Ohio Revised Code Search

...The auditor of state is responsible for the costs the auditor incurs in carrying out the auditor's duties under sections 5160.21 and 5160.22 of the Revised Code.

...(A) As part of the process of determining an individual's eligibility for a medical assistance program, at least all of the following information about the individual shall be verified: (1) Identity; (2) Citizenship and alien eligibility; (3) Social security number; (4) State residency status; (5) Disability status; (6) Gross nonexempt income; (7) Household status ; (8) Medical expenses; (9) Enrollm...

...(A)(1) As information described in division (A) of section 5160.29 of the Revised Code is received by the department of medicaid or an entity with which the department has entered into an agreement under section 5160.30 of the Revised Code, the department or entity shall do both of the following on at least a quarterly basis and in accordance with federal regulations: (a) Review the information to determine whet...

...If a violation of section 2913.401 of the Revised Code or a similar offense is suspected in the process of determining or redetermining a medical assistance recipient's eligibility, the case shall be referred for investigation to the county prosecutor of the county in which the medical assistance recipient resides, referred for an administrative disqualification hearing, or both.

...Nothing in sections 5160.29 to 5160.292 of the Revised Code prevents the department of medicaid or any entity with which the department has entered into an agreement under section 5160.30 of the Revised Code from doing either of the following: (A) Receiving or reviewing information related to individuals' eligibility for a medical assistance program beyond the information specified in division (A) of section 5160....

...(A) Except as provided in divisions (B) and (C) of this section, the department of medicaid may accept applications, determine eligibility, redetermine eligibility, and perform related administrative activities for medical assistance programs. (B) The department may enter into agreements with one or more agencies of the federal government, the state, other states, and local governments of this or other states...

...ty for a medical assistance program or services available to the recipient under a medical assistance program. (B) Regarding appeals authorized by this section, the department of medicaid shall do one or more of the following: (1) Administer an appeals process similar to the appeals process established under section 5101.35 of the Revised Code; (2) Contract with the department of job and family services purs...

...treatment under review. (3) "Emergency services" has the same meaning as in section 1753.28 of the Revised Code. (4) "Prior authorization requirement" means any practice implemented by a medical assistance program in which coverage of a health care service, device, or drug is dependent upon a medical assistance recipient or a health care provider, receiving approval from the department of medicaid or its designee, ...

...l entity providing coverage for medical services or items to individuals on a self-insurance basis; (c) A health insuring corporation as defined in section 1751.01 of the Revised Code; (d) A group health plan as defined in 29 U.S.C. 1167; (e) A service benefit plan as referenced in 42 U.S.C. 1396a(a)(25); (f) A managed care organization; (g) A pharmacy benefit manager; (h) A third party administrato...

...d a county department of job and family services against the liability of a third party for the cost of medical assistance paid on behalf of the recipient. When an action or claim is brought against a third party by a medical assistance recipient, any payment, settlement or compromise of the action or claim, or any court award or judgment, is subject to the recovery right of the department of medicaid or county depar...

...nd county department of job and family services, a medical assistance recipient and the recipient's attorney, if any, shall cooperate with each medical provider of the recipient. Cooperation with a medical provider shall consist of disclosing to the provider all information the recipient and attorney, if any, possess that would assist the provider in determining each third party that is responsible for the paym...

...(A) The application for, or enrollment in, a medical assistance program constitutes an automatic assignment of rights specified in division (B) of this section to the department of medicaid. This assignment includes the rights of the medical assistance recipient and also the rights of any other member of the assistance group for whom the recipient can legally make an assignment. (B) Pursuant to this section, ...

...(A) A third party shall cooperate with the department of medicaid in identifying individuals for the purpose of establishing third party liability regarding medical assistance programs. (B) In furtherance of the requirement in division (A) of this section and to allow the department to determine any period that the individual or the individual's spouse or dependent may have been covered by the third party and...

... claim for payment of a medical item or service that was submitted to the third party not later than six years after the date of the provision of such medical item or service; (3) Respond to the department's request for payment of a claim described in division (B)(2) of this section not later than sixty business days after receipt of written proof of the claim, either by paying the claim or issuing a written denia...

... claim for payment of a medical item or service provided to a medical assistance recipient is final on the date that is two years after the payment was made to the department of medicaid or the applicable medicaid managed care organization. After a claim is final, the claim is subject to adjustment only if an action for recovery of an overpayment was commenced under division (B) of this section before the date the cl...

...lf, seeks payment for a medical item or service provided to the individual.

...(A) If a third party violates section 5160.39, 5160.40, or 5160.41 of the Revised Code, a governmental entity that is responsible for issuing a license, certificate of authority, registration, or approval that authorizes the third party to do business in this state may impose a fine against the third party or deny, revoke, or terminate the third party's license, certificate, registration, or approval to do busi...

...(A) The medicaid director may adopt rules under section 5160.02 of the Revised Code to implement sections 5160.35 to 5160.43 of the Revised Code, including rules that specify what constitutes cooperating with efforts to obtain support or payments, or medical assistance payments, and when cooperation may be waived. (B) The department shall adopt rules under section 5160.02 of the Revised Code to do all of the...

... a county department of job and family services, or an entity performing duties on behalf of the department or a county department. (B) Except as permitted by this section, section 5160.47, or rules authorized by section 5160.48 or 5160.481 of the Revised Code, or when required by federal law, no person or government entity shall use or disclose information regarding a medical assistance recipient for any pur...

...(A) For the purposes of section 5160.45 of the Revised Code, an authorization shall be made on a form that uses language understandable to the average person and contains all of the following: (1) A description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion; (2) The name or other specific identification of the person or class of persons authori...

...d States department of health and human services and neighboring states to join and participate as an active member in the public assistance reporting information system; (2) Explore joining other multistate cooperatives, such as the national accuracy clearinghouse, to identify individuals enrolled in public assistance programs outside of this state. (B) The department may disclose information regarding a medical a...

...f veterans affairs to current or former service members and their eligible dependents, including the benefits provided through the programs known as tricare and champva. (B) (1) The department of medicaid shall review information in the public assistance reporting information system to determine whether an individual who is a medical assistance recipient may be eligible for federal military-related health care benef...

...on 173.20 of the Revised Code, shall be granted any limited access permitted in the rules authorized by division (A)(1) of this section. A contractor, grantee, or entity given access to information pursuant to the rules authorized by division (A)(2) of this section is bound by the director's rules. Disclosure of the information by the contractor, grantee, or entity in a manner not authorized by the rules is a ...

... a county department of job and family services, that other agency shall adopt rules consistent with sections 5160.45 to 5160.481 of the Revised Code to prevent the publication or disclosure of names, lists, or other information concerning those recipients.

...The department of medicaid shall administer the refugee medical assistance program authorized by the "Immigration and Nationality Act," section 412(e), 8 U.S.C. 1522(e).