Ohio Code 5124.34 – Payment for reserving beds
(A) As used in this section, “participation in therapeutic programs” includes visits to potential new residential settings.
Terms Used In Ohio Code 5124.34
- Provider: means an operator with a valid provider agreement. See Ohio Code 5124.01
(B) The department of developmental disabilities shall pay an ICF/IID provider one hundred per cent of the total per medicaid day payment rate determined for the ICF/IID under this chapter to reserve a bed for a resident who is a medicaid recipient if all of the following apply:
(1) The recipient is temporarily absent from the ICF/IID for a reason that makes the absence qualified for payments under this section as specified in rules authorized by this section;
(2) The resident’s plan of care provides for the absence;
(3) Federal financial participation is available for the payments.
(C) The maximum period during which medicaid payments may be made to reserve a bed shall not exceed the maximum period specified in federal regulations and shall not be more than thirty days during any calendar year for hospital stays, visits with relatives and friends, and participation in therapeutic programs. However, a resident shall not be subject to a maximum period during which payments may be made to reserve a bed if prior authorization of the department is obtained for hospital stays, visits with relatives and friends, and participation in therapeutic programs.
(D)(1) The director of developmental disabilities shall adopt rules under section 5124.03 of the Revised Code as necessary to implement this section, including rules that do the following:
(a) Specify the reasons for which a temporary absence from an ICF/IID makes the absence qualify for payments under this section;
(b) Establish conditions under which prior authorization may be obtained for the purpose of division (C) of this section.
(2) The rules authorized by division (D)(1)(a) of this section shall include the following as reasons for which a temporary absence from an ICF/IID qualifies for payments under this section:
(a) Hospitalization for acute conditions;
(b) Visits with relatives and friends;
(c) Participation in therapeutic programs outside the ICF/IID.