Ohio Revised Code Search

...e last day of the calendar year immediately preceding the state fiscal year. (3) The nursing facility must have a medicaid utilization rate of at least sixty-five per cent as of the last day of the calendar year immediately preceding the state fiscal year. (B) A critical access nursing facility's critical access incentive payment for a state fiscal year shall equal five per cent of the portion of the nursing fa...

...r CMS's successor metrics as described below, based on the most recent four-quarter average data, or the average data for fewer quarters in the case of successor metrics, available in the database maintained by CMS and known as nursing home compare in the most recent month of the calendar year during which the fiscal year for which the rate is determined begins: (i) The percentage of the nursing facility's long-st...

...If a provider of a nursing facility adds or replaces one or more medicaid certified beds to or at the nursing facility, or renovates one or more of the nursing facility's beds, the medicaid payment rate for the added, replaced, or renovated beds shall be the same as the medicaid payment rate for the nursing facility's existing beds.

...t an allowable cost for the purpose of determining the nursing facility's medicaid payment rate.

...ed to a nursing facility provider by a related party are includable in the allowable costs of the provider at the reasonable cost to the related party.

... lower rate to any resident who is not eligible for medicaid.

...No medicaid payment shall be made to a nursing facility provider for the day a medicaid recipient is discharged from the nursing facility.

...on for an acute condition, visits with relatives and friends, and participation in therapeutic programs outside the facility, when the resident's plan of care provides for such absence and federal financial participation for the payments is available. (B) The maximum period for which payments may be made to reserve a bed in a nursing facility shall not exceed thirty days in a calendar year. (C) The department shall...

...rovided to a medicaid recipient who is eligible for the services and resided in the nursing facility before the effective date of the involuntary termination.

...inning with state fiscal year 2024, the department of medicaid shall conduct a rebasing at least once every five state fiscal years. When the department conducts the rebasing for a state fiscal year, it shall conduct the rebasing for only the direct care and tax cost centers.

...The department of medicaid shall make its best efforts each year to calculate nursing facilities' medicaid payment rates under this chapter in time to pay the rates by the fifteenth day of August of each state fiscal year. If the department is unable to calculate the rates so that they can be paid by that date, the department shall pay each provider the rate calculated for the provider's nursing facilities under this...

... or other materials that support its position. The provider, group, or association and department of medicaid shall take actions regarding the rate reconsideration within time frames specified in rules authorized by this section. If the department determines, as a result of the rate reconsideration, that the rate determined for one or more nursing facilities is less than the rate to which the nursing facility ...

...ate for the nursing facility prospectively to reflect the corrected information. The department shall pay the adjusted rate beginning two months after the first day of the month after the provider files the amended cost report. If the department finds, from an exception review of resident assessment data conducted pursuant to section 5165.193 of the Revised Code after the effective date of a nursing facility...

...(A) The department of medicaid shall redetermine a provider's medicaid payment rate for a nursing facility using revised information if any of the following results in a determination that the provider received a higher medicaid payment rate for the nursing facility than 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...

...nalties authorized by this chapter, the department of medicaid may impose the following penalties on a nursing facility provider: (A) If the provider does not furnish invoices or other documentation that the department requests during an audit within sixty days after the request, a fine of no more than the greater of the following: (1) One thousand dollars per audit; (2) Twenty-five per cent of the cumulative amou...

...age bank prime rate using statistical release H.15, "selected interest rates," a weekly publication of the federal reserve board, or any successor publication. If statistical release H.15, or its successor, ceases to contain the bank prime rate information or ceases to be published, the department shall request a written statement of the average bank prime rate from the federal reserve bank of Cleveland or the ...

...(A) Except as provided in division (B) of this section, the department of medicaid shall deduct the following from the next available medicaid payment the department makes to a nursing facility provider who continues to participate in medicaid: (1) Any amount the provider is required to refund, and any interest charged, under section 5165.41 of the Revised Code; (2) The amount of any penalty imposed on the pr...

...The department of medicaid shall transmit to the treasurer of state for deposit in the general revenue fund amounts collected from the following: (A) Refunds required by, and interest charged under, section 5165.41 of the Revised Code; (B) Amounts collected from penalties imposed under section 5165.42 of the Revised Code.

...nce with Chapter 119. of the Revised Code: (A) Any audit disallowance that the department of medicaid makes as the result of an audit under section 5165.109 of the Revised Code; (B) Any adverse finding that results from an exception review of resident assessment data conducted for a nursing facility under section 5165.193 of the Revised Code after the effective date of the nursing facility's medicaid payment...

...on, other than a nursing facility provider, shall submit a claim for medicaid payment for a service provided to a nursing facility resident if the service is included in a medicaid payment made to the nursing facility provider under this chapter or in the allowable expenses reported on a provider's cost report for a nursing facility. No nursing facility provider shall submit a separate claim for medicaid paymen...

...ng facility who, under federal law, is eligible to have the medicaid program pay for a part of the cost-sharing expenses if the provider determines that, under rules adopted under section 5165.02 of the Revised Code, the nursing facility would not receive a medicaid payment for any part of the medicare cost-sharing expenses. In such a situation, a claim for the medicare cost-sharing expenses shall be considere...

...The department of medicaid may conduct a post-payment review of a claim submitted by a nursing facility provider and paid by the medicaid program to determine whether the provider was overpaid. The department shall provide the provider a written summary of the review's results. The review's results are not subject to an adjudication under Chapter 119. of the Revised Code; however, the provider may request that ...

...ting in the medicaid program shall provide the department of medicaid written notice of a facility closure or voluntary withdrawal of participation not less than ninety days before the effective date of the facility closure or voluntary withdrawal of participation. The written notice shall be provided to the department in accordance with the method specified in rules authorized by section 5165.53 of the Revised...

...) if the operator's nursing facility undergoes a voluntary withdrawal of participation.

...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 change of operator entails the relocation of residents. The department may waive the time requirements of division (A) of this section in an emergency, such as the death of the operator. The written notice shall ...