MedicaidReimbursementLow impact
5160-3-64.1 - Nursing facilities (NFs): payment for cost-sharing other than medicare part A. (Amend/Final File)
Ohio Medicaid·OH · Geriatrics, Internal Medicine, Family Medicine·Reimbursement
Effective date
Feb 14, 2019
We identified it
Jun 20, 2026
Summary
Ohio Medicaid updated Rule 5160-3-64.1 regarding payment for nursing facility cost-sharing expenses that are not covered by Medicare Part A. This policy governs how Medicaid handles secondary payments for nursing home residents when Medicare Part A benefits are exhausted or not applicable.
Action Required
Review current nursing facility billing practices to ensure compliance with Ohio Medicaid cost-sharing payment rules. Verify that claims for nursing facility residents with dual Medicare/Medicaid coverage are being processed correctly when Medicare Part A does not cover the service.