MedicaidCoverageLow impact
5160-3-08 - Criteria for nursing facility-based level of care. (Amend/Final File)
Ohio Medicaid·OH · Geriatrics, Internal Medicine, Family Medicine·Specialty Services
Effective date
Jul 1, 2025
We identified it
Jun 20, 2026
Summary
Ohio Department of Medicaid has finalized amendments to Rule 5160-3-08 regarding criteria for nursing facility-based level of care, with an effective date of July 1, 2025. This policy update affects Medicaid eligibility criteria and documentation requirements for nursing facility placement and services.
Action Required
By July 1, 2025: Billing team should review updated Ohio Medicaid criteria for nursing facility level of care determinations. This primarily affects practices that perform nursing facility evaluations or provide services to nursing facility residents. Contact Ohio Department of Medicaid at 614-752-3877 for specific criteria changes if your practice is involved in nursing facility care coordination.