(A) For persons eligible under both medicaid, administered by the Ohio department of medicaid (ODM), and the children with medical handicaps (CMH) program, administered by the Ohio department of health (ODH), medicaid is the first payer of health care claims (unless a consumer has third party insurance and/or is a medicare beneficiary, then rules 5160-1-05 and 5160-1-08 of the Administrative Code regarding coordination of benefits with a primary payer apply) and its payment constitutes payment in full.
(B) As long as eligibility has been established under the CMH program and services were authorized by the CMH, medicaid providers shall submit all claims for services to persons eligible under both medicaid and the CMH program first to ODM for adjudication under the medicaid program (unless there is a primary payer as described in paragraph (A) of this rule). .
Five Year Review (FYR) Dates: 08/05/2014 and 11/02/2019
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 4/7/77, 12/21/77, 12/30/77, 7/1/80, 3/5/82, 10/1/87, 7/7/02, 09/01/2007