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Monthly Rate Calculator (MRC)

The Monthly Rate Calculator is part of the Medicaid Service System and is a way to project costs and service hours for billing.

MRC Best Practices and Guidelines

The Monthly Rate Calculator, or MRC, is part of the Medicaid Service System, or MSS, and is a way to project costs and service hours for billing. MRC takes the 12-month waiver span and breaks it into projected service hours and costs for individual months.

Doing this allows MRC to take into account the small, daily changes that take place in a person’s schedule. With the understanding that these small changes can cause minor fluctuations in the number of service hours a person may need each month, MRC calculates a margin of hours for which the provider may still receive the Daily Billing Unit, or DBU. This margin is 3%. As long as the amount of actual service hours a provider delivers is within the 3% margin of the hours projected in the Cost Projection Tool, or CPT, they will receive the full payment projected for the month.

Where Does the Monthly Rate Calculator Apply?

MRC applies to settings where people share Homemaker/Personal Care (HPC) services provided by an agency.

It does not apply to

  • shared service settings with independent providers,
  • people who are in Ohio Shared Living situations,
  • people who share the same residence but do not share services,
  • a secondary provider who provides occasional or time-limited HPC to the person living in the shared services setting (a secondary provider bills in 15-minute units, while the primary agency provider bills the Daily Billing Unit),
  • or people who live alone but share HPC services with neighbors or others.

All Daily Rate Application, or DRA, sites or homes must transition to MRC by January 1, 2020.

Daily Billing Unit

MRC will determine what the Daily Billing Unit is for each day of the calendar month. The DBU is a flat rate that may be billed by the provider for each date of service. It is determined by taking HPC and On-Site/On-Call costs for each person in a calendar month and dividing those costs by the total number of dates of service in the month.

A date of service is defined by OAC 5123-9-31 (B)(5) as any day when the person is a resident of the home, including days when the person is temporarily away from the home, such as planned vacations, visits with family or friends, respite services, or hospital visits. Dates of service do not include days when a person is admitted to a nursing facility or intermediate care facility.

When a person enrolled in the Individual Options Waiver shares services with someone enrolled in the Level One Waiver or someone who receives local funding through the county board, MRC will continue to calculate a DBU for all people in the site.

The provider will bill the DBU for the person on the Individual Options Waiver and bill in 15-minute units for those who are on the Level One Waiver or receive local funding.

Exemptions

When the DBU for a month exceeds the Medicaid maximum reimbursement rate of $508.30, the county board may submit a request for the setting to be exempted from the DBU.

The MRC exemption can be submitted up to 60 days from the start date of the exemption requested. For example, a request can be submitted on May 1 with a start date of an MRC exemption request of March 1.

The county board will send an email to msssupport@dodd.ohio.gov stating the following information:

  • Name of Cost Projection Tool
  • Start date of MRC exemption
  • End date of MRC exemption
  • Reason for MRC exemption

DODD will review requests and make a decision within 30 days of receipt of a completed request. All the information as described above must be included for the request to be complete.

Sites can be exempted on a month-by-month basis. However, as planning and projecting are expected for the entire 12-month waiver span, the county board should submit all requested exempted months for each site in one email.

Electronic Visit Verification, or EVV, is not required for 24-hour residential settings for which the provider bills a daily rate. For months in which the site is exempted from MRC, the provider must comply with EVV.

MRC Tutorials

Related Laws

OAC 5123-9-31

Home and community-based services waivers - homemaker/personal care daily billing unit for sites where individuals enrolled in the individual options waiver share services