Ohio Revised Code Search

...The medicaid director shall adopt rules for purposes of specifying the criteria a person who is mentally or physically disabled and who is under twenty-one years of age must meet to be considered a minor for purposes of sections 3798.07 and 3798.12 of the Revised Code.

... United States centers for medicare and medicaid services. (3) When a provider or beneficiary submits a claim by using the standard claim form prescribed in the superintendent's rules, but the information provided in the claim is materially deficient, the third-party payer shall notify the provider or beneficiary not later than fifteen days after receipt of the claim. The notice shall state, with specificity, the i...

... payer that provides coverage under the medicaid program, shall not enter into a contractual arrangement under which time periods longer than those provided for in paragraph (c)(1) of 42 C.F.R. 447.46 are applicable to the third-party payer in paying a claim for any amount due for health care services rendered by the provider.

... health care benefits include medicare, medicaid, workers' compensation, the civilian health and medical program of the uniformed services and other elements of the tricare program offered by the United States department of defense, and similar state or federal programs. (D) Any provision of a contractual arrangement entered into between a third-party payer and a provider or beneficiary that is contrary to divisions...

...y payer for coverage provided under the medicaid program; (E) A third-party payer for coverage provided under the tricare program offered by the United States department of defense.

...Coverage under a plan through medicare, medicaid, or the federal employees benefit program; (g) Any coverage issued under Chapter 55 of Title 10 of the United States Code and any coverage issued as a supplement to that coverage. (2) "Health plan issuer" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the superintendent of insurance, that contracts, or offer...

...t apply to an auditing entity that is a medicaid managed care organization if application of those sections to the entity would be in violation of federal law.

...port to the general assembly, the joint medicaid oversight committee, and the governor, not later than the thirtieth day of January of each year.

... United States centers for medicare and medicaid services, measured at the time the drug is administered or dispensed, or, if no such rate is available at that time, a reimbursement rate that is less than the wholesale acquisition cost of the drug, as defined in 42 U.S.C. 1395w-3a(c)(6)(B); (2) A dispensing fee reimbursement amount that is less than the reimbursement amount provided to a terminal distributor of dan...

... including the centers for medicare and medicaid services or the office of the national coordinator for health information technology. (E) A health plan issuer, including a pharmacy benefit manager, shall furnish the data required under division (B) of this section regardless of whether the request is made using the drug's unique billing code, such as a national drug code or health care common procedure coding syst...

...Individual eligibility requirements for medicaid; (5) The use of enrollment forms used in an exchange; (6) Any other topics as required by the superintendent. (C) Agents that complete the training program required under division (A) of this section shall receive continuing education course credit under sections 3905.481 to 3905.486 of the Revised Code. All such credit shall count toward satisfying the continuin...

...roviding information on eligibility for medicaid; (5) Engage in any unfair method of competition or any fraudulent, deceptive, or dishonest act or practice. (D) An individual shall not act in the capacity of an insurance navigator, or perform insurance navigator duties on behalf of an organization serving as an insurance navigator, unless the individual has applied for certification and the superintendent finds...

...affect the viator's eligibility for the medicaid program or other government benefits or entitlements, and that advice should be obtained from the appropriate government agencies; (e) That the viator has a right to rescind the viatical settlement contract for at least fifteen calendar days after the viator receives the viatical settlement proceeds, as provided in section 3916.08 of the Revised Code. If the ins...

... (d) The child is not eligible for the medicaid program or the medicare program. (2) That attainment of the limiting age for dependent children shall not operate to terminate the coverage of a dependent child if the child is and continues to be both of the following: (a) Incapable of self-sustaining employment by reason of an intellectual disability or physical disability; (b) Primarily dependent upon the p...

... (d) The child is not eligible for the medicaid program or the medicare program. (2) That attainment of the limiting age for dependent children shall not operate to terminate the coverage of a dependent child if the child is and continues to be both of the following: (a) Incapable of self-sustaining employment by reason of an intellectual disability or physical disability; (b) Primarily dependent upon the p...

...nd any policy that provides coverage to medicaid recipients. (B) Notwithstanding section 3901.71 of the Revised Code, and subject to division (E) of this section, every policy of sickness and accident insurance shall provide benefits for the diagnosis and treatment of biologically based mental illnesses on the same terms and conditions as, and shall provide benefits no less extensive than, those provided under the p...

...rance. (b) Coverage provided under the medicaid program. (c) Coverage provided under an employer's self-insurance plan or by any of its administrators, as defined in section 3959.01 of the Revised Code, to the extent that federal law supersedes, preempts, prohibits, or otherwise precludes the application of this section to the plan and its administrators. (B) A standardized identification card or an electronic tec...

...rance. (b) Coverage provided under the medicaid program. (B) A standardized identification card or an electronic technology issued or required to be used as provided in division (A)(1) of this section shall contain uniform prescription drug information in accordance with either division (B)(1) or (2) of this section. (1) The standardized identification card or the electronic technology shall be in a format and con...

...ailability of, or eligibility for, the medicaid program in this state or in any other state when determining an individual's eligibility for coverage or when making payments to or on behalf of an enrollee, subscriber, policyholder, or certificate holder.

...ost containment services and includes a medicaid managed care organization, as defined in section 5167.01 of the Revised Code. (K) "Maximum allowable cost" means a maximum drug product reimbursement for an individual drug or for a group of therapeutically and pharmaceutically equivalent multiple source drugs that are listed in the United States food and drug administration's approved drug products with therapeutic...

...ervices provided through a program for medicaid or medicare; (B) A contract for payments made to providers for rendering health care services to claimants pursuant to claims made under Chapter 4121., 4123., 4127., or 4131. of the Revised Code; (C) An exclusive contract between a health insuring corporation and a single group of providers in a specific geographic area to provide or arrange for the provision...

...d services programs established for the medicaid program under sections 5164.758 and 5167.13 of the Revised Code.

...ts made by the centers for medicare and medicaid services in the United States department of health and human services for reimbursement of conditional payments made pursuant to section 1395y(b)(2) of title 42, United States Code (commonly known as the "Medicare Secondary Payer Act"). (D) This section does not affect the right of a claimant to compensation accruing subsequent to the filing of any such application,...

...5101.54 of the Revised Code; (b) The medicaid program pursuant to Chapter 5163. of the Revised Code; (c) The Ohio works first program administered by the department of job and family services pursuant to section 5107.10 of the Revised Code; (d) The supplemental security income program pursuant to 20 C.F.R. 416.1100; (e) The United States department of veterans affairs pension benefit program pursuant to 3...

... 5101.54 of the Revised Code; (2) The medicaid program pursuant to Chapter 5163. of the Revised Code; (3) The Ohio works first program administered by the department of job and family services pursuant to section 5107.10 of the Revised Code; (4) The supplemental security income program pursuant to 20 C.F.R. 416.1100; (5) The United States department of veterans affairs pension benefit program pursuant to 38 U...