Background
The Ohio Department of Medicaid (ODM) began paying claims approved for the private room incentive payment starting with December 18, 2024, dates of service. To establish eligibility for the private room incentive payment, nursing facilities (NFs) were required to apply to and receive approval from ODM to be a private room provider. This approval allows eligible providers to qualify for the Medicaid incentive payment for approved private rooms. In accordance with Ohio Revised Code (ORC) Section 5165.158,
beginning July 1, 2025, approved facilities must do both of the following to retain their eligibility for the private room rates:
• Have a policy in place to prioritize placement in a private room based on the medical and psychological needs of the resident; and
• Participate in the resident or family satisfaction survey performed each year by the Ohio Long-Term Care Ombudsman Program.
ODM is monitoring compliance with the above requirements for providers currently approved for the private room incentive as well as any newly applying providers.
Instructions for Reporting NF Private Room Compliance with July 1, 2025 Requirements
To complete this reporting, facilities will need to enter the facility’s Medicaid ID, NPI, and Medicare Number; and the name and email address of the person submitting the entry.
Please note that once a valid Medicaid Provider ID is entered and “Next” is selected, that Provider ID is locked into that entry response until “Submit” is selected. If you are completing the entry for more than one NF, you must close and relaunch a new entry 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.
Upon submission, facilities will receive an email from ODM
noreply@medicaid.ohio.gov that confirms receipt of the submission and includes their responses to all questions.
• NFs that meet the requirements will receive approval from ODM and may continue to bill the incentive rates for approved private rooms.
• NFs that fail to meet the requirements (either incomplete response, no response, or response outside of required time frame) will receive notification from ODM that they are no longer eligible to bill for and receive the private room incentive payment effective July 1, 2025 and will have to re-apply at
Private Room Application- Category 1 Beds and Private Room Application- Category 2 Beds once compliant to be considered for the incentive payment in the future. NFs that re-apply and are approved for the incentive payment will receive a new effective date and will receive incentive payments if funds are available at that time.Only timely and complete submissions will be considered. If the submission is not fully completed or NFs do not respond in a timely manner, they will lose their private room eligibility status and must re-apply at the links provided above to be considered for future incentive payments.
Providers are required to keep documentation to support the validity of their submissions and must be able to provide the documentation during future audits.
Submit any questions to NF_PrivateRoom@medicaid.ohio.gov
ODM sincerely thanks you for your participation in this process.