Ohio Administrative Code Search

...The release authority board members are appointed pursuant to section 5139.50 of the Revised Code. For the purpose of implementing rule 5139-68-01 of the Administrative Code, the following terms have the following definitions: (A) Board member is defined as one of the five members of the release authority appointed pursuant to section 5139.50 of the Revised Code. (B) Chair of the release authority ...

...The Ohio department of youth services and the court shall adhere to the following: (A) The Ohio department of youth services shall develop and furnish to all juvenile courts a standard disposition investigation report which the court will complete and submit to the Ohio department of youth services at the time the court transfers physical custody of the youth to the Ohio department of youth service...

...The Ohio department of youth services and the court shall adhere to the following: (A) The Ohio department of youth services shall develop and furnish to all juvenile courts a standard disposition investigation report which the court will complete and submit to the Ohio department of youth services at the time the court transfers physical custody of the youth to the Ohio department of youth service...

...The purpose of this rule is to provide guidelines on the development and communication of release expectations for youth committed to the department of youth services. (A) All youth committed to the department shall have release expectations developed after their admission to ODYS. (B) The release expectations shall include commitment expectations from the committing juvenile court, recommended ...

...The purpose of this rule is to provide consistent guidelines and criteria on the release authority regular release review process. (A) All youth shall receive a release review at least thirty days prior to their MSED, unless a youth has a significant amount of confinement credit, a commitment change or a revocation which prohibits conducting the review within that time frame (section 5139.56 of ...

...The purpose of this rule is to provide consistent guidelines and criteria on the release authority constructive journalization process. (A) At least thirty days prior to a youth's POA, the regional office shall forward a copy of the supervised release plan to the placement juvenile court requesting that the plan be journalized. (B) Within fifteen days after receiving a copy of the supervised release plan, the pl...

...(A) Definitions. For the purposes of rules promulgated by this agency in accordance with section 1347.15 of the Revised Code effective April 9, 2009, the following definitions apply: (1) "Access" as a noun means an instance of copying, viewing, or otherwise perceiving; whereas, "access" as a verb means to copy, view, or otherwise perceive. (2) "Acquisition of a new computer system" means th...

...Paragraphs (A)(7) to (F)(4) of this rule do not apply to pharmacy services covered under the medicare part D program. Pharmacy services covered under the medicare part D program should be billed in accordance with rule 5160-9-06 of the Administrative Code. (A) Definitions. (1) "Medicare" is a federally financed program of hospital insurance (part A) and supplemental medical insurance (also called SMI ...

...(A) For qualified medicare beneficiaries and medicaid recipients enrolled in medicare part C managed health care plans (medicare advantage plans) the department will pay as cost sharing the lesser of the following amounts: (1) The provider's billed charges for the service (except for hospital and nursing facility services); or (2) The deductible, coinsurance and co-payment amount as provided...

...(A) The reimbursement methodology set forth in paragraph (B) of this rule is limited to medicare part B services that meet all of the following criteria: (1) Are not hospital services defined in accordance with Chapter 5160-2 of the Administrative Code; (2) Are not nursing facility services included in the nursing facility per diem as defined in accordance with Chapter 5160-3 of the Administrative Code; (3) Are co...

...(A) The Ohio department of aging (ODA) is responsible for the daily administration of the assisted living HCBS waiver. ODA will administer this waiver pursuant to an interagency agreement with the Ohio department of medicaid (ODM), in accordance with section 5162.35 of the Revised Code. (B) The assisted living HCBS waiver is an alternative to nursing facility placement for persons age twenty-one ...

...(A) The Ohio department of aging (ODA) is responsible for the daily administration of the assisted living HCBS waiver. ODA will administer this waiver pursuant to an interagency agreement with the Ohio department of medicaid (ODM), in accordance with section 5162.35 of the Revised Code. (B) The assisted living HCBS waiver is an alternative to nursing facility placement for persons age twenty-one ...

...(A) The Ohio department of aging (ODA) is responsible for the daily administration of the assisted living HCBS waiver. ODA will administer this waiver pursuant to an interagency agreement with the Ohio department of medicaid (ODM), in accordance with section 5162.35 of the Revised Code. (B) The assisted living HCBS waiver is an alternative to nursing facility placement for persons age twenty-one ...

...(A) Definitions. (1) "Coordination of benefits" (COB) means the process of determining which health plan or insurance policy will pay first or determining the payment obligations of each health plan, medical insurance policy, or third party resource when two or more health plans, insurance policies or third party resources cover the same benefits for a medicaid covered individual. (2) "Coordinat...

...(A) Out-of-state providers: (1) Should be licensed, accredited, or certified by their respective states to be considered eligible to receive reimbursement for services provided to Ohio medicaid covered individuals. (2) Should meet any standards applicable to the provision of the service in the state in which the service is being furnished, as well as those standards set forth in the Ohio med...

...(A) In accordance with 42 C.F.R. 447.15 (as in effect October 1, 2018), the medicaid payment for a covered service constitutes payment-in-full. It shall not be construed as a partial payment even when the payment amount is less than the provider's charge. (1) The provider shall not collect nor bill a medicaid recipient for any difference between the medicaid payment and the provider's charge,...

...This rule sets forth eligibility requirements for practitioners, group practices, or organizational providers enrolling with, and seeking reimbursement from, the Ohio medicaid program. (A) Eligible provider means any practitioner, group practice, or organization identified by the Ohio department of medicaid (ODM) as a type of provider eligible to enroll in the medicaid program that: (1) Meets the ap...

...Provisions of provider agreements for long term care nursing facilities are defined in Chapter 5160-3 of the Administrative Code. Provisions for provider agreements for medicaid contracting managed care plans are defined in Chapter 5160-26 of the Administrative Code. A valid provider agreement with medicaid will act as a provider agreement for participation in the medicaid program. All medicaid provider ap...

...(A) For purposes of this rule, the following definitions apply: (1) "Ownership or control interest" means having at least five per cent ownership, or interest, either directly, indirectly, or in any combination. (2) "Provider" has the same meaning as "eligible provider," as defined in rule 5160-1-17 of the Administrative Code. (3) "Provider Agreement" means an agreement as defined in rule 5160-1-17.2 of the Admin...

...(A) In accordance with 42 C.F.R. 455.410 (as in effect October 1, 2019) and rule 5160-1-17 of the Administrative Code in order to become an eligible provider, a provider must meet the screening requirements described in this rule and in section 5164.34 of the Revised Code and pay an applicable application fee if required in the appendix to this rule. Provider screening and application fees are req...

...(A) Definitions for purposes of this rule only: (1) A "participating provider" is an active provider who bills the medicaid program for rendered services, or who is an active provider who orders, prescribes, refers, or certifies but does not bill the medicaid program. (2) An "ordering or referring only provider" is a provider who orders, prescribes, refers, or certifies an item or service reported on a claim, and i...

...(A) As specified in Chapter 5160-1 of the Administrative Code, all medicaid providers are required to keep such records as are necessary to establish that conditions of payment for medicaid covered services have been met, and to fully disclose the basis for the type, frequency, extent, duration, and delivery setting of services provided to medicaid recipients, and to document significant business transactions. Medic...

...(A) "Hold and Review" is defined in accordance with rule 5160-1-27 of the Administrative Code. (1) Hold and review without prior notification. (a) The Ohio department of medicaid (ODM) may place a medicaid provider's claim(s) payment on hold and review, in whole or in part, without first notifying the provider for the following reasons: (i) In response to allegations of fraud or other willful misrepresentation of ...

...(A) "Medicaid administrative agency" means a state agency other than the Ohio department of medicaid that: (1) Administers a component of the medicaid program under the terms of a contract with ODM under section 5162.35 of the Revised Code; and (2) Pays claims for medicaid services or reimburses local entities for claims paid for medicaid services. (B) "Hold and Review" is defined in accordance with rule 5160-1-2...

...(A) "Safeguarded information" includes but is not limited to the following types of information: (1) Names and addresses; and (2) Social security numbers; and (3) Medical services provided; and (4) Social and economic conditions or circumstances; and (5) Agency evaluation of personal information; and (6) Medical data, including diagnosis and past history of disease or disability; and (7) Any information receiv...