Ohio Revised Code Search

...(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 ...

...ucted pursuant to this section is not a public record for the purposes of section 149.43 of the Revised Code and shall not be made available to any person other than the following: (1) The person who is the subject of the criminal records check or the person's representative; (2) The medicaid director and the staff of the department who are involved in the administration of the medicaid program; (3) The depa...

...ction 109.5721 of the Revised Code is a public record for the purposes of section 149.43 of the Revised Code. Such a report or notice shall not be made available to any person other than the following: (1) The person who is the subject of the criminal records check or the person's representative; (2) The medicaid director and the staff of the department who are involved in the administration of the medicaid pro...

...equest made under this section is not a public record for the purposes of section 149.43 of the Revised Code and shall not be made available to any person other than the following: (1) The applicant or employee who is the subject of the criminal records check or the representative of the applicant or employee; (2) The chief administrator of the waiver agency that requires the applicant or employee to request th...

...uthorized agent, associate, manager, or employee in an action brought pursuant to section 109.85 of the Revised Code, shall terminate the provider's provider agreement and stop payment to the provider for medicaid services rendered from the date of conviction or entry of judgment. No such medicaid provider, owner, officer, authorized agent, associate, manager, or employee shall own or provide medicaid services on beh...

..., authorized agent, associate, manager, employee, or, if the provider is a noninstitutional provider, its owner, if either of the following applies: (a) The indictment charges the person with committing an act to which both of the following apply: (i) The act would be a felony or misdemeanor under the laws of this state or the jurisdiction within which the act occurred. (ii) The act relates to or results fro...

...(A) The department of medicaid may suspend a medicaid provider's provider agreement without prior notice if the department has evidence that the provider presents a danger of immediate and serious harm to the health, safety, or welfare of medicaid recipients. The department also shall suspend all medicaid payments to the medicaid provider for services rendered, regardless of the date that the services were rendered, ...

...d the provider by the national provider system pursuant to 45 C.F.R. 162.408. (4) The medicaid provider's application for a provider agreement is denied, or the provider's provider agreement is terminated or suspended, as a result of action by the United States department of health and human services and that action is binding on the provider's medicaid participation. (5) The medicaid provider's provider agreem...

...In any action taken by the department of medicaid under section 5164.38 or 5164.57 of the Revised Code or any other state statute governing the medicaid program that requires the department to give notice of an opportunity for a hearing in accordance with Chapter 119. of the Revised Code, if the department gives notice of the opportunity for a hearing but the medicaid provider or other entity subject to the not...

...rary, an independent provider is not an employee of the state, or any political subdivision of the state, for any purpose under state law due to being an independent provider or any actions taken to become or remain an independent provider.

...perate medicaid management information systems, including the provision of data processing services; (2) Determine the amounts of payments to be made upon claims for medicaid; (3) Prepare and furnish to the department lists and computer tapes of such claims for payment; (4) In addition to audits which may be conducted by the department and by the auditor of state, make audits of providers and the claims of me...

...(A) As used in this section, "electronic claims submission process" means any of the following: (1) Electronic interchange of data; (2) Direct entry of data through an internet-based mechanism 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,...

...12 of the Revised Code, be considered a public entity and the director shall seek federal financial participation for costs incurred by OCHSPS in performing the service or services.

...Not less than once each year and in accordance with all state and federal laws governing the confidentiality of patient-identifying information, the department of medicaid shall make summary data regarding perinatal services available on request to local organizations concerned with infant mortality reduction initiatives and recipients of grants administered by the division of family and community health services in...

...The medicaid director may implement a system under which medicaid payments for medicaid services are made to an organization on behalf of medicaid providers. The system may not provide for an organization to receive an amount that exceeds, in aggregate, the amount the medicaid program would have paid directly to medicaid providers if not for this section.

...The department of medicaid may conduct final fiscal audits of medicaid providers in accordance with the applicable requirements set forth in federal laws and regulations and determine any amounts the provider may owe the state. When conducting final fiscal audits, the department shall consider generally accepted auditing standards, which include the use of statistical sampling.

...Under the medicaid program, any amount determined to be owed the state by a final fiscal audit conducted pursuant to section 5164.55 of the Revised Code, upon the issuance of an adjudication order pursuant to Chapter 119. of the Revised Code that contains a finding that there is a preponderance of the evidence that a medicaid provider will liquidate assets or file bankruptcy in order to prevent payment of the a...

...(A)(1) Except as provided in division (A)(2) of this section, the department of medicaid may recover a medicaid payment or portion of a payment made to a medicaid provider to which the provider is not entitled if the department notifies the provider of the overpayment during the five-year period immediately following the end of the state fiscal year in which the overpayment was made. (2) In the case of a hospital me...

...(A) If a state agency that enters 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: ...

...The department of medicaid may deduct from medicaid payments for medicaid services rendered by a medicaid provider any amounts the provider owes the state as the result of incorrect medicaid payments the department has made to the provider.

...15, "selected interest rates," a weekly publication of the federal reserve board, or any successor publication. If statistical release H.15, or its successor, ceases to contain the bank prime rate information or ceases to be published, the department shall request a written statement of the average bank prime rate from the federal reserve bank of Cleveland or the federal reserve board.

...The authority, under state and federal law, of the department of medicaid or a county department of job and family services to recover excess medicaid payments made to a medicaid provider is not limited by the availability of remedies under sections 5162.21 and 5162.23 of the Revised Code for recovering benefits paid on behalf of medicaid recipients.

...Except as otherwise required by federal statute or regulation, no medicaid payment for any medicaid service provided by a hospital, nursing facility, or ICF/IID shall exceed the limits established under Subpart C of 42 C.F.R. Part 447.

...Medicaid payments for freestanding medical laboratory charges shall not exceed the customary and usual fee for laboratory profiles.

...ostic-related-group prospective payment system shall not exceed thirty days during a period beginning on the day of the recipient's admission to the hospital and ending sixty days after the termination of that hospital stay, except that the department of medicaid may make exceptions to this limitation. The limitation does not apply to children and youth participating in the program for children and youth with special...