Ohio Revised Code Search

...o pay; (c) Meet the requirements for a medicaid provider agreement and enter into the agreement with the department of medicaid to provide dental services to medicaid recipients. (3) The department of health agrees, as provided in section 3702.85 of the Revised Code, to repay, so long as the individual performs the service obligation agreed to under division (C)(1) of this section, all or part of the principal and ...

... pay; (c) Meet the requirements for a medicaid provider agreement and enter into the agreement with the department of medicaid to provide chiropractic services to medicaid recipients. (3) The department of health agrees, as provided in section 3702.98 of the Revised Code, to repay all or part of the principal and interest of a government or other educational loan taken by the individual for expenses described in ...

...om the federal centers for medicare and medicaid services or an accrediting organization approved under 42 U.S.C. 1395bb(a) demonstrating that the hospital is certified or accredited. (B) When filing an application to renew a license issued under section 3722.03 of the Revised Code, an applicant may avoid an inspection by the director if the applicant submits with the application a copy of the hospital's most recen...

... United States centers for medicare and medicaid services, unless the hospital does not provide all of the seventy services, in which case the list shall include as many of those services as the hospital does provide. (3) In selecting a shoppable service for purposes of inclusion on the list, a hospital shall do both of the following: (a) Consider how frequently the hospital provides the service and the hospital'...

...laims of contracted providers against a medicaid health insuring corporation for covered health care services provided to medicaid recipients, all claims against the insurer for liability for bodily injury or for injury to or destruction of tangible property that are not under policies, and all claims of a guaranty association or foreign guaranty association. All claims under life insurance, annuity policies, and fun...

... of long-term care services, including medicaid; (2) Available long-term care services and providers; (3) Changes or improvements in long-term care services or providers; (4) Alternatives to the purchase of private long-term care insurance; (5) The effect of inflation on benefits and the importance of inflation protection; (6) Consumer suitability standards and guidelines; (7) Any other topics required by t...

...lan, including an eligible recipient of medicaid, and includes all of the following terms: (1) "Enrollee" and "subscriber" as defined by section 1751.01 of the Revised Code; (2) "Member" as defined by section 1739.01 of the Revised Code; (3) "Insured" and "plan member" pursuant to Chapter 3923. of the Revised Code; (4) "Beneficiary" as defined by section 3901.38 of the Revised Code. (K) "Health care contrac...

...r compensation is based on the current medicaid or medicare physician fee schedule, and the change in payment or compensation results solely from a change in that physician fee schedule. (b) A routine change or update of the health care contract is made in response to any addition, deletion, or revision of any service code, procedure code, or reporting code, or a pricing change is made by any third party sourc...

...wing: (a) The centers of medicare and medicaid services, for reimbursement of conditional payments made pursuant to the "Medicare Secondary Payer Act," 42 U.S.C. 1395y; (b) The Ohio department of medicaid, or a medical assistance provider to whom the department has assigned a right of recovery for a claim for which the department has notified the provider that the department intends to recoup the department's pri...

... individuals seeking to be eligible for medicaid reimbursement as state of Ohio certified doulas; (3) Provide general advice, guidance, and recommendations to the department of medicaid regarding the medicaid coverage of doula services required under section 5164.071 of the Revised Code; (4) Beginning two years after April 30, 2024, and annually thereafter, submit a report to the general assembly in accordance wi...

...mental nutrition assistance program or medicaid (excluding administrative expenditures for transportation services covered by the medicaid program) even though the county expenditures meet or exceed the maximum allowable reimbursement amount established by rules adopted under section 5101.161 of the Revised Code. The director of job and family services may adopt internal management rules in accordance with sect...

...tance group. (E) An adult eligible for medicaid who is sanctioned under division (A)(3) of this section for a failure or refusal, without good cause, to comply in full with a provision of a self-sufficiency contract related to work responsibilities under sections 5107.40 to 5107.69 of the Revised Code loses eligibility for medicaid unless the adult is otherwise eligible for medicaid pursuant to an eligibility ...

...ities is to pay the nonfederal share of medicaid expenditures for one or more of the home and community-based services that the county board would, if not for the agreement, be required by section 5126.0510 of the Revised Code to pay. The agreement shall specify which home and community-based services the agreement covers. The department shall pay the nonfederal share of medicaid expenditures for th...

...such costs in determining an ICF/IID's medicaid payment rate. If the department does not consider such costs in determining an ICF/IID's medicaid payment rate, the provider may seek reconsideration of the determination in accordance with section 5124.38 of the Revised Code. If the department subsequently includes such costs in an ICF/IID's medicaid payment rate, the department shall pay the provider interest a...

...within thirty days; (2) Reduce the per medicaid day payment rate for the provider's ICF/IID by the amount specified in division (B) of this section for the period of time specified in division (C) of this section. (B) For the purpose of division (A)(2) of this section, an ICF/IID's per medicaid day payment rate shall be reduced by the following amount: (1) In the case of a reduction made during the period be...

...ties shall determine each ICF/IID's per medicaid day direct care costs component rate. An ICF/IID's rate shall be determined as follows: (1) Determine the product of the following: (a) The ICF/IID's quarterly case-mix score determined or assigned under section 5124.193 of the Revised Code for the following calendar quarter: (i) For the rate determined for fiscal year 2019, the calendar quarter ending December 3...

...with division (C) of this section a per medicaid day quality incentive payment for each ICF/IID that earns for the fiscal year at least one point under division (B) of this section. (B) Each fiscal year beginning with fiscal year 2022, the department, in accordance with rules authorized by this section, shall award to an ICF/IID points for quality indicators the ICF/IID meets for the fiscal year. The quality indica...

...r one hundred per cent of the total per medicaid day payment rate determined for the ICF/IID under this chapter to reserve a bed for a resident who is a medicaid recipient if all of the following apply: (1) The recipient is temporarily absent from the ICF/IID for a reason that makes the absence qualified for payments under this section as specified in rules authorized by this section; (2) The resident's plan of car...

...orts each year to determine ICFs/IID's medicaid payment rates under this chapter in time to pay the rates by August fifteenth of each fiscal year. If the department is unable to calculate the rates so that they can be paid by that date, the department shall pay each provider the rate calculated for the provider's ICFs/IID under those sections at the end of the previous fiscal year. If the department also is una...

...vidual's age and cultural group. (P) "Medicaid case management services" means case management services provided to an individual with a developmental disability that the state medicaid plan requires. (Q) "Prevocational services" means services that provide learning and work experiences, including volunteer work experiences, from which an individual can develop general strengths and skills that are not specific t...

...ities shall pay the nonfederal share of medicaid expenditures for medicaid case management services the county board provides to an individual with a developmental disability who the county board determines under section 5126.041 of the Revised Code is eligible for county board services.

...(A) When the medicaid director is authorized by a statute to adopt a rule, the director shall adopt the rule in accordance with the following: (1) Chapter 119. of the Revised Code if either of the following applies: (a) The statute authorizing the rule requires that the rule be adopted in accordance with Chapter 119. of the Revised Code. (b) Unless division (A)(2)(b) of this section applies, the statute auth...

...The medicaid director is the executive head of the department of medicaid. All duties conferred on the department by law or order of the director are under the director's control and shall be performed in accordance with rules the director adopts.

...If the medicaid director determines that a position with the department of medicaid can best be filled in accordance with division (A)(2) of section 124.30 of the Revised Code or without regard to a residency requirement established by a rule adopted by the director of administrative services, the medicaid director shall provide the director of administrative services certification of the determination.

...The department of medicaid shall collaborate with the superintendent of the bureau of criminal identification and investigation to develop procedures and formats necessary to produce the notices described in division (D) of section 109.5721 of the Revised Code in a format that is acceptable for use by the department. The medicaid director may adopt rules under section 5160.02 of the Revised Code necessary for such co...