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Ohio Laws and Rules
(A) An individual or entity that wishes to provide core medical services under the Ryan White part B program must request a provider agreement with the director. To be eligible for a provider agreement, the individual or entity must meet the following criteria;
(1) The individual or entity shall possess appropriate licenses and regulatory approvals required by Ohio law and be in good standing with the licensing or approving agency to provide the core services for which they are applying.
(2) The individual or entity shall participate in the Ohio medical assistance program established under section 5111.01 of the Revised Code, if providers of that type are eligible to be providers under the medical assistance program.
(3) The individual or entity shall have a current federal tax identification number.
(4) The individual or entity has not been denied an application to be a provider or had a provider agreement terminated by the department or other Ohio state agency.
(5) The individual or entity meets all federal and state requirements to enter into a provider agreement with the department to provide Ryan White part B services.
(B) An individual who is authorized as a Ryan White part B provider shall execute an agreement with the director. The provider agreement shall include, but not be limited to, the following provisions.
(1) The provider shall agree to provide core medical services to eligible Ryan White part B recipients upon receipt of authorization of such services.
(2) The provider shall bill other applicable payers, such as the medical assistance program or third party insurance prior to billing the Ryan White part B program.
(3) The provider shall agree to bill the director at the provider’s usual, customary, and reasonable rates for services.
(4) The provider shall agree to accept as payment in full the amount paid by the director or third-party administrator as set forth in rule 3701-44-04 of the Administrative Code.
(5) The provider shall agree to not bill the eligible Ryan White part B recipient or any other person for services for which payment is made under the Ryan White part B program.
(6) The provider shall agree to comply with all applicable provisions of the Ryan White part B program, sections 3701.24 to 3701.249 of the Revised Code, Chapter 3701-44 of the Administrative Code and the provider agreement.
(C) The director may deny a provider agreement application or terminate a provider’s eligibility upon determining the applicant or provider does not meet the eligibility requirements specified in this rule or the provider agreement.
(D) The director shall provide written notification of any decision regarding eligibility of a provider. If the director denies or terminate a provider agreement, the director shall state in the notice the reasons for denial or termination and the process for reconsideration under rule 3701-44-07 of the Administrative Code.
Replaces: 3701-44-06, 3701-44-12
Effective: 08/02/2009
R.C. 119.032 review dates: 08/01/2014
Promulgated Under: 119.03
Statutory Authority: 3701.241
Rule Amplifies: 3701.241
Prior Effective Dates: 9/23/91 (Emer), 12/22/91, 5/20/1999, 7/20/2001