Ohio Administrative Code Search

...or medically necessary care, health insurance premiums/co-payments/ deductibles, and modifications to the child's home to make the home accessible when such costs constitute: (a) At least one per cent of the family's gross income when the family's gross income is less than or equal to two hundred ten per cent of the federal poverty level; (b) At least two per cent of the family's gross income wh...

...the effective date of this rule (Health Insurance Portability and Accountability Act statutes). (9) 42 U.S.C. 1396a (a)(5) as in effect on the effective date of this rule (medicaid records). (10) 45 C.F.R. parts 160 to 164 as in effect on the effective date of this rule (Health Insurance Portability and Accountability Act rules). (I) Personal information systems that are computer systems F...

...er trust instruments or policies of insurance unless the original trust assets are entirely depleted, and then no more than the amount of the original trust corpus. (7) Parties other than the settlor who have no obligation to support the beneficiary may add funds to an established supplemental services trust by means of gift, bequest, or otherwise without limitation as to amount. Such funds, once...

... (c) Have and maintain a bond or other insurance in an amount in excess of the value of all trusteeship funds or other funds held by the contract agency for the benefit of its clients; (d) Maintain qualified and competent personnel who serve as representatives for individuals with developmental disabilities at an average ratio of no more than sixty individuals per each representative; (e) Have poli...

...tatutes or rules, including medical and insurance records, workers' compensation records, employment eligibility verification (I-9) forms, and social security numbers. The provider shall redact any confidential information contained in a record before copies are provided to the county board or the department. A provider shall make all other records available upon request by a county board or the d...

...and control. (E) The CCF shall provide insurance coverage that includes, at a minimum, property and comprehensive, general liability insurance. (F) When a CCF has a canteen available for use by residents, its fiscal operations are strictly controlled by standard accounting procedures (G) The CCF shall have a written policy, procedure, and practice that prohibits financial transactions between ...

... and control. (E) The CCF will provide insurance coverage that includes, at a minimum, property and comprehensive, general liability insurance. (F) When a CCF has a canteen available for use by residents, its fiscal operations are strictly controlled by standard accounting procedures (G) The CCF will have a written policy, procedure, and practice that prohibits financial transactions between ...

...ehicle fuel, oil, leasing, repairs, insurance, and licenses/permits (8) Travel/staff development. This category is limited to staff travel and professional development, in support of youth programs. This includes the costs incurred for staff attending conferences, seminars, registration fees, in-service training and approved meeting costs. Expense reports must be submitted for all training and tr...

...ehicle fuel, oil, leasing, repairs, insurance, and licenses/permits (8) Travel/staff development. This category is limited to staff travel and professional development, in support of youth programs. This includes the costs incurred for staff attending conferences, seminars, registration fees, in-service training and approved meeting costs. Expense reports must be submitted for all training an...

...for liability claims in the form of insurance, signed waivers or other legal provision, valid in the jurisdiction in which the program is located.

...for liability claims in the form of insurance, signed waivers or other legal provision, valid in the jurisdiction in which the program is located.

... and practice provide for institutional insurance coverage, including at a minimum the following: worker's compensation, general liability for employees, automobile liability, civil liability, and public employee blanket bond. (9) If there is a commissary or canteen, strict controls are maintained over its operation and generally accepted accounting procedures are followed. (10) Written policy, ...

... federally financed program of hospital insurance (part A) and supplemental medical insurance (also called SMI or part B) for aged and disabled persons. (2) "Medicare Benefits" means the health care services available to an individual through the medicare program where payment for the services is either completely the obligation of the medicare program or in part the obligation of the medicar...

...(3) Are covered as supplemental medical insurance benefits under the medicare program; and (4) Are provided to dual eligibles, defined in accordance with paragraph (A)(6) of rule 5160-1-05 of the Administrative Code, who elect to receive their medicare part B benefits through the original medicare program. (B) The Ohio department of medicaid (ODM) will pay the lesser of the following calculations for part B cost sh...

...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) "Coordination of benefits claim" (COB claim) means any claim that meets either the ...

..., or any other public or private health insurance program. (25) The provider has been convicted under federal or state law of a criminal offense relating to fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct. (26) The provider has not responded to two certified mail correspondences from ODM and the provider's business cannot otherwise be located. (27) The provider signed ...

...911.12 (burglary); (x) 2913.47 (insurance fraud); (xi) 2917.01 (inciting to violence); (xii) 2917.03 (riot); (xiii) 2917.31 (inducing panic); (xiv) 2919.22 (endangering children): (xv) 2919.25 (domestic violence); (xvi) 2921.03 (intimidation); (xvii) 2921.11 (perjury); (xviii) 2921.13 (falsification, falsification in a theft offense, falsif...

...d federal laws including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and any HIPAA related directives from the office for civil rights (OCR) at the department of health and human services (HHS) issued during COVID-19 national emergency and 42 C.F.R. part 2 (January 1, 2020). (2) It is the responsibility of the practitioner to deliver telehealth services in accordance w...

...e and federal laws including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and any HIPAA related directives from the office for civil rights (OCR) at the department of health and human services (HHS) issued during the COVID-19 national public health emergency and 42 C.F.R. part 2 (January 1, 2020). (2) It is the responsibility of the practitioner to deliver telehealth se...

...ommunication between the sponsor of the insurance product and the payer. (c) "ANSI X12 835 health care claims payment/remittance advice" or "835 remittance advice" is a transaction used to make a payment or send an explanation of benefits remittance advice. (d) "ANSI X12 837 health care claim" is a transaction used to submit health care claim billing or encounter information, or both, from p...

...ommunication between the sponsor of the insurance product and the payer. (j) "ANSI X12 835 health care claims payment and remittance advice" or "835 remittance advice" is a transaction used to make a payment or send an explanation of benefits remittance advice. (k) "ANSI X12 837 health care claim" is a transaction used to submit health care claim billing or encounter information, or both, fr...

...authorization compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in accordance with 45 C.F.R. 164.508 (as in effect October 1, 2015). (5) Release information as permitted by and in accordance with section 5160.45 of the Revised Code.

...pplicable; (6) Medical malpractice insurance; (7) Drug enforcement administration (DEA) certification, if applicable; (8) National practitioner data bank information regarding malpractice and clinical privilege actions; (9) Sanctions or limitations on licensure; (10) Eligibility for participation in medicare and medicaid, if applicable; and (11) Minimum five-year work history. The f...

... (medicaid), XXI (children's health insurance program - CHIP), or XVIII (medicare) of the Social Security Act; (3) Be based in Ohio or a contiguous state; (4) Have at least fifty Ohio medicaid enrolled and active affiliated individual providers; (5) Submit to the credentialing department a request in writing; and (6) Complete a pre-delegation audit conducted by ODM to include review of the...

...sated care costs for people without insurance" for each hospital means the sum of the inpatient uncompensated care costs below the poverty level and inpatient uncompensated care costs above the poverty level amounts as totaled on ODM 02930, schedule F, column 5. (6) "Total inpatient uncompensated care costs under one hundred per cent" for each hospital means the sum of the inpatient uncompens...