Ohio Revised Code Search

...ram is terminated pursuant to section 5165.12 of the Revised Code, the department of medicaid shall establish a home first component for the Ohio home care waiver program. An individual is eligible for the Ohio home care waiver program's home first component if the individual has been determined to be eligible for the Ohio home care waiver program and at least one of the following applies: (1) If the individu...

...of medicaid may create the following: (1) One or more medicaid waiver components under which home and community-based services are provided to individuals with developmental disabilities as an alternative to placement in ICFs/IID; (2) One or more medicaid waiver components under which home and community-based services are provided in the form of any of the following: (a) Early intervention and supportive services ...

...velopmental disabilities under section 5162.35 of the Revised Code with regard to one or more of the medicaid waiver components created by the department of medicaid under section 5166.20 of the Revised Code. The contract shall include the medicaid waiver component known as the transitions developmental disabilities waiver. The contract shall provide for the department of developmental disabilities to administer the ...

...(A) As used in sections 5166.30 to 5166.3010 of the Revised Code: (1) "Adult" means an individual at least eighteen years of age. (2) "Appropriate director" means the following: (a) The medicaid director in the context of both of the following: (i) The Ohio home care waiver program; (ii) The integrated care delivery system medicaid waiver component authorized by section 5166.16 of the Revised Code. ...

...vides home care attendant services: (1) The consumer; (2) The consumer's authorized representative, if any; (3) A registered nurse who agrees to answer any questions that the attendant, consumer, or authorized representative has about consumer care needs, medications, and other issues. (C) Document the activities of each visit required by division (B) of this section in the consumer's clinical record with...

...ttestation of both of the following: (1) That the consumer or consumer's authorized representative has demonstrated to the health care professional the ability to direct the attendant; (2) That the attendant has demonstrated to the health care professional the ability to provide the consumer assistance with nursing tasks or self-administration of medication that the health care professional has specifically a...

...all have the following payout limits: (1) Three hundred thousand dollars per year; (2) One million dollars for a participant's lifetime.

...e used only to pay for the following: (1) If the former participant has purchased a health insurance policy, the former participant's costs in purchasing the policy and paying for the former participant's out-of-pocket expenses under the policy for health care services and prescription drugs covered by the policy; (2) If the former participant has obtained health care coverage under an eligible employer-sponsored h...

...rector shall adopt rules under section 5166.02 of the Revised Code to do all of the following: (A) For the purpose of division (F)(1)(a) of section 5166.402 of the Revised Code, establish requirements regarding preventative health services for healthy Ohio program participants. The requirements may differ for participants of different ages and genders. (B) For the purpose of division (G)(2) of section 5166.402 of t...

...o which all of the following apply: (1) The drug is an antidepressant or antipsychotic. (2) The drug is administered or dispensed in a standard tablet or capsule form, except that in the case of an antipsychotic, the drug also may be administered or dispensed in a long-acting injectable form. (3) The drug is prescribed by any of the following: (a) A physician who has registered the physician's psychiatric...

...ain any of the following provisions: (1) A payment rate for a prescribed drug that is less than the national average drug acquisition cost rate for that drug as determined by the United States centers for medicare and medicaid services, measured at the time the drug is administered or dispensed, or, if no such rate is available at that time, a reimbursement rate that is less than the wholesale acquisition cost of t...

... emergency services on or after January 1, 2007, from a provider that is not under contract with the organization, the provider shall accept from the organization, as payment in full, not more than the amounts (less any payments for indirect costs of medical education and direct costs of graduate medical education) that the provider could collect if the enrollee received medicaid other than through enrollment in a me...

...(A)(1) Medicaid managed care organizations shall use the state pharmacy benefit manager selected under section 5167.24 of the Revised Code pursuant to the terms of the master contract entered into under that section. All payment arrangements between the department of medicaid, medicaid managed care organizations, and the state pharmacy benefit manager shall comply with state and federal statutes, regulations adopte...

...m the immediately preceding quarter: (1) The prices that the state pharmacy benefit manager negotiated for prescribed drugs under the care management system. The price must include any rebates the state pharmacy benefit manager received from the drug manufacturer; (2) The prices the state pharmacy benefit manager paid to pharmacies for prescribed drugs; (3) Any rebate amounts the state pharmacy benefit manager ...

...(A)(1) The department of medicaid shall establish a managed care performance payment program. Under the program, the department may provide payments to medicaid managed care organizations that meet performance standards established by the department. (2) In establishing performance standards, the department may consult any of the following: (a) Any quality measurements developed under the pediatric quality measures...

...Not later than July 1, 2016, the department of medicaid shall implement strategies to improve the integrity of the care management system, including strategies to do both of the following: (A) Increase the department's oversight of medicaid managed care organizations; (B) Provide incentives for identifying fraud, waste, and abuse in the care management system.

...ctor shall do both of the following: (1) Implement and enforce division (B) of section 3902.36 of the Revised Code with respect to medicaid managed care organizations; (2) Enforce, monitor compliance with, and ensure continued compliance with this section. (C) The director may adopt rules under section 5167.02 of the Revised Code as necessary to carry out the provisions of this section.

...rector shall adopt rules under section 5168.02 of the Revised Code establishing a methodology to pay hospitals that is sufficient to expend all money in the indigent care pool. Under the rules: (A) The department of medicaid may classify similar hospitals into groups and allocate funds for distribution within each group. (B) The department shall establish a method of allocating funds to hospitals, taking into consi...

... For the purposes specified in section 5168.25 of the Revised Code and subject to section 5168.28 of the Revised Code, there is hereby imposed an assessment on all hospitals each assessment program year. The amount of a hospital's assessment for an assessment program year shall equal the applicable assessment percentage of the hospital's total facility costs for the period of time specified in division (B) of this se...

...the hospital is assessed under section 5168.21 of the Revised Code for the assessment program year. Except as provided in division (B) of this section, the preliminary determination becomes the final determination for the assessment program year fifteen days after the preliminary determination is issued to the hospital. (B) A hospital may request that the department reconsider the preliminary determination issued ...

...he amount it is assessed under section 5168.21 of the Revised Code in accordance with a payment schedule the department of medicaid shall establish for each assessment program year. The department shall consult with the Ohio hospital association before establishing the payment schedule for any assessment program year. The department shall include the payment schedule in each preliminary determination notice the depar...

...he amount it is assessed under section 5168.21 of the Revised Code. The department shall take action to recover from a hospital any amount the audit reveals that the hospital should have paid but did not pay.

...yments made by hospitals under section 5168.23 of the Revised Code and all recoveries the department of medicaid makes under section 5168.24 of the Revised Code shall be deposited into the fund. All investment earnings of the fund shall be credited to the fund. The department shall use money in the fund to pay for the costs of the medicaid program, including the program's administrative costs.

...ment the assessment imposed by section 5168.21 of the Revised Code in a manner that does not cause a reduction in federal financial participation for the medicaid program under the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w).

...that the assessment imposed by section 5168.21 of the Revised Code is an impermissible health care-related tax under the "Social Security Act," section 1903(w), 42 U.S.C. 1396b(w), the medicaid director shall take all necessary actions to cease implementation of sections 5168.20 to 5168.27 of the Revised Code and shall promptly refund to each hospital the amount of money in the hospital assessment fund at the time th...