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Ohio Statutes, Title 51

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Ohio/Statutes

← All Ohio coverage

Title 51, Public Welfare

31 chapters · 2,012 sections in this title.

All chapters in Title 512,012 Ch 5123, Department of Developmental Disabilities182 Ch 5101, Department of Job and Family Service…145 Ch 5119, Department of Behavioral Health121 Ch 5120, Department of Rehabilitation and Cor…121 Ch 5165, Medicaid Coverage of Nursing Facilit…116 Ch 5103, Placement of Children113 Ch 5164, Medicaid State Plan Services113 Ch 5126, County Boards of Developmental Disab…111 Ch 5180, Department of Children and Youth94 Ch 5124, Intermediate Care Facility for Indiv…80 Ch 5153, County Children Services72 Ch 5104, Child Day-care69 Ch 5162, Medicaid and Medicaid Funds67 Ch 5168, Hospital Care Assurance Program; Hea…66

2,012 sections·Filtered byTitle 51✕

Ohio Rev. Code Ann. § 5165.03 Admission of mentally ill person to nursing facility
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(A) As used in this section: (1) "Dementia" includes Alzheimer's disease or a related disorder. (2) "Serious mental illness" means "serious mental illness," as defined by the United States department of health and human services in regulations adopted under section 1919(e)(7)(G)(…
Ohio Rev. Code Ann. § 5165.031 Hearing
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An individual who applies for admission to or resides in a nursing facility may appeal if adversely affected by a determination made by the department of mental health and addiction services under section 5119.40 of the Revised Code or by the department of developmental disabilit…
Ohio Rev. Code Ann. § 5165.04 Assessment to determine level of care
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(A) As used in this section, "representative" means a person acting on behalf of an applicant for or recipient of medicaid. A representative may be a family member, attorney, hospital social worker, or any other person chosen to act on behalf of an applicant or recipient. (B) The…
Ohio Rev. Code Ann. § 5165.06 Nursing facility eligibility

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Subject to section 5165.072 of the Revised Code, an operator is eligible to enter into and retain a provider agreement for a nursing facility if all of the following apply: (A) The nursing facility is certified by the director of health for participation in medicaid; (B) The nurs…

Ohio Rev. Code Ann. § 5165.07 Provider agreement requirements

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(A) Except as provided in section 5165.072 of the Revised Code, the department of medicaid shall enter into a provider agreement with a nursing facility operator who applies, and is eligible, for the provider agreement. (B) A provider agreement shall require the department to mak…

Ohio Rev. Code Ann. § 5165.071 Facility operator may contract with more than one provider

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A nursing facility operator may enter into provider agreements for more than one nursing facility.

Ohio Rev. Code Ann. § 5165.072 Revalidation

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The department of medicaid shall not revalidate a nursing facility provider agreement if the provider fails to maintain eligibility for the provider agreement as provided in section 5165.06 of the Revised Code.

Ohio Rev. Code Ann. § 5165.073 Termination for non-compliance with installation of fire extinguishing and fire alarm systems

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The department of medicaid shall terminate the provider agreement with a nursing facility provider that does not comply with the requirements of section 3721.071 of the Revised Code for the installation of fire extinguishing and fire alarm systems.

Ohio Rev. Code Ann. § 5165.08 Nursing facilities' provider agreement terms

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(A) As used in this section: "Bed need" means the number of long-term care beds a county needs as determined by the director of health pursuant to division (B)(3) of section 3702.593 of the Revised Code. "Bed need excess" means that a county's bed need is such that one or more lo…

Ohio Rev. Code Ann. § 5165.081 Action against facility for breach of provider agreement or other duties

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A nursing facility resident has a cause of action against a nursing facility provider for breach of the provider agreement obligations or other duties imposed by section 5165.08 of the Revised Code. The action may be commenced by the resident, or on the resident's behalf by the r…

Ohio Rev. Code Ann. § 5165.082 Qualification of beds

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(A) Except as provided in division (B) of this section, the operator of a nursing facility that elects to have the nursing facility participate in the medicaid program shall qualify all of the nursing facility's medicaid-certified beds in the medicare program. The medicaid direct…

Ohio Rev. Code Ann. § 5165.10 Annual cost report

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(A) Except as provided in division (C) of this section, each nursing facility provider shall file with the department of medicaid an annual cost report for each of the provider's nursing facilities that participate in the medicaid program. The cost report for a year shall cover t…

Ohio Rev. Code Ann. § 5165.101 Cost of franchise permit fee not reimbursable expense

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A nursing facility provider filing the nursing facility's cost report with the department of medicaid under section 5165.10 or 5165.522 of the Revised Code shall report as a nonreimbursable expense the cost of the nursing facility's franchise permit fee.

Ohio Rev. Code Ann. § 5165.1010 Nursing facility fines

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(A) Subject to division (D) of this section, the department of medicaid shall fine the provider of a nursing facility if the report of an audit conducted under section 5165.109 of the Revised Code regarding a cost report for the nursing facility includes either of the following: …

Ohio Rev. Code Ann. § 5165.102 Fines excluded from cost report

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No nursing facility provider shall report fines paid under sections 5165.60 to 5165.89 or section 5165.99 of the Revised Code in a cost report filed under section 5165.10 or 5165.522 of the Revised Code.

Ohio Rev. Code Ann. § 5165.103 Completion of cost reports

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Cost reports shall be completed using the form prescribed under section 5165.104 of the Revised Code and in accordance with the guidelines established under that section.

Ohio Rev. Code Ann. § 5165.104 Form of cost reports; guidelines

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The department of medicaid 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 for electronic su…

Ohio Rev. Code Ann. § 5165.105 Addendum for disputed costs

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The department of medicaid shall develop an addendum to the cost report form that a nursing facility provider may use to set forth costs that the provider believes the department may dispute. The department may consider such costs in determining a nursing facility's medicaid paym…

Ohio Rev. Code Ann. § 5165.106 Termination for failure to file report

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If a nursing facility provider required by section 5165.10 of the Revised Code to file a cost report for the nursing facility 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 (D) of that section, or fi…

Ohio Rev. Code Ann. § 5165.107 Amendments to cost reports

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(A) Except as provided in division (B) of this section and not later than three years after a nursing facility provider files a cost report with the department of medicaid under section 5165.10 of the Revised Code, the provider may amend the cost report if the provider discovers …

Ohio Rev. Code Ann. § 5165.108 Desk review of cost report

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(A) The department of medicaid shall conduct a desk review of each cost report it receives under section 5165.10 or 5165.522 of the Revised Code. Based on the desk review, the department shall make a preliminary determination of whether the reported costs are allowable costs. The…

Ohio Rev. Code Ann. § 5165.109 Audit

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(A) The department of medicaid may conduct an audit, as defined in rules adopted under section 5165.02 of the Revised Code, of any cost report filed under section 5165.10 or 5165.522 of the Revised Code. The decision whether to conduct an audit and the scope of the audit, which m…

Ohio Rev. Code Ann. § 5165.15 Calculation of payments to nursing facility providers

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Except as otherwise provided by sections 5165.151 to 5165.158 and 5165.34 of the Revised Code, the total per medicaid day payment rate that the department of medicaid shall pay a nursing facility provider for nursing facility services the provider's nursing facility provides duri…

Ohio Rev. Code Ann. § 5165.151 Initial rates for new nursing facilities

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(A) The total per medicaid day payment rate determined under section 5165.15 of the Revised Code shall 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 …

Ohio Rev. Code Ann. § 5165.152 Payments for services provided to low resource utilization residents

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The total per medicaid day payment rate determined under section 5165.15 of the Revised Code shall not be paid for nursing facility services provided to low case-mix residents. Instead, the total rate for such nursing facility services shall be one hundred fifteen dollars per med…

Ohio Rev. Code Ann. § 5165.153 Rates for outlier facilities or units

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(A) The total per medicaid day payment rate determined under section 5165.15 of the Revised 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 …

Ohio Rev. Code Ann. § 5165.154 Calculating prospective rates for facilities with residents whose care costs are not adequately measured

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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 5165.15 of the Revised Code shall not be paid for nursing facility services that a nursing facility not designated as an outlier nursing f…

Ohio Rev. Code Ann. § 5165.155 Amount of payments for dual eligible individuals

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(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 departm…

Ohio Rev. Code Ann. § 5165.156 Centers of excellence component

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The medicaid director may establish a centers of excellence component of the medicaid program. The purpose of the centers of excellence component is to increase the efficiency and quality of nursing facility services provided to medicaid recipients with complex nursing facility s…

Ohio Rev. Code Ann. § 5165.157 Alternative purchasing model for nursing facility services

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(A) As used in this section, "SFF list" and "CMS" have the same meanings as in section 5165.26 of the Revised Code. (B) The medicaid director shall establish an alternative purchasing model for nursing facility services provided by designated discrete units of nursing facilities …

Ohio Rev. Code Ann. § 5165.158 Private room incentive payment

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(A) As used in this section: (1) "Category one private room" means a private room that has unshared access to a toilet and sink. (2) "Category two private room" means a private room that has shared access to a toilet and sink. (B) Beginning six months following approval by the Un…

Ohio Rev. Code Ann. § 5165.16 Per medicaid day payment rate for ancillary and support costs; peer groups

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(A) The department of 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 purpo…

Ohio Rev. Code Ann. § 5165.17 Per medicaid day payment rate for reasonable capital costs

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(A) The department of 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 determin…

Ohio Rev. Code Ann. § 5165.19 Per medicaid day payment rate for direct care costs

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(A)(1) Semiannually, except as provided in division (A)(2) of this section, the department of 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…

Ohio Rev. Code Ann. § 5165.191 Resident assessment data

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Each calendar quarter, each nursing facility provider shall compile complete assessment data for each resident of each of the provider's nursing facilities, regardless of payment source, who is in the nursing facility, or on hospital or therapeutic leave from the nursing facility…

Ohio Rev. Code Ann. § 5165.192 Case-mix scores for nursing facilities

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(A)(1) Except as provided in division (B) of this section and in accordance with the process specified in rules authorized by this section, the department of medicaid shall do all of the following: (a) Every quarter, determine the following two case-mix scores for each nursing fa…

Ohio Rev. Code Ann. § 5165.193 Exception review of assessment data

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(A) The department of medicaid may, pursuant to rules authorized by this section, conduct an exception review of resident assessment data submitted by a nursing facility provider under section 5165.191 of the Revised Code. The department may conduct an exception review based on t…

Ohio Rev. Code Ann. § 5165.21 Per medicaid day payment rate for tax costs

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The department of medicaid shall determine each nursing facility's per medicaid day payment rate for tax costs. The rate for tax costs determined under this division for a nursing facility shall be used for subsequent years until the department conducts a rebasing. To determine a…

Ohio Rev. Code Ann. § 5165.23 Critical access incentive payments to qualified facilities

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(A) Each state fiscal year, the department of medicaid shall determine the critical access 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 facilit…

Ohio Rev. Code Ann. § 5165.26 Nursing facility's per medicaid day quality incentive payment rate

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(A) As used in this section: (1) "Base 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. …

Ohio Rev. Code Ann. § 5165.28 Rate for added, replaced, or renovated beds

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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 …

Ohio Rev. Code Ann. § 5165.29 Cost of operating rights for relocated beds not allowable cost

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If one or more medicaid-certified beds are relocated from one nursing facility to another nursing facility owned by a different person or government entity and the application for the certificate of need authorizing the relocation is filed with the director of health on or after …

Ohio Rev. Code Ann. § 5165.30 Related party costs to pass through

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Except as provided in section 5165.17 of the Revised Code, the costs of goods, services, and facilities, furnished 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.

Ohio Rev. Code Ann. § 5165.32 Reduction in rate not permitted

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The department of medicaid shall not reduce a nursing facility'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. § 5165.33 No payment for discharge date

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

Ohio Rev. Code Ann. § 5165.34 Payments made to reserve bed during temporary absence

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(A) The department of medicaid may make medicaid payments to a nursing facility provider under this chapter to reserve a bed for a recipient during a temporary absence under conditions prescribed by the department, to include hospitalization for an acute condition, visits with re…

Ohio Rev. Code Ann. § 5165.35 Payments made to facility for services provided after involuntary termination

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

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…