Ohio Administrative Code Search

...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, ...

...is rule, 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, sometimes referred t...

...institution, a hospital which has a provider agreement with the Ohio department of medicaid, or a Title XIX certified long-term care facility (LTCF). (5) "OhioMHAS" means the Ohio department of mental health and addiction services or the entity designated by OhioMHAS pursuant to division (A) of section 5119.41 of the Revised Code. (6) "RSS living arrangement" means an arrangement listed in p...

...institution, a hospital which has a provider agreement with the Ohio department of medicaid, or a Title XIX certified long-term care facility (LTCF). (5) "OhioMHAS" means the Ohio department of mental health and addiction services. (6) "RSS living arrangement" means an arrangement listed in paragraph (A) of rule 5122-36-02 of the Administrative Code. (7) "RSS" means the residential state s...

...reast and cervical cancer screening provider" means an entity which has entered into a written agreement with the ODH BCCP to provide specified breast and cervical cancer screening and diagnostic services for ODH BCCP enrollees. (b) "ODH BCCP designated local agency or subgrantee" means an entity which has received a grant from ODH to implement specified activities of the ODH BCCP. (c) "ODH BCCP...

...reast and cervical cancer screening provider" means an entity which has entered into a written agreement with the ODH BCCP to provide specified breast and cervical cancer screening and diagnostic services for ODH BCCP enrollees. (b) "ODH BCCP designated local agency or subgrantee" means an entity which has received a grant from ODH to implement specified activities of the ODH BCCP. (c) "ODH BCCP...

...ened for breast or cervical cancer by a provider who does not participate in, or was not paid for by ODH BCCP are still considered to be screened under NBCCEDP. (2) Be in need of treatment for breast or cervical cancer, precancerous conditions, or early stage cancer, as indicated by a treating health professional, based on the centers for disease control and prevention (CDC) NBCCEDP screening...

... ODM 07161 and ODM 7160 "Healthcare Provider's Treatment Plan" (rev. 9/2017) within five business days of receipt of the diagnostic information when: (i) The ODH BCCP enrollee has submited the ODM 07161; and (ii) The ODH BCCP screening provider notifies the designated ODH BCCP regional case manager that, as a result of the NBCCEDP funded screening, a treating health professional has ...

... ODM 07161 and ODM 7160 "Healthcare Provider's Treatment Plan" (rev. 9/2017) within five business days of receipt of the diagnostic information when: (i) The ODH BCCP enrollee has submitted the ODM 07161; and (ii) The ODH BCCP screening provider notifies the designated ODH BCCP regional case manager that, as a result of the screening, a treating health professional has determined the ...

...contracted refugee health screening providers and other medical services. There is no resource limit for an individual described in this rule. (B) Definitions. (1) "Countable income," for the purpose of this rule, has the same meaning as in rule 5160:1-3-03.2 of the Administrative Code. (2) "Current incurred medical expense" means a medical bill or a portion of a medical bill that: (a) Inc...

...contracted refugee health screening providers and other medical services. There is no resource limit for an individual described in this rule. (B) Definitions. (1) "Countable income," for the purpose of this rule, has the same meaning as in rule 5160:1-3-03.2 of the Administrative Code. (2) "Current incurred medical expense" means a medical bill or a portion of a medical bill that: (a) Inc...

...ability to the long-term care (LTC) provider as applicable. (G) When an individual's countable income is greater than the SIL, the individual may establish a qualified income trust (QIT) in accordance with rule 5160:1-6-03.2 of the Administrative Code to reduce his or her countable income to or below the SIL. (H) Determine whether an individual's income is at or below the SIL as follows: (1) T...

...ability to the long-term care (LTC) provider as applicable. (G) If an individual's countable income is greater than the SIL, the individual may establish a qualified income trust (QIT) in accordance with rule 5160:1-6-03.2 of the Administrative Code to reduce his or her countable income to or below the SIL. (H) Determine whether an individual's income is at or below the SIL as follows: (1) Tot...

...ability to the long-term care (LTC) provider as applicable. (G) When an individual's countable income is greater than the SIL, the individual may establish a qualified income trust (QIT) in accordance with rule 5160:1-6-03.2 of the Administrative Code to reduce his or her countable income to or below the SIL. (H) Determine whether an individual's income is at or below the SIL as follows: (1) T...

...s responsible for paying his or her LTC provider the PMRC amount in the first month of eligibility for LTC services. (D) When a court has entered an order against an institutionalized individual for the support of his or her spouse, an RMCP shall not apply to amounts of assets transferred pursuant to such order for the support of the spouse or a family member. (E) Any improper transfer by a spouse t...

...s responsible for paying his or her LTC provider the PMRC amount in the first month of eligibility for LTC services. (D) When a court has entered an order against an institutionalized individual for the support of his or her spouse, an RMCP shall not apply to amounts of assets transferred pursuant to such order for the support of the spouse or a family member. (E) Any improper transfer by a spouse t...

...nnot be initiated by a medical services provider or supplier, unless such provider or supplier is also the institutionalized individual's authorized representative. (7) Subtract the payment to a financial institution in an amount up to fifteen dollars per month, or the amount approved by the administrative agency, to administer a qualified income trust (QIT) account in accordance with rule 5160:1-6-03.2 of the Admin...