Ohio Administrative Code Search

...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...

...duals who may be covered by third-party insurance, such as medicare, for which the hospice seeks reimbursement. (A) The designated hospice should report the necessary enrollment information to the Ohio department of medicaid using the ODM provider web portal for the following: (1) Individuals in fee-for-service (FFS) medicaid hospice under the designated hospice's care on the effective date of thi...

...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...

...rage of hospice services under hospital insurance" under hospital insurance (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c09.pdf). (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 benefi...

...-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 ...

...-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...

...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 ...

... 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 or identified change, the administrative agency shall compare the individual's current information to the information on the most recent ODM ...

...(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) 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 a notice of privacy practices to all individuals eligible for medical a...

... (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...

... (a) New coverage under a health insurance policy, regardless of who is paying for the coverage; or (b) A change in health insurers; or (c) Loss or ending of other health insurance coverage; or (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 res...

...enefits, social security disability insurance (SSDI), railroad retirement, and unemployment compensation. (c) When eligibility or ineligibility for other benefits cannot be verified electronically, an official letter from the paying entity or financial institution is sufficient to verify the benefit. (5) In accordance with 42 C.F.R. 435.610 (as in effect October 1, 2020) and section 5160.38 of t...

...ndividual shall provide the name of the insurance company, billing address, subscriber identification number, group number, name of policy holder, and a list of covered individuals. In addition, the individual shall cooperate with requests: (a) From a third-party insurance company to provide additional information that is required to authorize coverage or obtain benefits through the third-party i...

...eiving social security disability insurance (SSDI); or (iv) Receiving adoption or foster care assistance under Title IV-E of the Social Security Act (as in effect October 1, 2019); or (v) In foster care and receiving child welfare services under Title IV-B of the Social Security Act (as in effect October 1, 2019). (d) Other individuals on such other basis as the secretary of the d...

...eiving social security disability insurance (SSDI); or (iv) Receiving adoption or foster care assistance under Title IV-E of the Social Security Act (as in effect October 1, 2022); or (v) In foster care and receiving child welfare services under Title IV-B of the Social Security Act (as in effect October 1, 2022); or (vi) Receiving federal kinship guardianship assistance program...