Ohio Administrative Code Search

...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...

...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...