Ohio Revised Code Search

...loped 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 practice guidelines used by the medicaid program to determine whether or not a health care service or drug is appropriate and consis...

...ed and implemented by the department of medicaid pursuant to division (B)(2) of section 5164.7512 of the Revised Code: (1) The process shall be clear and convenient. (2) The process shall be easily accessible on the department's web site. (3) The process shall require that a medicaid provider initiate a step therapy exemption request on behalf of a medicaid recipient. (4) The process shall require supporting...

...f the exiting operator's debt under the medicaid program or the portion of the debt that represents the franchise permit fee the exiting operator owes; (2) The entering operator involved in the change of operator with the exiting operator specified in division (A)(1) of this section. (B) "Allowable costs" are a nursing facility's costs that the department of medicaid determines are reasonable. Fines paid under ...

... (D) of this section, the department of medicaid may withhold from payment due an exiting operator under the medicaid program the total amount specified in the notice provided under division (C) of section 5165.52 of the Revised Code that the exiting operator owes or may owe to the department under the medicaid program. (B) In the case of a change of operator and subject to division (E) of this section, the follow...

... level four finding, the department of medicaid or contracting agency shall, subject to sections 5165.79 to 5165.83 of the Revised Code, impose a remedy for the deficiency or cluster of deficiencies. The department or agency may act under either division (A)(1) or (2) of this section: (1) The department or agency may impose one or more of the following remedies: (a) Issue an order terminating the nursing fac...

...pe level two finding, the department of medicaid or a contracting agency may, subject to sections 5165.82 and 5165.83 of the Revised Code, impose one or more of the following remedies: (1) Do either of the following: (a) Issue an order denying medicaid payments to the facility for all medicaid eligible residents admitted after the effective date of the order; (b) Impose a fine. (2) Issue an order denying med...

... immediate jeopardy, the department of medicaid or a contracting agency shall impose one or more of the remedies described in division (A)(1) of this section and, in addition, may take one or both of the actions described in division (A)(2) of this section. (1) The department or agency shall impose one or more of the following remedies: (a) Appoint, subject to the continuing consent of the provider, a tempor...

... United States centers for medicare and medicaid services every six months to evaluate the safety and quality of care provided by a nursing facility as required under the special focus facility program. (B) The department of medicaid shall issue an order terminating a nursing facility's participation in the medicaid program if either of the following apply: (1) The nursing facility fails to graduate from the sp...

...or 5165.84 of the Revised Code denying medicaid payments to a nursing facility for all medicaid eligible residents admitted after its effective date, or an order issued under section 5165.72, 5165.73, or 5165.74 of the Revised Code denying medicaid payments to a nursing facility for medicaid eligible residents admitted after the effective date of the order who have specified diagnoses or special care needs, sha...

... Title XIX. (B) If the department of medicaid or a contracting agency imposes a fine on a nursing facility under section 5165.72, 5165.73, or 5165.74 of the Revised Code, it may impose one or more of the following: (1) One hundred sixty per cent of the amount calculated under division (C) of this section for any deficiency or cluster of deficiencies that constitutes a severity level four and scope level fou...

...ng facility notifies the department of medicaid or a contracting agency, at any time during the six-month period following the exit interview of a survey that was the basis for citing a deficiency or deficiencies, that the deficiency or deficiencies have been substantially corrected in accordance with the plan of correction submitted and approved under section 5165.69 of the Revised Code, the department of hea...

...t," 42 U.S.C. 1396a(f), under which the medicaid program's eligibility requirements for aged, blind, and disabled individuals are more restrictive than the eligibility requirements for the supplemental security income program. "Administrative agency" means, with respect to a home and community-based services medicaid waiver component, the department of medicaid or, if a state agency or political subdivision contra...

...(A) The medicaid director shall adopt rules in accordance with Chapter 119. of the Revised Code governing medicaid waiver components. The rules may establish all of the following: (1) Eligibility requirements for the medicaid waiver components; (2) The type, amount, duration, and scope of medicaid services the medicaid waiver components cover; (3) The conditions under which the medicaid waiver components cov...

...each home and community-based services medicaid waiver component: (A) Only an individual who qualifies for a component shall receive that component's medicaid services. (B) A level of care determination shall be made as part of the process of determining whether an individual qualifies for a component and shall be made each year after the initial determination if, during such a subsequent year, the administr...

...am" means the program the department of medicaid administers that provides state plan services and medicaid waiver component services pursuant to rules adopted for the medicaid program and a medicaid waiver that went into effect July 1, 1998. (B) The department of medicaid may create and administer two or more medicaid waiver components under which home and community-based services are provided to eligible ind...

...66.161 of the Revised Code, "ODA or MCD medicaid waiver component" means all of the following: (1) The medicaid-funded component of the PASSPORT program; (2) The medicaid-funded component of the assisted living program; (3) The Ohio home care waiver program. (B) The medicaid director may create a home and community-based services medicaid waiver component as part of the integrated care delivery system. If...

...The department of medicaid shall enter into a contract with the department of developmental 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 s...

...emented on February 1, 2023, to address medicaid population health and social determinants of health and encourage optimal health and self-sufficiency of medicaid enrollees, the department of medicaid, in collaboration with the department of job and family services, shall develop a program to assist medicaid enrollees with securing meaningful employment. (B) As part of that program, each medicaid managed care orga...

...(A) As used in this section, "medicaid estate recovery program" means the program instituted under section 5162.21 of the Revised Code. (B) The administrator of the medicaid estate recovery program shall prescribe a form on which a beneficiary of a transfer on death designation affidavit as provided in section 5302.22 of the Revised Code, who survives the deceased owner of the real property or an interest in the rea...

...(A) The department of medicaid shall create the medicaid-funded component of the PASSPORT program. In creating the medicaid-funded component, the department of medicaid shall collaborate with the department of aging. (B) All of the following apply to the medicaid-funded component of the PASSPORT program: (1) The department of aging shall administer the medicaid-funded component through a contract entered into w...

...(A) The department of medicaid shall create the medicaid-funded component of the assisted living program. In creating the medicaid-funded component, the department of medicaid shall collaborate with the department of aging. (B) Unless the medicaid-funded component of the assisted living program is terminated under division (C) of this section, all of the following apply: (1) The department of aging shall admini...

... corporation that provides coverage to medicaid recipients shall post a performance bond in the amount of three million dollars as security to fulfill the obligations of the health insuring corporation to pay claims of contracted providers for covered health care services provided to medicaid recipients. The bond shall be payable to the department of insurance in the event that the health insuring corporation ...

... (b) On January 1, 2015, the ICF/IID's medicaid-certified capacity was at least twenty per cent less than the greatest medicaid-certified capacity it had before it became a downsized ICF/IID or partially converted ICF/IID. (2) An ICF/IID's sleeping room in which more than two residents reside if both of the following apply: (a) All of the residents of the sleeping room are under twenty-one years of age. (b)...

...January of each year, the department of medicaid shall complete a report on the effectiveness of the medicaid program in meeting the health care needs of low-income pregnant women, infants, and children. The report shall include all of the following, delineated by race and ethnic group: (1) The estimated number of pregnant women, infants, and children eligible for the program; (2) The actual number of eligible pe...

... Revised Code. (B) The department of medicaid shall create an infant mortality scorecard. The scorecard shall report all of the following: (1) The performance of the fee-for-service component of medicaid and each medicaid managed care organization on population health measures, including the infant mortality rate, preterm birth rate, low-birthweight rate, and stillbirth rate, delineated in accordance with divis...