adopted by the director of job
and family services in accordance with Chapter
119. of the Revised Code, for
personnel listed in
divisions (G)(1)(a), (b), and (d) of this section; (f) Costs of consulting and management fees related to direct care; (g) Allocated direct care home office costs. (2) In addition to the costs specified in division (G)(1)
of this section, for intermediate care facilities for the
mentally retarded only, direct care costs include both of the
following: (a) Costs for physical therapists and physical therapy
assistants, occupational therapists and occupational therapy
assistants, speech therapists, and audiologists; (b) Costs of training and staff development, employee
benefits, payroll taxes, and workers' compensation premiums or
costs for self-insurance claims and related costs as specified in
rules adopted by the director of job
and family services in accordance with Chapter
119. of the Revised Code, for personnel listed in division
(G)(2)(a) of this section. (3) Costs of other direct-care resources that are
specified as direct care costs in rules adopted by the
director of job and family services in accordance
with Chapter 119. of the Revised
Code. (H) "Fiscal year" means the fiscal year of this state, as
specified in section 9.34 of the Revised Code. (I) "Indirect care costs" means all reasonable costs other
than direct care costs, other protected costs, or capital costs.
"Indirect care costs" includes but is not limited to costs of
habilitation supplies, pharmacy consultants, medical and
habilitation records, program supplies, incontinence supplies,
food, enterals, dietary supplies and personnel, laundry,
housekeeping, security, administration, liability insurance,
bookkeeping, purchasing department, human resources,
communications, travel, dues, license fees, subscriptions, home
office costs not otherwise allocated, legal services, accounting services,
minor equipment,
maintenance and repairs, help-wanted advertising, informational
advertising, consumer satisfaction survey fees paid under section 173.55
of the Revised Code, start-up costs, organizational expenses, other
interest, property insurance, employee training and staff
development, employee benefits, payroll taxes, and workers' compensation
premiums or costs for self-insurance claims and related costs as
specified in rules adopted by the director of
job and family services in accordance
with Chapter 119. of the Revised Code, for personnel
listed in this division. Notwithstanding division (B)(1) of this
section, "indirect care costs" also means the cost of equipment,
including vehicles, acquired by operating lease executed before
December 1, 1992, if the costs are reported as administrative and
general costs on the facility's cost report for the cost
reporting period ending December 31, 1992. (J) "Inpatient days" means all days during which a
resident, regardless of payment source, occupies a bed in a
nursing facility or intermediate care facility for the mentally
retarded that is included in the facility's certified capacity
under Title XIX of the "Social Security Act," 49 Stat. 610
(1935), 42 U.S.C.A. 301, as amended. Therapeutic or hospital
leave days for which payment is made under section 5111.33 of the
Revised Code are considered inpatient days proportionate to the
percentage of the facility's per resident per day rate paid for
those days. (K) "Intermediate care facility for the mentally retarded"
means an intermediate care facility for the mentally retarded
certified as in compliance with applicable standards for the
medical assistance program by the director of health in
accordance with Title XIX of the "Social Security Act." (L) "Maintenance and repair expenses" means, except as
provided in division (X)(2) of this section, expenditures that
are necessary and proper to maintain an asset in a normally
efficient working condition and that do not extend the useful
life of the asset two years or more. "Maintenance and repair
expenses" includes but is not limited to the cost of ordinary
repairs such as painting and wallpapering. (M) "Nursing facility" means a facility, or a distinct
part of a facility, that is certified as a nursing facility by
the director of health in accordance with Title XIX of the
"Social Security Act," and is not an intermediate care facility
for the mentally retarded. "Nursing facility" includes a
facility, or a distinct part of a facility, that is certified as
a nursing facility by the director of health in accordance with
Title XIX of the "Social Security Act," and is certified as a
skilled nursing facility by the director in accordance with Title
XVIII of the "Social Security Act." (N) "Other protected costs" means costs for medical
supplies; real estate, franchise, and property taxes; natural
gas, fuel oil, water, electricity, sewage, and refuse and
hazardous medical waste collection; allocated other protected home office
costs;
and any additional costs
defined as other protected costs in rules adopted by the
director of job and family
services in accordance with Chapter 119. of
the Revised Code. (O) "Owner" means any person or government entity that has
at least five per cent ownership or interest, either directly,
indirectly, or in any combination, in a nursing facility or
intermediate care facility for the mentally retarded. (P) "Patient" includes "resident." (Q) Except as provided in divisions (Q)(1) and (2) of this
section, "per diem" means a nursing facility's or intermediate
care facility for the mentally retarded's actual, allowable costs
in a given cost center in a cost reporting period, divided by the
facility's inpatient days for that cost reporting period. (1) When calculating indirect care costs for the purpose
of establishing rates under section 5111.24 or 5111.241 of the
Revised Code, "per diem" means a facility's actual, allowable
indirect care costs in a cost reporting period divided by the
greater of the facility's inpatient days for that period or the
number of inpatient days the facility would have had during that
period if its occupancy rate had been eighty-five per cent. (2) When calculating capital costs for the purpose of
establishing rates under section 5111.25 or 5111.251 of the
Revised Code, "per diem" means a facility's actual, allowable
capital costs in a cost reporting period divided by the greater
of the facility's inpatient days for that period or the number of
inpatient days the facility would have had during that period if
its occupancy rate had been ninety-five per cent. (R) "Provider" means a person or government entity that
operates a nursing facility or intermediate care facility for the
mentally retarded under a provider agreement. (S) "Provider agreement" means a contract between the
department of job and family services and a nursing facility or
intermediate care facility for the mentally retarded for the
provision of nursing facility services or intermediate care
facility services for the mentally retarded under the medical
assistance program. (T) "Purchased nursing services" means services that are
provided in a nursing facility by registered nurses, licensed
practical nurses, or nurse aides who are not employees of the
facility. (U) "Reasonable" means that a cost is an actual cost that
is appropriate and helpful to develop and maintain the operation
of patient care facilities and activities, including normal
standby costs, and that does not exceed what a prudent buyer pays
for a given item or services. Reasonable costs may vary from
provider to provider and from time to time for the same provider. (V) "Related party" means an individual or organization
that, to a significant extent, has common ownership with, is
associated or affiliated with, has control of, or is controlled
by, the provider. (1) An individual who is a relative of an owner is a
related party. (2) Common ownership exists when an individual or
individuals possess significant ownership or equity in both the
provider and the other organization. Significant ownership or
equity exists when an individual or individuals possess five per
cent ownership or equity in both the provider and a supplier.
Significant ownership or equity is presumed to exist when an
individual or individuals possess ten per cent ownership or
equity in both the provider and another organization from which
the provider purchases or leases real property. (3) Control exists when an individual or organization has
the power, directly or indirectly, to significantly influence or
direct the actions or policies of an organization. (4) An individual or organization that supplies goods or
services to a provider shall not be considered a related party if
all of the following conditions are met: (a) The supplier is a separate bona fide organization. (b) A substantial part of the supplier's business activity
of the type carried on with the provider is transacted with
others than the provider and there is an open, competitive market
for the types of goods or services the supplier furnishes. (c) The types of goods or services are commonly obtained
by other nursing facilities or intermediate care facilities for
the mentally retarded from outside organizations and are not a
basic element of patient care ordinarily furnished directly to
patients by the facilities. (d) The charge to the provider is in line with the charge
for the goods or services in the open market and no more than the
charge made under comparable circumstances to others by the
supplier. (W) "Relative of owner" means an individual who is related
to an owner of a nursing facility or intermediate care facility
for the mentally retarded by one of the following relationships: (1) Spouse; (2) Natural parent, child, or sibling; (3) Adopted parent, child, or sibling; (4) Step-parent, step-child, step-brother, or step-sister; (5) Father-in-law, mother-in-law, son-in-law,
daughter-in-law, brother-in-law, or sister-in-law; (6) Grandparent or grandchild; (7) Foster parent, foster child, foster brother, or foster
sister. (X) "Renovation" and "extensive renovation" mean: (1) Any betterment, improvement, or restoration of a
nursing facility or intermediate care facility for the mentally
retarded started before July 1, 1993, that meets the definition
of a renovation or extensive renovation established in rules
adopted by the director of job and
family services in effect on December 22, 1992. (2) In the case of betterments, improvements, and
restorations of nursing facilities and intermediate care
facilities for the mentally retarded started on or after July 1,
1993: (a) "Renovation" means the betterment, improvement, or
restoration of a nursing facility or intermediate care facility
for the mentally retarded beyond its current functional capacity
through a structural change that costs at least five hundred
dollars per bed. A renovation may include betterment,
improvement, restoration, or replacement of assets that are
affixed to the building and have a useful life of at least five
years. A renovation may include costs that otherwise would be
considered maintenance and repair expenses if they are an
integral part of the structural change that makes up the
renovation project. "Renovation" does not mean construction of
additional space for beds that will be added to a facility's
licensed or certified capacity. (b) "Extensive renovation" means a renovation that costs
more than sixty-five per cent and no more than eighty-five per
cent of the cost of constructing a new bed and that extends the
useful life of the assets for at least ten years. For the purposes of division (X)(2) of this section, the
cost of constructing a new bed shall be considered to be forty
thousand dollars, adjusted for the estimated rate of inflation
from January 1, 1993, to the end of the calendar year during
which the renovation is completed, using the consumer price index
for shelter costs for all urban consumers for the north central
region, as published by the United States bureau of labor
statistics. The department of job and family services may treat a renovation
that costs more than eighty-five per cent of the cost of
constructing new beds as an extensive renovation if the
department determines that the renovation is more prudent than
construction of new beds. Sec. 5111.25. (A) The department of job and family
services shall pay each eligible nursing facility a per resident per day rate
for its reasonable capital costs established prospectively each fiscal year
for each facility. Except as otherwise provided in sections 5111.20 to
5111.32 of the Revised Code, the rate shall be based on the facility's capital
costs for the calendar year preceding the fiscal year in which the rate will
be paid. The rate shall equal the sum of divisions (A)(1) to (3) of this
section: (1) The lesser of the following: (a) Eighty-eight and sixty-five one-hundredths per cent of
the facility's desk-reviewed, actual, allowable, per diem cost of
ownership and eighty-five per cent of the facility's actual,
allowable, per diem cost of nonextensive renovation determined
under division (F) of this section; (b) Eighty-eight and sixty-five one-hundredths per cent of the following
limitation: (i) For the fiscal year beginning July 1, 1993, sixteen
dollars per resident day; (ii) For the fiscal year beginning July 1, 1994, sixteen
dollars per resident day, adjusted to reflect the rate of
inflation for the twelve-month period beginning July 1, 1992, and
ending June 30, 1993, using the consumer price index for shelter
costs for all urban consumers for the north central region,
published by the United States bureau of labor statistics; (iii) For subsequent fiscal years, the limitation in
effect during the previous fiscal year, adjusted to reflect the
rate of inflation for the twelve-month period beginning on the
first day of July for the calendar year preceding the calendar
year that precedes the fiscal year and ending on the following
thirtieth day of June, using the consumer price index for shelter
costs for all urban consumers for the north central region,
published by the United States bureau of labor statistics. (2) Any efficiency incentive determined under division (D)
of this section; (3) Any amounts for return on equity determined under
division (H) of this section. Buildings shall be depreciated using the straight line
method over forty years or over a different period approved by
the department. Components and equipment shall be depreciated
using the straight-line method over a period designated in rules
adopted by the director of job and family services in
accordance with Chapter 119. of the
Revised Code, consistent with the guidelines of the American
hospital association, or over a different period approved by the
department. Any rules adopted under this division that specify
useful lives of buildings, components, or equipment apply only to
assets acquired on or after July 1, 1993. Depreciation for costs
paid or reimbursed by any government agency shall not be included
in cost of ownership or renovation unless that part of the
payment under sections 5111.20 to 5111.32 of the Revised Code is
used to reimburse the government agency. (B) The capital cost basis of nursing facility assets
shall be determined in the following manner: (1) For purposes of calculating the rate to be paid for the
fiscal year beginning July 1, 1993, for facilities
with dates of licensure on or before
June 30, 1993, the capital cost basis shall be equal to the
following: (a) For facilities that have not had a change of ownership
during the period beginning January 1, 1993, and ending June 30,
1993, the desk-reviewed, actual, allowable capital cost basis
that is listed on the facility's cost report for the cost
reporting period ending December 31, 1992, plus the actual,
allowable capital cost basis of any assets constructed or
acquired after December 31, 1992, but before July 1, 1993, if the
aggregate capital costs of those assets would increase the
facility's rate for capital costs by twenty or more cents per
resident per day. (b) For facilities that have a date of licensure or had a
change of ownership during the period beginning January 1, 1993,
and ending June 30, 1993, the actual, allowable capital cost
basis of the person or government entity that owns the facility
on June 30, 1993. Capital cost basis shall be calculated as provided in
division (B)(1) of this section subject to approval by the United
States health care financing administration of any necessary
amendment to the state plan for providing medical assistance. The department shall include the actual, allowable capital
cost basis of assets constructed or acquired during the period
beginning January 1, 1993, and ending June 30, 1993, in the
calculation for the facility's rate effective July 1, 1993, if
the aggregate capital costs of the assets would increase the
facility's rate by twenty or more cents per resident per day and
the facility provides the department with sufficient
documentation of the costs before June 1, 1993. If the facility
provides the documentation after that date, the department shall
adjust the facility's rate to reflect the costs of the assets one
month after the first day of the month after the department
receives the documentation. (2) Except as provided in division (B)(4) of this
section, for purposes of calculating the rates to be paid for
fiscal years beginning after June 30, 1994, for
facilities with dates of licensure on or before June 30,
1993, the capital cost basis of each asset shall be equal to the
desk-reviewed, actual, allowable, capital cost basis that is
listed on the facility's cost report for the calendar year
preceding the fiscal year during which the rate will be paid. (3) For facilities with dates of licensure after June
30, 1993, the capital cost basis shall be determined in
accordance
with the principles of the medicare program established under
Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42
U.S.C.A. 301, as amended, except as otherwise provided in
sections 5111.20 to 5111.32 of the Revised Code. (4) Except as provided in division (B)(5) of this
section, if a provider transfers an interest in a facility to
another provider
after June 30, 1993, there shall be no increase in the capital
cost basis of the asset if the providers are related parties. If
the providers are not related parties or if they are related parties and
division (B)(5) of this section requires the adjustment of the
capital cost basis under this division, the basis of the asset
shall be adjusted by the lesser of the following: (a) One-half of the change in construction costs during
the time that the transferor held the asset, as calculated by the
department of job and family services using the "Dodge
building cost indexes, northeastern and north central states," published by
Marshall and Swift; (b) One-half of the change in the consumer price index for
all items for all urban consumers, as published by the United
States bureau of labor statistics, during the time that the
transferor held the asset. (5) If a provider transfers an interest in a
facility to another provider who is a related party, the capital cost basis of
the asset
shall be adjusted as specified in division
(B)(4) of this section for a transfer to a provider that is not a
related party if all of the following conditions are met: (a) The related party is a relative
of owner; (b) The Except as provided in division
(B)(5)(c)(ii) of this section, the
provider making the transfer
retains no ownership interest in the facility; (c) The United States internal revenue service
has issued a ruling department of job and family services
determines that the transfer is an arm's length
transaction for purposes of federal income taxation;
pursuant to
rules the department shall adopt in accordance with Chapter 119.
of the Revised Code no later than December 31,
2000. The rules
shall provide that a transfer is an arm's length transaction if all of
the following apply: (i) Once the transfer goes into effect, the provider that made
the transfer has no direct or indirect interest in the provider that acquires the facility or the
facility itself, including interest as an owner, officer, director, employee, independent contractor,
or consultant, but excluding interest as a creditor. (ii) The provider that made the transfer does not reacquire an
interest in the facility except through the exercise of a creditor's rights in the event of a default.
If the provider reacquires an interest in the facility in this
manner, the department shall treat the facility as if the transfer
never occurred when the department calculates its reimbursement
rates for capital costs. (iii) The transfer satisfies any other criteria specified in the
rules. (d) Except in the case of hardship
caused by a catastrophic event, as determined by the department,
or in the 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 the same
facility, the capital cost basis was adjusted most recently under division
(B)(5) of this section or
actual, allowable cost of ownership was determined most recently under
division
(C)(9) of this section. (C) As used in this division, "lease expense" means lease
payments in the case of an operating lease and depreciation
expense and interest expense in the case of a capital lease. As
used in this division, "new lease" means a lease, to a different
lessee, of a nursing facility that previously was operated under
a lease. (1) Subject to the limitation specified in division (A)(1)
of this section, for a lease of a facility that was effective on
May 27, 1992, the entire lease expense is an actual, allowable
cost of ownership during the term of the existing lease. The
entire lease expense also is an actual, allowable cost of
ownership if a lease in existence on May 27, 1992, is renewed
under either of the following circumstances: (a) The renewal is pursuant to a renewal option that was
in existence on May 27, 1992; (b) The renewal is for the same lease payment amount and
between the same parties as the lease in existence on May 27,
1992. (2) Subject to the limitation specified in division (A)(1)
of this section, for a lease of a facility that was in existence
but not operated under a lease on May 27, 1992, actual, allowable
cost of ownership shall include the lesser of the annual lease
expense or the annual depreciation expense and imputed interest
expense that would be calculated at the inception of the lease
using the lessor's entire historical capital asset cost basis,
adjusted by the lesser of the following amounts: (a) One-half of the change in construction costs during
the time the lessor held each asset until the beginning of the
lease, as calculated by the department using the "Dodge building
cost indexes, northeastern and north central states," published
by Marshall and Swift; (b) One-half of the change in the consumer price index for
all items for all urban consumers, as published by the United
States bureau of labor statistics, during the time the lessor
held each asset until the beginning of the lease. (3) Subject to the limitation specified in division (A)(1)
of this section, for a lease of a facility with a date of
licensure on or after May 27, 1992, that is initially operated
under a lease, actual, allowable cost of ownership shall include
the annual lease expense if there was a substantial commitment of
money for construction of the facility after December 22, 1992,
and before July 1, 1993. If there was not a substantial
commitment of money after December 22, 1992, and before July 1,
1993, actual, allowable cost of ownership shall include the
lesser of the annual lease expense or the sum of the following: (a) The annual depreciation expense that would be
calculated at the inception of the lease using the lessor's
entire historical capital asset cost basis; (b) The greater of the lessor's actual annual amortization
of financing costs and interest expense at the inception of the
lease or the imputed interest expense calculated at the inception
of the lease using seventy per cent of the lessor's historical
capital asset cost basis. (4) Subject to the limitation specified in division (A)(1)
of this section, for a lease of a facility with a date of
licensure on or after May 27, 1992, that was not initially
operated under a lease and has been in existence for ten years,
actual, allowable cost of ownership shall include the lesser of
the annual lease expense or the annual depreciation expense and
imputed interest expense that would be calculated at the
inception of the lease using the entire historical capital asset
cost basis of the lessor, adjusted by the lesser of the
following: (a) One-half of the change in construction costs during
the time the lessor held each asset until the beginning of the
lease, as calculated by the department using the "Dodge building
cost indexes, northeastern and north central states," published
by Marshall and Swift; (b) One-half of the change in the consumer price index for
all items for all urban consumers, as published by the United
States bureau of labor statistics, during the time the lessor
held each asset until the beginning of the lease. (5) Subject to the limitation specified in division (A)(1)
of this section, for a new lease of a facility that was operated
under a lease on May 27, 1992, actual, allowable cost of
ownership shall include the lesser of the annual new lease
expense or the annual old lease payment. If the old lease was in
effect for ten years or longer, the old lease payment from the
beginning of the old lease shall be adjusted by the lesser of the
following: (a) One-half of the change in construction costs from the
beginning of the old lease to the beginning of the new lease, as
calculated by the department using the "Dodge building cost
indexes, northeastern and north central states," published by
Marshall and Swift; (b) One-half of the change in the consumer price index for
all items for all urban consumers, as published by the United
States bureau of labor statistics, from the beginning of the old
lease to the beginning of the new lease. (6) Subject to the limitation specified in division (A)(1)
of this section, for a new lease of a facility that was not in
existence or that was in existence but not operated under a lease
on May 27, 1992, actual, allowable cost of ownership shall
include the lesser of annual new lease expense or the annual
amount calculated for the old lease under division (C)(2), (3),
(4), or (6) of this section, as applicable. If the old lease was
in effect for ten years or longer, the lessor's historical
capital asset cost basis shall be adjusted by the lesser of the
following for purposes of calculating the annual amount under
division (C)(2), (3), (4), or (6) of this section: (a) One-half of the change in construction costs from the
beginning of the old lease to the beginning of the new lease, as
calculated by the department using the "Dodge building cost
indexes, northeastern and north central states," published by
Marshall and Swift; (b) One-half of the change in the consumer price index for
all items for all urban consumers, as published by the United
States bureau of labor statistics, from the beginning of the old
lease to the beginning of the new lease. In the case of a lease under division (C)(3) of this
section of a facility for which a substantial commitment of money
was made after December 22, 1992, and before July 1, 1993, the
old lease payment shall be adjusted for the purpose of
determining the annual amount. (7) For any revision of a lease described in division
(C)(1), (2), (3), (4), (5), or (6) of this section, or for any
subsequent lease of a facility operated under such a lease, other
than execution of a new lease, the portion of actual, allowable
cost of ownership attributable to the lease shall be the same as
before the revision or subsequent lease. (8) Except as provided in division
(C)(9) of this section, if a
provider leases an interest in a facility to another provider who is a related
party,
the related party's actual, allowable cost of ownership shall
include the lesser of the annual lease expense or the reasonable
cost to the lessor. (9) If a provider leases an interest in a facility to another provider who
is a
related party, regardless of the date of the lease, the related
party's actual, allowable cost of ownership shall include the annual lease
expense, subject to the limitations specified in divisions
(C)(1) to (7) of this section,
if all of the following conditions are met: (a) The related party is a relative of owner; (b) If the lessor retains an
ownership interest, it is, except as provided in division
(C)(9)(c)(ii) of this section, in
only the real property and any improvements
on the real property; (c) The United States internal revenue service
has issued a ruling department of job and family services
determines that the lease is an arm's length transaction
for purposes of federal income taxation;
pursuant to
rules the department shall adopt in accordance with Chapter 119.
of the Revised Code no later than December 31,
2000. The rules
shall provide that a lease is an arm's length transaction if all of the
following apply: (i) Once the lease goes into effect, the lessor has no direct or
indirect interest in the lessee or, except as provided in division
(C)(9)(b) of this section, the facility itself,
including
interest as an owner, officer, director, employee, independent contractor, or
consultant, but excluding interest
as a lessor. (ii) The lessor does not reacquire an interest in the facility
except through the exercise of a lessor's rights in the event of a default. If the lessor reacquires
an interest in the facility in this manner, the department shall
treat the facility as if the lease never occurred when the
department calculates its reimbursement rates for capital costs. (iii) The lease satisfies any other criteria specified in the
rules. (d) Except in the case of hardship
caused by a catastrophic event, as determined by the department,
or in the 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, the
capital cost basis was adjusted most recently under division
(B)(5) of this section or
actual, allowable cost of ownership was determined most recently under
division
(C)(9) of this section. (10) This division does not apply to leases of specific
items of equipment. (D)(1) Subject to division (D)(2) of this section, the department shall pay
each nursing facility an efficiency incentive that is equal to fifty per cent
of the difference between the following: (a) Eighty-eight and sixty-five one-hundredths per cent of the facility's
desk-reviewed, actual, allowable, per diem cost of ownership; (b) The applicable amount specified in division (E) of
this section. (2) The efficiency incentive paid to a
nursing facility shall not exceed the greater of the following: (a) The efficiency incentive the facility was paid
during the fiscal year ending June 30, 1994; (b) Three dollars per resident per day, adjusted
annually for rates paid beginning July 1, 1994, for the
inflation rate for the twelve-month period beginning on the first
day of July of the calendar year preceding the calendar
year that precedes the fiscal year for which the efficiency
incentive is determined and ending on the thirtieth day of the
following June, using the consumer price index for
shelter costs for all urban consumers for the north central
region, as published by the United States
bureau of labor statistics. (3) For purposes of calculating the efficiency
incentive,
depreciation for costs that are paid or reimbursed by any
government agency shall be considered as costs of ownership, and
renovation costs that are paid under division (F) of this section
shall not be considered costs of ownership. (E) The following amounts shall be used to calculate
efficiency incentives for nursing facilities under this section: (1) For facilities with dates of licensure prior to
January 1, 1958, four dollars and twenty-four cents per patient
day; (2) For facilities with dates of licensure after December
31, 1957, but prior to January 1, 1968: (a) Five dollars and twenty-four cents per patient day if
the cost of construction was three thousand five hundred dollars
or more per bed; (b) Four dollars and twenty-four cents per patient day if
the cost of construction was less than three thousand five
hundred dollars per bed. (3) For facilities with dates of licensure after December
31, 1967, but prior to January 1, 1976: (a) Six dollars and twenty-four cents per patient day if
the cost of construction was five thousand one hundred fifty
dollars or more per bed; (b) Five dollars and twenty-four cents per patient day if
the cost of construction was less than five thousand one hundred
fifty dollars per bed, but exceeded three thousand five hundred
dollars per bed; (c) Four dollars and twenty-four cents per patient day if
the cost of construction was three thousand five hundred dollars
or less per bed. (4) For facilities with dates of licensure after December
31, 1975, but prior to January 1, 1979: (a) Seven dollars and twenty-four cents per patient day if
the cost of construction was six thousand eight hundred dollars
or more per bed; (b) Six dollars and twenty-four cents per patient day if
the cost of construction was less than six thousand eight hundred
dollars per bed but exceeded five thousand one hundred fifty
dollars per bed; (c) Five dollars and twenty-four cents per patient day if
the cost of construction was five thousand one hundred fifty
dollars or less per bed, but exceeded three thousand five hundred
dollars per bed; (d) Four dollars and twenty-four cents per patient day if
the cost of construction was three thousand five hundred dollars
or less per bed. (5) For facilities with dates of licensure after December
31, 1978, but prior to January 1, 1981: (a) Seven dollars and seventy-four cents per patient day
if the cost of construction was seven thousand six hundred
twenty-five dollars or more per bed; (b) Seven dollars and twenty-four cents per patient day if
the cost of construction was less than seven thousand six hundred
twenty-five dollars per bed but exceeded six thousand eight
hundred dollars per bed; (c) Six dollars and twenty-four cents per patient day if
the cost of construction was six thousand eight hundred dollars
or less per bed but exceeded five thousand one hundred fifty
dollars per bed; (d) Five dollars and twenty-four cents per patient day if
the cost of construction was five thousand one hundred fifty
dollars or less but exceeded three thousand five hundred dollars
per bed; (e) Four dollars and twenty-four cents per patient day if
the cost of construction was three thousand five hundred dollars
or less per bed. (6) For facilities with dates of licensure in 1981 or any
year thereafter prior to December 22, 1992, the following amount: (a) For facilities with construction costs less than seven
thousand six hundred twenty-five dollars per bed, the applicable
amounts for the construction costs specified in divisions
(E)(5)(b) to (e) of this section; (b) For facilities with construction costs of seven
thousand six hundred twenty-five dollars or more per bed, six
dollars per patient day, provided that for 1981 and annually
thereafter prior to December 22, 1992, department shall do both
of the following to the six-dollar amount: (i) Adjust the amount for fluctuations in construction
costs calculated by the department using the "Dodge building cost
indexes, northeastern and north central states," published by
Marshall and Swift, using 1980 as the base year; (ii) Increase the amount, as adjusted for inflation under
division (E)(6)(b)(i) of this section, by one dollar and
seventy-four cents. (7) For facilities with dates of licensure on or after
January 1, 1992, seven dollars and ninety-seven cents, adjusted
for fluctuations in construction costs between 1991 and 1993 as
calculated by the department using the "Dodge building cost
indexes, northeastern and north central states," published by
Marshall and Swift, and then increased by one dollar and
seventy-four cents. For the fiscal year that begins July 1, 1994, each of the
amounts listed in divisions (E)(1) to (7) of this section shall
be increased by twenty-five cents. For the fiscal year that
begins July 1, 1995, each of those amounts shall be increased by
an additional twenty-five cents. For subsequent fiscal years,
each of those amounts, as increased for the prior fiscal year,
shall be adjusted to reflect the rate of inflation for the
twelve-month period beginning on the first day of July of the
calendar year preceding the calendar year that precedes the
fiscal year and ending on the following thirtieth day of June,
using the consumer price index for shelter costs for all urban
consumers for the north central region, as published by the
United States bureau of labor statistics. If the amount established for a nursing facility under this
division is less than the amount that applied to the facility
under division (B) of former section 5111.25 of the Revised Code,
as the former section existed immediately prior to December 22,
1992, the amount used to calculate the efficiency incentive for
the facility under division (D)(2) of this section shall be the
amount that was calculated under division (B) of the former
section. (F) Beginning July 1, 1993, regardless of the facility's
date of licensure or the date of the nonextensive renovations,
the rate for the costs of nonextensive renovations for nursing
facilities shall be eighty-five per cent of the desk-reviewed,
actual, allowable, per diem, nonextensive renovation costs. This
division applies to nonextensive renovations regardless of
whether they are made by an owner or a lessee. If the tenancy of
a lessee that has made nonextensive renovations ends before the
depreciation expense for the renovation costs has been fully
reported, the former lessee shall not report the undepreciated
balance as an expense. (1) For a nonextensive renovation made after July 1, 1993,
to qualify for payment under this division, both of the following
conditions must be met: (a) At least five years have elapsed since the date of
licensure of the portion of the facility that is proposed to be
renovated, except that this condition does not apply if the
renovation is necessary to meet the requirements of federal,
state, or local statutes, ordinances, rules, or policies. (b) The provider has obtained prior approval from the
department of job and family services, and if required
the director of health has granted a certificate of need for the renovation
under section 3702.52 of the Revised Code. The provider shall submit a
plan that describes in detail the changes in capital assets to be
accomplished by means of the renovation and the timetable for
completing the project. The time for completion of the project
shall be no more than eighteen months after the renovation
begins. The department of job and family services shall
adopt rules in accordance with Chapter 119. of the Revised Code that specify
criteria and procedures for prior approval of renovation
projects. No provider shall separate a project with the intent
to evade the characterization of the project as a renovation or
as an extensive renovation. No provider shall increase the scope
of a project after it is approved by the department of job and
family services unless the increase in scope is approved by the
department. (2) The payment provided for in this division is the only
payment that shall be made for the costs of a nonextensive
renovation. Nonextensive renovation costs shall not be included
in costs of ownership, and a nonextensive renovation shall not
affect the date of licensure for purposes of calculating the
efficiency incentive under divisions (D) and (E) of this section. (G) The owner of a nursing facility operating under a
provider agreement shall provide written notice to the department
of job and family services at least forty-five days prior
to entering into any contract of sale for the facility or voluntarily
terminating participation in the medical assistance program. After the date
on which a transaction of sale is closed, the owner shall refund to the
department the amount of excess depreciation paid to the facility by the
department for each year the owner has operated the facility under a provider
agreement and prorated according to the number of medicaid patient days for
which the facility has received payment. If a nursing facility is sold after
five or fewer years of operation under a provider
agreement, the refund to the
department shall be equal to the excess depreciation paid to the facility. If
a nursing facility is sold after more than five years but less than ten years
of operation under a provider agreement, the refund to the department shall
equal the excess depreciation paid to the facility multiplied by
twenty per cent, multiplied by the difference between ten and the
number of years that the facility was operated under a provider
agreement. If a nursing facility is sold after ten or more years
of operation under a provider agreement, the owner shall not
refund any excess depreciation to the department. The
owner of a facility that is sold or that
voluntarily terminates participation in the medical assistance
program also shall refund any other amount that the department
properly finds to be due after the audit conducted under this
division. For the purposes of this division, "depreciation paid
to the facility" means the amount paid to the nursing facility
for cost of ownership pursuant to this section less any amount
paid for interest costs, amortization of financing
costs, and lease expenses. For the purposes of this
division, "excess depreciation" is the nursing facility's depreciated
basis, which is the owner's cost less accumulated depreciation,
subtracted from the purchase price net of selling costs
but not exceeding the amount
of depreciation paid to the facility. A cost report shall be filed with the department within
ninety days after the date on which the transaction of sale is
closed or participation is voluntarily terminated. The report
shall show the accumulated depreciation, the sales price, and
other information required by the department. The amount of the
last two monthly payments to a nursing facility made pursuant to
division (A)(1) of section 5111.22 of the Revised Code before a
sale or termination of participation shall be held in escrow by a
bank, trust company, or savings and loan association, except that
if the amount the owner will be required to refund under this
section is likely to be less than the amount of the last two
monthly payments, the department shall take one of the following
actions instead of withholding the amount of the last two monthly
payments: (1) In the case of an owner that owns other facilities
that participate in the medical assistance program, obtain a
promissory note in an amount sufficient to cover the amount
likely to be refunded; (2) In the case of all other owners, withhold the amount
of the last monthly payment to the nursing facility. The department shall, within ninety days following the
filing of the cost report, audit the cost report and issue an
audit report to the owner. The department also may audit any
other cost report that the facility has filed during the previous
three years. In the audit report, the department shall state its
findings and the amount of any money owed to the department by
the nursing facility. The findings shall be subject to
adjudication conducted in accordance with Chapter 119. of the
Revised Code. No later than fifteen days after the owner agrees
to a settlement, any funds held in escrow less any amounts due to
the department shall be released to the owner and amounts due to
the department shall be paid to the department. If the amounts
in escrow are less than the amounts due to the department, the
balance shall be paid to the department within fifteen days after
the owner agrees to a settlement. If the department does not
issue its audit report within the ninety-day period, the
department shall release any money held in escrow to the owner.
For the purposes of this section, a transfer of corporate stock,
the merger of one corporation into another, or a consolidation
does not constitute a sale. If a nursing facility is not sold or its participation is
not terminated after notice is provided to the department under
this division, the department shall order any payments held in
escrow released to the facility upon receiving written notice
from the owner that there will be no sale or termination. After
written notice is received from a nursing facility that a sale or
termination will not take place, the facility shall provide
notice to the department at least forty-five days prior to
entering into any contract of sale or terminating participation
at any future time. (H) The department shall pay each eligible proprietary
nursing facility a return on the facility's net equity computed
at the rate of one and one-half times the average interest rate
on special issues of public debt obligations issued to the
federal hospital insurance trust fund for the cost reporting
period, except that no facility's return on net equity shall
exceed one dollar per patient day. When calculating the rate for return on net equity, the
department shall use the greater of the facility's inpatient days
during the applicable cost reporting period or the number of
inpatient days the facility would have had during that period if
its occupancy rate had been ninety-five per cent. (I) If a nursing facility would receive a lower rate for
capital costs for assets in the facility's possession on July 1,
1993, under this section than it would receive under former
section 5111.25 of the Revised Code, as the former section
existed immediately prior to December 22, 1992, the facility
shall receive for those assets the rate it would have received
under the former section for each fiscal year beginning on or
after July 1, 1993, until the rate it would receive under this
section exceeds the rate it would have received under the former
section. Any facility that receives a rate calculated under the
former section 5111.25 of the Revised Code for assets in the
facility's possession on July 1, 1993, also shall receive a rate
calculated under this section for costs of any assets it
constructs or acquires after July 1, 1993. Sec. 5111.251. (A) The department of job and family
services shall pay each eligible intermediate care facility for the mentally
retarded for its reasonable capital costs, a per resident per day
rate established prospectively each fiscal year for each
intermediate care facility for the mentally retarded. Except as
otherwise provided in sections 5111.20 to 5111.32 of the Revised
Code, the rate shall be based on the facility's capital costs for
the calendar year preceding the fiscal year in which the rate
will be paid. The rate shall equal the sum of the following: (1) The facility's desk-reviewed, actual, allowable, per
diem cost of ownership for the preceding cost reporting period,
limited as provided in divisions (C) and (F) of this section; (2) Any efficiency incentive determined under division (B)
of this section; (3) Any amounts for renovations determined under division
(D) of this section; (4) Any amounts for return on equity determined under
division (I) of this section. Buildings shall be depreciated using the straight line
method over forty years or over a different period approved by
the department. Components and equipment shall be depreciated
using the straight line method over a period designated by the
director of job and family services in rules adopted
in accordance with Chapter 119. of
the Revised Code, consistent with the guidelines of the American
hospital association, or over a different period approved by the
department of job and family services. Any rules adopted
under this division that specify
useful lives of buildings, components, or equipment apply only to
assets acquired on or after July 1, 1993. Depreciation for costs
paid or reimbursed by any government agency shall not be included
in costs of ownership or renovation unless that part of the
payment under sections 5111.20 to 5111.32 of the Revised Code is
used to reimburse the government agency. (B) The department of job and family services shall pay
to each intermediate care facility for the mentally retarded an efficiency
incentive equal
to fifty per cent of the difference between any desk-reviewed,
actual, allowable cost of ownership and the applicable limit on
cost of ownership payments under division (C) of this section. For purposes
of computing the efficiency incentive, depreciation for costs paid or
reimbursed by any government agency shall be considered as a cost of
ownership, and the applicable limit under division (C) of this section shall
apply both to facilities with more than eight beds and facilities with eight
or fewer beds. The efficiency incentive paid to a facility with eight or
fewer beds shall not exceed
three dollars per patient day, adjusted annually for the
inflation rate for the twelve-month period beginning on the first
day of July of the calendar year preceding the calendar year that
precedes the fiscal year for which the efficiency incentive is
determined and ending on the thirtieth day of the following June,
using the consumer price index for shelter costs for all urban
consumers for the north central region, as published by the
United States bureau of labor statistics. (C) Cost of ownership payments to intermediate care
facilities for the mentally retarded with more than eight beds
shall not exceed the following limits: (1) For facilities with dates of licensure prior to
January 1, l958, not exceeding two dollars and fifty cents per
patient day; (2) For facilities with dates of licensure after December
31, l957, but prior to January 1, l968, not exceeding: (a) Three dollars and fifty cents per patient day if the
cost of construction was three thousand five hundred dollars or
more per bed; (b) Two dollars and fifty cents per patient day if the
cost of construction was less than three thousand five hundred
dollars per bed. (3) For facilities with dates of licensure after December
31, l967, but prior to January 1, l976, not exceeding: (a) Four dollars and fifty cents per patient day if the
cost of construction was five thousand one hundred fifty dollars
or more per bed; (b) Three dollars and fifty cents per patient day if the
cost of construction was less than five thousand one hundred
fifty dollars per bed, but exceeds three thousand five hundred
dollars per bed; (c) Two dollars and fifty cents per patient day if the
cost of construction was three thousand five hundred dollars or
less per bed. (4) For facilities with dates of licensure after December
31, l975, but prior to January 1, l979, not exceeding: (a) Five dollars and fifty cents per patient day if the
cost of construction was six thousand eight hundred dollars or
more per bed; (b) Four dollars and fifty cents per patient day if the
cost of construction was less than six thousand eight hundred
dollars per bed but exceeds five thousand one hundred fifty
dollars per bed; (c) Three dollars and fifty cents per patient day if the
cost of construction was five thousand one hundred fifty dollars
or less per bed, but exceeds three thousand five hundred dollars
per bed; (d) Two dollars and fifty cents per patient day if the
cost of construction was three thousand five hundred dollars or
less per bed. (5) For facilities with dates of licensure after December
31, l978, but prior to January 1, l980, not exceeding: (a) Six dollars per patient day if the cost of
construction was seven thousand six hundred twenty-five dollars
or more per bed; (b) Five dollars and fifty cents per patient day if the
cost of construction was less than seven thousand six hundred
twenty-five dollars per bed but exceeds six thousand eight
hundred dollars per bed; (c) Four dollars and fifty cents per patient day if the
cost of construction was six thousand eight hundred dollars or
less per bed but exceeds five thousand one hundred fifty dollars
per bed; (d) Three dollars and fifty cents per patient day if the
cost of construction was five thousand one hundred fifty dollars
or less but exceeds three thousand five hundred dollars per bed; (e) Two dollars and fifty cents per patient day if the
cost of construction was three thousand five hundred dollars or
less per bed. (6) For facilities with dates of licensure after
December 31, 1979, but prior to
January 1, 1981, not exceeding: (a) Twelve dollars per patient day if the beds were originally licensed as
residential facility beds by the department of mental retardation and
developmental disabilities; (b) Six dollars per patient day if the beds were originally
licensed as nursing home beds by the department of health. (7) For facilities with dates of licensure after December 31,
1980, but prior to January 1, 1982, not exceeding: (a) Twelve dollars per patient day if the beds were originally
licensed as residential facility beds by the department of mental retardation
and developmental disabilities; (b) Six dollars and forty-five cents per patient day if the beds
were originally licensed as nursing home beds by the department of health. (8) For facilities with dates of licensure after December 31,
1981, but prior to January 1, 1983, not exceeding: (a) Twelve dollars per patient day if the beds were originally
licensed as residential facility beds by the department of mental retardation
and developmental disabilities; (b) Six dollars and seventy-nine cents per patient day if the beds
were originally licensed as nursing home beds by the department of health. (9) For facilities with dates of licensure after December 31,
1982, but prior to January 1, 1984, not exceeding: (a) Twelve dollars per patient day if the beds were originally
licensed as residential facility beds by the department of mental retardation
and developmental disabilities; (b) Seven dollars and nine cents per patient day if the beds were
originally licensed as nursing home beds by the department of health. (10) For facilities with dates of licensure after December 31,
1983, but prior to January 1, 1985, not exceeding: (a) Twelve dollars and twenty-four cents per patient day if the
beds were originally
licensed as residential facility beds by the department of mental retardation
and developmental disabilities; (b) Seven dollars and twenty-three cents per patient day if the
beds were
originally licensed as nursing home beds by the department of health. (11) For facilities with dates of licensure after December 31,
1984, but prior to January 1, 1986, not exceeding: (a) Twelve dollars and fifty-three cents per patient day if the
beds were originally
licensed as residential facility beds by the department of mental retardation
and developmental disabilities; (b) Seven dollars and forty cents per patient day if the
beds were
originally licensed as nursing home beds by the department of health. (12) For facilities with dates of licensure after December 31,
1985, but prior to January 1, 1987, not exceeding: (a) Twelve dollars and seventy cents per patient day if the
beds were originally
licensed as residential facility beds by the department of mental retardation
and developmental disabilities; (b) Seven dollars and fifty cents per patient day if the
beds were
originally licensed as nursing home beds by the department of health. (13) For facilities with dates of licensure after December 31,
1986, but prior to January 1, 1988, not exceeding: (a) Twelve dollars and ninety-nine cents per patient day if the
beds were originally
licensed as residential facility beds by the department of mental retardation
and developmental disabilities; (b) Seven dollars and sixty-seven cents per patient day if the
beds were
originally licensed as nursing home beds by the department of health. (14) For facilities with dates of licensure after December 31,
1987, but prior to January 1, 1989, not exceeding thirteen dollars and
twenty-six cents per patient day; (15) For facilities with dates of licensure after December 31,
1988, but prior to January 1, 1990, not exceeding thirteen dollars and
forty-six cents per patient day; (16) For facilities with dates of licensure after December 31,
1989, but prior to January 1, 1991, not exceeding thirteen dollars and
sixty cents per patient day; (17) For facilities with dates of licensure after December 31,
1990, but prior to January 1, 1992, not exceeding thirteen dollars and
forty-nine cents per patient day; (18) For facilities with dates of licensure after December 31,
1991, but prior to January 1, 1993, not exceeding thirteen dollars and
sixty-seven cents per patient day; (19) For facilities with dates of licensure after December 31,
1992, not exceeding fourteen dollars and twenty-eight cents per patient day. (D) Beginning January 1, 1981, regardless of the original
date of licensure, the department of job and family
services shall pay a rate for the per
diem capitalized costs of renovations to intermediate care
facilities for the mentally retarded made after January 1, l981,
not exceeding six dollars per patient day using 1980 as the base
year and adjusting the amount annually until June 30, 1993, for
fluctuations in construction costs calculated by the department
using the "Dodge building cost indexes, northeastern and north
central states," published by Marshall and Swift. The payment
provided for in this division is the only payment that shall be
made for the capitalized costs of a nonextensive renovation of an
intermediate care facility for the mentally retarded.
Nonextensive renovation costs shall not be included in cost of
ownership, and a nonextensive renovation shall not affect the
date of licensure for purposes of division (C) of this section.
This division applies to nonextensive renovations regardless of
whether they are made by an owner or a lessee. If the tenancy of
a lessee that has made renovations ends before the depreciation
expense for the renovation costs has been fully reported, the
former lessee shall not report the undepreciated balance as an
expense. For a nonextensive renovation to qualify for payment under
this division, both of the following conditions must be met: (1) At least five years have elapsed since the date of
licensure or date of an extensive renovation of the portion of
the facility that is proposed to be renovated, except that this
condition does not apply if the renovation is necessary to meet
the requirements of federal, state, or local statutes,
ordinances, rules, or policies. (2) The provider has obtained prior approval from the
department of job and family services. The provider
shall submit a plan that describes in
detail the changes in capital assets to be accomplished by means
of the renovation and the timetable for completing the project.
The time for completion of the project shall be no more than
eighteen months after the renovation begins. The
director of
job and family services shall adopt rules in accordance with Chapter
119. of the Revised
Code that specify criteria and procedures for prior approval of
renovation projects. No provider shall separate a project with
the intent to evade the characterization of the project as a
renovation or as an extensive renovation. No provider shall
increase the scope of a project after it is approved by the
department of job and family services unless the increase
in scope is approved by the department. (E) The amounts specified in divisions (C) and (D) of this
section shall be adjusted beginning July 1, 1993, for the
estimated inflation for the twelve-month period beginning on the
first day of July of the calendar year preceding the calendar
year that precedes the fiscal year for which rate will be paid
and ending on the thirtieth day of the following June, using the
consumer price index for shelter costs for all urban consumers
for the north central region, as published by the United States
bureau of labor statistics. (F)(1) For facilities of eight or fewer beds that have
dates of licensure or have been granted project authorization by
the department of mental retardation and developmental
disabilities before July 1, 1993, and for facilities of eight or
fewer beds that have dates of licensure or have been granted
project authorization after that date if the facilities
demonstrate that they made substantial commitments of funds on or
before that date, cost of ownership shall not exceed eighteen
dollars and thirty cents per resident per day. The
eighteen-dollar and thirty-cent amount shall be increased by the
change in the "Dodge building cost indexes, northeastern and
north central states," published by Marshall and Swift, during
the period beginning June 30, 1990, and ending July 1, 1993, and
by the change in the consumer price index for shelter costs for
all urban consumers for the north central region, as published by
the United States bureau of labor statistics, annually
thereafter. (2) For facilities with eight or fewer beds that have
dates of licensure or have been granted project authorization by
the department of mental retardation and developmental
disabilities on or after July 1, 1993, for which substantial
commitments of funds were not made before that date, cost of
ownership payments shall not exceed the applicable amount
calculated under division (F)(1) of this section, if the
department of job and family services gives prior
approval for construction of the facility. If the department does not give
prior approval, cost of ownership payments shall not exceed the
amount specified in division (C) of this section. (3) Notwithstanding divisions (D) and (F)(1) and (2) of
this section, the total payment for cost of ownership, cost of
ownership efficiency incentive, and capitalized costs of
renovations for an intermediate care facility for the mentally
retarded with eight or fewer beds shall not exceed the sum of the
limitations specified in divisions (C) and (D) of this
section. (G) Notwithstanding any provision of this section or
section 5111.24 of the Revised Code, the director of
job and family services may adopt
rules in accordance with Chapter 119. of the Revised Code that
provide for a calculation of a combined maximum payment limit for
indirect care costs and cost of ownership for intermediate care
facilities for the mentally retarded with eight or fewer beds. (H) After June 30, 1980, the owner of an intermediate care
facility for the mentally retarded operating under a provider
agreement shall provide written notice to the department of
job and family services at least forty-five days prior to entering
into any
contract of sale for the facility or voluntarily terminating
participation in the medical assistance program. After the date
on which a transaction of sale is closed, the owner shall refund
to the department the amount of excess depreciation paid to the
facility by the department for each year the owner has operated
the facility under a provider agreement and prorated according to
the number of medicaid patient days for which the facility has
received payment. If an intermediate care facility for the
mentally retarded is sold after five or fewer years of operation
under a provider agreement, the refund to the department shall be
equal to the excess depreciation paid to the facility. If an
intermediate care facility for the mentally retarded is sold
after more than five years but less than ten years of operation
under a provider agreement, the refund to the department shall
equal the excess depreciation paid to the facility multiplied by
twenty per cent, multiplied by the number of years less than ten
that a facility was operated under a provider agreement. If an
intermediate care facility for the mentally retarded is sold
after ten or more years of operation under a provider agreement,
the owner shall not refund any excess depreciation to the
department. For the purposes of this division, "depreciation
paid to the facility" means the amount paid to the intermediate
care facility for the mentally retarded for cost of ownership
pursuant to this section less any amount paid for interest costs.
For the purposes of this division, "excess depreciation" is the
intermediate care facility for the mentally retarded's
depreciated basis, which is the owner's cost less accumulated
depreciation, subtracted from the purchase price but not
exceeding the amount of depreciation paid to the facility. A cost report shall be filed with the department within
ninety days after the date on which the transaction of sale is
closed or participation is voluntarily terminated for an
intermediate care facility for the mentally retarded subject to
this division. The report shall show the accumulated
depreciation, the sales price, and other information required by
the department. The amount of the last two monthly payments to
an intermediate care facility for the mentally retarded made
pursuant to division (A)(1) of section 5111.22 of the Revised
Code before a sale or voluntary termination of participation
shall be held in escrow by a bank, trust company, or savings and
loan association, except that if the amount the owner will be
required to refund under this section is likely to be less than
the amount of the last two monthly payments, the department shall
take one of the following actions instead of withholding the
amount of the last two monthly payments: (1) In the case of an owner that owns other facilities
that participate in the medical assistance program, obtain a
promissory note in an amount sufficient to cover the amount
likely to be refunded; (2) In the case of all other owners, withhold the amount
of the last monthly payment to the intermediate care facility for
the mentally retarded. The department shall, within ninety days following the
filing of the cost report, audit the report and issue an audit
report to the owner. The department also may audit any other
cost reports for the facility that have been filed during the
previous three years. In the audit report, the department shall
state its findings and the amount of any money owed to the
department by the intermediate care facility for the mentally
retarded. The findings shall be subject to an adjudication
conducted in accordance with Chapter 119. of the Revised Code.
No later than fifteen days after the owner agrees to a
settlement, any funds held in escrow less any amounts due to the
department shall be released to the owner and amounts due to the
department shall be paid to the department. If the amounts in
escrow are less than the amounts due to the department, the
balance shall be paid to the department within fifteen days after
the owner agrees to a settlement. If the department does not
issue its audit report within the ninety-day period, the
department shall release any money held in escrow to the owner.
For the purposes of this section, a transfer of corporate stock,
the merger of one corporation into another, or a consolidation
does not constitute a sale. If an intermediate care facility for the mentally retarded
is not sold or its participation is not terminated after notice
is provided to the department under this division, the department
shall order any payments held in escrow released to the facility
upon receiving written notice from the owner that there will be
no sale or termination of participation. After written notice is
received from an intermediate care facility for the mentally
retarded that a sale or termination of participation will not
take place, the facility shall provide notice to the department
at least forty-five days prior to entering into any contract of
sale or terminating participation at any future time. (I) The department of job and family services shall pay
each eligible proprietary intermediate care facility for the mentally
retarded a return on the facility's net equity computed at the
rate of one and one-half times the average of interest rates on
special issues of public debt obligations issued to the federal
hospital insurance trust fund for the cost reporting period. No
facility's return on net equity paid under this division shall
exceed one dollar per patient day. In calculating the rate for return on net equity, the
department shall use the greater of the facility's inpatient days
during the applicable cost reporting period or the number of
inpatient days the facility would have had during that period if
its occupancy rate had been ninety-five per cent. (J)(1) Except as provided in division
(J)(2) of this section, if a
provider leases or transfers an interest in a facility to another provider who
is a
related party, the related party's allowable cost of ownership
shall include the lesser of the following: (a) The annual lease expense or
actual cost of ownership, whichever is applicable; (b) The reasonable cost to the lessor
or provider making the transfer. (2) If a provider leases or transfers an interest in a
facility to another provider who is a related party, regardless of the date of
the lease
or transfer, the related party's allowable cost of ownership
shall include the annual lease expense or actual cost of
ownership, whichever is applicable, subject to the limitations
specified in divisions (B) to
(I) of this section, if all of the
following conditions are met: (a) The related party is a relative
of owner; (b) In the case of a lease, if the lessor retains any ownership
interest, it is, except as provided in division
(J)(2)(d)(ii) of this section, in
only the real property and any improvements on the real
property; (c) In the case of a transfer, the
provider making the transfer retains, except as provided in
division (J)(2)(d)(iv) of this
section, no ownership interest in
the facility; (d) The United States internal revenue service
has issued a ruling department of job and family services
determines that the lease or transfer is an arm's length
transaction for purposes of federal income taxation;
pursuant to rules the department shall adopt in
accordance with Chapter 119. of the Revised Code no
later than
December 31, 2000. The rules shall
provide that a lease or transfer is an arm's length transaction if all of
the following, as applicable, apply: (i) In the case of a lease, once the lease goes into effect, the
lessor has no direct or indirect interest in the lessee or, except as
provided in division (J)(2)(b) of this section, the
facility itself, including interest as an owner, officer, director, employee,
independent contractor, or
consultant, but excluding interest as a lessor. (ii) In the case of a lease, The lessor does not reacquire an
interest in the facility except through the exercise of a lessor's rights in the event of a default. If the lessor
reacquires an interest in the facility in this manner, the
department shall treat the facility as if the lease never occurred
when the department calculates its reimbursement rates for capital
costs. (iii) In the case of a transfer, Once the transfer goes into
effect, the provider that made the transfer has no direct or indirect interest in the provider that
acquires the facility or the facility itself, including interest as an owner, officer, director,
employee, independent contractor, or consultant, but excluding
interest as a creditor. (iv) In the case of a transfer, the provider that made the
transfer does not reacquire an interest in the facility except through the exercise of a creditor's rights in the
event of a default. If the provider reacquires an interest in the
facility in this manner, the department shall treat the facility
as if the transfer never occurred when the department calculates
its reimbursement rates for capital costs. (v) The lease or transfer satisfies any other criteria specified
in the rules. (e) Except in the case of hardship
caused by a catastrophic event, as determined by the department,
or in the 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 since, for
the same facility, allowable cost of ownership was determined
most recently under this division. Sec. 5111.62. The proceeds of all fines, including
interest, collected under sections 5111.35 to 5111.62 of the
Revised Code shall be deposited in the state treasury to the
credit of the residents protection fund, which is hereby created.
Moneys in the fund shall be used solely for the protection of the
health or property of residents of nursing facilities in which
the department of health finds deficiencies, including payment
for the costs of relocation of residents to other facilities,
maintenance of operation of a facility pending correction of
deficiencies or closure, and reimbursement of residents for the
loss of money managed by the facility under section 3721.15 of
the Revised Code.
The fund shall be maintained and administered
by the department of job and family services under rules developed
in consultation with the departments of health and
aging and adopted by the director of
job and family services under
Chapter 119. of the Revised Code. SECTION 2 . That existing sections 173.19, 3702.525, 3721.21, 5111.20, 5111.25,
5111.251, and 5111.62 of the
Revised Code are hereby repealed.
SECTION 3 . Notwithstanding the fourteen-month publishing deadline established
in section 173.46 of the Revised Code, the Department of Aging
shall not publish the Ohio Long-term Care Consumer Guide unless it
includes in the guide the results of customer satisfaction surveys
conducted under section 173.54 of the Revised Code. For the
purposes of this condition, the department may publish the guide
if it includes in the guide the results of surveys of families of
nursing facility residents covering at least twenty-five per cent of
the nursing facilities in this state and it has established a process
for conducting both family and resident satisfaction surveys under
section 173.54 of the Revised Code.
SECTION 4 . All items in this section are hereby appropriated as
designated out of any moneys in the state treasury to the credit
of the designated fund group. For all appropriations
made in this act, those in the first column are for fiscal year
2000 and those in the second column are for fiscal year 2001. The
appropriations made in this act are in addition to any other
appropriations made for the 1999-2001 biennium.
JFS DEPARTMENT OF JOB AND FAMILY SERVICESGeneral Revenue Fund
GRF | 600-525 | | Health Care/Medicaid | | | | | | |
State | | $ | 0 | | $ | 8,150,410 |
Federal | | $ | 0 | | $ | 11,699,590 |
Health Care Total | | $ | 0 | | $ | 19,850,000 |
Total GRF General Revenue Fund Group | | | | | | |
State | | $ | 0 | | $ | 8,150,410 |
Federal | | $ | 0 | | $ | 11,699,590 |
GRF Total | | $ | 0 | | $ | 19,850,000 |
TOTAL ALL BUDGET FUND GROUPS | | $ | 0 | | $ | 19,850,000 |
Health Care/Medicaid Of the foregoing appropriation item 600-525, Health Care/Medicaid, $3,650,000
shall be used in fiscal year 2001 to support additional slots for the
Department of Job and Family Services' Ohio Home Care Waiver Program. DMR DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIESGeneral Revenue Fund
GRF | 322-413 | | Residential and Support Services | | $ | 0 | | $ | 4,500,000 |
TOTAL GRF General Revenue Fund | | $ | 0 | | $ | 4,500,000 |
Federal Special Revenue Fund Group
3G6 | 322-639 | | Medicaid Waiver | | $ | 0 | | $ | 6,460,000 |
TOTAL FSR Federal Special Revenue Fund Group | | $ | 0 | | $ | 6,460,000 |
TOTAL ALL BUDGET FUND GROUPS | | $ | 0 | | $ | 10,960,000 |
Residential and Support Services Of the foregoing appropriation item 322-413, Residential and Support Services,
$4,500,000 shall be used in fiscal year 2001 as state matching funds to
support additional slots for the Individual Options Home and Community-based
waiver program operated pursuant to Title XVIII of the "Social Security Act,"
49 Stat. 620 (1935), 42 U.S.C. 301, as amended. Medicaid Waiver Of the foregoing appropriation item 322-639, Medicaid Waiver (Fund 3G6),
$6,460,000 shall be used in fiscal year 2001 to support additional slots for
the Individual Options Home and Community-based waiver program operated
pursuant to Title XVIII of the "Social Security Act," 49 Stat. 620 (1935), 42
U.S.C. 301, as amended. AGE DEPARTMENT OF AGINGState Special Revenue Fund Group
5K9 | 490-613 | | Long-Term Care Consumer Guide | | $ | 0 | | $ | 807,000 |
TOTAL SSR State Special Revenue | | | | | | |
Fund Group | | $ | 0 | | $ | 807,000 |
TOTAL ALL BUDGET FUND GROUPS | | $ | 0 | | $ | 807,000 |
Long-Term Care Consumer Guide Notwithstanding section 5111.62 of the Revised Code, not later than July 15,
2000, the Director of Budget and
Management shall transfer $407,000 cash from Fund 4E3, Resident
Protection Fund, to Fund 5K9, Long-Term Care Consumer Guide Fund. The foregoing appropriation item 490-613, Long-Term Care Consumer
Guide, shall be used by the Department of Aging for costs
associated with publishing the Ohio Long-Term Care Consumer Guide. DOH DEPARTMENT OF HEALTH
State Special Revenue Fund Group | | | | | | |
5L1 | 440-623 | | Nursing Facility Technical Assistance Program | | $ | 0 | | $ | 1,400,000 |
TOTAL SSR State Special Revenue | | | | | | |
Fund Group | | $ | 0 | | $ | 1,400,000 |
TOTAL ALL BUDGET FUND GROUPS | | $ | 0 | | $ | 1,400,000 |
Nursing Facility Technical Assistance Program Notwithstanding section 5111.62 of the Revised Code, not later than July 15,
2000, the Director of Budget and
Management shall transfer $1,400,000 cash from Fund 4E3, Resident
Protection Fund, to Fund 5L1, Nursing Facility Technical
Assistance Fund, to be used in accordance with section 3721.026 of
the Revised Code. Within the limits set forth in this act, the Director of Budget
and Management shall establish accounts indicating source and
amount of funds for each appropriation made in this act, and shall
determine the form and manner in which appropriation accounts
shall be maintained. Expenditures from appropriations contained in this act
shall be accounted for as though made in Am. Sub. H.B. 283 of the 123rd
General Assembly. The appropriations made in this act are subject to all provisions
of Am. Sub. H.B. 283 of the 123rd General Assembly. SECTION 5 . (A) Notwithstanding
division (Q)(1) of section 5111.20 of the Revised Code, when
calculating indirect care costs for the purpose of establishing
rates under section 5111.24 or 5111.241 of the Revised Code for
fiscal year 2001, "per diem," as used in sections 5111.20 to
5111.32 of the Revised Code, means a nursing facility's or
intermediate care facility for the mentally retarded's actual,
allowable indirect care costs in the cost reporting period divided
by the greater of the facility's inpatient days for that period or
the number of inpatient days the facility would have had during
that period if its occupancy rate had been seventy-five per cent.
(B) Notwithstanding division (Q)(2) of section 5111.20 of the
Revised Code, when calculating capital costs for the purpose of
establishing rates under section 5111.25 or 5111.251 of the
Revised Code for fiscal year 2001, "per diem," as used in sections
5111.20 to 5111.32 of the Revised Code, means a nursing facility's
or intermediate care facility for the mentally retarded's actual,
allowable capital costs in the cost reporting period divided by
the greater of the facility's inpatient days for that period or
the number of inpatient days the facility would have had during
that period if its occupancy rate had been eighty-five per cent. (C) Notwithstanding section 5111.261 and division (C) of section
5111.262 of the Revised Code, for costs incurred during calendar
year 1999, costs reported in a nursing facility's cost report for
purchased nursing services shall be allowable direct care costs up
to seventeen per cent of the nursing facility's cost specified in
the cost report for services provided that year by registered
nurses, licensed practical nurses, and nurse aides who are
employees of the facility, plus one-half of the amount by which
the reported costs for purchased nursing services exceed that
percentage. (D) As soon as practicable, the Department of Job and Family
Services shall follow this section for the purpose of calculating
nursing facilities' and intermediate care facilities for the
mentally retarded's Medicaid reimbursement rates for indirect care
and capital costs for fiscal year 2001. If the Department is
unable to calculate the rates before it makes payments for
services provided during fiscal year 2001, the Department shall
pay a nursing facility or intermediate care facility for the
mentally retarded the difference between the amount it pays the
facility and the amount that would have been paid had the
Department made the calculation in time. SECTION 6 . Except for sections 3702.525, 3721.21,
5111.25, and 5111.251 of the Revised Code as amended by this act, the
codified and uncodified sections of law contained
in this act are not subject to the referendum and take effect on
the later of 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 Code made by
this act
constitute items of law that are subject to the referendum.
Therefore, under Article II, Section 1c of the Ohio Constitution
and section 1.471 of the Revised Code, these items of law take
effect on the 91st day after this act is filed with the Secretary
of State. If, however, a referendum petition is filed against
these items of law, these items of law, unless rejected at the
referendum, take effect at the earliest time permitted by law.
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