Ohio Revised Code Search

...A qualified medicaid school provider participating in the medicaid school component of the medicaid program may submit a claim to the department of medicaid for federal financial participation for providing, in schools, services covered by the medicaid school component to medicaid recipients who are eligible for the services. No qualified medicaid school provider may submit such a claim before the provider incurs the...

...(A) The health care/medicaid support and recoveries fund is hereby created in the state treasury. All of the following shall be credited to the fund: (1) Except as otherwise provided by statute or as authorized by the controlling board, the nonfederal share of all medicaid-related revenues, collections, and recoveries; (2) Federal reimbursement received for payment adjustments made pursuant to section 1923 of the...

...into a contract with the department of medicaid under section 5162.35 of the Revised Code identifies that a medicaid overpayment has been made to a medicaid provider, the state agency may commence actions to recover the overpayment on behalf of the department. (B) In recovering an overpayment pursuant to this section, a state agency shall comply with the following procedures: (1) The state agency shall attemp...

... (D) of this section, the department of medicaid shall fine the provider of a nursing facility if the report 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 twe...

...nursing facility's participation in the medicaid program; (2) Appointment of a temporary manager of a facility under division (A)(1)(b) or (2)(b) of section 5165.72, or division (A)(1)(d) of section 5165.77 of the Revised Code; (3) An order issued under section 5165.72, 5165.73, 5165.74, 5165.77, or 5165.84 of the Revised Code denying medicaid payments to a facility for all medicaid eligible residents admitted ...

...sion (B) of this section, the total per medicaid day payment rate that the department of developmental disabilities shall pay to an ICF/IID provider for ICF/IID services the provider's ICF/IID provides during a fiscal year shall equal the sum of all of the following: (1) The per medicaid day capital component rate determined for the ICF/IID under section 5124.17 of the Revised Code; (2) The per medicaid day dir...

...an order terminating the county board's medicaid local administrative authority over all or part of home and community-based services, medicaid case management services, or all or part of both of those services. The department shall provide a copy of the order to the board of county commissioners, senior probate judge, county auditor, and president and superintendent of the county board. The department shall specify ...

...ities shall pay the nonfederal share of medicaid expenditures for the following home and community-based services provided 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: (1) Home and community-based services provided by the county board to such an individual; (2) Home and community-based services prov...

...rnishes or authorizes the furnishing of medicaid services, performs billing or coding functions, or is involved in monitoring of health care that an entity provides. "Employee" includes any officer or employee (including management employees) of an entity. "Entity" includes a governmental entity or an organization, unit, corporation, partnership, or other business arrangement, including any medicaid managed ca...

..."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. "Healthy start component" has the same meaning as in s...

...(A) The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall 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 ra...

...ts meet federal and state standards for medicaid certification, if all of the following apply: (a) The nursing facility initially obtained both its nursing home license under Chapter 3721. of the Revised Code and medicaid certification on or after January 1, 2008. (b) The nursing facility is located in a county that has a bed need excess at the time the provider excludes the parts from the provider agreement. (c) ...

...5165.26 of the Revised Code. (B) The medicaid director shall establish an alternative purchasing model for nursing facility services provided by designated discrete units of nursing facilities to medicaid recipients with specialized health care needs. The director shall do all of the following with regard to the model: (1) Establish criteria that a discrete unit of a nursing facility must meet to be designated ...

...396u-2(b)(2). (G) "Enrollee" means a medicaid recipient who participates in the care management system and enrolls in a medicaid MCO plan. (H) "ICDS participant" has the same meaning as in section 5164.01 of the Revised Code. (I) "Medicaid managed care organization" means a managed care organization under contract with the department of medicaid pursuant to section 5167.10 of the Revised Code. (J) "Medica...

...he following apply if the department of medicaid, pursuant to section 5164.38 of the Revised Code, refuses to enter into, terminates, or refuses to revalidate a provider agreement that authorizes a person or government entity to provide supported living under the medicaid program: (1) In the case of a refusal to enter into a provider agreement, the person or government entity's application to provide medicaid-funded...

... meets federal and state standards for medicaid certification; (2) Prohibit the provider from doing either of the following: (a) Discriminating against a resident on the basis of race, color, sex, creed, or national origin; (b) Subject to division (D) of this section, failing or refusing to do either of the following: (i) Admit as a resident of the ICF/IID an individual because the individual is, or may (as a...

...pmental disabilities and department of medicaid written notice of a change of operator if the ICF/IID participates in the medicaid program and the entering operator seeks to continue the ICF/IID's participation. The written notice shall be provided to the department of developmental disabilities and department of medicaid in accordance with the method specified in rules authorized by section 5124.53 of the Rev...

...alth and developmental disabilities and medicaid director at least ninety days' notice of the person's intent to make the conversion. (2) The person complies with the requirements of sections 5124.50 to 5124.53 of the Revised Code regarding a voluntary termination if those requirements are applicable. (3) If the person intends to convert all of the ICF/IID's beds, the person notifies each of the ICF/IID's residents...

...developmental disabilities-administered medicaid waiver component" means a medicaid waiver component administered by the department of developmental disabilities pursuant to section 5166.21 of the Revised Code. (B) If a county board of developmental disabilities determines that available resources are not sufficient to meet the needs of all individuals who request non-medicaid programs or services, it shall establi...

... (b) Is required, as a condition of the medicaid program paying for the individual's services in the institution, to spend for costs of medical or nursing care all of the individual's income except for an amount for personal needs specified by the department of medicaid; (c) Cannot reasonably be expected to be discharged from the institution and return home as determined by the department of medicaid. (4) "Qu...

...(A) The medicaid director may do the following for any reason permitted or required by federal law and when the director determines that the action is in the best interests of 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 ...

...anism implemented by the department of medicaid; (3) Any other process for the electronic submission of claims that is specified in rules adopted under section 5162.02 of the Revised Code. (B) Not later than January 1, 2013, and except as provided in division (C) of this section, each medicaid provider shall do both of the following: (1) Use only an electronic claims submission process to submit to the depar...

...nt is located. (B) The department of medicaid shall establish standards for medicaid payments for health care services the department determines are appropriate to be covered by the medicaid program when provided as telehealth services. The standards shall be established in rules adopted under section 5164.02 of the Revised Code. In accordance with section 5162.021 of the Revised Code, the medicaid director shal...

...nursing facility's participation in the medicaid program shall be terminated under sections 5165.60 to 5165.89 of the Revised Code as follows: (1) If the department of medicaid is terminating the facility's participation, it shall issue an order terminating the facility's provider agreement. (2) If the department of health, acting as a contracting agency, is terminating the facility's participation, it shall ...

...(A) The department of medicaid may create the following: (1) One or more medicaid waiver components under which home and community-based services are provided to individuals with developmental disabilities as an alternative to placement in ICFs/IID; (2) One or more medicaid waiver components under which home and community-based services are provided in the form of any of the following: (a) Early intervention and s...