Ohio § 5124.193 Quarterly determination of case-mix scores

Ohio Statutes

§ 5124.193 — Quarterly determination of case-mix scores

Ohio § 5124.193

Title 51Public Welfare

Ch. 5124Intermediate Care Facility for Individuals with Intellectual Disabilities Services

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Bluebook

Ohio Rev. Code Ann. § 5124.193 (2026).

Text

(A)Except as provided in division (B) of this section, the department of developmental disabilities shall do both of the following:

(1)For each calendar quarter, determine a case-mix score for each ICF/IID using both of the following:

(a)The most recent (as of the date the determination is made) resident assessment data compiled and revised for the ICF/IID's residents under section5124.191of the Revised Code;

(b)The case-mix scores of the ICF/IID's residents as determined under section5124.192of the Revised Code.

(2)After the end of each calendar year, determine an annual average case-mix score for each ICF/IID using the ICF/IID's quarterly case-mix scores for that calendar year.

(B)(1) Subject to divisions (B)(2) and (3) of this section, the department, for one or more months of

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(A) Except as provided in division (B) of this section, the department of developmental disabilities shall do both of the following:

(1) For each calendar quarter, determine a case-mix score for each ICF/IID using both of the following:

(a) The most recent (as of the date the determination is made) resident assessment data compiled and revised for the ICF/IID's residents under section5124.191of the Revised Code;

(b) The case-mix scores of the ICF/IID's residents as determined under section5124.192of the Revised Code.

(2) After the end of each calendar year, determine an annual average case-mix score for each ICF/IID using the ICF/IID's quarterly case-mix scores for that calendar year.

(B)(1) Subject to divisions (B)(2) and (3) of this section, the department, for one or more months of a calendar quarter, may assign to an ICF/IID a case-mix score that is five per cent less than the ICF/IID's case-mix score as of the day immediately preceding the day on which the reduction takes effect if the provider does not timely comply with division (D) of section5124.191of the Revised Code.

(2) Subject to division (B)(3) of this section, before assigning a case-mix score to an ICF/IID under division (B)(1) of this section, the department shall permit the provider to come into compliance with division (D) of section5124.191of the Revised Code. The department may assign the case-mix score if the provider fails to comply not later than forty-five days after the end of the calendar quarter to which the noncompliance pertains or a later date specified in rules authorized by this section.

(3) The department shall take action under division (B)(1) or (2) of this section only in accordance with rules authorized by this section. The department shall not take an action that affects medicaid payment rates for prior payment periods except in accordance with sections5124.41and5124.42of the Revised Code.

(C) The director of developmental disabilities shall adopt rules under section5124.03of the Revised Code as necessary to implement this section.