Ohio Administrative Code Search
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Rule 5139-37-05 | Personnel.
...2923.13 (having weapons while under disability), 2923.161 (improperly discharging firearm at or into a habitation, in a school safety zone, or with intent to cause harm or panic to persons in a school building or at a school function), 2925.02 (corrupting another with drugs), 2925.03 (trafficking, aggravated trafficking in drugs), 2925.04 (illegal manufacture of drugs - illegal cultivation of ... |
Rule 5139-37-05 | Personnel.
...2923.13 (having weapons while under disability), 2923.161 (improperly discharging firearm at or into a habitation, in a school safety zone, or with intent to cause harm or panic to persons in a school building or at a school function), 2925.02 (corrupting another with drugs), 2925.03 (trafficking, aggravated trafficking in drugs), 2925.04 (illegal manufacture of drugs - illegal cultivation of ... |
Rule 5139-68-02 | Disposition investigation report and transfer of physical custody.
...uth's mental retardation, developmental disability and/or mental health issues, youth's medical information, youth's alcohol & drug history, personal/social data, youth's social security number, youth's self-assessment of strengths and weaknesses, youth's assessment of family strengths and weaknesses, summary or impressions, and recommendations for disposition; (2) Periodically, the Ohio departme... |
Rule 5139-68-02 | Disposition investigation report and transfer of physical custody.
...uth's employment, youth's developmental disability and/or mental health issues, youth's medical information, youth's alcohol & drug history, personal/social data, youth's social security number, youth's self-assessment of strengths and weaknesses, youth's assessment of family strengths and weaknesses, summary or impressions, and recommendations for disposition; (2) Periodically, the Ohio depa... |
Rule 5160-1-01 | Medicaid medical necessity: definitions and principles.
... cognitive impairment, or developmental disability. (B) Medical necessity for individuals not covered by EPSDT is defined as procedures, items, or services that prevent, diagnose, evaluate, or treat an adverse health condition such as an illness, injury, disease or its symptoms, emotional or behavioral dysfunction, intellectual deficit, cognitive impairment, or developmental disability and without which the person c... |
Rule 5160-1-01 | Medicaid medical necessity: definitions and principles.
... cognitive impairment, or developmental disability. (B) Medical necessity for individuals not covered by EPSDT is criteria of coverage for procedures, items, or services that prevent, diagnose, evaluate, or treat an adverse health condition such as an illness, injury, disease or its symptoms, emotional or behavioral dysfunction, intellectual deficit, cognitive impairment, or developmental disability and without whi... |
Rule 5160-1-17.2 | Provider agreement for providers.
...al origin, source(s) of payment, or disability; submit claims only for services actually performed; and, bill ODM for no more than the usual and customary fee charged other patients for the same service. (B) To ascertain and recoup any third-party resource(s) available to the consumer prior to billing ODM. ODM will then pay any unpaid balance up to the lesser of the provider's billed charge o... |
Rule 5160-1-17.8 | Provider screening and application fee.
....13 (having weapons while under a disability); (xxi) 2923.161 (improperly discharging a firearm at or into a habitation or school); (xxii) 2923.162 (discharge of firearm on or near prohibited premises); (xxiii) 2923.21 (improperly furnishing firearms to minor); (xxiv) 2923.32 (engaging in a pattern of corrupt activity); (xxv) 2923.42 (participating in a criminal gang);... |
Rule 5160-1-18 | Telehealth.
...ty for individuals with an intellectual disability. |
Rule 5160-1-32 | Medicaid: safeguarding and releasing information.
...iagnosis and past history of disease or disability; and (7) Any information received in connection with the identification of third party coverage; and (8) Any information received for verifying income eligibility and amount of medical assistance payments. Income information received from the social security administration (SSA) or the internal revenue service (IRS) must be safeguarded according to the requirements... |
Rule 5160-1-32 | Medicaid: safeguarding and releasing information.
...osis and past history of disease or disability; (7) Any information received in connection with the identification of third party coverage; and (8) Any information received for verifying income eligibility and amount of medical assistance payments. Income information received from the social security administration (SSA) or the internal revenue service (IRS) should be safeguarded according to t... |
Rule 5160-1-39 | Verification of home care service provision to home care dependent adults.
... sixty years of age, and has a physical disability or mental impairment. (b) "Home care service provider" is: (i) A medicare certified home health agency or other accredited agency in accordance with Chapter 5160-12 of the Administrative Code that provides service in the home to the home care dependent adult; or (ii) A medicare certified hospice provider in accordance with Chapter 5160-56 of the Administrative Cod... |
Rule 5160-3-15 | Preadmission screening and resident review (PASRR) definitions.
...ntal illness (SMI) and/or developmental disability (DD) as defined in paragraphs (B)(6) and (B)(28) of this rule when the individual's circumstances fall within one of the following two categories: (a) The individual requires an 'emergency nursing facility stay', as defined in paragraph (B)(7) of this rule; (b) The individual is seeking admission to a nursing facility for a 'respite nursing facili... |
Rule 5160-3-15.1 | Preadmission screening requirements for individuals seeking admission to nursing facilities.
...al illness (SMI) and/or a developmental disability (DD) as defined in rules 5122-21-03 and 5123-14-01 of the Administrative Code are identified and not admitted to a NF unless a thorough evaluation indicates that such placement is appropriate and adequate services will be provided regardless of payor source. (B) A level I screening as defined in rule 5160-3-15 of the Administrative Code is requir... |
Rule 5160-3-15.2 | Resident review requirements for individuals residing in nursing facilities.
...eir mental illness or developmental disability status. (B) Resident review requirements. (1) No individual with SMI or DD can be retained as a resident in a nursing facility (NF), regardless of payment source, unless it has been determined in accordance with rules 5122-21-03 and 5123:14-01 of the Administrative Code, that: (a) The individual needs the level of services provided by a NF; or ... |
Rule 5160-10-09 | DMEPOS: apnea monitors.
... retardation or other developmental disability; (d) Terminal illness; (e) Congenital heart defect, with or without associated arrhythmia; (f) History of apnea in immediate siblings; (g) History of monitor use with immediate siblings; (h) History of apnea or SIDS in family members other than immediate siblings; (i) Parental anxiety or family request for a monitor; and (j) Need to monitor blo... |
Rule 5160-10-09 | DMEPOS: apnea monitors.
...cated hydrocephalus; (c) Developmental disability; (d) Terminal illness; (e) Congenital heart defect, with or without associated arrhythmia; (f) History of apnea in immediate siblings; (g) History of monitor use with immediate siblings; (h) History of apnea or SIDS in family members other than immediate siblings; (i) Parental anxiety or family request for a monitor; and (j) Need to monitor blo... |
Rule 5160-10-16 | DMEPOS: wheelchairs.
...nce of illness, injury, impairment, disability, or other condition that limits ambulation. Therefore, a wheelchair needs to provide mobility to an individual for whom ambulation is not possible, takes inordinate physical effort, or causes considerable physical discomfort. (b) A wheelchair also needs to be suited to the purposes and daily routines of the individual using it. (c) A manual wheelcha... |
Rule 5160-10-21 | DMEPOS: incontinence garments and related supplies.
..., developmental delay, or developmental disability causing the incontinence; (c) The type of incontinence; and (d) The type and quantity of incontinence garments or incontinence supplies being prescribed. (2) Payment cannot be made for items related to stress incontinence to which no specific physiological, psychological, or physiopsychological cause can be attributed. (3) A certification ... |
Rule 5160-10-21 | DMEPOS: incontinence garments and incontinence supplies.
... developmental delay, or developmental disability causing the incontinence; (c) The type of incontinence; and (d) The type and quantity of incontinence garments or incontinence supplies being prescribed. (2) An increase in the prescribed quantity of an incontinence item is subject to PA, as is a change in the type of incontinence item. (No additional authorization is needed for a decrease in q... |
Rule 5160-21-02 | Reproductive health services: pregnancy prevention.
...gion, race, color, national origin, disability, age, sex, military status, health status, number of pregnancies, or marital status. (2) A medicaid recipient must be able to obtain pregnancy prevention services voluntarily, free from coercion or pressure and free to choose the type or method of service to be used. (3) A medicaid provider must not make the receipt of pregnancy prevention servi... |
Rule 5160-21-02 | Reproductive health services: pregnancy prevention services.
...gion, race, color, national origin, disability, age, sex, sexual orientation, gender identity, gender expression, military status, health status, number of pregnancies, or marital status. (2) Medicaid-eligible individuals can obtain medicaid-covered pregnancy prevention services voluntarily, free from coercion or pressure and free to choose the type or method of service to be used. (3) The r... |
Rule 5160-26-01 | Managed care: definitions.
...ising out of an injury, disease, or disability to the member. (OOO) "Waste" means payment for or the attempt to obtain payment for items or services when there may be no intent to deceive or misrepresent, but poor or inefficient billing or treatment methods result in unnecessary costs. |
Rule 5160-26-02 | Managed care: eligibility and enrollment.
...ividuals diagnosed with a developmental disability who have a level of care that meets the criteria specified in rule 5123-8-01 of the Administrative Code and receive services through a HCBS waiver administered by the Ohio department of developmental disabilities (DODD). (4) Except for individuals receiving medicaid in the adult extension category under section 1902(a)(10)(A)(i)(VIII) of the Soci... |
Rule 5160-26-02.1 | Managed care: termination of enrollment.
...ender identity, sexual orientation, disability, national origin, race, color, religion, military status, ancestry, genetic information, health status or need for health services. The MCO may not use a policy or practice that has the effect of discrimination on the basis of the criteria listed in this rule. (c) If a member requests disenrollment because he or she meets the requirements of paragrap... |