Ohio Revised Code Search

...ursuant to this section. (5) "Nursing facility" has the same meaning as in section 5165.01 of the Revised Code. (6) "PACE program" means the component of the medicaid program the department of aging administers pursuant to section 173.50 of the Revised Code. (7) "PASSPORT administrative agency" means an entity under contract with the department of aging to provide administrative services regarding the PASSPORT ...

...aw, including a county home or a county nursing home that is certified under Title XVIII or Title XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301, as amended, is staffed and equipped to provide long-term care services, and is actively providing long-term care services; (2) A long-term care facility that is licensed or otherwise authorized to operate in this state in accordance with applicable l...

...the beds are proposed to be licensed as nursing home beds under Chapter 3721. of the Revised Code; (2) Approval of beds in a new county home or new county nursing home, or an increase of beds in an existing county home or existing county nursing home if the beds are proposed to be certified as skilled nursing facility beds under the medicare program, Title XVIII of the "Social Security Act," 49 Stat. 286 (1965), 4...

...pon the services of others, including a nursing home, residential care facility, home for the aging, and a veterans' home operated under Chapter 5907. of the Revised Code. (b) "Home" also means both of the following: (i) Any facility that a person, as defined in section 3702.51 of the Revised Code, proposes for certification as a skilled nursing facility or nursing facility under Title XVIII or XIX of the "Soci...

...g: (1) Provide the following skilled nursing care to its residents: (a) Supervision of special diets; (b) Application of dressings, in accordance with rules adopted under section 3721.04 of the Revised Code; (c) Subject to division (B)(1) of this section, administration of medication. (2) Subject to division (C) of this section, provide other skilled nursing care on a part-time, intermittent basis for not ...

...care facility is certified as a skilled nursing facility or a nursing facility under Title XVIII or XIX of the "Social Security Act," 49 Stat. 620 (1935), 42 U.S.C.A. 301, as amended, or prior to January 1, 1990, if the facility is not so certified, the individual completed a program that the director determines included a competency evaluation component no less stringent than the competency evaluation programs appro...

... illness seeking admission to a nursing facility requires the level of services provided by a nursing facility and, if the individual requires that level of services, whether the individual requires specialized services for mental illness. The determination required by this division shall be based on an independent physical and mental evaluation performed by a person or entity other than the department. (2) Except ...

...dividual seeking admission to a nursing facility requires the level of services provided by a nursing facility and, if the individual requires that level of services, whether the individual requires specialized services for mental retardation. (2) A determination under this division is not required for any of the following: (a) An individual seeking readmission to a nursing facility after having been transferr...

... subsequently licensed as a residential facility under section 5123.19 of the Revised Code; (b) In the case of an ICF/IID that was originally licensed as a residential facility under section 5123.19 of the Revised Code, the date it was originally so licensed; (c) In the case of an ICF/IID that was not required by law to be licensed as a nursing home or residential facility when it was originally operated as a r...

... (B) "Allowable costs" are a nursing facility's costs that the department of medicaid determines are reasonable. Fines paid under sections 5165.60 to 5165.89 and section 5165.99 of the Revised Code are not allowable costs. (C) "Ancillary and support costs" means all reasonable costs incurred by a nursing facility other than direct care costs, tax costs, or capital costs. "Ancillary and support costs" includes, ...

...Every provider agreement with a nursing facility provider shall do both of the following: (1) Permit the provider to exclude one or more parts of the nursing facility from the provider agreement, even though those parts meet federal and state standards for medicaid certification, if all of the following apply: (a) The nursing facility initially obtained both its nursing home license under Chapter 3721. of the Revis...

...all not be the initial rate for nursing facility services provided by a new nursing facility. Instead, the initial total per medicaid day payment rate for nursing facility services provided by a new nursing facility shall be determined in the following manner: (1) The initial rate for ancillary and support costs shall be the rate for the new nursing facility's peer group determined under division (C) of section 51...

...ised Code shall not be paid for nursing facility services provided by a nursing facility, or discrete unit of a nursing facility, designated by the department of medicaid as an outlier nursing facility or unit. Instead, the provider of a designated outlier nursing facility or unit shall be paid each state fiscal year a total per medicaid day payment rate that the department shall prospectively determine in accordance...

...lternative purchasing model for nursing facility services provided by designated discrete units of nursing facilities to medicaid recipients with specialized health care needs. The director shall do all of the following with regard to the model: (1) Establish criteria that a discrete unit of a nursing facility must meet to be designated as a unit that, under the alternative purchasing model, may admit and provide ...

...f medicaid shall determine each nursing facility's per medicaid day payment rate for ancillary and support costs. A nursing facility's rate shall be the rate determined under division (C) of this section for the nursing facility's peer group. (B) For the purpose of determining nursing facilities' rates for ancillary and support costs, the department shall establish six peer groups composed as follows: (1) Each ...

...f medicaid shall determine each nursing facility's per medicaid day payment rate for capital costs. A nursing facility's rate shall be the rate determined under division (C) of this section for the nursing facility's peer group. (B) For the purpose of determining nursing facilities' rates for capital costs, the department shall establish six peer groups. (1) Each nursing facility located in any of the following c...

...f medicaid shall determine each nursing facility's per medicaid day payment rate for direct care costs by multiplying the facility's semiannual case-mix score determined under section 5165.192 of the Revised Code by the cost per case-mix unit determined under division (C) of this section for the facility's peer group. (2) Beginning January 1, 2024, during state fiscal years 2024 and 2025, the department shall dete...

...ng two case-mix scores for each nursing facility: (i) A quarterly case-mix score that includes each resident who is a medicaid recipient and is not a low case-mix resident; (ii) A quarterly case-mix score that includes each resident regardless of payment source. (b) Every six months, determine a semiannual average case-mix score for each nursing facility by using the quarterly case-mix scores determined for ...

...cess incentive payment for each nursing facility that qualifies as a critical access nursing facility. To qualify as a critical access nursing facility for a state fiscal year, a nursing facility must meet all of the following requirements: (1) The nursing facility must be located in an area that, on December 31, 2011, was designated an empowerment zone under the "Internal Revenue Code of 1986," section 1391, 26 U...

...se rate" means the portion of a nursing facility's total per medicaid day payment rate determined under divisions (A) and (B) of section 5165.15 of the Revised Code. (2) "CMS" means the United States centers for medicare and medicaid services. (3) "Long-stay resident" means an individual who has resided in a nursing facility for at least one hundred one days. (4) "Nursing facilities for which a quality score...

... rights" means the rights of a nursing facility resident under sections 3721.10 to 3721.17 of the Revised Code, the "Social Security Act," sections 1819(c) and 1919(c), 42 U.S.C. 1395i-3(c) and 1396r(c), and federal regulations issued under those sections of the "Social Security Act." As used in sections 5165.60 to 5165.89 of the Revised Code: (A) "Certification requirements" means the requirements for nursi...

... (v) "Long-term care facility" means a nursing home, residential care facility, or home for the aging, as those terms are defined in section 3721.01 of the Revised Code; a residential facility licensed under section 5119.34 of the Revised Code that provides accommodations, supervision, and personal care services for three to sixteen unrelated adults; a nursing facility, as defined in section 5165.01 of the Revised C...

...able cause to believe is operating as a nursing home, residential care facility, or home for the aging without a valid license required by section 3721.05 of the Revised Code or, in the case of a county home or district home, is operating despite the revocation of its residential care facility license. The director may delegate the director's authority and duties under this chapter to any division, bureau, agency, or...

...artment of medicaid shall pay a nursing facility provider for nursing facility services the provider's nursing facility provides during a state fiscal year shall be determined as follows: (A) Determine the sum of all of the following: (1) The per medicaid day payment rate for ancillary and support costs determined for the nursing facility under section 5165.16 of the Revised Code; (2) The per medicaid day pa...

...afety and quality of care provided by a nursing facility as required under the special focus facility program. (B) The department of medicaid shall issue an order terminating a nursing facility's participation in the medicaid program if either of the following apply: (1) The nursing facility fails to graduate from the special focus facility program after two standard health surveys while in the program. (2) ...