Step 10 of the agreed-upon-procedures in OAC 5101:3-2-23 , Appendix A permits hospitals to include charges for pending Medicaid accounts in the <100% FPL logs and Medicaid Cost Report Schedule F entries. How should this process be administered?
OHA recommends hospitals get a signed HCAP application from the patient or his/her legal representative at discharge for every patient who is <100% FPL and has a Medicaid application pending with the County Department of Job and Family Services (CDJFS). These accounts should be kept in a separate, "Medicaid Pending" log until the CDJFS determination is complete. If the CDJFS approves the Medicaid application, the account can be removed from the Medicaid Pending log and billed to Medicaid. If the Medicaid application is denied, and the patient is eligible for HCAP based on the requirements in OAC 5101:3-2-07.17, the account should be removed from the Medicaid Pending log and included in the log and Cost Report entry for <100% or >100%, with or without insurance, whichever is appropriate. At the point a Cost Report is filed, and assuming the patient is eligible for HCAP based on the requirement of OAC 5101:3-2-07.17, the hospital may add any accounts still Medicaid pending with dates of
