Ohio Administrative Code Search

...initions applicable to this rule. (1) "Doula" is an individual listed in the registry specified in section 4723.89 of the Revised Code. (2) "Doula service" is any of the support activities specified in section 4723.89 of the Revised Code. (3) "Independent" and "non-independent," with respect to a doula, have the same meanings as in rule 5160-4-02 of the Administrative Code. (B) Provid...

...(A) Definitions. (1) "Acupuncture" has the same meaning as in Chapter 4762. of the Revised Code. (2) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (B) Providers. (1) Rendering provider. The following eligible providers may render a covered acupuncture service: (a) An acupuncturist recognized under section 4762.02 of the Revised Code; or (b) An ...

...has the same meaning as in Chapter 4729:1-1 of the Administrative Code. (B) Providers. An individual pharmacist may enroll in medicaid as a pharmacist provider. (C) Coverage. (1) Payment may be made only for a pharmacist service for which the following criteria are met: (a) The service is within a pharmacist's scope of practice; (b) The service is medically necessary in accordance with ...

...ule, the following definitions apply: (1) "Diabetes self-management training" (DSMT) is the education and instruction of an individual with diabetes by a qualified provider for the purpose of providing the individual with necessary skills and knowledge to participate in the management of the individual's diabetes, including the self-administration of injectable drugs. (2) "National Diabetes ...

...le for payment for pharmacy services: (1) A "pharmacy provider" designation and provider number can be obtained by a "terminal distributor of dangerous drugs," as defined in section 4729.01 of the Revised Code, who also: (a) Has a valid drug enforcement agency (DEA) registration; and (b) Has a pharmacist as the "responsible person," as defined in rule 4729-5-11 of the Administrative Code; and (c) Complies with e...

...(A) Covered drugs. (1) "Compounded prescriptions" are prescription drugs made by combining two or more drugs. Active pharmaceutical ingredients (API) and excipients are listed on the ODM pharmacy program website at https://pharmacy.medicaid.ohio.gov. (2) "Covered prescribed drug" means a drug covered by the Ohio department of medicaid (ODM) pharmacy program, or a managed care plan entity as defi...

...l equipment in accordance with Chapter 5160-10 of the Administrative Code, with the following stipulations: (1) The provider must apply to, and be approved by, the Ohio department of medicaid (ODM) to be eligible to dispense medical supplies/durable medical equipment. (2) All products require a prescription written by a practitioner authorized to prescribe. The prescription must be obtained by and kept on file at t...

...uipment in accordance with Chapter 5160-10 of the Administrative Code, with the following stipulations: (1) The provider must: (a) Apply to, and be approved by, the Ohio department of medicaid (ODM) to be eligible to dispense medical supplies/durable medical equipment; and (b) Use the same medicaid provider number as when billing for pharmaceuticals; and (c) Be licensed, registered, or e...

...a managed care plan as defined in rule 5160-26-01 of the Administrative Code, are prescribed drugs as defined in rule 5160-9-05 of the Administrative Code that are dispensed to an eligible patient for use in the patient's residence, including a nursing facility (NF), as defined in section 5165.01 of the Revised Code, or intermediate care facility for individuals with intellectual disabilities (ICF...

...managed care entity as defined in rule 5160-26-01 of the Administrative Code, are prescribed drugs as defined in rule 5160-9-05 of the Administrative Code that are dispensed to an eligible recipient for use in the recipient's residence, including a nursing facility (NF), as defined in section 5165.01 of the Revised Code, or intermediate care facility for individuals with intellectual disabilities ...

... review (DUR), and patient counseling (1) Patient profiles, prospective DUR and patient counseling must be performed for medicaid patients by medicaid pharmacy providers in accordance with Chapter 4729-5 of the Administrative Code. (2) Documentation and records required by Chapter 4729-5 of the Administrative Code must be maintained in accordance with rule 5160-1-17.2 of the Administrative Code. (3) In addition to...

...eview (DUR), and recipient counseling (1) Recipient profiles, prospective DUR and recipient counseling must be performed for medicaid recipients by medicaid pharmacy providers in accordance with agency 4729 of the Administrative Code. (2) Documentation and records required by - agency 4729 of the Administrative Code must be maintained in accordance with rule 5160-1-17.2 of the Administrative Cod...

...(A) Definitions. (1) "340B ceiling price" means the highest price allowed to be charged by a manufacturer to a 340B covered entity as described in section 340B(a)(4) of the "Public Health Service Act," 42 U.S.C. 256b(a)(4) (in effect as of January 7, 2011). (2) "Actual acquisition cost (AAC)" means the best determination by the Ohio department of medicaid (ODM) of the actual amount the provi...

...the recipient in accordance with rules 5160-1-09 and 5160-9-09 of the Administrative Code. (B) The ingredient cost portion of the calculated allowable is determined in accordance with the following criteria: (1) No ingredient cost is allowed for a pandemic vaccine or any other medication, provided by the Ohio department of health or other government entity at no cost to the provider. (2) Fo...

... executed on a tamper-resistant form. (1) To be considered tamper resistant, a prescription form must contain all of the following three characteristics: (a) One or more features designed to prevent unauthorized copying of a completed or blank prescription form; (b) One or more features designed to prevent the erasure or modification of information written on the prescription by the prescriber; and (c) One or mor...

... executed on a tamper-resistant form. (1) To be considered tamper resistant, a prescription form must contain all of the following three characteristics: (a) One or more features designed to prevent unauthorized copying of a completed or blank prescription form; (b) One or more features designed to prevent the erasure or modification of information written on the prescription by the prescriber; ...

...ist specified in paragraph (C) of rule 5160-9-03 of the Administrative Code. (B) Rules 5160-1-09 and 5160-1-60 of the Administrative Code establish additional requirements regarding co-payments. (C) Rule 5160-1-09 of the Administrative Code establishes exceptions to the requirement that an individual pay a co-payment. (D) The exception established in paragraph (C)(4) of rule 5160-1-09 of the Administrative Code re...

...specified in paragraph (C) of rule 5160-9-03 of the Administrative Code. (B) Rules 5160-1-09 and 5160-1-60 of the Administrative Code establish additional requirements regarding co-payments. (C) Rule 5160-1-09 of the Administrative Code establishes exceptions to the requirement that an individual pay a co-payment. (D) The exception established in paragraph (C)(4) of rule 5160-1-09 of the Ad...

...ical supplies, and supplier services. (1) Additional conditions specific to a particular DMEPOS item or service may be set forth in other rules in this chapter of the Administrative Code. (2) Policies set forth in other rules in this chapter supersede any provisions in this rule with which they conflict. (B) Definitions that apply to rules in this chapter of the Administrative Code. (1) "Certi...

...(A) Scope. (1) This rule sets forth general coverage and payment policies for durable medical equipment (DME), prostheses, orthotic devices, medical supplies, and supplier services dispensed or rendered by an enrolled DMEPOS provider. (2) Additional conditions specific to a particular DMEPOS item or service may be set forth in other rules in this chapter of the Administrative Code. (3) Policies...

...(A) Definitions and explanations. (1) "Basic equipment package" is the following standard set of parts and accessories that come with a wheelchair at the time of purchase: (a) A sling or solid seat with back, a captain's chair, or a stadium-style seat; (b) Standard casters or wheels with tires; (c) Standard armrests; (d) Standard front rigging, such as non-elevating legrests with footrests or...

...(A) Definitions and explanations. (1) "Group 1," "group 2," and "group 3" are classes of pressure-reducing support surface. (a) Group 1 surfaces are generally non-powered pads or overlays that are designed to be placed on top of a hospital bed or standard mattress. They achieve their effect through the application of, for example, a gel layer, air pressure, natural lamb's wool, or synthetic ...

...(A) Definitions and explanations. (1) "Group 1," "group 2," and "group 3" are classes of pressure-reducing support surface. (a) Group 1 surfaces are generally non-powered pads or overlays that are designed to be placed on top of a hospital bed or standard mattress. They achieve their effect through the application of, for example, a gel layer, air pressure, natural lamb's wool, or synthetic ...

...(A) Coverage. (1) Separate payment may be made for a speech-generating device (SGD) furnished to a resident of a long-term care facility (LTCF). (2) The default certificate of medical necessity (CMN) form is the ODM 02924, "Certificate of Medical Necessity: Speech-Generating Devices" (rev. 7/2018). The CMN must include the following elements: (a) A formal, written report of a face-to-face evalu...

...(A) Coverage. (1) Separate payment may be made for a speech-generating device (SGD) furnished to a resident of a long-term care facility (LTCF). (2) The default certificate of medical necessity (CMN) form is the ODM 02924, "Certificate of Medical Necessity: Speech-Generating Devices" (rev. 7/2018). The CMN includes the following elements: (a) A formal, written report of a face-to-face evaluatio...