Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-3 - Long-Term Care Facilities; Nursing Facilities; Intermediate Care Facilities for the Individuals with Intellectual Disabilities › Section 5160-3-02.3 - Nursing facilities (NFs): institutions eligible to participate in medicaid as NFs

Current through all regulations passed and filed through July 1, 2024
(A) Definitions.
(1) "Certification" means the process by
			 which the state survey agency certifies its findings to the federal centers for
			 medicare and medicaid services (CMS) or the Ohio department of
			 medicaid (ODM) with respect to a facility's compliance
			 with health,
									 safety, and resident
			 rights requirements of divisions (a), (b), (c), and (d) of section 1919
			 of the  Social Security Act,
			 42 U.S.C.
			 1396r (December 20, 2006).
(2) "Certified beds" mean beds that are
			 counted in a provider facility that meets medicaid standards. A count of
			 facility beds may differ depending on whether the count is used for
			 certification, licensure, eligibility for medicare or medicaid payment
			 formulas, or other purposes.
(3)
			 "Distinct part" means a portion of an institution or institutional complex that
			 is certified to provide skilled nursing facility (SNF) and/or nursing facility
			 (NF) services. A distinct part shall be
			 physically distinguishable from the larger institution and fiscally separate
			 for cost reporting purposes. A distinct part may be a separate building, wing,
			 floor, hallway, or one side of a corridor. A hospital-based SNF or NF is a
			 distinct part by definition. A long term care facility with both SNF and NF
			 distinct parts is one facility, even though the distinct parts are certified
			 separately for medicare and medicaid. "Distinct part", when applied to NFs or
			 SNF/NFs, has the same definition and requirements as in
			 42
			 C.F.R. 483.5
									(October
			 1, 2015).
(4) "Dually
			 participating" means simultaneous participation of an institution or
			 institutional complex in both the medicare and medicaid programs.
(5) "Dually participating long term care
			 facility" means an institution that participates as both a SNF under the
			 medicare program, and as a NF under the medicaid program. Such a facility is
			 referred to as a SNF/NF.
(6)
			 "Facility" means the entity subject to certification and approval in order for
			 the provider to be approved for medicaid payment. A facility may be an entire
			 institution such as a free-standing nursing home, or may be a distinct part of
			 an institution such as a hospital or continuing care retirement
			 community.
(7) "Long term care
			 facility" means a NF, SNF, or dually participating SNF/NF
			 .
(8) "Long term care
			 institutional services" means those medicaid funded, institutional medical,
			 health, psycho-social, habilitative, rehabilitative, and/or personal care
			 services that may be provided to eligible individuals in a NF or
			 SNF/NF.
(9) "NF services" means
			 those services available in institutions, or parts of institutions, that are
			 certified as nursing facilities by the Ohio department of health (ODH) or by the state
			 survey agency of another state.
(10) "Religious non-medical health care
			 institution" (RNHCI) means an institution as defined in section 1861(ss)(1) of the Social Security Act,
			 
									42
			 U.S.C. 1395x(ss) (1)
									
									(August 5,
			 1997) , such as the "Christian Science RNHCIs" accredited by the
			 "Commission for Accreditation of Christian Science Nursing
			 Organizations/Facilities, Inc." RNHCIs are subject to conditions of
			 participation in the medicaid program according to 42 C.F.R. 403 subpart G(October 1, 2015).
(11) "State survey agency" means the agency
			 designated as the state health standard setting authority, and state health
			 survey agency responsible for certifying and determining compliance of long
			 term care facilities with the requirements for participation in the medicaid
			 program. The state survey agency in Ohio is ODH.