Ohio Code 5165.34 – Payments made to reserve bed during temporary absence
(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.
Terms Used In Ohio Code 5165.34
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- Occupancy rate: means the percentage of licensed beds that, regardless of payer source, are either of the following:
(1) Reserved for use under section 5165. See Ohio Code 5165.01
- Provider: means an operator with a provider agreement. See Ohio Code 5165.01
- state: means the state of Ohio. See Ohio Code 1.59
(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.