Ohio Admin. Code 5160-1-25 - Interest on overpayments made to medicaid providers
(A) Except for
medicaid contracting managed care plans (MCPs), and nursing facilities and
intermediate care facilities for individuals with
intellectual disabilities (ICF/IID)
the
mentally retarded (ICF-MR) rate recalculations performed in accordance
with sections
5165.41 and
5124.41
rule 5101:3-3-22 of the
Revised Code
Administrative Code, any provider of services or
goods contracting with the Ohio department of medicaid
(ODM)
job and family services (ODJFS)
pursuant to Title XIX of the Social Security Act who, without intent, obtains
payment from the medicaid program
under Chapter 5111. of the Revised Code in excess
of the amount to which the provider is entitled becomes liable for payment of
interest charged in accordance with this rule on the amount of the overpayment.
The interest rate charged is the average bank prime
rate in effect on the first day of the calendar quarter during which the
provider receives notice of the excess payment,
maximum real estate mortgage rate applicable on the
date the payment was made to a provider as determined in accordance
with section
5164.60
division (A) of section 1343.01 of the Revised
Code, as amended. Interest payments shall
be calculated on the basis of simple interest.
(B) Interest payments shall be charged on a
daily basis for the period from the date the payment was made to the date upon
which repayment is received by the state.
(C) The "date payment was made" shall mean
the following:
(1) For any reasonable cost
basis, prospective payment basis, or other cost-related rate final settlement
issued by ODJFS
ODM , the "date payment was made" shall be ten days
from the date the final settlement is received by the provider as shown by the
U.S. postal service return receipt slip, with a notice of rights to appeal
pursuant to Chapter 119. of the Revised Code.
(2) For audits conducted in accordance with
rule 5101:3-1-27
5160-1-27 of the Administrative Code, the "date
payment was made" shall be the latest date a warrant or electronic funds
transfer (EFT) was issued to pay an item included in the random
sample.
(3) For post-payment
reviews conducted in accordance with rule 5101:3-1-27
5160-1-27
of the Administrative Code, the "date payment was made" shall be the latest
date a warrant or EFT was issued in payment of a claim that is included in the
review.
(D) The "date
upon which repayment is received by the state" shall mean the following:
(1) In the case of repayment by check or EFT,
the "date upon which repayment is received by the state" shall be the date the
repayment is date-stamped by ODJFS
ODM , the date the repayment is deposited as certified
mail with the U.S. postal service, or the date the EFT is deposited in the
state's account.
(2) In the case of
repayment by one or more offsets implemented by the ODJFS
ODM claims
adjustment unit against future claims payments owed to the provider, the "date
upon which repayment is received by the state" shall be the date on which the
total amount of the overpayment is fully recovered.
(E)
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.60
Prior Effective Dates: 8/1/82 (Temp), 11/1/82, 2/1/84, 10/1/87, 5/30/02, 09/01/2007
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(A) Except for medicaid contracting managed care plans (MCPs), and nursing facilities and intermediate care facilities for individuals with intellectual disabilities (ICF/IID) the mentally retarded (ICF-MR) rate recalculations performed in accordance with sections 5165.41 and 5124.41 rule 5101:3-3-22 of the Revised Code Administrative Code, any provider of services or goods contracting with the Ohio department of medicaid (ODM) job and family services (ODJFS) pursuant to Title XIX of the Social Security Act who, without intent, obtains payment from the medicaid program under Chapter 5111. of the Revised Code in excess of the amount to which the provider is entitled becomes liable for payment of interest charged in accordance with this rule on the amount of the overpayment. The interest rate charged is the average bank prime rate in effect on the first day of the calendar quarter during which the provider receives notice of the excess payment, maximum real estate mortgage rate applicable on the date the payment was made to a provider as determined in accordance with section 5164.60 division (A) of section 1343.01 of the Revised Code, as amended. Interest payments shall be calculated on the basis of simple interest.
(B) Interest payments shall be charged on a daily basis for the period from the date the payment was made to the date upon which repayment is received by the state.
(C) The "date payment was made" shall mean the following:
(1) For any reasonable cost basis, prospective payment basis, or other cost-related rate final settlement issued by ODJFS ODM , the "date payment was made" shall be ten days from the date the final settlement is received by the provider as shown by the U.S. postal service return receipt slip, with a notice of rights to appeal pursuant to Chapter 119. of the Revised Code.
(2) For audits conducted in accordance with rule 5101:3-1-27 5160-1-27 of the Administrative Code, the "date payment was made" shall be the latest date a warrant or electronic funds transfer (EFT) was issued to pay an item included in the random sample.
(3) For post-payment reviews conducted in accordance with rule 5101:3-1-27 5160-1-27 of the Administrative Code, the "date payment was made" shall be the latest date a warrant or EFT was issued in payment of a claim that is included in the review.
(D) The "date upon which repayment is received by the state" shall mean the following:
(1) In the case of repayment by check or EFT, the "date upon which repayment is received by the state" shall be the date the repayment is date-stamped by ODJFS ODM , the date the repayment is deposited as certified mail with the U.S. postal service, or the date the EFT is deposited in the state's account.
(2) In the case of repayment by one or more offsets implemented by the ODJFS ODM claims adjustment unit against future claims payments owed to the provider, the "date upon which repayment is received by the state" shall be the date on which the total amount of the overpayment is fully recovered.
(E)
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.60
Prior Effective Dates: 8/1/82 (Temp), 11/1/82, 2/1/84, 10/1/87, 5/30/02, 09/01/2007