OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
H.B. 461 Bill Analysis
134th General Assembly
Click here for H.B. 461’s Fiscal Note
Version: As Reported by House Economic and Workforce Development
Primary Sponsor: Rep. Carruthers
Effective Date:
Erika Kramer, Attorney
SUMMARY
Establishes a private room per day payment rate to be added as part of a nursing
facility’s per Medicaid day payment rate.
Provides that the private room per day payment is available for each nursing facility
provider that has provided services to a Medicaid recipient in a private room beginning
on or after July 1, 2022.
Sets the nursing facility private room per day rate for FY 2023 at $25 and requires the
Department of Medicaid to determine the rate for subsequent fiscal years.
Specifies how to calculate a nursing facility’s private room capacity.
Prohibits a nursing facility provider from billing the Department for more private rooms
in one day than the facility’s private room capacity and permits the Department to
recoup excess payments.
Requires the Department to calculate the initial private room capacity for each nursing
facility within 60 days of the bill’s effective date, or of the date a new nursing facility is
certified by the U.S. Centers for Medicare and Medicaid Services (CMS).
Requires each nursing facility provider to notify the Department if the provider removes
Medicaid beds licensed by the Department of Health or surrenders beds that were
certified by CMS.
Requires the Department of Medicaid to adjust the facility’s private room capacity
within 60 days of receiving such a notice.
May 19, 2022
Office of Research and Drafting LSC Legislative Budget Office
DETAILED ANALYSIS
Nursing facility private room payment
The bill establishes a private room per day rate to be added as part of a nursing facility’s
per Medicaid day payment rate calculation. The private room per day rate is added to the per
Medicaid day payment rate for each nursing facility provider that has provided services to a
Medicaid recipient in a private room beginning on or after July 1, 2022.1 A private room is a
room with permanent walls that contains one licensed or certified bed that is occupied by one
individual, with direct unshared access to a hallway, and direct unshared access to a toilet and
sink shared by no more than one other room, and that meets all applicable licensure and other
building and safety standards.2
Under current law, a nursing facility’s per Medicaid day payment rate is calculated as
follows:
1. Determine the sum of each facility’s: ancillary and support costs, capital costs, direct
costs, and tax costs (collectively known as “cost centers”);
2. If the facility qualifies as a critical access nursing facility, add to (1) the facility’s critical
access incentive payment;
3. To the sum under (2) above, add $16.44;
4. To that sum, subtract $1.79.
The bill adds a new component to the above calculation and requires the private room per day
payment rate to be added as part of the sum under steps (1) and (2) above, to which $16.44
under step (3) is added.3
Payment amount
For FY 2023 (July 1, 2022 through June 30, 2023), the nursing facility private room per
day rate is $25. The bill requires the Department of Medicaid to determine the private room
per day rate for subsequent fiscal years.4
Private room capacity
As part of the payment amount calculation, the bill establishes a methodology to
calculate a nursing facility’s private room capacity. Private room capacity means the total
number of private rooms in the facility for purposes of the private room per day payment. After
a facility’s private room capacity is initially calculated, it can change only if the facility removes
1 R.C. 5165.27(A).
2 R.C. 5165.01(LL).
3 R.C. 5165.15.
4 R.C. 5165.27(B).
P a g e |2 H.B. 461
As Reported by House Economic and Workforce Development
Office of Research and Drafting LSC Legislative Budget Office
licensed beds from its licensed capacity or, if the facility is not licensed, if the facility surrenders
beds that have been certified by the U.S. Centers for Medicare and Medicaid Services (CMS). A
nursing facility’s private room capacity is calculated as follows:
1. Determine the number of resident rooms in the nursing facility that are occupied by or
are available to be occupied by a resident during the fiscal year;
2. Determine the number of licensed beds during the fiscal year, or if the facility is not
licensed, the number of certified beds;
3. Subtract the sum under (1) from the sum under (2);
4. Subtract the sum under (3) from the sum under (1). 5
The bill prohibits a nursing facility provider from billing the Department for more private
rooms in one day than the facility’s private room capacity and permits the Department to
recoup any such excess payments, including by using vendor offsets.6
Initial private room capacity
The Department must calculate the initial private room capacity for each Ohio nursing
facility within 60 days of the bill’s effective date for existing nursing facilities, or within 60 days
of the date the facility is certified as a nursing facility by CMS for new nursing facilities.7
Change in private room capacity
The bill requires each nursing facility provider to submit to the Department, and the
Department to collect, the number of rooms occupied and available for occupancy in the
facility. A nursing facility provider must notify the Department if the provider removes Medicaid
beds licensed by the Department of Health or surrenders beds certified by CMS, including the
number of beds removed or surrendered and the effective date of the change. Upon receiving
the notice, the Department of Medicaid must:
Verify with the Department of Health, if applicable, the number of beds removed and
the effective date of the removal;
Within 60 days of receipt of the notice, adjust the facility’s private room capacity;
Amend the facility’s provider agreement.
The Department of Medicaid must include in the facility’s private room per day rate the
facility’s adjusted private room capacity beginning on the later of (1) the date the beds were
removed or surrendered or (2) the date the Department received notice of the removal or
surrender.8
5 R.C. 5165.27(C).
6 R.C. 5165.27(D).
7 R.C. 5165.27(E).
8 R.C. 5165.27(E).
P a g e |3 H.B. 461
As Reported by House Economic and Workforce Development
Office of Research and Drafting LSC Legislative Budget Office
HISTORY
Action Date
Introduced 10-25-21
Reported, H. Economic and Workforce Development 05-18-22
ANHB0461RH-134/ec
P a g e |4 H.B. 461
As Reported by House Economic and Workforce Development
Statutes affected: As Reported By House Committee: 5165.01, 5165.15
As Re-referred to House Committee: 5165.01, 5165.15