Effective: September 29, 2013
Latest Legislation: House Bill 59 - 130th General Assembly
The department of health's determination that a change of operator has or has not occurred for purposes of licensure under Chapter 3721. of the Revised Code shall not affect the department of medicaid's determination of whether or when a change of operator occurs or the effective date of an entering operator's provider agreement under section 5165.511, section 5165.512, or, pursuant to section 5165.515, section 5165.07 of the Revised Code.
Structure Ohio Revised Code
Chapter 5165 | Medicaid Coverage of Nursing Facility Services
Section 5165.01 | Definitions.
Section 5165.011 | Nursing Facility References.
Section 5165.03 | Admission of Mentally Ill Person to Nursing Facility.
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 5165.08 | 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 5165.1010 | 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 5165.155 | 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 5165.37 | 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 5165.45 | 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 5165.49 | 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 5165.75 | 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 5165.84 | 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 5165.88 | Confidentiality.
Section 5165.89 | Hearing on Transfer or Discharge of Resident Who Medicaid or Medicare Beneficiary.