Ohio Administrative Code Search

...(A) For the purpose of this rule: (1) A "plan of care" is the medical treatment plan that is established, approved, and signed by a treating physician, advance practice nurse or physician's assistant in accordance with the Coronavirus Aid, Relief, and Economic Security (CARES) Act, S.3548 (2020), prior to a provider requesting reimbursement for a service. The plan of care has the same meaning...

...ified in the Revised Code or in agency 5160 of the Administrative Code apply to services addressed in this rule. (B) Definitions. (1) "Clinic" is an entity that meets all of the following criteria: (a) It renders clinic services on an outpatient basis under the direction of a physician or dentist. Clinic services are defined in 42 CFR 440.90 (October 1, 2016). (b) It operates from a fixed location, a specifically...

...ified in the Revised Code or in agency 5160 of the Administrative Code apply to services addressed in this rule. (B) This rule does not apply to federally qualified health centers (FQHCs) nor to rural health clinics (RHCs), policies for which are set forth in Chapter 5160-28 of the Administrative Code. (C) Definition. "Clinic" is an entity that meets all of the following criteria: (1) It render...

...ance with other chapters of agency 5160 of the Administrative Code. (B) The following definitions apply to this chapter: (1) Terms that have the same meaning as in 42 C.F.R. 414.605 (October 1, 2020) include the following items: (a) "Advanced life support, level 1 (ALS1)"; (b) "Advanced life support, level 2 (ALS2)"; (c) "Basic life support (BLS)"; (d) "EMT-basic," "EMT-intermediate, and...

...(A) Definitions. (1) "Private transportation vendor (PTV)" is an entity that meets the following criteria: (a) It seeks to establish or to maintain a contract with a county department of job and family services (CDJFS) to supply transportation service to medicaid recipients in accordance with rule 5160-15-10 of the Administrative Code; and (b) It is not a government agency, transit authority, p...

...(A) Definitions. (1) "Private transportation vendor (PTV)" is an entity that meets the following criteria: (a) It seeks to establish or to maintain a contract with a county department of job and family services (CDJFS) to supply transportation service to medicaid recipients in accordance with rule 5160-15-10 of the Administrative Code; and (b) It is not a government agency, transit authority, p...

...vider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (B) Transportation-specific criteria. For each entity enrolled as an eligible provider of transportation services, the following conditions are met: (1) The entity, each crew member, and each attendant comply with all applicable local, state, and federal laws, regulations, and rules, including all applicable provisions ...

...ollowing wheelchair van services: (1) Transport by wheelchair van; (2) Mileage, wheelchair van; and (3) Attendant services, wheelchair van. (B) Payment may be made only if all the conditions in this paragraph are met. (1) The necessity of the wheelchair van service is established. A necessary wheelchair van service is presumed to satisfy the criteria for medical necessity set forth i...

...lowing ground ambulance services: (1) Basic life support, provided in a non-emergency (BLS non-emergency); (2) Basic life support, provided in an emergency (BLS emergency); (3) Advanced life support, level 1, provided in a non-emergency (ALS1 non-emergency); (4) Advanced life support, level 1, provided in an emergency (ALS1 emergency); (5) Advanced life support, level 2 (ALS2); (6) S...

...lowing services and associated costs: (1) Transportation services for an individual who is not medicaid-eligible at the time of transport; (2) Transportation of a medicaid-eligible individual for a purpose other than the receipt of medicaid-coverable services; (3) Transportation of a medicaid-eligible individual to or from a service provided outside the limits of the individual's medicaid b...

... necessary in accordance with rule 5160-15-22, 5160-15-23, or 5160-15-24 of the Administrative Code. A medicaid managed care organization (MCO) is not obliged to use the practitioner certification process described in paragraph (B) of this rule to certify the necessity of a transportation service furnished to a medicaid-eligible individual enrolled in the MCO. (B) For transportation services that...

...pose. This rule implements section 5164.96 of the Revised Code regarding supplemental medicaid payments to eligible emergency medical services organizations operated by a government entity. (B) Definitions applicable to this rule. (1) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (2) "Ground ambulance transport" comprises the following service...

...(A) Definitions. (1) "Freestanding birth center (FBC)" has the same meaning as in 42 U.S.C. 1396d(l)(3)(B) (October 1, 2016). (2) "Independent practitioner" and "non-independent practitioner" have the same meaning as in rule 5160-4-02 of the Administrative Code. (3) "Low-risk expectant mother" has the same meaning as in rule 3701-83-33 of the Administrative Code. (B) Provider requirements....

...(A) Definitions. (1) "Freestanding birth center (FBC)" is an entity defined in 42 U.S.C. 1396d(l)(3)(B) (in effect as of January 1, 2023) that is operated in conformity with rules 3701-83-33 to 3701-83-42 of the Administrative Code. (2) "Independent practitioner" and "non-independent practitioner" have the same meaning as in rule 5160-4-02 of the Administrative Code. (3) "Low-risk expectant...

...rs who meet the provisions in sections 5103.60, 5103.602, 5103.603, 5103.6010, 5103.6011, 5103.6017 and 5103.6018 of the Revised Code and the provisions described in this rule. (B) Definitions. For the purpose of this rule the following definitions apply: (1) "Clinical Director" is a practitioner of physician services who supervises day-to-day clinical operations of the pediatric recovery center...

...(A) For purposes of rules 5160-19-01 and 5160-19-02 of the Administrative Code, the following definitions apply: (1) "Attribution" is the process through which medicaid recipients are assigned to specific PCPs who are able to participate in the medicaid program in accordance with rule 5160-1-17.2 of the Administrative Code. ODM is responsible for attributing fee-for-service recipients; MCOs are r...

...(A) For purposes of rules 5160-19-01 and 5160-19-02 of the Administrative Code, the following definitions apply: (1) "Attribution" is the process through which medicaid recipients are assigned to specific primary care practitioners (PCPs) who are able to participate in the medicaid program in accordance with rule 5160-1-17.2 of the Administrative Code. The Ohio department of medicaid (ODM) is res...

...outcomes. (A) For purposes of Chapter 5160-19 of the Administrative Code, the following definitions apply: (1) "Attribution" is the process through which the Ohio department of medicaid (ODM) or its designee assigns eligible individuals to a specific CMC entity. (2) "CMC attributed medicaid individuals" are the eligible pregnant and postpartum Ohio medicaid recipients for whom an entity eligibl...

...outcomes. (A) For purposes of Chapter 5160-19 of the Administrative Code, the following definitions apply: (1) "Attribution" is the process through which the Ohio department of medicaid (ODM) or its designee assigns eligible individuals to a specific CMC entity. (2) "CMC attributed medicaid individuals" are the eligible pregnant and postpartum women for whom an entity eligible under this rule h...

...(A) Definitions. (1) "Abuse potential drug" as used in the appendix to this rule, means any drug that contains substances which have a potential for abuse because of depressant or stimulant effects on the central nervous system or hallucinogenic effects. Abuse potential drugs include any drug that is reportable to Ohio automated RX reporting system (OARRS) as described in rules 4729:8-2-01 and 47...

...(A) Definitions. (1) "Abuse potential drug" as used in the appendix to this rule, means any drug that contains substances which have a potential for abuse because of depressant or stimulant effects on the central nervous system or hallucinogenic effects. Abuse potential drugs include any drug that is reportable to Ohio automated RX reporting system (OARRS) as described in rules 4729:8-2-01 and 47...

...(A) Definitions. (1) For the purposes of this rule, "hysterectomy" means, in accordance with 42 C.F.R. 441.251 (October 1, 2010 edition), a medical procedure or operation for the purpose of removing the uterus. (2) For the purposes of this rule, "institutionalized individual" means, in accordance with 42 C.F.R. 441.251 (October 1, 2010 edition), an individual who is: (a) Involuntarily confined or detained, under a...

...(A) Coverage. (1) Unless a different time period is specified, services described in this rule are covered through the pregnancy and the delivery. (2) Basic pregnancy-related services include but are not limited to antepartum care, delivery, outpatient postpartum care, and family planning services. (a) Antepartum care. Payment for a visit may be made for either of two purposes: (i) Basic...

...(A) Coverage. (1) Unless a different time period is specified, services described in this rule are covered through the pregnancy and the delivery. (2) Basic pregnancy-related services include but are not limited to antepartum care, delivery, outpatient postpartum care, and family planning services. (a) Antepartum care. Payment for a visit may be made for either of two purposes: (i) Basic...

...(A) Coverage. (1) Unless a different time period is specified, services described in this rule are covered through the pregnancy and the delivery. (2) Basic pregnancy-related services include but are not limited to antepartum care, delivery, outpatient postpartum care, and family planning services. (a) Antepartum care. Payment for a visit may be made for either of two purposes: (i) Basic...