Ohio Revised Code Search

...payment rate determined under section 5165.15 of the Revised Code, the department of medicaid shall pay the provider of a nursing facility the lesser of the following for nursing facility services the nursing facility provides on or after January 1, 2012, to a dual eligible individual who is eligible for nursing facility services under the medicaid program and post-hospital extended care services under Part A ...

...ursing facility provider under section 5165.191 of the Revised Code. The department may conduct an exception review based on the findings of a medicaid certification survey conducted by the department of health, a risk analysis, or prior performance of the provider. Exception reviews shall be conducted by appropriate health professionals under contract with or employed by the department. The professionals may revi...

...ll consist of the following members: (1) Four members appointed by the speaker of the house of representatives, three from the majority party and one from the minority party; (2) Four members appointed by the president of the senate, three from the majority party and one from the minority party. (B) Appointments to the commission shall be made not later than December 31, 2021. In the event of a vacancy, a repla...

... at an amount equal to the following: (1) In the case of a nursing facility that had an occupancy rate exceeding ninety-five per cent, an amount not exceeding fifty per cent of the per medicaid day payment rate the provider would be paid if the recipient were not absent from the nursing facility that day; (2) In the case of a nursing facility that had an occupancy rate not exceeding ninety-five per cent, an amount ...

...the provider was entitled to receive: (1) The provider properly amends a cost report for the nursing facility under section 5165.107 of the Revised Code; (2) The department makes a finding based on an audit under section 5165.109 of the Revised Code; (3) The department makes a finding based on an exception review of resident assessment data conducted under section 5165.193 of the Revised Code after the effective d...

...ecified in rules authorized by section 5165.53 of the Revised Code. The written notice shall be provided to the department not later than forty-five days before the effective date of the change of operator if the change of operator does not entail the relocation of residents. The written notice shall be provided to the department not later than ninety days before the effective date of the change of operator if the ch...

...e department of medicaid under section 5165.511 or 5165.512 of the Revised Code shall do all of the following: (1) Comply with all applicable federal statutes and regulations; (2) Comply with section 5165.07 of the Revised Code and all other applicable state statutes and rules; (3) Subject to division (B) of this section, comply with all the terms and conditions of the exiting operator's provider agreement, includ...

...withheld under division (A) of section 5165.521 of the Revised Code, less any amount the exiting operator owes the department under the medicaid program, as follows: (A) Unless the department issues the initial debt summary report required by section 5165.525 of the Revised Code not later than sixty days after the date the exiting operator files the properly completed cost report required by section 5165.522 of th...

...ing, as selected by the survey team: (1) Copies of all survey notes and any other written materials created during the survey; (2) A written summary of the survey team's recommendations regarding findings of noncompliance with certification requirements; (3) An audio or audiovisual recording of the interview. If the survey team selects this option, at least two copies of the recording shall be made and the s...

...(A) Except as provided in section 3721.17 of the Revised Code, a finding shall be cited only on the basis of a survey and a determination that one or more actions, practices, situations, or incidents at a nursing facility caused or resulted from the facility's failure to comply with one or more certification requirements. The department of health shall determine whether the actions, practices, situations, or in...

...view, if all of the following apply: (1) The facility meets the requirements, established in regulations issued by the United States secretary of health and human services under Title XIX for certification of nursing facilities that have a deficiency. (2) The department of health has approved a plan of correction submitted by the facility under section 5165.69 of the Revised Code for each deficiency. (3) The...

...ram shall be terminated under sections 5165.60 to 5165.89 of the Revised Code as follows: (1) If the department of medicaid is terminating the facility's participation, it shall issue an order terminating the facility's provider agreement. (2) If the department of health, acting as a contracting agency, is terminating the facility's participation, it shall issue an order terminating certification of the facili...

... submitted and approved under section 5165.69 of the Revised Code, the department of health shall conduct a follow-up survey to determine whether the deficiency or deficiencies have been substantially corrected in accordance with the plan. (B) The department of medicaid or a contracting agency shall terminate a nursing facility's participation in the medicaid program whenever the facility has not substantiall...

... adopt rules in accordance with Chapter 119. of the Revised Code governing medicaid waiver components. The rules may establish all of the following: (1) Eligibility requirements for the medicaid waiver components; (2) The type, amount, duration, and scope of medicaid services the medicaid waiver components cover; (3) The conditions under which the medicaid waiver components cover medicaid services; (4) Th...

...uals with Disabilities Education Act," 111 Stat. 37 (1997), 20 U.S.C. 1400, as amended. (G) Safeguards shall be taken to protect the health and welfare of individuals receiving medicaid services under a component, including safeguards established in rules adopted under section 5166.02 of the Revised Code and safeguards established by licensing and certification requirements that are applicable to the providers...

...icaid waiver that went into effect July 1, 1998. (B) The department of medicaid may create and administer two or more medicaid waiver components under which home and community-based services are provided to eligible individuals who need the level of care provided by a nursing facility or hospital. In administering the medicaid waiver components, the department may specify the following: (1) The maximum number...

...A) As used in this section and section 5166.161 of the Revised Code, "ODA or MCD medicaid waiver component" means all of the following: (1) The medicaid-funded component of the PASSPORT program; (2) The medicaid-funded component of the assisted living program; (3) The Ohio home care waiver program. (B) The medicaid director may create a home and community-based services medicaid waiver component as part o...

...ased services specified in division (A)(1) of section 5166.20 of the Revised Code and provided under any of the medicaid waiver components that the department administers under section 5166.21 of the Revised Code, the department shall consider both of the following: (1) The number of individuals with developmental disabilities placed on the county board's waiting list established for the services pursuant to sectio...

...ply with the requirements of sections 5166.30 to 5166.3010 and rules adopted under section 5166.02 of the Revised Code; (B) Provides the director evidence satisfactory to the director of all of the following: (1) That the individual either meets the personnel qualifications specified in 42 C.F.R. 484.4 for home health aides or has successfully completed at least one of the following: (a) A competency evaluati...

...g unless both of the following apply: (1) The medication is administered orally, topically, or via a gastrostomy tube or jejunostomy tube, including through any of the following: (a) In the case of an oral medication, a metered dose inhaler; (b) In the case of a topical medication, including a transdermal medication, either of the following: (i) An eye, ear, or nose drop or spray; (ii) A vaginal or rectal su...

...(A) As used in sections 5166.40 to 5166.409 of the Revised Code: (1) "Adult" means an individual who is at least eighteen years of age. (2) "Buckeye account" means a modified health savings account established under section 5166.402 of the Revised Code. (3) "Contribution" means the amounts that an individual contributes to the individual's buckeye account and are contributed to the account on the individual's beha...

..." have the same meanings as in section 5160.01 of the Revised Code. (B) The medicaid director shall establish a medicaid waiver component to provide continuous medicaid enrollment for children from birth through three years of age. A child who is determined eligible for medical assistance under Title XIX of the "Social Security Act" or child health assistance under Title XXI of the "Social Security Act" shall rema...

...s the system established under section 5167.03 of the Revised Code. (D) "Controlled substance" has the same meaning as in section 3719.01 of the Revised Code. (E) "Dual eligible individual" has the same meaning as in section 5160.01 of the Revised Code. (F) "Emergency services" has the same meaning as in the "Social Security Act," section 1932(b)(2), 42 U.S.C. 1396u-2(b)(2). (G) "Enrollee" means a medicai...

...(A) As used in this section: (1) "Help me grow program" means the program established by the department of health pursuant to section 5180.21 of the Revised Code. (2) "Targeted case management" has the same meaning as in 42 C.F.R. 440.169(b). (B) A medicaid managed care organization shall provide to a medicaid recipient who meets the criteria in division (C) of this section, or arrange for such recipient to ...

...(A) As used in this section: (1) "Board of health" means the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code. (2) "Certified community health worker" has the same meaning as in section 4723.01 of the Revised Code. (3) "Community health worker services" means the services described in section 4723.81 of the Rev...