Assessment to determine level of care – Ohio Rev. Code Ann. § 5165.04

“Assessment to determine level of care”

The department of job and family services may require each applicant for or recipient of Medicaid who applies or intends to apply for admission to a nursing facility or resides in a nursing facility to undergo an assessment to determine whether the applicant or recipient needs the level of care provided by a nursing facility.  To the extent possible, the assessment will be based on information from the resident assessment instrument, and on information provided by the person being assessed or his representative.  The department of Medicaid or the agency that performed the assessment will give written notice of its conclusions with a day of the level of care determination, or if the person submits the application but has not been hospitalized then the department has five days to make the level of care determination.

A person may appeal the conclusion and the department must provide written notice of the person’s right to request a state hearing with an explanation of the procedure to do so.  If a nursing facility admits a person and provides above the necessary assessed level of care, the nursing facility will not be paid through Medicaid.