Ohio Administrative Code Search

... same institution within thirty days of discharge. (11) Discharges. A patient is said to be "discharged" when he or she: (a) Is formally released from a hospital; (b) Dies while hospitalized; (c) Is discharged, within the same hospital, from an acute care bed and admitted to a bed in a distinct part psychiatric unit as described in paragraph (B) (6) of this rule or is discharged within the same hospital, from a ...

... of the Administrative Code. (B) "Discharged" - a patient who: (1) Is formally released from a hospital; (2) Dies while hospitalized; (3) Is discharged within the same hospital from an acute care bed and admitted to a bed in an inpatient psychiatric facility or is discharged within the same hospital from a bed in an inpatient psychiatric facility to an acute care bed. Rule 5160-2-65 o...

... of the Administrative Code. (B) "Discharged" means a patient who: (1) Is formally released from a hospital; (2) Dies while hospitalized; (3) Is discharged within the same hospital from an acute care bed and admitted to a bed in an inpatient psychiatric facility, or is discharged within the same hospital from a bed in an inpatient psychiatric facility to an acute care bed. Rule 5160-2...

... counts as a full day. (ii) The day of discharge is not counted as a covered day, but charges for any covered services other than those described in revenue center codes 0100-0179 are covered for the days on which the services were rendered, not for the days the charges were posted. (b) Rehabilitation services related to chemical dependencies: Coverage of inpatient days for treatment of a chemical dependency is lim...

... counts as a full day. (ii) The day of discharge is not counted as a covered day, but charges for any covered services other than those described in revenue center codes 0100-0219 are covered for the days on which the services were rendered, not for the days the charges were posted. (b) Late discharge--The medicaid program will not pay for a patient's continued stay beyond the checkout t...

...ces that are generally applied prior to discharge (e.g., initial prostheses); and (iii) Other items that are medically necessary as described in rule 5160-1-01 of the Administrative Code to permit or facilitate the patient's discharge from the hospital until such time as the recipient can obtain a permanent item or supply. (b) Covered items must be included in the hospital's inpatient billing. (c) Medical supplies...

...at are generally applied prior to discharge (e.g., initial prostheses); and (iii) Other items that are medically necessary as described in rule 5160-1-01 of the Administrative Code to permit or facilitate the patient's discharge from the hospital until such time as the recipient can obtain a permanent item or supply. (b) Covered items should be included in the hospital's inpa...

...Effective for services or discharges on or after the effective date of this rule, hospitals shall be classified into mutually exclusive peer groups for purposes of setting rates and making payments under the "All Patient Refined-Diagnosis Related Group" (APR-DRG) inpatient prospective payment system, the "Enhanced Ambulatory Patient Grouping" (EAPG) outpatient prospective payment system or to those hospit...

... base rate will be the average cost per discharge of the new peer group without any consideration for hospital-specific risk provisions, as described in rule 5160-2-65 of the Administrative Code and rule 5160-2-75 of the Administrative Code, of either the new or previous peer group. (D) Rates for new, acquired, replacement, and merged hospitals. (1) Hospitals new to medicaid. (a) Hospitals desc...

...tem and the method of classification of discharges within DRGs. (2) The assignment of DRGs and severity of illness (SOI). (3) The assignment of relative weights to DRGs based on the methodology set forth in rule 5160-2-65 of the Administrative Code. (4) The establishment of peer groups as set forth in rule 5160-2-65 of the Administrative Code. (5) The methodology used to determine prospective payment rates as des...

...strative Code; to determine whether the discharge occurred at a medically appropriate time; to assess the quality of care rendered as mandated in 42 C.F.R. 456.3(b), in effect as of October 1, 2021; and to assess compliance with agency 5160 of the Administrative Code. (2) If any of the cases reviewed for a hospital do not meet the conditions described in paragraph (B)(1) of this rule, then ODM may deny payment or re...

...is readmitted within forty-five days of discharge for the same underlying condition. (4) A complete application for the hospital care assurance program is necessary prior to determination of eligibility. Each hospital will develop an application that, at a minimum, documents income, family size and eligibility for the medicaid program. The patient or a legal representative will need to sign the ...

... the Administrative Code. (g) Medicaid discharges and associated charges and days as reported on the cost report are consistent with those reflected for the same period in the department's paid claims history. In cases where data submitted by the hospital on the cost report are inconsistent with data in the department's paid claims data file, the cost report is subject to adjustment as described in paragraph (D)(2) ...

... Administrative Code. (g) Medicaid discharges, visits, and associated charges and days as reported on the cost report are consistent with those reflected for the same period in the department's paid claims history. In cases where data submitted by the hospital on the cost report are inconsistent with data in the department's paid claims data file, the cost report is subject to adjustment as d...

... not a medical or surgical admission. A discharge from a medical/surgical unit and an admission to a distinct part psychiatric unit within the same facility is considered to be a psychiatric admission and is subject to pre-certification. (b) An "emergency psychiatric admission" is an admission where the attending psychiatrist believes that there is likelihood of serious harm to the patient or others and that the pat...

... not a medical or surgical admission. A discharge from a medical unit and an admission to a distinct part psychiatric unit within the same facility is considered a psychiatric admission and is subject to pre-certification. (5) "Standards of medical practice" are nationally recognized protocols for diagnostic and therapeutic care. These protocols are approved by the medicaid program. ODM will notify providers of the ...

...Effective for services or discharges on or after the effective date of this rule, payments made to Ohio hospitals under the prospective payment systems or non-diagnostic related groups (DRG) prospective payment system will receive a cost coverage add-on. The provisions of this rule do not apply to the medicaid maximum allowed amount calculation described in rule 5160-2-25 of the Administrative Code. (A) De...

...Effective for services or discharges on or after the effective date of this rule, payments made to Ohio hospitals under the prospective payment systems or non-diagnostic related groups (DRG) and non-ambulatory patient grouping (EAPG) prospective payment systems will receive a cost coverage add-on. The provisions of this rule do not apply to the medicaid maximum allowed amount calculation described in rule 5...

...s for inpatient hospital services for discharges on or after the effective date of this rule. (A) Hospitals defined as eligible providers of hospitals services in rule 5160-2-01 of the Administrative Code and are 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 desc...

...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...

...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...