Ohio Administrative Code Search

... and 5139.04 of the Revised Code. (F) Discharge is defined as the termination of the Ohio department of youth services' legal custody of a youth, division (C) of section 5139.51 of the Revised Code. (G) Discharge date (DD) is defined as the month, day and year on which a youth is officially discharged from the department's custody. (H) Discharge eligibility date (DED) is defined as the proje...

...s and criteria on the release authority discharge review process. (A) Youth may be discharged from the department from either parole status or institutional status based on the length of their sentence and the manner in which they are leaving the department's custody. (B) Institutional discharges may occur when a youth's sentence reaches or exceeds age twenty-one, the youth is sentenced as a...

...ion and materials about the release and discharge processes. The information shall be provided during the reception/orientation period and included in the youth handbooks. (B) The release authority shall provide educational materials and informational sessions for the families of youth committed to ODYS. Custodial parents and legal guardians shall receive communications of all release authority decisions concerning...

...r example, hiring, promotion, demotion, discharge, salary/compensation issues, leave requests/issues, time card approvals/issues); (14) Complying with an executive order or policy; (15) Complying with an agency policy or a state administrative policy issued by the department of administrative services, the office of budget and management, or other similar state agency; (16) Complying with a...

...m the date the individual was fully discharged from all imprisonment, probation or parole: (i) 2903.04 (involuntary manslaughter); (ii) 2903.041 (reckless homicide); (iii) 2905.04 (child stealing, as that offense existed prior to July 1, 1996); (iv) 2905.05 (child enticement); (v) 2905.11 (extortion); (vi) 2907.21 (compelling prostitution); (vii) 2907.22 (promot...

...ed sixty-five days from the date of discharge for inpatient hospital claims. (c) Three hundred sixty-five days from the date of service or inpatient hospital discharge, as applicable, for denied claims that are re-submitted for payment. (2) Provider-reported underpaid claims should be adjusted within three hundred sixty-five days from the date of service or inpatient hospital discharge, as appli...

... of the date of service or hospital discharge, or within one hundred eighty days of the notice of state hearing decision or eligibility determination; (7) Reimbursement from a third party as defined in section 5160.35 of the Revised Code is not available; (8) The request is not for reimbursement of medicare part A out-of-pocket expenses. (C) Within ninety days of meeting the conditions spec...

...e the eligible member for BHCC upon discharge from the SUD residential treatment period. (6) For eligible members who also meet criteria for assertive community treatment (ACT) or intensive home based treatment (IHBT) as defined in Chapter 5160-27 of the Administrative Code, the following applies: (a) The eligible member will be attributed to or maintain attribution with a QBHE. (b) If the QBHE...

... 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...

... 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...

...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...