Ohio Revised Code Search

... professional" means the following: (1) A physician authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery; (2) An advanced practice registered nurse who holds a current, valid license issued under Chapter 4723. of the Revised Code that authorizes the practice of nursing as an advanced practice registered nurse and is designated as a clinical spec...

...(A) As used in this section: (1) "Community mental health services provider or facility" means a community mental health services provider or facility that has its community mental health services certified by the department of mental health and addiction services under section 5119.36 of the Revised Code or by the department of children and youth under section 5103.03 of the Revised Code. (2) "Mental health pr...

...f medicaid recipients or the state: (1) Deny, refuse to revalidate, suspend, or terminate a provider agreement; (2) Exclude an individual, provider of services or goods, or other entity from participation in the medicaid program. (B) No individual, provider, or entity excluded from participation in the medicaid program under this section shall do any of the following: (1) Own, or provide services to, any ot...

...wnership 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 receive payments to which the provider is not ent...

...ment shall do both of the following: (1) Not later than five days after suspending the provider agreement, notify the medicaid provider of the suspension; (2) Not later than ten business days after suspending the provider agreement, notify the medicaid provider that the department intends to terminate the provider agreement. (C) The notice that the department provides to a medicaid provider under division (B)(2...

...(A) As used in this section: (1) "Aide services" means all of the following: (a) Home health aide services covered by the medicaid program as part of the home health services benefit pursuant to 42 C.F.R. 440.70(b)(2); (b) Home care attendant services covered by a participating medicaid waiver component, as defined in section 5166.30 of the Revised Code; (c) Any of the following covered by a home and communit...

...al. (B) If, as authorized by section 5160.10 of the Revised Code, the medicaid director chooses to contract with a person to perform either or both of the following services, the director may contract with any qualified person, including OCHSPS, to perform the service or services on behalf of the department of medicaid: (1) Review and analyze claims for medicaid services provided to children in accordance wit...

...ship of the committee shall include: (1) Three pharmacists licensed under Chapter 4729. of the Revised Code; (2) Two doctors of medicine and two doctors of osteopathy who hold licenses issued under Chapter 4731. of the Revised Code, one of whom is a family practice physician; (3) A registered nurse licensed under Chapter 4723. of the Revised Code; (4) A pharmacologist who has a doctoral degree; (5) A psychi...

...(A) As used in sections 5164.7512 to 5164.7514 of the Revised Code: (1) "Clinical practice guidelines" means a systematically developed statement to assist providers and medicaid recipients in making decisions about appropriate health care for specific clinical circumstances and conditions. (2) "Clinical review criteria" means the written screening procedures, decision abstracts, clinical protocols, and clinical ...

... in the "Social Security Act," section 1917(b)(1)(C)(iii), 42 U.S.C. 1396p(b)(1)(C)(iii). An individual participating in the program who is subject to the medicaid estate recovery program instituted under section 5162.21 of the Revised Code shall be eligible for the reduced adjustment or recovery under division (D) of that section.

...d in the "Social Security Act," section 1945 (h)(1), 42 U.S.C. 1396w-4(h)(1), who also have developmental disabilities may receive health home services, as defined in the "Social Security Act," section 1945 (h)(4), 42 U.S.C. 1396w-4(h)(4). Any such system shall focus on the needs of individuals and have as its goal improving services and outcomes under the medicaid program by improving integration of long-term care s...

...(A)(1) In addition to any other eligibility requirement of this chapter, to be eligible to serve as a personal care aide under the integrated care delivery system, an individual must successfully complete thirty hours of pre-service training acceptable to the department of medicaid. To maintain eligibility, each personal care aide must successfully complete six hours of in-service training acceptable to the depart...

...(A) As used in this section: (1) "Dementia" includes Alzheimer's disease or a related disorder. (2) "Serious mental illness" means "serious mental illness," as defined by the United States department of health and human services in regulations adopted under section 1919(e)(7)(G)(i) of the "Social Security Act," 42 U.S.C. 1396r(e)(7)(G)(i). (3) "Individual with a mental illness" means an individual who has a se...

...re consultation provided under section 173.42 of the Revised Code. To the maximum extent possible, the assessment shall be based on information from the resident assessment instrument specified in rules authorized by section 5165.191 of the Revised Code. The assessment shall also be based on criteria and procedures established in rules authorized by division (F) of this section and information provided by the ...

...defined in rules adopted under section 5165.02 of the Revised Code, of any cost report filed under section 5165.10 or 5165.522 of the Revised Code. The decision whether to conduct an audit and the scope of the audit, which may be a desk or field audit, may be determined based on prior performance of the provider, a risk analysis, or other evidence that gives the department reason to believe that the provider has repo...

...rt of an audit conducted under section 5165.109 of the Revised Code regarding a cost report for the nursing facility includes either of the following: (1) Adverse findings that exceed three per cent of the total amount of medicaid-allowable costs reported in the cost report; (2) Adverse findings that exceed twenty per cent of medicaid-allowable costs for a particular cost center reported in the cost report. (B) A ...

...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, 2012, to a dual eligible individual who is eligible for nursing facility services under the medicaid program and post-hospital extended care services under Part A ...

...ursing facility provider under section 5165.191 of the Revised Code. The department may conduct an exception review based on the findings of a medicaid certification survey conducted by the department of health, a risk analysis, or prior performance of the provider. Exception reviews shall be conducted by appropriate health professionals under contract with or employed by the department. The professionals may revi...

...ll consist of the following members: (1) Four members appointed by the speaker of the house of representatives, three from the majority party and one from the minority party; (2) Four members appointed by the president of the senate, three from the majority party and one from the minority party. (B) Appointments to the commission shall be made not later than December 31, 2021. In the event of a vacancy, a repla...

... at an amount equal to the following: (1) In the case of a nursing facility that had an occupancy rate exceeding ninety-five per cent, an amount not exceeding fifty per cent of the per medicaid day payment rate the provider would be paid if the recipient were not absent from the nursing facility that day; (2) In the case of a nursing facility that had an occupancy rate not exceeding ninety-five per cent, an amount ...

...the provider was entitled to receive: (1) The provider properly amends a cost report for the nursing facility under section 5165.107 of the Revised Code; (2) The department makes a finding based on an audit under section 5165.109 of the Revised Code; (3) The department makes a finding based on an exception review of resident assessment data conducted under section 5165.193 of the Revised Code after the effective d...

...ecified in rules authorized by section 5165.53 of the Revised Code. The written notice shall be provided to the department not later than forty-five days before the effective date of the change of operator if the change of operator does not entail the relocation of residents. The written notice shall be provided to the department not later than ninety days before the effective date of the change of operator if the ch...

...e department of medicaid under section 5165.511 or 5165.512 of the Revised Code shall do all of the following: (1) Comply with all applicable federal statutes and regulations; (2) Comply with section 5165.07 of the Revised Code and all other applicable state statutes and rules; (3) Subject to division (B) of this section, comply with all the terms and conditions of the exiting operator's provider agreement, includ...

...withheld under division (A) of section 5165.521 of the Revised Code, less any amount the exiting operator owes the department under the medicaid program, as follows: (A) Unless the department issues the initial debt summary report required by section 5165.525 of the Revised Code not later than sixty days after the date the exiting operator files the properly completed cost report required by section 5165.522 of th...

...ing, as selected by the survey team: (1) Copies of all survey notes and any other written materials created during the survey; (2) A written summary of the survey team's recommendations regarding findings of noncompliance with certification requirements; (3) An audio or audiovisual recording of the interview. If the survey team selects this option, at least two copies of the recording shall be made and the s...