Ohio Revised Code Search
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Section 5162.1310 | Evaluation of success of expansion eligibility group.
...ility group have with the following: (1) Obtaining employer-sponsored health insurance coverage; (2) Improving health conditions that would otherwise prevent or inhibit stable employment; (3) Improving the conditions of their employment, including duration and hours of employment. (B) For the purpose of aiding the department's evaluations under this section, medicaid managed care organizations shall collect a... |
Section 5162.211 | Lien against property of recipient or spouse as part of estate recovery program.
...ision (B) of this section and section 5162.23 of the Revised Code, no lien may be imposed against the property of an individual before the individual's death on account of medicaid services correctly paid or to be paid on the individual's behalf. (B) Except as provided in division (C) of this section, the department of medicaid may impose a lien against the real property of a medicaid recipient who is a perma... |
Section 5162.22 | Transfer of personal needs allowance account.
...(A) As used in this section: (1) "Commissioner" means a person appointed by a probate court under division (E) of section 2113.03 of the Revised Code to act as a commissioner. (2) "Home" has the same meaning as in section 3721.10 of the Revised Code. (3) "Personal needs allowance account" means an account or petty cash fund that holds the money of a resident of a residential facility or home and that the fac... |
Section 5162.23 | Recovering benefits incorrectly paid.
...ector shall adopt rules under section 5162.02 of the Revised Code permitting county departments of job and family services to take action to recover benefits incorrectly paid on behalf of medicaid recipients. The rules shall provide for recovery by the following methods: (1) Soliciting voluntary payments from recipients or from persons holding property in which a recipient has a legal or equitable interest; ... |
Section 5162.24 | Recovering health care costs provided to child.
...y" has the same meaning as in section 5160.35 of the Revised Code. (B) In addition to the authority granted under section 5160.38 of the Revised Code, the department of medicaid may, to the extent necessary to reimburse its costs, garnish the wages, salary, or other employment income of, and withhold amounts from state tax refunds to, any person to whom both of the following apply: (1) The person is required... |
Section 5162.30 | Medicaid administrative claiming program.
... the following pursuant to sections 3701.261 and 3701.262 of the Revised Code: (1) Cancer reports under the Ohio cancer incidence surveillance system; (2) The incidence, prevalence, costs, and medical consequences of cancer on medicaid recipients and other low-income populations. (B) The medicaid director shall consult with the director of health in creating the medicaid administrative claiming program. |
Section 5162.365 | Responsibility for repaying overpayments.
...ovider is responsible for repaying: (1) Make a payment to the federal government to meet or delay the provider's repayment obligation; (2) Assume the provider's repayment obligation; (3) Forgive the provider's repayment obligation. (C) Each qualified medicaid school provider shall indemnify and hold harmless the department of medicaid for any cost or penalty resulting from a federal or state audit finding... |
Section 5162.50 | Health care-federal fund.
...wing shall be credited to the fund: (1) Funds that division (B) of section 5168.11 of the Revised Code requires be credited to the fund; (2) The federal share of all rebates paid by drug manufacturers to the department of medicaid in accordance with a rebate agreement required by the "Social Security Act," section 1927, 42 U.S.C. 1396r-8; (3) The federal share of all supplemental rebates paid by drug manufa... |
Section 5162.73 | Dental services for pregnant Medicaid recipients.
...d, all of the following shall apply: (1) Medicaid recipients who are members of the group described in section 5163.06 of the Revised Code shall be eligible to receive two dental cleanings per year. (2) The Department shall give priority to those Medicaid recipients residing in areas of the state with high preterm birth rates. (3) The Department shall inform Medicaid recipients about the program and market the... |
Section 5162.80 | Good faith estimates for charges and payments.
...credited, or certified under Chapter 3721., 3727., 4715., 4725., 4731., 4732., 4734., 4747., 4753., 4755., 4757., or 4779. of the Revised Code shall provide in writing, before products, services, or procedures are provided, a reasonable, good-faith estimate of all of the following for the provider's non-emergency products, services, or procedures: (1) The amount the provider will charge the patient or the consumer's... |
Section 5163.01 | Definitions.
...regulation is amended effective January 1, 2014. "Expansion eligibility group" means the medicaid eligibility group described in section 1902(a)(10)(A)(i)(VIII) of the "Social Security Act," 42 U.S.C. 1396a(a)(10)(A)(i)(VIII). "Federal financial participation" has the same meaning as in section 5160.01 of the Revised Code. "Federal poverty line" has the same meaning as in section 5162.01 of the Revised Code. "Hea... |
Section 5163.07 | Income eligibility threshold for parents and caretaker relatives.
... by the "Social Security Act," section 1931(b)(2)(C), 42 U.S.C. 1396u-1(b)(2)(C), to set the 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." |
Section 5163.091 | Qualifications for program.
...dance with rules authorized by section 5163.098 of the Revised Code qualifies for the medicaid program: (A) Applies for the medicaid buy-in for workers with disabilities program; (B) Provides satisfactory evidence of all of the following: (1) That the individual is at least sixteen years of age and under sixty-five years of age; (2) Except as provided in section 5163.096 of the Revised Code, that one of the ... |
Section 5163.098 | Program implementing rules; disregarded income.
...ector shall adopt rules under section 5163.02 of the Revised Code as necessary to implement the medicaid buy-in for workers with disabilities program. The rules shall do all of the following: (1) Specify assets, asset values, and amounts to be disregarded in determining asset and income eligibility limits for the program; (2) Establish meanings for the terms "earned income," "health insurance," "resources," ... |
Section 5163.101 | Implementation of the presumptive eligibility for children option.
...(A) As used in this section: (1) "Children's hospital" has the same meaning as in section 2151.86 of the Revised Code. (2) "Federally qualified health center" has the same meaning as in section 1905(l)(2)(B) of the "Social Security Act," 42 U.S.C. 1396d(l)(2)(B). (3) "Federally qualified health center look-alike" has the same meaning as in section 3701.047 of the Revised Code. (4) "Presumptive eligibility for... |
Section 5163.22 | Life insurance policies.
...vices. (B) As used in this section: (1) "Beneficiary" means the person or entity designated in a life insurance policy to receive the proceeds of the policy on the death of the insured or maturity of the policy. (2) "Owner" means the person who has the right to designate the beneficiary of a life insurance policy and to change the designation. (C) The value of a life insurance policy that would otherwise be... |
Section 5163.31 | Real property not homestead after 13-month institutional residence.
...ead or principal place of residence: (1) The individual's spouse; (2) The individual's child if any of the following apply: (a) The child is under twenty-one years of age. (b) The child is considered blind or disabled under the "Social Security Act," section 1614, 42 U.S.C. 1382c. (c) The child is financially dependent on the individual for housing as determined in accordance with rules adopted under section... |
Section 5163.40 | Healthy start component.
...t component of the medicaid program: (1) Establish a short application form for the component that requires the applicant to provide no more information than is necessary for making determinations of eligibility for the component, except that the form may require applicants to provide their social security numbers. The form shall include a statement, which must be signed by the applicant, indicating that she d... |
Section 5163.50 | Improving medicaid eligibility determinations and processing.
...ta relating to all of the following: (1) Medicaid enrollee or applicant identity verification; (2) Medicaid enrollee death verification; (3) Employment and wages; (4) Lottery winnings; (5) Residency verification including residency relating to concurrent enrollment in medicaid programs in other states; (6) Household composition; (7) Medicaid enrollee incarceration status; (8) Third-party liability ver... |
Section 5164.02 | Rules to implement chapter.
...l be adopted in accordance with Chapter 119. of the Revised Code. (B) The rules shall establish all of the following: (1) The amount, duration, and scope of the medicaid services covered by the medicaid program; (2) The medicaid payment rate for each medicaid service or, in lieu of the rate, the method by which the rate is to be determined for each medicaid service; (3) Procedures for enforcing the rules adopted ... |
Section 5164.03 | Mandatory and optional services.
...hich either of the following applies: (1) State statutes expressly permit the medicaid program to cover the optional service; (2) State statutes do not address whether the medicaid program may cover the optional service. (D) The medicaid program shall not cover any optional services that state statutes prohibit the medicaid program from covering. |
Section 5164.092 | Coverage of remote ultrasounds and fetal nonstress tests.
... under the following circumstances: (1) The medicaid provider responsible for the procedure uses digital technology that meets both of the following criteria: (a) The technology is used only to collect medical and other data from a patient and electronically transmit that data securely to a health care provider in a different location for that provider's examination of the data; (b) The technology has been a... |
Section 5164.301 | Medicaid provider agreements for physician assistants.
... has the same meaning as in section 4731.65 of the Revised Code. (B) The department of medicaid shall establish a process by which a physician assistant may enter into a provider agreement. (C)(1) Subject to division (C)(2) of this section, a claim for medicaid payment for a medicaid service provided by a physician assistant to a medicaid recipient may be submitted by the physician assistant who provided the ... |
Section 5164.31 | Funding for implementing the provider screening requirements.
...er before doing any of the following: (1) Entering into a provider agreement with a medicaid provider that seeks initial enrollment as a provider; (2) Entering into a provider agreement with a former medicaid provider that seeks re-enrollment as a provider; (3) Revalidating a medicaid provider's continued enrollment as a provider. (B) The department is not to collect an application fee from a medicaid provider th... |
Section 5164.32 | Expiration of medicaid provider agreements.
...ector shall adopt rules under section 5164.02 of the Revised Code as necessary to implement this section. The rules shall be consistent with subpart E of 42 C.F.R. Part 455 and include a process for revalidating medicaid providers' continued enrollments as providers. All of the following apply to the revalidation process: (1) The department shall refuse to revalidate a provider's provider agreement when the pr... |