Nursing Facility Private Rooms Application Instructions
Welcome to the Ohio Department of Medicaid’s (ODM) online application process by which nursing facilities (NF) can apply for incentive payments for Category One private rooms.
Pursuant to Am. Sub. H.B. 33 and Ohio Revised Code 5165.158, nursing facilities may apply to ODM to receive private room incentive payments for providing private rooms to Medicaid recipients. ODM has developed this online application and has filed emergency Ohio Administrative Code rule 5160-3-16.31 to facilitate this process.
This application for Category One private rooms is available and will remain open until all funds are allocated. The application process will require nursing facilities to provide ODM with the information about the rooms for which the nursing facility is seeking an incentive payment, and to upload supporting documentation.
The application will require:
1. The Medicaid ID of the facility.
2. Name and email address of the person submitting the application.
3. Total number of nursing facility beds licensed by the Ohio Department of Health as of date of application.
4. Number of Category One beds for which an incentive payment is being requested.
The application will require that nursing facilities identify how the private rooms were created by selecting all scenarios that apply in the application. These include:
1. Private rooms were in existence on July 1, 2023, and all of the licensed beds were in service on the application date.
2. Private rooms were created by surrendering licensed beds from its licensed capacity, or, if the nursing facility does not hold a license, surrendering beds that have been certified by CMS. A nursing facility where the beds are owned by a county and the facility is operated by a person other than the county may satisfy this requirement by removing beds from service.
3. Private rooms that will be created by surrendering licensed beds from its licensed capacity, or, if the nursing facility does not hold a license, surrendering beds that have been certified by CMS. A nursing facility where the beds are owned by a county and the facility is operated by a person other than the county may satisfy this requirement by removing beds from service.
a. NOTE: Surrendering beds does not need to be complete at the time of application but will need to be complete before an application can be approved by ODM.
4. Private rooms were created by adding space to the nursing facility or renovating non-bedroom space, without increasing the total licensed bed capacity.
a. NOTE: Renovating space needs to be complete before an application can be approved, but renovations do not need to be complete at the time of application.
5. A nursing facility licensed after July 1, 2023, in which all licensed beds are in service on the application date or in which private rooms were created by surrendering licensed beds from its licensed capacity.
The application will also require that nursing facilities upload the following supporting documentation:
1. A .xlsx (excel) document (maximum of 10 MB) list of all licensed nursing facility rooms and their corresponding number of beds, designating the rooms for which private room incentive payment approval is requested and identifying which rooms are Category One as defined in section 5165.158 of the Revised Code. Label on the room list which Category One beds have been created by surrendering beds. Please include the Medicaid ID on the Room List.
2. Up to five .pdf documents (maximum of 10 MB each) that show the floor plan of the entire nursing facility that identifies each private room with the designated room number and designated bathroom also labeling how many beds reside within each facility room. Arrows should indicate the path between each resident room and the bathroom and each resident room and the hallway. Label on the floor plan which Category One beds have been created by surrendering beds. Please include the Medicaid ID on the Floor Plan.
All required documents must be in .pdf format. All document file names must begin with the provider's seven-digit Medicaid ID as the first seven characters of the file name. All files submitted must be clear and legible.
Upon submission of the application, submitters will receive an email from
NF_PrivateRoom@medicaid.ohio.gov that confirms receipt of the application and includes their responses to all questions. If you are submitting an application for more than one nursing facility, you must close and relaunch a new application for each Medicaid Provider ID.
Additional information may be requested by ODM to ensure a nursing facility’s eligibility. Facilities will have 10 business days from the date of the request to provide this additional information. Failure to submit the requested information within 10 business days will invalidate the original application's submission and place in line. The nursing facility may submit a new application, which will be considered chronologically based on the new submission date.
Please note that once a valid Medicaid Provider ID is entered and “Next” is selected, that Provider ID is locked into that application response until “Submit” is selected. If you are completing the application for more than one NF, you must close and relaunch a new application for each Medicaid Provider ID response. Please be sure to confirm the Medicaid Provider ID is correct before selecting “Next”. If you have not hit “Submit”, simply using the “Back” button will not clear the first Medicaid Provider ID entered. To ensure accurate responses, please begin a new application for each NF.
Submit any questions to NF_PrivateRoom@medicaid.ohio.gov
ODM sincerely thanks you for your participation in this process.