Ohio Administrative Code Search

...s for inpatient hospital services for discharges on or after the effective date of this rule. (A) Hospitals defined as eligible providers of hospital services in rule 5160-2-01 of the Administrative Code and grouped in paragraph (B)(1) of rule 5160-2-05 of the Administrative Code are subject to the all patient refined diagnosis related groups (APR-DRG) prospective payment methodology as described...

...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 ...

... acceptable basis for the transfer or discharge of these residents. (ii) Nothing in this provision invalidates other legal grounds for NF-initiated discharge of medicaid residents after the effective date of withdrawal. (b) Provide residents admitted after the effective date of withdrawal with information that the facility is not participating in the medicaid program with respect to those resi...

....01 of the Revised Code. (9) "Hospital discharge exemption," also known as hospital exemption means an exemption from the preadmission screening as defined in paragraph (B)(21) of this rule, when an individual meets the hospital discharge exemption criteria in rule 5160-3-15.1 of the Administrative Code. (10) "Indications of developmental disabilities (DD)." An individual shall be considered to ...

...orker, professional counselor, hospital discharge planners or one of the professionals listed in paragraph (H)(6) of this rule. (2) The level I has to be submitted via the electronic system designated by ODM. (3) The submitter of the level I is responsible for gathering information from the individual, family, legal guardian and available medical records to ensure an accurate level I and, when a...

...ual was admitted under the hospital discharge exemption as defined in rule 5160-3-15 of the Administrative Code, and has since been found to require more than thirty days of services at the NF. The resident review will be submitted no later than the twenty-ninth day from the date of admission; or (2) The individual had been in a NF and was admitted directly into a different NF following an in...

...or a return admission after an official discharge. A NF admission is distinguished from the readmission of a resident who has not exhaused all bed-hold days.. (6) "NF bed-hold day," also referred to as "NF leave day," means a day for which a bed is reserved for a NF resident while the resident is temporarily absent from the NF for hospitalization, therapeutic leave days, or visitation with friends or relatives. Paym...

...ibility. (G) Release of funds upon discharge. (1) Upon discharge of a resident, a NF provider shall release all the resident's funds, up to and including the maximum resource limit amount. (2) Other than for items and services that the resident has requested and that may be charged to the resident's PNA account in accordance with this rule, a NF provider shall not withhold PNA account funds...

... the program. (c) If the NF decides to discharge current ventilator dependent individuals, the NF shall discharge in accordance with rule 3701-61-03 of the Administrative Code. If the NF decides to retain current ventilator dependent individuals, the per medicaid day payment rate shall be the rate determined under section 5165.15 of the Revised Code beginning the day after the last date of partic...

...of form JFS 09400. (D) Notification of discharge. Discharge has the same meaning as defined in rule 5101:3-3-16.4 of the Administrative Code. The NF shall notify the CDJFS within five business days of the discharge of a medicaid eligible resident by completing the JFS 09401 identifying the type of discharge, and forwarding the JFS 09401 to the CDJFS. The CDJFS shall adjust medicaid eligibility within ten days after...

...the full month is limited to admission, discharge, death, changes in payer, and hospice enrollment that occurs during the month. (D) If a medicaid recipient in the NF has a patient liability (PL) obligation as determined by the Ohio department of medicaid or its designee, the amount of PL in accordance with rule 5160:1-6-07 of the Administrative Code, is to be reported by the NF on the recipi...

...ents. (3) NFs must use the MDS 3.0 discharge item set for any residents who transfer or are discharged, and the MDS 3.0 tracking record for any residents entering or reentering or who died in the facility in accordance with 42 C.F.R. 483.20. (4) NFs must use the MDS correction request in section X of the MDS 3.0 for modification or inactivation of MDS records that have been accepted into the CMS...

...tifying the failed edits. (4) The "Discharge and Reentry Tracking Form Summary," which identifies all discharge assessments and reentry tracking forms that were received by ODM. (H) ODM shall provide two preliminary "Calculation of Facility Case Mix Scores" reports. The first report will reflect records submitted up to the quarterly filing date. The second report will reflect records submitt...

...n services (including admission and discharge services). Payment may be made for not more than twenty-two hours of medical observation of an individual who is treated in a hospital but does not require inpatient hospital admission. (a) Emergency department services are not observation. (b) If during observation the individual is admitted to the hospital as an inpatient, payment for the obser...

...n services (including admission and discharge services). Payment may be made for not more than twenty-two hours of medical observation of an individual who is treated in a hospital but does not need to be admitted as an inpatient. (a) Emergency department services are not observation. (b) If during observation the individual is admitted to the hospital as an inpatient, payment for the observ...

... Home services; and (b) Hospital discharge services, thirty minutes or less. (3) Payment for the debridement of nails is limited to one treatment per sixty-day period. (4) Payment may be made for the following services only if an individual has a localized infection; is under the care of another healthcare practitioner for a metabolic disease such as diabetes mellitus or another condi...

...; (vi) An abnormal pneumogram at discharge from a medical facility; (vii) Severe gastroesophageal reflux and associated apnea; (viii) Severe upper airway abnormality (e.g., achondroplasia, Pierre Robin syndrome); or (ix) Another, specified disorder necessitating close cardiorespiratory monitoring to facilitate a more timely discharge to home from a medical facility; and (b) An...

...care facility (LTCF) who is being discharged or will be discharged, then the evaluation period is thirty days, and the most recent blood gas study performed within forty-eight hours before discharge is used. (ii) Otherwise, the evaluation period is thirty days, and the most recent blood gas study performed within thirty days before the date of certification is used. (4) A renewing CMN ...

...sixty consecutive days from the date of discharge from an inpatient hospital stay if all of the following are met as certified by the qualifying treating clinician using the ODM 07137: (1) The individual is discharged from a covered inpatient hospital stay of three or more days, with the discharge date recorded on form ODM 07137. It is considered one inpatient hospital stay when an individual is...

...y consecutive days from the date of discharge from an inpatient hospital stay of three or more covered days in accordance with rule 5160-2-03 of the Administrative Code. For purposes of this rule, a covered inpatient hospital stay is considered one hospital stay when an individual is transferred from one hospital to another hospital, either within the same building or to another location. (a) The...

...nd any resulting activities; and (w) A discharge summary signed and dated by the directing RN, at the point the RN is no longer going to provide assessment and consultation services to the individual or when the individual no longer needs services from the supervising RN. The summary should include information regarding the progress made toward goal achievement and indicate any recommended follow-ups...

...nd any resulting activities; and (w) A discharge summary signed and dated by the directing RN, at the point the RN is no longer going to provide assessment and consultation services to the individual or when the individual no longer needs services from the supervising RN. The summary should include information regarding the progress made toward goal achievement and indicate any recommended follow-ups...

...plete the "follow-up after hospital discharge" activities in which the CPC entity will have established relationships with all emergency departments and hospitals from which it frequently receives referrals and has an established process to ensure a reliable flow of information. (7) Complete the "tests and specialist referrals" activities in which the CPC entity will have established bi-direc...

... ODM. (7) Follow-up after hospital discharge. It is the responsibility of the CMC entity to: (a) Establish relationships with emergency departments (EDs) and hospitals from which it frequently sends and receives referrals and has an established process to ensure a reliable flow of information; (b) Proactively and consistently obtain patient discharge summaries from hospitals and other facilitie...

...ndividual's assigned pharmacy following discharge from an inpatient treatment program for addiction, upon request.