Ohio Admin. Code 5160-2-01 - Eligible providers

(A) All hospitals, except those excluded in paragraphs (A)(1) and (A)(2) of this rule, that meet medicare (Title XVIII) conditions of participation as described in 42 C.F.R 482 effective as of October 1, 2016 2022, are eligible to participate in the Ohio medicaid (Title XIX) program upon execution of a provider agreement. Also considered to be eligible is a hospital that is currently determined to meet the requirements established criteria for Title XVIII participation and has in effect a hospital utilization review plan applicable to all patients who receive medical assistance under Title XIX. The following hospitals are excluded from participation:

(1) Tuberculosis hospitals, and

(2) Hospitals that have fifty per cent or more of their beds registered pursuant to Chapter 3701-59 of the Administrative Code as alcohol and/or drug abuse rehabilitation beds, and have no beds licensed as psychiatric beds pursuant to Chapter 5122-14 of the Administrative Code.

(B) Freestanding psychiatric hospitals with more than sixteen beds may provide inpatient psychiatric services in accordance with paragraphs (B)(1) to (B)(4) of this rule:

(1) For recipients individuals age aged sixty-five or older, hospitals shall will operate pursuant to the provisions of 42 C.F.R. 441 subpart C effective as of October 1, 2016 2022.

(2) For recipients individuals under age twenty-one, hospitals shall will operate pursuant to the provisions of 42 C.F.R. 441 subpart D effective as of October 1, 2016 2022.

(3) For recipients individuals age aged twenty-one or older, but under age sixty-five, hospitals shall will operate pursuant to the provisions of 42 C.F.R. 482 subpart E effective as of October 1, 2016 2022.

(4) In the case of a an recipient individual under age twenty-two, the hospital shall will provide services before the recipient individual reaches age twenty-one or, if the recipient individual was receiving services immediately before he or she they reached age twenty-one, then before the earlier of the following:

(a) The date he or she the individual no longer requires needs the services; or

(b) The date he or she the individual reaches age twenty-two.

(C) Ohio medicaid will not reimburse freestanding psychiatric hospitals with more than sixteen beds for inpatient psychiatric services rendered to recipients individuals age aged twenty-one or older, but under age sixty-five, except in accordance with the provisions of 42 C.F.R. 438.6(e) effective as of October 1, 2016 2022.

(D) Freestanding psychiatric hospitals with sixteen or fewer beds may provide inpatient psychiatric services to recipients individuals of any age and shall will operate pursuant to the provisions of 42 C.F.R. 482 subpart E effective as of October 1, 2016 2022.

Notes

Ohio Admin. Code 5160-2-01

Effective: 8/20/2023
Five Year Review (FYR) Dates: 6/5/2023 and 08/20/2028
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.03, 5164.02
Prior Effective Dates: 04/07/1977, 12/21/1977, 06/01/1985, 10/01/1987, 09/03/1991 (Emer.), 11/10/1991, 06/01/1995, 08/01/2002, 10/16/2006, 04/30/2015, 07/01/2017