Section 5165.155 | Amount of payments for dual eligible individuals.
(A) As used in this section, "medicaid maximum allowable amount" means one hundred per cent of a nursing facility's total per medicaid day payment rate.
(B) Instead of paying the total per medicaid day 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 of Title XVIII:
(1) The coinsurance amount for the services as provided under Part A of Title XVIII;
(2) The medicaid maximum allowable amount for the services, less the amount paid under Part A of Title XVIII for the services.
Available Versions of this Section
- September 29, 2013 – House Bill 59, 130th General Assembly [ View September 29, 2013 Version ]