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Ohio Statutes, Title 51

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Title 51, Title 51. Public Welfare

31 chapters · 1,983 sections in this title.

All chapters in Title 511,983 Ch 5123, Chapter 5123 | Department of Develop…182 Ch 5101, Chapter 5101 | Department of Job and…144 Ch 5119, Chapter 5119 | Department of Behavio…121 Ch 5120, Chapter 5120 | Department of Rehabil…121 Ch 5165, Chapter 5165 | Medicaid Coverage of …116 Ch 5103, Chapter 5103 | Placement of Children113 Ch 5126, Chapter 5126 | County Boards of Deve…111 Ch 5180, Chapter 5180 | Department of Childre…94 Ch 5164, Chapter 5164 | Medicaid State Plan S…92 Ch 5124, Chapter 5124 | Intermediate Care Fac…80 Ch 5153, Chapter 5153 | County Children Services72 Ch 5104, Chapter 5104 | Child Day-care69 Ch 5168, Chapter 5168 | Hospital Care Assuran…66 Ch 5107, Chapter 5107 | Ohio Works First Program64

80 sections·Filtered byTitle 51✕Ch 5124✕

Ohio Rev. Code Ann. § 5124.01 Definitions
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As used in this chapter: (A) "Addition" means an increase in an ICF/IID's square footage. (B) "Affiliated operator" means an operator affiliated with either of the following: (1) The exiting operator for whom the affiliated operator is to assume liability for the entire amount of…
Ohio Rev. Code Ann. § 5124.02 Assumption of powers and duties regarding medicaid program's coverage of ICF/IID services
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The department of medicaid shall enter into a contract with the department of developmental disabilities under section 5162.35 of the Revised Code that provides for the department of developmental disabilities to assume the powers and duties of the department of medicaid with reg…
Ohio Rev. Code Ann. § 5124.03 Rules
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To the extent authorized by rules authorized by section 5162.021 of the Revised Code, the director of developmental disabilities shall adopt rules in accordance with Chapter 119. of the Revised Code as necessary to implement this chapter.
Ohio Rev. Code Ann. § 5124.05 Scope of coverage
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The medicaid program shall cover ICF/IID services when all of the following apply: (A) The ICF/IID services are provided to a medicaid recipient eligible for the services.(B) The ICF/IID services are provided by an ICF/IID for which the provider has a valid provider agreement.(C)…

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Ohio Rev. Code Ann. § 5124.06 Eligibility to enter into provider agreements

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(A) Subject to section 5124.072 of the Revised Code, an ICF/IID operator is eligible to enter into a provider agreement for an ICF/IID if all of the following apply: (1) The ICF/IID is certified by the director of health for participation in medicaid;(2) The ICF/IID is licensed b…

Ohio Rev. Code Ann. § 5124.07 Department provider agreements; contents

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(A) Except as provided in section 5124.072 of the Revised Code, the department of medicaid shall enter into a provider agreement with an ICF/IID operator who applies, and is eligible, for the provider agreement. (B) A provider agreement shall require the department of development…

Ohio Rev. Code Ann. § 5124.071 Agreements with more than one ICF/IID

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An ICF/IID operator may enter into provider agreements for more than one ICF/IID.

Ohio Rev. Code Ann. § 5124.072 Revalidation of agreements

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The department of medicaid shall not revalidate an ICF/IID provider agreement if the provider fails to maintain eligibility for the provider agreement as provided in section 5124.06 of the Revised Code.

Ohio Rev. Code Ann. § 5124.08 Provider agreements with ICF/IID providers

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(A) Every provider agreement with an ICF/IID provider shall do both of the following: (1) Except as provided by division (B) of this section, include any part of the ICF/IID that meets federal and state standards for medicaid certification;(2) Prohibit the provider from doing eit…

Ohio Rev. Code Ann. § 5124.081 Resident's cause of action for breach

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An ICF/IID resident has a cause of action against the provider of the ICF/IID for breach of the provider agreement obligations or other duties imposed by section 5124.08 of the Revised Code. The action may be commenced by the resident, or on the resident's behalf by the resident'…

Ohio Rev. Code Ann. § 5124.10 Cost reports

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(A) Except as provided in division (D) of this section and divisions (C)(2) and (4) of section 5124.101 of the Revised Code, each ICF/IID provider shall file with the department of developmental disabilities an annual cost report for each of the provider's ICFs/IID for which the …

Ohio Rev. Code Ann. § 5124.101 Cost reports for downsized or partially converted provider

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(A) The provider of an ICF/IID in peer group 1, peer group 2, peer group 3, or peer group 4 that becomes a downsized ICF/IID or partially converted ICF/IID on or after July 1, 2013, or becomes a new ICF/IID on or after that date, may file with the department of developmental disa…

Ohio Rev. Code Ann. § 5124.102 Fines paid excluded from reports

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No ICF/IID provider shall report fines paid under section 5124.99 of the Revised Code in a cost report filed under section 5124.10, 5124.101, or 5124.522 of the Revised Code.

Ohio Rev. Code Ann. § 5124.103 Form of cost reports

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Cost reports shall be completed using the form prescribed under section 5124.104 of the Revised Code and in accordance with the guidelines established under that section.

Ohio Rev. Code Ann. § 5124.104 Duties of department

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The department of developmental disabilities shall do all of the following: (A) Prescribe the form to be used for completing a cost report and a uniform chart of accounts for the purpose of reporting costs on the form;(B) Distribute a paper copy of the form, or computer software …

Ohio Rev. Code Ann. § 5124.105 Addendum for disputed costs

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The department of developmental disabilities shall develop an addendum to the cost report form that an ICF/IID provider may use to set forth costs that the provider believes the department may dispute. The department may consider such costs in determining an ICF/IID's medicaid pa…

Ohio Rev. Code Ann. § 5124.106 Failure to timely file report; consequences

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(A) If an ICF/IID provider required by section 5124.10 of the Revised Code to file a cost report for the ICF/IID fails to file the cost report by the date it is due or the date, if any, to which the due date is extended pursuant to division (E) of that section, or files an incomp…

Ohio Rev. Code Ann. § 5124.107 Amendments to reports

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(A) Except as provided in division (B) of this section and not later than three years after an ICF/IID provider files a cost report with the department of developmental disabilities under section 5124.10 or 5124.101 of the Revised Code, the provider may amend the cost report if t…

Ohio Rev. Code Ann. § 5124.108 Desk review

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The department of developmental disabilities shall conduct a desk review of all cost reports it receives under sections 5124.10, 5124.101, and 5124.522 of the Revised Code. Based on the desk review, the department shall make a preliminary determination of whether the reported cos…

Ohio Rev. Code Ann. § 5124.109 Audits

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(A) The department of developmental disabilities may conduct an audit, as defined in rules adopted under section 5124.03 of the Revised Code, of any cost report filed under section 5124.10, 5124.101, or 5124.522 of the Revised Code. The decision whether to conduct an audit and th…

Ohio Rev. Code Ann. § 5124.15 Amount of payments

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(A) Except as otherwise provided by section 5124.101 of the Revised Code, sections 5124.151 to 5124.154 of the Revised Code, and division (B) of this section, the total per medicaid day payment rate that the department of developmental disabilities shall pay to an ICF/IID provide…

Ohio Rev. Code Ann. § 5124.151 Initial rates for services provided by a new ICF/IID

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(A) The total per medicaid day payment rate determined under section 5124.15 of the Revised Code shall not be the initial rate for ICF/IID services provided by a new ICF/IID. Instead, the initial total per medicaid day payment rate for ICF/IID services provided by a new ICF/IID s…

Ohio Rev. Code Ann. § 5124.152 Payment rate for service provided by outlier ICF/IID or unit

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(A) The total per medicaid day payment rate determined under section 5124.15 of the Revised Code shall not be paid for ICF/IID services provided by an ICF/IID, or discrete unit of an ICF/IID, designated by the department of developmental disabilities as an outlier ICF/IID or unit…

Ohio Rev. Code Ann. § 5124.153 Payment rate for services provided to resident who meets criteria for admission to outlier ICF/IID or unit

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(A) To the extent, if any, provided for in rules authorized by this section, the total per medicaid day payment rate determined under section 5124.15 of the Revised Code shall not be paid for ICF/IID services that an ICF/IID not designated as an outlier ICF/IID or unit provides t…

Ohio Rev. Code Ann. § 5124.154 Computing rate for services provided by developmental centers

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The department of developmental disabilities is not required to pay the total per medicaid day payment rates determined under section 5124.15 of the Revised Code for ICF/IID services provided by developmental centers. Instead, the department may determine the medicaid payment rat…

Ohio Rev. Code Ann. § 5124.17 ICF/IID's per medicaid day capital component rate

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(A) For each fiscal year, the department of developmental disabilities shall determine each ICF/IID's per medicaid day capital component rate. An ICF/IID's rate for a fiscal year shall equal the sum of the following: (1) The lesser of the following: (a) The sum of all of the foll…

Ohio Rev. Code Ann. § 5124.19 ICF/IID's per medicaid day direct care costs component rate

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(A) For each fiscal year, the department of developmental disabilities shall determine each ICF/IID's per medicaid day direct care costs component rate. An ICF/IID's rate shall be determined as follows: (1) Determine the product of the following: (a) The ICF/IID's quarterly case-…

Ohio Rev. Code Ann. § 5124.191 Definition of ICF/IID resident; assessment of residents

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(A) As used in sections 5124.191 to 5124.193 of the Revised Code, "ICF/IID resident" includes an individual who is on hospital or therapeutic leave from an ICF/IID. (B) In accordance with rules adopted under section 5124.03 of the Revised Code, the department of developmental dis…

Ohio Rev. Code Ann. § 5124.192 Acuity groups for purpose of assigning case-mix scores

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(A) The department of developmental disabilities shall establish six acuity groups for the purpose of assigning case-mix scores to ICF/IID residents. An ICF/IID resident's case-mix score shall be the score of the resident's acuity group as specified in rules authorized by this se…

Ohio Rev. Code Ann. § 5124.193 Quarterly determination of case-mix scores

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(A) Except as provided in division (B) of this section, the department of developmental disabilities shall do both of the following: (1) For each calendar quarter, determine a case-mix score for each ICF/IID using both of the following: (a) The most recent (as of the date the det…

Ohio Rev. Code Ann. § 5124.194 Changes to instructions, guidelines, or methodology

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(A) No change that the department of developmental disabilities makes to either of the following is valid unless the change is applied prospectively and the department complies with division (B) of this section: (1) The department's instructions or guidelines for the resident ass…

Ohio Rev. Code Ann. § 5124.21 Per medicaid day indirect care costs component rate

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(A) For each fiscal year, the department of developmental disabilities shall determine each ICF/IID's per medicaid day indirect care costs component rate. An ICF/IID's rate shall be the lesser of the individual rate determined under division (B) of this section and the maximum ra…

Ohio Rev. Code Ann. § 5124.23 Per medicaid day other protected costs component rate

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For each fiscal year, the department of developmental disabilities shall determine each ICF/IID's per medicaid day other protected costs component rate. An ICF/IID's rate shall be the ICF/IID's desk-reviewed, actual, allowable, per diem other protected costs from the applicable c…

Ohio Rev. Code Ann. § 5124.24 Determination of per medicaid day quality incentive payment

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(A) For fiscal year 2022 and each fiscal year thereafter, the department of developmental disabilities shall determine in accordance with division (C) of this section a per medicaid day quality incentive payment for each ICF/IID that earns for the fiscal year at least one point u…

Ohio Rev. Code Ann. § 5124.25 Payment of medicaid rate add-on for outlier services provided for ventilator-dependent residents

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(A) Subject to division (D) of this section, the department of developmental disabilities may pay a medicaid rate add-on to an ICF/IID provider for outlier ICF/IID services the ICF/IID provides to qualifying ventilator-dependent residents on or after September 29, 2013, if the pr…

Ohio Rev. Code Ann. § 5124.26 Payment of medicaid rate add-on for outlier ICF/IID services

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(A) Subject to division (D) of this section, the department of developmental disabilities may pay a medicaid rate add-on to an ICF/IID provider for outlier ICF/IID services the ICF/IID provides to residents identified as needing intensive behavioral support services, if the provi…

Ohio Rev. Code Ann. § 5124.29 Limiting compensation of owners, their relatives, administrators, and resident meals outside facility

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Except as otherwise provided in section 5124.30 of the Revised Code, the department of developmental disabilities, in determining whether an ICF/IID's direct care costs and indirect care costs are allowable, shall place no limit on specific categories of reasonable costs other th…

Ohio Rev. Code Ann. § 5124.30 Costs of goods furnished by related party

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Except as provided in section 5124.17 of the Revised Code, the costs of goods, services, and facilities, furnished to an ICF/IID provider by a related party are includable in the allowable costs of the provider at the reasonable cost to the related party. Last updated August 24, …

Ohio Rev. Code Ann. § 5124.31 Adjustment of payment rates

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The department of developmental disabilities shall adjust medicaid payment rates determined under this chapter to account for reasonable additional costs that must be incurred by ICFs/IID to comply with requirements of federal or state statutes, rules, or policies enacted or amen…

Ohio Rev. Code Ann. § 5124.32 Reduction in rate not permitted

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The department of developmental disabilities shall not reduce an ICF/IID's medicaid payment rate determined under this chapter on the basis that the provider charges a lower rate to any resident who is not eligible for medicaid.

Ohio Rev. Code Ann. § 5124.33 No payment for day of discharge

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No medicaid payment shall be made to an ICF/IID provider for the day a medicaid recipient is discharged from the ICF/IID, unless the recipient is discharged from the ICF/IID because all of the beds in the ICF/IID are converted from providing ICF/IID services to providing home and…

Ohio Rev. Code Ann. § 5124.34 Payment for reserving beds

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(A) As used in this section, "participation in therapeutic programs" includes visits to potential new residential settings.(B) The department of developmental disabilities shall pay an ICF/IID provider one hundred per cent of the total per medicaid day payment rate determined for…

Ohio Rev. Code Ann. § 5124.35 Timing of payments after involuntary termination

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Medicaid payments may be made for ICF/IID services provided not later than thirty days after the effective date of an involuntary termination of the ICF/IID that provides the services if the services are provided to a medicaid recipient who is eligible for the services and reside…

Ohio Rev. Code Ann. § 5124.37 Timing of payments; calculations

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The department of developmental disabilities shall make its best efforts each year to determine ICFs/IID's medicaid payment rates under this chapter in time to pay the rates by August fifteenth of each fiscal year. If the department is unable to calculate the rates so that they c…

Ohio Rev. Code Ann. § 5124.38 Process for reconsideration of rates

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(A) The director of developmental disabilities shall establish a process under which an ICF/IID provider, or a group or association of ICF/IID providers, may seek reconsideration of medicaid payment rates established under this chapter. Except as provided in divisions (B) to (E) …

Ohio Rev. Code Ann. § 5124.40 Adjustment of rates

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If an ICF/IID provider properly amends a cost report for an ICF/IID under section 5124.107 of the Revised Code and the amended report shows that the provider received a lower medicaid payment rate under the original cost report than the provider was entitled to receive, the depar…

Ohio Rev. Code Ann. § 5124.41 Redetermination of rates

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(A) The department of developmental disabilities shall redetermine a provider's medicaid payment rate for an ICF/IID using revised information if either of the following results in a determination that the provider received a higher medicaid payment rate for the ICF/IID than the …

Ohio Rev. Code Ann. § 5124.42 Additional penalties

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In addition to the other penalties authorized by this chapter, the department of developmental disabilities may impose the following penalties on an ICF/IID provider: (A) If the provider does not furnish invoices or other documentation that the department requests during an audit…

Ohio Rev. Code Ann. § 5124.43 Determination of interest rate

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For the purposes of sections 5124.41 and 5124.42 of the Revised Code, the department of developmental disabilities shall determine the current average bank prime rate using statistical release H.15, "selected interest rates," a weekly publication of the federal reserve board, or …

Ohio Rev. Code Ann. § 5124.44 Deductions

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(A) Except as provided in division (B) of this section, the department of developmental disabilities shall deduct the following from the next available medicaid payment the department makes to an ICF/IID provider who continues to participate in medicaid: (1) Any amount the provid…