Ohio Administrative Code Search

...(A) Definitions. (1) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (2) "Eye care services" is a collective term for the following services and materials involving the health of the eyes: (a) Vision care services, which include the following procedures: (i) Diagnostic and comprehensive examination; (ii) Testing; (iii) Therapeutic treatme...

...(A) Scope. This rule sets forth general coverage and payment policy for eye care services. Additional provisions for eye care services provided through a medicaid managed care organization are described in Chapter 5160-26 of the Administrative Code. (B) Definitions. (1) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (2) "Eye care services" is a col...

...(A) For the purpose of this rule the following definitions apply. (1) "Doctor of podiatric medicine" (or "podiatric physician" or "podiatrist") is as described in section 4731.51 of the Revised Code. (a) Doctors of podiatric medicine are deemed to be physicians only in respect to functions they are legally authorized to perform in accordance with section 4731.51 of the Revised Code and rule ...

...(A) Scope. This rule sets forth provisions governing payment for behavioral health services provided by certain licensed professionals in non-institutional settings. (1) Provisions governing payment for behavioral health services as the following service types are set forth in the indicated part of the Administrative Code: (a) Cost-based clinic services, Chapter 5160-28; and (b) Medicaid school pro...

...(A) Scope. This rule sets forth provisions governing payment for professional, non-institutional spinal manipulation and related diagnostic imaging services. (B) Providers. (1) Rendering providers. The following eligible providers may render a service described in this rule: (a) A chiropractor, defined in Chapter 4734. of the Revised Code. (b) A mechanotherapist, defined in Chapter 4731. of th...

...(A) Scope. This rule sets forth provisions governing payment for skilled therapies as non-institutional professional services furnished by skilled therapists and skilled therapist assistants or aides. Provisions governing payment for skilled therapies as the following service types are set forth in the indicated part of the Administrative Code: (1) Hospital services, Chapter 5160-2; (2) Nurs...

...(A) Scope. This rule sets forth provisions governing payment for skilled therapies as non-institutional professional services furnished by skilled therapists and skilled therapist assistants or aides. Provisions governing payment for skilled therapies as the following service types are set forth in the indicated part of the Administrative Code: (1) Hospital services, Chapter 5160-2; (2) Nurs...

...(A) Providers. (1) Rendering providers. The following practitioners, defined in Chapter 4759. of the Revised Code, may enroll in medicaid as eligible providers of dietitian services: (a) A licensed dietitian; and (b) A registered dietitian. (2) Billing ("pay-to") providers. The following eligible providers may receive medicaid payment for submitting a claim for a covered service on behalf ...

...(A) Providers. (1) Rendering providers. The following practitioners, defined in Chapter 4759. of the Revised Code, may enroll in medicaid as eligible providers of dietitian services: (a) A licensed dietitian; and (b) A registered dietitian. (2) Billing ("pay-to") providers. The following eligible providers may receive medicaid payment for submitting a claim for a covered service on behalf of a ...

...(A) Scope and definitions. (1) This rule sets forth provisions governing payment for professional, non-institutional lactation consulting services. (2) "Lactation consultation" is the development and implementation of management strategies for complex problems related to breastfeeding and human lactation. (3) "International Board Certified Lactation Consultant" (IBCLC) is a professional member...

...(A) Definitions applicable to this rule. (1) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (2) "Lactation consultation" is the development and implementation of management strategies for complex problems related to breastfeeding and human lactation. (3) "International Board-Certified Lactation Consultant (IBCLC)" is a professional member of ...

...(A) Definitions applicable to this rule. (1) "Doula" is an individual listed in the registry specified in section 4723.89 of the Revised Code. (2) "Doula service" is any of the support activities specified in section 4723.89 of the Revised Code. (3) "Independent" and "non-independent," with respect to a doula, have the same meanings as in rule 5160-4-02 of the Administrative Code. (B)...

...(A) Definitions. (1) "Acupuncture" has the same meaning as in Chapter 4762. of the Revised Code. (2) "Eligible provider" has the same meaning as in rule 5160-1-17 of the Administrative Code. (B) Providers. (1) Rendering provider. The following eligible providers may render a covered acupuncture service: (a) An acupuncturist recognized under section 4762.02 of the Revised Code; or (b) An ...

...(A) Definition. "Pharmacist" has the same meaning as in Chapter 4729:1-1 of the Administrative Code. (B) Providers. An individual pharmacist may enroll in medicaid as a pharmacist provider. (C) Coverage. (1) Payment may be made only for a pharmacist service for which the following criteria are met: (a) The service is within a pharmacist's scope of practice; (b) The service is medically...

...(A) Definitions. For the purposes of this rule, the following definitions apply: (1) "Diabetes self-management training" (DSMT) is the education and instruction of an individual with diabetes by a qualified provider for the purpose of providing the individual with necessary skills and knowledge to participate in the management of the individual's diabetes, including the self-administration of...

...(A) Provider types eligible for payment for pharmacy services: (1) A "pharmacy provider" designation and provider number can be obtained by a "terminal distributor of dangerous drugs," as defined in section 4729.01 of the Revised Code, who also: (a) Has a valid drug enforcement agency (DEA) registration; and (b) Has a pharmacist as the "responsible person," as defined in rule 4729-5-11 of the Administrative Code;...

...(A) Covered drugs. (1) "Compounded prescriptions" are prescription drugs made by combining two or more drugs. Active pharmaceutical ingredients (API) and excipients are listed on the ODM pharmacy program website at https://pharmacy.medicaid.ohio.gov. (2) "Covered prescribed drug" means a drug covered by the Ohio department of medicaid (ODM) pharmacy program, or a managed care plan entity as defi...

...(A) Eligible pharmacies in the Ohio medicaid program may bill for medical supplies and durable medical equipment in accordance with Chapter 5160-10 of the Administrative Code, with the following stipulations: (1) The provider must apply to, and be approved by, the Ohio department of medicaid (ODM) to be eligible to dispense medical supplies/durable medical equipment. (2) All products require a prescription written ...

...(A) Eligible pharmacies in the Ohio medicaid program may bill for medical supplies and durable medical equipment in accordance with Chapter 5160-10 of the Administrative Code, with the following stipulations: (1) The provider must: (a) Apply to, and be approved by, the Ohio department of medicaid (ODM) to be eligible to dispense medical supplies/durable medical equipment; and (b) Use the ...

...(A) Covered prescribed drugs Drugs covered by the Ohio department of medicaid (ODM) pharmacy program, or a managed care plan as defined in rule 5160-26-01 of the Administrative Code, are prescribed drugs as defined in rule 5160-9-05 of the Administrative Code that are dispensed to an eligible patient for use in the patient's residence, including a nursing facility (NF), as defined in section 5165...

...(A) Covered prescribed drugs Drugs covered by the Ohio department of medicaid (ODM) pharmacy program, or a managed care entity as defined in rule 5160-26-01 of the Administrative Code, are prescribed drugs as defined in rule 5160-9-05 of the Administrative Code that are dispensed to an eligible recipient for use in the recipient's residence, including a nursing facility (NF), as defined in sectio...

...(A) Patient profiles, prospective drug utilization review (DUR), and patient counseling (1) Patient profiles, prospective DUR and patient counseling must be performed for medicaid patients by medicaid pharmacy providers in accordance with Chapter 4729-5 of the Administrative Code. (2) Documentation and records required by Chapter 4729-5 of the Administrative Code must be maintained in accordance with rule 5160-1-17...

...(A) Recipient profiles, prospective drug utilization review (DUR), and recipient counseling (1) Recipient profiles, prospective DUR and recipient counseling must be performed for medicaid recipients by medicaid pharmacy providers in accordance with agency 4729 of the Administrative Code. (2) Documentation and records required by - agency 4729 of the Administrative Code must be maintained in ...

...(A) Definitions. (1) "340B ceiling price" means the highest price allowed to be charged by a manufacturer to a 340B covered entity as described in section 340B(a)(4) of the "Public Health Service Act," 42 U.S.C. 256b(a)(4) (in effect as of January 7, 2011). (2) "Actual acquisition cost (AAC)" means the best determination by the Ohio department of medicaid (ODM) of the actual amount the provi...

...(A) Payment for prescribed drugs is the lesser of the provider's billed charges or the calculated allowable, after any coordination of benefits is applied as described in paragraph (E) of this rule. For prescribed drugs that are subject to a co-payment, the amount paid by the Ohio department of medicaid (ODM) is decreased by the amount equal to the co-payment billed to the recipient in accordance ...