Terms Used In Ohio Code > Chapter 5165 - Medicaid Coverage of Nursing Facility Services

• Affiliated operator: means an operator affiliated with either of the following:

  (1) The exiting operator for whom the affiliated operator is to assume liability for the entire amount of the exiting operator's debt under the medicaid program or the portion of the debt that represents the franchise permit fee the exiting operator owes;

  (2) The entering operator involved in the change of operator with the exiting operator specified in division (A)(1) of this section. See Ohio Code 5165.01

• Allegation: something that someone says happened.
• Amortization: Paying off a loan by regular installments.
• Ancillary and support costs: includes , but is not limited to, costs of activities, social services, pharmacy consultants, habilitation supervisors, qualified intellectual disability professionals, program directors, medical and habilitation records, program supplies, incontinence supplies, food, enterals, dietary supplies and personnel, laundry, housekeeping, security, administration, medical equipment, utilities, liability insurance, bookkeeping, purchasing department, human resources, communications, travel, dues, license fees, subscriptions, home office costs not otherwise allocated, legal services, accounting services, minor equipment, maintenance and repairs, help-wanted advertising, informational advertising, start-up costs, organizational expenses, other interest, property insurance, employee training and staff development, employee benefits, payroll taxes, and workers' compensation premiums or costs for self-insurance claims and related costs as specified in rules adopted under section 5165. See Ohio Code 5165.01
• Another: when used to designate the owner of property which is the subject of an offense, includes not only natural persons but also every other owner of property. See Ohio Code 1.02
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Applicable calendar year: means the calendar year immediately preceding the first of the state fiscal years for which a rebasing is conducted. See Ohio Code 5165.01
• as of the last day of the calendar year: refers to the occupancy and utilization rates during the calendar year identified in the cost report filed under section 5165. See Ohio Code 5165.01
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Bond: includes an undertaking. See Ohio Code 1.02
• Capital costs: means the actual expense incurred by a nursing facility for all of the following:

  (a) Depreciation and interest on any capital assets that cost five hundred dollars or more per item, including the following:

  (i) Buildings;

  (ii) Building improvements;

  (iii) Except as provided in division (D) of this section, equipment;

  (iv) Transportation equipment. See Ohio Code 5165.01

• Case-mix score: means a measure determined under section 5165. See Ohio Code 5165.01
• Change in control: means either of the following:

  (1) Any pledge, assignment, or hypothecation of or lien or other encumbrance on any of the legal or beneficial equity interests in the applicable person;

  (2) A change of fifty per cent or more in the legal or beneficial ownership or control of the outstanding voting equity interests of the applicable person necessary at all times to elect a majority of the board of directors or similar governing body and to direct the management policies and decisions. See Ohio Code 5165.01

• Change of operator: includes circumstances in which an entering operator becomes the operator of a nursing facility in the place of the exiting operator or there is a change in owner of a nursing facility. See Ohio Code 5165.01
• Child: includes child by adoption. See Ohio Code 1.59
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Contract: A legal written agreement that becomes binding when signed.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Cost center: means the following:

  (1) Ancillary and support costs;

  (2) Capital costs;

  (3) Direct care costs;

  (4) Tax costs. See Ohio Code 5165.01

• Custom wheelchair: means a wheelchair to which both of the following apply:

  (1) It has been measured, fitted, or adapted in consideration of either of the following:

  (a) The body size or disability of the individual who is to use the wheelchair;

  (b) The individual's period of need for, or intended use of, the wheelchair. See Ohio Code 5165.01

• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Date of licensure: means the following:

  (a) In the case of a nursing facility that was required by law to be licensed as a nursing home under Chapter 3721 of the Revised Code when it originally began to be operated as a nursing home, the date the nursing facility was originally so licensed;

  (b) In the case of a nursing facility that was not required by law to be licensed as a nursing home when it originally began to be operated as a nursing home, the date it first began to be operated as a nursing home, regardless of the date the nursing facility was first licensed as a nursing home. See Ohio Code 5165.01

• Deed: The legal instrument used to transfer title in real property from one person to another.
• Dependent: A person dependent for support upon another.
• Desk-reviewed: means that a nursing facility's costs as reported on a cost report submitted under section 5165. See Ohio Code 5165.01
• Direct care costs: means all of the following costs incurred by a nursing facility:

  (1) Costs for registered nurses, licensed practical nurses, and nurse aides employed by the nursing facility;

  (2) Costs for direct care staff, administrative nursing staff, medical directors, respiratory therapists, and except as provided in division (O)(8) of this section, other persons holding degrees qualifying them to provide therapy;

  (3) Costs of purchased nursing services;

  (4) Costs of quality assurance;

  (5) Costs of training and staff development, employee benefits, payroll taxes, and workers' compensation premiums or costs for self-insurance claims and related costs as specified in rules adopted under section 5165. See Ohio Code 5165.01

• Effective date of a change of operator: means the day the entering operator becomes the operator of the nursing facility. See Ohio Code 5165.01
• Effective date of a facility closure: means the last day that the last of the residents of the nursing facility resides in the nursing facility. See Ohio Code 5165.01
• Effective date of a voluntary withdrawal of participation: means the day the nursing facility ceases to accept new medicaid residents other than the individuals who reside in the nursing facility on the day before the effective date of the voluntary withdrawal of participation. See Ohio Code 5165.01
• Effective date of an involuntary termination: means the date the department of medicaid terminates the operator's provider agreement for the nursing facility. See Ohio Code 5165.01
• Entering operator: means the person or government entity that will become the operator of a nursing facility when a change of operator occurs or following an involuntary termination. See Ohio Code 5165.01
• Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. ^{Source: U.S. Courts}
• Escrow: Money given to a third party to be held for payment until certain conditions are met.
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Exiting operator: means any of the following:

  (1) An operator that will cease to be the operator of a nursing facility on the effective date of a change of operator;

  (2) An operator that will cease to be the operator of a nursing facility on the effective date of a facility closure;

  (3) An operator of a nursing facility that is undergoing or has undergone a voluntary withdrawal of participation;

  (4) An operator of a nursing facility that is undergoing or has undergone an involuntary termination. See Ohio Code 5165.01

• facility closure: means either of the following:

  (a) Discontinuance of the use of the building, or part of the building, that houses the facility as a nursing facility that results in the relocation of all of the nursing facility's residents;

  (b) Conversion of the building, or part of the building, that houses a nursing facility to a different use with any necessary license or other approval needed for that use being obtained and one or more of the nursing facility's residents remaining in the building, or part of the building, to receive services under the new use. See Ohio Code 5165.01

• 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.
• Franchise permit fee: means the fee imposed by sections 5168. See Ohio Code 5165.01
• in writing: includes any representation of words, letters, symbols, or figures; this provision does not affect any law relating to signatures. See Ohio Code 1.59
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Inpatient days: means both of the following:

  (1) All days during which a resident, regardless of payment source, occupies a licensed bed in a nursing facility;

  (2) Fifty per cent of the days for which payment is made under section 5165. See Ohio Code 5165.01

• Involuntary termination: means the department of medicaid's termination of the operator's provider agreement for the nursing facility when the termination is not taken at the operator's request. See Ohio Code 5165.01
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Legacy: A gift of property made by will.
• Lien: A claim against real or personal property in satisfaction of a debt.
• Low case-mix resident: means a medicaid recipient residing in a nursing facility who, for purposes of calculating the nursing facility's medicaid payment rate for direct care costs, is placed in either of the two lowest case-mix groups, excluding any case-mix group that is a default group used for residents with incomplete assessment data. See Ohio Code 5165.01
• Medicaid days: means both of the following:

  (1) All days during which a resident who is a medicaid recipient eligible for nursing facility services occupies a bed in a nursing facility that is included in the nursing facility's medicaid-certified capacity;

  (2) Fifty per cent of the days for which payment is made under section 5165. See Ohio Code 5165.01

• Medicaid-certified capacity: means the number of a nursing facility's beds that are certified for participation in medicaid as nursing facility beds. See Ohio Code 5165.01
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• New nursing facility: means a nursing facility for which the provider obtains an initial provider agreement following medicaid certification of the nursing facility by the director of health, including such a nursing facility that replaces one or more nursing facilities for which a provider previously held a provider agreement. See Ohio Code 5165.01
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• 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

• operating lease: shall be construed in accordance with generally accepted accounting principles. See Ohio Code 5165.01
• Operator: means the person or government entity responsible for the daily operating and management decisions for a nursing facility. See Ohio Code 5165.01
• Owner: means any person or government entity that has at least five per cent ownership or interest, either directly, indirectly, or in any combination, in any of the following regarding a nursing facility:

  (a) The land on which the nursing facility is located;

  (b) The structure in which the nursing facility is located;

  (c) Any mortgage, contract for deed, or other obligation secured in whole or in part by the land or structure on or in which the nursing facility is located;

  (d) Any lease or sublease of the land or structure on or in which the nursing facility is located. See Ohio Code 5165.01

• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Per diem: means a nursing facility's actual, allowable costs in a given cost center in a cost reporting period, divided by the nursing facility's inpatient days for that cost reporting period. See Ohio Code 5165.01
• Person: includes an individual, corporation, business trust, estate, trust, partnership, and association. See Ohio Code 1.59
• Personal property: All property that is not real property.
• Private room: means a nursing facility bedroom that meets all of the following criteria:

  (1) It has four permanent, floor-to-ceiling walls and a full door. See Ohio Code 5165.01

• Property: means real and personal property. See Ohio Code 1.59
• Provider: means an operator with a provider agreement. See Ohio Code 5165.01
• Provider agreement: means a provider agreement, as defined in section 5164. See Ohio Code 5165.01
• Purchased nursing services: means services that are provided in a nursing facility by registered nurses, licensed practical nurses, or nurse aides who are not employees of the nursing facility. See Ohio Code 5165.01
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• Reasonable: means that a cost is an actual cost that is appropriate and helpful to develop and maintain the operation of patient care facilities and activities, including normal standby costs, and that does not exceed what a prudent buyer pays for a given item or services. See Ohio Code 5165.01
• Rebasing: means a redetermination of each of the following using information from cost reports for an applicable calendar year that is later than the applicable calendar year used for the previous rebasing:

  (1) Each peer group's rate for ancillary and support costs as determined pursuant to division (C) of section 5165. See Ohio Code 5165.01

• Related party: means an individual or organization that, to a significant extent, has common ownership with, is associated or affiliated with, has control of, or is controlled by, the provider. See Ohio Code 5165.01
• Relative of owner: means an individual who is related to an owner of a nursing facility by one of the following relationships:

  (1) Spouse;

  (2) Natural parent, child, or sibling;

  (3) Adopted parent, child, or sibling;

  (4) Stepparent, stepchild, stepbrother, or stepsister;

  (5) Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, or sister-in-law;

  (6) Grandparent or grandchild;

  (7) Foster caregiver, foster child, foster brother, or foster sister. See Ohio Code 5165.01

• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Rule: includes regulation. See Ohio Code 1.59
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• state: means the state of Ohio. See Ohio Code 1.59
• State fiscal year: means the fiscal year of this state, as specified in section 9. See Ohio Code 5165.01
• Statute: A law passed by a legislature.
• Tax costs: means the costs of taxes imposed under Chapter 5751 of the Revised Code, real estate taxes, personal property taxes, and corporate franchise taxes. See Ohio Code 5165.01
• Temporary restraining order: Prohibits a person from an action that is likely to cause irreparable harm. This differs from an injunction in that it may be granted immediately, without notice to the opposing party, and without a hearing. It is intended to last only until a hearing can be held.
• Testify: Answer questions in court.
• Title XIX: means Title XIX of the "Social Security Act" 42 U. See Ohio Code 5165.01
• Title XVIII: means Title XVIII of the "Social Security Act" 42 U. See Ohio Code 5165.01
• United States: includes all the states. See Ohio Code 1.59
• Voluntary withdrawal of participation: means an operator's voluntary election to terminate the participation of a nursing facility in the medicaid program but to continue to provide service of the type provided by a nursing facility. See Ohio Code 5165.01
• Whoever: includes all persons, natural and artificial; partners; principals, agents, and employees; and all officials, public or private. See Ohio Code 1.02