5111.251 Per resident per day rate for reasonable capital costs - intermediate care facility.
5111.251 Per resident per day rate for reasonable capital costs - intermediate care facility.
(A) The department of job and family services shall pay a provider for each of the provider’s eligible intermediate care facilities 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 5111.33 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 under section 5111.02 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 authorized by 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 5111.33 of the Revised Code is used to reimburse the government agency.
(B) The department of job and family services shall pay to a provider for each of the provider’s eligible intermediate care facilities 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 provider for 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 for 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 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 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 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 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 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 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 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 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 under section 5111.02 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 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 providers of 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 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 5111.241 of the Revised Code, the director of job and family services may adopt rules under section 5111.02 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 the date on which a transaction of sale is closed, the provider shall refund to the department the amount of excess depreciation paid to the provider for the facility by the department for each year the provider has operated the facility under a provider agreement and prorated according to the number of medicaid patient days for which the provider has received payment for the facility. For the purposes of this division, “depreciation paid to the provider for the facility” means the amount paid to the provider for 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 provider’s cost less accumulated depreciation, subtracted from the purchase price but not exceeding the amount of depreciation paid to the provider for the facility.
(I) The department of job and family services shall pay a provider for each of the provider’s eligible proprietary intermediate care facilities 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 department of job and family services determines that the lease or transfer is an arm’s length transaction pursuant to rules adopted under section 5111.02 of the Revised Code. 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.
Amended by 128th General Assembly ch. 7, SB 79, § 1, eff. 10/6/2009.
Effective Date: 06-06-2001; 07-01-2005