SFLEA-393-2022-0001_SPA-example.pdf

Table of Contents

State/Territory Name: Ohio

State Plan Amendment (SPA) #: 21-0022

This file contains the following documents in the order listed:

1) Approval Letter

2) CMS 179 Form/Summary Form (with 179-like data)

3) Approved SPA Pages

State of Ohio Attachment 4.19-A

Page 1-32

TN: 21-022 Approval Date _________

Supersedes:

TN: 20-017 Effective Date: 07/01/2021

(1) For each hospital, multiply the result in subsection (E)(5) of this section by the inpatient cost-to-charge ratio calculated in subsection (E)(1) of this section.

(2) Apply the amount calculated in subsection (E)(6) of this section as an increase to the hospital's inpatient cost-to-charge ratio.

(F) Short-Term Adjustments

To ensure that funds appropriated for the cost coverage add-on are fully expended in support of the intended purpose, the department may make short-term adjustments to increase or decrease hospital-specific rates. Such adjustments will be calculated in accordance with the cost coverage sustainability pool as described in subsection (B)(2) of this section. The number of discharges or visits used to establish a case-mix adjusted hospital-specific rate, may be adjusted to reflect the time period for which the rate will be in effect. Any such adjustments will be developed in consultation with the department’s actuary and approved by the Medicaid director.

11/10/2021