Ohio Revised Code|Chapter 5165 | Medicaid Coverage Of Nursing Facility Services

Section 5165.01 | Definitions.

Section 5165.011 | Nursing facility references.

Section 5165.02 | Rules.

Section 5165.03 | Admission of mentally ill person to nursing facility.

Section 5165.031 | Hearing.

Section 5165.04 | Assessment to determine level of care.

Section 5165.06 | Nursing facility eligibility.

Section 5165.07 | Provider agreement requirements.

Section 5165.071 | Facility operator may contract with more than one provider.

Section 5165.072 | Revalidation.

Section 5165.073 | Termination for non-compliance with installation of fire extinguishing and fire alarm systems.

Section 5165.08 | Nursing facilities' provider agreement terms.

Section 5165.081 | Action against facility for breach of provider agreement or other duties.

Section 5165.082 | Qualification of beds.

Section 5165.10 | Annual cost report.

Section 5165.101 | Cost of franchise permit fee not reimbursable expense.

Section 5165.102 | Fines excluded from cost report.

Section 5165.103 | Completion of cost reports.

Section 5165.104 | Form of cost reports; guidelines.

Section 5165.105 | Addendum for disputed costs.

Section 5165.106 | Termination for failure to file report.

Section 5165.107 | Amendments to cost reports.

Section 5165.108 | Desk review of cost report.

Section 5165.109 | Audit.

Section 5165.1010 | Nursing facility fines.

Section 5165.15 | Calculation of payments to nursing facility providers.

Section 5165.151 | Initial rates for new nursing facilities.

Section 5165.152 | Payments for services provided to low resource utilization residents.

Section 5165.153 | Rates for outlier facilities or units.

Section 5165.154 | Calculating prospective rates for facilities with residents whose care costs are not adequately measured.

Section 5165.155 | Amount of payments for dual eligible individuals.

Section 5165.156 | Centers of excellence component.

Section 5165.157 | Alternative purchasing model for nursing facility services.

Section 5165.16 | Per medicaid day payment rate for ancillary and support costs; peer groups.

Section 5165.17 | Per medicaid day payment rate for reasonable capital costs.

Section 5165.19 | Per medicaid day payment rate for direct care costs.

Section 5165.191 | Resident assessment data.

Section 5165.192 | Case-mix scores for nursing facilities.

Section 5165.193 | Exception review of assessment data.

Section 5165.21 | Per medicaid day payment rate for tax costs.

Section 5165.23 | Critical access incentive payments to qualified facilities.

Section 5165.26 | Nursing facility's per medicaid day quality incentive payment rate.

Section 5165.261 | Nursing facility payment commission.

Section 5165.28 | Rate for added, replaced, or renovated beds.

Section 5165.29 | Cost of operating rights for relocated beds not allowable cost.

Section 5165.30 | Related party costs to pass through.

Section 5165.32 | Reduction in rate not permitted.

Section 5165.33 | No payment for discharge date.

Section 5165.34 | Payments made to reserve bed during temporary absence.

Section 5165.35 | Payments made to facility for services provided after involuntary termination.

Section 5165.36 | Rebasing.

Section 5165.37 | Calculating rates and making payments.

Section 5165.38 | Reconsideration of rate.

Section 5165.40 | Adjustment of rates.

Section 5165.41 | Redetermination of rates.

Section 5165.42 | Additional penalties.

Section 5165.43 | Determination of interest rate.

Section 5165.44 | Deductions.

Section 5165.45 | Deposits to general revenue fund.

Section 5165.46 | Administrative adjudication.

Section 5165.47 | Claim for medicaid payment for service provided to nursing facility resident.

Section 5165.48 | Nursing facility not required to submit Medicaid claim for Medicare cost-sharing expenses under certain circumstances.

Section 5165.49 | Post-payment reviews of nursing facility Medicaid claims.

Section 5165.50 | Notice of facility closure or withdrawal of participation.

Section 5165.501 | Compliance with Social Security Act required.

Section 5165.51 | Notice of change of operator.

Section 5165.511 | Agreements with entering operators effective on date of change of operator.

Section 5165.512 | Agreements with entering operators effective on a later date.

Section 5165.513 | Entering operator duties under provider agreement.

Section 5165.514 | Exiting operator deemed operator pending change.

Section 5165.515 | Provider agreement with operator not complying with prior agreement.

Section 5165.516 | Medicaid reimbursement adjustments; change of operator.

Section 5165.517 | Determination of change of operator for purposes of licensure not controlling.

Section 5165.52 | Overpayment amounts determined following notice of closure, etc.

Section 5165.521 | Withholding amounts owed from medicaid payments to exiting operator.

Section 5165.522 | Cost report by exiting operator; waiver.

Section 5165.523 | Failure to file cost report; payments deemed overpayments.

Section 5165.524 | Final payment withheld pending receipt of cost reports.

Section 5165.525 | Determination of debt of exiting operator; summary report.

Section 5165.526 | Release of amount withheld less amounts owed.

Section 5165.527 | Release of amount withheld on postponement of change of operator.

Section 5165.528 | Disposition of amounts withheld from payment due an exiting operator.

Section 5165.53 | Adoption of rules regarding change in operators.

Section 5165.60 | Definitions for sections 5165.60 to 5165.89.

Section 5165.61 | Adoption of rules.

Section 5165.62 | Enforcement of provisions.

Section 5165.63 | Contracts with state agencies for enforcement.

Section 5165.64 | Annual standard surveys.

Section 5165.65 | Exit interview with administrator.

Section 5165.66 | Citations for failure to comply with one or more certification requirements.

Section 5165.67 | Survey results.

Section 5165.68 | Statement of deficiencies.

Section 5165.69 | Plan of correction.

Section 5165.70 | On-site monitoring.

Section 5165.71 | Deficiencies not substantially corrected.

Section 5165.72 | Uncorrected deficiencies constituting severity level four findings.

Section 5165.73 | Uncorrected deficiencies constituting severity level three and scope level three or four findings.

Section 5165.74 | Uncorrected deficiencies constituting severity level one or two or severity level three, scope level two finding.

Section 5165.75 | Imposing remedies and fines.

Section 5165.76 | Fine collected if termination order does not take effect.

Section 5165.77 | Emergency remedies.

Section 5165.771 | Special focus facility program.

Section 5165.78 | Appointment of temporary resident safety assurance manager.

Section 5165.79 | Terminating provider agreements.

Section 5165.80 | Transfer of residents to other appropriate care settings.

Section 5165.81 | Qualifications of temporary manager of nursing facility.

Section 5165.82 | Residents to whom denial of medicaid payments applies.

Section 5165.83 | Fines.

Section 5165.84 | Order denying payment when deficiency is not corrected within time limits.

Section 5165.85 | Termination of participation for failure to correct deficiency within six months.

Section 5165.86 | Delivery of notices.

Section 5165.87 | Appeals.

Section 5165.88 | Confidentiality.

Section 5165.89 | Hearing on transfer or discharge of resident who medicaid or medicare beneficiary.

Section 5165.99 | Penalty.