Chapter

Medicaid Coverage of Nursing Facility Services

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