Ohio Code 5165.46 – Administrative adjudication
All of the following are subject to an adjudication conducted in accordance with Chapter 119. of the Revised Code:
Terms Used In Ohio Code 5165.46
- 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
(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.