Ohio Administrative Code Search

...(A) To be eligible for the Ohio resilience through integrated systems and excellence (OhioRISE) home and community-based services (HCBS) 1915(c) waiver (waiver), a youth will be determined by the Ohio department of medicaid (ODM) to meet all of the following: (1) Meet eligibility criteria set forth in paragraphs (A)(1) to (A)(3) of rule 5160-59-02 of the Administrative Code; (2) Be determined to meet the following ...

...(A) To be eligible for the Ohio resilience through integrated systems and excellence (OhioRISE) home and community-based services (HCBS) 1915(c) waiver (waiver), a youth will be determined by the Ohio department of medicaid (ODM) to meet all of the following: (1) Meet eligibility criteria set forth in paragraphs (A)(1) to (A)(3) of rule 5160-59-02 of the Administrative Code; (2) Be determine...

...(A) To be eligible for the Ohio resilience through integrated systems and excellence (OhioRISE) home and community-based services (HCBS) 1915(c) waiver (waiver), a youth will be determined by the Ohio department of medicaid (ODM) to meet all of the following: (1) Meet eligibility criteria set forth in paragraphs (A)(1) to (A)(3) of rule 5160-59-02 of the Administrative Code; (2) Be determined to meet the following ...

...(A) Scope. This rule sets forth provisions governing coverage for transitional services and supports provided as part of the Ohio resilience through integrated systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act 42, U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: (1) "Homemaker/personal ...

...(A) Scope. This rule sets forth provisions governing coverage for transitional services and supports provided as part of the Ohio resilience through integrated systems and excellence (OhioRISE) 1915(c) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act 42, U.S.C. 1396n (January 1, 2022). (B) Definitions. For this rule, the following definitions apply: ...

...(A) Scope. This rule sets forth provisions governing coverage for transitional services and supports provided as part of the Ohio resilience through integrated systems and excellence (OhioRISE) waiver program (waiver) established in accordance with 1915(c) of the Social Security Act 42, U.S.C. 1396n (January 1, 2025). (B) Definitions. For this rule, the following definitions apply: (1) "Homemaker/personal care" ha...

...For cost reporting purposes, each eligible psychiatric residential treatment facility (PRTF), as defined in Chapter 5160-59 of the Administrative Code, is to submit cost reports that cover a consecutive twelve-month period of the provider's operations as designated by the department. (A) Effective for medicaid cost reports filed for cost-reporting periods ending in state fiscal year (SFY) 2024, the P...

...(A) Chapter 5160-70 of the Administrative Code prescribes the procedures to be followed when medicaid providers seek review of actions or proposed actions of the department, except for any action taken or decision made by the department with respect to entering into or refusing to enter into a contract with a managed care organization pursuant to section 5167.10 of the Revised Code and any action taken under section ...

...(A) Notice of intended action (1) Whenever ODM proposes to take an action that the Ohio general assembly has expressly made subject to the administrative adjudication procedure outlined in Chapter 119. of the Revised Code, ODM shall give notice of the intended action to the party informing the party of the party's right to a hearing. Notice shall be given by certified mail, return receipt requested, and shall, at ...

...(A) Making a request for hearing (1) A request for hearing must be submitted to the depository agent in writing by the medical assistance recipient or by the medical assistance recipient's authorized representative or attorney and shall be subject to the requirements of this rule. (2) The request for hearing shall address only the issue of whether the amount determined for reimbursement...

...(A) An appellant who disagrees with a hearing decision has the right to request an administrative appeal from the director. (B) Notice of the right to and the method of obtaining an administrative appeal shall be included in all hearing denial notices, hearing dismissal notices, and hearing decisions. (C) Administrative appeal requests (1) A request for an administrative appeal must be in ...

...(A) This rule contains definitions generally used in determining eligibility for medical assistance. (B) Definitions. (1) "Abuse" means any action by an individual or entity that results in unnecessary costs to the medical assistance program. (2) "Administrative agency" means the Ohio department of medicaid (ODM) and/or an agent of ODM authorized to determine eligibility for a medical assistance program. (3) "Ali...

...(A) This rule contains definitions generally used in determining eligibility for medical assistance. (B) Definitions. (1) "Abuse" means any action by an individual or entity that results in unnecessary costs to the medical assistance program in accordance with 42 C.F.R 455.2 (as in effect October 1, 2021). (2) "Administrative agency" means the Ohio department of medicaid (ODM) and/or an agent o...

...(A) This rule contains definitions generally used in determining eligibility for medical assistance. (B) Definitions. (1) "Abuse" means any action by an individual or entity that results in unnecessary costs to the medical assistance program in accordance with 42 C.F.R 455.2 (as in effect October 1, 2022). (2) "Administrative agency" means the Ohio department of medicaid (ODM) and/or an agent o...

...(A) Medicaid will not pay for services provided under the conditions set out in paragraph (C) of this rule, even if an individual has been found eligible for a medical assistance category and is enrolled in medicaid. (B) Definitions. (1) "Inmate" means an individual who is serving time for a criminal offense or who is confined in a state or federal prison, jail, detention facility, or other pena...

...(A) Medicaid will not pay for services provided under the conditions set out in paragraph (C) of this rule, even when an individual has been found eligible for a medical assistance category and is enrolled in medicaid. (B) Definitions. (1) "Inmate" means an individual who is serving time for a criminal offense or who is confined in a state or federal prison, jail, detention facility, or other pe...

...(A) Medicaid will not pay for services provided under the conditions set out in paragraph (C) of this rule, even when an individual has been found eligible for a medical assistance category and is enrolled in medicaid. (B) Definitions. For the purposes of this rule: (1) "Eligible juvenile" means: (a) An individual under the age of twenty-one; or (b) A former foster care child up to the age...

...(A) This rule describes section 1903(r)(3) of the Social Security Act (as in effect October 1, 2019) and paragraph (d) of 42 C.F.R 435.945 (as in effect October 1, 2019), that each medicaid state agency have an eligibility determination system which provides for data matching through the public assistance reporting information system (PARIS). (B) Definition. "PARIS" is a system for matching d...

...(A) This rule describes section 1903(r)(3) of the Social Security Act (as in effect October 1, 2024) and paragraph (d) of 42 C.F.R 435.945 (as in effect October 1, 2024), that each medicaid state agency have an eligibility determination system which provides for data matching through the public assistance reporting information system (PARIS). (B) Definition. "PARIS" is a system for matching d...

...(A) This rule describes the responsibilities of the administrative agency. (B) Calculation of time periods for eligibility determinations. All calculations of time periods used in the determination of eligibility, including an annual renewal or a redetermination as a result of a reported change, shall be computed as follows: (1) When counting the number of days in a specified time period, the in...

...(A) This rule describes the responsibilities of the administrative agency. (B) Calculation of time periods for eligibility determinations. All calculations of time periods used in the determination of eligibility, including an annual renewal or a redetermination as a result of a reported change, shall be computed as follows: (1) When counting the number of days in a specified time period, the in...

...(A) This rule sets out requirements for the administrative agency to identify and refer consumer fraud and erroneous payments made on behalf of an individual by medicaid. (B) Investigation of complaints. Upon notification of a complaint of medicaid fraud, abuse or questionable practices, the administrative agency must conduct a preliminary investigation in accordance with 42 C.F.R. 455.14 (as in ...

...(A) This rule describes Ohio's medicaid estate recovery program and the undue hardship waiver request process. (B) Definitions. (1) "Estate" includes both of the following: (a) All real and personal property and other assets to be administered under Title XXI of the Revised Code and property that would be administered under that title if not for section 2113.03 or 2113.031 of the Revised Co...

...(A) This rule describes the responsibilities of an individual, or someone acting on his or her behalf, who is applying for or receiving medical assistance. (B) Individual responsibilities. (1) When applying for or receiving any medical assistance, an individual must: (a) Sign, under penalty of perjury, and submit an application for medical assistance. The individual's signature may be written (...

...(A) This rule describes the responsibilities of an individual, or someone acting on an individual's behalf, who is applying for or receiving medical assistance. (B) Individual responsibilities. (1) When applying for or receiving any medical assistance, an individual must: (a) Sign, under penalty of perjury, and submit an application for medical assistance in accordance with rule 5160:1-2-01 of ...