Ohio Revised Code Search

...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."

...ode, 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. (C) To the extent required by section 5163.094 of the Revised Code, pays the premium established under that section.

...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...

...der this division shall not exceed five per cent of the total of all premium payments made to all medicaid managed care organizations. Each medicaid managed care organization shall agree to the withholding as a condition of receiving or maintaining its provider agreement with the department. When the amount is established and each time the amount is modified thereafter, the department shall certify the amount to th...

...zation shall ensure that at least fifty per cent of the aggregate net payments it makes to providers are based on the value received from the providers' services. The department of medicaid may measure a medicaid managed care organization's compliance with this section based on the actions of the organization, the providers in the organization's provider panel, the organization's subcontractors, or any combination o...

...l not assess any hospital more than two per cent of the hospital's total facility costs. The department shall establish an assessment rate or rates each program year that will do both of the following: (1) Yield funds that, when combined with intergovernmental transfers and federal matching funds, will produce a program of sufficient size to pay a substantial portion of the indigent care provided by hospitals; ...

...indirect guarantee percentage; (b) Six per cent. (3) Divide the product determined under division (A)(2) of this section by the number of days in the fiscal year; (4) Determine the sum of the following: (a) The total number of beds in all nursing homes and hospital long-term care units that are subject to the franchise permit fee for the fiscal year; (b) The total number of nursing home beds that are exempt ...

...epartment of medicaid may assess a five per cent penalty on the amount due for each month or fraction thereof the installment is overdue.

...pmental disabilities may assess a five per cent penalty on the amount due for each month or fraction thereof the installment is overdue.

...department of medicaid may assess a ten per cent penalty on the amount due for each month or fraction thereof that the component of the franchise fee is overdue.

...eed by offering to pay the owner eighty per cent of the purchase price or to provide another available lot or right, as applicable, at no additional cost. The board may repurchase any cemetery lot or right from its owner at any time at a price that is mutually agreed upon by the board and the owner.