Medicaid Coverage of Nursing Facility Services | Midpage

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Ohio Revised Code

Chapter 5165

Medicaid Coverage of Nursing Facility Services

5165.01Definitions 5165.011Nursing facility references 5165.02Rules 5165.03Admission of mentally ill person to nursing facility 5165.031Hearing 5165.04Assessment to determine level of care 5165.06Nursing facility eligibility 5165.07Provider agreement requirements 5165.071Facility operator may contract with more than one provider 5165.072Revalidation 5165.073Termination for non-compliance with installation of fire extinguishing and fire alarm systems 5165.08Nursing facilities' provider agreement terms 5165.081Action against facility for breach of provider agreement or other duties 5165.082Qualification of beds 5165.10Annual cost report 5165.101Cost of franchise permit fee not reimbursable expense 5165.102Fines excluded from cost report 5165.103Completion of cost reports 5165.104Form of cost reports; guidelines 5165.105Addendum for disputed costs 5165.106Termination for failure to file report 5165.107Amendments to cost reports 5165.108Desk review of cost report 5165.109Audit 5165.1010Nursing facility fines 5165.15Calculation of payments to nursing facility providers 5165.151Initial rates for new nursing facilities 5165.152Payments for services provided to low resource utilization residents 5165.153Rates for outlier facilities or units 5165.154Calculating prospective rates for facilities with residents whose care costs are not adequately measured 5165.155Amount of payments for dual eligible individuals 5165.156Centers of excellence component 5165.157Alternative purchasing model for nursing facility services 5165.158Private room incentive payment 5165.16Per medicaid day payment rate for ancillary and support costs; peer groups 5165.17Per medicaid day payment rate for reasonable capital costs 5165.19Per medicaid day payment rate for direct care costs 5165.191Resident assessment data 5165.192Case-mix scores for nursing facilities 5165.193Exception review of assessment data 5165.21Per medicaid day payment rate for tax costs 5165.23Critical access incentive payments to qualified facilities 5165.26Nursing facility's per medicaid day quality incentive payment rate 5165.28Rate for added, replaced, or renovated beds 5165.29Cost of operating rights for relocated beds not allowable cost 5165.30Related party costs to pass through 5165.32Reduction in rate not permitted 5165.33No payment for discharge date 5165.34Payments made to reserve bed during temporary absence 5165.35Payments made to facility for services provided after involuntary termination 5165.36Rebasing 5165.37Calculating rates and making payments 5165.38Reconsideration of rate 5165.40Adjustment of rates 5165.41Redetermination of rates 5165.42Additional penalties 5165.43Determination of interest rate 5165.44Deductions 5165.45Deposits to general revenue fund 5165.46Administrative adjudication 5165.47Claim for medicaid payment for service provided to nursing facility resident 5165.48Nursing facility not required to submit Medicaid claim for Medicare cost-sharing expenses under certain circumstances 5165.49Post-payment reviews of nursing facility Medicaid claims 5165.50Notice of facility closure or withdrawal of participation 5165.501Compliance with Social Security Act required 5165.51Notice of change of operator 5165.511Agreements with entering operators effective on date of change of operator 5165.512Agreements with entering operators effective on a later date 5165.513Entering operator duties under provider agreement 5165.514Exiting operator deemed operator pending change 5165.515Provider agreement with operator not complying with prior agreement 5165.516Medicaid reimbursement adjustments; change of operator 5165.517Determination of change of operator for purposes of licensure not controlling 5165.518Nursing facility operator identity 5165.52Overpayment amounts determined following notice of closure, etc 5165.521Withholding amounts owed from medicaid payments to exiting operator 5165.522Cost report by exiting operator; waiver 5165.523Failure to file cost report; payments deemed overpayments 5165.524Final payment withheld pending receipt of cost reports 5165.525Determination of debt of exiting operator; summary report 5165.526Release of amount withheld less amounts owed 5165.527Release of amount withheld on postponement of change of operator 5165.528Disposition of amounts withheld from payment due an exiting operator 5165.53Adoption of rules regarding change in operators 5165.60Definitions for sections 5165.60 to 5165.89 5165.61Adoption of rules 5165.62Enforcement of provisions 5165.63Contracts with state agencies for enforcement 5165.64Annual standard surveys 5165.65Exit interview with administrator 5165.66Citations for failure to comply with one or more certification requirements 5165.67Survey results 5165.68Statement of deficiencies 5165.69Plan of correction 5165.70On-site monitoring 5165.71Deficiencies not substantially corrected 5165.72Uncorrected deficiencies constituting severity level four findings 5165.73Uncorrected deficiencies constituting severity level three and scope level three or four findings 5165.74Uncorrected deficiencies constituting severity level one or two or severity level three, scope level two finding 5165.75Imposing remedies and fines 5165.76Fine collected if termination order does not take effect 5165.77Emergency remedies 5165.771Special focus facility program 5165.78Appointment of temporary resident safety assurance manager 5165.79Terminating provider agreements 5165.80Transfer of residents to other appropriate care settings 5165.81Qualifications of temporary manager of nursing facility 5165.82Residents to whom denial of medicaid payments applies 5165.83Fines 5165.84Order denying payment when deficiency is not corrected within time limits 5165.85Termination of participation for failure to correct deficiency within six months 5165.86Delivery of notices 5165.87Appeals 5165.88Confidentiality 5165.89Hearing on transfer or discharge of resident who medicaid or medicare beneficiary 5165.99Penalty