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Ohio Revised Code
Title 51
Chapter 5165
Medicaid Coverage of Nursing Facility Services
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5165.01
Definitions.
5165.011
Nursing facility references.
5165.02
Rules.
5165.03
Admission of mentally ill person to nursing facility.
5165.031
Hearing.
5165.04
Assessment to determine level of care.
5165.06
Nursing facility eligibility.
5165.07
Provider agreement requirements.
5165.071
Facility operator may contract with more than one provider.
5165.072
Revalidation.
5165.073
Termination for non-compliance with installation of fire extinguishing and fire alarm systems.
5165.08
Nursing facilities' provider agreement terms.
5165.081
Action against facility for breach of provider agreement or other duties.
5165.082
Qualification of beds.
5165.10
Annual cost report.
5165.101
Cost of franchise permit fee not reimbursable expense.
5165.102
Fines excluded from cost report.
5165.103
Completion of cost reports.
5165.104
Form of cost reports; guidelines.
5165.105
Addendum for disputed costs.
5165.106
Termination for failure to file report.
5165.107
Amendments to cost reports.
5165.108
Desk review of cost report.
5165.109
Audit.
5165.1010
Nursing facility fines.
5165.15
Calculation of payments to nursing facility providers.
5165.151
Initial rates for new nursing facilities.
5165.152
Payments for services provided to low resource utilization residents.
5165.153
Rates for outlier facilities or units.
5165.154
Calculating prospective rates for facilities with residents whose care costs are not adequately measured.
5165.155
Amount of payments for dual eligible individuals.
5165.156
Centers of excellence component.
5165.157
Alternative purchasing model for nursing facility services.
5165.158
Private room incentive payment.
5165.16
Per medicaid day payment rate for ancillary and support costs; peer groups.
5165.17
Per medicaid day payment rate for reasonable capital costs.
5165.19
Per medicaid day payment rate for direct care costs.
5165.191
Resident assessment data.
5165.192
Case-mix scores for nursing facilities.
5165.193
Exception review of assessment data.
5165.21
Per medicaid day payment rate for tax costs.
5165.23
Critical access incentive payments to qualified facilities.
5165.26
Nursing facility's per medicaid day quality incentive payment rate.
5165.28
Rate for added, replaced, or renovated beds.
5165.29
Cost of operating rights for relocated beds not allowable cost.
5165.30
Related party costs to pass through.
5165.32
Reduction in rate not permitted.
5165.33
No payment for discharge date.
5165.34
Payments made to reserve bed during temporary absence.
5165.35
Payments made to facility for services provided after involuntary termination.
5165.36
Rebasing.
5165.37
Calculating rates and making payments.
5165.38
Reconsideration of rate.
5165.40
Adjustment of rates.
5165.41
Redetermination of rates.
5165.42
Additional penalties.
5165.43
Determination of interest rate.
5165.44
Deductions.
5165.45
Deposits to general revenue fund.
5165.46
Administrative adjudication.
5165.47
Claim for medicaid payment for service provided to nursing facility resident.
5165.48
Nursing facility not required to submit Medicaid claim for Medicare cost-sharing expenses under certain circumstances.
5165.49
Post-payment reviews of nursing facility Medicaid claims.
5165.50
Notice of facility closure or withdrawal of participation.
5165.501
Compliance with Social Security Act required.
5165.51
Notice of change of operator.
5165.511
Agreements with entering operators effective on date of change of operator.
5165.512
Agreements with entering operators effective on a later date.
5165.513
Entering operator duties under provider agreement.
5165.514
Exiting operator deemed operator pending change.
5165.515
Provider agreement with operator not complying with prior agreement.
5165.516
Medicaid reimbursement adjustments; change of operator.
5165.517
Determination of change of operator for purposes of licensure not controlling.
5165.518
Nursing facility operator identity.
5165.52
Overpayment amounts determined following notice of closure, etc.
5165.521
Withholding amounts owed from medicaid payments to exiting operator.
5165.522
Cost report by exiting operator; waiver.
5165.523
Failure to file cost report; payments deemed overpayments.
5165.524
Final payment withheld pending receipt of cost reports.
5165.525
Determination of debt of exiting operator; summary report.
5165.526
Release of amount withheld less amounts owed.
5165.527
Release of amount withheld on postponement of change of operator.
5165.528
Disposition of amounts withheld from payment due an exiting operator.
5165.53
Adoption of rules regarding change in operators.
5165.60
Definitions for sections 5165.60 to 5165.89.
5165.61
Adoption of rules.
5165.62
Enforcement of provisions.
5165.63
Contracts with state agencies for enforcement.
5165.64
Annual standard surveys.
5165.65
Exit interview with administrator.
5165.66
Citations for failure to comply with one or more certification requirements.
5165.67
Survey results.
5165.68
Statement of deficiencies.
5165.69
Plan of correction.
5165.70
On-site monitoring.
5165.71
Deficiencies not substantially corrected.
5165.72
Uncorrected deficiencies constituting severity level four findings.
5165.73
Uncorrected deficiencies constituting severity level three and scope level three or four findings.
5165.74
Uncorrected deficiencies constituting severity level one or two or severity level three, scope level two finding.
5165.75
Imposing remedies and fines.
5165.76
Fine collected if termination order does not take effect.
5165.77
Emergency remedies.
5165.771
Special focus facility program.
5165.78
Appointment of temporary resident safety assurance manager.
5165.79
Terminating provider agreements.
5165.80
Transfer of residents to other appropriate care settings.
5165.81
Qualifications of temporary manager of nursing facility.
5165.82
Residents to whom denial of medicaid payments applies.
5165.83
Fines.
5165.84
Order denying payment when deficiency is not corrected within time limits.
5165.85
Termination of participation for failure to correct deficiency within six months.
5165.86
Delivery of notices.
5165.87
Appeals.
5165.88
Confidentiality.
5165.89
Hearing on transfer or discharge of resident who medicaid or medicare beneficiary.
5165.99
Penalty.