Ohio Administrative Code Search

...U.S.C. 1396n (January 1, 2022), and the providers eligible to deliver those services to youth enrolled on the waiver. (B) Providers seeking to deliver services in the waiver program will meet the criteria in Chapter 5160-59 and set forth in rules 5160-44-02 and 5160-44-31 of the Administrative Code, as appropriate. Providers that have responsibility for developing the child and family-centered care plan cannot prov...

...U.S.C. 1396n (January 1, 2025), and the providers eligible to deliver those services to youth enrolled on the waiver. (B) Providers seeking to deliver services in the waiver program will meet the criteria in Chapter 5160-59 and rules 5160-44-02 and 5160-44-31 of the Administrative Code, as appropriate. Upon prior approval by the Ohio department of medicaid (ODM), providers that have responsibility for developing th...

... the Administrative Code. (C) Eligible providers and conditions of participation. (1) The following providers are eligible to provide the out-of-home respite service available under the waiver program: (a) An ICF/IID who is certified by the Ohio department of health (ODH), holds certification as a residential respite provider, and has an active license with the Ohio department of developmental disabilities (DODD)....

... Administrative Code. (C) Eligible providers and conditions of participation. (1) The following providers are eligible to provide the out-of-home respite service available under the waiver program: (a) An ICF/IID who is certified by the Ohio department of health (ODH), holds certification with the Ohio department of developmental disabilities (DODD) as a residential respite provider as set ...

... the Administrative Code. (C) Eligible providers and conditions of participation. (1) The following providers are eligible to provide TSS under the waiver program: (a) An entity operating in accordance with paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code. Eligible rendering practitioners employed by or under contract with the entity include those described in paragraph (A)(3), (A)(4), (A)(...

... Administrative Code. (C) Eligible providers and conditions of participation. (1) The following providers are eligible to provide TSS under the waiver program: (a) An entity operating in accordance with paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code. Eligible rendering practitioners employed by or under contract with the entity include those described in paragraph ...

... the Administrative Code. (C) Eligible providers and conditions of participation. (1) The following providers are eligible to provide TSS under the waiver program: (a) An entity operating in accordance with paragraph (A)(1) or (A)(2) of rule 5160-27-01 of the Administrative Code. Eligible rendering practitioners employed by or under contract with the entity include those described in paragraph (A)(3), (A)(4), (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 PRTF will annually complete and submit the ODM 10278 "Ohio Medicaid Psychiatric Residential Treatment Facility (PRTF) Cost Report" that is applicable to the state fiscal year and each state...

...society or association. (15) "Medicaid provider" or "provider" means a person or governmental entity with a valid provider agreement to provide medical services or supplies to medicaid recipients. To the extent appropriate in the context, "medicaid provider" or "provider" includes a person or governmental entity applying for a provider agreement, a former medicaid provider, or both. (16) "Notice by ordinary mail" m...

...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 5165.60 to 5165.89 of the Revised Code. The rules in Chapter 5...

...e documentation or information that the provider failed, upon request, to furnish to ODM or its contractor during the final fiscal audit process unless ODM agrees to the admissibility of such post final fiscal audit production of documentation or information; (4) The authority to hold pre-hearing conferences for the purpose of resolving issues that can be resolved by the participants in the hearing, including facili...

...Is created or received by a health care provider, health plan, employer or health care clearinghouse; and (b) Relates to the past, present, or future physical condition or mental health condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual and either: (i) Identifies the individual; or (ii) There is a reas...

...ormation, and to uniformly identify providers. (37) "Immigrant" means a person who comes to the United States (U.S.) with plans to live in the country permanently. This term includes, but is not limited to, an individual who is a refugee, asylee, parolee, or other entrant regardless of whether he or she is residing in the U.S. legally. (38) "Income" means cash, in-kind income as defined in p...

...ormation, and to uniformly identify providers. (38) "Immigrant" means a person who comes to the United States (U.S.) with plans to live in the country permanently. This term includes, but is not limited to, an individual who is a refugee, asylee, parolee, or other entrant regardless of whether he or she is residing in the U.S. legally. (39) "Income" means cash, in-kind income as defined in p...

...a) The agency may use county employees, provider or contractor employees, or volunteers who have been properly trained to staff outstation locations under the following conditions: (i) County outstation intake workers may perform all eligibility processing functions, including the eligibility determination, if the worker is authorized to do so at the regular intake office. (ii) Provider or...

...rative agency may use county employees, provider or contractor employees, or volunteers who have been properly trained to staff outstation locations under the following conditions: (i) County outstation intake workers may perform all eligibility processing functions, including the eligibility determination, when the worker is authorized to determine medical assistance eligibility at a regul...

...insurance company. (b) From a medicaid provider, managed care plan, or a managed care plan's contracted provider to provide additional information that is required for the provider or plan to obtain payments from a third-party insurance company for medicaid covered services. (c) From a third-party insurance company, medicaid provider, managed care plan, or a managed care plan's contracted provider t...

...insurance company. (b) From a medicaid provider, managed care plan, or a managed care plan's contracted provider to provide additional information that is required for the provider or plan to obtain payments from a third-party insurance company for medicaid covered services. (c) From a third-party insurance company, medicaid provider, managed care plan, or a managed care plan's contracted provider t...

...rted by the individual's medicaid provider; (b) The prior authorization requirement for some services, products, or procedures applies even when the individual is under twenty-one years of age; (c) The prior authorization process may enable individuals under twenty-one years of age to receive services not available to adults, including services that are limited in number for adul...

...e individual's medical assistance provider; (b) The prior authorization requirement for some services, products, or procedures applies even when the individual is under twenty-one years of age; (c) The prior authorization process may enable an individual under twenty-one years of age to receive services not available to adults, including services that are limited in number for ad...

... (ix) A list of medicaid prenatal care providers, if requested, available to the community and/or information about medicaid-contracting MCPs. (2) Inform individuals enrolled in a MCP that they should contact the MCP for medical care options and referrals. (3) Re-inform the individual of the benefits of healthchek services as soon as possible after the infant's birth. (4) Refer the individual to support services ...

.... (x) A list of medicaid prenatal care providers, when requested, available to the community. (2) Inform individuals enrolled in an MCO that they should contact the MCO for medical care options and referrals. (3) Re-inform the individual of the benefits of healthchek services as soon as possible after an infant's birth. (4) Refer the individual to support services as requested verbally, ...

...y to a third party, generally a funeral provider. The purpose of the assignment is to fund a burial contract. (a) Assignment of ownership. (i) Revocable assignment of ownership. (a) The burial space exclusion described in rule 5160:1-3-05.7 of the Administrative Code does not apply because the funeral provider has not received payment and no purchase of burial spaces has been made. The provider has no obligation t...

...y to a third party, generally a funeral provider. The purpose of the assignment is to fund a burial contract. (a) Assignment of ownership. (i) Revocable assignment of ownership. (A) The burial space exclusion described in rule 5160:1-3-05.7 of the Administrative Code does not apply because the funeral provider has not received payment and no purchase of burial spaces has been made. The provider has no obligation t...

...ule, means a contract with a burial provider for a burial space held for the individual or a member of the individual's immediate family. (2) "Burial space," means a burial plot, gravesite, crypt, mausoleum, casket, urn, niche, or other repository customarily and traditionally used for the deceased's bodily remains. The term also includes a contract for care and maintenance of the gravesite, ...