reglab/housing_qa huggingface dataset:
Ohio Rev Code § 5165.30 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.30 | Related Party Costs to Pass Through.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|Except as provided in section 5165.17 of the Revised Code, the costs of goods, services, and facilities, furnished to a nursing facility provider by a related party are includable in the allowable costs of the provider at the reasonable cost to the related party.
Ohio Rev Code § 5165.32 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.32 | Reduction in Rate Not Permitted.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid shall not reduce a nursing facility's medicaid payment rate determined under this chapter on the basis that the provider charges a lower rate to any resident who is not eligible for medicaid.
Ohio Rev Code § 5165.33 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.33 | No Payment for Discharge Date.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|No medicaid payment shall be made to a nursing facility provider for the day a medicaid recipient is discharged from the nursing facility.
Ohio Rev Code § 5165.34 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.34 | Payments Made to Reserve Bed During Temporary Absence.

Effective: November 22, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|(A) The department of medicaid may make medicaid payments to a nursing facility provider under this chapter to reserve a bed for a recipient during a temporary absence under conditions prescribed by the department, to include hospitalization for an acute condition, visits with relatives and friends, and participation in therapeutic programs outside the facility, when the resident's plan of care provides for such absence and federal financial participation for the payments is available.(B) The maximum period for which payments may be made to reserve a bed in a nursing facility shall not exceed thirty days in a calendar year.(C) The department shall establish the per medicaid day payment rates for reserving beds under this section. In establishing the per medicaid day payment rates, the department shall set the per medicaid day payment rate at an amount equal to the following:(1) In the case of a nursing facility that had an occupancy rate exceeding ninety-five per cent, an amount not exceeding fifty per cent of the per medicaid day payment rate the provider would be paid if the recipient were not absent from the nursing facility that day;(2) In the case of a nursing facility that had an occupancy rate not exceeding ninety-five per cent, an amount not exceeding eighteen per cent of the per medicaid day payment rate the provider would be paid if the recipient were not absent from the nursing facility that day.(D) For the purpose of setting a nursing facility's per medicaid day payment rate to reserve a bed for a day during the period beginning on September 29, 2013, and ending December 31, 2013, the department shall determine the nursing facility's occupancy rate by using information reported on the nursing facility's cost report for calendar year 2012. For the purpose of setting a nursing facility's per medicaid day payment rate to reserve a bed for January 1, 2014, or thereafter, the department shall determine the nursing facility's occupancy rate by using information reported on the nursing facility's cost report for the calendar year preceding the state fiscal year in which the reservation falls.
Ohio Rev Code § 5165.35 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.35 | Payments Made to Facility for Services Provided After Involuntary Termination.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|Medicaid payments may be made for nursing facility services provided not later than thirty days after the effective date of an involuntary termination of the nursing facility that provides the services if the services are provided to a medicaid recipient who is eligible for the services and resided in the nursing facility before the effective date of the involuntary termination.
Ohio Rev Code § 5165.36 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.36 | Rebasing.

Effective: June 30, 2021|Latest Legislation:  House Bill 110 - 134th General Assembly|(A) The department of medicaid shall conduct a rebasing at least once every five state fiscal years. Except as provided in division (B) of this section, when the department conducts a rebasing for a state fiscal year, it shall conduct the rebasing for only the direct care, ancillary and support, and tax cost centers. A nursing facility provider shall spend money received from the rebasing conducted in state fiscal year 2022 on the direct care, ancillary and support, and tax cost centers only. (B) A nursing facility provider shall spend seventy per cent of any additional dollars received by the provider as a result of a rebasing on direct care costs, including employee salaries. The department may recover any amounts that are not spent in accordance with this requirement. This requirement applies to the department's rebasing in fiscal year 2022 and all subsequent rebasings. The director shall adopt rules authorized under section 5165.02 of the Revised Code as necessary to implement this division, including to ensure that nursing facility operators spend at least seventy per cent of the additional dollars resulting from a rebasing on direct care costs. Last updated August 12, 2021 at 3:37 PM
Ohio Rev Code § 5165.37 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.37 | Calculating Rates and Making Payments.

Effective: November 22, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|The department of medicaid shall make its best efforts each year to calculate nursing facilities' medicaid payment rates under this chapter in time to pay the rates by the fifteenth day of August of each state fiscal year. If the department is unable to calculate the rates so that they can be paid by that date, the department shall pay each provider the rate calculated for the provider's nursing facilities under this chapter at the end of the previous state fiscal year. If the department also is unable to calculate the rates to pay the rates by the fifteenth day of September and the fifteenth day of October, the department shall pay the previous state fiscal year's rate to make those payments. The department may increase by five per cent the previous state fiscal year's rate paid for any nursing facility pursuant to this section at the request of the provider. The department shall use rates calculated for the current state fiscal year to make the payments due by the fifteenth day of November.If the rate paid to a provider for a nursing facility pursuant to this section is lower than the rate calculated for the nursing facility for the current state fiscal year, the department shall pay the provider the difference between the two rates for the number of days for which the provider was paid for the nursing facility pursuant to this section. If the rate paid for a nursing facility pursuant to this section is higher than the rate calculated for it for the current state fiscal year, the provider shall refund to the department the difference between the two rates for the number of days for which the provider was paid for the nursing facility pursuant to this section.
Ohio Rev Code § 5165.38 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.38 | Reconsideration of Rate.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The medicaid director shall adopt rules under section 5165.02 of the Revised Code that establish a process under which a nursing facility provider, or a group or association of nursing facility providers, may seek reconsideration of medicaid payment rates established under this chapter, including a rate for direct care costs recalculated before the effective date of the rate as a result of an exception review of resident assessment data conducted under section 5165.193 of the Revised Code. The only issue that a provider, group, or association may raise in the rate reconsideration shall be whether the rate was calculated in accordance with this chapter and the rules adopted under section 5165.02 of the Revised Code. The provider, group, or association may submit written arguments or other materials that support its position. The provider, group, or association and department of medicaid shall take actions regarding the rate reconsideration within time frames specified in rules authorized by this section. If the department determines, as a result of the rate reconsideration, that the rate determined for one or more nursing facilities is less than the rate to which the nursing facility is entitled, the department shall increase the rate. If the department has paid the incorrect rate for a period of time, the department shall pay the provider the difference between the amount the provider was paid for that period for the nursing facility and the amount the provider should have been paid for the nursing facility.
Ohio Rev Code § 5165.40 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.40 | Adjustment of Rates.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|If a nursing facility provider properly amends a cost report for the nursing facility under section 5165.107 of the Revised Code and the amended report shows that the provider received a lower medicaid payment rate under the original cost report than the provider was entitled to receive, the department of medicaid shall adjust the provider's rate for the nursing facility prospectively to reflect the corrected information. The department shall pay the adjusted rate beginning two months after the first day of the month after the provider files the amended cost report. If the department finds, from an exception review of resident assessment data conducted pursuant to section 5165.193 of the Revised Code after the effective date of a nursing facility's rate for direct care costs that is based on the resident assessment data, that inaccurate resident assessment data resulted in the provider receiving a lower rate for the nursing facility than it was entitled to receive, the department prospectively shall adjust the provider's rate accordingly. The department shall make payments to the provider using the adjusted rate for the remainder of the six-month period for which the resident assessment data is used to determine the rate, beginning one month after the first day of the month after the exception review is completed.
Ohio Rev Code § 5165.41 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.41 | Redetermination of Rates.

Effective: November 22, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|(A) The department of medicaid shall redetermine a provider's medicaid payment rate for a nursing facility using revised information if any of the following results in a determination that the provider received a higher medicaid payment rate for the nursing facility than the provider was entitled to receive:(1) The provider properly amends a cost report for the nursing facility under section 5165.107 of the Revised Code;(2) The department makes a finding based on an audit under section 5165.109 of the Revised Code;(3) The department makes a finding based on an exception review of resident assessment data conducted under section 5165.193 of the Revised Code after the effective date of the nursing facility's rate for direct care costs that is based on the resident assessment data;(4) The department makes a finding based on a post-payment review conducted under section 5165.49 of the Revised Code.(B) The department shall apply the redetermined rate to the periods when the provider received the incorrect rate to determine the amount of the overpayment. The provider shall refund the amount of the overpayment. The department may charge the provider the following amount of interest from the time the overpayment was made:(1) If the overpayment resulted from costs reported for calendar year 1993, the interest shall be no greater than one and one-half times the current average bank prime rate.(2) If the overpayment resulted from costs reported for a subsequent calendar year:(a) The interest shall be no greater than two times the current average bank prime rate if the overpayment was no more than one per cent of the total medicaid payments to the provider for the state fiscal year for which the overpayment was made.(b) The interest shall be no greater than two and one-half times the current average bank prime rate if the overpayment was more than one per cent of the total medicaid payments to the provider for the state fiscal year for which the overpayment was made.
Ohio Rev Code § 5165.42 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.42 | Additional Penalties.

Effective: November 22, 2017|Latest Legislation:  House Bill 49 - 132nd General Assembly|In addition to the other penalties authorized by this chapter, the department of medicaid may impose the following penalties on a nursing facility provider:(A) If the provider does not furnish invoices or other documentation that the department requests during an audit within sixty days after the request, a fine of no more than the greater of the following:(1) One thousand dollars per audit;(2) Twenty-five per cent of the cumulative amount by which the costs for which documentation was not furnished increased the total medicaid payments to the provider during the state fiscal year for which the costs were used to determine a rate.(B) If an exiting operator or owner fails to provide notice of a facility closure or voluntary withdrawal of participation in the medicaid program as required by section 5165.50 of the Revised Code, or an exiting operator or owner and entering operator fail to provide notice of a change of operator as required by section 5165.51 of the Revised Code, a fine of not more than the current average bank prime rate plus four per cent of the last two monthly payments.
Ohio Rev Code § 5165.43 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.43 | Determination of Interest Rate.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|For the purposes of sections 5165.41 and 5165.42 of the Revised Code, the department of medicaid shall determine the current average bank prime rate using statistical release H.15, "selected interest rates," a weekly publication of the federal reserve board, or any successor publication. If statistical release H.15, or its successor, ceases to contain the bank prime rate information or ceases to be published, the department shall request a written statement of the average bank prime rate from the federal reserve bank of Cleveland or the federal reserve board.
Ohio Rev Code § 5165.44 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.44 | Deductions.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|(A) Except as provided in division (B) of this section, the department of medicaid shall deduct the following from the next available medicaid payment the department makes to a nursing facility provider who continues to participate in medicaid: (1) Any amount the provider is required to refund, and any interest charged, under section 5165.41 of the Revised Code;(2) The amount of any penalty imposed on the provider under section 5165.42 of the Revised Code.(B) The department and a nursing facility provider may enter into an agreement under which a deduction required by division (A) of this section is taken in installments from payments the department makes to the provider.
Ohio Rev Code § 5165.45 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.45 | Deposits to General Revenue Fund.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid shall transmit to the treasurer of state for deposit in the general revenue fund amounts collected from the following: (A) Refunds required by, and interest charged under, section 5165.41 of the Revised Code;(B) Amounts collected from penalties imposed under section 5165.42 of the Revised Code.
Ohio Rev Code § 5165.46 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.46 | Administrative Adjudication.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|All of the following are subject to an adjudication conducted in accordance with Chapter 119. of the Revised Code: (A) Any audit disallowance that the department of medicaid makes as the result of an audit under section 5165.109 of the Revised Code;(B) Any adverse finding that results from an exception review of resident assessment data conducted for a nursing facility under section 5165.193 of the Revised Code after the effective date of the nursing facility's medicaid payment rate for direct care costs that is based on the resident assessment data;(C) Any medicaid payment deemed an overpayment under section 5165.523 of the Revised Code;(D) Any penalty the department imposes under section 5165.42 of the Revised Code or section 5165.523 of the Revised Code.
Ohio Rev Code § 5165.47 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.47 | Claim for Medicaid Payment for Service Provided to Nursing Facility Resident.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|No person, other than a nursing facility provider, shall submit a claim for medicaid payment for a service provided to a nursing facility resident if the service is included in a medicaid payment made to the nursing facility provider under this chapter or in the allowable expenses reported on a provider's cost report for a nursing facility. No nursing facility provider shall submit a separate claim for medicaid payment for a service provided to a resident of the nursing facility if the service is included in a medicaid payment made to the provider under this chapter or in the allowable expenses on the provider's cost report for the nursing facility.
Ohio Rev Code § 5165.48 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.48 | Nursing Facility Not Required to Submit Medicaid Claim for Medicare Cost-Sharing Expenses Under Certain Circumstances.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The provider of a nursing facility is not required to submit a claim to the department of medicaid regarding the medicare cost-sharing expenses of a resident of the nursing facility who, under federal law, is eligible to have the medicaid program pay for a part of the cost-sharing expenses if the provider determines that, under rules adopted under section 5165.02 of the Revised Code, the nursing facility would not receive a medicaid payment for any part of the medicare cost-sharing expenses. In such a situation, a claim for the medicare cost-sharing expenses shall be considered to have been adjudicated at no payment.
Ohio Rev Code § 5165.49 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.49 | Post-Payment Reviews of Nursing Facility Medicaid Claims.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|The department of medicaid may conduct a post-payment review of a claim submitted by a nursing facility provider and paid by the medicaid program to determine whether the provider was overpaid. The department shall provide the provider a written summary of the review's results. The review's results are not subject to an adjudication under Chapter 119. of the Revised Code; however, the provider may request that the medicaid director reconsider the review's results. The director shall reconsider the review's results on receipt of a request made in good faith. The department shall not deduct any amounts the department claims to be due from the provider as a result of the review from the provider's medicaid payments pursuant to section 5165.44 of the Revised Code until the conclusion of the director's reconsideration, if any, of the review.
Ohio Rev Code § 5165.50 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.50 | Notice of Facility Closure or Withdrawal of Participation.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|An exiting operator or owner of a nursing facility participating in the medicaid program shall provide the department of medicaid written notice of a facility closure or voluntary withdrawal of participation not less than ninety days before the effective date of the facility closure or voluntary withdrawal of participation. The written notice shall be provided to the department in accordance with the method specified in rules authorized by section 5165.53 of the Revised Code. The written notice shall include all of the following:(A) The name of the exiting operator and, if any, the exiting operator's authorized agent;(B) The name of the nursing facility that is the subject of the written notice;(C) The exiting operator's medicaid provider agreement number for the nursing facility that is the subject of the written notice;(D) The effective date of the facility closure or voluntary withdrawal of participation;(E) The signature of the exiting operator's or owner's representative.
Ohio Rev Code § 5165.501 (2021)
2021 Ohio Revised Code|Title 51 | Public Welfare|Chapter 5165 | Medicaid Coverage of Nursing Facility Services|Section 5165.501 | Compliance With Social Security Act Required.

Effective: September 29, 2013|Latest Legislation:  House Bill 59 - 130th General Assembly|An operator shall comply with the "Social Security Act," section 1919(c)(2)(F), 42 U.S.C. 1396r(c)(2)(F) if the operator's nursing facility undergoes a voluntary withdrawal of participation.