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Ohio Statutes, Title 51

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Ohio/Statutes

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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

116 sections·Filtered byTitle 51✕Ch 5165✕

Ohio Rev. Code Ann. § 5165.36 Rebasing
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Beginning 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. …
Ohio Rev. Code Ann. § 5165.37 Calculating rates and making payments
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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 tha…
Ohio Rev. Code Ann. § 5165.38 Reconsideration of rate
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The medicaid director shall adopt rules under section 5165.02 of the Revised Code that establish a process under which a nursing facility provider, or a group or association of nursing facility providers, may seek reconsideration of medicaid payment rates established under this c…
Ohio Rev. Code Ann. § 5165.40 Adjustment of rates
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If a nursing facility provider properly amends a cost report for the nursing facility under section 5165.107 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 …

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Ohio Rev. Code Ann. § 5165.41 Redetermination of rates

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(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 prov…

Ohio Rev. Code Ann. § 5165.42 Additional penalties

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In addition to the other penalties 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 six…

Ohio Rev. Code Ann. § 5165.43 Determination of interest rate

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For the purposes of sections 5165.41 and 5165.42 of the Revised Code, the department of medicaid 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 any successor publ…

Ohio Rev. Code Ann. § 5165.44 Deductions

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(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 requ…

Ohio Rev. Code Ann. § 5165.45 Deposits to general revenue fund

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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 …

Ohio Rev. Code Ann. § 5165.46 Administrative adjudication

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All of the following are subject to an adjudication conducted in accordance 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 re…

Ohio Rev. Code Ann. § 5165.47 Claim for medicaid payment for service provided to nursing facility resident

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No person, 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 expense…

Ohio Rev. Code Ann. § 5165.48 Nursing facility not required to submit Medicaid claim for Medicare cost-sharing expenses under certain circumstances

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The provider of a nursing facility is not required to submit a claim to the department of medicaid regarding the medicare cost-sharing expenses of a resident of the nursing facility who, under federal law, is eligible to have the medicaid program pay for a part of the cost-sharin…

Ohio Rev. Code Ann. § 5165.49 Post-payment reviews of nursing facility Medicaid claims

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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. T…

Ohio Rev. Code Ann. § 5165.50 Notice of facility closure or withdrawal of participation

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An exiting operator or owner of a nursing facility participating 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 clos…

Ohio Rev. Code Ann. § 5165.501 Compliance with Social Security Act required

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An operator shall comply with the "Social Security Act," section 1919(c)(2)(F), 42 U.S.C. 1396r(c)(2)(F) if the operator's nursing facility undergoes a voluntary withdrawal of participation.

Ohio Rev. Code Ann. § 5165.51 Notice of change of operator

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(A) An exiting operator or owner and entering operator shall provide the department of medicaid written notice of a change of operator if the nursing facility participates in the medicaid program and the entering operator seeks to continue the nursing facility's participation. Th…

Ohio Rev. Code Ann. § 5165.511 Agreements with entering operators effective on date of change of operator

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The department of medicaid may enter into a provider agreement with an entering operator that goes into effect at 12:01 a.m. on the effective date of the change of operator if all of the following requirements are met: (A) The department receives a properly completed written noti…

Ohio Rev. Code Ann. § 5165.512 Agreements with entering operators effective on a later date

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(A) The department of medicaid may enter into a provider agreement with an entering operator that goes into effect at 12:01 a.m. on the date determined under division (B) of this section if all of the following are the case: (1) The department receives a properly completed writte…

Ohio Rev. Code Ann. § 5165.513 Entering operator duties under provider agreement

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(A) A provider that enters into a provider agreement with the 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…

Ohio Rev. Code Ann. § 5165.514 Exiting operator deemed operator pending change

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In the case of a change of operator, the exiting operator shall be considered to be the operator of the nursing facility for purposes of the medicaid program, including medicaid payments, until the effective date of the entering operator's provider agreement if the provider agree…

Ohio Rev. Code Ann. § 5165.515 Provider agreement with operator not complying with prior agreement

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The department of medicaid may enter into a provider agreement as provided in section 5165.07 of the Revised Code, rather than section 5165.511 or 5165.512 of the Revised Code, with an entering operator if the entering operator does not agree to a provider agreement that satisfie…

Ohio Rev. Code Ann. § 5165.516 Medicaid reimbursement adjustments; change of operator

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The medicaid director may adopt rules under section 5165.02 of the Revised Code governing adjustments to the medicaid payment rate for a nursing facility that undergoes a change of operator. No rate adjustment resulting from a change of operator shall be effective before the effe…

Ohio Rev. Code Ann. § 5165.517 Determination of change of operator for purposes of licensure not controlling

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The department of health's determination that a change of operator has or has not occurred for purposes of licensure under Chapter 3721. of the Revised Code shall not affect the department of medicaid's determination of whether or when a change of operator occurs or the effective…

Ohio Rev. Code Ann. § 5165.518 Nursing facility operator identity

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(A) Each nursing facility shall ensure that the identity of the operator that holds the license to operate the facility issued under section 3721.02 of the Revised Code and the operator that holds the medicaid provider agreement for the facility issued under section 5165.07 of th…

Ohio Rev. Code Ann. § 5165.52 Overpayment amounts determined following notice of closure, etc

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(A) On receipt of a written notice under section 5165.50 of the Revised Code of a facility closure or voluntary withdrawal of participation, on receipt of a written notice under section 5165.51 of the Revised Code of a change of operator, or on the effective date of an involuntar…

Ohio Rev. Code Ann. § 5165.521 Withholding amounts owed from medicaid payments to exiting operator

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(A) Except as provided in divisions (B), (C), and (D) of this section, the department of medicaid may withhold from payment due an exiting operator under the medicaid program the total amount specified in the notice provided under division (C) of section 5165.52 of the Revised Co…

Ohio Rev. Code Ann. § 5165.522 Cost report by exiting operator; waiver

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(A) Except as provided in division (B) of this section, an exiting operator shall file with the department of medicaid a cost report not later than ninety days after the last day the exiting operator's provider agreement is in effect or, in the case of a voluntary withdrawal of p…

Ohio Rev. Code Ann. § 5165.523 Failure to file cost report; payments deemed overpayments

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If an exiting operator required by section 5165.522 of the Revised Code to file a cost report with the department of medicaid fails to file the cost report in accordance with that section, all payments under the medicaid program for the period the cost report is required to cover…

Ohio Rev. Code Ann. § 5165.524 Final payment withheld pending receipt of cost reports

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The department of medicaid may not provide an exiting operator final payment under the medicaid program until the department receives all properly completed cost reports the exiting operator is required to file under sections 5165.10 and 5165.522 of the Revised Code.

Ohio Rev. Code Ann. § 5165.525 Determination of debt of exiting operator; summary report

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The department of medicaid shall determine the actual amount of debt an exiting operator owes the department under the medicaid program by completing all final fiscal audits not already completed and performing all other appropriate actions the department determines to be necessa…

Ohio Rev. Code Ann. § 5165.526 Release of amount withheld less amounts owed

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The department of medicaid shall release the actual amount 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 summa…

Ohio Rev. Code Ann. § 5165.527 Release of amount withheld on postponement of change of operator

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The department of medicaid, at its sole discretion, may release the amount withheld under division (A) of section 5165.521 of the Revised Code if the exiting operator submits to the department written notice of a postponement of a change of operator, facility closure, or voluntar…

Ohio Rev. Code Ann. § 5165.528 Disposition of amounts withheld from payment due an exiting operator

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(A) All amounts withheld under section 5165.521 of the Revised Code from payment due an exiting operator under the medicaid program shall be deposited into the medicaid payment withholding fund created by the controlling board pursuant to section 131.35 of the Revised Code. Money…

Ohio Rev. Code Ann. § 5165.53 Adoption of rules regarding change in operators

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The medicaid director shall adopt rules under section 5165.02 of the Revised Code to implement sections 5165.50 to 5165.53 of the Revised Code, including rules applicable to an exiting operator that provides written notification under section 5165.50 of the Revised Code of a volu…

Ohio Rev. Code Ann. § 5165.60 Definitions for sections 5165.60 to 5165.89

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As used in this section, "a resident's 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 t…

Ohio Rev. Code Ann. § 5165.61 Adoption of rules

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The medicaid director may adopt rules under section 5165.02 of the Revised Code that are consistent with regulations, guidelines, and procedures issued by the United States secretary of health and human services under the "Social Security Act," sections 1819 and 1919, 42 U.S.C. 1…

Ohio Rev. Code Ann. § 5165.62 Enforcement of provisions

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The department of medicaid is hereby authorized to enforce sections 5165.60 to 5165.89 of the Revised Code. The department may enforce the sections directly or through contracting agencies. The department and agencies shall enforce the sections in accordance with the requirements…

Ohio Rev. Code Ann. § 5165.63 Contracts with state agencies for enforcement

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The department of medicaid may enter into contracts with other state agencies pursuant to section 5162.35 of the Revised Code that authorize the agencies to perform all or part of the duties assigned to the department of medicaid under sections 5165.60 to 5165.89 of the Revised C…

Ohio Rev. Code Ann. § 5165.64 Annual standard surveys

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(A) The department of health shall conduct a survey, titled a standard survey, of every nursing facility in this state on a statewide average of not more than once every twelve months. Each nursing facility shall undergo a standard survey at least once every fifteen months as a c…

Ohio Rev. Code Ann. § 5165.65 Exit interview with administrator

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(A) A department of health survey team shall conclude each survey of a nursing facility not later than one business day after the survey team ceases to need to be on site at the facility for the survey. Not later than the day that the survey team concludes the survey, the survey …

Ohio Rev. Code Ann. § 5165.66 Citations for failure to comply with one or more certification requirements

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(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 w…

Ohio Rev. Code Ann. § 5165.67 Survey results

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The results of a survey of a nursing facility that is conducted under section 5165.64 of the Revised Code, including any statement of deficiencies and all findings and deficiencies cited in the statement on the basis of the survey, shall be used solely to determine the nursing fa…

Ohio Rev. Code Ann. § 5165.68 Statement of deficiencies

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(A) Not later than ten days after an exit interview, including an exit interview at which a department of health survey team discloses a finding that immediate jeopardy exists, the department of health shall deliver to the nursing facility a detailed statement, titled a statement…

Ohio Rev. Code Ann. § 5165.69 Plan of correction

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(A) Whenever a nursing facility receives a statement of deficiencies under section 5165.68 of the Revised Code, the facility shall submit to the department of health for its approval a plan of correction for each finding cited in the statement. The plan shall include all of the f…

Ohio Rev. Code Ann. § 5165.70 On-site monitoring

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The department of health may appoint employees of the department to conduct on-site monitoring of a nursing facility whenever a finding is cited, including any finding cited pursuant to division (E) of section 5165.66 of the Revised Code, or an emergency is found to exist. Appoin…

Ohio Rev. Code Ann. § 5165.71 Deficiencies not substantially corrected

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(A) If the department of health cites a deficiency or deficiencies that was not substantially corrected before a survey and that does not constitute a severity level four finding or create immediate jeopardy, the department of medicaid or a contracting agency shall permit the nur…

Ohio Rev. Code Ann. § 5165.72 Uncorrected deficiencies constituting severity level four findings

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(A) If the department of health cites a deficiency, or cluster of deficiencies, that was not substantially corrected before a survey and constitutes a severity level four finding, the department of medicaid or contracting agency shall, subject to sections 5165.79 to 5165.83 of th…

Ohio Rev. Code Ann. § 5165.73 Uncorrected deficiencies constituting severity level three and scope level three or four findings

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If the department of health cites a deficiency, or cluster of deficiencies, that was not substantially corrected before a survey and constitutes a severity level three and scope level three or four finding, the department of medicaid or a contracting agency may, subject to sectio…

Ohio Rev. Code Ann. § 5165.74 Uncorrected deficiencies constituting severity level one or two or severity level three, scope level two finding

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(A) If the department of health cites a deficiency, or cluster of deficiencies, that was not substantially corrected before a survey and constitutes a severity level three and scope level two finding, the department of medicaid or a contracting agency may, subject to sections 516…

Ohio Rev. Code Ann. § 5165.75 Imposing remedies and fines

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(A) In determining which remedies to impose under section 5165.72, 5165.73, or 5165.74 of the Revised Code, including whether a fine should be imposed, the department of medicaid or a contracting agency shall do both of the following: (1) Impose the remedies that are most likely …