09/17/2026

ODM Files Revised Nursing Facility Ventilator Rule

The Ohio Department of Medicaid (ODM) filed a revised replacement for Ohio Administrative Code 5160-3-18 on September 15 after receiving substantial stakeholder feedback. The proposal replaces the existing nursing facility ventilator program rule rather than amending it. ODM’s April filing materials described the redesign as extensive enough to require rescinding the current rule and adopting a new rule under the same number.

• The proposed rule creates three levels of respiratory support. Tier 1 covers basic noninvasive support such as CPAP and BPAP under the regular nursing facility per diem. Tier 2 covers complex noninvasive ventilation and adds a separate payment and prior authorization requirements. Tier 3 covers invasive mechanical ventilation under the ventilator payment methodology. Ventilator weaning remains a separate service and payment category.
• The redesign also adds more detailed requirements for respiratory therapy staffing, pulmonologist availability, designated ventilator units, clinical documentation, annual outcome reporting, billing and provider applications. ODM said earlier stakeholder feedback led to the addition of noninvasive ventilation coverage, some staffing flexibility, clearer tier criteria and more detailed documentation, outcome and billing provisions.
• LeadingAge Ohio’s April comments supported the proposed respiratory therapy staffing structure and prior authorization for complex noninvasive ventilation while requesting changes to the clinical criteria for Tier 2, including reducing the proposed six-hour daily use threshold to four hours and adding blood gas criteria. The Sept. 15 filing should be reviewed to determine how those recommendations and subsequent public comments were addressed.

What Happens Next

• The rule is at the original-file stage. The current version of OAC 5160-3-18, effective December 31, 2020, remains the published effective rule while the replacement proceeds through Ohio’s rulemaking process.
• Providers should watch for the public hearing, final filing and confirmed effective date. The revised filing will determine the final clinical, staffing, documentation, payment and prior authorization requirements.

What to Do

• Nursing facilities participating in or considering the ventilator program should begin comparing current operations with the proposed requirements, particularly respiratory staffing, physical plant standards, clinical documentation, Tier 2 prior authorization and billing.
• Continue following the current rule until the replacement becomes effective, while preparing policies and workflows for the new requirements.
• Review ODM’s draft rule and Business Impact Analysis and LeadingAge Ohio’s comments on OAC 5160-3-18. The Sept. 15 Register of Ohio filing contains the filed rule and associated rulemaking documents.