Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-3 - Long-Term Care Facilities; Nursing Facilities; Intermediate Care Facilities for the Individuals with Intellectual Disabilities
Section 5160-3-64 - Nursing facilities (NFs): payment for medicare part A cost sharing
Current through all regulations passed and filed through September 16, 2024
(A) For nursing facility services the nursing facility provides on or after January 1, 2012, "medicaid maximum allowable amount" means one hundred per cent of the nursing facility's medicaid rate on the date that the service was provided.
(B) For qualified medicare beneficiaries (QMB) as defined in rule 5160:1-3- 02.1 of the Administrative Code and medicaid consumers admitted to a nursing facility as a medicare part A benefit, the Ohio department of medicaid (ODM) will pay as cost sharing for nursing facility services the lesser of:
(C) The medicaid provider is ultimately responsible for accurate and valid reporting of medicaid claims submitted for payment. Providers submitting medicare part A crossover claims to the medicaid program must be able to provide upon request documentation supporting that the information provided on the claim matches the information on the part A plan's remittance advice.
