reglab/housing_qa huggingface dataset:
Ohio Rev Code § 5165.106 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.106 | Termination for Failure to File Report.

Effective: November 22, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|If a nursing facility provider required by section 5165.10 of the Revised Code to file a cost report for the nursing facility fails to file the cost report by the date it is due or the date, if any, to which the due date is extended pursuant to division (D) of that section, or files an incomplete or inadequate report for the nursing facility under that section, the department of medicaid shall provide immediate written notice to the provider that the provider agreement for the nursing facility will be terminated in thirty days unless the provider submits a complete and adequate cost report for the nursing facility within thirty days. During the thirty-day termination period or any additional time allowed for an appeal of the proposed termination of a provider agreement, the provider shall be paid the nursing facility's then current per medicaid day payment rate, minus the dollar amount by which nursing facility's per medicaid day payment rates are reduced during state fiscal year 2013 in accordance with division (A)(2) of section 5111.26 of the Revised Code (renumbered as section 5165.10 of the Revised Code by H.B. 59 of the 130th general assembly) as that section existed on the day immediately preceding September 29, 2013. On the first day of each July, the department shall adjust the amount of the reduction in effect during the previous twelve months to reflect the rate of inflation during the preceding twelve months, as shown in the consumer price index for all items for all urban consumers for the north central region, published by the United States bureau of labor statistics.
Ohio Rev Code § 5165.107 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.107 | Amendments to Cost Reports.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) Except as provided in division (B) of this section and not later than three years after a nursing facility provider files a cost report with the department of medicaid under section 5165.10 of the Revised Code, the provider may amend the cost report if the provider discovers a material error in the cost report or additional information to be included in the cost report. The department shall review the amended cost report for accuracy and notify the provider of its determination. (B) A provider may not amend a cost report if the department has notified the provider that an audit of the cost report or a cost report of the provider for a subsequent cost reporting period is to be conducted under section 5165.109 of the Revised Code. The provider may, however, provide the department information that affects the costs included in the cost report. Such information may not be provided after the adjudication of the final settlement of the cost report.
Ohio Rev Code § 5165.108 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.108 | Desk Review of Cost Report.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) The department of medicaid shall conduct a desk review of each cost report it receives under section 5165.10 or 5165.522 of the Revised Code. Based on the desk review, the department shall make a preliminary determination of whether the reported costs are allowable costs. The department shall notify each nursing facility provider of whether any of the reported costs are preliminarily determined not to be allowable, the medicaid payment rate determined under this chapter that results from that determination, and the reasons for the determination and resulting rate. The department shall allow the provider to verify the calculation and submit additional information.
Ohio Rev Code § 5165.1010 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.1010 | Nursing Facility Fines.

Effective: September 29, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|(A) Subject to division (D) of this section, the department of medicaid shall fine the provider of a nursing facility if the report of an audit conducted under section 5165.109 of the Revised Code regarding a cost report for the nursing facility includes either of the following:(1) Adverse findings that exceed three per cent of the total amount of medicaid-allowable costs reported in the cost report;(2) Adverse findings that exceed twenty per cent of medicaid-allowable costs for a particular cost center reported in the cost report.(B) A fine issued under this section shall equal the greatest of the following:(1) If the adverse findings exceed three per cent but do not exceed ten per cent of the total amount of medicaid-allowable costs reported in the cost report, the greater of three per cent of those reported costs or ten thousand dollars;(2) If the adverse findings exceed ten per cent but do not exceed twenty per cent of the total amount of medicaid-allowable costs reported in the cost report, the greater of six per cent of those reported costs or twenty-five thousand dollars;(3) If the adverse findings exceed twenty per cent of the total amount of medicaid-allowable costs reported in the cost report, the greater of ten per cent of those reported costs or fifty thousand dollars;(4) If the adverse findings exceed twenty per cent but do not exceed twenty-five per cent of medicaid-allowable costs for a particular cost center reported in the cost report, the greater of three per cent of the total amount of medicaid-allowable costs reported in the cost report or ten thousand dollars;(5) If the adverse findings exceed twenty-five per cent but do not exceed thirty per cent of medicaid-allowable costs for a particular cost center reported in the cost report, the greater of six per cent of the total amount of medicaid-allowable costs reported in the cost report or twenty-five thousand dollars;(6) If the adverse findings exceed thirty per cent of medicaid-allowable costs for a particular cost center reported in the cost report, the greater of ten per cent of the total amount of medicaid-allowable costs reported in the cost report or fifty thousand dollars.(C) Fines paid under this section shall be deposited into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code.(D) The department may not collect a fine under this section until all appeal rights relating to the audit report that is the basis for the fine are exhausted.
Ohio Rev Code § 5165.15 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.15 | Calculation of Payments to Nursing Facility Providers.

Effective: June 30, 2021|Latest Legislation:  House Bill 110 - 134th General Assembly|Except as otherwise provided by sections 5165.151 to 5165.157 and 5165.34 of the Revised Code, the total per medicaid day payment rate that the department of medicaid shall pay a nursing facility provider for nursing facility services the provider's nursing facility provides during a state fiscal year shall be determined as follows: (A) Determine the sum of all of the following: (1) The per medicaid day payment rate for ancillary and support costs determined for the nursing facility under section 5165.16 of the Revised Code; (2) The per medicaid day payment rate for capital costs determined for the nursing facility under section 5165.17 of the Revised Code; (3) The per medicaid day payment rate for direct care costs determined for the nursing facility under section 5165.19 of the Revised Code; (4) The per medicaid day payment rate for tax costs determined for the nursing facility under section 5165.21 of the Revised Code; (5) If the nursing facility qualifies as a critical access nursing facility, the nursing facility's critical access incentive payment paid under section 5165.23 of the Revised Code. (B) To the sum determined under division (A) of this section, add sixteen dollars and forty-four cents. (C) From the sum determined under division (B) of this section, subtract one dollar and seventy-nine cents. (D) To the sum determined under division (C) of this section, add, for state fiscal year 2022 and for state fiscal year 2023, the per medicaid day quality incentive payment rate determined for the nursing facility under section 5165.26 of the Revised Code. Last updated August 16, 2021 at 3:38 PM
Ohio Rev Code § 5165.152 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.152 | Payments for Services Provided to Low Resource Utilization Residents.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|The total per medicaid day payment rate determined under section 5165.15 of the Revised Code shall not be paid for nursing facility services provided to low resource utilization residents. Instead, the total rate for such nursing facility services shall be one hundred fifteen dollars per medicaid day.
Ohio Rev Code § 5165.154 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.154 | Calculating Prospective Rates for Facilities With Residents Whose Care Costs Are Not Adequately Measured.

Effective: November 22, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|(A) To the extent, if any, provided for in rules authorized by this section, the total per medicaid day payment rate determined under section 5165.15 of the Revised Code shall not be paid for nursing facility services that a nursing facility not designated as an outlier nursing facility or unit provides to a resident who meets the criteria for admission to a designated outlier nursing facility or unit, as specified in rules authorized by section 5165.153 of the Revised Code. Instead, the provider of a nursing facility providing nursing facility services to such a resident shall be paid each state fiscal year a total per medicaid day payment rate that the department of medicaid shall prospectively determine in accordance with a methodology established in rules authorized by this section.(B) The medicaid director may adopt rules under section 5165.02 of the Revised Code to implement this section. The rules may require that a nursing facility receive authorization from the department before admitting or retaining a resident who meets the criteria for admission to a designated outlier nursing facility or unit. If the director adopts such rules, the rules shall specify the criteria and procedures the department will apply when granting the authorization.
Ohio Rev Code § 5165.155 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.155 | Amount of Payments for Dual Eligible Individuals.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) As used in this section, "medicaid maximum allowable amount" means one hundred per cent of a nursing facility's total per medicaid day payment rate. (B) Instead of paying the total per medicaid day payment rate determined under section 5165.15 of the Revised Code, the department of medicaid shall pay the provider of a nursing facility the lesser of the following for nursing facility services the nursing facility provides on or after January 1, 2012, to a dual eligible individual who is eligible for nursing facility services under the medicaid program and post-hospital extended care services under Part A of Title XVIII:(1) The coinsurance amount for the services as provided under Part A of Title XVIII;(2) The medicaid maximum allowable amount for the services, less the amount paid under Part A of Title XVIII for the services.
Ohio Rev Code § 5165.156 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.156 | Centers of Excellence Component.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The medicaid director may establish a centers of excellence component of the medicaid program. The purpose of the centers of excellence component is to increase the efficiency and quality of nursing facility services provided to medicaid recipients with complex nursing facility service needs. The director may adopt rules under section 5165.02 of the Revised Code governing the component, including rules that establish a method of determining the medicaid payment rates for nursing facilities providing nursing facility services to medicaid recipients participating in the component. The rules may specify the extent to which, if any, of the provisions of sections 5165.153 and 5165.154 of the Revised Code are to apply to the centers of excellence component. If such rules are adopted, the nursing facilities that provide nursing facility services to medicaid recipients participating in the centers of excellence component shall be paid for those services in accordance with the method established in the rules instead of the total per medicaid day payment rate determined under section 5165.15 of the Revised Code.
Ohio Rev Code § 5165.157 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.157 | Alternative Purchasing Model for Nursing Facility Services.

Effective: September 29, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|(A) The medicaid director shall establish an alternative purchasing model for nursing facility services provided by designated discrete units of nursing facilities to medicaid recipients with specialized health care needs. The director shall do all of the following with regard to the model:(1) Establish criteria that a discrete unit of a nursing facility must meet to be designated as a unit that, under the alternative purchasing model, may admit and provide nursing facility services to medicaid recipients with specialized health care needs;(2) Specify the health care conditions that medicaid recipients must have to have specialized health care needs, which may include dependency on a ventilator, severe traumatic brain injury, the need to be admitted to a long-term acute care hospital or rehabilitation hospital if not for nursing facility services, and other serious health care conditions;(3) For each fiscal year, set the total per medicaid day payment rate for nursing facility services provided by designated discrete units of nursing facilities under the alternative purchasing model at either of the following:(a) Thirty-four per cent of the statewide average of the total per medicaid day payment rate for long-term acute care hospital services as of the first day of the fiscal year;(b) Another amount determined in accordance with an alternative methodology that includes improved health outcomes as a factor in determining the payment rate.(4) Require, to the extent the director considers necessary, a medicaid recipient to obtain prior authorization for admission to a long-term acute care hospital or rehabilitation hospital as a condition of medicaid payment for long-term acute care hospital or rehabilitation hospital services.(B) The criteria established under division (A)(1) of this section shall provide for a discrete unit of a nursing facility to be excluded from the alternative purchasing model if the unit is paid for nursing facility services in accordance with section 5165.153, 5165.154, or 5165.156 of the Revised Code. The criteria may require the provider of a nursing facility that has a discrete unit designated for participation in the alternative purchasing model to report health outcome measurement data to the department of medicaid.(C) A discrete unit of a nursing facility that provides nursing facility services to medicaid recipients with specialized health care needs under the alternative purchasing model shall be paid for those services in accordance with division (A)(3) of this section instead of the total per medicaid day payment rate determined under section 5165.15, 5165.153, 5165.154, or 5165.156 of the Revised Code.
Ohio Rev Code § 5165.191 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.191 | Resident Assessment Data.

Effective: September 30, 2021|Latest Legislation:  House Bill 110 - 134th General Assembly|Each calendar quarter, each nursing facility provider shall compile complete assessment data for each resident of each of the provider's nursing facilities, regardless of payment source, who is in the nursing facility, or on hospital or therapeutic leave from the nursing facility, on the last day of the quarter. A resident assessment instrument specified in rules authorized by this section shall be used to compile the resident assessment data. Each provider shall submit the resident assessment data to the department of health and, if required by the rules, the department of medicaid. The resident assessment data shall be submitted not later than fifteen days after the end of the calendar quarter for which the data is compiled. If the resident assessment data is to be submitted to the department of medicaid, it shall be submitted to the department through the medium or media specified in the rules. Rules adopted under section 5165.02 of the Revised Code shall do all of the following: (A) In a manner consistent with the "Social Security Act," section 1919(e)(5), 42 U.S.C. 1396r(e)(5), specify a resident assessment instrument to be used by nursing facility providers under this section; (B) Specify whether nursing facility providers must submit the resident assessment data to the department of medicaid; (C) Specify any resident assessment data that is excluded from the case mix calculation made under section 5165.192 of the Revised Code; (D) If the rules specify that nursing facility providers must submit the resident assessment data to the department, specify the medium or media through which the data is to be submitted. Last updated August 12, 2021 at 3:35 PM
Ohio Rev Code § 5165.21 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.21 | Per Medicaid Day Payment Rate for Tax Costs.

Effective: October 17, 2019|Latest Legislation:  House Bill 166 - 133rd General Assembly|The department of medicaid shall determine each nursing facility's per medicaid day payment rate for tax costs. The rate for tax costs determined under this division for a nursing facility shall be used for subsequent years until the department conducts a rebasing. To determine a nursing facility's rate for tax costs, the department shall divide the nursing facility's desk-reviewed, actual, allowable tax costs paid for the applicable calendar year by the number of inpatient days the nursing facility would have had if its occupancy rate had been one hundred per cent during the applicable calendar year.
Ohio Rev Code § 5165.23 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.23 | Critical Access Incentive Payments to Qualified Facilities.

Effective: November 22, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|(A) Each state fiscal year, the department of medicaid shall determine the critical access incentive payment for each nursing facility that qualifies as a critical access nursing facility. To qualify as a critical access nursing facility for a state fiscal year, a nursing facility must meet all of the following requirements:(1) The nursing facility must be located in an area that, on December 31, 2011, was designated an empowerment zone under the "Internal Revenue Code of 1986," section 1391, 26 U.S.C. 1391.(2) The nursing facility must have an occupancy rate of at least eighty-five per cent as of the last day of the calendar year immediately preceding the state fiscal year.(3) The nursing facility must have a medicaid utilization rate of at least sixty-five per cent as of the last day of the calendar year immediately preceding the state fiscal year.(B) A critical access nursing facility's critical access incentive payment for a state fiscal year shall equal five per cent of the portion of the nursing facility's total per medicaid day payment rate for the state fiscal year that is the sum of the rates identified in divisions (A)(1) to (4) of section 5165.15 of the Revised Code.
Ohio Rev Code § 5165.261 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.261 | Nursing Facility Payment Commission.

Effective: September 30, 2021|Latest Legislation:  House Bill 110 - 134th General Assembly|(A) There is hereby established the nursing facility payment commission. The commission shall consist of the following members: (1) Four members appointed by the speaker of the house of representatives, three from the majority party and one from the minority party; (2) Four members appointed by the president of the senate, three from the majority party and one from the minority party. (B) Appointments to the commission shall be made not later than December 31, 2021. In the event of a vacancy, a replacement member shall be appointed in the same manner as initial appointments. Members shall serve without compensation. At the initial meeting, commission members shall elect one member from the majority party of the house of representatives and one member from the majority party of the senate to serve as joint co-chairpersons of the commission. (C) The commission shall analyze the efficacy of all of the following: (1) The current quality incentive payment formula under section 5165.26 of the Revised Code for efficacy; (2) The nursing facility base rate calculation, as defined under section 5165.26 of the Revised Code; (3) The nursing facility cost centers, which are redetermined as part of the rebasing process under section 5165.36 of the Revised Code; (4) Establishing a bed buyback program under which a nursing facility operator can permanently surrender one or more long-term care beds due to a decrease in bed utilization. (D) Not later than August 31, 2022, the commission shall submit a report to the general assembly, in accordance with section 101.68 of the Revised Code, with its recommendations and determinations on the items listed under division (C) of this section. Last updated September 9, 2021 at 3:01 PM
Ohio Rev Code § 5165.28 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.28 | Rate for Added, Replaced, or Renovated Beds.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|If a provider of a nursing facility adds or replaces one or more medicaid certified beds to or at the nursing facility, or renovates one or more of the nursing facility's beds, the medicaid payment rate for the added, replaced, or renovated beds shall be the same as the medicaid payment rate for the nursing facility's existing beds.
Ohio Rev Code § 5165.29 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.29 | Cost of Operating Rights for Relocated Beds Not Allowable Cost.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|If one or more medicaid-certified beds are relocated from one nursing facility to another nursing facility owned by a different person or government entity and the application for the certificate of need authorizing the relocation is filed with the director of health on or after July 1, 2005, amortization of the cost of acquiring operating rights for the relocated beds is not an allowable cost for the purpose of determining the nursing facility's medicaid payment rate.