Ohio Revised Code Search

...r of operation, shall not exceed twenty per cent of the total expenditures for such children's home during the preceding year.

...incomes not exceeding one hundred fifty per cent of the federal poverty line.

...(A) The medicaid director may submit a waiver request to the United States secretary of health and human services to provide health assistance to any individual who meets all of the following requirements: (1) Is the parent of a child who is under nineteen years of age, resides with the parent, and is enrolled in the children's health insurance program part I or II or the medicaid program; (2) Is uninsured; ...

...e in an amount equal to one hundred two per cent of the cost the department of medicaid incurs in making the data used to prepare the item available to the contracting person. (C) Except as required by federal or state law and subject to division (E) of this section, both of the following conditions apply with respect to a request for data described in division (A) of this section: (1) The request shall be made t...

...has a variance of expenditures of eight per cent or greater; (2) Asks any questions related to the form; (3) Refuses to certify the information provided on the form; (4) Refuses to release any funds to the state. (B) When providing notice under this section, the director shall include any letter or information that is provided by the United States centers for medicare and medicaid services in its questioning ...

...may retain or collect not more than ten per cent of the federal financial participation the state agency or political subdivision obtains through an approved, administrative claim regarding the component or aspect of the component. If the department retains or collects a percentage of such federal financial participation, the percentage the department retains or collects shall be specified in a contract the departmen...

...payment rate increases greater than ten per cent under the medicaid program, the medicaid director shall notify the standing committees with oversight of the medicaid program as provided in section 103.41 of the Revised Code of the increase.

...n eligibility group is set below ninety per cent, the department of medicaid shall do both of the following: (1) Immediately discontinue all medical assistance for members of the group. (2) Not later than fifteen business days after the change to the federal medical assistance percentage, certify to the director of budget and management, legislative service commission, the president of the senate, and the speaker...

...me eligibility threshold is two hundred per cent of the federal poverty line for women during pregnancy and the postpartum period beginning on the last day of the pregnancy who are covered by the medicaid program under division (B) of section 5163.06 of the Revised Code.

...income eligibility threshold at ninety per cent of the federal poverty line for parents and caretaker relatives who are covered by the medicaid program under that section of the "Social Security Act."

...Code, does not exceed two hundred fifty per cent of the federal poverty line; (5) That the individual meets the additional eligibility requirements for the medicaid buy-in for workers with disabilities program established in rules authorized by section 5163.098 of the Revised Code.

...ibed drugs to increase by more than one per cent over such costs for the most recent previous fiscal year for which the amount of such costs is known.

...e not exceeding two hundred twenty-five per cent of the federal poverty line, has a medical need for the service, and meets all other eligibility requirements for the service specified in rules adopted under section 5164.02 of the Revised Code. The rules may not require a medicaid recipient to undergo a level of care determination to be eligible for a state plan home and community-based service.

..." means any person having at least five per cent ownership in a medicaid provider. (B)(1) No medicaid provider shall do any of the following: (a) By deception, obtain or attempt to obtain payments under the medicaid program to which the provider is not entitled pursuant to the provider's provider agreement, or the rules of the federal government or the medicaid director relating to the program; (b) Willfully...

..." means any person having at least five per cent ownership in a noninstitutional medicaid provider. (B)(1) Except as provided in division (C) of this section and in rules authorized by this section, the department of medicaid shall suspend the provider agreement held by a medicaid provider on determining either of the following: (a) There is a credible allegation of fraud against any of the following for which ...

...ebate agreement that is less than sixty per cent of the target rebate amount. If no rebate agreement is established or renegotiated under this section, the director may consider removing the drug from the medicaid program's preferred drug list and imposing a prior authorization requirement on the drug in accordance with section 5160.34 of the Revised Code. (D) The director shall publish a list of the prescribed dru...

... shall equal not less than seventy-five per cent of the medicare payment rates for the services in effect on the date the services are provided to medicaid recipients eligible for the services: (1) Initial care for normal newborns; (2) Subsequent day, hospital care for normal newborns; (3) Same day, initial history and physical examination and discharge for normal newborns; (4) Initial neonatal critical c...

... if its occupancy rate were one hundred per cent; (b) If division (A)(4)(a) of this section does not apply, the median rate for tax costs for the new nursing facility's peer group in which the nursing facility is placed under division (B) of section 5165.16 of the Revised Code. (5) The initial quality incentive payment rate for the new nursing facility shall be the amount determined under section 5165.26 of the...

...mum allowable amount" means one hundred per cent of a nursing facility's total per medicaid day payment rate. (B) Instead of paying the total per medicaid day payment rate determined under section 5165.15 of the Revised Code, the department of medicaid shall pay the provider of a nursing facility the lesser of the following for nursing facility services the nursing facility provides on or after January 1, 201...

...er of the following: (a) Thirty-four per cent of the statewide average of the total per medicaid day payment rate for long-term acute care hospital services as of the first day of the fiscal year; (b) Another amount determined in accordance with an alternative methodology that includes improved health outcomes as a factor in determining the payment rate. (4) Require, to the extent the director considers nece...

...edicaid utilization percentage of fifty per cent. If the department determines that there are more approvable eligible applications submitted than can be accommodated within the applicable spending limit specified in this division, the department shall prioritize category one private rooms. (e) On the application date, the nursing facility is listed on table A or table D of the SFF list, as defined in section 5165...

...r if its occupancy rate had been ninety per cent; (b) Subject to division (C)(2) of this section, identify which nursing facility in the peer group is at the twenty-fifth percentile of the rate for ancillary and support costs for the applicable calendar year determined under division (C)(1)(a) of this section. (2) In making the identification under division (C)(1)(b) of this section, the department shall exclud...

...its occupancy rate had been one hundred per cent during the applicable calendar year.

...ts. The department may increase by five per cent the previous state fiscal year's rate paid for any nursing facility pursuant to this section at the request of the provider. The department shall use rates calculated for the current state fiscal year to make the payments due by the fifteenth day of November. If the rate paid to a provider for a nursing facility pursuant to this section is lower than the rate calculat...

...of operator, must equal at least ninety per cent of the sum of the following: (a) The average monthly medicaid payment made to the exiting operator pursuant to the exiting operator's provider agreement for the nursing facility that is the subject of the involuntary termination, voluntary withdrawal of participation, facility closure, or change of operator; (b) Whichever of the following apply: (i) If the exi...