Ohio Administrative Code Search

...aintain and furnish proof of licensure, insurance and bonding for general contracting services of applicable jurisdictions to ODM, ODA or their designee upon request. (g) Obtain final written approval from the individual and ODM, ODA or their designee after completion of the home modification service. (2) The provider shall obtain and maintain evidence of compliance with: (a) The written conse...

...ignificant phone numbers and health insurance identification numbers of the individual. (b) Information regarding medical diagnosis (es), treatment(s) and preferences. (c) The individual's medication profile and medication administration record, as applicable. (d) The individual's treatment administration record, as applicable. (e) The name and contact information for the individual's primary ...

...ignificant phone numbers and health insurance identification numbers of the individual. (b) Information regarding medical diagnoses, treatment and preferences. (c) The individual's medication profile and medication administration record, as applicable. (d) The individual's treatment administration record, as applicable. (e) The name of and contact information for the individual's primary c...

...d state laws, including the "Health Insurance Portability and Accountability Act of 1996" (HIPAA) regulations set forth in 45 C.F.R. parts 160 and 164 (as in effect on October 1, 2020), and the medicaid safeguarding information requirements set forth in 42 C.F.R. 431.300 to 431.306 (as in effect on October 1, 2020), along with sections 5160.45 to 5160.481 of the Revised Code. (13) Ensure that th...

...d state laws, including the "Health Insurance Portability and Accountability Act of 1996" (HIPAA) regulations set forth in 45 C.F.R. parts 160 and 164 (as in effect on October 1, 2020), and the medicaid safeguarding information requirements set forth in 42 C.F.R. 431.300 to 431.306 (as in effect on October 1, 2020), along with sections 5160.45 to 5160.481 of the Revised Code. (13) Ensure that th...

... and in compliance with the "Health Insurance Portability and Accountability Act of 1996" (HIPAA) regulations set forth in 45 C.F.R. parts 160 and 164 (October 1, 2020) and the medicaid safeguarding information requirements set forth in 42 C.F.R. 431.000 to 431.306 (October 1, 2020) along with sections 5160.45 to 5160.481 of the Revised Code. (k) Provide accurate and complete information includin...

...ers, and in compliance with the "Health Insurance Portability and Accountability Act of 1996" (HIPAA) regulations set forth in 45 C.F.R. parts 160 and 164 (October 1, 2021) and the medicaid safeguarding information requirements set forth in 42 C.F.R. 431.000 to 431.306 (October 1, 2021) along with sections 5160.45 to 5160.481 of the Revised Code. (k) Provide accurate and complete information includin...

... (i) 2911.12 (burglary); (j) 2913.47 (insurance fraud); (k) 2917.01 (inciting to violence); (l) 2917.03 (riot); (m) 2917.31 (inducing panic); (n) 2919.22 (endangering children): (o) 2919.25 (domestic violence); (p) 2921.03 (intimidation); (q) 2921.11 (perjury); (r) 2921.13 (falsification, falsification in a theft offense, falsification to purchase a firearm, or falsification to obtain a concealed ha...

... (i) 2911.12 (burglary); (j) 2913.47 (insurance fraud); (k) 2917.01 (inciting to violence); (l) 2917.03 (riot); (m) 2917.31 (inducing panic); (n) 2919.22 (endangering children): (o) 2919.25 (domestic violence); (p) 2921.03 (intimidation); (q) 2921.11 (perjury); (r) 2921.13 (falsification, falsification in a theft offense, falsification to purchase a firearm, or falsification to obtain a concealed ha...

...ignificant phone numbers and health insurance identification numbers of the individual. (b) The medical history of the individual. (c) The name of individual's treating physician. (d) A copy of the initial and all subsequent person-centered services plans. (e) Documentation of all drug and food interactions, allergies and dietary restrictions. (f) A copy of any advance directives including, b...

...ignificant phone numbers and health insurance identification numbers of the individual. (b) The medical history of the individual. (c) The name of individual's treating physician. (d) A copy of the initial and all subsequent person-centered services plans. (e) Documentation of all drug and food interactions, allergies and dietary restrictions. (f) A copy of any advance directives including, b...

...duals who may be covered by third-party insurance, such as medicare, for which the hospice seeks reimbursement. (A) The designated hospice shall report the required enrollment information to the Ohio department of medicaid using the medicaid information technology system (MITS) for the following: (1) Individuals in fee-for-service (FFS) medicaid hospice under the designated hospice's care on t...

...rage of hospice services under hospital insurance" under hospital insurance, www.cms.gov (revised May 08, 2015). (a) Transports to an individual's home which occur on the effective date of the hospice election, the date of admission, prior to the initial assessment or prior to establishing the plan of care are not covered under the hospice benefit. (b) If the hospice determines that the individual's...

...-party resources, including private insurance, and taking into account patient liability for room and board, ODM may be billed for the balance owed to the designated hospice, except for services covered by individuals receiving hospice through managed care. For each day the medicaid eligible individual is enrolled in hospice, the total reimbursement for hospice services cannot exceed the medicaid ...

...services plan. (2) "Creditable insurance" or "creditable coverage" means health insurance coverage as defined in 42 U.S.C. 300gg-3(c) (October 1, 2020). (3) "Dual benefits member" or "opt-in member" means a member for whom a MyCare Ohio plan is responsible for the coordination and payment of both medicare and medicaid benefits. (4) "Financial management service (FMS)" means a support th...

...services plan. (2) "Creditable insurance" or "creditable coverage" means health insurance coverage as defined in 42 U.S.C. 300gg-3(c) (October 1,2021). (3) "Dual benefits member" or "opt-in member" means a member for whom a MyCare Ohio plan is responsible for the coordination and payment of both medicare and medicaid benefits. (4) "Financial management service (FMS)" means a support tha...

...gnated by ODM in an ODM-produced Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant 834 daily or monthly enrollment file of new members, continuing members, and terminating members. (e) The plan shall not be required to provide medicaid coverage to an individual until the individual's membership in the plan is confirmed via an ODM-produced HIPAA compliant 834 daily or monthly enrollment fi...

...ed by ODM in an ODM-produced Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant 834 daily or monthly enrollment file of new members, continuing members, and terminating members. (e) The MCOP shall not be required to provide medicaid coverage to an individual until the individual's membership in the MCOP is confirmed via an ODM-produced HIPAA compliant 834 daily or month...

...d party. When the third party is an insurance company, the appellant or the appellant's authorized representative or attorney shall also provide the names and addresses of the beneficiaries of the issuance policy. Upon a showing of good cause, or upon the hearing examiner's own initiative, this thirty day period may be increased or decreased. (E) Subpoenas (1) The depository agent shall issu...

...r medical assistance. (10) "Creditable insurance" or "creditable coverage" means health insurance coverage as defined in 42 U.S.C. 300gg-3(c) (as in effect October 1, 2016). (a) This includes: (i) A group health plan. (ii) Health insurance coverage. (iii) Medicare part A, as set forth in 42 U.S.C. 1395c to 1395i-5 (as in effect October 1, 2016) or part B, as set forth in 42 U.S.C. 1395j to 1395w-4 (as in effec...

...r a transfer from another agency or insurance affordability program in accordance with 42 C.F.R. 435.4 (as in effect October 1, 2021). (5) "Approve" or "approval" means a determination by the administrative agency that an individual is eligible for one or more categories of medical assistance applied for by the individual or on behalf of the individual by his or her authorized representative....

...r a transfer from another agency or insurance affordability program in accordance with 42 C.F.R. 435.4 (as in effect October 1, 2022). (5) "Approve" or "approval" means a determination by the administrative agency that an individual is eligible for one or more categories of medical assistance applied for by the individual or on behalf of the individual by his or her authorized representative....

... agency to report: (a) Possible health insurance coverage of an individual. A separate report shall be made for each possible health insurance policy. (b) Potential TPL due to an injury, disability, or court order. (2) At renewal, or upon any reported change, the administrative agency shall compare the individual's current information to the information on the most recent ODM 06612 "Health ...

...(A) The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law requiring the administrative agency to issue a notice of privacy practices. (B) The administrative agency shall: (1) Ensure appropriate safeguards are taken in accordance with rule 5160-1-32 of the Administrative Code. (2) Issue all individuals eligible through the medical assistance programs a notice of privacy practices,...

... (a) New coverage under a health insurance policy, no matter who is paying for the coverage; (b) A change in health insurers; (c) Loss or ending of other health insurance coverage; (d) A court order requiring a person or entity to pay some or all of the individual's medical expenses; or (e) Any accident or injury for which another person or entity may be responsible, such as a...