Ohio Revised Code
Chapter 5165 | Medicaid Coverage of Nursing Facility Services
Section 5165.03 | Admission of Mentally Ill Person to Nursing Facility.

Effective: September 29, 2013
Latest Legislation: House Bill 59 - 130th General Assembly
(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 the "Social Security Act," section 1919(e)(7)(G)(i), 42 U.S.C. 1396r(e)(7)(G)(i).
(3) "Mentally ill individual" means an individual who has a serious mental illness other than either of the following:
(a) A primary diagnosis of dementia;
(b) A primary diagnosis that is not a primary diagnosis of dementia and a primary diagnosis of something other than a serious mental illness.
(4) "Mentally retarded individual" means an individual who is mentally retarded or has a related condition, as described in the "Social Security Act," section 1905(d), 42 U.S.C. 1396d(d).
(5) "Specialized services" means the services specified by the United States department of health and human services in regulations adopted under the "Social Security Act," section 1919(e)(7)(G)(iii), 42 U.S.C. 1396r(e)(7)(G)(iii).
(B)(1) Except as provided in division (D) of this section, no nursing facility shall admit as a resident any mentally ill individual unless the facility has received evidence that the department of mental health and addiction services has determined both of the following under section 5119.40 of the Revised Code:
(a) That the individual requires the level of services provided by a nursing facility because of the individual's physical and mental condition;
(b) Whether the individual requires specialized services for mental illness.
(2) Except as provided in division (D) of this section, no nursing facility shall admit as a resident any mentally retarded individual unless the facility has received evidence that the department of developmental disabilities has determined both of the following under section 5123.021 of the Revised Code:
(a) That the individual requires the level of services provided by a nursing facility because of the individual's physical and mental condition;
(b) Whether the individual requires specialized services for mental retardation.
(C) The department of medicaid shall not make medicaid payments to a nursing facility on behalf of any individual who is admitted to the facility in violation of division (B) of this section for the period beginning on the date of admission and ending on the date the requirements of division (B) of this section are met.
(D) A determination under division (B) of this section is not required for any individual who is exempted from the requirement that a determination be made by division (B)(2) of section 5119.40 of the Revised Code or rules adopted by the department of mental health and addiction services under division (E)(3) of that section, or by division (B)(2) of section 5123.021 of the Revised Code or rules adopted by the department of developmental disabilities under division (E)(3) of that section.

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