Ohio Administrative Code|Rule 5160-2-67 | Medical education.

                                                
Effective for dates of discharge on or after the
		effective date of this rule, to qualify for a medical education payment as
		described in this rule, Ohio hospitals must have an approved medical education
		program as defined in 42 C.F.R. 415.152 (October 1, 2016) and the costs of the
		approved medical education program were reflected in their state fiscal year
		(SFY) 2014 Ohio medicaid hospital cost report (ODM 02930 rev. 6/2014). This
		rule describes the methodology used for computing the direct graduate medical
		education and indirect medical education components of each hospital's
		medical education add-on rate.
(A) Computation of direct graduate medical education (DGME)
		  costs, which are the costs that are directly related to the training of interns
		  and residents and allied professionals in an approved medical education
		  program.
(1) Tabulate the costs
			 captured on the ODM 02930 for interns and residents and allied
			 professionals.
(2) Tabulate the total
			 facility charges and total medicaid fee-for-service and managed care charges
			 reported on the ODM 02930. Calculate the medicaid factor by dividing the sum of
			 total medicaid fee-for-service and managed care charges by total
			 charges.
(3) Tabulate the total
			 medicaid fee-for-service and managed care discharges from the ODM
			 02930.
(4) The medicaid portion
			 of DGME costs equal the total DGME costs as described in paragraph (A)(1) of
			 this rule multiplied by the medicaid factor as described in paragraph (A)(2) of
			 this rule.
(5) A cost per discharge
			 is computed using the medicaid portion of DGME costs as described in paragraph
			 (A)(4) of this rule divided by the total number of medicaid discharges as
			 described in paragraph (A)(3) of this rule.
(B) Computation of indirect medical
		  education (IME) costs, which are the costs that recognize the increased costs
		  of patient care that results from operating an approved medical education
		  program.
(1) Identify the number
			 of interns and residents and number of beds reported on the ODM
			 02930.
(2) Compute the IME
			 factor by using the logarithmic formula 1.35 * ((1+((interns and
			 residents)/beds)^0.405)-1).
(3) Tabulate the total
			 medicaid fee-for-service and managed care net operating costs reported on the
			 ODM 02930.
(4) The medicaid portion
			 of IME is the medicaid net operating costs as described in paragraph (B)(3) of
			 this rule multiplied by the IME factor as described in paragraph (B)(2) of this
			 rule.
(5) A cost per discharge
			 is computed using the medicaid portion of IME costs as described in paragraph
			 (B)(4) of this rule divided by the total number of medicaid discharges as
			 described in paragraph (A)(3) of this rule.
(a) The IME cost per discharge is capped. The capped value is the
				statewide mean IME cost per discharge plus one standard deviation.
(b) If the hospital's IME cost per discharge is greater than
				the capped IME cost per discharge as described in paragraph (B)(5)(a) of this
				rule, then the hospital's IME cost per discharge is equal to the capped
				IME cost per discharge as described in paragraph (B)(5)(a) of this
				rule.
(C) Case-mix adjustment of medical education add-on
		  rate.
(1) The case-mix score
			 for each hospital equals the sum of the relative weight values for all SFY 2014
			 discharges divided by the total number of medicaid discharges as described in
			 paragraph (A)(3) of this rule.
(2) Sum the DGME cost per
			 discharge as described in paragraph (A)(5) of this rule and the IME cost per
			 discharge as described in paragraph (B)(5) of this rule.
(3) Divide the sum of the DGME cost per
			 discharge and IME cost per discharge as described in paragraph (C)(2) of this
			 rule by the case-mix score as described in paragraph (C)(1) of this rule. The
			 resulting value is the hospital's total medical education add-on
			 rate.
(4) The hospital's total medical
			 education add-on rate as described in paragraph (C)(3) of this rule shall be
			 subject to a payment neutrality adjustment of fifty-nine and seven-tenths per
			 cent.
(D) Medical education and stop-loss/stop-gain.
(1) For each hospital,
			 determine the total value of current medical education payments as reimbursed
			 by the all patient refined diagnosis related groups prospective payment system
			 prior to July 1, 2017 by multiplying the hospital's medical education
			 add-on rate effective January 1, 2017 by the hospital's case-mix score in
			 effect prior to July 1, 2017 by the total number of medicaid discharges for the
			 twelve month period used to estimate the fiscal impact.
(2) Determine the
			 hospital's projected medical education payments by multiplying the
			 case-mix adjusted medical education add-on rate as described in paragraph (C)
			 of this rule by the total number of medicaid discharges for the twelve month
			 period used to estimate the fiscal impact.
(3) If the
			 hospital's current medical education payments as described in paragraph
			 (D)(1) of this rule are greater than the projected medical education payments
			 as described in paragraph (D)(2) of this rule, then the hospital's medical
			 education add-on rate shall be the medical education add-on rate used to
			 calculate current medical education payments as described in paragraph (D)(1)
			 of this rule.
(4) If the
			 hospital's projected medical education payments as described in paragraph
			 (D)(2) of this rule are more than one-hundred and ten per cent of current
			 medical education payments as described in paragraph (D)(1) of this rule, then
			 the hospital's medical education payments shall be the current medical
			 education add-on rate multiplied by one-hundred and ten per cent.
(5) If the
			 hospital's projected medical education payments as described in paragraph
			 (D)(2) of this rule are greater than its current medical education payments as
			 described in paragraph (D)(1) of this rule but less than one-hundred and ten
			 per cent of its current medical education payments as described in paragraph
			 (D)(1) of this rule, then the hospital's medical education add-on rate is
			 the add-on rate used to calculate projected medical education payments as
			 described in paragraph (D)(2) of this rule.
(E) Recognition of approved medical education programs outside of
		  rebasing.
(1) For rate years when a
			 rebasing is not being conducted, hospitals that have added an approved graduate
			 medical education program and demonstrate such costs on the interim-settled
			 cost report that ends in the SFY ending in the calendar year preceding the
			 immediate past calendar year prior to January first of the rate year, the
			 interim medical education add-on rate shall be the sum of eighty per cent of
			 the statewide average DGME add-on rate plus fifty per cent of the statewide
			 average IME add-on rate.
(2) For a hospital that
			 only demonstrates costs for medical education of allied professionals on the
			 interim-settled cost report that ends in the SFY ending in the calendar year
			 preceding the immediate past calendar year prior to January first of the rate
			 year, the medical education add-on rate will be fifty per cent of the statewide
			 average DGME add-on rate.
(3) For a hospital that
			 has a newly approved graduate medical education program but whose costs are not
			 yet reflected on a cost report, the medical education add-on rate will be fifty
			 per cent of the statewide average DGME add-on rate.
(a) A hospital with a newly approved graduate medical education
				program must notify the department no later than October first of the calendar
				year immediately preceding January first of the rate year.
(b) Notification to the department must include documentation
				from the "Accreditation Council of Graduate Medical Education" that
				the hospital has an approved medical education program or documentation of
				medicare's recognition of the hospital's approved full-time
				equivalent interns and residents count, or both.
(4) For a hospital whose interim-settled
			 cost report that ends in the SFY ending in the calendar year preceding the
			 immediate past calendar year prior to January first of the rate year no longer
			 reflects costs for interns and residents, the medical education add-on rate
			 will be reduced by the portion of the add-on rate that represented their IME
			 costs.
(5) For a hospital whose interim-settled
			 cost report that ends in the SFY ending in the calendar year preceding the
			 immediate past calendar year prior to January first of the rate no longer
			 reflects costs for interns and residents and allied professionals, the medical
			 education add-on rate will be reduced to zero.
(F) The medical education payment is the
		  product of a hospital's medical education add-on rate as described in
		  either paragraph (C), (D), or (E) of this rule and the relative weight of the
		  claim's assigned all patient refined diagnosis related group and severity
		  of illness as described in rule 5160-2-65 of the Administrative
		  Code.