Ohio Revised Code Search

...The department of medicaid shall assess the efforts of medicaid managed care organizations to recoup overpayments made to providers who are network providers and providers who are not network providers. The assessments shall examine the amount of time recoupment efforts take starting from the time providers receive final payment and ending when the recoupment effort is completed. Each medicaid managed care organizati...

...The department of medicaid may provide financial incentive awards to medicaid managed care organizations that meet or exceed performance standards specified in provider agreements or rules adopted by the medicaid director under section 5167.02 of the Revised Code. The department may specify in a contract with a medicaid managed care organization the amounts of financial incentive awards, methodology for distrib...

...essments deposited into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code; (2) The total amount of intergovernmental transfers required to be made in the same program year by governmental hospitals under section 5168.07 of the Revised Code, less the amount of transfers deposited into the health care/medicaid support and recoveries fund created under section 5162.5...

...stributing funds to hospitals under the medicaid program pursuant to sections 5168.01 to 5168.14 of the Revised Code and depositing funds into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code, there is hereby imposed an assessment on all hospitals. Each hospital's assessment shall be based on total facility costs. All hospitals shall be assessed according to the r...

...(A) The department of medicaid may require governmental hospitals to make intergovernmental transfers each program year for the purpose of distributing funds to hospitals under the medicaid program pursuant to sections 5168.01 to 5168.14 of the Revised Code and depositing funds into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code. The department shall not require...

...r moneys deposited into the health care/medicaid support and recoveries fund created under section 5162.52 of the Revised Code, the department of medicaid shall not use money paid to the department under sections 5168.06 and 5168.07 of the Revised Code or money that the department pays to hospitals under section 5168.09 of the Revised Code to replace any funds appropriated by the general assembly for the medicaid pro...

...s for a fiscal year, the department of medicaid shall use at least all of the following: (1) Information from medicaid cost reports filed under section 5165.10 of the Revised Code that are the most recent at the time the determination is made; (2) The projected total medicaid payment rates for nursing facility services for the fiscal year; (3) The projected total number of medicaid days for the fiscal year.

...ion 5168.65 of the Revised Code from a medicaid payment due the ICF/IID until the ICF/IID pays the installment and penalty; (2) Offset an amount less than or equal to the installment and penalty assessed under section 5168.65 of the Revised Code from a medicaid payment due the ICF/IID; (3) Provide for the department of medicaid to terminate the ICF/IID's provider agreement. (B) The department may offset a med...

...money in the fund shall be used to make medicaid payments to medicaid providers and medicaid managed care organizations. (B) Any interest or other investment proceeds earned on money in the fund shall be credited to the fund and used to make medicaid payments in accordance with division (A) of this section.

...(A) At least quarterly, the medicaid director shall report to the members of the joint medicaid oversight committee and the executive director of the joint medicaid oversight committee both of the following: (1) The fee rates and the aggregate total of the fees assessed for each of the following: (a) The hospital assessment established under section 5168.21 of the Revised Code; (b) The nursing home and hospital...

...(A) The medicaid director shall impose a penalty for each day that a hospital fails to report the information required under section 5168.05 of the Revised Code on or before the dates specified in that section. The amount of the penalty shall be established by the director in rules adopted under section 5168.02 of the Revised Code. (B) In addition to any other remedy available to the department of medicaid under law...

...to a prescription, for the benefit of a medicaid recipient with a diagnosis of incontinence, and by a medicaid provider that maintains a valid provider agreement under section 5164.30 of the Revised Code with the department of medicaid, provided that the medicaid program covers diapers or incontinence underpads as an incontinence garment. (b) As used in division (B)(56)(a) of this section, "incontinence underpad" ...

... (b) The director of health; (c) The medicaid director; (d) The director of mental health and addiction services; (e) The administrator of workers' compensation. (2) Members of the advisory council shall also include individuals who are working to address prescription drug availability and affordability in any of the following areas: (a) Insurance; (b) Local, state, and federal government service; ...

...ct entered into with the department of medicaid as an interagency agreement under section 5162.35 of the Revised Code, the department of aging shall carry out the day-to-day administration of the component of the medicaid program known as the program of all-inclusive care for the elderly or PACE. The department of aging shall carry out its PACE administrative duties in accordance with the provisions of the int...

...ible individuals may be enrolled in the medicaid-funded component of the PASSPORT program in accordance with this section. An individual is eligible for the PASSPORT program's home first component if both of the following apply: (1) The individual has been determined to be eligible for the medicaid-funded component of the PASSPORT program. (2) At least one of the following applies: (a) The individual has bee...

...vidual must have an application for the medicaid-funded component of the assisted living program pending and the department or the department's designee must have determined that the individual meets the nonfinancial eligibility requirements of the medicaid-funded component and not have reason to doubt that the individual meets the financial eligibility requirements of the medicaid-funded component. (C) While rece...

...erage that provides for the coverage of medicaid recipients, or an evidence of coverage that provides for the coverage of beneficiaries under any other federal health care program regulated by a federal regulatory body, or an evidence of coverage that provides for the coverage of beneficiaries under any contract covering officers or employees of the state that has been entered into by the department of administrative...

... for policies used for the coverage of medicaid recipients, or for policies used for the coverage of beneficiaries under any other federal health care program regulated by a federal regulatory body, or for policies used for the coverage of beneficiaries under any contract covering officers or employees of the state that has been entered into by the department of administrative services, if both of the followin...

...o 5 U.S.C.A. 8905, or for policies for medicaid recipients, or for policies for beneficiaries of any other federal health care program regulated by a federal regulatory body, or for policies for beneficiaries of contracts covering officers or employees of the state entered into by the department of administrative services, if both of the following apply: (1) The solicitation document has been approved by the U...

...n pleas on behalf of the department of medicaid, and the prosecuting attorney of the county in which a violation of division (B) of section 2913.401 of the Revised Code occurs may bring a civil action in the court of common pleas of that county on behalf of the county department of job and family services, against a person who violates division (B) of section 2913.401 of the Revised Code for the recovery of th...

... United States centers for medicare and medicaid services. (3) "Medical claim" has the same meaning as in section 2305.113 of the Revised Code. (4) "Reimbursement determination" means an insurer's determination of whether the insurer will reimburse a health care provider for health care services and the amount of that reimbursement. (5) "Reimbursement policies" means an insurer's policies and procedures governi...

...her the obligee if the children are not medicaid recipients, or to the department of medicaid when a medicaid assignment is in effect for any child under the support order. (E) The cost of providing health insurance coverage for a child subject to an order shall be defrayed by a credit against that parent's annual income when calculating support as required under section 3119.02 of the Revised Code using the basic ...

...of children and youth, or department of medicaid regarding the provision of public family services, including the provision of the following services to prevent or reduce economic or personal dependency and to strengthen family life: (a) Services authorized by a Title IV-A program, as defined in section 5101.80 of the Revised Code; (b) Social services authorized by Title XX of the "Social Security Act" and prov...

...alth services may advocate on behalf of medicaid recipients enrolled in medicaid managed care organizations and medicaid-eligible individuals, any of whom have been identified as needing addiction or mental health services.

...o pay; (c) Meet the requirements for a medicaid provider agreement and enter into the agreement with the department of medicaid to provide primary care services to medicaid recipients. (3) The department of health agrees, as provided in section 3702.75 of the Revised Code, to repay, so long as the primary care physician performs the service obligation agreed to under division (B)(1) of this section, all or part of ...