Ohio § 5165.38 Reconsideration of rate

Ohio Statutes

§ 5165.38 — Reconsideration of rate

Ohio § 5165.38

Title 51Public Welfare

Ch. 5165Medicaid Coverage of Nursing Facility Services

This text of Ohio § 5165.38 (Reconsideration of rate) is published on Counsel Stack Legal Research, covering Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ohio Rev. Code Ann. § 5165.38 (2026).

Text

The medicaid director shall adopt rules under  section5165.02of 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 section5165.193of 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 section5165.02of the Revised Code. The provider, group, or association  may submit written arguments or ot

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The medicaid director shall adopt rules under section5165.02of 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 section5165.193of 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 section5165.02of 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.