Ohio Rev. Code Ann. § 5124.26 – Payment of medicaid rate add-on for outlier ICF/IID services

(A) Subject to division (D) of this section, the department of developmental disabilities may pay a medicaid rate add-on to an ICF/IID provider for outlier ICF/IID services the ICF/IID provides to residents identified as needing intensive behavioral support services, if the provider applies to the department to receive the rate add-on and the department approves the application. The department may approve a provider's application if both of the following apply:
1. (1) The provider submits to the department a best practices protocol for providing outlier ICF/IID services under this section and the department determines that the protocol is acceptable;
2. (2) The provider meets all other eligibility requirements for the rate add-on established in rules adopted under section 5124.03 of the Revised Code.
(B) An ICF/IID that has been approved by the department to provide outlier ICF/IID services under this section shall provide the services in accordance with both of the following:
1. (1) The best practices protocol described in division (A)(1) of this section;
2. (2) Requirements regarding the services established in rules adopted under section 5124.03 of the Revised Code.
(C) To qualify to receive outlier ICF/IID services from an ICF/IID under this section, a resident of the ICF/IID must be a medicaid recipient, be determined to need intensive behavioral support services, and meet all other eligibility requirements established in rules adopted under section 5124.03 of the Revised Code.
(D) The department shall negotiate with the department of medicaid the amount of the medicaid payment rate add-on, if any, to be paid under this section or the method by which that amount is to be determined.